Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Dying after leaving AMA

Steve Burgess, MD
Conditions
August 7, 2021
Share
Tweet
Share

The nurse called: “The patient wants to leave AMA.”

These calls come, fortunately not often. Typically the patient is not terribly ill, but they really miss their cigarettes or alcohol. Spending another day or two in the hospital would be wise, but leaving against medical advice is not actually jeopardizing their life.

This was different. This patient was very ill, but competent to make his own decisions. He had COVID, and this was day 10 in the hospital. He was stable, but requiring high flow oxygen, 100 percent at 60 liters per minute. He was in his own room on our COVID floor, which he probably viewed as a 12 by 12-foot cell after 10 days. We don’t even let them in the hallway.

I sat down and said that I was told he wanted to leave. He was calm and collected, and said that what we were doing was not working. Which, I must admit, is partially true. We don’t have great treatments for COVID, and while I was pleased he was not in our ICU, he really did not feel any better than when he was admitted. He had a valid point.

I asked about his plan. He said he would call his doctor. I made that call instead, and his PCP called him, but the patient was resolute: He was going home.

We took his high-flow oxygen off to see how he did. The pulse oximeter dropped to 60 percent within a minute. No difference, he was leaving.

He indicated that he would not want CPR or intubation, so we executed a written DNR. He remained on an oxygen tank at 5 liters until he was in his wife’s car, headed home.

He died the next day. He became unresponsive at home; his wife called 911. Paramedics performed CPR and gave epinephrine. He was breathing, but in PEA. When the spouse told the ED physician that he did not want CPR or intubation, they stopped.

This one hurt. Yes, patients die, and I really don’t believe any of our doctors or nurses share in the responsibility for this death. But this patient should not have died; he was in his 60’s and was only on blood pressure meds and a PPI. Respiratory therapists, nurses, and doctors all told him that he would die if he left. He just did not believe us. This was not glioblastoma or a major trauma where everything we do really does not matter; sometimes the patient is going to die regardless. No, had this patient stayed, or gotten vaccinated before contracting COVID, he very likely would have lived.

How did we get here? How did we get to the point that severely ill patients, competent to make their own medical decisions, believe that all the RTs, nurses, and doctors are wrong about COVID? How do intelligent people (you may not agree with them, but that does not mean they lack mental capacity) believe that this virus does not kill people? That we are all in some vast conspiracy to get them to take a vaccine that is really going to hurt them, not save lives?

And what do we do about it? I’m a hospitalist, and I care for several COVID patients every day that I work. That’s been the case since early 2020, and it’s not improving. We round on these patients for days or weeks, and they usually improve, but it’s very slow. I’m tired of it, and it’s only about 25 percent of my patients. It’s closer to 100 percent for the nurses and RTs on the COVID floors and in the ICUs; I can only imagine their exhaustion.

This is where we are: Hospitalizations rising, new variants that are more infectious, and many people believing that this is all a hoax, or that millions of people have conspired together to make injections that harm people rather than helping them. Patients leaving AMA and dying because there’s no trust anymore.

This is where we should be: People recognizing that we don’t like wearing masks or getting shots but maybe we should in order to get things under control, people trusting that health care workers are really working toward the best interest of everyone, health care workers optimistic because they see progress.

ADVERTISEMENT

How do we get from here to there?

Steve Burgess is a hospitalist and creator, CME Vacations, designed to give participants the ultimate CME “working vacation.”

Hospital Medicine Update and Outpatient Medicine Update are available online or in great vacation destinations, including Florida, the Bahamas, San Diego, San Antonio, and cruises.

To meet the DEA requirement, an online 8-hour course is available, Diagnosing and Treating Opioid and Other Substance Use Disorders.

Image credit: Shutterstock.com

Prev

Try this new technique when talking to vaccine skeptics

August 7, 2021 Kevin 0
…
Next

What do you really want in life?

August 7, 2021 Kevin 0
…

Tagged as: COVID, Infectious Disease

Post navigation

< Previous Post
Try this new technique when talking to vaccine skeptics
Next Post >
What do you really want in life?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Steve Burgess, MD

  • 13.1 million missing Americans since 1980. Where’s the outrage?

    Steve Burgess, MD
  • CME budgets expire soon: Use it or lose it

    Steve Burgess, MD

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • A silent moment with a dying patient

    Ramses Perez
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • Primary care is dying: Why that should scare every large employer

    Elizabeth Mitchell
  • Our doctors are dying in medical school

    Imshan Dhrolia, MPH
  • How COVID is exposing poor working conditions in the U.S.

    Irene Martinez, MD

More in Conditions

  • Nurses aren’t eating their young — we’re starving the profession

    Adam J. Wickett, BSN, RN
  • What if medicine had an exit interview?

    Lynn McComas, DNP, ANP-C
  • Finding healing in narrative medicine: When words replace silence

    Michele Luckenbaugh
  • Why coaching is not a substitute for psychotherapy

    Maire Daugharty, MD
  • Why doctors stay silent about preventable harm

    Jenny Shields, PhD
  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...