Update on Horatio – Late December 2011

Horatio’s work called my father when he did not show up to work a couple of weeks ago. This was then followed a week later by another call from his manager regarding the same subject, except this time he had missed both Monday and Tuesday (I’m reminded of the scene in Office Space in which the consultants inquire about him missing days of work, and he responds, “well I wouldn’t say I’ve been missing it, Bob”).

After receiving the call, my father went over to Horatio’s house and found him completely drunk with an empty 1.75 liter of Smirnoff Vodka in his kitchen. My father asked Horatio to come with him back to his house where it is an alcohol free home. This would allow him to sober up and resume working (I disagree with my father forcing Horatio to come back to his house because this is a form of enabling as well as the fact that it must be my brother’s own motivation to stay in an alcohol free home). From what I heard, there was a lot of resistance to get him to leave his house, but he finally came with my father.

These two occurrences are very disappointing and demonstrate a new pattern of Horatio’s drinking cycle. It appears that he is able to maintain his sobriety during the weekdays in which he must show up at work (sober or not), however, when it comes to the weekend, he is unable to control the temptation to get obliviated with a large bottle of vodka.

A simple solution for him to avoid these severe alcohol binges would be to temporarily move to my Father’s house over the weekend when he is most vulnerable to his weaknesses. Unfortunately, this is not something that he will be too agreeable with, but I hope that he will at least listen and contemplate the idea.

For some reason, I am looking forward to getting home and having a discussion with Horatio. I shall update you after I sit down with him and discuss the current situation. Your ideas and suggestions are much appreciated, feel free to leave a comment or send an email.

Update on Horatio – Early December 2011

It is coming up on 2 months since I last wrote about my alcoholic brother, Horatio. He has had some great success at abstinence along with some unfortunate bouts of relapse. Every relapse is just as hard, if not harder than the last on him.

When Horatio and I sat down and talked 2 months ago, together we decided on two large areas. The first being that he will give me 30 consecutive days of abstinence. We discussed that this is a mountain of a task and that I would not expect him to be able to accomplish this without relapsing at least a handful of times. I emphasized that I did not care if he relapsed, only that he was honest with me when he did so that we could start over from day 1 again. He has still not given me 30 consecutive days, but I look forward to when I can congratulate him on a job well done.

The second order that we agreed on was that he would put all areas of his life aside until he was sober for at least 30 days. This meant that he could not look for a job, he could not look for a girlfriend, and he could not work on other areas of his life that were not directly related to remaining sober. If he wanted to exercise or go to AA meetings or relax with family and friends, then that was perfectly acceptable, so long as it was sober activities. Unfortunately, he has not succeeded in this area either. He had been actively looking for a job and was hired 10 days ago.

This concerns me for many reasons. The primary reason is that Horatio does not have good coping skills. This is what leads him to pick up the bottle in the first place. An individual with poor coping skills will have a much greater likelihood of succumbing to relapse. He has already disclosed to me that over the very first weekend after his first 3 days of work that he had a relapse. Fortunately he was able to sober up before Monday morning and still has the job as far as I know. I assume that it is only a matter of time before they find out his dirty habit.

In our most recent discussion I reiterated that I was uncomfortable with him having a job when he still has not given me 30 days of abstinence. Rather than hassling him about this, we discussed ways to help him cope with stress and made sure that he knew I would always pick up the phone if he was thinking about having a drink. I hope that he has the strength to do so.

Methadone For Sale!!!

After a year of clinical rotations, I am still not absolutely certain what particular field of medicine I want to enter.  However, I do know that there are fields that I would not want to touch with a ten foot pole:

-Surgery – No thanks. Although I enjoyed cutting in to people and the simplicity of surgery itself, it’s just not for me.  My ego is fine how it is and does not need that extra boost of being able to say, excuse me, I’m a surgeon.  Especially for the price of living a life of 5am mornings and despicable attendings.

-OB/GYN – No thanks. While I appreciate that there is a field for female doctors to think that they are surgeons, I would rather not subject my manhood to the catty girls club that entails OB/GYN.

-Anesthesiology – No thanks.  I don’t understand why some of my best friends desire this field.  They say it has lots of procedures and it’s fun, but all I see is intubations, lumbar punctures, and being the surgeon’s servant.  I’m pretty sure it’s mainly the money and shift work that entices them.

-Pathology – No thanks. I’m not one for looking into microscopes in small dark rooms with little human contact.

-Radiology – No Thanks.  Again, I’m just not a fan of small dark rooms with little human interaction.  The most you ever say to the patient is, ‘please remain still.’

Click on image to enlarge

And then there is emergency medicine.  The residents in this field are stereotyped as the cowboys of medicine.  This allegory is often true; the residents are thrown in situations in which the right decision has to be made quickly.  Do we intubate this asthmatic with a rising pCO2 or not, do we spinal tap this obtunded child with fever and nuchal rigidity or not, do we place a chest tube in this 60 y/o man with acute CHF exacerbation who’s oxygen saturation is 80% due to refractory pulmonary edema.

The problem that I have with emergency medicine is not the field itself; rather, it is the type of patients that you have to deal with which deters my interest in the field.  Everybody knows this patient, even if you haven’t done a rotation in the ER.  She’s the one that doesn’t have health insurance and thinks the ER is a primary care doctor that she can get prenatal care from when she doesn’t have an OB/GYN doc.  Or the non-compliant male that continually returns to the ER in respiratory distress because he refuses to quit smoking, but it doesn’t really matter anyway because his 80-pack/year smoking history has already signed his obituary.

The patient that really tickled my nerves was a man that appeared to be the age of 35 years old.  He was an alcoholic, and openly admitted to it.  As well, he openly admitted to being an ex-heroin addict currently taking methadone.  He was actually a really nice guy and we ended up bonding because he genuinely seemed like he wanted to stop drinking.  My brother is an alcoholic so I shared some of my thoughts and ideas as well as related to him.  The patient has been unable to maintain a job for months because his life has been swallowed by alcohol and he can’t live with out it, much like my brother.  I felt like I was having an impact on this patient as I shared some of my stories with him and he shared his thoughts and troubles with me.

He was brought to the ER with the two large police officers standing on the opposite side of the gurney (who did not deny any of his story).  He was being booked for what I originally had assumed was for drinking in public or some other alcohol related charge and didn’t ask any further questions about it.  While the patient was at the police station, he had a seizure, this being the reason why he presents to me in the ER.  He stated that he had been drinking two pints of blueberry bourbon every day for the past two months.  The seizure was due to withdrawal from alcohol.  The patient stated that this was not out of the ordinary and that he previously had seizures before when he stopped drinking cold turkey.  So I do the normal history and physical, investigating for any other potential cause of the seizure (cranial nerves were intact, no motor or sensory deficits, negative cerebellar signs, no obvious metabolic disorder).

It was not until later on when the patient was giving a urine sample in the bathroom that the police officers spoke up to ask if I knew why he was being booked.  I assume the one officer asked in such an inquisitive manner because I was being nice to the patient rather than treating him like a drug addict or criminal.  The officer continues to explain that he is an ex-heroin addict that is now on methadone (which I had already gathered).  The important part of this is that since he does not have a job and has no means of income, the government steps in and pays for his methadone.  The money that pays for his methadone essentially comes from the police officers, you, me and everybody else who pays taxes.  Now the officer gets to the reason why the patient was being booked.  He states, “we caught him earlier on the street trying to sell.”

Dumbly confused as to why this was significant I pause, then ask, “sell what?” A thought crosses my mind that perhaps I was missing some kind of cop jargon and the patient was actually selling his body on the street for money.

The officer replies, “methadone.”

As I walked away, I wondered why the cop felt it significant to tell me this, then I began to realize.  The patient was receiving methadone from the government, which you and I are paying for.  He is then selling the methadone, which is essentially money from your pocket and mine, and using it to support his disgusting habit of two a day pints of blueberry bourbon.  Unfortunately, it doesn’t end there.  Since he was brought to the ER for having a seizure secondary to alcohol withdrawal, he is wasting even more taxpayer’s money by being in a hospital and wasting the time of the staff and the expenses required to run labs and tests to make certain that he is medically cleared to go to jail.

I find that I am unable to cognitively deal with this type of blatant abuse of a system and still try to say that I am happy with my job.  I know that I’m just turning a blind eye by choosing a different specialty, but it’s what my mind must do in order to keep my sanity.  If you have any better suggestions, then feel free to comment.