Hope

A few minutes before the actual beginning of my Sunday morning shift, I was trying to hide out at a computer station way down at the end of the hallway so I could do my morning cleansing ritual, which requires the burning of a smudge stick while I chant "nam myo ho renge kyo" totally nude.

A ratty-looking patient stepped out the doorway of his hospital room and accosted another oncoming nurse: "When's my X-ray? First they said they'd do it in my room and now they say I have to go down for it."

Steven was polite and explained that he didn't know but that he would enquire.

"This is getting out of control," the patient muttered, "I'm gonna get out of here."

This gentleman was in his early thirties but he looked several decades older. He had come to the emergency room the night before complaining of chest pain and palpitations. So far his workup had shown him to have rather decent runs of ventricular tachycardia lasting a minute or two per episode.



He very likely was a candidate for placement of an AICD and it also would probably be good if he modified his lifestyle a bit. He looked like the sort of person who shot methamphetamine into his bloodstream while driving drunk. Maybe I'd seen him before on one of those police video shows on television.

A short while later I heard his dayshift nurse Sandra talking about how this patient had to be out of the hospital by 10 that morning. "He says he's got an appointment with his tax accountant."

"At 10 a.m. Sunday?!" I asked.

Sandra said that if the doctors didn't discharge him by then that he'd leave against medical advice. She already had the paperwork stamped up for him to do so. I said that was good and he'd be out of her hair.

The patient's wife showed up at 0930 and demanded discharge orders immediately. Sandra explained the situation, that the ventricular arrhythmia was potentially life-threatening, the workup was not yet complete, the cardiologist was already here and wanted to see the patient soon, etc. But the wife also went with the tax story.

They had already paid thousands of dollars in taxes, you see, and they had to see their accountant by 10 a.m.

Neither the patient nor his wife looked like they could afford laundry detergent, let alone large tax payments. But naturally, they left. Against Medical Advice.

Later our charge nurse said that the whole thing wasn't good. "It's too early in the day, and it's only Sunday. Sheesh, it's hardly begun and we've already had our Wanker Of The Week."

"Let's hope he was the one," said Sandra.

Yes, I hoped so too.