Patients....ya gotta love 'em

A 43 year old white male presents to our emergency department with a severely infected hand. He has a purulent, long lesion (1.5 cm) over his digitus tertius (middle finger) and this finger as well as adjacent digits are darkly discolored. The purulent discharge from the wound is foul smelling. The wound is cleaned and patient sent for hand and arm radiographic evaluation. Xray results show clear signs of osteomyelitis of the phalanges as well as small bones of the hand and possibly beyond. The patient reports the wound occurred during a bar fight about 2 weeks ago. This same patient has been treated for acute alcoholism on three other occasions over the past 4 years and is currently on the liver transplant list as a result of his severe cirrhotic alcoholic liver disease.

Question……do you think this guy should remain on the transplant list??? BTW…..the hand had to be amputated after 3 days of intensive antibiotic therapy.

Ahhhh an ethical problem!!

My answer is no...in the first instance, based on the notion that organs are not readily available for transplant -- and someone more deserving may be overlooked in the process.

Then the softer, more humane person kicks in. What are the reasons for his alcoholism? Does he have dependents, and how will they fare after his death?

Here's what I didn't tell you. When the guy came in with the infected hand, he was intoxicated (confirmed by BA). So he was removed from the list. He is unemployed, uninsured and father of two. They are poor and destined to become worse off. He will die. He is currently back in the hospital with aspiration pneumonia secondary to influenza. He'll probably die. PROBLEM SOLVED!!!!!

59 year old hispanic woman presents in the ER. She is severely jaundiced with a history or cirrhocis, alcohol abuse, and malnutrition. Her amonia levels are over 100. She is alert and oriented to name only. She needs a new liver. Should she be placed on the donor list?

PS: Spanish speaking only family. On Medicaid.

The fact that she is on Medicaid enhances her chances in most states!!!!! America1 Whose says we don't take care of our poor?

Answer: She is transferred to Cedar Sinai and put on the transfer list! Only in America!