Not me. (Today)
Though this episode and the step work I am doing have helped me reflect on the ‘bottom’ parts of my drinking and my life.
This is another of those work posts, that I just have to write, because I have to get it out. It has moved me and stirred my deepest emotions, both positive and negative, and I think this kind of situation brings out both the best in me as a doctor and potentially the worst. Living on this knife edge between going the extra mile that could (literally) save someones life and falling in to the crevice which is over involvement, control and micromanagement is both stressful and requires reflection, communication and support.
So. On Monday I was the duty doctor at my surgery. This role involves talking to all the people who call up saying that they need to see the doctor that day, when we have no more appointments. Essentially I see the ones that need seeing, and others I offer advice, medication , signposting to another provider or booking an appointment later in the week. The number varies from 6 to 60 calls a morning.
Monday was busy.
Half way down my list I saw a call from a woman who I know is an alcoholic in denial. She has a small child and social services and the local alcohol team have been involved with her over the last six months. I will call her X, although that is not her initial. X has managed to shake off social services and the alcohol support team by insisting she was abstinent, but we (and I particularly) were quite sure this was not the case. But you cant help anyone until they ask for help …I saw her name on my list, got a prickle at the back of my neck, and picked up the phone.
Not good. She was drunk and desperate. I told her to come straight in, that I didn’t care if she had been drinking that morning, but come in, and tell me the truth. I sensed an opportunity and was keen to grab it. She did. I have not seen someone in such a bad state of alcohol withdrawal since I worked in hospital (more than 20 years ago) She was hallucinating, scratching till her arms bled, tearful, incoherent and falling over. She told me everything, and then more. Her rock bottom had arrived because her partner had left with their child and she was alone at home.
Now the rant. Like I said, she was in an appalling state and acute alcohol withdrawal is a medical emergency, the risks to life are very real from fitting, aspirating your own vomit and accidents to name a few. If she had MONEY I could have got an IP alcohol detox follows by 4 weeks residential rehab (which is the least she needs) on that same day. Because she has no money there is NOTHING. The advice from the ‘drugs and alcohol team’ was to go home and drink (really !!! ) at 80% of what you were drinking and withdraw slowly. FFS this person is an alcoholic, by definition she cannot control her drinking. This made me very angry, and frustrated and scared and led to that feeling (which I hate) of total powerlessness. I have previously offered to supervise a home detox – but only if there is a responsible adult also living with the patient (to supervise the medication and call an ambulance if necessary) I gave her 20mg of valium which barely touched her symptoms and eventually by a combination of begging and medical jargon slinging managed to get an acute hospital bed to at least start the detox. A friend of hers from that amazing fellowship collected her from the surgery and took her to hospital.
48 hours later, they are going to discharge her. FFS. Some muppet again suggested that she go back to ‘controlled drinking’ (really these people need some education) but in the end one of her friends from AA has agreed that X can stay with her, she will bring her in every day, and I will supervise a home detox (to complete the process safely) Will she agree to this? I have no idea. Her parents are at their wits end, her partner has left, this is, must be, rock bottom for X – but I am also wise enough to know it may not be…
So where am I in all this? Going the extra mile, that’s for sure. Taking a chance, yes. Over involved – probably. Not bonkers – shes not staying with me, I haven’t offered to fund her rehab (!) and I won’t detox her unless she is with another adult. But I’m examining my own boundaries, and considering my own emotional response to a fellow addict in deep deep trouble. The part of me that has always always cared too much for my patients is in the driving seat of my decision making (my first choice of career was Oncology but, in a rare flash of emotional clarity years ago, I knew I was not emotionally detached enough to work solely with people who are likely to die)
However, and I think this is important, I do recognise that I can only do so much. In the end the responsibility for her recovery is with her, I can help, (I can help a LOT) but I cannot do it for her. In her desperation, humiliation and shame on Monday I told her I too was an alcoholic (and I sort of regret that now – although I am quite sure she will not remember) and by great good fortune the AA friend who came to her rescue, and has offered a place of safety is my friend D. She and I have spoken about this and I’m confident that we can support each other and talk though our feelings about this to (and this is the most important thing) keep ourselves sober and not get sucked too far into it.
Is this over-involvement with a patient a good excuse to run away from my OWN stuff ? Am I using X’s disaster to avoid facing stuff that’s very painful for me ? Possibly – I have certainly recognised that this is a tendency I have. And there is certainly a LOT of painful stuff swilling around at the moment. Completing an inventory of incidents when my alcoholism made me behave badly, and another set where my addiction caused my life to become unmanageable … that’s hard, shaming and embarrassing. Even with 802 days sobriety (as an aside I cannot imagine doing this in the very beginning of recovery, the intense self- loathing that comes along would have been just overwhelming for me before now). The nice feeling of being useful, important and having people think (very) well of me for helping and supporting X – is that a distraction from the other stuff where I feel so very inadequate and that I have failed in so many ways?
I will discuss this with Angela later. And I will reflect reflect reflect – I hope this will help me avoid the trap of overstepping boundaries in a destructive way.
Because boundaries are there to keep the patient safe as well as the doctor. And I need to remember that.
This morning, talking to my AA friends at coffee I confided that I often mutter the serenity prayer when I’m feeling overwhelmed… so here it is