Should We Just Let Them Die?

 

I just logged onto our computer system at work to see what our patient list is looking like and if there have been any emergency surgeries this weekend. I noticed something peculiar about the bed assignment of one of our young patients. I opened a nurse’s note to discover that just two days after we operated to repair one of the heart valves that had been damaged by this patient’s IV drug use, the patient was discovered using IV drugs while in the bathroom.

Of course, they deny any wrongdoing but the evidence is overwhelming. I have no idea how this young person’s life will turn out after the follow-up visits are done, but I can say the chances are they will end up like so many of our other patients that require open heart surgery because of their drug use — dead.

When I was working as a bedside nurse in the Emergency Department observation area in Portland at a level 1 trauma center, IV drug users made up about one-third of my patients. They were bread and butter for us. Usually, they came in with abscesses at their injection sites or sepsis. This patient group was trying to deal with; initially, they would be cooperative and seem as though they wanted help, but after 24 hours, they would start jonesing for their fix. Sometimes they would ask to be discharged quickly because of a “family emergency,” they would want to go outside for some “fresh air,” or they would just leave when everyone’s back was turned. After a while, you get hip to their tricks.

The most frustrating part of caring for this patient population is their lack of commitment/willingness to get treatment. Their entire lives are ruled by their need to get their next fix, and not even going through open heart surgery is enough of a wake-up call to get them to change. One patient pushed me past my capacity to care when she came into the ED with her second bout of endocarditis. The first time around, she received treatment when she was flown from another state by a religious health care organization to Portland to have one of her valves replaced. When she was discharged from the hospital, she looked around and decided Portland was a pretty awesome place to be homeless and do IV drugs. I could not ask even the most basic of questions without snark, apathy, and contempt dripping from every answer. At one point, she admitted that she was just going to keep using until it killed her, even if Cardiothoracic (CT) surgery decided to do surgery to try and save her. She was admitted to a medicine service for medical treatment of her infection while CT surgery decided what to do; I never found out what happened to her.

When I left the bedside, the Emergency Department, and Portland for the long hours of CT surgery in Ohio, I thought most of my dealings with drug users were over. I was wrong. So, so, so very wrong. Ohio is at the heart of the opioid crisis. Next to West Virginia, it has some of the highest heroin use in the country. That’s most of what I see — heroin, with a little cocaine thrown in every once in a while.

There’s not much in the way of meth here; that’s more of a rural South and Southwestern thing. But regardless of the drug, the method of delivery is the same, as are the effects on the body. People are careless about cleaning their skin and their needles when they inject. Bacteria colonized on the skin enters the body through the venous system and sets up shop on the valves in the heart- mostly the tricuspid and mitral valves, but sometimes the aortic valve too. We can remove the tricuspid valve and leave it out, causing only some mild to moderate symptoms. It is not absolutely essential the way the mitral and aortic valves are.

Endocarditis causes damage to the valves when bacteria form little clusters on the leaflets of the valve — the flaps of tissue that open and close, regulating the flow of blood flow through the heart. The infection can burrow into the wall of the aorta, requiring replacement of the entire aortic root. Left untreated, many of these people will die.

Last year, I assisted on the first 8.5 hours of an 11-hour surgery on a woman not yet 30 years old who was having her third open heart surgery. She almost died on the table and it is truly by the grace of God and the skill of the surgical team that she did not. Every so often, I check the obituaries online to see if she shows up. Sometimes we find out months after their surgery that they died.

Sometimes they use during their post-op stay and arrest in the hospital, which happened to a patient of mine a few months ago. I came in around 6:30 a.m. to discover that she had died in the middle of the night after taking her heart monitor off and overdosing on something someone brought her. The staff did CPR for 20 minutes and called it. She was younger than me.

Often these patients don’t have insurance and their very expensive hospitalizations are courtesy of the dear taxpayer. Fortunately for these patients, we do not yet have a single-payer system that would ration the care they get. Instead, they get chance after chance, surgery after surgery.

I struggle with this. From a pragmatic standpoint, it is ridiculous to ask the taxpayer to foot the bill for multiple open heart surgeries and the subsequent six weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physician heals compels me to want to give these patients a chance … and another … and another.

Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome?

There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy — they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

Help me out, folks. My empathy is struggling. And I’m tired from all these long surgeries.

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  1. philo Member
    philo
    @philo

    Doctor Robert (View Comment):

    Vicryl Contessa: From a pragmatic standpoint, it is ridiculous to ask the tax payer to foot the bill for multiple open heart surgeries and the subsequent 6 weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physican healed compels me to want to give these patients a chance…and another… and another. Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome? There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy- they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

    We are being crazy, but we sometimes must. A question. Transplantable organs are a rare commodity. Do we allow heavy drinkers to get liver transplants, IV drug users to get heart transplants? One suspects not. If not, should the same logic not apply here?

    Who gets to define “heavy drinker?” (Actually, a serious question.)

    • #31
  2. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    philo (View Comment):

    Doctor Robert (View Comment):

    Vicryl Contessa: From a pragmatic standpoint, it is ridiculous to ask the tax payer to foot the bill for multiple open heart surgeries and the subsequent 6 weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physican healed compels me to want to give these patients a chance…and another… and another. Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome? There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy- they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

    We are being crazy, but we sometimes must. A question. Transplantable organs are a rare commodity. Do we allow heavy drinkers to get liver transplants, IV drug users to get heart transplants? One suspects not. If not, should the same logic not apply here?

    Who gets to define “heavy drinker?” (Actually, a serious question.)

    Usually daily drinking of 3 or more drinks/day.

    • #32
  3. Boss Mongo Member
    Boss Mongo
    @BossMongo

    Doug Watt (View Comment):
    You do what you can.

    Doug Watt (View Comment):
    …she told me that I couldn’t be there every night. She was right.

    Doug Watt (View Comment):
    The paramedics stabilized him, but he refused to go to the hospital, he walked off into the night.

    God bless you, and those like you.  I spent the majority of my professional life figuring out how to bring the Good News to bad people;  to help them, as it were, to achieve room temperature.  I can only imagine the cost to you and your LEO/First Responder brethren trying to save those who refuse to be saved.

    Thank you.

    • #33
  4. Aaron Miller Inactive
    Aaron Miller
    @AaronMiller

    My main concern in all of this is that the time, energy, and resources required to address every problem of drug addicts steal attention needed by other patients. How often and how much does other care suffer as a result? 

    I worry about emergency physicians anyway, so often pulled into long hours and overwhelming caseloads that wear on both body and spirit. If emergency caregivers are willing to be sacrificial slaves to circumstance (meaning hospitals can’t take a day off and doctors remain on call), they could yet be free to decide for themselves the conditions by which they help. Doctors should not be government assets who help when and as directed. 

    • #34
  5. Boss Mongo Member
    Boss Mongo
    @BossMongo

    Vicryl Contessa (View Comment):
    Usually daily drinking of 3 or more drinks/day.

    What? That’s what I call the “warm-up.” 

    Really?  Today’s a day off for me, and whilst I spent part of the morning in sober reflection and prayers of gratitude, I had my first six pack complete by about, eh, 0930.  3 or more/day.  Por favor.

    • #35
  6. Randy Weivoda Moderator
    Randy Weivoda
    @RandyWeivoda

    Vicryl Contessa (View Comment):

    The Reticulator (View Comment):

    Tex929rr (View Comment):
    The issue is: where does overuse of a medical system become unfair to the people paying the bills?

    It becomes unfair right from the start. But this is about more than fairness.

    But if people don’t have any skin in the game, they abuse the system. My grandmother is kind of guilty of that with Medicare- “well I’m not paying for it so I’ll just go have X procedure/test done.”

    Several years ago when John Stossel was still on the television show 20/20, he did a report on Medicare spending and talked to some retirees in Florida.  One senior citizen (who did not look poor, as I recall) admitted that she sometimes went to the doctor when nothing was wrong with her, she just enjoyed chatting with the doc.  Stossel asked her if it was fair that young people were forced to pay for her social calls and she responded, “Who ever said life is fair?”  It’s hard to feel compassion for those who hold you in contempt and believe that they should strip you of your earnings if they can get away with it.

    • #36
  7. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Boss Mongo (View Comment):

    Vicryl Contessa (View Comment):
    Usually daily drinking of 3 or more drinks/day.

    What? That’s what I call the “warm-up.”

    Really? Today’s a day off for me, and whilst I spent part of the morning in sober reflection and prayers of gratitude, I had my first six pack complete by about, eh, 0930. 3 or more/day. Por favor.

    I feel like we’ve talked about this on the AMU…

    • #37
  8. Boss Mongo Member
    Boss Mongo
    @BossMongo

    Vicryl Contessa (View Comment):

    Boss Mongo (View Comment):

    Vicryl Contessa (View Comment):
    Usually daily drinking of 3 or more drinks/day.

    What? That’s what I call the “warm-up.”

    Really? Today’s a day off for me, and whilst I spent part of the morning in sober reflection and prayers of gratitude, I had my first six pack complete by about, eh, 0930. 3 or more/day. Por favor.

    I feel like we’ve talked about this on the AMU…

    Uh, that’s an evening event.  I usually don’t remember much…

    • #38
  9. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Aaron Miller (View Comment):

    My main concern in all of this is that the time, energy, and resources required to address every problem of drug addicts steal attention needed by other patients. How often and how much does other care suffer as a result?

    I worry about emergency physicians anyway, so often pulled into long hours and overwhelming caseloads that wear on both body and spirit. If emergency caregivers are willing to be sacrificial slaves to circumstance (meaning hospitals can’t take a day off and doctors remain on call), they could yet be free to decide for themselves the conditions by which they help. Doctors should not be government assets who help when and as directed.

    I don’t know that the care for other patients really suffers. We see all patients every day and given each patient the attention they need. Some patients require more attention than others, but not necessarily because they’re IV drug users.

    • #39
  10. Randy Weivoda Moderator
    Randy Weivoda
    @RandyWeivoda

    Vicryl Contessa (View Comment):
    It’s also amazing to me how often times it’s the mothers and boyfriends that enable the drug use. I can’t tell you how many times I see a parent or child bring drugs in for the patient.

    That is just insane.

    Al French, sad sack (View Comment):

    It’s good to see you back on Ricochet.

    Yes, it’s been lonely without you, Vicryl.

    • #40
  11. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Boss Mongo (View Comment):

    Vicryl Contessa (View Comment):

    Boss Mongo (View Comment):

    Vicryl Contessa (View Comment):
    Usually daily drinking of 3 or more drinks/day.

    What? That’s what I call the “warm-up.”

    Really? Today’s a day off for me, and whilst I spent part of the morning in sober reflection and prayers of gratitude, I had my first six pack complete by about, eh, 0930. 3 or more/day. Por favor.

    I feel like we’ve talked about this on the AMU…

    Uh, that’s an evening event. I usually don’t remember much…

    There’s your sign.

    • #41
  12. MarciN Member
    MarciN
    @MarciN

    We need to approach the heroin and opiate addiction issue as a mental illness problem. It seems to me that people are using these drugs to treat their anxiety.

    • #42
  13. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    philo (View Comment):

    Doctor Robert (View Comment):

    Vicryl Contessa: From a pragmatic standpoint, it is ridiculous to ask the tax payer to foot the bill for multiple open heart surgeries and the subsequent 6 weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physican healed compels me to want to give these patients a chance…and another… and another. Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome? There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy- they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

    We are being crazy, but we sometimes must. A question. Transplantable organs are a rare commodity. Do we allow heavy drinkers to get liver transplants, IV drug users to get heart transplants? One suspects not. If not, should the same logic not apply here?

    Who gets to define “heavy drinker?” (Actually, a serious question.)

    Actually, the CAGE assessment is a good tool to use to determine if alcohol use is a problem. If you answer “yes” to two or more, you might have problem with alcohol.

    1. Have you ever felt you needed to Cut down on your drinking?
    2. Have people Annoyed you by criticizing your drinking?
    3. Have you ever felt Guilty about drinking?
    4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?[2]
    • #43
  14. philo Member
    philo
    @philo

    Vicryl Contessa (View Comment):

    philo (View Comment):

    Doctor Robert (View Comment):

    Vicryl Contessa: From a pragmatic standpoint, it is ridiculous to ask the tax payer to foot the bill for multiple open heart surgeries and the subsequent 6 weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physican healed compels me to want to give these patients a chance…and another… and another. Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome? There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy- they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

    We are being crazy, but we sometimes must. A question. Transplantable organs are a rare commodity. Do we allow heavy drinkers to get liver transplants, IV drug users to get heart transplants? One suspects not. If not, should the same logic not apply here?

    Who gets to define “heavy drinker?” (Actually, a serious question.)

    Usually daily drinking of 3 or more drinks/day.

    Yes, I realize there is a definition…or guideline. But who gets to decide what it is and how to interpret a particular case at any given point of the rationing of scarce resources.  Switch to “obesity” for a similar discussion. More later…

    • #44
  15. 9thDistrictNeighbor Member
    9thDistrictNeighbor
    @9thDistrictNeighbor

    Vicryl Contessa (View Comment):
    I do know that the provider community did patients a massive disservice by handing out pills like it was water.

    There was a psychiatrist who is in prison now who was the largest prescriber of Subutex in the country.  He ran a network of clinics and in one five-month period he bought over 87,000 doses…of just that drug.  He at times claimed he was doing it to help people, but in selling the pills for $3-5 each, it was all about money.

     

    This whole patient right to have your pain addressed does not mean you have the right to be pain free, which is what it turned into. I try to be very explicit with patients when I see them before surgery that our goal is to make the pain tolerable, not make you free from pain. You should be able to live with 4 or 5/10 pain.

    I had knee surgery last month for a fracture and I sure wish they had one of those cartoon face pain charts they use for children.  I even asked for one.  When you are in pain it is easier to look at a picture than use a scale, for me anyway.   But one person’s 4 is another person’s 8 or 9.  I can’t do the whole norco thing because I just send it right back up the way it came.  Once they figured out what would help, the pain lessened on it’s own.  I want home taking tylenol and using ice packs. However, I have a friend who broke her pelvis and was washing down norco with cosmopolitans. 

     

    • #45
  16. Drusus Inactive
    Drusus
    @Drusus

    As several have mentioned above, we do not allow continued alcohol abuse for someone on a transplant list. And most people have disdain for those who continue to smoke since the effects of smoking are so apparent and deadly.  Not to mention the addicts of the OP. But what about obesity? Just as deadly and far more widespread. And the public health (and taxpayer burden) questions are even more profound. 

     

    • #46
  17. 9thDistrictNeighbor Member
    9thDistrictNeighbor
    @9thDistrictNeighbor

    Vicryl Contessa (View Comment):

    Actually, the CAGE assessment is a good tool to use to determine if alcohol use is a problem. If you answer “yes” to two or more, you might have problem with alcohol.

    1. Have you ever felt you needed to Cut down on your drinking?
    2. Have people Annoyed you by criticizing your drinking?
    3. Have you ever felt Guilty about drinking?
    4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?[2]

    I know someone who was nervous about riding in a horse show. She had a Camelback filled with adult beverages. At 8 a.m. Her nickname? “Vodka Anne.”

    I’ve heard the saying that for an alcoholic, one drink too many and a thousand is never enough.  I have also heard of the 1-2-3 rule: no more than one drink an hour, two drinks a day, three times a week.

    • #47
  18. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    Drusus (View Comment):

    As several have mentioned above, we do not allow continued alcohol abuse for someone on a transplant list. And most people have disdain for those who continue to smoke since the effects of smoking are so apparent and deadly. Not to mention the addicts of the OP. But what about obesity? Just as deadly and far more widespread. And the public health (and taxpayer burden) questions are even more profound.

     

    I understand the thought, but I do sympathize with people who struggle with their weight for the simple fact that you take someone with a tendency towards addiction, and now make their trigger food. Food is something you must eat everyday to survive. You don’t have to drink alcohol or smoke or do drugs to survive, but you do have to eat. Also, sugar lights up the same receptors in the brain that cocaine does. Sugar is so addictive and it’s in ev-er-y-thing. Mustang and I have been watching our food recently (and we’re both losing weight, alhamdulillah), and we found these veggie medleys in the frozen section at Trader Joe’s that we really like. I looked at the package the other day and even the veggies have dextrose on them! It’s also really hard to go out to eat with friends that are skinny and they order dessert but we can’t. There’s almost a sense of injustice- why do they get to eat whatever they want but I can’t? 

    • #48
  19. Boss Mongo Member
    Boss Mongo
    @BossMongo

    Vicryl Contessa (View Comment):
    Have you ever felt you needed to Cut down on your drinking?

    Nope.

    Vicryl Contessa (View Comment):
    Have people Annoyed you by criticizing your drinking?

    Yes.  But they were just looking for leverage to win a different argument.

    Vicryl Contessa (View Comment):
    Have you ever felt Guilty about drinking?

    Nope.

    Vicryl Contessa (View Comment):
    Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?[2]

    Nope.  In fact, let me just state (on account of folks who don’t know me might think I’m a full-blown rummie), I still travel/deploy and go into “no booze” mode without batting an eye.  I can be sober all day, but why would I do that?  Too, I am sometimes a day (morning) drinker, but my nerves are always steady, and I’ve only ever had two hangovers my entire life. 

    As fighter/self-defense specialist Rory Miller said about drinking, “what else are you going to do waiting for the next fight to come along?”

    • #49
  20. Shauna Hunt Inactive
    Shauna Hunt
    @ShaunaHunt

    EB (View Comment):

    Vicryl Contessa (View Comment):
    our goal is to make the pain tolerable, not make you free from pain. You should be able to live with 4 or 5/10 pain.

    This was a great post. And it’s a very hard question to answer. I understand both sides and probably lean slightly to the side of no repetitive surgeries.

    To the comment you made above, I think there is a difference between treating “temporary” pain (as after surgery) and chronic pain. When I had knee surgery, I took the hydrocodone for about three weeks, but began tapering myself off on my own. I could have continued a little longer, but it just got to be too much trouble trying to balance the pain meds and Raisin Bran/Senocot. At that point, my pain probably was around 4-ish.

    But I knew that it was temporary. I think that people living daily with 4-5 level pain are an entirely different story. And they need to be helped. Before my knee surgery, my pain daily varied between 2 and 4 with an occasional, momentary 7. I got used to it, but realized over time that it really sapped my energy and affected my mental outlook. I can’t imagine living with 4-5 every day.

     

    I would love to have 4-5 pain every day! I could get so much done. My kids would have their mom back. My pain levels are usually 7-8 range. 

    • #50
  21. Fake John/Jane Galt Coolidge
    Fake John/Jane Galt
    @FakeJohnJaneGalt

    Shauna Hunt (View Comment):

    EB (View Comment):

    Vicryl Contessa (View Comment):
    our goal is to make the pain tolerable, not make you free from pain. You should be able to live with 4 or 5/10 pain.

    This was a great post. And it’s a very hard question to answer. I understand both sides and probably lean slightly to the side of no repetitive surgeries.

    To the comment you made above, I think there is a difference between treating “temporary” pain (as after surgery) and chronic pain. When I had knee surgery, I took the hydrocodone for about three weeks, but began tapering myself off on my own. I could have continued a little longer, but it just got to be too much trouble trying to balance the pain meds and Raisin Bran/Senocot. At that point, my pain probably was around 4-ish.

    But I knew that it was temporary. I think that people living daily with 4-5 level pain are an entirely different story. And they need to be helped. Before my knee surgery, my pain daily varied between 2 and 4 with an occasional, momentary 7. I got used to it, but realized over time that it really sapped my energy and affected my mental outlook. I can’t imagine living with 4-5 every day.

     

    I would love to have 4-5 pain every day! I could get so much done. My kids would have their mom back. My pain levels are usually 7-8 range.

    Sorry to hear that.  Constant pain.  24/7/365 with no end in sight is hard to bear.  When I hear people talk about grin an bear it, or nobody promised a pain free life just do not understand what they are talking about.  

    • #51
  22. Miffed White Male Member
    Miffed White Male
    @MiffedWhiteMale

    philo (View Comment):

    Doctor Robert (View Comment):

    Vicryl Contessa: From a pragmatic standpoint, it is ridiculous to ask the tax payer to foot the bill for multiple open heart surgeries and the subsequent 6 weeks of skilled nursing care they will need after their surgery for ongoing IV antibiotics. Especially if they just go home, start using again, and die a few months later. But from a Judeo-Christian standpoint, the need to show compassion and try to heal the way the Great Physican healed compels me to want to give these patients a chance…and another… and another. Do we continue to give people unlimited treatment, or do we cut them off after a time? Are we being compassionate caregivers, or are we just being crazy by repeating the same action but expecting a different outcome? There is disagreement amongst the surgeons I work with as to our moral obligation to operate. Some feel operating is a bad idea and call in an ethics consult; others feel that you should always operate even if the patient tells you they have no plans to quit. One large hospital in a neighboring city has a one and done policy- they will not perform redo valve replacements/repairs on people that reinfect themselves with ongoing IV drug use. I truly don’t know what the solution is.

    We are being crazy, but we sometimes must. A question. Transplantable organs are a rare commodity. Do we allow heavy drinkers to get liver transplants, IV drug users to get heart transplants? One suspects not. If not, should the same logic not apply here?

    Who gets to define “heavy drinker?” (Actually, a serious question.)

    Someone who drinks enough to have damaged their liver?

     

    • #52
  23. Miffed White Male Member
    Miffed White Male
    @MiffedWhiteMale

    Drusus (View Comment):

    As several have mentioned above, we do not allow continued alcohol abuse for someone on a transplant list. And most people have disdain for those who continue to smoke since the effects of smoking are so apparent and deadly. Not to mention the addicts of the OP. But what about obesity? Just as deadly and far more widespread. And the public health (and taxpayer burden) questions are even more profound.

     

    You have to eat.

     

    You don’t have to smoke or drink.

     

    • #53
  24. SkipSul Inactive
    SkipSul
    @skipsul

    Vicryl Contessa (View Comment):

    Drusus (View Comment):

    As several have mentioned above, we do not allow continued alcohol abuse for someone on a transplant list. And most people have disdain for those who continue to smoke since the effects of smoking are so apparent and deadly. Not to mention the addicts of the OP. But what about obesity? Just as deadly and far more widespread. And the public health (and taxpayer burden) questions are even more profound.

     

    I understand the thought, but I do sympathize with people who struggle with their weight for the simple fact that you take someone with a tendency towards addiction, and now make their trigger food. Food is something you must eat everyday to survive. You don’t have to drink alcohol or smoke or do drugs to survive, but you do have to eat. Also, sugar lights up the same receptors in the brain that cocaine does. Sugar is so addictive and it’s in ev-er-y-thing. Mustang and I have been watching our food recently (and we’re both losing weight, alhamdulillah), and we found these veggie medleys in the frozen section at Trader Joe’s that we really like. I looked at the package the other day and even the veggies have dextrose on them! It’s also really hard to go out to eat with friends that are skinny and they order dessert but we can’t. There’s almost a sense of injustice- why do they get to eat whatever they want but I can’t?

    Amen!

    I do not drink much or often, and smoke or vape recreationally every now and again, those are not problems for me.  But food?  Dangerous.

    • #54
  25. Shauna Hunt Inactive
    Shauna Hunt
    @ShaunaHunt

    Fake John/Jane Galt (View Comment):
    Sorry to hear that. Constant pain. 24/7/365 with no end in sight is hard to bear. When I hear people talk about grin an bear it, or nobody promised a pain free life just do not understand what they are talking about.

    Thank you! I’m sorry if you, or someone you love, struggles with chronic pain. It’s nice to know that you’re not alone. 

    • #55
  26. philo Member
    philo
    @philo

    Drusus (View Comment): …But what about obesity? Just as deadly and far more widespread. And the public health (and taxpayer burden) questions are even more profound. 

    LEADING QUESTION: To the average government functionary reviewing the file, is a 195 pound, 45 year old male obese? (Follow-up: Does it matter what state he lives in? Does it matter if he is a Republican or a Democrat? Does it matter what the report from the IRS in the file says?)

    Miffed White Male (View Comment):
    Someone who drinks enough to have damaged their liver?

    LEADING QUESTION: To the average government functionary reviewing the file, was it the alcohol or one of the other three factors present that caused the damage to that liver? (Follow-up: Does it matter what state he lives in? Does it matter if he is a Republican or a Democrat? Does it matter what the report from the IRS in the file says?)

     

    • #56
  27. JustmeinAZ Member
    JustmeinAZ
    @JustmeinAZ

    JMHO. Give them one chance (maybe two) to get clean. Then let them die. And no organ transplants.

    • #57
  28. MichaelKennedy Inactive
    MichaelKennedy
    @MichaelKennedy

    Good post.  I ran a trauma center for seven years but, fortunately, it was before the big opioid crisis.  Saw lots of DUIs many in illegals.

    Doc: If you don’t quit, you’ll die. But, hey, I get paid either way.

    The Old Man never smoked again.

     

    My father was a 5 pack a day smoker. His GP finally told him that and he quit that day. Too late. He died of emphysema a couple of years later.  I did vascular surgery and had quite a few smokers as patients, as you can imagine.  I would tell them they couldn’t smoke for a month before surgery and some even found their symptoms go away.  A plastic surgeon friend had his ex-wife  resume smoking too soon after a face lift. She sloughed her face.  Died after.

    • #58
  29. Randy Webster Member
    Randy Webster
    @RandyWebster

    Boss Mongo (View Comment):

    Doc: If you don’t quit, you’ll die. But, hey, I get paid either way.

    The Old Man never smoked again.

    What the doc failed to point out was that if you do quit, you’ll still die (reformed smoker here).

    • #59
  30. Vicryl Contessa Thatcher
    Vicryl Contessa
    @VicrylContessa

    MichaelKennedy (View Comment):

    Good post. I ran a trauma center for seven years but, fortunately, it was before the big opioid crisis. Saw lots of DUIs many in illegals.

    Doc: If you don’t quit, you’ll die. But, hey, I get paid either way.

    The Old Man never smoked again.

     

    My father was a 5 pack a day smoker. His GP finally told him that and he quit that day. Too late. He died of emphysema a couple of years later. I did vascular surgery and had quite a few smokers as patients, as you can imagine. I would tell them they couldn’t smoke for a month before surgery and some even found their symptoms go away. A plastic surgeon friend had his ex-wife resume smoking too soon after a face lift. She sloughed her face. Died after.

    I tell people all the time that if they smoke after their CABG and we used radial artery for one of their grafts, they will cause vasospasm and that graft will go down. It’ll make the vein grafts go down too and turn you’re back to square one.

    • #60
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