"Then there is the surgeon who was branding his initials into his patient's livers." - OOOK. A lot north of appropriate. : )
I agree that the tough decisions with long-term benefits might be somewhat in contrast with altruism, thanks for pointing out. Making this sort of decisions somehow comes naturally to me and I personally consider them altruistic, although my terminology might be wrong (I consider everything that ends up as beneficial for the society - everything that improves the total happiness/unhappiness ratio - as ultimately altruistic).
Your logic with money makes sense to me. The feeling or poorness/wealthiness comes from what we are used to and what we see around us. I've always considered that it is unnecessary to insist on some sort of ideal wealth distribution. That said, the current imbalances are horrible, with 1% of the population controlling the majority of the total money.
As long as we continue to work toward a better world it will get better. In many ways it has gotten better. Of course, in many ways it has gotten worse too. Remains to be seen who will prevail.