The Yale Journal for Humanities in Medicine

In Sickness as in Health

Brian Deady, M.D.
brian_deady@shaw.ca

A nurse leaned into the small office – my sanctuary from the noise and frenetic energy of the emergency department – to interrupt the necessary paperwork. A woman, a patient’s wife, she said, had arrived to talk to me.

I walked to the family room to greet her, gathering my thoughts, rehearsing what I might say to her. She stood up to greet me and as we introduced ourselves I struggled to contain my surprise. She was sober and healthy-looking, not what I had expected. Her husband had been transported earlier by ambulance, tremulous, perspiring and ill at ease. And now I could hear him escalating in the background, his bad-tempered irritability turned against the nurse assigned to care for him.

I gave her a brief rundown on his condition. She sighed deeply and said that for years he had been a functioning alcoholic. He got up every morning, worked all day and came home. And over the course of the evening he'd have a few drinks. As the years went by, it was more and more just the bottle he came home for. The children she had hoped for never came.

She paused and looked toward me. Her eyes said this: I know you're busy and it's okay if you don't have time, but if you can listen, I really need to talk.

"Go ahead. It's all right; I'm listening."

"Thanks." She smiled stiffly and then restarted. "A few years ago he got injured on the job and couldn't work for six months. Then it was the drinking from the moment he got up until bedtime. He was never able to return to work. Truth is, he drank till he couldn't walk properly anymore. He had this odd sort of a hop."

So he got help and quit drinking for a few months, she said. But his ataxia improved little if at all.

"Then that was it. The lack of improvement was hard for him to take. He became depressed and started drinking again, this time even heavier than before. He just seemed to wallow in his misery. He lay there night and day with one bottle after another pressed to his lips, like he didn’t give a rat's ass anymore, pardon me.”

She wiped her eyes with a tissue, tears streaming down her cheeks. I noticed that her face was flushed, as if the candor had embarrassed her.

"Look, I'm sorry. Is there anything we can help you with? Someone to talk to? A chaplain perhaps?"

"No, no thanks. May I see him?"

“Of course,” I said, “But there is something puzzling me. I mean, if you don’t mind my asking?”

She didn’t respond, as if she knew where this was headed.

“He told me that his vomiting of blood scared you, correct?” 

“Yes, it did,” she said.

“Rightly so. We were worried about bleeding esophageal varices; you remember he had had those banded in the past?”

“Yes, of course I recall. That’s what scared me. The doctors told me last time that if those started to bleed again, he could die.”

“Precisely. So we had an emergency gastroscopy performed. Fortunately, there was no active bleeding identified. His stomach was inflamed, a condition called alcoholic gastritis, presumably the earlier source of bleeding. So I hope that it will all settle down.”

“Oh, thank you.”

“Sorry, one other thing, though.”

“Yes?”

“After the bleeding started, he ran out of booze. Is that it?”

“Yes, that’s true, too.”

“So first the bloody vomiting followed by the withdrawal symptoms, what with running out of alcohol, and he was forced to come here. Correct?” She nodded in agreement and looked toward me, a wince discernible in her visage.

“Right,” I continued, “And so it just made me question how he got his drink in the first place. Because clearly he’s in no shape to go out and get it himself, is he?”

And then there were the tears again. I watched her wring the tissue in her hands and look away, as if meeting my eyes at that moment was simply too difficult, as if she couldn’t bear to see me pass judgement. She didn’t bother to wipe her eyes this time; she simply excused herself and made her way out of the family room.

As I watched her walk toward her ill husband, I recalled the marriage vows we all exchange and a thought flickered through my mind: could I, would I do as she has done? Or would I turn on my heels and flee?

It seemed to me that while he had chosen the bottle, she had chosen to stay. I wondered if she once had believed she could change him if only she could love him enough, if only she could be stronger, if only, if only. But now, her shoulders rounded and head cast slightly downward, it was evident that she had lost hope. And in those brief moments of observing her forlorn procession to his bedside, I came to understand that she had given up the quest for her husband’s sobriety. In so doing, she had accepted his alcoholism as a condition that could not be cured through love and good intentions. Not her love, not anyone’s.

Perhaps there was a line where loneliness intersected with neediness, where loyalty became enabling or where passivity rushed into aggressiveness. But who was I to convict how her now, the scalding tears of unrequited dreams raining from her eyes?

Published: May 1, 2004