Withdrawal

“Go talk to this guy with alcohol withdrawal,” said my preceptor. “Sure thing,” I responded. Even if I was a bit unsure as to the workup of alcohol withdrawal, I was simply stoked to be on the emergency medicine service for an overnight shift. So, off I went, flying blind towards this patient’s room without so much as having seen his chart on a positively arctic evening in Minneapolis.

In retrospect, my naivete upon entering the room was cringe-worthy. I swung back the curtain, and before even introducing myself, said, “So, I’ve heard you’ve had a bit to drink.” A classic, novice bedside manner faux pax. Immediately, I was caught off-guard upon seeing the patient. He wasn’t all that much older than I was: tremulous, anxious-appearing — there was a sadness in his eyes. He was so clearly not in a good way that it completely deflated the jovial, well-intentioned ignorance that I approached him with. I knew I had to switch up the tone or else I’d never build a connection with him.

I pulled up a chair: “I’d like to hear your story,” I said, “it doesn’t need to be fancy, just in your own words. It’ll give me a chance to hear what’s been bothering you and how we can help. I’ll try my best not to interrupt, and I’ll chime in with questions if they’ll help me better understand how you’re feeling.”

“I don’t know man, it won’t be good, I can’t shut my mind off. My brain has been in high gear, I haven’t been able to sleep.” His gaze was fixed on his trembling hands. I wanted to reassure him: “Don’t worry how good it is, man. Just go for it.”

He sighed, paused, and glanced at me. “I’ve been an alcoholic for ten years.” There was another pause. “I drink anything brown. About a liter a day. My wife…” he paused. “She got sick of my shit. I’ve been a bad husband to her.”

I was shocked. I had known this guy for all of a single minute, and he was already disclosing extremely personal details about life to me — an MS2 who did not even have a reasonable workup for alcohol withdrawal. Still, I felt an earnest desire to hear this guy out. His pain was real. I could feel it, and it was up to me to be there with him, hear his story, and hopefully help him– I felt honored to be there in my own quiet way.

“Man, I can tell you’re hurting,” I said. “Emergency departments aren’t fun places to be in the first place. If you’re okay with it, I’d like to hear more about what brings you here tonight, and if there’s a reason why you brought up your wife just now.”

“Yeah, there is.” His gaze drifted back to his hands as he became tearful, his voice shaking, “She got sick of my shit, my drinking. I found out she was sleeping with another man three days ago. When I found out, I went home and put a bottle of Oxycontin to my mouth, and I chased the pills with whatever I could find in the house.I hoped I wouldn’t wake up.” A tear ran down his cheek as he sniveled. “Somehow, I woke up, and for the past three days I haven’t slept.”

I was stunned, not just by his disclosure but by the immediacy of it all– how medicine and the lives of our patient’s can impress upon us in such visceral and urgent ways.

It really felt like a moment where filling the air was the wrong move. In the expanse of that fleeting silence, I felt torn. A part of my mind was racing through the sterile scientific knowledge of differentials, toxidromes, labs, and medications. In my heart though, I felt this sting, a sense of tragedy for this guy. I thought, “This guy is really in it, he’s going through hell right now, and there was a very real chance he could have died. He didn’t die, thank God, and now, he’s here chatting with me, even though I don’t really know how to help him medically… But he’s still here…”

I felt a sense of beauty and sadness in that moment with this guy who was a total stranger minutes before. I felt grateful to just be there with him, really. Grateful that he wasn’t dead.

“Well man, first thing’s first.” I said as I shot him a warm grin and clapped him on the leg as he lay in his hospital bed. “I’m so glad I have the chance to meet you.”

He looked up and smiled wearily, almost taken aback. “Thanks.”

In the following minutes, we talked more about how much he’s been drinking, where he was doing it, what he thought would be helpful for him, his social support system, and if he has felt like hurting himself or others since his suicide attempt. We both decided that getting some sleep would be a solid move since he was so exhausted and to use some benzodiazepines to reduce the risk of seizure as he came out of withdrawal.

I stopped by his room a few hours later while some of his family was at his bedside. Seeing him sleeping -finally having some peace- brought me some measure of happiness. I couldn’t help him resolve all of the adversity in his life, but I got to be with him when he needed help. I played a humble part in resolving an urgent and dangerous health need he had at the time. “Sleep is a wonderful medicine in itself,” I thought, somewhat ironically as I worked an overnight shift as a tired medical student.

What really stuck with me about that patient was not what we did for him medically or the dangerous status of his health, but rather how meaningful it felt for me to be there with him. People in healthcare often say that emergency physicians don’t have longitudinal relationships with patients. And while that is true in a plain light, I would argue that emergency physicians experience their patients in extremely sensitive moments of vulnerability. In those moments, doctors have the opportunity to make an impression upon their patients that can be felt for a lifetime. The same can be said for patients unto physicians.

I don’t think I’ll ever forget that guy nor will he ever know how much it meant to me that I got to be there with him. And that’s OK. Perhaps that’s the job. Perhaps that’s medicine, or at least a large part of it. To just show up, to be there for people.

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” – Maya Angelou