Saturday, August 26, 2006

Turning Corners, Connecting Dots

Recovery, healing, and a new life reality are always around the corner. In healthcare, watching someone make that shift is incredibly gratifying.

Two of my current patients are both making great strides in their recovery, accepting help and attempting to make positive choices. One's drug of choice is alcohol. The other has a predilection for cocaine and heroin. Each one has other health problems which only magnify the urgency of making better choices: cirrhosis, hypertension, diabetes, neuropathy, depression, anxiety. No matter the constellation of comorbidities, the potential outcome---disability and death---is certain.

I try to offer a clean slate with each visit. My role, while multifaceted, is also quite simple. I provide guidance, compassion, tough love when needed, and a steady hand through the rough patches. I tell them: when the cravings come, call me. When the pain is too much, call me. When you feel like you're so afraid you want to die, call me. When you need a pep talk, call me. And these two people really do call---as do some others---and now it's paying dividends.

One of the secrets to guiding our patients towards health is getting them to pay attention. If they don't focus on the fact that their liver is affected directly by every drink, every drug, every decision, they just don't connect the dots. If they forget how important it is to tightly control their blood sugars, they lose sight of the prize. If they can't connect their current symptoms with their lifestyle choices, they're lost. Health is a complex entity, and seeing the lightbulb go off in their head is a gratifying moment in itself. Watching them use that lightbulb to illuminate their darkest corners of pain and regret is pure magic.

When it all comes down to it, it is compassion which drives the vehicle. Even when they come in, sit down in the exam room, and say "I fucked up. I used again this weekend. My life is over," I try to keep my expression neutral, my voice calm. "OK. You made a poor choice. But today you're here. Let's talk about today and tomorrow. What next? What's the next step?" I maintain my equilibrium, look them in the eye, hand reasurringly on their arm, my gaze steady but soft, open and inviting of confidence.

One man has been clean of alcohol since January of 2005 and has turned his life around. He is still struggling with the fact that he can't hang out with his old friends anymore and feels isolated. "I don't have much fun since I quit drinking. Everyone else seems to be having such a good time. It's lonely." But he keeps on the straight and narrow, and though his liver is riddled with cirrhosis, it seems we caught it just in time. While he may not be agood candidate for a transplant, he's a good candidate for a paradigm shift. He's living and eating well and trying his best. He turned a corner and never looked back. That liver will eventually kill him, but we don't focus there, turning our gaze forever on the present.

Another patient relapses again and again but now may be on the right road. I finally got him into an outpatient addictions treatment program and he's doing the work, plus going to meetings every day. Frightened of death and disability, knowing that his liver is damaged (but not yet beyond repair like the gentleman in the previous paragraph), he wants to do it all. He sees the cardiologist, shows up for appointments, sees our psychologist, and continues to make the right choices. We treat him like the respectable human being he is, with dignity and respect. He responds by coming back again and again, ready for more. I cant promise him he'll live forever, but I can promise him improved health and quality of life if he pays attention. And his attention is currently riveted----eyes on the prize.

For each patient who I cannot reach, who is lost to their own devices, there are several who respond to the call and step up to the proverbial plate. Their stellar performance, their willingess to engage again and again, that can keep me going. The others? I keep sending out the bait and trying to reel them in. Some respond from time to time, some crash and burn, many die. The hand is always there if they want it----if they can even see it. One such gentleman is now institutionalized forever, having ruptured his esophagus from intractable vomiting. He admits that he should have listened, that he should have known this day would come. Regretful and sad, his body filled with tubes, unable to ever eat or drink again, he is a living example of what happens when one fails to pay attention and falls into the abyss again. It's dark in there, and he was saved only by a miracle. He's a living example, a sad reminder to many. I feel such compassion for him, such sadness.

Back to the present, there are many more willing to take the leap of faith, and we're ready for them every day. What a treat to watch as a person turns that corner, beaming a smile of pride, and seems to finally "get it" in a way that is irreversibly joyful. The dark moments still come, the corners in need of illumination still harboring silent watchful demons, but there's still room for recovery and growth, the light filling the room with hope. That light is what we try to point out, and many thankfully refuse to shade their eyes and step over that threshold. It is a wonder to behold.
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