A Bad Situation

Just a quick post about a bad situation. A 16 year old male came into our ED the other night with an osteosarcoma of his femer head. An osteosarcoma is a bone cancer that you don't want to mess around with. Complicating this is that he is an illegal from Mexico. He was diagnosed and treated there, when medical complications arose the mother lost faith in her country's doctors and crossed the border to the US, where a certain hospital took her son in. The hospital offered to pay for his medical treatment for free. As treatment progressed it became understood that the only way to save this young man was to do a hip disarticulation, basically cut out all of the tumor and amputate the leg. Since a large portion of the hip would have to be removed, getting even a fake leg would likely be impossible, this boy decided he would rather die. After lengthy discussions with the boy and mother, they left the hospital on pain medication, before leaving they were warned that they would not get the same generous offer upon returning and were unlikely to find it elsewhere. I meet him two months later when his pain medication is no longer controlling his pain. They are now requesting that we move ahead with the surgery that the other hospital purposed. I call the higher ups to request admission...admission denied. Per congressional law I'm alotted the power to stabilize any acutely life threatening problems and discharge the patient after that is done. We run basic labs and find no such immediately "life threatening" problems. I sit with the mother and tell her as she's crying that we can't help her son. I offer what little I can, a script for improved pain management and advice to return to Mexico as soon as she possibly can (which she has the power to - I asked - but which she is extremely resistive). I sat there in silence for a long time...what could I have done differently? I don't know. I've thought about this alot and I can come up with two arguments one very logical, cold, and practical and the other much more humanistic, either way I can't really wrap my head around it yet...the factors that led to that situation are just so complex, so horribly muddled, that I can't even process it. Any takers? Did I do the wrong thing? Part of me says I did, despite having done it "by the book", part of me says I didn't. That mother thinks we did. Do you?