He was correct. This was no place for this man to use up more of his life, lying between bleached sheets, in a room with no natural light and no plants, forced to decline a breakfast tray of processed meat and eggs.

“I’m sorry about that, about the delays and the food,” I said, then paused. “Joshua, I have to be honest with you. In your case, you don’t really need to be admitted to the hospital. A cancer workup is the kind of thing that is typically completed as an outpatient, and I really think you’ll be more comfortable that way. Of course, we can continue with your admission to the hospital as well. I’ll leave the choice to you. I’m just saying, why be cooped up here when you can be comfortable at home and outside in this beautiful weather? If you like, I can write you a prescription for pain medication to take at home, if needed, and I can call the oncology doctor now to make sure you’re scheduled for an appointment where the evaluation can be finished. The decision is yours.”

He was a man who wore freedom more handsomely than any confine, so this idea suited him well. “Please, please. That sounds so much better. I don’t want to be cooped up here if it’s not necessary.”

“Let me just call the oncology doctor now and see what they say, in case there’s any additional information they’ll need before you go. Is that all right?”

He clasped his hands in front of his chest and bowed his head slightly as he looked at me. “Yes! You’ll come back and let me know?”

“I’ll let you know. I promise,” I said, smiling.

The oncology doctor called back and requested that I order a couple more blood tests as part of the cancer workup, including a PSA level and a chest CT for cancer staging. Her office would take Mr. Clements’s information and call him for an appointment within the week.

Mr. Clements, apparently relieved by this expedited evaluation, agreed to stay to complete these studies. He then called his family with updates and asked them to bring him food, since he would be with us a couple more hours.

As I finished placing these additional orders, the orthopedic doctor came over to let me know that he had seen Mr. Spano and drained his abscess at his bedside. He recommended that he be admitted to the Internal Medicine service for intravenous antibiotics, as we had discussed. He warned me, though, that Mr. Spano was refusing to stay.

“What?” I said, baffled. “You’re kidding. He was just begging for us to save his life.”

“Not kidding,” he responded as he left the department.

I reviewed Mr. Spano’s results. His vital signs were now normal, and his labs were reassuring. His CT showed a superficial abscess and soft tissue swelling, but no gas formation—more good news.

I hurried down the hallway to Mr. Spano’s room. He was sitting in a chair, shoving his feet into his sneakers. His brother had apparently already left, and he was now alone in the room with Carissa, who was trying to explain to him how important it was for him to be admitted to the hospital as planned.

“Mr. Spano, what’s going on?” I asked, pretending not to know anything about his newfound urgency to leave.

“I gotta get out of here,” he snapped. “I have things to do. I can’t just lie around here. I’m better now. I need to go.”

“Mr. Spano, you’re better because we gave you a lot of very strong medicine to treat you. You’ll need more of that medication to ensure you continue to get better.”

“Well, then I can just leave with this IV. Just give me the medicine and I’ll inject myself, or I can get my family to do it. I have family members who are nurses and doctors.”

“Mr. Spano, you cannot leave with the IV. Your leaving with this IV would be against every hospital policy everywhere.”

“Well, then just give me pills,” he said, tearing the IV out of his arm and throwing it to the ground. Blood dripped from his arm onto the floor, and he snatched a piece of gauze off the medicine cart next to him, held it to his arm, and then threw it to the floor next to the IV he had already discarded. He stooped down to tie his shoelaces.

“If you must leave, I’ll certainly write you a prescription for antibiotic pills to take at home, but Mr. Spano, remember when you came in just a couple of hours ago? Remember when you sat on that stretcher crying and begging us to save your life? Remember how I told you that you have an infection that could kill you?”

His hands stopped mid-bow on the left laces. For a moment he looked at me, and seemed to follow my point reluctantly. He nodded.

“Well, that is still the case. You still need that medication. You could still get very sick and perhaps die if you leave now without adequate treatment.”

“Listen, there are other things I have to do,” he said, bending over to complete the last lace. He stood up again and walked over to the side table to collect his jacket and phone. “I can’t just sit here all day and night in a hospital. I have to finish paperwork for a job interview. I have a court hearing for custody of my son next week.”

“If all goes well, you’ll be out of the hospital within a couple of days,” I told him. “That won’t conflict with court next week. As far as paperwork, isn’t there a way you could complete it here?”

“Listen, I just have too much to do, so I’m leaving,” he said.

After he left, Carissa and I looked at the trash on the floor and the trail of blood.

“What a waste,” Carissa said, as she kicked the trash into a pile and threw a chuck (a large medical napkin with a surface to soak up liquids) over the blood. “I knew he was gonna do that from the very beginning. What a complete and utter waste of time.”

Mr. Spano had left without his prescription for antibiotics, without the dressing changes for his leg, without his discharge instructions, and without follow-up appointments.

I walked back to my station to scribble out some notes stating that Mr. Spano had left against medical advice. I forwarded the notes to his primary care provider and to Orthopedics, hoping that one or both services would try to contact him to make sure he was healing well.

Within ninety minutes, a very patient Joshua Clements would also get to go home. Radiology called again, providing a reading of his chest CT that was much like the CT of his abdomen: “Nodules too numerous to count.” While the normal range for prostate-specific antigen is around 4, his level was over 200. I called Urology, who took his information for a walk-in appointment in four days to discuss what was certain to be a widely metastatic prostate cancer.

I called back the oncology service, who appreciated the follow-up and reported that someone would call Mr. Clements later that day to set up an appointment. Then I went back to his room to find him flanked by a fortysomething couple; the man’s face was almost identical to his. The spirit in the room was aloft with laughter.

“Hello, everyone. I’m Dr. Harper. I’m back to give you the most recent results before you get on with your day.”

“Dr. Harper, this is my son, Reid, and my daughter-in-law, Tracy,” Mr. Clements announced, making his introductions.

“Hello,” I said, greeting each of them. “So, Mr. Clements—”

“Joshua,” he reminded me.

“Oh, yes, sorry. I keep doing that! Joshua, I have two more results for you. Your PSA level, the level for your prostate antigen, is super high. You probably remember talk of this from your last bout with prostate cancer.”

“Yes, yes, I do.”

“Also, the CT of your chest shows the same thing as your abdomen: numerous nodules everywhere. The combination of all this information suggests that this is all coming from the prostate cancer we were discussing earlier.”

“I figured, Dr. Harper. I figured it. Wow,” he said, looking at his children. “Wow, I feel fine!” He placed his hands on his chest and took deep, ample breaths as his hands expanded with each inhalation and contracted with each exhalation. “They’re all over my chest, but I’m breathing fine.” He looked at his children and continued to drink in the air. Lowering his hands to his lap, he said, “You know, Doctor, I’m not afraid. I’m just not. I’ve had a really good life.” And then he laughed—a joyous, relieved, contented laugh.

His son looked at him and then at me. “You know, he’s right. This old man has had quite a run,” he said, chuckling. “Now I have to run around behind him like I’m the dad!”

“Ah, then all is as it should be,” I responded, joining them in laughter.