Interior hospital: (Patient screaming and crying out as they are wheeled in through the ambulance bay and brought into a room …)

Doctor: What brings you in today?

Patient: You gotta help me, Doc … My chest hurts. I think I’m having a heart attack!

Doctor: OK, sir. We’re going to do a series of tests, including an EKG and chest X-ray, and give you aspirin.

Patient: Whatever you’ve got to do, I don’t wanna die! I’ve got family … I’ve got kids! Don’t let me die!

Doctor: We’re going to do everything we can to help you …

(About 90 minutes later …)

Doctor: Okay, sir, your tests show you’re having a heart attack. You don’t need to be rushed to the cath lab right now, but we’re going to admit you for further work-up. You’ll probably go first thing in the morning.

Patient: You mean I have to stay in the hospital?

Doctor: Yes, we’re going to do an echo, start you on some heparin, and monitor you.

Patient: Well, I’m feeling better, and if all you’re going to do is monitor me, then I can come back in the morning …

Doctor: Well, no. You need the blood thinner to keep your heart arteries from clogging further, and you need to be monitored.

Patient: Well, I have things to do; I can’t just sit around all night waiting.

Doctor: You do understand you’re having a heart attack?

Patient: Well, you say I am, but I don’t think I am. I feel pretty good now.

Doctor: That’s because we’ve given you medications to help increase the blood supply to your heart, but there are other things we need to do …

Patient: Well, I’ve got to go feed my dogs, and I can’t just call in to work. Plus, my elderly mother needs me to get some things from the store for her … I’ll come back in the morning … Besides, I’m dying for a smoke.

Doctor: Okay, well, this AMA form says you’re leaving against medical advice, and you understand you could die from your heart attack or your heart could suffer irreversible damage. There’s also a risk of stroke … other risks include …

Patient: I’m not signing that! You don’t need to get all dramatic with “you’re going to die” and all that.

Doctor: You have to understand the risks of leaving without getting proper treatment for your heart attack.

(Patient starts removing all of their medical monitoring equipment and starts getting their clothing.)

Patient (pointing to their IV): Get this $#!+ out of my arm and let me go. You’re just trying to make money off me, and I’m not staying around for that! Just write me for some pain meds and get me a taxi because I’m leaving!

Doctor: You’re leaving AMA, so we’re not going to do that.

Patient: So I’m just supposed to walk home, I guess, with my quote-unquote heart attack?! What kind of $%#* place is this? You didn’t do anything. I’ve been sitting around waiting, and now you just want me to sit around all night. Plus, I didn’t even get anything to eat; I hadn’t eaten all day.

Doctor: We couldn’t give you anything to eat in case you got worse and needed to go to the cath lab sooner.

Patient: No wonder everyone says this place sucks …

(Patient is escorted by security, screaming and yelling at everyone as they are walked out …)

And, Scene.

Veronica Bonales is an emergency physician.