THE BONDAGE OF ALCOHOLISM

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THE BONDAGE OF ALCOHOLISM

Dr. Arun Kumar Gautham

‘And always night and day, he was in the tombs, crying out and cutting himself with stones’. Mark 5:5

I was done for the day. I picked my bags and was trudging along the changing room when I received a call regarding a sick patient. I left my medical paraphernalia and ran to the Emergency Department. The resuscitation room was abuzz with activity and emotion. I was envious of these physicians who dealt with high voltage scenarios round the clock. I had to jostle for space among the crowd to reach the man I was called to see.

Thirty year old Ravi* lay in an ill-fitting trolley with blue bed sheet over him. The head end of the trolley was elevated to give his lungs some breathing space. The IV drip flowed like a rivulet into his neck. The monitor attached screamed for attention, displaying deranged parameters in yellow and red. Ravi was breathing at a frantic pace. He was also rolling in pain. I introduced myself and he was coherent enough to decipher my poor Tamil and reply. I had a cursory look at the emergency chart.  On arrival, his blood pressure was not recordable. Six litres of saline, a dose of high end antibiotics, and infusion of dopamine had helped him recover to his present state. Apparently he was still in distress. He blurted out his history in broken lines even as he struggled to catch his breath.

Ravi was a daily wage labourer. On the days he was lucky to get some work, he was paid… most days he would just stay at home. For the last 20 days he developed pain and swelling in his right leg. Initially he neglected it but as the pain became an impediment to his basic chores he visited a doctor. A preliminary scan of the leg showed that a blood clot had formed in one of the large veins and this had developed a secondary infection. A dose of over-the-counter medicines did not work, steadily pushing Ravi to this present predicament. Before I rolled his wheeled stretcher to the ICU, I enquired his wife about his habits. ‘He consumes alcohol’, she said in a dejected voice.

Through the corridors of the hospital, along the wards of radiology and neurosurgery, I took him to the surgical ICU. I put him in bed no 2. My senior relieved me from my shift and I went home. Over dinner, Ravi flashed through my mind. I was amazed to see that 6 of the 13 beds in surgical ICU were occupied by patients of road traffic accidents and all were under the influence of alcohol. Five among them at that time were on ventilators and drugs without which their circulation would fail. Three of them had sustained head injury and two were on tracheostomy. The biggest tragedy was that all of them (except one) were below the age of 40.

The next day I reached the ICU with a special curiosity to know what happened to Ravi. In the night he was taken for an emergency surgery. His leg was too infected to be saved. They had to remove his leg and part of his thigh (above knee amputation). The attending doctor told me that he may need a higher amputation as there was still a mass of infected tissue threatening his life. In the ICU, Ravi was intubated and was being ventilated by a machine with tubes popping out of his mouth, nose, neck and bladder.

Moments later, a whisper wafted into my ears, “Bed no. 2 – the relatives want to take the patient away, against medical advice.” I was shocked, but felt that the relatives could be cajoled to stay after a counselling session. The surgeon, the ICU consultant, the nurses…they all tried to reason but were not able to change the mind of a frail old man in a lungi and crumpled shirt with a beard ill-kempt and voice trembling. He was Ravi’s father. As a last ditch attempt, the chief of ICU himself wanted to talk to the old man. Ravi was too young to give up hope on. His vitals were stable. His heart had calmed down and his support requirement had come down since the time of admission. Ravi was improving. Leaving the hospital at that moment would be an unwise idea.

I just wanted to see how the encounter between my chief and the old man would go. I accompanied Dr. SM and sat on a sofa facing Ravi’s father and brother in law. The father was firm and clear that he wanted to leave. We asked him why. He had a heart breaking story to tell.

Ravi was married 10 years ago. He has 3 daughters to feed. But like millions of families that are ravaged by alcoholism, Ravi’s family also faced its brunt. He was a chronic alcoholic spending all he had on drinks. He would not take care of his family. His children were out of school. His poor wife had to face the mental anguish of a practically useless husband and the physical assault and battery the inebriated mind would perpetrate. The last ten days were worse. He just lay on his bed consuming bottles of alcohol aided by his friends who brought the needful. The entire family was supported by the meagre wages of Ravi’s old father.

It was not that Ravi’s father did not understand the gravity of the current situation. He himself said, ‘I know that he’ll die. I know that he will not cross the hospital premises alive. I just have to show his body to his mother. All my life I spent my money on him. He did not change. He will not change. Now he does not even have a leg. I have his three daughters to tend to. I cannot waste my last resources on him. The story is over sir. Just let us go.’ Saying this he fell over my chief’s legs and began to wail inconsolably.

We let Ravi go. When the intern who accompanied Ravi to the vehicle returned, I asked him how Ravi was. He said he felt no pulse during the transfer into the vehicle. The bondage of alcoholism had extracted yet another young life.

It is to stories like these that doctors need to stand up to. It is bondages like these that have to be broken before families and society can be blessed with wholesome life. What is the mandate of health care professionals in a society mired in the darkness of alcoholism? Are the problems of our patients purely medical or are they social and economical also? Is it ethical to confine ourselves to mere medical care rather than make an effort to address issues like alcoholism which directly contribute to life-destroying illness? What is the distance we are willing to go – will we go the second mile to raise our voice against these issues?

In the pages of the Gospel there is an episode captured where the disciples of Jesus are unsuccessful in driving out evil spirits while Jesus does it. Disciples ask Him how he was able to. Jesus says, “This can happen only through prayer and fasting.” May be we should look at the big picture and discern. May be we should pray for people like Ravi, against TASMAC and the minds that are bent on expending long lives for ephemeral highs.

The Tamil
Nadu
State
Marketing
Corporation
(TASMAC) is a company owned by the Govt. of Tamil Nadu, which has a monopoly over wholesale and retail vending of alcoholic beverages in the Indian state of Tamil Nadu
. The monopoly trade has led to widespread irregularities like adulteration, corruption, overpricing and black marketing in the retail outlets. It has also led to increased complaints about disturbances created by drunk patrons from residents in areas where the retail outlets are situated. Alcoholism is growing at a rate of 8% p.a. in Tamilnadu. Tamilnadu is also the state with largest sale of alcohol by volume. The present state government was elected with total prohibition as one of its manifestos. Whether, this will come to be remains to be seen.)

*Names have been changed to protect identity, but the stories still remain the same…


Dr. Arun Kumar Gautham is a Post-graduate registrar, Department of Anaesthesia, Christian Medical College, Vellore.

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