The Doctor Will See You Now [Non-Fiction]

Chapter 65: Acute Medicine

My colleague phones me to tell me she has a case who is discharging against medical advice (DAMA) later that evening. I finish at 10pm so she asks if I can sign the DAMA papers. I say that's fine. She warns me that the patient is a bit... odd.

The patient, a woman in her 40s, comes in with heavy gum bleeding, which has now stopped. However, before full investigations have been conducted, she demands to be discharged. She has to wait for transport by her family, who have now arrived. She is mentally fit to discharge herself. So I go to sign her papers.

She requests a doctor's certificate. I agree to give her one for the duration of her stay. She requests an extra day. I say no; if she feels she is fit enough to walk out, she is fit to go to work. She makes roundabout conversations as to why she deserves the extra day off, that she still feels unwell ("Well, you should stay then, if you're so unwell," I say), that she has pets at home she needs to feed ("That has nothing to do with this," I say), she just wants to go out for a few hours ("You should have discussed that with your case doctor during the day, not me," I say), and that her employer won't let her take the day off.

"No" is a complete sentence. Which is what I said. She can stay to discuss this further with her case doctor who will be rounding tomorrow morning or she can sign herself out tonight. One or the other.

She goes to wait at her bedside. She then comes back. The conversation restarts as if it had never taken place in the first place. She wants more sick leave. She feels unwell. She has to feed her pets. Her case doctor didn't tell her the results of her scans or blood work (I advised she can stay, then, and speak to said case doctor tomorrow morning). Her case doctor promised her this and that (except my colleague never mentioned these things). No. No. No.

I stand up. She is still talking about the same things. I have five new admissions to see, some of them are quite unwell elderly people. During her continuous repetition of the above topics, my pager is going off constantly about the admissions and unwell inpatients.

"Excuse me," I interrupt, "but that is all on the paperwork. I won't give you more sick leave. Now I have to go. If you have queries, you can call your case doctor tomorrow morning."

"What's that supposed to mean?" she says.

"I have over 400 patients to see. There is just one of me."

"Well, what does that have to do with me?" she says in disgust.

At this point, I want to snap at her "No, selfish as you are, it truly has nothing to do with you, but it also means you are nowhere near the top of my priority list and you have nothing to do with me either." But the onus is on me to be professional, so I just repeat that I am very busy, and that I have to go.

I walk off. Gosh, this makes me so angry.