The first time I heard a patient tell me “I can’t stay…” broke my heart! As a new nurse to the USA, I didn’t know this would be a regular occurrence…I’ve heard these words uttered in Canada but never for this reason!
As my patient is being wheeled from triage in a wheelchair, I noticed the very distinct facial droop that represented a potential stroke (CVA). The overhead paging system confirmed my thoughts as it rang out “stroke alert”.
A group of efficient nurses, doctors and techs helped me settle the patient, obtain all the necessary data, and get the diagnostic labs, EKG, monitor, and CT initiated.
This patient was physically and emotionally healthy with a supportive family. They were from an average middle-class background and while at work he/she began to have symptoms of facial droop and slurred speech. The symptoms were concerning but the CT did not confirm a CVA. The Doctor wished to admit the patient for observation. Admission is not unusual to observe for progressing symptoms and to follow up with additional CT scans or MRI. BUT, the patient refused…
“I can’t stay…I can’t AFFORD to be here…” and the patient signed an AMA (against medical advice) and left, knowing the potential of risk for life and limb!
Why, why would they go?
Did they understand they could die…yes! Did they understand the CVA could still be present and cause debilitating paralysis…yes!
But, money trumps everything…
Here in the USA, I have learned that having insurance does not always mean being able to afford healthcare. Premiums are high, deductibles are outrageous and many people still don’t have insurance. These insurance issues cause patients to leave the ED because of financial choices verses staying for health reasons. I am far from an expert on the healthcare system here and I have lots to learn BUT I do know the patients and speak from experience, this story is not an isolated to one…every time I hear a patient say “I can’t afford to stay…” I know they are making incredibly difficult choices between health and money, a struggle no one should have to face.
disclaimer: person, place and time have been left out of this story to prevent identification and preserve HIPPA. This story has been told in general terms to avoid identification and is intended to remain a personal experience.
The Nomad Nightingale 