I got paged in the afternoon for a patient who was scheduled to be discharged.
Nurse: We just need a prescription for oxygen for her. Social work said they could get it filled.
Me: Wait, does she normally use oxygen? Who usually prescribes it for her?
Nurse: No she doesn't use home oxygen, but she's been on oxygen ever since she got here. The husband is really anxious to take her home, so do you mind coming in to write for it?
Me: So she's never been on oxygen before and all of a sudden she can't get off it?
Nurse: We tried taking her off and her oxygen saturation dropped into the 70s.
Me: Ummm...I'm not comfortable discharging her like that. If she's never had this problem and all of a sudden ,since surgery, she has this problem, I don't think I can discharge her in good conscience. I mean, that needs to be worked up because it's not normal.
Nurse: Well the husband is yelling at me--
Me: I'll be there in 15 minutes and I'll talk to him.
The husband was a jerk, but I explained that I really didn't want the patient to leave with an oxygen tank since I had no way of regulating that. I mean, then I wouldn't know how much she was using or how often, those things are flammable as hell, and really, I think it's a bad idea to not work that up completely. They both yelled at me, but I said that I was going to ask internal med to look at her and determine why she needed oxygen. If they said everything was great but she needed some oxygen, then fine, I'd gladly write them a script. but if they said something was wrong, we'd have to try and fix it. The husband yelled at me again, but they were both OK with it in the end after I explained that I really didn't want her to go home, have some sort of fall or stroke or something terrible, and have to come back.
About 2 hours later the nurse paged me that the patient was being moved to the ICU because she had suddenly developed chest pain, increased shortness of breath, and crazy high cardiac enzymes.
I seriously started shaking and it took me a little while to calm down. I'm really glad I didn't send her home.