The VIP Patient

Vacation's over, and I've started another month of floors at "the Bing," the suburban community hospital where we rotate 2-3 times a year. The last time I did a floor month there was back in October, so it took a while for me to remember my password and the way things worked in this hospital. Right away, I got a list of 12 patients, among which was the father-in-law of one of the PGY3's in the medicine program. We were told that he was a "VIP" patient, and to treat him well. To be sure, he was more intelligent than most of the patients I've seen, almost to a fault.

One thing for certain: he didn't make things easy for us. He was a noncompliant diabetic who had already lost a toe to amputation, and when I saw him both legs were bandaged up due to ulcers. "They told me to keep it wrapped up and that once it starts to smell, it's really serious," he said, then added that he never smelled anything bad from his foot ulcers. The wound care nurse who later saw him begged to differ; she called to tell me his ulcers were oozing and the stench was foul. We were hoping to discharge him later today but he needed home care and case management wasn't called in time to set it up, so my resident had to break the news to him that he had to stay in the hospital an extra night.

Needless to say the patient was pissed. When I first saw him in the morning, he was respectful and in good spirits ("Have you met my daughter-in-law?"), but when he heard he had to stay an extra night at the hospital, he demanded to leave and even wanted to drive home (never mind that he was admitted secondary to a fall --> fx and his driving would be dangerous to both himself and others on the road) My resident even called his classmate (the patient's daughter-in-law) to see if she could talk him into staying at the hospital, but that only made him angrier. "That wasn't fair," he told my resident, and I can't say I blame the guy. It was only when the nurse said the patient's insurance may not cover his admission if he leaves AMA that the patient said he'd think about staying. I have no idea at this time whether he's still at the hospital or gone, but hopefully he'll stay until at least someone picks him up to take him home.