Friday, July 2, 2010

The Damaged Eyes of Alcoholism

I walked into the dimly lit treatment room, Room 31, to find my next patient quietly and calmly lying in her cot. She had curly graying hair which, when added with the deeply creased wrinkles of her face, made her look much older than her stated age. Despite her attempts to welcome me with a warm smile, her greeting seemed forced. Her smile was but a thready, thin blanket failing to cover the the cold of her pain.

The pain of an alcoholic.

Standing in the corner, huddled together as a unified front, stood two teenagers. A boy and girl. Unlike their mother, they made no attempt to cover their worry. Their appearances were youthful--Converse Chuck Taylor sneakers, straight-legged jeans, graphic t-shirts, and hip stylish haircuts. But their eyes, those pained and aching eyes, bore an unfortunate truth to the years of sadness they had endured. Of their lost innocence.

I introduced myself to the patient before focusing my attention a little more closely on her children. Despite their worry, they were gracious in returning my hellos, introducing themselves.
I turned back to the patient. "Ms. Smith," I asked, "what happened that brought you to our ER this evening?"

Ms. Smith looked at me blankly, a confused haze slowly overtaking her face. I spoke again. "Do you know why you are here this evening?" She continued to stare at me, worrying me with her silence, before eventually nodding her head "no." She spoke. "I have no idea what happened."

I turned to her children. "Can either of you tell me what happened with your mother?"

The son stared down at his feet in response to my question. The daughter, however, connected with my eye contact and spoke up as she nervously tucked her wispy, blondish curls behind her ears. "I think she had a seizure." She got quiet then, her eyes getting more glassy as we continued to hold one another's gaze.

"Please, go on," I encouraged her and she bravely continued her story. She and her brother had been out and, upon returning home, had found their mother lying on the kitchen floor, unresponsive. An abrasion on their mother's forehead and a bleeding tongue greeted them upon closer inspection. After finding a pulse but failing to arouse their mother with yelling and shaking her flaccid body, they called 911. They all rode in the ambulance to the ER. They later put together, with the help of the paramedics, that their mother had probably had an alcohol withdrawal seizure. "She tried to quit cold turkey a few days ago," the daughter continued, shaking her head, "and I told her she needed to go somewhere to get some help."

The mother, intently witnessing her children struggling, started crying as she spoke. "I haven't had a drink for two weeks, honey."

With her words, the son looked up from his feet. "No, Mom, that's not true. You were drunk just over the weekend." The mother offered no excuses to his words.

Just then, the room's curtain pulled open and in walked a middle-aged man, his face strongly resembling the children's faces in both looks and worry.

"Daddy," the girl exclaimed, jumping away from her brother and into her father's arms. "Hi Dad," the son added shyly, giving his father a brief smile before turning his eyes downward again. His pain was palpable.

"Hello, sir," I said, introducing myself, "you must be Mr. Smith."

"I am," he replied, thanking me for taking care of his ex-wife. He turned from me back to his children. "Are you both okay?" he asked, pulling them into his chest for a hug. I caught my breath at his genuine display of love and concern for his kids. It was just what they needed at just the right time.

The kids smiled and looked up into their father's eyes, nodding their heads "yes." Their worried eyes relaxed and I was able to see some small sparkles mirror off their reflection as they continued gazing at their father.

Before turning to a physical exam, I asked a few more questions. It turns out that this patient had an extensive alcohol abuse history. Eight years prior, she had successfully completed an alcohol rehabilitation program and had remained sober for six years, before succumbing to alcohol's temptations again just two years earlier. According to her children and ex-husband, the past few years had been "hell" and had affected all of their lives in a very gloomy, detrimental way. They were just nearing the point of giving up on her, I'm afraid, when two weeks back, the patient announced to her family that she was done with alcohol "for good."

"That didn't last long, though," the son added, "because she got drunk that very night and passed out."

On exam, this woman appeared very fatigued, both mentally and physically. She did have the forehead abrasion that the kids had noticed on their kitchen floor, her eyes nervously flittered horizontally (known medically as nystagmus) within their reddened borders, and her tongue, on the left side, was bitten. Her vital signs were stable and the rest of her exam was unremarkable. It was evident that she had had some type of seizure, most likely an alcohol withdrawal seizure.

We did a full work-up. Her head CT was negative, her labs reflected dangerously low levels of both magnesium and potassium (which we began immediately replacing via her IV), and her alcohol level was zero. Besides addressing her electrolyte imbalances, we also gave her IV multivitamins, hydration, and thiamine to protect her damaged body.

We admitted this patient, much to her family's appreciation. She needed specific medical attention for her alcohol abuse and withdrawal seizure. After arranging all of this, I went back into her room to find this patient and her family much as I had left them, with much love being shared between the children and their father and their mother quietly sitting in the cot observing her children. There was much sadness, for me, from the many facets of this scenario.

"Maam," I said, after reviewing her work-up and disposition, "do you want to stop drinking? Will you accept some help for your problem with alcohol?"

Her answer was music to my ears, and it came without hesitation. "I have to stop drinking," she said. "If not for me, I need to do this for my kids." She paused and looked at her kids, who were now watching her intently. "I love you both too much to continue on this path anymore." With those words, both kids gingerly walked over and wrapped their arms around their mother, the daughter now openly weeping.

How do I know this patient was sincere about wanting help? As I spoke to them about their options for several available in-patient rehabilitation programs, she seemed to be intimately familiar with most of the options. This mother had done her research and had begun taking her own steps toward sobering up and becoming the mother she could be to her children again. She appeared very sincere in wanting nothing more.

I looked at both children hunched over the railings on either side of the treatment cot as they hugged their mother. Despite the daughter's weeping and the son's hesitancy, I could see that their eyes, despite their sparkling and youthfulness just minutes earlier as their father had hugged them, had become edgy, wistful, and nervous again. Old and young and, unfortunately, back to old again, reflecting their aged, hurt souls.

I am not naive. I know it is going to take a lot regained trust and renewed love to keep these children's eyes permanently young. To erase the damage caused by their mother's alcoholism.

Then again, maybe I am naive, because a large part of me thinks that this mother can succeed. For her children's sakes, I can hope for nothing more.

As always, big thanks for reading. I hope your holiday weekend is a good one. Next posting will be Monday, July 5. See you then...

34 comments:

coulrophobic agnostic said...

How sad, to return to drinking after six years without.

I hope she makes it this time.

Jacqueline said...

Never had to deal with anything like this, but for some reason, this story touched me...tears flowing. May God bless this family.

PS I'm working on an e-mail to you...just been crazy busy.

Laanykidsmom said...

So desperately sad. I cannot imagine the grip alcohol has on her for a mother to do that to her children. I hope she can be successful this time.

Empress Bee (of the High Sea) said...

unfortunately i know all about this one. sarge has 23 years clean and sober and son, chuck, and just over one. what scares me is the trauma to the family that they don't even know is there. they need as much help as she does. if not, they will either end up there themselves or marry into the same situation. it's what they know. it's their normal.

aa is a wonderful program after a drying out place for physical reasons. and there are similar programs for the family. unfortunately some of those are as messed up at the home life.

i remember one gal talking about packing vicodin in her husband's lunch. he had a tooth pulled. two weeks earlier. he said his jaw hurt. his dentist gave it to him. she took it and doled it out to him. co-dependent? oh my GOSH! that particular group was as sick as any i have seen and i couldn't get out of there fast enough.

anyway i guess what i am saying is the kids are in trouble. and it scares the krap out of me. i hope the dad takes them for everyone's sake.

sorry to go on so long, sometimes this stuff just rises to the surface in my brain. didn't mean to pull your ear.

smiles, bee
xoxoxoxoxoxoxo

Chrysalis Angel said...

I hope she makes it.

Have a great 4th of July, StorytellER Doc!

Gia's Spot said...

This was my mom, Jane, she did succeed finally only to die of the cancer that her lifelong struggle with alcohol produced. Those children and that family will always thank you for your care of their Mom! Thank you again for a wonderfully heartfelt tribute!
As always, tearfully,
Gia

Confessions of a Mother, Lawyer & Crazy Woman said...

Tears. You are a great writer and tell such a compelling story. Hoping for the best for this family.

Sara said...

There is so much hope for families like this to rebuild their relationships as adults.

Katie said...

Another beautifully written tale! My family history is chalked full of alcohol abuse and misuse, but I'm blessed in that all of currently living relatives can drink socially. I pray this woman and her children can tear down the walls that have been built between them.
<>< Katie

Cal said...

Such a sad story, very well told. It is sad that she had been clean for 6 years and then returned to drinking. Wish all the best for this family. Sometimes I wonder how I would cope having such an emotionally charged job as yours.

Have Myelin? said...

Alcohol is a demanding Mistress.

Stephany said...

My bio Dad died in his 30's from alcoholism. I was 9, and still feel the relief of that presence removed from my life.(Sad and blunt as that sounds). But the horror he produced while living, unfortunately lingers in distant memories.

Anonymous said...

1975 - A kind doctor said, "If your brother does not stop drinking he will die." My father said, "Well he doesn't drink any more than the rest of us." It is a family disease. Thanks for letting that family know they all need help, love and a kind and loving God to help them through.

rheumablog said...

My ex-husband was (and may still be) an alcoholic; it was what ended our marriage. He'd try to stop drinking, be sober for a month or two, and then declare that he could "handle it" and start again with a beer at dinner. That would turn into two beers, then three, and before long we were back in that awful cycle. When he was drunk he was irrational and verbally abusive; one of the hardest things about it was that he rarely remembered the things he said and did under the influence. It took six years, but I finally got myself and my daughter out of the situation.

I guess I finally realized that I couldn't help him or change him -- that he had to want to do it himself. Since he wouldn't own up to being alcoholic, it was clear to me that it wasn't going to happen.

Alcohol is such a terrible, dangerous drug. I feel so awful for that family, Dr. Jim. I hope the woman can give it up for good, and I hope the kids will also get help in dealing with what they've gone through as they grew up with her.

Thanks for another wonderfully told story. I'm glad you were there to help them.
-Wren

littlepretendnurse said...

This one hits close to home. I come from a long line of alcoholics. My father, grandfather (on the other side even), many uncles, aunts,and cousins.

I have seen the effects of alcohol in many points of its cycle. I can remember as a young child walking home with my grandpa trying to keep him outta the ditch. I can remember waiting for hours for my dad to return home from paying bills one weekend to find that he had drunk over 300 dolllars. Money that had been collected by church members to help my grandmother with her bills which didn't get paid and groceries were never bought. It all started with just one drink that day. As a young adult I watched a friend collapse into my arms and fall apart because she had made choices she just wouldn't have made sober. As a nurse I have seen what it does to the body. I had a pt that looked about 12 months pregnant her belly was so big from ascites. I thought she had peed all over herself till I saw the cathater. Her legs were weeping that much. It was all directly traced back to alcohol.

This is why when people ask me to go to bars with them or just have one drink with them I politely decline.
Sorry for the long comment but this one certainly hit VERY close to home.

Anonymous said...

Thank you.

Signed, in recovery for a few 24 hours with two beautiful children and a husband.

If I don't put my recovery first in my life, I will have no family.

Anonymous said...

Too familiar.

Too painful.

SeaSpray said...
This comment has been removed by the author.
911RN said...

Hit very close to home...we buried my brother-in law to Cirrhosis- 4 years ago- at the "too young to die" age of 49! Buried another close friend- 3 years ago, at the same age with same diagnosis.

We just performed a family sponsored "intervention" for my 55 year old brother-in-law- he is currently in extended Rehab. He was on the same path and we could not see another family member or friend die without doing "something". We had learned from the other two premature deaths. It was pay for Rehab or pay for his imminent funeral. So far, so good for him. He remains in rehab...4 weeks and counting. Has a few more weeks to go.

As a ER nurse, I see the damages from alcohol abuse/misuse daily. The revolving door of those seeking Detox (time and time again), young cirrhotic patients arriving for emergency taps for distended, ascitic abdomens and I appreciate the toll the disease takes on them and their loved ones.Sadly, most have nothing AND nobody by the time the end arrives. They have exhausted any and all material and people resources by the end. Anyone who works in the ER has seen true tale unfold (too many times).

"Mrs. Smith" is fortunate- she still has loving children and a husband who are supportive. They are willing to still help her.I pray she makes it. Tough disease but it's possible to fight it with the right treatment and support.Demanding Mistress, indeed!

As for me, I choose not to drink or only minimally- on rare occassions.Just not my thing... I have just never had the taste for it nor liked the feeling of being intoxicated. Fortunately, my parents were not drinkers.

However, I see raging and budding alcoholism within extended family members (mine and my husband's). I am watching the drinking habits of my numerous nieces and nephews- as young adults, now, and fear they are heading down the same path as some of their parents.

I have taken the opportunity to discuss the family history and nature of addiction/abuse with them on the 'right' occassions during quiet, teachable moments. I hope some of it sinks in. The pain of alcoholism and/or drug addiction is a heavy, life destroying burden for all those close to it. Plain and simple- hell on earth.

Thanks for a compelling, relevant, real life "story". Wish it was fiction but KNOW (all too well) that what you speak of is reality, for too many, on a daily basis.

911RN said...

Hit very close to home...we buried my brother-in law to Cirrhosis- 4 years ago- at the "too young to die" age of 49! Buried another close friend- 3 years ago, at the same age with same diagnosis.

We just performed a family sponsored "intervention" for my 55 year old brother-in-law- he is currently in extended Rehab. He was on the same path and we could not see another family member or friend die without doing "something". We had learned from the other two premature deaths. It was pay for Rehab or pay for his imminent funeral. So far, so good for him. He remains in rehab...4 weeks and counting. Has a few more weeks to go.

As a ER nurse, I see the damages from alcohol abuse/misuse daily. The revolving door of those seeking Detox (time and time again), young cirrhotic patients arriving for emergency taps for distended, ascitic abdomens and I appreciate the toll the disease takes on them and their loved ones.Sadly, most have nothing AND nobody by the time the end arrives. They have exhausted any and all material and people resources by the end. Anyone who works in the ER has seen true tale unfold (too many times).

"Mrs. Smith" is fortunate- she still has loving children and a husband who are supportive. They are willing to still help her.I pray she makes it. Tough disease but it's possible to fight it with the right treatment and support.Demanding Mistress, indeed!

As for me, I choose not to drink or only minimally- on rare occassions.Just not my thing... I have just never had the taste for it nor liked the feeling of being intoxicated. Fortunately, my parents were not drinkers.

However, I see raging and budding alcoholism within extended family members (mine and my husband's). I am watching the drinking habits of my numerous nieces and nephews- as young adults, now, and fear they are heading down the same path as some of their parents.

I have taken the opportunity to discuss the family history and nature of addiction/abuse with them on the 'right' occassions during quiet, teachable moments. I hope some of it sinks in. The pain of alcoholism and/or drug addiction is a heavy, life destroying burden for all those close to it. Plain and simple- hell on earth.

Thanks for a compelling, relevant, real life "story". Wish it was fiction but KNOW (all too well) that what you speak of is reality, for too many, on a daily basis.

Peter said...

During my training in the 70's I worked in a male ward whose main occupants were alcoholics who lived on the streets of Darlinghurst.

Putting aside the dreadful conditions they lived in and their deplorable health conditions, most were great characters with a wealth of stories that could both warm your heart and make you cry.

Once young men with great ambitions and family ties, life passed them by as they became old men before their time.

Where are they now? At peace at last, one hopes.

Take Care,
Peter

Anonymous said...

Thank you for writing this; I needed to read it. I have been sober for over a year but have fallen off of AA meetings over the last few months... Think it's time to hit one again.

God, six years sober and right back at it.

Anna said...

Jim another great post! I hope to that the mother will finally take the right steps, children do not deserve that kind of life. Anna :)

Smalltown RN said...

Like so many have written here it touches close to home for me as well. Reading some of the comments it echos things I have seen and experienced. There is nothing worse than seeing a loved one experience an alcoholic seizure. There's nothing worse than watching someone you love not be able to take control of the devil drug.

The governments are so busy policing street drugs...alcohol is just as bad...actually I think worse because it is legal...it is considered OK or acceptable.

I truly hope this woman is able to find the path to wellness and hopefully regain the love and trust of her children.

So many lives have been ruined from this evil drug.

Thank you for a wonderful and valuable post!

Em said...

I have been a follower to your blog for awhile now but I don't believe I've ever commented. I just wanted you to know how beautiful of a story-teller you are and that I think it is wonderful that there are still doctors like you left in this world. It gives me a kind of hope. Have an awesome day and check out my currently-abandoned-but-I-swear-I-am-gonna-post-again-soon blog. Em.

Em said...
This comment has been removed by the author.
Em said...

Oh no! I accidently posted my comment above twice so I removed the second comment but it left it with a comment-removed message! Now it looks like I made bad comments and removed them! Great! Oh well. Anyway - the removed comment? It was a duplicate. Sorry! And now this will be my 3rd comment for you that I have left today. I'm going for a record. Most-amount-of-comments-I-can-leave-on-someone's-blog-today :) Em.

SeaSpray said...

She CAN succeed. I have witnessed it. She was told she could never drink or smoke again. i know someone else who quit cold turkey and I guess amazingly never had seizures such as you describe.

And AA is loaded with positive testimonies.

I have seen in my personal life ..the ravages of alcoholism, but thankfully didn't progress as far. It leaves it's scars though. that is inevitable.

Years ago ..I read a book by Suzanne Summers (Read it in 1988), in which she discussed her horrendous child hood growing up with her alcoholic father. her siblings became alcoholic. She didn't but she had self destructive behaviors. In the end ..they were all healed of the disease because he went to AA. I don't recall if her mother went to Al-Anon ..an excellent group for people negatively impacted by an alcoholic in their life. these programs are free and last I knew ..they had a high success rate.

Alcoholism, drugs, food, smoking, gambling, shopping, porn etc., etc., pick your addiction ..so many are afflicted with theses things. No one plans to be an addict and I imagine the line for which one crosses over to the dark side of addiction is different for everyone. But there is help. The addict has to make the choice. there is a saying .."But for the grace of God ..there go I." It's easy for some people to judge ..but unless you've been down that road ...

That being said ..it DESTROYS lives and robs innocence from children. The negative ripple effect is profound.

People living with an addict should get help for themselves. If there is one well person in the house ..then the children stand a better chance of not succumbing to the disease themselves.

There is help and people can overcome these things. but it is work.

I am amazed when you hear stories where alcoholics or someone with a life threatening disease will say they are grateful it happened or they wouldn't be in the good place in life that they are with the awareness that they have.

You are so compassionate Jim. I've often seen ED docs that do not have the patients for this stuff. I guess it depends on the circumstances.

Rogue Medic said...

Very sad.

A parent with a responsibility for two children and for herself, but abandoning all of that for a habit.

Habits are hard to break. Add a chemical dependency and it becomes much more difficult.

There must have been a time, in the beginning, when we could have said – no. But somehow we missed it. - Tom Stoppard

Kate said...

anymore, I can't stand to see the hope in the children's eyes when the mom goes to treatment "one more time." I think maybe I need a break from volunteering at the treatment center because that kind of attitude doesn't help anyone.

Karen said...

I hope and pray this patient can finally want to/need to stay sober, for her children, and for herself.

Anonymous said...

Alcoholism is a family disease. But it can also be a family in recovery. Just spent the weekend in San Antonio, Texas for 75th AA International Convention with 60,000 recovering alcoholics. WOW! The best weekend of my life. Recovery is beautiful. Al-anon is an awesome resource for families of alcoholics. These programs have changed our lives.

Hope said...

Dear Dr. Storyteller,
Imagine if instead of an alcoholic, this was a type 1 who took too much insulin and went into a coma. Would she be so deserving of the judgement that Mrs. Smith is getting. It seems that people have more compassion for Mr. Smith who decided that his wife's disease was reason enough to break his family up and leave two children there to deal with the consequences. It is obvious that Mrs. Smith has a problem and it is obvious that she has made attempts to control it. But alcoholism is a disease of relapses. That she said "I'm quitting" and then drank is just shows that the alcohol controls her, not the other way around. It's what alcoholics do. I just find it sad that even when she is trying to get control, she can't find any compassion from anyone.

Rogue Medic said...

Hope,

Dear Dr. Storyteller,
Imagine if instead of an alcoholic, this was a type 1 who took too much insulin and went into a coma.



Actually, this is not that uncommon, either. Some people who work in emergency medicine are more critical of those who manage their diabetes poorly.


Would she be so deserving of the judgement that Mrs. Smith is getting.


I think you have been reading too much judgment into the post and the comments.


It seems that people have more compassion for Mr. Smith who decided that his wife's disease was reason enough to break his family up and leave two children there to deal with the consequences.


Where does it state that this is the case?


It is obvious that Mrs. Smith has a problem and it is obvious that she has made attempts to control it. But alcoholism is a disease of relapses. That she said "I'm quitting" and then drank is just shows that the alcohol controls her, not the other way around. It's what alcoholics do. I just find it sad that even when she is trying to get control, she can't find any compassion from anyone.


Perhaps you should reread this and reconsider your comment about lack of compassion.

If you read through the comments, you will find that your comment is very different from the others. You may feel that you are more observant than everyone else, but I think that you are the one who has not noticed the compassion in the post.