Last week, I posted about an alcoholic patient that I treated on the Medical Admissions Unit. I was replying to a comment that a medical student wrote, but my reply got so long I figure it deserves a post of its own. You can read the original post here.
I'm a final year student, and to be honest, I hope I never talk to a patient like that. Yeah, blah blah blah tough love, but to me that sounds like a good excuse for a dose of old-fashioned, hideous paternalism and moralising. Your patient probably doesn't need her face rubbed in the mess of her life, it's only likely to compound whatever emotional crap she is using drink as an escape mechanism from. I really like your blog and think you sound like an ace doctor (and everyone is to be forgiven for moments of getting annoyed with patients) so don't think I'm being mean, it's just my viewpoint on how I'd approach it.
11 May 2007 23:22
You make a valid point, and one that I’ve thought about loads since that conversation with Joy. I don’t feel proud or happy about making her cry, it was not my intention to make her feel bad or to “rub her face in the mess of her life.” I could have been less dogmatic in what I was saying but the whole situation made me feel sad and angry and I felt I had to say something about it. All I did was spell out the truth.
Let me explain;
My anger stemmed from frustration. Like many addicts, I don’t think Joy thought she had a problem. I don’t think Joy could see how much hurt she was causing. I’m certain Joy didn’t have an idea of what the future would hold is she continued to neck a litre or two of spirits a day i.e. that she would die before her time in a messy, ugly and probable painful way.
Joy has got herself into a cycle of helplessness where she EXPECTS everything to be done for her. She EXPECTS that her mother will come round and pick her off the floor. That her mother will clean up her vomit, clean her bathroom and make sure her flat is habitable. She EXPECTS that the paramedics will be there every time she feels hungover. She EXPECTS that the doctors and nurses in hospital will make her feel better and help her over the symptoms if withdrawal.
Joy is RIGHT to have these expectations, these things have happened many times before and will probably happen many times in the future. I don’t think Joy saw any need to change her ways.
The point I was trying to make to Joy was that it is not FAIR to expect all these things. I wasn’t thinking about the medical side of things - after all, me, the nurses and the paramedics have been trained to deal with this sort of thing and we get paid for it. I was thinking about the grief that Evelyn (Joy’s mother) and Joy’s children were going through every single day. Joy just didn’t care about her family, and her family obviously cared deeply about her. That’s what made me mad, that’s what makes me sad. Joy continues to lie, to manipulate, to get drunk then call her seventy-something year old mother at 2am saying she’s fallen over etc… etc…
JB, obviously you are entitled to you opinions as I am mine. Yes, I was moralising. Yes as was being paternalistic, but in this particular case, do you honestly think this is a bad thing? I appreciate that it’s easy for me (a non-addict) to tell Joy to give up her addiction and I appreciate that I don’t have first hand experience of what it involves, because I’ve never had to do it. Joy has her reasons to drink and while I can sympathise that life is hard, I also recognise that there are millions of people on this earth for whom life is hard but do NOT turn to drink and manipulate those trying to help them. At the end of the day, we all have to take responsibility for our own actions and Joy was not taking ANY responsibility for hers.
I’m sure Joy had her reasons to start drinking, I was trying to make her see some reasons to stop.
Was I wrong to at least attempt to make her see how much drinking is destroying her life and the lives of those who care about her?
You’re a final-year medical student, so you probably don’t need me to tell you that alcoholic liver disease (ALD) is one of the very few medical conditions that is totally reversible. Unlike diabetes or heart failure or emphysema or cancer, people with ALD can get better, they can actually cure themselves – but only if they stop drinking.
In the last fortnight, I’ve seen five people die from decompensated alcoholic liver disease. Five dead people who would still be living today if they had stopped drinking. Of those five people, only one had family around them when they died. Four died alone, surrounded by strangers on a hospital ward.
This makes stories like Joy’s so much more tragic. It’s like that train crash that you can see coming but feel you can do nothing to prevent. I was just trying to prevent Joy from crashing, but I suspect – like so many before me – that I’ll fail.