Bobbie, 44y/o, came to the hospital for increasing edema of his legs and abdomen. One of my patients.

Just wondering why a young man came here for swelling legs, which is a very common symptom of congested heart failure due to the "pump" failing to function, and thus making fluid overload in lungs, legs, and the whole body. Then my nightshift coworker, Mark, told me that this guy is an ETOH abuser, aka. an alcoholic.

I see. So Bobbie is here for cirrhosis.

"...he has that yellow tinge all over him -- his face and the whole body. Not sure if he goes to a tanning sallon or not. His jaundice is very bad..." Mark said with a disgusting tone of voice when he made this comment. I had a red flag about Bobbie. Is he also an intravenous drug user too? Hepatitis A? B? C? HIV? AIDS? In addition to using alcohol, what else has this guy been exposed to? Substance users have something in common: they are SO DESPARATE that they do NOT care what they are using as long as they can get high.

"End stage liver disease," said Mark. "He was hoping to get a liver transplant at Henry Ford (hospital)..."

WHAT? Liver transplant? But how long has he been sober? It almost sounds ETHICALLY WRONG if he is still drinking. Treating someone who has made bad lifestyle choices, like using drugs, alcohol, smokes, indulges McDonald's garbage and not do any exercise, is one thing. But giving a nasty drunk a brand new liver is TOTALLY unheard of.

"...his sodium is really low, so he is on a fluid restriction. But he is noncompliant, always asking for water whenever he has a chance. And his mother is not helping. She brings pop to her son all the time.... In addition, he gets lactulose twice a day..." continued Mark, giving me report of Bobbie.

GREAT! Now I have to be a fluid police too -- making sure that this guy will not sneak up on more water or, like Mark's observation, Bobbie's own mother sneaks up and brings pop from home to her very sick and noncompliant son. And by the way, Bobbie's taking lactulose to get rid of high ammonia level in the blood, which explains Bobbie is slow and disoriented. And the only way to be therapeutic is by pooping all damn day (to rid of ammonia.) Meaning, I and my PCA will be cleaning a drunk's poop all day long.

I LOVE MY JOB!

At 10 O'clock after I passed morning medication, I was paged and requested to go to Bobbie's room to "talk to his family."

ABOUT WHAT? Will it be about how she allows her own son to drink at her own house day in and out to the point that he destroys his own liver at the age of 44? Or will it be about how she sent her son to the hospital for treatment, but at the same time helps her own son to be noncompliant with his treatment? Or she would like to talk about this co-dependant relationship between the mother and son?

I was surprised when I saw Bobbie's mother. That's Mary, our nightshift PCA from the pool. She is a hard worker. Been working in the hospital for decades. I know that she is a single mother. But is Bobbie really her son? As a healthcare profession worker, she could have known better NOT to raise an alcoholic/ substance abuser in her own house. What is really going on?

"...Bobbie has always had a drinking problem since he was in high school. At first he had DUI's and I thought the problem would be gone by the time when he grows up..."said Mary, Bobbie's mother. "...but the drinking problem get worse and worse that he's destroyed his own marriage and his relationship with his only daughter..." she continued.

I feel SO BAD for this mother.

"...I want to know if this is it for Bobbie...If this is the time for him to go, I want him to be happy and I pray..." Mary continued.

But my question is if this mother is really ready for her son to die from drinking? If she is, then why did she bother to send Bobbie to the hospital? Why did she tell me about she only wants her son to be happy? Is it a little bit too late now? Should I tell her that her son is dying for sure if he does not get a liver transplant in a year or 2? And did she even google for her own research that more people on the (transplant) waiting list die within 2 years anyway? And if Bobbie can not be sober or proves to be sober for at least 6 months, he will NEVER EVER be considered a transplant. Does she know that?

And in the meanwhile there are so many more people on the list for so many different reasons, why does Bobbie deserve a second chance?