Seeing the slow change

There are slow changes that creep up on us. Changes to which we adapt so much that we may hardly realise they have become our reality.
 
I’ve been thinking about the nature of imperceptible change after one of my patients came to me with her ex-husband. I’ll call them Louise and Nick.
 
‘We just got used to it,’ Louise said, glancing at her ex-husband. ‘We both didn’t realise how unwell he was.’
 
Nick and Louise still share a house. The marriage has ended, but these two are still tied together by children, history, and finances.
 
They sit in front of me as Louise calmly tells me about Nick. I’d watched as he walked slowly into the consultation room and sat down heavily. It was 10.00 am, but he’d had a few stubbies already.
 
Nick has just been seen by a gastroenterologist who, after assessing his liver, had given him a hard truth. Unless he stopped drinking alcohol completely, Nick’s end-stage liver disease meant he would not make another six months. He’s 54.
 
Nick has always been a heavy drinker. He drinks between 15 and 20 stubbies a day, and drinks steadily. He doesn’t seem drunk. Just miserable.
 
As Nick speaks, he tells me he has managed short periods of abstinence in the past. But he found as soon as he quit, he experienced the full force of a relentless low mood. Drinking had been masking it. After he found stopping drinking didn’t improve his mood, he started drinking again.
 
He’s been to the emergency department after having seizures. He’s on multiple anticonvulsants. It’s not clear if any of the seizures have been associated with ceasing alcohol.
 
Nick tells me he’s tried multiple antidepressants. He’s seen a counsellor. Nothing has helped. All of his friends are heavy drinkers. The ones who are still alive continue to drink heavily.
 
Nick tells me he’s happy to be supported to ‘detox’. With his history, this would need to be as an inpatient. I tell him the process of safe detox only takes a few days and that a hospital admission is very likely to be less than a week. Louise is nodding and encouraging him. It feels like a positive step.
 
‘What do you think you’ll do when you come out of hospital?’ I ask him.
 
He looks me in the eye and raises his hand in a drinking motion.
 
I feel a sense of inexorable decline, futility and nihilism. It hangs heavily in the room. This is not Nick’s first time attempting to change. It is not his first detox. This situation has been going on for years.
 
Given his response, I ask whether he might consider a longer time in rehab. Nick says he thinks he can only stand two weeks away from home. I try to sell him the idea of the liver’s amazing ability to recover if only given a chance.
 
Will this work? It’s impossible to say, but I have to try. I’ll do my best to assist him to try another detox followed by several weeks in residential rehab. I hope an alcohol-free period might help him to think more clearly.  
 
We begin to plan. I plan my series of phone calls to set the process in motion. I ask Louise to help her ex-husband one more time, to help arrange rehab. I encourage thiamine, food and gentle exercise.
 
Louise smiles and thanks me. Then she says it again. That she hadn’t realised how unwell Nick really is. I see her guilt and sadness just beneath the surface. I nod. Slow creeping change can be hard to see.
 
After my morning consultations, I go outside to find it raining lightly.
 
I breathe deeply, look at the sky and allow my own sadness rise up and out of me.
 
I don’t know if we’ll find a reprieve for Nick. All I know is that I’ll continue to work with these two people, with this long, slow tragedy, looking for ways to help improve his quality of life. To make the most of the time he has left.
 
However long that is.
 
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alcohol dependency