Thursday, May 11, 2006


Day 41:

Yesterday night, the other half of our team admitted a 28 year old guy found passed out in a Greyhound bus station restroom, surrounded by needles he had used to shoot up heroin. Apparently, he also had HUGE lice crawling all over him, but I include that detail only for the sake of trying to gross you out.

His chest x-ray revealed large cavitary lesions in the lungs, leading us to suspect tuberculosis. TB is a very contagious disease, and it poses a signifcant public health risk. In fact, it is one of the few illnesses that you can be treated for against your will, as the state has a vested interest in protecting society from the threat you theoretically pose to everyone else. A similar justification allows hospitals to hold psych patients against their wishes if they are expressing homicidal/suicidal ideation.

An ethical dilemma arose for us this afternoon when our gentlemanly patient decided he wanted to leave Truman AMA (against medical advice). Dr. V talked with him for 45 minutes, trying to convince the man to stay, but the patient was determined to leave and would not be swayed from his course of action. The question then became, "Could we hold this patient against his will?"

Because sputum cultures were still pending and the PPD skin test we had placed had not had sufficient time to give us a meaningful result, we had no confirmatory evidence that he had TB, just a strong suspicion. This is apparently insufficient justification to hold a patient against his wishes. The patient was therefore allowed to walk out of the hospital.

All Dr. V could do was ask the man to please wear a mask while he was walking through the hallways towards the exit.


At 8:46 AM, Anonymous Sam said...


Thats crazy! Did the test come back? if he did have tb, what would happen? I mean...yowza. my head just exploded.

Remind me to fly to kansas when i come visit, not take the greyhound :)
ACTUALLY, lets make it easier and say you can visit me.
yes. agreed.

At 7:56 PM, Blogger Danielle said...

LOVE that last line... LOL. It's not funny since it is true, I know. No, it is still funny, LOL.


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