She was in again. As always the senses were alerted in their familiar sequence. First comes the heavy smell of dirt and neglect shot with the unmistakable pang of bloody diarrhoea. Entering her bay I see her shrivelled body and disproportionally large stomach (full of fluid) protruding from the sheets. Then approaching her bed, the begrudging presence of life is confirmed through a few barely audible words- slurred, confused, ignored.
Barely 6 weeks had elapsed since her last admission where she nearly died from the complications of alcohol- induced cirrhosis. We had used expensive and time consuming interventions as she nearly bled to death from vomiting blood, and the nurses had washed her daily while her confusion and weakness had rendered her unable to go to the toilet. Yet as the days had progressed she was transformed during her hospital stay- jaundice settled, abdominal swelling reduced, hair washed, sober. The glaze of her eyes replaced by a new connection with the surrounding world. ‘This is it doc, no more drinking- a real wake up call.’
The following day Smirnoff bottle tops were found under her bed and, dictated by hospital policy, we had to discharge her.
Now the inevitable had happened. The endless chain of cause and effect- linear, one-way, no return. Medically speaking she was suffering from ‘decompensated liver disease.’ Imagine a faulty sewer dutifully dealing with a town’s waste- it could do better, but it copes. That is, until the 20,000 people pitch up at the annual festival and make their personal contributions. Our sewer can no longer cope, gives up the ghost and floods the town. Such is the state of our patient’s liver, and as she continues to drink it simply cannot cope and floods her disintegrating body with toxins and waste.
She may survive this admission. She may not. She may survive the year. But there is a 70% chance she will not. And as I stand before her and contemplate my role as her doctor, the treacly tar of cynicism begins to wash over me. What on earth can I do? What is the point?
Big questions surface, cycled in the mind, perhaps muttered over the Maxwell House coffees (NHS standard issue, composition: coffee 5%, soil 55%, industrial stimulants 40%) in the doctors’ room. Is ‘society’ doing enough? Is the fact that these people are here in our ward a damning indictment of the structural injustice in our nation, or is this another person who has been offered everything and accepted nothing?
But there is a sense in which these questions are largely irrelevant to me as I struggle to manage her mounting medical problems on the busy ward. I may not be addressing the mass of the iceberg below the surface, but my job is to deal with the tip that does come into my view. What can I do? The cynic will say she’ll be in again. Statistically they may well be right (if she survives). Yet a dear friend once warned me of the dangers of cynicism. It rots. And perhaps in a profession which has such lofty intentions on the outside, it is particularly sad to see in doctors.
It need not be so. I may not be successful with my lady but I will be faithful- faithful to my duty to care for a lady broken and battered by life and choices and toxins. So I prescribe the antibiotics, order the X-rays, check the blood tests. I see her every day to check for signs of deterioration or improvement. She may make it, she may well not. I don’t know and I don’t need to- I leave that in the hands of the One who does.