Against Medical Advice

I finally woke – I mean really woke and was able to sit up and process things, at 10 am.

I had periodically stirred all night, always noting that the empty 500ml IV bag had not been replaced. At some point breakfast came, involving milk and something I could not eat, so I had kept sleeping. Milk was not something I needed in my GI tract right now.

But at 10 am I emerged from my long slumber, and the doctor sitting at her desk acknowledged me and we spoke briefly. She has a son who lives in Chicago. She reviewed my tests and told me they all looked good.

I told her I was dehydrated and desperately needed water. The last time this happened I needed 6 liters. She instructed the nurse to hang another bag and that I needed a lot of water. So another 500 ml bag was hung.

They brought lunch and promised water to drink. I tried to eat a few bites of bland pasta and chickpeas, but it didn’t go well. With my teeth out of place and clunking weirdly against each other, eating was difficult. Water never came.

Finally I asked if I could go. She said the doctor yesterday had wanted me to stay, and I would have to sign out. It’s true, he had indeed said 24 – 48 hours, but they were doing absolutely nothing for me. They hadn’t checked vitals since arrival. They had given me 1 liter of IV fluids and 500 ml by mouth – below what we would traditionally consider to be “maintenance fluids.” I had received no medication of any kind; nothing for pain or nausea.

If anything their scant efforts would make me worse. I knew I needed hydration but would not get it here.

So I signed out and left. The doctor asked a younger male patient if he could translate as I signed the paperwork but he couldn’t. I didn’t care. I signed anyway.

In the states people threaten patients that insurance won’t cover a hospitalization if they sign out against medical advice (AMA) but my understanding is that’s not true. Frankly, it is my view that, excepting some rather extreme circumstances, the concept of leaving AMA is paternalistic and wrong – I think it’s making an informed decision.

I texted with my siblings and with Lisa and made an informed decision. I left.

I thanked the doctor for her care and walked out from the bay, probably a bit unstably. I tried to buy a bottle of water from the machine in the lobby, but I dropped my euro and it rolled far beyond my reach. Outside, my telephone wasn’t able to call the taxi, so Lisa had the hotel she was staying at phone them for me.

I sat in a tent outside the ER, a holdover from the peak of COVID, waiting for my ride. I was glad for the shelter from a fine drizzle falling from the sky, and I was happy to have a place to sit (falling would look bad right now). And I was completely relieved to finally take my seat inside the taxi that pulled up.

At the hotel I quickly downed a liter of water and then napped for 2 hours before we went to the train station to go to Rome. At the train station I bought another liter of PowerAde so I could get some sugar and salt into the system

By the time we reached Rome I was feeling somewhat better so we tried to go to one of my favorite restaurants and eat something, but my appetite was still terrible and my mouth was sore. The cacio pepe was great and the spinach sublime, but in the end, I couldn’t physically eat. So we paid the bill and I went back to the hotel and slept.

I have a flight home tomorrow. I have x-rays to be taken and dental work that needs to be done.

And I want to feel better.

I’m a doctor and I signed out of a hospital against medical advice. It was the right thing, and I’d absolutely do it again.

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