I found myself humming this a few shifts ago, when trying to transfer a patient with lingering effects from COVID. My patient had already lost two family members. Even though his infection was gone months ago, he was still struggling. So I thought I’d pen a little something, mainly to give you a behind the scenes perspective and one big lesson.
On a good day in US healthcare, when all the gears are properly greased, and no COVID, and no flu season, and no holiday weekend, and no WOW week at Cal Poly, and no forest fires, and … you should be able to show up anywhere within our envy-of-the-world medical system with whatever problem you may have, and find arrows pointing you the best ways towards optimal care.
If you walk into an urgent care with an arrow in your neck, a call to 911, with some well placed gauze, will generally move you to the best nearest trauma center. If you see your doctor with one-sided paralysis, it shouldn’t take much to move you from the waiting room to a stroke center. If you say you’re suicidal in an ER, ideally a crisis team will help you get the best psychiatric care and support you need. If you show up in labor at a hospital that doesn’t have obstetrics, you and your future bundle of joy will hopefully be stabilized and transferred appropriately, or delivered by some white-knuckled ER doc.
Unfortunately, COVID is sand in the gears… peanut butter in the dog food… my children in basically everything. Flu during flu season has a similar effect. When ICUs are full, and tertiary care hospitals can no longer accept the sickest of patients, most tributaries back up and flow stagnates throughout the system.
My recent patient had myocarditis and worsening lung function. He needed an echo, a nephrologist, a cardiologist, and an ICU, because his lungs were filling with fluid, and he exceeded what my hospital had to offer.
I/we spent hours calling the heavy hitter hospitals. But we found no takers. They either didn’t have beds, or their ICU beds were full, or they couldn’t take another COVID patient (even though mine tested negative).
Admission at my hospital wasn’t an option. So ultimately, hours later, my patient’s relative said, “let’s just leave and drive to xyz hospital.” Guess what. That’s what I’d have done as well, but hours sooner.
My point here is that I as a doc can’t tell you to leave and pull such an outrageously risky move. But with shoe on the other foot, it’s absolutely what I would have done with my own loved one.
So if you find yourself in a similar predicament, if you have a ride, caring family, home oxygen, +/- a urinal, “You can check out any time you like, and you absolutely can leave.” You may have to sign an “AMA” but whatever.
Moral: Nowadays, do everything you can to land in the right clinical setting with your first try, even it means a debate with your medics from the gurney. Because transfers are just a big old drag. Feel free to call us as well if you’re on the fence.
Here’s a preCOVID post from a while back with some similar sentiment: AMA should be DBU … (Don’t Blame Us)