Wednesday, January 26, 2005


Six inches of snow blanketed our region over night and this morning. The dogs seemed to be begging me to stay home and play, but I was a good little worker bee and drove the sloshy roads to work, the first stop being to get gas, shivering in the cold as I pumped fossil remains into my hunk of rolling steel and plastic. Next stop was a bar and hall in a nearby town, where I found my previously mentioned patient, "X", sitting at a table reading the paper as several older gentlemen drank beers at the bar. It was 9:30am. I felt like a visitor from another planet, or at least another era.

We ensconced ourselves in the very clean and well-kempt hall---replete with chandeliers, large tables and a dance floor---and I launched into my "scare-the-shit-out-of-him-with-the-naked-truth-speech". I showed pictures of a healthy liver, a fibrotic liver, a cirrhotic liver, and a cancer-ridden liver, and was very frank that his organ is enlarged, cirrhotic, and predisposed to failure, or possibly carcinoma, and that each drink of alcohol is akin to pouring gasoline on a roaring fire. He looked at me with his very sad (non-jaundiced) eyes and had little to say verbally, but his grave expression told me that I had hit home. That said, whether he can translate that into action and change remains to be seen, the tentacles of addiction being powerful and beseeching friends who will attract the afflicted person like the smell of barbecue will attract a hungry dog.

So, after having blown off his post-hospitalization follow-up visit, never filling his prescriptions that were given to him upon discharge, and drinking lots of alcohol since getting released, he is faced with an earnest nurse whom he trusts telling him that if he keeps drinking, he will most certainly die, and probably not with the kind assistance of a beautiful prostitute-turned-nurse like Nicholas Cage in "Leaving Las Vegas". He will most likely go into acute liver failure while in his apartment late at night, with various gruesome clinical situations unfolding too quickly for him to call 911---but wait, he doesn't have a phone. If his liver does go into acute failure, he might become extremely confused ("obtunded" is a term we like to use) from the rising level of ammonia (yes, ammonia) in his blood, poisoning his brain and curtailing his ability to think clearly. He might then hemorrhage internally or lapse into a coma, his friend with the spare key finding him stiff with rigor mortis in a day or two. These and other unpleasant scenarios certainly await him if he chooses to continue to walk down that road of addiction.

Will my candor pay off? Will he choose to move towards healing and recovery? I can't say, but I wouldn't hold my breath. I'll keep tossing him a line, offering my hand, but if his hands are busy with the bottle, my offers will go untaken, and I will attend yet another wake some time in the near future, just like the one I attended a few weeks ago. That gentleman was addicted to crack and cocaine, and try as I might, I could not turn him towards proper treatment of his AIDS, and he died of liver failure as well, a victim of his own trauma and loss, lapsing into a seizure and dying a quiet death in a specialized care center in Boston where we had sent him to die.

The saga of X will continue, as will so many other sagas that will go untold, those to which I am witness, and those which occur on the fringes of society where they reach their dramatic denouement with barely a ripple made or notice given. I dance in these lives, or at least on their outskirts, but there are often reluctant partners who refuse my hand and slip into the darkness. May their learning in the next life be less painful; may their souls know peace.
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