To Understand

yellow eyes

"I think he smells a bit like alcohol, but maybe it's just me," Sonrisa said as she handed me the chart. "Are you drinking on the job again?" I asked her.

I went into the room and met the man, who was there with his daughter. He immediately wanted to talk about his memory difficulties. He just couldn't understand why he can't remember anything anymore. "Is there a test we can take for that?"

Ostensibly he was there for a pre-operative physical for an orthopedic surgery. He's had several before, no complications. It’s just that he keeps falling, or crashing, or getting in car wrecks.

I looked over his labs. Bili climbing, now at 4.3. INR 1.4. Platelets 78. Albumin 2.7. Ammonia 83. He's on lactulose.

The operation still hasn't been scheduled. "They said I need to see you first."

He's had 2 GI bleeds before. One was sobering enough he quit drinking for awhile. But it didn't last. Currently he has "cut back a lot," maybe drinking a 6-pack of beer a day.

I wouldn't operate on him either.

"So what do we have to do to get the numbers better?"

"Well, I have good news and bad news. The good news is we can get you better for the surgery. The bad news is it's entirely up to you. You have to stop drinking. Completely."

Tears came into his eyes. Which are yellow. And he hadn't noticed they were yellow before (his daughter had.)

And then we talked for a while about how he could do that. And he decided to go to the hospital.

45 minutes, a perfunctory review of labs, and then I told the patient there was nothing I could do. "Patient, heal thyself." And he has to stop the one security, the one constant in his life. And that's just the way it is.

"You seem like quite a lady," he said as he left. Not sure what he meant by that. I just gave him pretty bad news. This is one situation where I really can't do anything at all. Except listen. And tell him his health is in his hands alone.

What is this force that so destroys the mind, body, and soul? And what is this pain that is so great that he must pour himself full of anesthetic each night? We see it every day. We blame the man for choosing this way of life. And then we move on.

But I want to understand. I want a window into this self-destruction. So many times I’ve wordlessly pleaded with patients to give me some kind of clue. Why does he do it? Because if either one of us knows, then maybe we'll find the key. So the few years left can be spent with family, happier, healthier. I looked him in his yellow eyes. He doesn't want to die yet.