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F10.23 Alcohol Dependence with Withdrawal

A mere five weeks into my third year of medical school, I met a patient who would leave an indelible mark. Jose was a Hispanic man that teetered between overweight and obese; I am a tall, medium-build Chinese-American who was thin in high school.  He struggled with depression during 40 odd years of life; my biggest worry growing up was excelling on the competitive piano circuit.  He spoke of a family rife with discord and unhappiness; my family is intact and supportive.  He dropped out of college; I want to stay in school forever.  He ate rice and tortillas; I ate rice and tofu. We were different but for a moment, our lives intersected.

During my first week on the psychiatric consult service, my attending directed, “Interview the 45-year-old man here for alcohol detox on the fourth floor.”  When I walked into the room, he was somnolent, confused and tremulous from his alcohol withdrawal.  He viewed me with suspicion and annoyance, as I was another medical minion sent to disturb his rest. Seeing his pain, I placed another pillow behind his head and tilted the bed so he could sit up.  He was having trouble opening his eyes so I shut off the light and then I sat next to him. We made small talk about the World Cup and Latin-American soccer players.  He told me about his disappointment in Neymar’s injury.  I told him about attending my first soccer game in Argentina that ended in a riot.  Gradually he began to view me with less suspicion and began sharing his story.

I held my breath as he described his physically abusive and absent relationship with his father, and all of a sudden the petty disagreements I had with my own seemed insignificant.  He whispered about the uncle who sexually assaulted him.  He cried about his first sweetheart who he married, who then left him when she could not handle his drinking.  He proclaimed with pride about achieving junior status in college and lamented that he has not one friend to talk to.  I realized that the abuse he suffered, constant worry about money and his fragmentary education set him up for failure; I could easily have been the one in that bed and he wearing the short white coat.

Although our physical appearances and social standing differed, we were both second-generation immigrants whose families moved to America. However, whereas I was lucky to be afforded all the privileges and luxuries in life that fast track one towards success, he was not. My parents arrived with medical degrees and instilled in me an ethos of grit and hard work. His parents arrived with that same work ethic but without education and access to the doors that it can open. Whereas my father held a stethoscope and penlight during his 16-hour days, his father held a hammer and tape measure.

My patient told me he wanted help, that he wanted to get better, but I know that the odds are poor.  Even for those with world-class levels of care and social support, addiction is one of the hardest afflictions for people to overcome. For those not so blessed with financial and social resources, addiction can truly be a difficult ordeal. Two weeks later, a counselor called and said that Jose has been attending AA meetings and is 15 days sober. I can only hope that our time together brought him some solace during his stay because I am grateful for everything he taught me.

Author’s note: Patient-specific information has been changed to protect the patient’s identity.

Jimmy Xu Jimmy Xu (1 Posts)

Contributing Writer Emeritus

University of Wisconsin School of Medicine and Public Health

Jimmy Xu is a former project manager at Epic Systems and is interested in the intersection of healthcare and technology. He hosts a monthly DocTalk Madison meetup that brings together physicians and local entrepreneurs at 100state.