“By God’s grace, Dr. Sal!”
“Yes, T.J.! What’s the good news?”
“Guess what Mr. Thompson’s potassium is now?”
We high-fived each other immediately and breathed a huge sigh of relief. For six days straight, we’ve been giving Mr. T potassium through an IV and by mouth with little to no change in his potassium level.
He came to the hospital after being found passed out in his home. Very low initial blood pressure, and incidentally found to have very low potassium. The culprit? We thought it was Mr. T drinking alcohol throughout the week, barely eating anything at home, and only drinking bottles of Diet Coke every single day. What complicated matters were that he wanted to leave AMA every day he was under our care. Every. Single. Day.
“I can just eat bananas at home. Why the heck am I still here?” said Mr. T.
“Your potassium is still dangerously low despite all the potassium we give you. It would be best if you were here until we figure out what’s going on,” I pleaded with him.
“I’m going home today! This is taking too long. I need to go!”
“If you go home without us fixing your potassium problem, your heart will start beating abnormally. It might even stop beating. You can die.”
After a brief silence, Mr. T agreed to stay one more day.
This exact conversation replayed itself for several more days until one morning when I was on the way to the hospital, his night nurse called me.
“He just ripped his midline out and is extremely agitated. He’s fixing to leave AMA.”
Mr. T was the first patient I saw, and when I walked into his room, I saw blood all over his shirt, face, and bed sheets. I told him one last time we needed to put in another midline and to give us the chance to give one more round of potassium and see how the number looked in the afternoon. It was either the tone of my voice or something else, but Mr. T suddenly sunk into his bed, arms crossed, and he looked into my eyes.
“Fine, fix me by this afternoon, or I am going.”
The second midline went, and another round of IV and PO potassium.
And voila! After days of potassium sitting around 2.0, by God’s grace, it increased to 4.1!
We ultimately discharged him home with oral potassium for a month and followed up with the nephrologist. It was indeed not eating much of anything for an entire two weeks that caused such a fight with his potassium level. It was never a kidney issue.
What did I learn from Mr. T? Don’t give up on your patient. No matter how often they threaten to leave AMA, no matter how depressing it is, when what you’re doing seems to not be working. Don’t give up. Continue to advocate for your patient, and educate your patient on why they are in the hospital and exactly why we do what we do.
Image credit: Shutterstock.com