I first met WR during a prior admission to HOCC back in November 2023 and she underwent surgery.  She was frustrated with her overall care and her pain management. I built rapport with her during that time, offering a listening and empathetic ear. She also has a complex social/living situation. 

After discharge from HOCC, she told me she left rehab AMA and wasn’t sure what to do. I instructed her to come back to HOCC ED as she could barely take care of herself at home, was having accidents, and could not ambulate well.  It took a bit of convincing due to her medically related PTSD, however, she did return within a week to the HOCC ED and was admitted to the floor. She began to show signs of infection, but again, she was extremely frustrated with her care and her pain management. I discussed with her floor RN and created a plan moving forward to prevent WR from leaving AMA. The patient was discharged on antibiotics, and I was unable to get in touch with her after discharge for over a week. 

After several attempts, I finally got in touch with WR, did a quick phone assessment of her wound and pain, and learned that she had not been taking her antibiotics. Due to chronic unmanaged pain, she also buys pain meds on the street. Because of her PTSD, she did not reach out to Dr. Q’s office for help or for more antibiotics.  I scheduled her with Dr. Q as she was adamant she would not come back to HOCC, and the patient did not show. I told WR that if she comes back to the ED, I would come sit with her the entire time and give the neurosurgery team a heads up that she was coming. 

Eventually, she did end up coming back to HOCC ED and was again admitted, before I even got a chance to see her, she again left AMA because the nurses were not giving her pain meds frequently enough. She came back a couple of days later and I spent over a half an hour discussing everything and the importance of her staying to address her severe spine infection. Encouraged her to reach out to me over the weekend (even though I don’t work weekends) if she’s thinking about leaving AMA. She reached out on Saturday to let me know that she left AMA. I urged her to please consider coming back and letting Dr. Q complete the biopsy. She came back 5 days later and during this admission, I spent lots of time with WR chatting, building a relationship, and also learning more about her as a person. I learned about her family dynamics, specifically her 10-year-old daughter. I learned about her street drug use, amount, frequency, etc. We discussed her mental health, during which she disclosed some suicidal thoughts to me. I reached out to her covering team and requested they place a consult to psych and also a consult to pain management due to her chronic opioid use and recurrent inadequate pain control in the hospital, leading to her several episodes of leaving AMA. I also met with her floor nurse and explained her background and requested that she stay patient with WR and medicate her as much as her orders allow.  Since then, her pain has been much better controlled.