In response to some concerned commentary, an update. Against most the odds, Mr. Smith is still alive, though he's making trips back to the OR roughly every other day to stop bleeding. No-one expected him to make it this far though, except, just maybe, that priest. We'll see.
Lupus is not, unfortunately, a curable disease. Lupus manifesting itself so dramatically is even less likely to be so, but there are very good treatments and we are getting better. In the meantime, we are making Mr. Smith comfortable, keeping him as stable as possible, and doing what we can to treat his lupus.
The introduction to one of the classic texts on ICU care says, in part, that our role as doctors is not to save lives, but to relieve suffering, as it is impossible to do the former consistently. Sometimes though, you can do both. Though even there, Ambrose Pare, the father of modern surgery, has inscribed upon his tombstone the words "I treated him, God healed him." There is no better epitaph for a physician.