I have a patient that my intern and I are trying not to get too attached too. One look at him, aside from a big belly, he looks perfectly fine. He is a nice chap and a real hoot to be around. Aside from liver cirrhosis, he has no other problems. He looks fantastic. I wonder why he isn't on the tranplant list. My intern and I want to work him up so that we can get him on the transplant list. We wondered why nobody had championed for this guy to get a new liver. There's a funny thing called the MELD score in medicine. It takes a bunch of values into account and basically says the odds of being alive in a given point in time. This guy's score says that there's a 90% chance that he'll be dead by the end of this year. Kind of sobering, I know. It's hard for me to fathom. I can see how it'd be hard for family to fathom. Here's a guy who looks really healthy and we need to talk to him about putting him in hospice. If I were the patient, I'd think that I was crazy too. Do I champion his cause, only to be let down? Or is this the beginning of me not fighting for my patients? Hard to say. You want to be your patients' advocate, but you don't want to burn out and become useless to all of your patients. So I guess the easiest thing to do is send him home, knowing that you're sending him home to die. You hope that he doesn't come back on your service because you want to believe that he got well and lived happily ever after. It's always the nice guys...
-bender
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