The man had been a patient for decades, retired now from a career in which firearms were a part of the job. He was enjoying his days hunting, or at the shooting range with friends.
But episodes of confusion had led to a suspicion of dementia, and the nights were the worst: At sundown, he became disoriented, anxious and a little paranoid, and had started sleeping with his loaded pistol under the pillow.
One night, he pointed it at his wife as she returned from the bathroom. It wasn't clear whether he recognized her, but he was certainly confused — and she was terrified. Thankfully, the incident did not end in disaster.
Pediatricians and emergency room doctors have been debating for years when and how to counsel their patients about gun ownership and safety — and kicked up political controversy in doing so. But with so many gun-owners reaching and well into their senior years, the essay writers appear confident that few would question a doctor's motives in raising the safety of gun ownership when a person's mental competence has come into question.
"No one would challenge you about discussing driving safety with a patient having memory trouble," said IHPI member Dr. Donovan Maust, a University of Michigan psychiatry professor who also practices in the Veterans Affairs Ann Arbor Healthcare System. "I don't think anyone would question your discussing power tools.
"As a physician, my interest is in the safety of my patient and those around him," added Maust, one of the essay's authors. "So this feels like it would be negligent not to discuss this with a patient and his or her family."
To make it easier, the essay authors offered a chart detailing the stages of dementia and the "clinical considerations" that each stage raises. They also proposed a draft "Agreement with my Family" — an advanced directive of sorts for firearms.
And they have made the case that while restrictions on gun ownership may be a political flashpoint, it is a simple matter of safety in the exam room — and therefore a legitimate topic of discussion.
"As with driving, physicians must balance the welfare and privacy interests of individual patients with the health and safety of patients' families and the public," the essay authors wrote.
In households where dementia patients have access to firearms, the doctors raised concerns about suicides, accidental shootings, theft and unauthorized use of guns.