Initially appeared on doktorko.com 3/12/2005.
Three patients on my list:
1. A middle-aged male who came in because of an INTENTIONAL multiple drug overdose; had Multiple Organ Dysfunction Syndrome, was admitted to the ICU, underwent continuous hemodialysis for a more than a week, now SIGNIFICANTLY improved. We're setting him up for outpatient rehab, but from the look of things, he'll probably get back on junk right after discharge. Incidentally, he slaps his mom around when she won't give him money for drugs.
2. A middle-aged male who killed his liver with beer, STILL doesn't want to quit drinking despite having end-stage liver disease, came in with ascites, who ALSO has hepatorenal syndrome. Now we're talking about transhepatic shunts, million-dollar medicines, dialysis, and maybe even a liver transplant just to keep him alive.
3. An elderly female who has end-stage emphysema, continues to smoke DESPITE all medical advice to the contrary, COMPLAINS that because she isn't getting the right treatment, she isn't getting better. She wants all the free samples, and home oxygen so she can keep on doing what she wants at home.
What's wrong with this picture? Call me a cynic, but i've seen too many people DIE back home for lack of enough money to buy even FIRST-GENERATION (i.e. low-level) antibiotics. Organ transplants, regular dialysis sessions, and STAT interventions were things we only read about in books. Here, i see people doing the dumbest things because they know that their FIRST-RATE medical system has a safety net for people JUST LIKE THEM.
Where is the justice? What is the point of moving heaven and earth just to keep these "people" alive? They made their choices and made their lives a living hell. If that's what they want, maybe we should just let them BURN.
Sometimes it takes a superhuman effort NOT to get jaded.
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