Monday, August 29, 2011

*pant* *pant* *pant*

I'm twisting my spine at a worrisome angle, checking behind me to make sure I still have a butt. I had thought I had run it off this weekend, but no, it's still there.

Something happened last week that I forgot about until yesterday, one of those once-in-a-lifetime moments that nurses hear about happening to other people but don't believe will ever happen to them:

I had a sensible, intelligent, well-informed patient leave AMA and I totally agreed with his decision.

This particular patient had some pretty complex, chronic problems that had been exacerbated by a combination of dehydration and missed medications, and he ended up in the emergency room at Holy Kamole with weird symptoms. The fine folks at HK sent him to us for definitive diagnosis and treatment. Turns out he had missed some meds and gotten dehydrated.

So we ran a few liters into him and titrated his meds back up to therapeutic levels and were getting ready to get him on out when one of the new attendings on service decided we needed to do a much more thorough workup for stroke, something that did not actually happen to this patient. That would've required he spend several more days in the hospital, according to the doc, even though everything could be done as an outpatient.

So he asked about checking out AMA. The attending covering for Doctor Overreactive is a rational sort, but was worried about officially discharging somebody else's patient. So we did everything we'd normally do for a discharge except fill out the official paperwork, and off he went with a smile.

I'm still not entirely sure that this doesn't signal the End Times. Usually, if a patient checks out of our facility against medical advice, it's because they're either angry about the treatment they've gotten or are peevish because they're out of drugs. People who leave in the middle of treatment for whatever landed 'em in the hospital are not in the best of headspaces. This guy? Totally fine.

In other news, the appointment with Dr. Crane went fine. I got poked and squoze and told to make appointments for scans in November. Nothing's swollen in my neck, thank God, but he still wants a CT and an MRI to make sure I'm good on a radiological level. He dithered for a couple of minutes about whether to do both a with-and-without contrast CT *and* an MRI this time, saying he didn't want to "scan me to death," until I said "Dooood. I had CANSUH. Scan me all you want, okay? Just make sure it hasn't come back." So: scans in November, chest and abdominal CTs sometime next year, and then on to regular follow-up in perpetuity.

Next time I'll tell you about the Stupid Thing somebody said to me regarding having had my mouth hacked on. For now, I'm due another cup of coffee.


clairesmum said...

Had a client once who signed AMA out of a nursing home, went home in a taxi, and called 911 - the best way she could figure out to get to the hospital - and had lifesaving surgery soon after arrival in the ER. The nursing home called in a report to APS, saying patient was demented!
Glad your visit to Dr Crane was uneventful.

Lynda Halliger-Otvos said...

I hear ya, Jo. Scan me, man !~! When in doubt, scan. My baby-making days are over for ever and then a few more lifetimes too.

messymimi said...

Patient made the right call, and so did you on the testing.

Enjoy the coffee.

Knot Tellin said...

I had to go to the dentist during my radiation treatments. He wanted to take an x-ray, so covered me up with the lead apron. Seemed kind of unnecessary at that point. I was like "Take it off! It's too heavy on my radiation burns..."

Anonymous said...

Several years ago, my husband was told on a Saturday afternoon that he needed one more diagnostic test, but it wasn't available till Monday afternoon, or, depending on scheduling, possibly later in the week. There was no way of knowing at present about the scheduling, of course, because it was the weekend.
Since everything else indicated that he hadn't in fact had a stroke, which is what he'd come in for, he decided it was time to go home.
He was told that if he left AMA, he'd be fully responsible for his entire bill, including the test he was refusing--Medicare wouldn't cover anything at all--hospitalization, doctor consults, or testing--if he left AMA.
So how much would that amount to? he asked.
We have no idea, and there is absolutely no way to get that information, he was told.
Eventually, and luckily before they had managed to induce a stroke for real, the hospitalist appeared, and authorized his release.

Anonymous said...

Somebody said a Stupid Thing about your surgery? Should we get together a war party and . . . ah, "discuss" their error with them?