"Captain Cachectic"

This is the nickname I've given a patient I helped care for here in the ER yesterday.
This is also my first post about working in the ER, as opposed to the field. I will try to explain things that I think may be outside of the realm of a fellow Medic (stuff we don't need to know pre-hospital).
The first explanation I'll make is for the word cachectic. I never heard it myself before working here. It basically means a frail, old, pathetic and beyond-emaciated person. And that, he was.
He comes in looking whiter than the MD's lab coat and panting for breath. He's also not making a whole lot of sense. He's so dry his skin is flaking off. His feet are being eroded by decubitus ulcers. He's got a G-tube (into the stomach feeding tube) and has an indwelling Foley catheter (tube that goes up the urethra into the bladder). He's also wearing a diaper.
This guy was septic. More times over than someone healthy could probably handle. Yet, he was still alive, although for how long, I couldn't say. I thought he was gonna die right in front of me.
He had a whole host of problems. The first was his sepsis, which I mentioned. He also was in A-Fib w/RVR (Rapid A-Fib as we sometimes call it). He was hypotensive, requiring Dopamine, and we kept having to turn it up. We switched to Levophed ("Leave 'em Dead", or Norepinepherine) later. He was in Respiratory (and probably Metabolic) Acidosis (HC03 of 13 on the ABG, for those who care). He was dehydrated (as established earlier) and Hyperkalemic. He also "ruled-in" for an MI via lab results. The question became, what wasn't wrong with him.
The causes of his sepsis were many. He had multiple pneumonias and a UTI (Urinary Tract Infection). He also had a case of Cellulitis (bad skin infection that can sometimes be "flesh eating") brewing on one arm. Who knows what else was going on.
So, the story of how he got this way goes sorta like this: he fell five months ago and broke a hip. He was in hospital for some weeks, and then a Nursing Home for rehab after that. In the hospital they placed the urinary catheter. Well, turns out it had never been changed. Geez, no wonder he had an infection! (They shouldn't be left in more than a week or two.)
He lived at home, with a reported elderly wife. Said wife shows up here shortly after he arrives via Medic. To look at her, she doesn't seem like she's too incapable of taking care of the guy. Plus, his brother or uncle is with her, and tells me he has a Home Health Nurse. Hmmmm. OK, so the "Nurse" is obviously an idiot. Wifey, upon first impression, smells like she's been drinking. The picture becomes clearer and more maddening.
This man had languished, unnoticed to everyone around him. Poor guy. Seems despite their lack of effort and caring, he had hung on.
The pneumonias probably developed from him not ambulating enough after surgery, and thus the decubitus ulcers also formed. He probably had the heart attack from any number of causes. We're lucky he didn't go into a Ventricular Dysrythmia, too, with the K+ problem.
We did what we could for the guy. Intubated him, put in a central line, gave him drugs for his pressure and antibiotics for his multiple infections, yadda, yadda, then shipped him off to the ICU. I hope someone in the ICU decides to help him with his social situation, if he lives. Which I doubt.
I really like old people. I really hate people who don't take care of old people.