SSSFELICIANO’S MAR [15-06]:The Dilemma of the Sick and Poor: To Give Up My Own Health for Others or to Preserve Health for My Own

Indexing Title: SSSFELICIANO’S MAR [15-06]
MAR Title: The Dilemma of the Sick and Poor: To Give Up My Own Health for Others or to Preserve Health for My Own
Date of Medical Observation:  July 2015
Tag: The choice for the sick and poor
Category: Professional/Ethical – Reinforcement
            It was at 3 am of our duty day when the Emergency Room finally went to its calm. It was  “lights off” for the Surgery Department, but for the Internal Medicine, it was the other way around. I then came across with a referral of a 36-year-old male with Acute Kidney Injury secondary to Leptospirosis, severe, for IJ (internal jugular) catheter insertion. After explaining to the patient the contemplated procedure, consent and materials were secured. IJ catheter was inserted successfully after a few hours that day.
            A day after, a junior intern came to me to refer the patient. I was then thinking that the IJ catheter had some problem that’s why he was referred back. However, she handed me an ultrasound result of the Kidneys and Urinary Bladder. It showed nephrolithiasis on his right, measuring 0.7 cm on the inferior pole, besides the diffuse parenchymal kidney injury. What bothered me though was the remark of “Surgically absent left kidney”. I immediately went to the patient to have a careful history and physical examination. He narrated that it was due to financial incapability which prompted him to have his left kidney donated in 2005. He had thoughts that he was Superman-strong and healthy; and that it would stay for life, but he was wrong. I carefully explained to him his condition and the danger he is in now. We requested  for a CT stonogram which showed ureterolithiasis, aside from the stones in his kidney.I had a conversation with his attending physician from the Internal Medicine Department and told me that the injury in his kidneys are getting irreversible, meaning he now has End-Stage Kidney Disease. The plan for him is to remove the obstruction, apart from the creation of a permanent access for dialysis. Sadly, I revealed these to him.  He received the bad news wholeheartedly and was still willing to undergo the operation. He remarked, “Gagawin ko po lahat dok. May pag-asa pa naman po diba?”. [I will do everything Doctor. I still have my chance, right?]. Now I believe, he really is Superman and his faith is his kryptonite.
Category: (Physical, Psychosocial, Professional/Ethical), (Discovery, Stimulus, Reinforcement)
            I live in an apartment where the trash is being collected by young children every night. Everytime these kids would shout “basura!” at our gate, I would always ask my sister to have our gate opened so they could collect the trash. My sister would then get irritated why I never bother to stand up to open the gate instead. One day, she asked me why I never did. I told her that I don’t want to see the poor, the sick, and the neglected. It hurts me everytime I would see kids collecting garbage for their living , hearing an old man shout “balot” in the wee hours of a rainy night, and see the blind and deaf along the streets who sing just to be able to make it through the day. She then questioned how do I get to survive being in the hospital seeing the poor and the sick.  
            We encounter a bunch of patients every day. The reason for our existence as doctors are our patients-the sick people. For this, it is inevitable that we see the poorest of the poor and the worst among the sick. What made this patient special is that he was one of those whom I never want to see just like the kiddie garbage collectors. They have the sincerest hearts but their lives are torn by poverty. Fate brought him to help another person’s life in the past, but who would have known that in the future, he too would be in need of help for himself.  If he would have known that he too will have a kidney disease in the future, would he still have his kidney saved given the situation he has-no food, no shelter? My patient is just one of those who are left with no choice. His dilemma was to give up his right kidney or give up his left kidney. Neither of these choices will spare him from danger, but he had to do it. 

Another important point that this case left me was to think of our role as doctors. It is inarguable that we should be advocates of patient’s health and safety. Now,  the question is, given another healthy patient, do we advocate that he help another one who is in dire need of his help, or  should he refuse to give help for his own future good?

ROJoson’s Notes (16jan20):
Whether poor or not poor, to donate an organ or not, deciding factors include the following:
  • How much does the person value his own body and organs?  If he  is concerned he will not have a reserve (in case of a paired organ in which he will donate one), he will probably not donate.  Otherwise, he may donate for either a cause or for money.
  • Is he donating for a cause?  If yes, such as his close relative, he will donate.
  • Does he need money for donating? If yes, he will donate.
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