Mrs. J. was in today after her recent hospitalization for bleeding from her stomach. After a half dozen tranfusions and almost as many hospitalizations for GI bleeding, the truth finally came out. At age 86, Mrs. J has cirrhosis of the liver and she is bleeding from large distended veins in her esophagus. In cirrhosis the liver becomes so hardened and scarred from the alchohol, that all the blood that must go through the liver to get to the general circulation must find an alternative tributary, tiny vessels that connect the liver to the esophagus. But after years of trying to get through these vessels they are large distended blood vessels, and in one day, Mrs. J bled out half of her blood to reduce her total hemoglobin level from 12 to 6. In typical alcoholic family fashion, I got a call from one daughter before Mrs. J's appointment : don't tell her brother about it. Alcoholic family members often weave an intricate web of delusion and deception to keep the truth from coming out.
Later, A., a Mexican immigrant, came in for his annual physical. Previously I had made a breakthrough with A., he had recognized his alcohol abuse and begun attending AA. It was clear that his anxiety disorder was being self-treated with alcohol, but in reality the alcohol was making it worse. Now, he's back to drinking again. But now he doesn't try to hide it. He tells me, "Yeah, I did drink last weekend, and I don't know how much." Did he mean he couldn't count how much and he was stone drunk? Yes. Did he feel rotten for 3 o 4 days after getting drunk? Yes. Today was his first day of feeling well again. A., you need to go to AA tomorrow, do you want me to take you? They won't let me in because I am not an alcoholic. Don't be ashamed. AA is a place where people with that same shame are brothers. Ok he says, he will try to go.
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