A 40-year-old man with dilated cardiomyopathy (DCM) is admitted onto my ward for syncope (loss of consciousness). With a significant heart history like DCM, we worry about a sudden bout of arrhythmia (irregular heartbeat) that triggered this syncope episode, i.e. cardiac syncope. A holter exam (24 hour heart trace / ECG) didn't show anything -- not entirely unsurprising, because he didn't have syncope again on the ward. We schedule him for an inpatient echocardiogram (heart ultrasound) to see his heart function, because he may need an implanted cardiac defibrillator (ICD) in the long term.

It's been four days since his admission. We're just waiting on the standby echo (that is, they'll scan him when there is space in the schedule). A few of my other patients are waiting for this. One has waited for eight days already. Dude's getting fed up.

"Look, I've been fine for these few days. How long do I have to wait?"

"Well, it's standby inpatient. Which means you get it done as an emergency whenever there's a slot available. It can be tomorrow. It can be in a week. You can do it as an outpatient, but that'll be in two years' time because that's the outpatient waiting time."

He scoffs. "Two years? I'll be dead by then."

"Maybe, maybe not. Which is why I'd advise you to stay."

"Well, how long would it be?!"

I try not to sigh at the repetitiveness.

"Like I said, it's standby. You can wait a few more days to get it done as an inpatient or two years as an outpatient. Or you can go private," I add.

"As if I have the money to go private!" he snaps.

So he doesn't want to wait another few days for a free, emergency inpatient echo (which everyone else is queuing for as well).

But also doesn't want to wait two years for a free outpatient one.

But also doesn't want to or can't afford a private echo.

I repeat his three options and then leave. So many choosing beggars.

(In the end, he stayed another three more days and got his echo. The cardiac team wished for him to then stay for work-up to get an implanted cardiac defibrillator inserted in view of his poor heart function and suspected cardiac syncope. He then discharged against medical advice.

Sigh.