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Learning From the Alcoholic Down the Hall

By Jeremy Samuel Faust, MD, MS, MA, FACEP | on December 1, 2013 | 0 Comment
Opinion
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Have you ever saved an alcoholic? To my knowledge I never have. When I started residency, I approached acutely intoxicated patients with the earnestness of the newbie that I was. Once they were clinically sober, I would ask patients the CAGE questions: Should you “cut back?;” Do you get “annoyed” at others talking to you about your alcohol use?; Does your drinking cause you to feel “guilt?”; and do you ever drink an “eye-opener” to get your day started?

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ACEP News: Vol 32 – No 12 – December 2013

After I grew tired of the “professional” alcoholics rattling off their answers: “no, no, no, and nah,” I began to remove the CAGE questions from my protocol. But I kept handing them photocopies with information for the local rehab centers.

When I started to notice those papers littered outside the emergency department entrance and saw many repeat patients, I turned the corner that most emergency department doctors regrettably and irrevocably must turn at some point. I saw these patients as hopeless. I stopped seeing alcoholics as patients I could help. My job was to figure out if they needed a head CT or whether I could avoid one.

I simply began to convince the rotating internal medicine interns not to run “banana bag” IVs – they are expensive and there’s data suggesting they do not benefit patients – and to make sure I didn’t miss anything more dangerous such as toxic alcohols, drugs, or other causes of altered mental status. But for a typical resident like me, the most important part of treating a run-of-the-mill chronic alcoholic was that I wait just long enough so that the patient was clinically sober for discharge, but not so long that I risked forcing the patient into alcohol withdrawal.

My cavalier attitude came to an abrupt halt on the night of Sept. 22, 2013. I came home to my apartment after an unremarkable shift and noticed a green sign on the door crease of my across-the-hall neighbor’s apartment. The sign was from the New York City Police Department, and it had not been there at 10:30 a.m. when I had left my apartment. No unauthorized persons were permitted to enter the apartment. I called the number on the sign but there were no after-hours operators.

I had known my neighbor “Linda” since I moved into my building in 2008. She always called me doctor, even before I graduated from medical school. She came from some family money who helped pay for her apartment. She had been married but was now divorced. When I first moved in, her daughter “Natalie” spent a significant portion of her time there, her school drawings adorning their apartment door. Over time, though, I saw them less. Eventually, I stopped seeing Natalie altogether. The drawings disappeared. I wondered if Linda had lost custody. The only reminder of her was the Wifi network, named “Natalie.”

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Topics: AlcoholicIntoxicationResidentResident's Voice

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About the Author

Jeremy Samuel Faust, MD, MS, MA, FACEP

Jeremy Samuel Faust, MD, MS, MA, FACEP, is Medical Editor in Chief of ACEP Now, an instructor at Harvard Medical School and an attending physician in department of emergency medicine at Brigham & Women’s Hospital in Boston. Follow him on twitter @JeremyFaust.

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