Ruins of hospital on Ellis Island

He came with her to all of her doctor’s appointments, more than an observer he was involved, concerned, present. He came off as her protector. I thought we were on the same team.

The alcohol was getting worse, though. So was her liver failure.

“Who buys all of the beer she drinks?”

“I do,” she spoke up. “And he does.” 

I glanced over at him.

“Sometimes she makes me.”

“Makes you how exactly?”

“She can get really ugly.” He looked away sheepishly, unable to meet my eye.

“You mean to tell me that all of this time that she has been going to her liver specialist appointments, all of this time that we have been talking about how she needs a complete and immediate cessation of alcohol, all of this time that you have sat in that chair and nodded your head in agreement, you have actually been providing her with the substance that is killing her?”

I wanted to scream at him. What the hell are you doing? Sabotaging her? Murdering her? WTH?

But I don’t know what their life together has been like. Is he the equivalent to a battered woman in an abusive relationship? 

I just don’t know.

So I suggest counseling, giving them contact information for treatment centers, and usher them out the door wondering all the while if I have somehow failed them both.


104 thoughts on “Ruined

  1. One word: codependency.

    I know from experience. He buys for her because he is her caretaker, and she likely controlling, and both are codependent. This indeed does need counseling and is A LOT of work to change, so it may not change. The facts and logic will not help. It is an emotional feedback system that takes deep work to undo. Likely there is nothing you can do to really change It, but suggest counseling, which you did. Kudos to you for doing that. The rest is up to them.

    Unfortunately…I speak from experience.

    Liked by 6 people

  2. You realized that you don’t know what passes between these two people. That’s not a failing but a simple fact. As physicians, we can’t know our patients’ experience completely, only what they tell us; the quality of their words and how we listen. Better or worse, you offered them counseling and perhaps they will receive a new perspective. This is very wise on your part.

    Liked by 3 people

  3. This is heartbreaking. I knew somebody like that. Emotions are such difficult things to traverse, you haven’t failed them at all, you’re trying your best for them. Some people have weak wills, unfortunately. I am sending you some support, that sounds taxing on your own emotions.

    Liked by 1 person

  4. Definitely codependent. She may not even be abusive but alcoholics are notoriously good at manipulation. And if she’s been on a bender it may be hard to say no because detoxing cold turkey, especially the more times a person detoxes, can be very dangerous. So if he feels like she might die if she doesn’t get her alcohol he might accommodate.

    Liked by 4 people

  5. I see this kind of enabling, and the oblivious wondering why they aren’t getting better, daily. It’s so frustrating, but there’s only so much you can do…if they aren’t truly willing to help themselves.

    Liked by 1 person

  6. You haven’t failed them Victo. Hopefully they will respond to counselling.
    I’ve known instances of failed dieters because of their feeder partners and see it as a sense of bullying and dominance whichever way round it is.

    Liked by 1 person

  7. Those addicted to alcohol behave like those addicted to any substance. They will do whatever it takes to get their fix. They are Shameless, just like William Macy in the TV show of the same name. In this case it appears that bullying her spouse does the trick. And so she will bully and bully and bully in an unrelenting manner. You can’t know an alcoholic (or their codependents) until you’ve actually lived with one.

    Liked by 3 people

  8. That is a tough position for you to be in. I don’t think you’ve failed them, it’s just that as their Dr- or really as just another human, you can’t make the man take steps to change his behaviour, and well, the woman is ill but stopping the booze is a step she has to willingly take. Something in their relationship is satisfying a need for them both even though from the outside it is clearly toxic.

    Liked by 1 person

  9. There are some people that will listen to the advice, nod in the right places, say the right things, then thank you and go out and do the same all over again. But having said that, I don’t think we should stop trying.

    Liked by 1 person

  10. I wonder if he drinks too…. but just does not have the same issues as she does, poor thing. That may be the way they socialize or even bond… by drinking together. Counseling would be great but wow, what a challenge. You did not fail them. There is no failure, it is poor life choices maybe. But it is their lives.

    Liked by 1 person

  11. I understand the wondering, “What more could I have done?…” but as others are saying, sometimes people just have to be responsible for their own lives — and deaths. You provided ample education. It is the whole leading horses to water but not being able to make them drink thing. How many obese people have you talked to about food and nutrition who are still obese, smokers about cigarettes who still smoke, etc. etc. etc. I certainly don’t hold my doctor responsible when I eat too many potato chips (as if that would ever happen). It is also job security for you. 🙂 I used to see patients who complained of sore backs, shoulders and necks and these itty bitty women would be lugging seventy pounds of crap in these huge bags every where they’d go. We’d talk about it. We’d problem solve options. We’d discuss the mechanics. And sure enough, the next time they were in, it was “Oh my back hurts!” as they slogged their industrial sized purse onto the chair.

    Liked by 1 person

    • I HATE not being able to help in a more meaningful way. You are right that often there is just not anything else to do, but sometimes I wonder if I ought to yell more. That whole, “the definition of insanity is doing the same thing and expecting different results” thing. Maybe yelling more would help? Sigh.

      Liked by 1 person

      • Yelling would help, but not in the way I think you meant. Yelling, as in driving in your car, rolling the windows down and screaming until you laugh or swallow bugs or both. Expletives are even better. Yeah, I used to have existential moments of “why do I even bother?” when it seemed like all I was doing was spinning my wheels. But then, I’d have a great session, and I’d remember how good that felt (for a while). And not to be a Pollyanna, because: me, but after leaving a profession I loved (usually, sorta) in order to have to work like a gerbil in a wheel (which is a step up from the chronic unemployment)? I wouldn’t mind a few more of those “why do I even bother talking to them?” moments.

        Liked by 2 people

  12. People make their own choices…good or bad. All you can do is give them the information to make those choices. As a healer, it must frustrate the heck out of you when you see people like this couple who are choosing to not listen to your counsel. My question is why are they even bothering going to doctors if she won’t quit drinking? You have not failed. You have done your best…the rest is up to them.

    Liked by 2 people

    • I have people all day making choices like not taking their meds, knowing it is going to hasten their demise. They aren’t having side effects. It isn’t a cost issue. They aren’t depressed. They just don’t want to take three little pills a day. But by golly they keep each and every one of their appointments.

      Liked by 1 person

  13. As the daughter of a man who had Cirrhosis, yet would not stop drinking until he was diagnosed with liver cancer. I was surprised he stopped then.
    You haven’t failed them. You aren’t qualified to deal with that disease.
    I’m always so impressed by how much you care. Thank you.

    Liked by 1 person

  14. Our Doctor schedules hour appointments. And even in that time there is no way to cover everything. What pisses me off is that you have someone like me who is trying my best to save myself and my daughter and needing the healthcare system, pharmaceuticals, insurance, to help us…doing EVERYTHING right. And someone like that who has the capability, the knowledge, to save herself, and chooses not to. It is a choice. She could choose to get help. He could choose to not be an enabler. I cannot choose to not have a muscle disease or lyme disease. These people, I have no sympathy for whatsoever.

    Liked by 1 person

  15. After working for 30 years as an addictions counselor, I’ve learned that addiction is way more powerful than most people realize. Even if she goes to detox, gets through the physical withdrawal, the dynamics are going to take a lot of work to unravel.The husband may be intimidated, but he could also be getting a pay off, too. Maybe he’s afraid of change because he needs to be needed, maybe he’s drinking, too. Deep, complicated stuff that you can not get to in a doctor visit. But you were real with them, and you planted a seed. Sometimes that’s all you can do.

    Liked by 1 person

  16. How, exactly, did you fail them?

    I have a semi-annual trip to Las Vegas with some friends. One of them is a gambling addict. Everytime he comes, he falls apart in the casinos. We warn him but that’s all we do. He’s an adult. We’re not his mama and papa. It’s not on us to take care of this grown man. You stand beside them, offer support, give them all the warnings but ultimately, we, each of us, are all responsible for our own actions.

    Liked by 1 person

    • People expect physicians to have all the answers, to work miracles. It is easy to fall into making the same demands of myself. There are a lot of terrible deaths and liver failure is one of those. I hate to watch it happen to anyone.


  17. Addictions are so difficult. And really you can’t ever make anyone stop. At least in my experience. I don’t imagine a doctor would have any more success than a friend or family member. The only time I’ve ever seen anyone give it up is when something scared them into it. But you never can know exactly what that scary thing will be for each person–sometimes it’s the littlest thing. You are doing all you can do, I think. (K)

    Liked by 1 person

  18. Almost impossible to say unless you visit them at home when they’re not expecting it. You’re a hospital doctor? My dad was a GP. Such a lot of responsibility and heartache. I hope you get enough successes to balance things out. People were always surprised that I didn’t follow in dad’s footsteps but I don’t have the temperament for it.

    Liked by 1 person

  19. Often in situations like this I think of the monk Zosima’s unusual view, which has been hard for me to understand, but somehow still helps:  

    “My friends, ask gladness from God. Be glad as children, as birds in the sky. And let man’s sin not disturb you in your efforts, do not fear that it will dampen your endeavor and keep it from being fulfilled, do not say, ‘Sin is strong, impiety is strong, the bad environment is strong, and we are lonely and powerless, the bad environment will dampen us and keep our good endeavor from being fulfilled.’ Flee from such despondency, my children! There is only one salvation for you: take yourself up, and make yourself responsible for all the sins of men. For indeed it is so. . .”

    *          *          *

    –Brothers Karamoz, Book VI, Chapter 3,  One connentator says that Zosima’s message is a theme of the book:  “Those who take responsibility for their fellow human beings–Zosima, Alyosha– enhance life; those who reject it –Ivan, Fyodor Pavlovich– spread suffering.” You, Dr. V., are definitely enhancing life, even though there are days. . .

    Liked by 1 person

  20. This struck a chord with me wondering if I enabled my alcoholic mother at times. It is the same with obese patients who can’t leave their beds. My mother turned into a monster at times so perhaps her husband both wants to keep her quiet and want her dead (subconsciously).

    Liked by 1 person

    • I know there are situations in my past that I can look back on now and wonder what the hell I was thinking at the time but back then it made perfect logical sense. It is terribly easy to have insanity and bad choices sneak up on you.

      Liked by 1 person

  21. This morning in rounds, we explored the history of obstetrics and the term”Victo Dolore” came up. I thought about you and blooding and how much I miss this realm! Glad to see you’re still here and your blog is thriving!

    Liked by 1 person

  22. This is really tough. It is so hard to watch people destroy themselves and know that only they have the power to save themselves (but they don’t seem able). Such a sad story. And people’s lives behind closed doors that bring them to such a place are more complex they we can ever guess at.

    Liked by 1 person

  23. Pingback: Writing Links 6/12/17 – Where Genres Collide

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