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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Wednesday, July 18, 2007

NEJM: Leaving against medical advice

In tomorrow's New England Journal of Medicine, a first-year internal medicine resident at Massachusetts General Hospital, writes an eye-opening essay about his experience treating a critically ill patient who, against medical advice, decided to leave the hospital.

The patient, a 29-year-old heroin addict who spoke only Spanish, was hospitalized with a heart infection and failing heart, among other problems.

"We tried deals and scare tactics, telling him as clearly as we could that he was more likely to die if he left this way," writes Dr. Viviany R. Taqueti. "When he countered with 'that is up to God,' we offered him consultation with a priest. An interventionalist, overhearing this exchange, called us warm and fuzzy. Our efforts felt futile, and we were weary. Yet it seemed wrong not to keep trying."

Later, Taqueti writes, "I listened to his heart one more time ... I heard those ominous rumbles and screeches, and they startled me with their threat of impending death, obvious even to me. But (the patient) could not hear them, and I wondered how much of his failure to hear was due to our failure to translate.

"I placed the stethoscope in his ears. (The patient) raised his eyebrows in astonishment but said nothing. I knew this simple hearing aid could not remedy his deafness, arising as it did from barriers of language, culture, denial, distrust, and drug dependency. I was left frustrated, sad, and tired."

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