Monday, 24 April 2017

Gift

Take a little ride with me.  Yes, you.  We're going on a trip, you and I.  Close your eyes.  Now imagine a house, a big house.  A beautiful house.  This house has a wide, lush green lawn, quaint blue shutters, and a sparkling pool in the back.  The house sits on a calm, pristine lake and has a private dock where there is a boat tied up.

Unfortunately your own house burned down some time ago, and now you have nowhere to live.  So you look at this house, and you love it.  You want it.  Not only that, you need it.  You see, it's cold outside, and you have no shelter.  Any day now you fear that you will succumb to the elements.  Your desperation is reaching a critical point.

Then one day as you are standing there staring at this dream house, a man approaches you, seemingly out of nowhere.  He has a smile on his face as he confidently walks up to you and hands you an envelope without a word.  He then smiles warmly once again, turns, and walks away.  Confused, you open the envelope, and inside you find a set of keys.  Looking further you pull out a sheaf of papers - a deed.  No, not just a deed, the deed.  The deed to this house.  The deed to this house with your name on it.

What?  What is this?  Has someone really just given you a house??  Is that even possible?  You tremulously try the key in the door, and it works.  The door swings silently open and you walk inside, incredulous at your luck.  The house is fully furnished.  Even the refrigerator is stocked with food, everything you could want.  You start to tear up as you realise that it was just before you got to the point where you thought you might die that some kind benefactor you don't know and will never meet has given you the greatest gift you could imagine, exactly what you need to live.  Someone has given you the gift of another chance at life.

What do you do to repay the kindness of a complete stranger?  What could you possibly do to show your gratitude?  How do you respond?  I'll tell you:

You throw a huge party, you shit all over the house, you tear it apart, and then you burn it to the ground.  On purpose.  THAT is what you fucking do.

Wait, what?  Why would you do such a thing?  What kind of asshole would take such a gift and stomp all over it?

Zachary (not his real name™), that's who.  Why?  Why would he do that?  I have no idea, you'll have to ask Zachary, because he's the only asshole I know with experience with this kind of utter twatfuckery.

It was a typical Saturday night, which is to say that everyone who rolled through the door of my trauma bay, whether he had fallen, gotten into a car crash, was assaulted, or was stabbed in the head, was drunk.  And Zach was no different.  I believe I saw every type of drunk that night, and Zach was a Type 5 Drunk, meaning he thought he was much funnier than he actually was, which was not at all.  Not even a little bit.

After getting the story from the medics (car vs tree, tree wins), we started our examination of Zach from head to toe.  This always involves undressing the patient completely so that we can look at everything.  His shirt was barely halfway over his head when I recognised a tell-tale sign on his abdomen:

A Mercedes Benz scar.

This was no ordinary scar, and I could have recognised it from across the room.  Anyone who knows anything about surgery will know this immediately as a liver transplant scar, and if you didn't know that before, now you do.

I'm going to pause here to let this scenario sink into your brain for a moment before I go on, because I can feel my blood starting to boil just like it was that night.  If yours isn't yet, it should be.

. . .

*deep breath*

. . .

Ok, ready to go on?  I'm going to skip the remainder of Zach's story, because 1) it isn't that interesting, and 2) just thinking about it is enough to make me want to throw my computer out the window (Zachary was fine despite his best efforts to kill himself and everyone around him).  The short short version, the reason I was so angry, is that Zach had killed his original liver with heavy alcohol abuse over many years, he got a new one, and he was now pissing it away by drinking again.

I'm going to pause again.  My apologies.

. . .

*DEEP breath*

. . .

If you haven't figured out why I'm so angry then you haven't been paying attention and WHY THE HELL ARE YOU EVEN HERE.  *DEEEEEEP breath*  I'm sorry, I shouldn't direct my anger at you when it isn't your fault.  That isn't fair. 

Think of the house.  Like in that imaginary scenario, Zachary was given an extraordinary gift - a new liver, and a new chance at life.  There are no two ways about it; without the new liver, he would have died a horrible early death.  But Zachary was saved.  Some poor soul gave his or her own life to give Zachary a second chance, a new life, and Zach thanked his anonymous benefactor by treating his new liver exactly the same way as he treated his first liver: by shitting all over it.

The things I see in my trauma bay often amuse me, sometimes they sadden me, and sometimes they confuse me.  Rarely, however, do they infuriate me.  Zachary infuriated me.

Perhaps I'm out of line.  Maybe I'm just being dramatic and stupid and I'm over-reacting over nothing.

No.  No I'm not. 

68 comments:

  1. I have words. It reminds me of a story I saw sometime in the past couple years: a kid was in desperate need of a gently used heart. he was denied due to having a significant criminal record. he found a lawyer who sued on his behalf, pro bono, as I recall, and got him the heart. within a year he did something incredibly stupid and got some sort of permanent damage done to it.

    which means not only did he shit all over the gift of a second chance, it is likely somebody else, who would have appreciated the gift, never got that chance.

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    1. I remember the story you are talking about. It was revealed that the kid already had one heart transplant. Then he got the 2nd one and died in a police chased a year later.

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    2. If you're thinking of Anthony Stokes, I don't think he had multiple transplants.

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    3. I'd forgotten the name, but I was only remembering one transplant.
      17 years old.
      http://www.ajc.com/news/teen-suspect-who-died-after-roswell-police-chase-was-heart-recipient/0Mf7yWpS1BD96DRql20WcI/

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  2. Ken Brown hits it. It's not really the case that "Some poor soul gave his or her own life to give Zachary a second chance". Rather, some poor soul died for other reasons, and Zachary was given a second chance, which he is the process of wasting, and most likely, somebody else died instead who would have treasured that second chance.

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    1. I don't think that's quite it either. The poor soul who died was a donor. They signed thinking that in the event of their untimely death, their organs will go to someone who desperately needs it. If I were that donor, I'd be really pissed to know that it went to someone that'd just waste it. You could argue that I'd be dead so I wouldn't be able to feel anything but I think it is still really disrespectful to them.

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    2. you missed it: there is a very good likelihood that there was someone else on that list who could have received that liver - and there is a chance that the other person never got one. there are still more people needing a donated organ than there are organs available. - something I am very conscious of since last year, a good friend of mine died for lack of an available heart. so Zach didn't just waste the gift he was given - there is a chance he also took the chance away from somebody else.

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  3. The "Mickey Mantle", you might call it. Or the "George Best".

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  4. Perhaps he had an underlying substance abuse problem (alcohol) that was missed.

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  5. Clarifying my response, I am not upset with Doc. I think the whole situation is sad and yes, wasteful.

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  6. We need to remember that alcoholism is a disease, not a lifestyle choice.

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    1. treating the disease with megadoses of alcohol is a lifestyle choice.

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    2. And people suffering from diseases should seek treatment, should they not? You'd think that allowing a disease to progress to the point where an organ becomes irreparably damaged and needs to be replaced would be a wake-up call that it's time to go to rehab already.

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  7. Take it back. I am leaving it in my will, if my parts are recycled and some asshole is treating them like shit, sue for them back..

    Like when my kids are being dicks over toys, take that shit and throw it away. If he don't want it- fuck him..

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  8. All drug consumption is a choice. Alcohol included. Not a lifestyle. Either you go buy a 12 pack of beer, or you don't. It really is that simple. Either you surround yourself with people better off than you are and smarter than you are and set your goals high or not. That's a choice too. Either you're grateful for this 2nd chance or you're not. And obviously Zachary (not his real name) was not.

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    1. Let's pretend Zach is a heroin addict instead of an alcoholic. Perhaps, 18 months ago he was in a devastating, traumatic MVA. After many weeks in hospital and more months of therapy he's been cut loose from the medical system. But he's left with an opioid addiction. Not an altogether uncommon occurrence but one that's finally being addressed among medical professionals. Anyway, now that Zach is on his own and no longer getting prescriptions for opioids he finds himself in a pickle because the craving is severe. The withdrawals are painful. So he seeks illegal drugs which eventually lead to heroin, a cheap alternative. It may be easy for one to dismiss this as simply "his choice" and with this attitude it makes it extremely easy to look down one's nose at an addict. But in reality, rehab and other forms of help are expensive and more difficult to obtain than one might think. Even qualifying for low-income help is difficult. They deserve more empathy and understanding than some seem to be able to muster. Educating oneself on the issues at hand is essential.

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    2. so... which medication causes alcohol addiction?

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    3. I'm merely pointing out the fallacy in Not your average housewife's believe that all drug consumption is a choice. Thus my lead in statement creating a different scenario. Never made a claim anywhere that any medication causes alcohol addiction. So...perhaps you misread or misconstrued.

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    4. I don't know. As someone who hasn't drank a drop of alcohol or smoked a cigarette in my life (I'm 25) let alone done harmful drugs, I'm finding it really hard to sympathize. There's been plenty of times when I've been pressured or had the opportunity to indulge but I ...just didn't. Why would I? Why does anyone? It's really bad for your health and illegal. I just don't understand. How hard or easy it is to get into rehab wouldn't matter if you never started to begin with.

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    5. Good for you, junwi. As it should be. Now cross your fingers that you're never in the position that I put the fictitious Zachary in my comment above. Some things fall in the "but for the grace of God go I" category.

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    6. it's a lot easier to not start than it is to stop, that's for sure.

      and Cathy: it was your "let's start by assuming zach is an opiate addict" some opiate addicts get started on prescription painkillers. alcoholics, to the best of my knowledge, don't have that potential.

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    7. Okay, Ken, To be clear, my statement was "Let's pretend" because I was depicting a fictitious scenario regarding the whole starting addictive drugs is always a choice. You are missing my point. I was responding to a comment within the thread and not to the main topic. Perhaps that's the confusion.

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    8. and I was responding to your false comparison of opioid addiction resulting from prescription medication and alcohol abuse.

      and even with opioids you have the choice of seeking help to get free of them. yes, besides knowing people with transplants, and people who survived cancer, I know people who have gotten free from addictions.

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    9. You are certainly correct. One can and should seek help. As I'm sure you know, some do, more than once. Surely, you know the success rate of most facilities. And "knowing people" anecdotal at best. Go ahead and have the last word, you seem to have a need.

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    10. I just wrote out a brilliant reply, hit preview and off to the little black hole in the universe it went, to never come back again. So - I'll try again.

      Having had high functioning addict parents of both drugs and alcohol I think I qualify personally to have an opinion based off life experience. Both my parents eventually got clean, my mother survived cancer and in her 70's now has an opioid addiction. My father, went to rehab and relapsed once, went to rehab again and this time has stayed clean. My grown daughter is now in rehab after trying and almost successfully killing herself -albeit slowly, from Meth. However, all of my sisters and I have never, not once, touched drugs. I won't speak for them, but I've been given the chance to use drugs, but like junwi, I just passed. It never appealed to me. I don't drink or smoke either. And for good measure, I am an organ donor. But truthfully, I read everything I could about enabling, studied it, wrote it, and went to meetings of NA, AA and Al anon. It's a rather long story so I'll spare you the details but I teamed up an absolute angel of a police officer in the city in which she was staying. More than 1200 miles away from where I live. With his help, and my not enabling her behavior any longer than I already had just to be in contact with her, I told her "I'll find you" and in less than 24 hours I did and I had my own daughter arrested in a way that she would not pick up charges and got her in rehab as fast as I could. She is still there. And through many phone calls and counseling sessions, she thanked me for saving her life. She didn't need to thank me, she is my daughter. But nevertheless, I do have intimate knowledge of the true to God choices addicts make to well, remain addicts.

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  9. Frustrating, indeed.

    I don't see why ANY organs should be given to people who have not addressed or overcome their underlying health problems or addiction yet. Why are organs only distributed by "the person's gonna die soon" and not by "the person has demonstrated to be able and willing to do life changes"? I.e. by a trial period of staying clean one year, with regular lab tests? And yes, if you fail them, then you're a lost cause and don't qualify. There's no such thing as a "right for a new organ". Face it! You gotta earn it. Work for it. Show you're worth it. Only that will do the trick.

    Why do we shy away making conditions for receiving a new organ?

    Why give a new lung to a smoker? Why give a liver to a drinker?

    I don't get it. The real problem is not the destroyed liver - the problem is the addiction. And to ruin yourself was your choice, not fate.

    It's not that complicated after all, just need to be strict and consequential.

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    1. IIRC, you can't be an active user and get a transplant. They guy was probably sober and relapsed as soon as he had his shiny new liver.

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    2. correct: people are disqualified if the hospital thinks the organ will be wasted on them. the friend I lost last year went to the bottom of the list because he admitted he had an occasional drink, and used medical marijuana. (occasional meaning a glass of wine with dinner, sometimes)

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    3. A lot of people can't. I'm a double-lung transplant recipient and some centers will not, at all, transplant you if you smoke or have smoked, which is just, in my opinion. Some will only start the work up if you have been tobacco free for at least 6 months or a year--and they do blood tests to ensure that you are, in fact, telling them the truth. Some centers won't list you if you live with people who smoke, because, again, that's a problem.
      It's not the hospital--it's the transplant center *at* said hospital. And every center has different criteria for who is going to be listed at that center.
      If you are truly addicted, then no center will give you an organ. Period. There's too many people on the list, and there are too few organs to go around.
      In my experience--and I'm twelve years post now--there are three types of people post-tx. There are people who are so afraid of living that they basically live in little bubbles. There are people who take reasonable precautions and don't do stupid things, but live their lives. And then there are people like this--who do the things that their centers tell them, specifically, NOT TO DO, yet, they do them anyway, because they are dumbasses.
      This kid is definitely in the dumbass category.

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    4. Ken,
      I'm sorry to hear about your friend. My deepest condolences.
      N.Y.A.H.

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  10. No one can ever say "There! Addiction cured! Thank God that's behind me!" It's an ongoing, life long process. So by some of your standards no addict should ever qualify for a transplant. So be it. But at least know what you're talking about!

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    1. Cathy, some centers *don't* list you. See my comment above.

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    2. Cathy you seem to be choosing to play with a half deck of cards. First you move into opiods about addiction to ALCOHOL which was purely what they were talking about and now only half reading comments from actual transplant recipients on how those centers qualify people

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    3. Cathy,
      Addiction or beating addiction is an ongoing, lifelong CHOICE.

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    4. So true! Or we could say, lifelong struggle, at least for some!

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    5. Cathy giving into addiction is entirely their choice. Completely. How they deal with their addiction is entirely their choice. Only in rare cases is taking up that substance not their choice (some people are forcibly injected with heroie for instance but thats EXTREMELY rare).

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  11. Addiction is a difficult one.
    If we accept that we have free will then on one hand we all choose to do what we do, be that drink or smoke or shoot up or not.

    On the other hand I suspect it's difficult for those of us who are not addicted to anything to understand what it's like. My best guess is that it's like being constantly hungry or constantly cold. Imagine that eating was killing you but you felt constantly starving and you were constantly passing supermarkets, restaurants etc.

    If you're really hungry then that's all you can think about. Yes, you are free to walk on past that chip-shop but your body is crying out for a meal and it's not going to kill you right away so you pop in just to stop feeling hungry for a while and worry about the consequences tomorrow.

    I would be interested to know from someone who's been through it whether that's a fair analogy but I can imagine how easy it would be to constantly just make those cravings go away for now and worry about it later.

    Having said all of that, if there's anything that can bring home the message that you need to take control and sort your sh*t out it's needing a liver transplant! If that won't make you realize that you're killing yourself nothing will.

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    1. I will say I struggle with "food addiction." And your description of it was spot on. Seeing it out into words really really hit home.

      Mind if I snag it and paraphrase it share? To describe food addiction to people who just tell me "well then don't eat as much"

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    2. Of course.

      We all succumb to those little cravings every day. Whether it's having that extra cookie you know you don't really need or putting off that job you know you need to do but isn't vitally urgent yet (I should be doing my month-end billing right now!).

      We all have a bit of the "buy now, pay later" of life but when the cravings become so overwhelming that you can think of nothing else then it must be difficult to act rationally.

      I should, however, clarify a couple of things:

      Firstly, I agree there is no excuse for drinking and driving. I don't think it's directly related to the transplant question but it's not acceptable under any circumstances.

      The second thing is priority. I do not dispute that in a situation of limited supply, priority for organs should be given to those who are not expected to abuse them. I believe in the UK that you have to stay dry for a certain time before they will even consider you for the liver waiting list and I agree with that requirement. It should not be a closed door to ex addicts but simply in terms of getting value from the donated organ it does not make sense to give it to someone you expect to abuse it when there are other potential recipients who would cherish the gift and get many healthy years from it.

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  12. On the one hand, yes, addiction is hard. It seems deeply unfair to condemn a person to death because of a disease they didn't choose to have and may struggle immensely with. On the other, there is always a limited number of organs available, thanks in part to our opt-in donor policy (at least in the US) and general cultural squeamishness about death. Any time one person is given an organ, the odds are good that someone else also needs that same organ and isn't getting it. People on organ waiting lists die all the time. And people are refused admission to those lists in the first place for what feel like trivial reasons all the time, too. Inability to pay condemns people in the US all the time. I would say not having a chance at a needed organ transplant because of poverty is far more unfair than because of a refusal to stop drinking (and driving! Don't forget, this #&$%!! was in the ER because he was driving drunk and crashed his car! Alcoholism may be a disease, but insisting on getting behind the wheel sure as hell isn't), wouldn't you?

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  13. 21 people die every day while waiting on the list for a transplant (in the U.S.). In 2005, when I received mine, it was 18. The numbers are skyrocketing.
    As far as ability to pay, yeah, you have to be able to pay for the meds after. (The surgery and post-rehab stuff is covered by all (if not all, then almost all) insurance companies in the country.) I mean, sucks, but it's truth. There's no point in doing the surgery if you can't afford the meds that will keep you alive after. Some centers require you to have thousands of dollars CASH available before they'll list you. Those centers are crazy. :-P
    But it's not just about the shortage of donors; it's also about the person who wants an organ. Just because you want one doesn't mean you're going to get one. You have to be emotionally and physically stable enough to get one and follow the regimen afterwards. If you can't do that, then you're probably not going to get listed. Some people are just too sick--they wouldn't survive the surgery. Etc.

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    1. "There's no point in doing the surgery if you can't afford the meds that will keep you alive after."

      That's more the part that I think is ridiculous and unfair, though very typical of American priorities - that insurers are expected to pay for the surgery, but not for the medication that will insure that the transplant remain successful. Which is the same thing as condemning people to death for being poor, imo.

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    2. Well, it's more like the idiocy that is different prescription plans attached to insurance. I've argued with my insurance/prescription guys SO Many times about my meds...the nice thing, though, is that the drug companies realize this and offer a super low copay, or no copay. So, really, not affording the meds isn't as big of an issue now as it was even a few years ago.

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  14. I understand your need to pause and take deep breaths while writing this. I had to pause and take deep breaths while reading it. I understand addiction, I struggle with craving alcohol every day (honestly every hour). I have been winning the struggle for years now, but it never really ends. I know this. So I can be sympathetic to someone who isn't winning, at least to a degree. There are several points in this story that cause me to not have sympathy for this Zach-Ass. One, he was driving while drunk. That was something I never did even at rock bottom, killing myself was allowed, killing someone else was not. Two, he was given a second chance at not dying and it wasting it. My sister has had 3 kidney transplants. The first time it failed was because of the toll puberty and pregnancy put on the kidney. The second time it failed was bad luck, a flu hit so hard she couldn't keep the anti-rejection medication down and they couldn't help fast enough in the hospital. She is on her third run. She has made sure(surgically) that she won't get pregnant again so she won't have that stress. She is extremely vigilant about taking care of her health and well being because in her words, "I'm taking care of the gift I have been given, the chance to see my kids grow up, I won't waste that."

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  15. “Some poor soul gave his or her own life to give Zachary a second chance, a new life, and Zach thanked his anonymous benefactor by treating his new liver exactly the same way as he treated his first liver: by shitting all over it.“

    I haven’t read anything of yours which I disliked as much as that statement.

    Yes, I understand your fury that somebody is abusing the gift he was given while somebody else died because he didn’t get said gift. BUT nobody “gave his or her own life to give Zachary” anything. That somebody would have died even if none of his or her organs could have been donated.

    I received my new lungs over 14 years ago, and – proven by the fact that I’m still alive – I’m taking good care of them, because I am eternally grateful to the donor and her family that they gave this incredible gift and many years of life. But I will in no way accept responsibility (implied or not) for her death.

    Do you really want to start treating people differently on the basis of how “good” they are? What constitutes “good”? Is a non-alcoholic person inherently more “good” than an alcoholic? But what if the non-alcoholic is a criminal and the alcoholic is a physician? Or what if the non-alcoholic is a housewife and the alcoholic is your favorite politician?

    Cheerio
    Softship

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    1. Softship - You misunderstand. I in no way meant that the donor died because of Zachary or that it was his fault or anything like that. I meant that his donor, like yours, decided to make the ultimate sacrifice by becoming an organ donor before he or she died. Nothing more, nothing less.

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  16. One of my dearest friends had heart failure, spent 6 weeks in the hospital (3 in ICU), and, at one point, was put on a list for a heart transplant. Eventually it was determined that he didn't need one (hooray!). What a relief, after so many of us cried ourselves silly over the thought of losing him, gave up time with our families (it was over Thanksgiving and Christmas) to be at his bedside holding his hand, making meals for him and driving him to dr. appointments for months afterward...we found out he'd taken up smoking!! Two packs a day. I was so disgusted I let the friendship fade.

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  17. Anyone who has by behavior or lifestyle destroyed the organs he or she was born to have should not not be on a transplant list until every other person needing the same organ has received a transplant. No livers for alcoholics, no hearts or lungs for smokers. I'm not particularly pro-transplant at all given the outrageous costs of the surgery and antirejection meds and limited quality of life years added, but that is another subject entirely.

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    1. Softship could jump in here, but I'll say for my part, the "limited quality of life" is totally wrong. I've had *amazing* quality of life. I've done so many things I never would've or could've done before. I'm not sure why you think it's a limited quality of life.

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    2. Emily, I totally agree!

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    3. a hell of a lot better quality of life than if you didn't have those transplant, for sure.

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  18. To qualify: not limited quality of life itself, but limited number of YEARS added for the unbelievable cost of the transplant itself and medications to maintain. I do realize that a transplant can improve life for the short term, not convinced the overwhelming cost can be justified to society at large who bears responsibility for most individuals.

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    1. Barbara, take kidney transplantation... in the US (I'm assuming that's where you are), each dialysis treatment costs about $500, and a patient normally needs 3 treatments a week where s/he is hooked up to a machine for 4+ hours. That adds up to about $80,000 /year.
      The estimated cost for kidney transplants in the US in 2011 was about $250,000.
      Excluding the cost of medication, a kidney transplantation costs less than 4 years of dialysis (we won't mention the quality of life gained by not being hooked).
      I wonder whether you are just as critical of cancer treatments? Chemo can be far more expensive than transplantations. My sister (in the US) had chemo that cost over $50,000 per infusion. Would you also ask cancer patients to forego chemo because the treatment may improve life only "for the short term"?

      Cheerio
      Softship

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    2. Actually, I am just as critical of cancer treatments. Mostly because I don't feel patients are sufficiently informed of the possible limited value of chemotherapy (extending life by a couple of months or weeks while experiencing dreadful side effects). Nearly all of the cancer patients I have known thought they were treating for a cure, though the oncologists surely knew otherwise. I am a firm proponent of hospice and realistic plans for end of life care and I am a long term breast cancer survivor (diagnosed in my early 30's with three small children). I will not go through that again. Chemo (though sometimes lifesaving) doesn't "improve life" at all though it may extend it, albeit briefly at great cost for some.

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    3. Barbara, I wonder that you have so little gratitude for the fact that you are alive, that you were able to raise your children.
      I agree that patients are often not sufficiently informed of the consequences (or lack thereof) of the treatments they are to receive. However, I don’t believe the right response to that is to withhold treatment, but to inform them. But how?
      The game “so-and-so-many-percent-chances-of-survival” are misleading. What meaning does it have to me if some claims something has a 5 year survival rate of 50%? None, because it doesn’t predict how it will turn out for the individual patient.
      So how to inform? Tell them their chemo (depending on which it is) they’re going to be incredibly sick, possibly much sicker than they’ve ever been in their lives? That their lung transplantation will make them feel like they’ve been hit by train?
      I am also a proponent of hospice and realistic end of life care, but that doesn’t mean that we should necessarily stop receiving medical care when a condition is treatable.
      How do you want to draw the line whether a disease should be treated? On the basis of risk? On the basis of cost? Chemo no, transplantation no, craniectomy no, ventrical restoration no? Or on the basis of age? A person over 70 should never be saved, a person who is over 50 should rarely by saved, and a child’s life should be saved at all costs? Or do you want to put a dollar amount on people’s lives? $100,000 is OK, but $1,000,000 is not?
      I find your “…Chemo (though sometimes lifesaving)…” odd. Though there’s some debate how effective (for example) chemo for breast cancer is (probably a high rate of spontaneous remission if it remained untreated), it is a fact that many women (and men) who have received chemo not only thrive for years, but die of totally unrelated causes late in life. Are you suggesting those people should be thrown under the bus?
      Yes, successful treatment (for example chemo or transplantation) comes only briefly at a great cost for some. However, it comes with a great reward for others. I am truly grateful I was “rewarded”.
      Sorry, I really am sick and tired of people telling me that the quality of life I possess wasn’t worth the risk and investment.

      Cheerio
      Softship

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    4. depriving others because you weren't happy with your result sounds just a little bit selfish to me. but yes, people should get a fair and realistic explanation of what their options are and what the expectation can be. for terminal cancer, my state's own records have demonstrated that palliative care usually provides longer and better quality of life than aggressive treatment. - but for survivable cancer, then by all means, get it treated.

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    5. Ken... Of course the problem is - how and when do you decide whether the cancer is "terminal" or "survivable". In many cases only once when treatment has failed.
      No, I'm not saying that every cancer should be treated to the very end. And yes, I agree that palliative care is the superior option for many.

      Delete
    6. and that must be a personal decision between patient and physician.

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    7. Gotta agree with Ken on this one. Coming from a family with a heavy genetic predisposition to colon cancer, my family is fairly well informed about colon cancer. My brother got diagnosed early, no chemo, just a removal of the lesion and he's been cancer free for 14 years. My dad died of it within 6 months of diagnosis. Cousins under 40 fought tooth and nail and eventually succumbed to it. A cousin over 50 died within 3 months of diagnosis.

      Here's the thing - they are all given the ability to control their lives and deaths. They are given the options of palliative care, or aggressive care (cousin Scott was 32 when he was diagnosed, with 2 small kids. He fought late stage until he started realizing his kids' childhoods were being defined by his illness, then he and his wife changed their mind, with the input of their docs, about how to go about dealing with the rest of his life and his body).

      It's always a personal decision between the patient and the physician.

      Now, in all of this, what nobody's really touching on is Zachary (not his real name) was driving drunk. Not only did he not care about himself enough to adhere to the requirements of his own care, not only did he not care enough about his donor to not drink, he failed to care about the general populace and got into a car while loaded. That's a special kind of stupid. It's a special kind of "screw you" to the same humanity that gave him his second chance.

      All you arguing about the choice to drink and the nature of addiction - the proof of the man's character is in the driving. I have never seen a study that says that alcoholics are also compelled to get behind the wheel of a car and drive around until they hit something or somebody. Nope, that's purse choice. It's also a demonstration of just what he thinks about everybody else.

      What a waste of a liver - used to extend the life of somebody who cares so little about everybody else that he drinks and drives.

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    8. indeed. we hadn't gotten around to the "and driving" part.

      Delete
  19. Bud Shaw's memoir is an unusual, very human account of liver transplant surgery. One of the strangest accounts of a surgeon dealing with massive blood loss is his description of a patient's blood dripping from his - the surgeon's testicles. The title of this book "Last Night in the OR" I have no connection with the author. This is one of the best accounts of a surgeon's experiences that I have ever read.

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    Replies
    1. Thanks for your tip. I bought it and read it. Yes, the description of blood loss was pretty remarkable... even the thought of wearing waders to surgery ... Oh my!
      I know got 24 units of blood in the course of my double lung transplantation surgery. But it never occurred to me that I might been splashed all over the OR. LOL. I once asked the surgeon whether I could watch the video of it, maybe I should be glad he refused. LOL

      Cheerio
      Softship

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    2. our old schoolers would say that before we learned about bloodborne pathogens, it wasn't a good (car crash) call unless they had blood up to the elbows.

      Delete
  20. OldFoolRN-many thanks for the recommendation! I read an excerpt and was terribly disappointed there wasn't more to read. Ordered from Amazon, looking forward to it. (also an RN)

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  21. It's been some time that I haven't posted here; the reason being that I'm 4 month fresh out of rehab for alcoholism and since this Saturday 29 of April, I stopped smoking too.

    That said, There are many examples here in Doc Bastard's many posts suffer from a lack of consciousness and self-preservation.

    Perhaps it's my character and personality but while being in rehab therapy, I had a metric ton of time (6 months) to reflect on these matter as they applied to myself. I was also an observant, careful observant, of the other peoples there at the rehab center. Some come and go; some stay for the whole term; some stay for nearly the whole term but drop out 2 weeks from the end.

    Sound like that Zach guy has given up. In any case, I won't make the same mistake given that I finally convinced my academic psychiatrist that I have the needed chops to apply for med school later on. He's been following me since that last 7 years (my situation was extreme) and was the hardest hardened iron head I ever encountered in my life to agree, and, help me to apply for med and graduate school. Period.

    Now, you'll have to excuse me but I need to start dissecting the over 10 000 publications on consciousness so that I write about them on my blog.

    Alain

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    Replies
    1. props on making the decisions. hope you are a lifelong success

      Delete
    2. I'll work hard on that part, lifelong. So far so good.

      Delete

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