47 Times Patients Ignored Medical Advice And The Outcome Was Devastating

I had a 37 year old patient with covid that was on high-flow 50L 100%. They were rapidly heading towards intubation as sats were in the 80% maxed out on O2. Patient changed their code status to DNR/DNI, then left AMA a few hours later and WALKED HOME. Someone found them passed out outside and called EMS, when they got there, sats were in the 40’s. Patient was brought back to the ED and after quickly calling family, they did an emergency intubation. They’re now in the ICU with little to no brain activity.

Necrotizing fasciitis walked out. Can’t remember why. Just remember thinking she would be dead by morning.

Guy who would deSAT from everything and was getting close to being intubated. He was tired, he wanted it, but his family was freaking nuts. He wouldn’t even talk to them after a certain point. His wife was livid that we wouldn’t give him this and that treatment/medications she heard about from her “doctor friend” (aka Facebook memes) because they weren’t approved for hospital use, would cancel out his medications, end him, or simply do nothing. She signed him out AMA and my heart literally broke while watching him be wheeled out on a stretcher gasping for air and looking confused while his wife trailed behind with her arms crossed and looking pissed off. I looked him up a week later and saw his obituary stating he passed that same day. And you *know* she blamed us for his death.

The worst? Guarded prisoner and DUAI patient with a pneumothorax and chest tube who didn't care if he survived, just wanted to call his girl so she could pick up some valuable stuff that was left on the scene of his MVA. He couldn't call from the hospital for security reasons so he insisted on leaving AMA and the police were like, "His choice, we can't stop him. We'll just take him back to jail and let him make his call if he signs the form." After many attempts to explain why he shouldn't do it, we pulled the tube and sent him off with them. Unbelievable.

Then of course there was the patient who had a motorcycle crash and messed up his leg, and kept leaving AMA because the PCA pumps, oral narcotics, IV push narcotics, and multimodals we hooked him up with weren't enough to control his pain. How do you even get that desensitized? About a week after his first admission, which he AMAed from, he was admitted and AMAed twice in four days, in between which he tried to go to another local hospital (who just sent him back to us because we started his treatment, and we're the area's Level 1 Trauma Center anyway). That's the only patient I've well-and-truly lost my cool with, when he was screaming bloody hell loud enough to be heard halfway across the floor while we were actively working to set up his morphine PCA pump (He insisted on morphine instead of dilaudid because the dilaudid didn't help enough. Idiot.) Edit: To be clear this pt was a chronic med and even his father when he called us at one point stated that he was probably leaving AMA to do illegal substances. So yeah, I actually do know how this guy got so desensitized.

Late 40’s guy with SVC Syndrome got intubated for airway, self extubated, left AMA.

*Unexpectedly*, he came back the same day after he passed out in the parking lot in front of the house supervisor. He required an emergency cricothyrotomy. After he woke up, he stayed for about four days getting diuretics and steroids. Then he left AMA again. 2 weeks later he comes in as a post-code. Family let’s him go a week later. RIP, fool. Such a shame.

A patient who could not stand. Had no family to take them home. Refused to take their antibiotics, and had huge open wounds. The patient was in "sound" mind so we could not hold them when they were insistent they leave. After myself, the charge and the Dr. tried to get them to stay they finally left. We called cab and the patient stated "I'm going to Walmart to buy me a wheelchair".

Sickle cell crisis. Hemoglobin of 5.4. Was mad that we wouldn’t give her a higher dose of her dilaudid PCA pump because her blood pressure was bad. So she huffed and puffed herself out that door and ledt.

Patient needed to be intubated, was satting 80-85 on 15L hi flow. Signed out AMA, waited for a ride for about 20 mins. We were hoping he’d decline hard while waiting for his cab, instead he walked to the cab and went home. Arrived cold and DOA the next morning. We tried, couldn’t bring him back.

In icu, severely hypoxic COPDer, current smoker, high flow 40L 60% FIO2, 3 person assist, screaming at me to get him outta bed by myself after he kept taking off his O2 and desatting to 30s. Left AMA, night RN wheeled him to lobby on room air, taxi took him home, and he called 911 because he couldn’t get up stairs. Ended up in the same icu bed an hour later.

All my worst AMA stories involved a resident (usually young and female) kneeling by the bedside of the patient and baby talking to them until they agree to stay.

My worst in my baby career so far was an amputee patient coming to the PACU. He was AAOX4 and cranky that we had orders for NPO status and our PACU doesn’t carry real tray orders anyway. After denying him food, he accused everyone and threatened to attack me after seeing me exit the break room where we had our potluck. Explained that food was for nurses and we were not going to break his orders just because others could eat. He signed an AMA and I watched from behind security as he was wheeled out, cursing and blaming the whole world and calling us bought by the hospital. Most nurses there were unimpressed by him but having someone directly look at you with very little suppressed violence in their eyes (and clearly not in their words) was jarring.

70s female with active GI bleed drove herself to ED. She was admitted to my step down floor at the start of my night shift with Hgb around 6. I have her some blood and she kept talking about some lawyer from NYC flying in to handle her sons estate. She HAD to get back home to deal with this. She of course was set for scopes in the morning but went AMA before midnight and drove herself home. She was back in the ED next morning by squad.

A man was brought in after he was found wandering the train station totally confused/not making any sense. They started him on acyclovir and treated him as r/o meningitis. He got sent for an LP, which came back as herpes encephalitis. So he was on the correct treatment but a few days of antivirals made him more oriented and he ended up wanting to AMA. MD allowed it because he answered all questions appropriately (apparently).

He got brought back less than 24 hours later, the police found him wandering trying to find the heavy machinery he operates as part of his actual job. He ended up actually getting a repeat LP for reasons I don’t really understand. Also they incidentally found out he definitely has cancer.

Massive bilateral PE. Left AMA because their S.O couldn't spend the night. Tried saying their S.O couldn't drive at night because they had Lupus. Family called to harass us that night.

DKA with recent foot amputation left AMA because we wouldn't feed him while he was being treated for DKA. Started throwing things.

When ever someone says they want to leave AMA I like to call their bluff and bring in paper work right away. See ya.

Patient (late 30’s) was there for CVA. They can only speak 2 words but AOx4 by pointing and writing. Wild story about road rage but family believed the boyfriend was ab*sing her. Boyfriend was the only one who “witnessed the road rage that cause the stroke”. Family requests no overnight visitors and social worker agrees, as does MD. She flips out demands to leave AMA. I bring her the form and she proceeds to smash the clipboard into my face and shove me by the shoulders out of the room. She left. Horrible person and has a history of firing and being horrible to staff whenever she is there. No one was surprised. I pressed charges but I’m sure this won’t go anywhere.

We had someone once who was extremely septic with a ruptured large colon that signed out AMA. His reason for signing out AMA was that he felt like the doctor he had had that morning was mean to him. The patient was pleasant otherwise and we had booked transport already for him to basically go straight to the OR. We told him that imminent death would occur if he did not get this treated ASAP, but he didn’t seem to care.

My personal theory is that there is a distinct category of brain injury patient. Where they have just enough subclinical brain damage to make them irrational but not enough to be able to get POA or a legal hold on them.

That’s my only explanation for all my DKA patients who go home even with blood sugars of 700 and rising. We tell them they can die, or survive with long term damage, but they don’t care. They just have this glassy faraway look on their face as we explain exactly how much danger they’re in. My guess is they’ve DKA-ed at home multiple times and made their brain cells go all wackadoo.

Patient with a blood sugar of >700. Still completely oriented so there’s nothing we could do. I hope they got care before they inevitably went unconscious.

I had a pt (precovid-19) that was on high flow , bariatric that we need a lift to stand her up. She would instantly desat. She said she had to go to the bank. We have a policy of not helping pts or providing W/C to pt leaving AMA. She signed the paper work some how managed to get herself up 10 minutes later she managed to walk one room distance like 10 yards and couldn't handle it any more. I ended up calling a RRT and readmitted her back in her room.

Flu patient (pre-covid times.)

Sats in the 80s on bipap, but didn’t like how it felt on his face. No idea what the room air sat was because he wouldn’t let us take vitals. Left AMA.

Back the next day, found down at home. This time he got intubated.