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.”
It wasn’t until the spring of 2012 that I discovered that Linda had become an increasingly self-abusive, though quiet, alcoholic. One night I heard whimpers outside my apartment. I got out of bed to investigate. I opened my door to find Linda face down in the hallway in only her bathrobe, bloodied. She smelled awful.
I immediately rolled her onto her side. She was non-responsive but she had bounding pulses. I ran back into my apartment to grab my stethoscope and my phone. She had good breath sounds but was not responding to my forceful sternal rubs.
Finally I recognized that awful smell: my alcoholic patients. I dialed 911. While EMS was en route, she became more responsive. When they arrived, we took a look around her apartment. It was beautifully decorated – like the home of a real adult. But there was also a broken wine bottle on the kitchen floor and blood everywhere. I tracked the blood back to her bathroom. Worried about an overdose, I opened the medicine cabinet – no prescription medications. I was relieved.
It was weeks before I saw her again. When I did, she had a cane. I could hardly believe it: an attractive 40-something-year-old woman, making do with a cane.
“Hi doctor. I’m back,” she said.
“Are you ok?” I asked.
“Yes. And I have you to thank. If you hadn’t found me so soon, my hematoma probably would have been inoperable, they told me.”
She had drunken herself into an accidental traumatic intracranial bleed. She had gone to the OR and had been recovering in physical therapy for weeks.
“I’m never going to drink again. I’m done.”
I was stunned but I didn’t let on. I told her I was glad to have helped her in any small way. After never really helping an alcoholic patient, I was proud of myself. Maybe I finally had.
The doorman later told me that she had been drinking for years – especially after losing custody of Natalie. Linda had called 911 for herself many times when she had gotten too drunk. Lately, things had been escalating. The doorman said that delivery men would bring her booze to her apartment. When they refused because she ordered too much, she called another store. I had never noticed. I’d always assumed she had many meals delivered, like half the city.
After her surgery and PT, things were quiet – there was less traffic at her front door. The day I matched into residency, she slid a congratulatory message under my door. I was hosting a party for my classmates. I opened the note and read it, holding her note in one hand and a bottle of champagne in the other.
“Dear Dr. Jeremy, Congratulations on finishing medical school. If it had not been for you, I don’t know if I would be alive.”
Months went by. Her cane disappeared and her walking improved. Then, delivery men began to reappear. I’d hear a knock at her door while I was eating after a shift. I’d peer through my New York City apartment peephole to see what was going on. I couldn’t ever quite make out what was in those delivery bags.
“Maybe it’s Thai food,” I thought.
Then, when I got home on Sept. 22, 2013, I saw that NYPD green sign taped onto her door, near where Natalie’s watercolors once hung. The sign mentioned an order pursuant to an obscure NYPD code. I Googled it.
All that came up was comments from a sleepy old online discussion forum with some chatter between a few faceless netizens talking about mysterious green signs on their neighbors’ doors. They were discussing their neighbors who had died in their homes. I got a pit in my stomach. I went downstairs to speak to the doorman.
“What happened to Linda?”
“I don’t know,” he said. “When I came on to my shift, the super told me the police removed her body today. She’d been drinking again.”
I have still never saved an alcoholic. But I’ve resumed printing out those detox program referral forms, though, and I counsel my alcoholic patients. I never asked Linda the CAGE questions; Now all that is left behind is a green NYPD sign and a Wifi network called “Natalie.”
Dr. Jeremy Samuel Faust is an EM resident at Mount Sinai Hospital in New York and Elmhurst in Queens. He tweets about #FOAMed and classical music @jeremyfaust.
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