My challenge, my chance

I’m on a general surgery attachment this month, and am with the emergency team this week so have been spending long days clerking patients and following surgeons as they charge round the hospital. As ever, I’ve had a high volume of patients with serious problems induced by alcohol, which longterm readers will know is something I struggle a lot with. This time, however, I’ve literally been the first person to assess them before I’ve handed over to my seniors, and there’s a responsibility, and opportunity, that comes with that.

Something I’ve noticed is that ‘problem drinkers’ tend to fall into one of two categories; they either are completely adament that they are ‘not an alcoholic‘, that they can stop when they want, and that this somehow makes them ‘better’ than others they see labelled in that way – or, as soon as you meet them, they tell you that they are an alcoholic, in this defeated way that suggests that they kind of know that not much is going to be done, aside from patching them up and shipping them home again. It’s as though the second group think that if they own up, we’ll tar them with a coat of hopelessness, and give up on them. We won’t fight for them. We’ll leave them be to carry on, which is probably a lot easier and less scary, than sorting their problems out. Sadly, this is often what happens; most healthcare workers only see the problem of the ‘revolving door’ patient, who comes in again and again, and never seems to change, regardless of whether it’s an issue of access to help, or ability to ask for it. I want to be someone who has time.

The interesting thing is that often these patients, in either group, don’t have the right label for themselves, at all – dependancy, afterall, is a syndrome, characterised by both physical (such as withdrawal symptoms) and more psychological aspects (such as narrowed repertoire, and salience of alcohol over other substances and past-times). I ended up having a long conversations with two of my patients, one of which lead to him realising that he does in fact have a dependancy on alcohol, and is quite a long way past the ‘social drinker’ he had classed himself as – and the other with someone who is a longstanding ‘known alcoholic’, trying to get to the bottom of what else could be done to help, and work out why it is that he’s got such a poor view of himself that he didn’t think anyone would bother to help him sort his drinking out in the first place. I guess a learning point here is that often we don’t have accurate views of ourselves, whether by lack of awareness, denial, or selfloathing. We sometimes need another perspective to get things straight. We all do this to some extent.

As always, I found talking to these patients hard to do, – and as always, every time I speak with a person with substance misuse issues, I think of my dad, and the years we all lost to his drinking, and all the hang-ups I’ve garnered from them – but I was also glad to be there, as someone  supernummary who has a bit of extra time to spend with patients, and doesn’t just fob them off as a no-hope case. I was glad to be there, getting the story out in the open, listening to the reasons they had drank more than usual, and being able to answer honestly, about what they were doing to their health. I was glad to be there to stick up for them when I reported back, as I like to think someone might have stuck up for my dad when he was at his illest, and not just stuck him in a corner to sober up. If we don’t stick up for them, they will never get the help they need. If we don’t stick up for them, they’ll keep that revolving door swinging until one day, they die before their time. I know that it’s so easy to get ‘compassion fatigue’ when you’re working in a busy unit with a high turnover, and are always on the go, but I want to help combat this.  My dad probably wouldn’t be alive today, if someone hadn’t help us get him into rehab, when they did. He’s alive because someone had the time to help and the time to care. I don’t want to find one day that I have someone’s blood on my hands (figuratively, but possibly literally given my line of work) – because I didn’t care enough. I want to make sure other people get another chance. As a Christian, I’m only too aware of how much we all need second chances. The God I follow, is a God of second, and third, and seventy-seventh chances. If I’m going to follow, I need to be a person who gives these chances too, as well as receiving them.

I know that it’s likely I may always have shaky moments when I’m managing these sorts of patients. I know that sometimes, when I’m already fraught and tired and emotional, it may break me a little, for a while, and make me cry in a corner somewhere, for a while. It’s one of my struggles, one of my wounds. We all have them. It reminded me of this post here. But I also know that I’m learning, all the time. I’m learning. And sometimes, I think that’s the best we can hope for, the best we can aim for. As long as I keep learning, I’ll be fine.