AMA

I was on day call today and got my first experience of a patient who wanted to leave the hospital against medical advice - or AMA as we call it. I can't blame the patient but there are times when I just don't really understand what a patient wants. The patient, who has just delivered a baby through c-section 3 days ago, has an uterine rupture and high blood pressure reading that warrants a full 96-hour stay. She has a complicated social history - positive drug screen, no prenatal care, and G10P4504 prior to this delivery which means she had 5 prior miscarriages. Her newborn did not live beyond the first 24-hour and I was told by the nurse that when the baby was sent to the NICU she didn't spend any time there. After the baby passed away, she would cry in her room in the Postpartum area and constantly complained about pain from her c-section incision. As her bed is in an area surrounded by newborns, we offered to switch her to another room on a different floor but she refused. Then she would complain about how we don't understand how emotionally painful is it for her to hear babies crying all day long. All the nurses there wanted me to send her home so they became ecstatic knowing that she wanted to leave AMA. I had to explain to her all the risks of leaving the hospital early and have her signed a form saying that she understands.

"What about her meds?" I asked the charge nurse.
"You don't give them any meds home if they are leaving the hospital this way."
"What? Really? But her BP is still high despite the BP meds!"
"Don't worry - you are free of any liability after she signed the AMA form - she'll come back if she's sick enough. And definitely no pain meds."

But that's not the point!! I ended up writing a prescription for her BP meds (which I later found out that I did the right thing) and told her to come back in a week for staple removal. I hope she got the part about coming back. She was then taken away by a guy who's at least 10 years younger than her.

"What do you mean he's not her son?" I asked the nurse.
"That's her partner, kiddo."
"Oookie."

Talk about complicated social history.