A Lesson from the Third Year

During my medicine clerkship, I had the privilege of caring for a man whose case brought up many questions and dilemmas in my mind. Mr. L. was a 70-year-old Chinese man who spoke only Cantonese, but in a dialect that most translators found incomprehensible. He apparently had no family and was in this country illegally. He lived with a group of other Chinese people, all of whom worked for a restaurant and lived with the owners. It was questionable whether Mr. L. had ever seen a western doctor before. He presented to the emergency department with severe abdominal pain, having not voided in some time.

The doctors determined that Mr. L. had a urinary obstruction secondary to benign prostatic hypertrophy. They relieved this problem through catheterization, but Mr. L.'s kidneys functioned so poorly that the doctors thought Mr. L. had some form of chronic renal failure as well. A doctor performed a renal biopsy that showed severe glomerulosclerosis, and renal failure was imminent. Dialysis was begun promptly. After learning of his condition, the owners of the restaurant declined to assume care for the man. They refused to allow him to continue residing with the other workers or to provide transportation. Since no other family or friends could be found to provide care, Mr. L. sat in the hospital for …