Why is it my responsibility to keep an adult man who is fully aware of what he is doing (and the consequences of his actions) safe from harm?
If a 30-year-old man wants to regularly drink himself into a stupor, why is it my responsibility to stop him? When he is sober, I can offer him a chance to talk to a psychologist, to a social worker who can help him go to detox if he wants to. If he refuses (when he is sober), that's his business.
If you, as an adult man, regularly drink so much alcohol that your friends worry that you are going to fall over and crack your skull open, or that you are going to get hit by a bus, that's your problem. I resent being treated like a babysitter for adults who completely know what they are doing. If you drink a whole bottle of Bacardi, you're going to be so drunk that you get hit by a bus.
I resent the fact that I have to take care of your swearing, spitting, screaming, crying, pissing, shitting, pleading ass until you are sober enough to go home and not fall on the train tracks. I resent the fact that your friends, who bring you in EVERY WEEK, keep asking me, "What are you going to DO FOR HIM? Can't you see he's sick?" Yeah, I can. But HE CAN'T. He refuses all the help that we try to give him (in terms of detox, and rehab, and psychiatric help for his alcohol addiction). So I mop him up, give him fluids, give him medicine to make him feel better--so he can get up and go out and start all over again. YOU are his community! Whatever happened to interventions? Whatever happened to a little tough love by friends and family? Whatever happened to "Dude, you can't drink like this anymore. It makes me not like you. You are going to die if you don't stop." It might mean a lot more coming from a friend than from a stranger. But instead, you go out with him. You watch him drink himself into a pissing, crying mess. For all I know, YOU buy him his booze. And then you dump him on us when you can't deal with him anymore.
So when he comes in with a skull fracture after a faceplant onto the concrete, I'll take care of him. When he comes in after having a seizure, I'll take care of him. And I'll be nice. But I don't have to like it. And I don't have to like YOU, either.
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26 comments:
Ah, entitlement culture and socialism in the small.
This sounds as if you think we are not bio-chemical creatures at all. Your description sounds scriptural, not medical. Do you really think we aren’t subject to strong physical and psychological manipulations from addiction? Is addiction simply a matter of choice, and no more gray than that? As you will, I always love you anyway. Bink
We do this for the same reason we admit:
crack chest pain
I ran out of insulin (how?)
out of meds for a month, BP 200+
out of meds for a month, weight up 20 lbs, 5+ edema
COPD, still smoking
apparantly personal responsibility is no longer relevant once you are sick.
While encouragement to quit drinking is helpful in getting an alcoholic to decide to stop drinking, it's not exactly the greatest idea to blame the friends and family if the alcoholic doesn't heed their advice. Basically everyone in my family had been telling my dad he needs help for > 1 decade, and he finally now just finished alcohol treatment. Like you said, you can't force a grown man into treatment. Even if you could, the treatment wouldn't do anything if they themselves didn't want to stop drinking.
So, yeah, not my fault my dad (or whoever) drank. It's HIS fault. No one was putting the glass to his mouth but him, ya know.
Nobody wants to accept responsibility for anything.
Some people derive more pleasure than others from drinking, so they are tempted to drink more. If they do continue to choose to make bad decisions, they will probably develop a nasty addiction. They will then have physical cravings for the chemical of choice.
No. It is not simple, but it is still a choice.
A choice made with each purchase.
A choice made with each sip.
A choice made with each swallow.
For an addict, the right choice may involve a lot of discomfort - pain, cravings, nausea, vomiting, diarrhea, seizures, . . . , but we all deal with choices between doing things the easy way and the hard way.
Continuing to drink is the easy way.
The easy way right up until the side effects begin to affect one's life. Sane people should realize that the choice becomes easier there. Our society does not encourage sanity.
That much is the essence of addiction.
Hey Bink and nurse K
- missing the point much? The guy doesn't give a fuck and his friends certainly don't. Who picks up the slack? The ER, the other sick people there and the tax payers.
Some addicts recover, some families and friends make it work somehow. Speaking as a taxpayer, I don't mind doing my part. But GGRN can't vent and point out who's to blame?
I'm plenty left wing liberal but enough already.
Oh, yeah - Mike Wilson: yours is a typical, simplistic and useless remark.
noisejoke,
Please, be a bit more clear about what you mean. Are you imitating the drunken ramblings of an intoxicated person as a joke (without the noise, apparently)?
Let's not forget that alcoholism results in permanent brain damage (permanent--ever seen MRI's of chronic boozers?) so when we ask someone to make a "choice" regarding their addictions we are asking them to use their higher reasoning abilities (frontal lobe, motivation, long term goal oriented area) to do so. That is like getting someone with a third degree block to run a marathon. Demanding performance from an organ which is damaged and clearly not able to perform said function.
Albinoblackbear: fascinating post. Very learned, sophisticated, and thoughtful. So tell me please, because I really want to know: how, exactly, did that brain get damaged?
I never said they didn't DO the damage to themselves. I am not saying people shouldn't take responsibility for their actions either--what I was commenting on is element of what we call "choice" once someone is an addict.
And, as an aside...the brains of addicts often do suffer 'damage' of various forms from things like childhood neglect, malnutrition, lack of stimulation etc. which sets up the pathways which addiction takes hold in nicely.
I get just as exasperated as the next guy in dealing with the revolving door of drunks that puke on me at work...but I find it easier to cope with that 'fighting a losing battle' sensation if I put it into a bigger context.
Wow. A debate about alocoholism. Yes people make their own decisions. Many more people will enable to continue making those choices because it is easier than cutting them out fo their life. Still I think GG hit it on the head. Why when the enablers can't deal any more do we have to pick up the slack? Being drunk, high or other wise is no excuse for behaving like an animal or a giant 5 year old.
Normally, I'd stay out of the fray...
Normally.
However: Hi, I'm Holly. I'm the Adult Dtr of an Alcoholic and Dysfunctional Family. I've known for the last 32 yrs my Mother is an alcoholic. But that's her Axis II Dx.
But knowing that and knowing WHY she drinks...is all beside the point.
This is GG's place to vent. Don't preach to her about the Disease model/theory of alcoholism. I dare say she's just as aware of that model as y'all are.
Hell's Bells, we are ALL aware of that model/theory. I used to buy into it. There are alcoholics/addicts in my fam going back at least 4 generations. I maintain it's a CHOICE. Because however much the genetic dice may be loaded against you, you DECIDE every time whether or not you are going to drink/toke/swallow your drug of choice.
Any user has a CHOICE to treat their underlying cause of drinking/using. Because most, not all, but most do it to self medicate some pain/or other hole in their soul.
So ultimately it IS a matter of personal responsibility. It is NOT any ER nurse's responsibility to answer the question of the user's friends or Family about what S/HE is going to DO for the patient. Rather... if the family/friends are so frellin' concerned...let THEM haul said User to the door of a rehab facility and dump them off, saying "Last Chance." and then stick with it.
No more rescues, no more bail outs. Because it is only when the user has reached their own lowest point that they will choose to stop...or die.
To try to rescue them before that is the road to madness. I know, I've btdt, have several Tee Shirts and use them for dust rags now.
So don't bother preaching to me, either.
Good post, holly . .. sorry about your mom . . . my father-in-law quit drinking 35+ years ago and STILL blames his terrible behaviors on "alcoholism." He and my mother-in-law don't get the "choice" thing . . . they blame it on the 'disease' even after all these years. Very convenient for them!
The ONLY way to get rid of negative behavior, like you said, is to stop putting up with it!!! That includes drinking as well as just plain manipulative behaviors and acting like a jerk.
'Rogue Medic said...
Nobody wants to accept responsibility for anything.'
Man ---- you have a lot of nerve !!! You sing one tune on your own blog and quite another here .... closet communist !!!!
The skirt's point is that the drunk's sig figs / support community need to step up and kick his ass in line.
How can you endorse her position and assert that 'bad paramedics' are the 'fault' of the medical director? How is it that all the folks that work with the 'bad medics' on a daily basis don't have a responsibility to do the right thing ..... document>remediate>terminate the bad apples ??
I never wrote that medics don't have any part in getting rid of the bad medics.
The ultimate responsibility lies with the medical director, who allows the bad medics to treat patients. Saying go forth and do whatever, but not providing close oversight is the problem. Medical directors not accepting responsibility for doing their job is the problem.
Drug addicts do not need permission from a medical director to get indulge their addiction, so there is nobody with the responsibility to make sure that they are not harming patients (unless the addicts are medics, nurses, doctors, . . . ).
Personal responsibility ---- that's the ticket.
If you rely on the system / government to help / save you, then you are already dead.
The US achieved global
hegemony because its citizens realized that they had a responsibility to each other and to the collective.
Even the Democrats understood this at one time:
"And so, my fellow Americans: ask not what your country can do for you - ask what you can do for your country.
My fellow citizens of the world: ask not what America will do for you, but what together we can do for the freedom of man."
Don't wait for the government (medical director) to fix the problem ---- take the bull by the horns and fix it yourself !
ld wrote:
"Personal responsibility ---- that's the ticket."
Just don't extend that to the medical director. If the medical director is not doing the medical director's job, somehow it is my responsibility to fix it.
Just never criticize the medical director.
'“Many hands make light work.”
John Heywood
Any doctor out ranks you by like 10 grades ..... with that rank comes a GREAT deal of additional responsibility ..... the medics work under his authority, but that doesn't mean that he needs to get down in the weeds to QA them ..... he has bigger fish to fry ...... does the director of nursing QA every ER nurse ..... NO! The local manager ---- who is in a position to monitor the staff nurses -- handles the QA. Does the hospital medical director QA the nurses, respiratory therapists, physical therapists, etc ??? NO !! AND YES --- all healtcare workers need 'a signature' to work ----- most need several signatures !!!! And in almost every case the 'signing authority' is not the QA authority.
King Arthur: Then who is your medical director?
Woman: We don't have a medical director.
Dennis: I told you, we're an anarco-sydicalist commune. We take it in turns to be a sort of executive officer for the week...
King Arthur: Yes...
Dennis: ...but all the decisions of that officer have to be ratified at a special bi-weekly meeting...
King Arthur: Yes I see...
Dennis: ...by a simple majority in the case of purely internal affairs...
King Arthur: Be quiet!
Dennis: ...but by a two thirds majority in the case of...
King Arthur: Be quiet! I order you to be quiet!
Woman: Order, eh? Who does he think he is?
ld wrote,
"that doesn't mean that he needs to get down in the weeds to QA them ..... he has bigger fish to fry"
I suppose you are talking about talking to the medics directly on the phone to approve treatments, because the medical director knows that many of the medics are not competent.
The medical director is not making anything safer for the patients, but is performing a Pontius Pilate ablution.
Rogue Medic (AKA: Medic X) has solved one of the oldest philosophical riddles know to man:
If a tree falls in a forest ...... it must be the doctor's fault.
Albinoblackbear:
You and I agree a lot more than we disagree. I agree that alcoholism is a disorder, and that healthcare providers should treat its victims as skillfully and compassionately as they do the victim of any other disorder. I am also familiar with the research suggesting that some genetic features may make some people more susceptible to addictive disorders than others. No argument on either of these important points.
Where you and I see things a little differently (and only a little) may be made apparent in your statement, “the brains of addicts often do suffer 'damage' of various forms from things like childhood neglect, malnutrition, lack of stimulation etc. which sets up the pathways which addiction takes hold in nicely.” Your statement is accurate, however I question, slightly, your implied conclusion. While everything in the quoted sentence is true, I think that you may not have considered the equally significant truth that most victims of “neglect, malnutrition, lack of stimulation, etc.” are NOT addicted. So, while you are correct to look for physiological components to addictive disorders (another point on which you and I agree), I think that you might not adequately consider the individual’s choices as a factor. A very important factor.
As two professionals who agree that we should treat our addicted patients, we have to look at the uncomfortable business of how to do that. Medical science provides us with some helpful tools with which to do this. I hope that our tools will improve in the future, as I think they will. However, as of now, and probably into the future, it is a fact that the patient will continue to get worse unless he or she makes a decision to adopt different behavior patterns, and then, acts on those decisions. That is not a harsh or uncaring statement, just a true one, and one that applies just as surly to our patients with diabetes, heart disease, etc.
In addition to having cared for alcoholic patients, I happen to be a retired drunk and junky. (My patients suffer from alcoholism, but me, I’m a drunk and a junky. That is another story for another day, and I won’t bore you further with the semantics.) I know from experience how powerfully addictive disorders degrade a person’s will, corrupt his or her judgement, and limit his or her power to make choices. I also know from experience how painful it is to change the patterns of behavior associated with addictive disorders. I do not wish that suffering on anyone. However, suffer we must, if we (alcoholics, I mean) are going to change our lives for the better. And, it begins with a decision; as well as help from compassionate professionals like you.
GuitarGirl, I understand how you feel, and you are right. We drunks are miserable to deal with, and have no right to treat nurses, doctors, paramedics, therapist, friends, or family the way we do! You have every right to blow off a little steam after a tough shift, especially on your own blog. I do not find your post offensive in any way, because, while I do not know you at all, I believe that you feel as strongly as you do because you care deeply for your patients. I am behaving myself these days. However, if I ever get myself in a hole again, I hope that someone as capable and caring as you and Albinoblackbear will be there to offer what little help you can offer: that being, help to survive one more day, and so, have one more chance to make better choices tomorrow. Thank you, very much, for all that you do. I would be dead if not for professionals like you. You do far more good than you know.
PS: Albinoblackbear, I love your screen name! I think it is one of the best I have ever seen. Good luck in med school!
Albinoblackbear,
You should probably wait and see how the '08 elections turn out before you enroll in med school. If Obama wins --- illegal aliens will have a higher earning potential than doctors. If its about saving humanity or some such thing --- well, you can do that right now --- you don't need to be a doctor to do that.
Getting back to the original GGRN post: Many seem to be missing the point - This guy and his buddies (young, healthy, employed men who you think would know better) decide on a regular basis to get extremely shit faced. But unlike me making my way home and nursing my own hangover, they see no problem in dumping their own regularly scheduled idiocy on an ER. So, it's not even alcoholism per se that's being discussed.
Anonymous June 12 4:43 pm - Please stuff your recycled, retarded, retrograde boot licking "Republican Platform for Illiterate Toddlers" talking points wallet card way up your puckered tight ass. "If Obama wins --- illegal aliens will have a higher earning potential than doctors", and the rest of your post resides in the universe BEYOND meaningless. If you'd like a detailed criticism please explain what you actually mean and please provide documentation.
I'll take a leap and infer you believe Obama to be some sort of Radical Muslim triple spy with a bomb strapped to his back ready to go off AFTER he turns the US into a Russian or worse, Canadian, gulag.
I doubt any drinker would continue to drink with a drunk of this caliber unless they were trying on some level to appear less alcoholic by comparison. (Would you be seen with this guy on a Saturday night?)
Alcoholism is a tricky dynamic. Drunks keep company with worse drunks because it is like vitamins for their denial system.
In the meantime, his friends and family develop all kinds of incredible devices and peculiar mental twists to try and cope with all of the chaos and hopelessness of life with the alcoholic.
I've seen it. I've lived it. From both sides, too. I was way saner as a drunk than I am as a co-drunk. Trust me. Even the family dog is sick.
And on the choice/will debate, I can't resist. So here's this:
Every day I spent in my addiction, I wanted to stop. I went to extraordinary lengths--I made choices, decisions, plans, resolutions, heroic efforts, commitments, and futile attempts galore. Every day I woke up determined to get clean and stay that way no matter what, and failed.
It took a year of this before eventually the wheel came around my way and finally I was successful. Some people I met report similar efforts lasting 5 years or even 10. But most gave up on themselves and floated through time like jellyfish for a lot longer.
I've learned a lot in the last 7 years but there's not really a lot that I actually _know_. This I really do know: When you're done, you're done. That's all there is to it. Until that time, there is suffering. The end.
And guess what? You don't get to say when that is. There is no secret formula, no magic "help", nor winning strategy. Some continue for a lifetime, some eventually get their shit together, and some experience a revolving door of combinations of the above (to the supreme irritation of the rest of us). Most die. Too many things happen to your body and your mind and your spirit in the addiction process that cannot be undone with mere correct choices.
When I was sick, there was this goofy, bass-ackwards cousin of mine that I caught making a cheap and ignorant religious comment about my condition. The stupidest thing I have ever heard in my short life. He said that I was possessed by Satan. (Of course, he's a dipshit and I never spoke to him again.) Nevertheless, in my private moments, I think it's an apt comparison. Man takes the drink/Drink takes the drink, etc. There's truth to it.
And P.S.: I don't recall ever answering career surveys in high school with "Other" so I could fill in the blank with "Drunk."
I never went to the career center to lookup the annual salary range for junkies.
There are no colleges offering degrees in Crack Whoring.
And of all my friends who grew up to eventually kill themselves with their addictions, not one of them ever told me they planned to drink themselves to death when they grew up. They all wanted to be ballerinas and firefighters, remember? Didn't you?
Addiction is a *shit* way to live, and that's great. Let's NOT incentivize living in shit. But please, please don't kill what little compassion for these people might be left in the health care profession. You think they don't know they're despised by every corner of society already? You think they don't sense that all walks of humanity loathe them for their weakness? Trust me. The rest of the world at large is communicating it in very clear terms.
I might be doing okay now, and if you met me on the street, I'd bet you'd never suspect where I come from. In fact, I work very hard to keep my secret. The world will never judge me more harshly than I judge myself, but I can't really get much accomplished while I'm here if everyone I encounter sees me as a weakling who {gasp} can't make decent choices!
I never forgot the people who were kind to me when I was all effed up. None of it was wasted. Although you couldn't always tell from the outside, I was still in there under all that shitty behavior. I never stopped being a human-being.
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