Things to do

I had a bit of a shock yesterday with one of my patients.  He is a 41 year old who had a very swollen left leg.  His upper thigh was tight, red and very painful.  Without my prompting he said he had noticed it was hard to breath the last few days.  The combination of these complaints will send off warning flags in any medical provider. His leg and breathing shouted blood clot.  Worse than that, he could have a piece of the clot sitting in his lungs.

I calmly told him my suspicions, and the plan to admit  him to the hospital to do the tests we needed to see if this was indeed a clot. I was shocked then, when his blank stare ended and he shook his head and said "nah" like he was turning down a request for an extra slice of cake.

"I don't think you understand what I'm saying" I explained. "If you walk out of this clinic, that clot could dislodge and go to your lungs and instantly you'd be unable to breath, and could die"  I say this trying not to sound condemning.  He again just shook his head and said "we all have to die sometime".

There's not much else to do in these situations. I tried exploring the reason WHY he didn't want to come in- but no real reason was apparent besides "I've got things to do at home" He did add, "I guess I could come in some other day" Sure, I thought, when it's convenient for you to save your life, we'll talk.

I ended up having him sign something called an AMA paper.  It's a document protecting me in case he dose drop dead once he gets home. He signed this document that says he knew he was leaving against my advice.

What keeps playing in my mind is the eerie similarity of this encounter to one I had when I worked a month in Papua New Guinea 3 years ago. A man about his age had come to our hospital in the highlands of new guinea with what seemed to be clearly a blood clot.  I recall having a similar conversation with this man about coming into our meager hospital for treatment and having him refuse.  He had things to do at his village.  Death was a real possibility, and just like my patient, he made some comment about the time to die coming for everyone.  At the time I attributed his insolence to the ignorance of the new guinea people.  I was shocked at the carelessness of his attitude.  Now I know, it's not something immune to a developing country.

I know we do all have to die sometime, but it seems irresponsible to play rush and roulette with that life!