Wednesday, April 26, 2006

Good News Welcome Here

"You mean I'm actually a little better?"

"That's right. I'm thrilled," said the hematologist/oncologist.

"Wow. That's good," he beamed. I just smiled from my chair.

I've written about Patient X a number of times. He almost died from alcoholic hepatitis about eighteen months ago. He was living in the basement of a friend's business, drinking himself sick, psoriasis ravaging his skin, his gout painful and swollen. He was miserable and would lash out at every opportunity. I used to avoid him.

Then his liver crapped out and we read him the riot act. After discharge from the hospital, he went on a little weekend bender. The following Monday we had a frank discussion, and I offered him two alternatives: stop drinking, or die a wretched death. He hasn't had a drink since January of 2005, and the credit is all his. No AA. No meetings. No psychotherapy. Just him and his mind.

That said, he's not out of the woods forever. There is cirrhosis and permanent scarring of the liver that will never go away. Last month, he came to see me with complaints of black, tarry stool and vomitus like coffee grounds. Needless to say, that led to a hospitalization---stat.

Today was follow-up with his hematologist. He had been diagnosed with hemochromatosis---a dangerous iron overload in the liver and blood. Luckily, he had the type caused by damage from alcohol, not the genetically inherited variant. Thus, his current labs elucidate the fact that his liver, freed from the toxicity of alcohol intake, has recovered completely from the iron overload, illustrating for us that some of the non-cirrhotic areas have actually healed. As we enjoyed the fruits of this success, the hematologist and I exchanging very pleased looks back and forth, Patient X sat on the exam table beaming.

"You know I'm leaving for another hospital in six weeks," the doctor said. "You'll be following up with someone else next time."

"Can't I see you at that other place?" he asked like a puppy eager to please his master.

"It's a half-hour ride for you," she said, "but I'd be happy to continue to see you. After all, it'll only be an annual visit now."

"I'd be willing to take you there next year, Mr. X," I chimed in. I pictured taking him out to lunch, making an afternoon of it.

"Wow." He was beaming. "That's double good news. I get better, and I get to see you again next year."

The doctor's kindness and bedside manner is impeccable---just the right combination of warmth and clinical acumen. Perfect. In fact, she and I had an amazing and moving interaction with another mutual patient last year, and her manner is still amazingly consistent. I'll miss knowing that she's here in our hospital system, but she'll actually be working closer to my hometown, and we'll still bump into each other on the street from time to time since we both live in the same area served by her new hospital.

She describes for us her plans for a two-month break between jobs and a trip to another country this summer.

"Well, I'd better apply for a passport right away," quips Patient X. "I don't want to get left behind. Should I pack light?" We all laugh heartily.

This man has faced death without fear. Not only that, he has wrestled with his own addiction, grappled it to the ground, pinned its face into the dirt, and shown no mercy. He buried that addiction under the topsoil of his new love of life and desire to live. It's history, a memory.

"My old man forced me to drink a quart of whiskey when I was fifteen. Boy was I sick. I guess he wanted a drinking partner. That started it, and it didn't stop 'til last year. Jesus."

"I'm so sorry," the doctor said, hand on his shoulder.

"But this is great!" he continued, recovering from that memory. "All I want is to ride my bike, watch movies, eat well, and take my meds." His ruddy face was lit from within.

"Well, get some labs in six months, follow up with this guy" (she points a thumb at me) "and I can see you next spring."

"You got it, doc," he says. "Have a great time this summer. I mean it. And thanks again."

She closes the door and we walk down the hall.

"Congratulations," I say. "Want a ride home?"

"Nah. You go on. I gotta use the can, then I'll catch the bus." He shakes my extended hand, his foot holding the men's room door open.

"See ya."


"Don't be a stranger."


I exit into the sun and slight breeze, smiling. It's a very good day to live.


Melaina RN, PHN, MS, CNS, ACHPN said...

Wow. That is a great turn-around. I have seen too many people - and young people - die ugly deaths from alcoholism.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

So true. And even if he dies younger than his life expectancy because of the irreversible damage, it will be with the knowledge that he did everything in his power to turn those odds back in his favor. I am so proud of him.

Anonymous said...


Makes it all worth the effort, doesn't it?

What a story; what a dramatic turn around!