I knew my patient on a first name basis, because that’s how many times I’ve seen him in the emergency department. When I was an intern our usual exchange consisted of what caused him to relapse again. Stress, boredom, isolation, I’d heard almost every rationale. Three years later, and observing this same pattern, it became clear to me that he probably hadn’t spent much of the last 40 years sober.
Over the years I worked with him I got to know him fairly well. He shared that his wife left him years ago, that his daughter doesn’t speak to him, that he doesn’t have any friends. The picture he painted for me regarding his feeling of aloneness in the world was wrenching, but he never said that word out loud. “Alone.” Maybe it was too hard for him to hear that word come out of his mouth, because then he would have to face the harsh reality of its existence. And his circumstances.
All that appeared to be left of his human relationships and social life was with the people at the liquor store he shopped at several times a week, the emergency department staff when he came in for his medical woes, and the psychiatry team when he came into the emergency department asking for a medical detox. All of the residents know him. We try to understand his triggers, his mood symptoms, and get to the bottom of what is fueling his drinking. The difficult part is that he enjoys it. He describes alcohol like a long lost love. He speaks of it as if it’s a person. He talked about the joy he gets from the smell, from the taste, from its ability to numb him, his ability to lean on it when he has a tough day, and is able to drown his sorrows in its contents. It’s there from the time he wakes up until the time he goes to sleep at night. It’s the only constant in his life, and never leaves his side.
He often comes in requesting help for his addiction. We have hospitalized him many times to complete a medical detox, with the plan to transition him into long term care. He never went. Each time he would come into the hospital there was always a glimmer of hope that perhaps one day he would invest in his health and well-being and commit to becoming sober. But that day never came.
I was in the emergency department one night, evaluating another patient when I caught wind that my patient was hospitalized. He was found unresponsive, was taken to the intensive care unit, resuscitated, intubated, and the medical team was hoping for the best. Knowing what I knew about the abuse his body had taken over the years, I was hopeful, but not surprised when I found out that his labs indicated his body was failing him and there was no hope for recovery. Family was contacted, and in their desire to show him mercy or be rid of him, the decision was made to make him comfortable. He died the next day. Nobody was at his bedside. Nobody cried for him. His family came the next morning to sign papers, and were offered his things. They took them, threw them in the trash and left.
There is something about a patient dying that makes you rethink every step you took in their care. Did I try hard enough? Did I do enough? Did I make a difference? I believe that every person who was involved in this patient’s care hoped and wished that he would get better. I remember having a very frank discussion with him about his elevated liver enzymes and hypertension being negatively impacted by his drinking. I distinctly remember being very honest, almost to the point of cruelty, by telling him that his body would not be able to take much more of his drinking, and that someday his alcohol use would kill him. He would usually deflect, laugh, and say “but not today.” For his sake I hoped that would be true, knowing that each day provides an opportunity to do things differently than the day before.
I wish he listened.