Look Past Stubborn

The information received from the overnight team is straightforward: Another woman who doesn't take her insulin has a high A1C. She was tossed onto the pile many overtired providers build up in their mind, the heap of patients who are not compliant with their prescribed medications; therefore, why should we care for patients who will not care for themselves? I go to see her on morning rounds. Aside from the A1C, I also know that the patient didn't come in on her own. She was dropped off by a friend worried about her ability to care for herself at home. The patient reluctantly agreed to come to the hospital for a few hours. She wanted to leave when the emergency department recommended admission, but she nearly fell when she stood—and she stayed for the night to receive intravenous fluids for positive orthostatic vital signs. When I meet her, the patient's hair is an unkempt frizz, and her skin speaks of the years she has been smoking. She does not look up when I tell her good morning. The patient speaks down to the bed, looking at her phone lying on the covers as she demands to know: When can I go home already? I ask what she knows about the reason why she's in the hospital. She cracks her knuckles, and she tells me that she doesn't really care. She wants to go home. The patient warns she'll leave against medical advice if I don't discharge her by this afternoon.