Isolation Toasts Sadness

Joan is smart, funny, warm, and engaging, and I liked her from the start. Hospitalized after her homemaker found her unconscious on the floor and subsequently diagnosed with a small stroke, Joan was doing better and eager to go home when I met her in my role as hospital-to-home liaison. Ultimately, though, she was persuaded to postpone her discharge and accept a ten day stay on the inpatient rehabilitation service to gain strength and work on the balance deficiencies that seemed to contribute to her history of multiple falls. That she had abused alcohol in the past also was noted, but waking up in the Emergency Department and learning she had suffered a stroke had startled and scared her, so Joan had been receptive to abstinence counseling and remarked many times that she didn't miss drinking and wasn't about to resume her old ways.

I followed her as she progressed through rehab, and accepted her as my own patient when she finally did go home. For weeks she stayed sober, and I discovered that she was well informed about issues of the day, highly articulate, and strongly committed to work with the homeless, once having been homeless herself. Indeed, one of her pressing objectives was to regain strength sufficient to resume work at a local shelter, either as an employee or volunteer, depending on the shelter's need and budget at the time. Her "no nonsense" attitude coupled with her ready smile and quick wit struck me as a uniquely winning and effective combination, and we talked about her ability to offer both academic insight and the wisdom of personal experience in her work on the problem of homelessness. And every time I saw her she smiled and affirmed that she was "done with the booze." As time went on I saw no hint of alcohol in her home, and her air of practicality and bottom-line realism led me to believe that while not out of the woods, her prognosis was good.

Until today.

I knocked and knocked on her door, but heard only a television or radio inside. Confident that Joan wasn't yet able to go out, I knocked longer and more loudly, until a muffled voice seemed to answer from within. I waited. And waited. And then knocked some more, and called out, "Joan, it's Sue. Are you in there?"

"I'm in here. Where else would I be?" came the slow, familiarly sarcastic, . . . and unfamiliarly slurred response. "Let me drag myself up."

"Take your time and be safe," I answered. And I waited.

All grew quiet, and I debated leaving ("Has she fallen back to sleep," I wondered) or calling for help ("Is she on the floor?"). But then came shuffling, silence, stumbling, more shuffling, fumbling with the lock, and, after the handle had spun helplessly while the door didn't open, finally, a slurred command, "Open it and come in."

I did, and there she was, dressed only in an oversized t-shirt, balancing precariously on legs she did not seem to recognize as hers, and breathing alcohol fumes in my face. She staggered against the adjacent bathroom door frame and tried to look casual as she leaned on it for support. "I went to the store for the first time yesterday, all by myself. . . . All. by. my. . . . self!" she said with a forced, crooked smile.

"And what did you buy?" I asked, knowing the answer.

"Tons of food," she said, "Tons and tons and tons and tons of food." She stumbled to the refrigerator, opened it, and repeated, "Tons and tons of food." Collapsing onto a chair she looked up at me as though expecting a response to a profound pronouncement.

"Did you also buy some booze?"

"A little," she slurred, attempting with small success to make a pinching gesture with one thumb and forefinger.

"Let's have a look at you, Joan," I said, beginning a cursory exam, because there's truly nothing to be said to a drunken drunk. "Do you have any of that booze left, or did you drink it all?"

"A . . . LOT. I have a LOT left!" she announced with a sloppy smile.

"You did well for quite a few weeks, Joan, and tomorrow's another day. You can start again. One day at a time."

"Yeah. One day at a time."

Peddling away on my bicycle a short time later I felt a profound sadness that permeated my being from head to heart to toes. And I realized that after forty years of practice there's been nothing sadder in my repertoire of experiences than the people doing themselves in with alcohol. And there's not a thing I can do for them until they hit that proverbial bottom and make the decision to help themselves.

If a patient is dying of cancer I can act to control pain, prevent tissue breakdown, maintain hydration, and more. In the face of fear and fever, of multiple trauma in the middle of a street somewhere, of a disease with no cure, of a body whose vital organs are failing irreversibly, of confusion and dementia, of ignorance and inability to learn, and more, I can offer some means of aid. At the very least, or perhaps the very most, I can be present to stand, sit, or walk with another who treads a dark road that perhaps none understand. But the inebriated alcoholic may not even know I'm there; indeed, tomorrow Joan may tell her Physical Therapist that she wonders why she didn't see me this week, never knowing that it was what she put in her mouth that blinded her eyes and her memory to my presence.

I'm glad I was the one who found Joan today, because I know the intelligence, sensitivity, passion, warmth, and hardship of the human being behind the booze. And I'm a seasoned warhorse who knows what I saw and what can and cannot be done at this point in Joan's journey. A younger, greener nurse might have set herself up for unnecessary failure; I could peddle away with sadness, yes, but also with understanding.

Joan needs to meet some friends of a fellow named Bill W., and she probably knows that. I will see her once more, hope she is sober, and if so will suggest an introduction and tell her where in her neighborhood that introduction can happen. And then it's up to her. I told her booze-smitten self today that I'd see her only once more, because there's nothing more I can do for her . . . although there is a great deal she can do for herself, and much support to be had once she makes that commitment.

The world needs Joan and people like her, desperately. She understands the problem of homelessness from every perspective and has the smarts and the skills to communicate with everybody from the badly beaten single mom with no place to go to the policy makers. Few can do that. We need her. But today she drinks.

I write this from a corner lounge overlooking the driveway to the Emergency Department of the hospital where Joan goes, where EMS would bring her if she called 911 or someone else made that call on her behalf. I see ambulances coming and going, and wonder if one of them carries a smart, funny, warm, engaging woman who was found on the floor today with a fractured [fill in the blank]. Or I wonder if she is alone in her tiny apartment finishing off "a LOT" of booze tonight.

And I feel the most profound sadness possible, because there is nothing to be done . . . until Joan takes action herself. Bill W.'s friends reach a point of making amends to those they have harmed whenever possible, except when doing so would cause further harm. Sadness isn't the worst thing in the world, and mentally healthy people know how to handle it and gently let it go. But when people like Joan become acquainted with people like Bill's friends I wonder if they ever truly know not just the overt and subtle harm they may have caused themselves and others, but also just how very sad those who care have been, and how the practice thought to bring pleasure actually is perhaps the most isolating one possible. For in a drunken haze not even the connection of another quiet presence is possible, and no matter how lively the bar or how many people at the party, the alcoholic always drinks alone.

Now in this festive season, as I watch ambulances come and go, I wonder how many times in the guise of fun and celebration

Isolation Toasts Sadness.