Pancreatitis, Alcohol and Denial
by Ned Wicker
She just couldn’t understand what all the fuss was about. Karen was admitted to the medical unit of the hospital, through the Emergency Department, after a painful flare-up of her ongoing battle with pancreatitis.
The pancreatitis issue was resolved relatively quickly and by the morning of the second day of her hospitalization she was feeling “so much better” and stated that she was ready to go home. That was her version of the situation, but her husband and two daughters had an entirely different view.
As is so often the case with an alcoholic, Karen did not believe, at any level, that she had a problem. Her family was scared and told the medical staff that they did not want her at home. It was too dangerous.
Husband and daughters were constant companions for the first couple of days in the hospital, giving Karen loving support. Her first night was rough, as the staff was dealing with her pain, but once the pain subsided, she was ready to bolt.
I met her for the first time on the morning of her second day, and she thought it strange that a chaplain would come into see a person who was freed of any physical, mental or spiritual distress. She thanked me for coming in to see her, but quickly dismissed me. The two daughters gave me that “we need to talk” look so I lingered for a few moments.
I praised the daughters and the husband, explaining how important their being there was, and then I explained the importance of being near to help Karen stay “safe.” That really resonated with the three of them, but went unnoticed by Karen.
Husband is sober because of AA
The daughters asked me to walk down the hall with them and have a talk. They told me that their father had been sober since 1999 and had gone through the 12 Steps through Alcoholics Anonymous.
“He became a new person and for the first time we had a real father,” they said. The girls talked of a complete transformation, and in glowing terms, talked of their love and respect for their dad. The affection, however, was dampened by one disturbing detail—he was enabling Karen.
“Mom doesn’t believe she has a drinking problem and if we talk about it, she gets really angry,” they said. “Dad doesn’t do anything.” The girls wanted to know what they could do. We talked about available resources, not the least of which was the local chapters of AA and Al-Anon. Alcoholism is a family disease and each member of the family has a role to play in the alcoholic’s recovery.
They had never received any support from friends, the church or the community. Isolated and feeling alone, they had endured the drinking over the years.
Mother has SERIOUS health problems but it doesn’t matter!
Their mother is only 50 years-old, but her long-term alcoholism had caused damage to the pancreas, not only blocking the ducts, but the chemical by-products of the metabolizing of the alcohol had also damaged the pancreatic tissue itself.
Karen was making no connection between her drinking and the pancreatic attacks. She denied that alcohol played any part in her disease. She did suggest that she might change her diet ever so slightly to lessen the severity of any subsequent attacks.
The dietitian came in to counsel her on that, but the daughters explained to the dietitian and the nurses that a dietary adjustment wasn’t the issue, because she didn’t eat very much at all. She drank. The alcohol was the issue.
Karen had experienced the intense abdominal pain of pancreatitis, but refused to allow the doctors, the nurses, her family, and the chaplain to point to her alcohol consumption.
Her “world class” denial of course would dismiss the data liking alcohol and pancreatitis, as so many cases that hospital staff’s see are flare-ups directly related to drinking. She did not want to listen when told that the alcoholic pancreatitis was likely to significantly shorten her lifespan. She had developed chronic pancreatic disease and had as a result developed difficulty digesting food, explaining her daughter’s comments about her not eating.
Was she willing to cut back on her drinking?
One of the doctors tried to explain that at the very least, if she would be willing to at least cut back on her drinking, the frequency of the episodes or the severity of the episodes might decrease.
She would have none of that because her drinking was not an issue. She insisted that she just had pancreatitis, like so many other people. She argued with the doctor about the definition of pancreatitis itself. The family struggled listing to the conversations, because Karen was refusing to listen at all.
A disease will have a biochemical marker, something that indicates why type of the disease is present and where it came from. But there isn’t such a marker for the alcohol-based pancreatitis. There is ongoing study in this area.
The one paradox of interest is the fact that not all heavy drinkers, or alcoholics, will develop pancreatitis. The drinking can be a major contributing factor, but not necessarily the determinant. The person’s diet, the type of alcohol, smoking, heredity can come into play, suggesting that something other than the drinking may cause the disease. The work continues, but the results are incomplete.
We do know one important fact, alcohol is highly toxic and can be a contributing factor to so many maladies. The best first step towards controlling alcohol pancreatitis is simple—don’t drink. That doesn’t necessarily guarantee freedom from the disease, but it is a significant help.
In Karen’s case, pancreatitis aside, she is drinking herself to death. Her husband knows it, her daughters know it and the medical team knows it. Karen denies the truth and refuses to acknowledge the rather large elephant in the room—she’s an alcoholic.