Seventeen hours at the University of Michigan emergency department, November 5–6, 2026
Part I of a trilogy
By Omar Nabil Metwally, MD
Friday, November 6, 2026
This is testimony. It is my firsthand account, written the day it ended, of what happened to me as a patient. I am a physician. I have worked in emergency departments. I know what a busy night looks like, and I know the difference between a busy night and this.
I have kept to what I saw, what I asked for, and what I was told. Where I give a time, it is the time as I remember it.
I. Six Months
For six months I have had pain that runs like electricity from my spine down my legs, into my groin, and into the sole of my right foot. Six months ago I was playing with my daughter. Now I am disabled. I lost my job.
The first clinician I saw for it was an orthopedic physician assistant at Trinity Health. As far as I could tell, no one was supervising him. I never saw a surgeon. I described pain that was neurologic in character. He injected my hip, left me with a large bruise, and did not reassess when nothing improved.
Imaging found a torn labrum. I am the one who opened that door, and everyone after me walked through it. A labral tear is real, and it does not explain this pain. An incidental finding is not a diagnosis, and no one stepped back to ask whether this was mechanical, vascular, or a nerve. It was a nerve. The diagnosis I carry now is spinal stenosis.
I say this as context, not as the subject. The subject is one night.
II. 3 p.m.
I arrived at the University of Michigan emergency department around 3 p.m. on Thursday, November 5. My wife dropped me off at the entrance. After that, I was alone.
For the first couple of hours I sat in a wheelchair at the entrance, in front of the security office. A large camera was pointed at my face. I looked into it. I smiled at it. At least something there was looking at me.
Around me were people in wheelchairs, people with chemotherapy ports, people in custody with corrections officers beside them. We waited by the door together.
The old ladies in wheelchairs next to me were trading pro tips for getting seen faster. The average wait, according to them, was eight hours. Eight hours? My God. The best trick, they said, was to have your doctor call the emergency department ahead of time. Then you get in faster.
While I sat there, a woman came in and said she was having chest pain. Someone looked her up on a list and told her she would have to go to psychiatric emergency first. I don’t know what was on that list. I know that she said chest pain, and the first thing that happened was a lookup, not an exam.
That was the feeling of the whole place: a conveyor belt. People were processed, not seen. There are brilliant physicians and researchers at Michigan. I trained alongside some of them. This is not about them. It is about a system that has decided what it can afford to notice.
III. The Hallway
From the wheelchair I moved to a stretcher in a hallway, under bright lights that never went off.
The pain did what it does. Bolts down both legs. The sole of my right foot on fire. There is no position on a hallway stretcher that helps.
I was thirsty, and I asked for water. I asked again. I asked at least five times. Each time the answer was some version of: let me text the doctor.
My urine turned brown.
I had to remind them to start the IV. Then I had to remind them to turn it off. My mouth was so dry that I asked for another bolus of lactated Ringer’s. The nurse said sure, let me text the doctor again.
I asked for water until my dry mouth got drier.
Sixteen hours under bright lights is enough to turn a normal person into an animal. Light, thirst, no sleep, no answer: these are torture tactics. It is not even malpractice. It is beyond that. It is straight-up torture.
Is this a healing place, or a destroying place?
IV. Midnight
Around midnight, someone gave me something to drink.
I had arrived around 3 p.m. That is about nine hours between walking in thirsty and being given water, in a hospital, with my urine already brown.
Withholding water from a patient who is asking for it is not a triage decision. Nothing about my case required it. I was not waiting for surgery. I was not too sick to swallow. I was in a hallway, and no one came.
V. 2 a.m.
Around 2 a.m. I was moved to a room with a door.
That is roughly eleven hours from arrival to a door I could close. I slept a few hours.
VI. 8 a.m.
Around 8 a.m. on Friday, November 6, I left against medical advice.
Before I left, I was told that if I went AMA, I would have to take a bus home. At best.
Seventeen hours after I arrived, I walked out with the same pain I came in with, a phone call in passing from the Michigan Medicine orthopedics clinic where I had an initial appointment scheduled for next week saying that the initial global authorization request from Blue Care Network was unsuccessful and that I would have to contact my doctor again or arrange to pay cash. And two follow-up phone calls from care providers I was meeting over the phone as I stood outside a café on State Street waiting to be picked up, trying to smile back at passersby.
I walked from Taubman toward central campus with my legs firing. My credit card had just been canceled after unauthorized charges, and the new one hadn’t arrived. I had no cash. I had no ride-share apps on my phone.
So I walked, and I went through my options. I could call my wife, but we were on ice. I could ask the Ann Arbor police for a ride. I could hitchhike.
Then the phone calls started coming in.
The first was the orthopedic resident. “Let me check with my attending.” Famous last words.
I could imagine them, rosy-faced on that cool, crisp, overcast autumn day, sipping their coffee as they watched their AI write their notes, while I stood in front of a café in caffeine-withdrawal delirium tremens, unable to buy a coffee, handing Vietnam a second victory, or a third.
Then the new hospitalist, who had just taken over the shift. Before I left, I had told him the pain was overwhelming, and that my daughter was the last thing holding me together. He did his job. He made sure I was in the right state of mind to make the decision I made, and I respect him for that. Dealing with an AMA patient is never easy. I always knew I would be one of those patients.
And then I realized I still had an IV in my arm. I tried to pry it off, but the adhesive was too strong.
In the end, my wife came for me. We were on ice, and she came anyway. She took me to York. While An Hien got the coffee, I went back to prying at the adhesive, my daughter next to me. Damn adhesive. Super strong. Then it occurred to me that if I pulled the IV out, blood would squirt everywhere, and that is probably not a good thing to do in a busy café. So I asked my wife to watch our daughter, went to the bathroom, finished prying off the adhesive, pulled out the IV, and applied hemostasis with the brown paper towels. Then I came back and had coffee and breakfast with my wife and our daughter. I had not eaten in twenty-four hours. It was like breaking the fast in Ramadan. My urine was still clarifying.
People ask what I want. I don’t want trillions of dollars. No amount of money gives back six months. I want to live without this pain. I want to walk. I want to get down on the floor and play with my daughter again.
Twelve hours after I walked out, my father drove me to an MRI. That is a different story, and a better one.