A 52-year-old man was admitted to a Veterans Affairs hospital with lethargy. His medical history was most notable for major depressive disorder complicated by 4 previous suicide attempts, polysubstance abuse, and poorly controlled insulin-dependent diabetes mellitus. During the past decade, he had several admissions for suicidality and intoxication. He lives in an apartment where he is seen every other day by a visiting nurse for assistance with medications. Two days before admission, he was noted by the visiting nurse to be in his usual state of health.