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?
Explore This IssueACEP 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.”