Monday, September 03, 2007

Ethical?

I'm pretty pissed right now, so excuse the PC absence in this rant.

We had a medical ICU patient last night. She vomited and pooped blood on one of the floors and then stopped breathing. We had the 'code bed' so she came to us.

This woman was a big drinker and drank herself into Hep C and liver failure. In 1999 she shaped up and got a new liver. I wonder how long she waited before she hit the bottle again. So she comes to the hospital days ago after..... Dum DA DA...... vomiting blood. She did some time in the medical ICU and then to the floor.

Thats where I come in....

This lady was tubed, maxed on pressors (her bp was in the shitter) acidotic as hell and (oh yeah) her hemoglobin was 4. So I spent the night giving her LOTS and LOTS of blood and blood products, trying desperately to get her bp up and arguing with the medical ICU intern. Around midnight her pupils stopped working. She was bleeding from everywhere and probably spontaneously bled into the brain. The intern tried to convince me that the pupils were working and I "just couldn't see it."
So she is probably brain dead, the intern doesn't believe it and we are in a blood shortage and she is getting blood as fast as she bleeds it out. Grrrrrrr........

LifeNet was in the ICU for several other cases in the hospital (its Labor Day weekend, this is not a surprise). The coordinator and I are friends... I told her if they gave this chick another liver I would kick her ass!!!

I was so over the night that I didn't make it to work tonight... oh well. Hopefully the chick will be gone when I come back.

5 Comments:

Blogger MonkeyGirl said...

It's bad enough when the deadbeats are wasting our oxygen. But when they're wasting blood and even organs?!?!

That's freakin' ridiculous.

7:08 AM  
Blogger PJ Geraghty said...

For the record, you don't get the Hepatitis C virus (HCV) from drinking. Liver failure from the combination of HCV and drinking, however, is another thing altogether. The vast majority of liver recipients are people who lost their "original equipment" due to either HCV or ETOH. Liver candidates, before they are listed for a new liver, must demonstrate that they have "reformed" their lives. The length of "reform" necessary varied from program to program, but where you are I think it's 12-18 months. It's not clear from your post that this patient relapsed; in 8 years, it's entirely likely that the HCV (which cannot be cured, only slowed) has damaged her new liver to the point where it no longer functions. If this had been caught early enough, she might have been eligible for retransplant. It does not sound like she will be this time.

Many of us did things years ago that we're not proud of. Some of those things have consequences that only show up 20+ years later. HCV is one of those...there wasn't a reliable test for it prior to the mid-1980s, and so people got it from blood transfusions, not just illicit behaviors like IV drug abuse or unprotected sex. There are a lot of liver candidates and recipients out there who contracted HCV in the 1960s and 1970s but had no problems until the last 15 years. Many of them, despite their youthful indiscretions, turned out to be decent citizens. Should we deny them a chance at life because of a mistake they made 30+ years ago?

In any event, the rush to judgement, while common, is not always appropriate. I'm sorry this woman is likely to die, but the liver transplant team at your hospital gave her an extra 8 years of life. I know that team well, having worked with them for seven years myself (and having spent much of that time on your unit) and I'd trust them to do my transplant, if I needed one.

6:05 PM  
Anonymous Vtskully said...

You know I hate those people who think that no matter what anyone else says they have to correct them. People piss me off and people like that especially piss me off. They are always the ones who think that there stuff dont stink and that they know everything. By the way "reform" rarely happens yet you numnuts continue to give good organs to those people who destroyed there organs in the first place. Heres an idea, if you fucked up your organs to begin with why should I give you a second chance to fuck up someone elses organs. If you were born with a problem that causes your organs to not function normally or you contract a disease (not of your own making) that causes your organs to need replacement then I do not have a problem with that. However when you destroy your good organs so that you can have a good time then I have no pity on you. Anyone who would offer a second chance to a moron like that is nothing more than a bleeding heart liberal and is the majority of the reason that this country is as messed up as it is. I guess according to what Mr. Geraghty is saying we should give a murderer a second chance because he only killed someone thirty years ago and he would never do it again. GIVE ME A BREAK NUMNUTS. Get back to reality. Stop giving away good organs to bad people. The rule for replacing organs should be IF YOU FUCKED UP YOURS THEN YOU DONT GET REPLACEMENT ORGANS, PERIOD. I hate stupid people. You know there are some people who should not be allowed in the GENE Pool, not even in the shallow end of the pool. Second chances are for minor mistakes, not major fuck ups like destroying your own organs. JEEPGIRL you rock and dont let what some know it all liberal numnut says get to you. According to him we should all give everyone a second chance even after they destroy there own selves. What a numnut.

11:33 PM  
Blogger PJ Geraghty said...

Sorry, Jeepgirl. I had no intention of attracting attention from someone who would drop the average IQ of your commenters by ~75%.

However, I stand by my original post. Vtskully must have led a perfect life (albeit a thesaurus- and dictionary-free one) for which I congratulate him, and I hope he never needs an organ transplant.

Lastly, I believe this is the first instance in my lifetime that someone has even suggested that I'm a "liberal." I wonder if this means I have to cancel my National Review subscription?

3:50 AM  
Anonymous Vtskully said...

Once again Mr. Geraghty you proved my point. You must be one of those "Well Actually" guys. You know the ones who know matter what anyone says they come back with "Well Actually" because they think that they always have the answer. Well here's the true answer, IF YOU FUCK UP YOUR ORGANS YOU SHOULD NOT GET SOMEONE ELSE'S, PERIOD. If those are too big of words for you to understand let me know. I can break out my Thesaurus and get you some you can understand. Again I hate stupid people particularly liberal numnuts. You can get back to your National Review and I will get back to the real world where we see how "REFORM" really works.

6:01 PM  

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