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Written by Dr. DO
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Thursday, 19 March 2009 21:28 |
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Mr. K. was a 45 year old man who I saw in the ER last week. He was having abdominal pain and back pain. We got a CT without contrast to see if he had a kidney stone and hopefully to evaluate his appendix (even though contrast usually helps with that). The CT scan came back negative, but he was so tender over the area of his appendix, I continued to worry he might have appendicitis. His white blood cell count came back and was very high. This increased my suspicion even more.
I spoke with Mr. K. about my concerns and recommended we admit him to the hospital to be evaluated by surgery. He told me that he couldn't possibly stay overnight because he couldn't miss work. I finally talked him into staying for a couple of hours and talked the surgical resident into coming to see him in the ER. The resident agreed Mr. K. should be admitted and scheduled for laparoscopic surgery to look at his appendix. He tried to talk him into staying but was unsuccessful. I again went to Mr. K's room and had a long discussion with him. I explained to him that if he had appendicitis and his appendix ruptured, he could die. He told me that he had a new job he'd only been at for a few months and was still on probation. He told me that he would be fired for missing a day of work. He said that he felt lucky to have a job and knew how hard it would be to find a new one if he lost this one. After much talking, he said that he would just have to take the risk and sign out AMA. I'm not sure how he could even go to work the next day if he was still in so much pain. Every time this happens, I expect to see the patient coming in on my next shift....even sicker than before. |
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Last Updated on Tuesday, 14 April 2009 22:18 |
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