Saturday, March 19, 2011
a touch of the holy water
for a period of time in my early twenties, i lived with my italian grandparents. just about every night i would make my grandfather a cup of espresso. inevitably he would call from the living room - 'and don't forget to give me a touch of the holy water!' by that he meant anisette, the anise-flavored liqueur that he loved. maybe that's why he could drink that espresso and promptly fall asleep. but sometimes, you can have too much of the holy water. and if you have too much for too long, then you have real trouble.
i will not be the first nor the last to tell you that alcohol withdrawal is a miserable unpredictable thing. tremors, hallucinations, seizures. it is ugly and sad and deadly. at a minimum, it is the bane of any medical resident's life. hospitals do try to ward off disaster. committees are formed and protocols are written. but the sleeping beast of withdrawal is not so easily tamed. first of all, you have no idea how much someone is actually drinking, the least likely person to give you an accurate accounting being the drinker. so it is often impossible to predict if there is even a risk of withdrawal. secondly, you have no idea when they stopped drinking and therefore when the fun of withdrawal will begin. and if you try to order hourly neuro checks in anticipation of withdrawal the nurses will give you hell. no way, they'll say. i've got six other people to care for. i can't do that. so as you are writing for the substance abuse consult, you are secretly hoping you can discharge your patient in that precious window of opportunity you have between their last drink and their first seizure. most of the time you are not so lucky.
in our training hospital we had a wing in the oldest part of the hospital called 3 west. it was a long narrow hall with patient rooms on either side and the nursing station way down at one end. if your patient was at the opposite end of the hall then they were a long, long way from the watchful eyes of the nursing staff. they were also just one doorway away from the faculty offices of the internal medicine department. i think it was my second month of internship when i admitted a seemingly normal woman to that very last bed at the end of the hall. i can't remember why we admitted her - pneumonia? but i do remember this. i was sitting at the 3 west nursing station, writing notes, when my patient came staggering down the hall - barefoot and wild-eyed, gown hanging off her shoulder, ten feet of iv tubing dragging behind her on the floor. she was reaching for things in the air (nonexistent things) and mumbling something incoherent. she was a mess. firmly gripping her left arm like an improbable prom date, was one of our most distinguished attendings. he was about six foot five, white coat perfectly starched, and had a deep imposing voice. standing over me with his eyebrows drawn together he said, 'is this your patient?' long pause as i stared in horror. 'i think some ativan would be in order.'
i hope he was laughing on the inside. it was the understatement of a lifetime. seems she had crossed over, unbeknown to me or the nursing staff, into the otherworld of alcohol withdrawal and found her way out of her bed and into his office, iv pole be damned. can you imagine? i was too mortified to speak. i think my grandfather had it right, just a touch of the holy water please.