Today the rain blew into town. Watching from the tenth floor of the hospital, sheets of precipitation crept closer as headlights glinted off the slick street pavement and the wind whipped the trees below. Soon, the hospital floated on a turbulent gray sea of clouds, and the rain billowed about on gusts of wind. One of the more impressive storms I’ve seen this year. By sunset, however, the trees glowed in rich beams of sunlight and streaked purple clouds danced across the blue-gray sky.
So here I am, biding my time in the call room as kids are out knocking on doors and trick-or-treating. This year, I guess I work most holidays: July 4th, Halloween (on call), Thanksgiving, Christmas, New Year’s Eve (again, on call). But life isn’t bad here at ___________ . One holiday gone by is another holiday closer to anesthesia!
My only bit of excitement so far was dealing with another intern’s ICU patient who wanted to leave AMA (Against Medical Advice). She’d had a cardiac catherization today after her heart briefly stopped yesterday. She insisted on going out to smoke, which I refused to grant. At this point she demanded to sign the paperwork to leave. I had a little chat with Risk Management as well as the patient’s attending before getting out the AMA paperwork.
I decided to try one last time to sweet-talk the patient. I halfway felt like it wasn’t worth the effort to plead with a patient who was so uncooperative with medical care. But I tried one more time…and it worked! I emphasized that we wanted to do our best to take care of her, and that it absolutely was not in her best interests to smoke or to leave the hospital, but that we could not force her to stay against her will. If she stayed, we would do everything we could to make her comfortable (from “relaxing” medication to nicotine patches).
Again, she asked if she could smoke, and–I was pleased with myself for coming up with this–I told her that smoking was not up for discussion. What we were discussing was whether she would stay and let her doctors take care of her, or whether she was going to refuse our advice and leave the hospital. No in-betweens. Two more times I needed to remind her that I was not willing to discuss smoking, and she finally acquiesced.