How Did He Get There?
by Ned Wicker
I deal a lot with drug overdoses and alcohol withdrawal in my work as an acute care chaplain. Sometimes that takes place in the emergency room as the patient is fighting for his/her life and family is gathering hoping for the best outcome. Sometimes it's in the Intensive Care Unit, as the patient is on a ventilator, hooked to IV lines and the family waits nervously trying to understand what is going on and what might happen next. Sometimes it’s on the medical unit, like my most recent encounter. The patient is “out of the woods” and there is no family around, mainly because the patient will be discharged that day.
The setting isn’t what sparks my interest in these patients; rather it’s the circumstances of their lives. My most recent visit was with a 26 year-old man, who almost drank himself to death and is reaching out for help in selecting a treatment program. Sadly, the company I work for used to have an outstanding in-patient treatment program, but that was jettisoned for financial reasons, as hospitals have learned that you can’t make money on addicts unless they have a robust insurance package. My patient lived at home with his parents and didn’t have a job.
I learned that his mother was very supportive of him getting into treatment, but could not contribute any financial support. His younger brother, also at home and without work, was not in a position to help either. As for his father, well he’s an alcoholic and was instrumental in getting his son on the path to nowhere years ago when he took him fishing and drank beer all afternoon. All through middle school, high school and into his early adult years, the son drank and throughout those years the amount he drank grew, both in frequency and volume. Now at 26, it was at least a quart every day, mostly vodka, but sometimes whiskey.
We talked about his home environment. There is always liquor. His father comes home and drinks, every day. Even if he wanted to dry out, going back into that house would be detrimental to any personal goals he was setting for himself. But without a job, there aren’t a lot of options. Nevertheless, he will return home and there is little doubt that father will set aside his libations just to give the kid a break. The booze will be right there, and he said that his father is all too willing to pour one for him.
How do you fight this?
So, how do you fight this? My patient told me he plans to get into AA, a good choice to be sure and we talked about finding an AA group that suits him. One size does not fit all when it comes to AA and often it takes a few visits to various meetings to find one’s comfort spot.
We talked about getting mom and brother into Al-anon, knowing that they need help and support also, not just to help my patient through his recovery, but to deal with the father who has no intentions of quitting, no sympathy for those who have to endure his disease, and no real knowledge of understanding of his role in his son’s recovery. It’s an uphill climb, not impossible, but very difficult.
Did he know he almost died?
I asked him if he understood all the medical information in his chart, or if he had any curiosity about how close to death he had come in this most recent episode. He was not aware that alcohol is extremely toxic, that it gets into every pour, every cell. He had no understanding that alcohol could lead to so many other issues.
Even in a medical chart, it might site this condition or that condition, but not mention the fact that alcohol was the major contributing factor. We talked about the detoxification process he had undergone and what medical complications could result, such as concern over cardiovascular disease, which for a 26 year-old is unimaginable. But there it was, right there in the chart. The doctor had said something to him before, but he didn’t hear. He didn’t understand and never bothered to ask. It wasn’t real to him.
The conversation shifted to the reality of his current medical condition, and the certainty of a limited life expectancy should he choose to continue drinking. Like so many alcoholics, there was denial, as he said he could cut back and reverse the tide. But we took time to talk about it, mostly him carrying the conversation and eventually the fact of his potential early demise became a reality in his mind.
Our conversation filled in some of the holes in the doctor’s presentation. Often doctors talk at patients, but fail to make a connection. There are times when I, as a chaplain, say what the doctor can’t say. Doctors are tied to strict professional and scientific standards. Sometimes there needs to be some interpretation, or clarifying comments. We both agreed that he hadn't completely grasped his situation. It was important that he heard and understood what the doctor was telling him.
The future very uncertain for him.
Sadly, this is where our story ends, as my patient was discharged to home and it remains to be seen if he ever attends a meeting, or if any treatment options are pursued. Will mom and brother get help? Will the family reach out to the father and try to intervene? The nature of my business is the fact that in most cases, I see somebody once. But we laid down some treatment options, pointed him so some community resources to help with employment and gave him some encouragement. Sadly, he needs so much.