Against Medical Advice

Time for a little thought experiment here folks:

Imagine that you weigh about 500 pounds. You get one of those big boy beds with the inflatable mattress that prevents new decubitus ulcers on your ass (like the one you have at home). You haven't moved said ass from your bed since last fall. You've got a couple new-ish metal joints because your massive girth destroyed the perfectly good ones you were born with and you can't even move your own legs because of their enormity.

Yeah, you remember the glory days when you qualified for the 1980 Olympic games in Greco-roman wrestling (but didn't go because of Regan) . You were an Engineer and that white coat wearing kid is talking down to you when he explains hypertension. You don't want to eat the low-fat, low-sodium diet ordered for you and send your tray back to the kitchen. It tastes like cardboard...

However, you are too ignorant of your own health to remember that time you were in florid pulmonary edema and dyspnic back in May. You got an ultrasound of your heart showing some diastolic heart failure...but they treated you with maalox and you got better. You're on an ACE, a Beta blocker, a duretic, lipitor and aspirin...the standard care for heart failure...but no one ever told you that you had heart failure.

Now imagine that you're hungry because you've been in a few hours of tests, and all you really want is a nice big ham and cheese sandwich...an no one will get it for you. You're ordered for a cardiac diet. Now imagine that you call the nurse and demand that your diet be changed to allow you a ham and cheese sandwich...shouldn't be a problem, the doctor will fix that right away. MMMM salty ham and fatty cheese...you're really hungry. Good thing you got rid of that crappy dinner tray 10 minutes ago...too many veggies.

Now imagine that some jackass in a short white coat comes in and tells you that you have a history of CHF (Surprise) and HTN and that a low salt, low fat diet would be best for you and that he's not going to change your diet...no you can't have your sandwich. You've never had CHF, no doctor ever told you that!!! That has to be wrong, get that out of your charts.

When he's paged a second time (you really are hungry this time), he proceeds to remind you of this CHF thing that no one ever told you about and explains how a salty diet will make you retain fluid and cause you to go into heart failure and get you into the same situation you were in last time. You're livid and want to talk to an administrator to have the CHF thing removed from your record...it's 8PM on friday and you want a damned sandwich...no that fruit plate and 2 bowls of cereal won't do.

The next time he's paged that fucker pulls the echo report from may and points to the words "Dyspnea" and "Edema" under diagnoses. He explains how even though your systolic function was ok for the time being, your dilated right heart will cause you to drown in your own juices if you have a regular diet...so no ham sandwichs for you! Well, you might as well leave this place cause they're not going to feed you (that dinner tray looked too healthy) you tell the nurse that you want to sign out AMA. Someone will drop you off at home and get you into bed...you can get those Q8Hr antibiotics at home anyway...i mean you just hook them up to the PICC.

That fucker in the white coat is back with the AMA form all filled out for me to sign. You'll have to find your own way home? In the snow storm? The medicaid crane to move you back to your bed at home at 9:15PM?? No one is setting up care for you at home if you leave now and there's the chance you may die of sepsis??? That's it...you're calling your lawyer. You're going to sue everyone over a ham sandwich? They can't threaten me with death and heart failure. How? You'll find a way...you were an olympic athlete!

Oh, the nice nurse is going to get you a nice low-sodium grilled chicken sandwich from the overpriced hospital cafe...that'll work! How can that white coated guy be concerned for your well being??? He won't even give you what you want for dinner! Thank you ma'am...

Reason number 1,000,000 I will not be going into internal medicine...stupid shit like diet orders and ignorant patients.


Albinoblackbear said...

Bang. Head. Against. Wall. Repeat.

Wow. You are much more diplomatic and patient than most people I know.

Holy crapola. That is unbelievable.

frylime said...

yeah, i can't be a medicine doc either. have you had to deal with any chronic pain drug seeking sicklers...or the gastroparetics who are obese but "throw everything they eat up"...???

Resident Anesthesiologist Guy (RAG) said...

Thank god for the medicine docs. I did only a few months intern year and don't know how they stomache that crap. I was less than polite with these patients - couldn't stand them. Want to leave? Go ahead. I care, but not enough to waste my night concerning myself over your stupid lifestyle and idiocy.

My residents, however, would say that I couldn't let them leave. I had to "stop them" somehow. They took it as a personal defeat if a patient decided to leave once they were semi-stabilized. I thought of it as one more pain-in-the-ass off the census.

The Lone Coyote said...

OMG. LMAO. That is a great story.