Thursday Morning With Ray and Don

The Wednesday night report from the emergency department described him as "Dx GI bleed, coughing up red blood X3days, 20 yr hx heavy drinking." They'd sunk a nasogastro tube, got nothing, and sent him up to us in a wheelchair. That's usually a good sign.

His labwork showed an initial blood alcohol level of 330 on admission to the ED the night before. High enough. His hemoglobin/hematocrit levels were okay but they decided to admit him anyway. We were to do more serial hemoglobin levels and transfuse blood if he got low. The gastroenterologist would see him in the morning and maybe scope him. He could have Ativan if he needed it.

I stopped in to see this patient the next day, Thursday morning, as I was wandering the hospital hallways aimlessly. His IV pump was beeping so I checked it and everything was fine. We chatted a little. He said he'd been taking Naprosyn regularly for some joint problem that he was planning to have surgically corrected sometime. He seemed pleasant enough. Then I went off to do stuff.

An hour or two later, about 11 a.m., Portia pulled me aside and said that he was screaming at her that he wanted to leave.

I don't like it when people scream at my coworkers.

When I walked in to the room he was trying to get dressed and he said "Take this thing out," meaning his IV, so he could pull his shirt on. His face was beet red, he was sweating, and he was trembling.

"Oh," I said. "I know what's going on here. You're jonesing for a drink. You're withdrawing. Man, that cannot feel good. You look sick."

He was. Classic. Textbook. Either that, or he is a very good actor.



That's a still of the late great Ray Milland in The Lost Weekend. He won an Oscar for that performance, the best of his career. The film also scored three other Oscars: best director for Billy Wilder, best screenplay, and best film. It did similarly well at Cannes. Jane Wyman co-stars. I saw it years ago on television. It's stark and unpleasant.

But not as unpleasant as the real thing, I guess.

"This is a problem," I said to Don. ("Don" was the name of the lead character in The Lost Weekend.) "You could stay here a while, and we could help you through this. Really. We've got drugs that'll make this a lot easier for you. This could be it."

He said that he just wanted to go.
He had people to meet.
He was going to leave.
Now.
He didn't drink that much, two or three beers a day.
He hadn't had anything to drink in a week.
He couldn't just call and explain to whoever he was supposed to meet that he was sick and in the hospital.
He had to get out now.
He was hungry.
We hadn't let him eat.
He didn't need any tests.
He was fine.

That's only part of the story, of course. Those are just some of the words. I had a few words of my own.

"You're an alcoholic. You're white-knuckling right now. Every cell in your body is screaming. You drink enough to cause bleeding in your digestive tract. You came here because you were vomiting blood. That doesn't get better without treatment. You can go home and take Prilosec, stop the naprosyn, and hope for the best. But you could also stay here and I'll get you enough Ativan to take your discomfort away for a while." He continued to get dressed. Muttering. Barely controlling his anger.

Portia had already told me that she had gone through about the same kind of thing with him. That's when he yelled at her.

He denied an alcohol problem. I asked him about the admission note indicating he had decades of hard drinking behind him, and said he "didn't care" and he started to pull out his IV himself. I asked him to wait a moment. The he got right up in my face and I thought "this is it. He's going to pound the shit out of me," but he held off. I got some supplies and took it out right.

Then Doctor Fela showed up. He asked Don what had happened, and I answered instead.

"He wants to leave, Against Medical Advice, because he's going into withdrawal and he wants to drink," I said. Don agreed to sign the form before he left, saying that he refused any further treatment. Doctor Fela went on to do some documentation. I followed him down the hall.

"I'm sorry for speaking on behalf of the patient instead of letting him answer for himself, Dr. Fela. But you know what? He was just going to lie to you," I said.

"I didn't even really get a chance to see him," said Dr. Fela, but he added that he "couldn't help him anyway."

While Don was waiting at the elevator to leave I approached him again and told him to please come back to us if he gets sick again, and he promised that he would. He had a hint of sadness on his face. He reached out and shook my hand, thanked me, oddly, then left.

My spouse's sister did a few days ago. They weren't close. She was an alcoholic. Bipolar. Did other drugs, too, but it was primarily alcohol. She was found dead at home, blood running out her nose.

As we age, people around us start to die.



Bergen-Belsen.

Alcohol.

Methamphetamine.

I probably would have tried to talk Don into taking some Ativan Wednesday night and on into Thursday morning. Oh well, fuck that, it probably would not have helped. He wasn't in the weeds yet then anyway. Fuck all.