“Drink Responsibly” and Other Concerns

 “I entitled it, ‘the things we think and do not say.’”

—Jerry McGuire

I came home from work as a travel nurse in San Diego one day and I was mentally and emotionally spent. I had a three patient assignment that day, and all three had a history of alcohol abuse. They were middle-aged males. They all had end stage liver disease. And they all needed a liver transplant. Fortunately, they had all quit drinking before they reached the state my Mom had, however they were still incredibly ill. I ended up giving nine total doses of lactulose that day.  (For those of you who are not nurses, in the hospital setting we give lactulose to liver patients to help maintain ammonia levels…it makes patients go #2 a lot.)  So that’s how my day at work went.

I collapsed on my bed and kicked off my work clogs and stared up at the ceiling for while. I was exhausted from taking care of three people who were suffering from what my Mom died of; end stage liver disease.

When I really started to think about it I began to realize what my perspective was. I looked back on my career so far as a progressive care nurse and thought about how many people I had to detox from alcohol alone.  I found myself overwhelmed by how much Ativan and Valium I’ve had to medicate people with.  I had seen people try to drink hand sanitizer out of desperation for alcohol.  I was becoming sincerely concerned with how much this particular addiction literally sucked the life out of people. I had seen alcoholism drain the soul out of countless patients and cohesiveness out of families, my own included. I reached over into my nightstand and sought out my leather bound journal that had a large tree on the cover. I sat in my room and wrote a lengthy journal entry;

“Alcoholism is an epidemic. No doubt about it. Now I am not a prohibitionist by any means, I believe that alcohol, when used in celebratory events like weddings, can actually enhance the energy at such gatherings. However for as long as I can remember, alcohol is everywhere in American society. Alcohol is at every football game and advertised during every NFL game I have ever watched on television. Alcohol is at Fenway Park, it’s at Gillette Stadium, it’s at concerts, it’s on the lawn seating at a favorite particular concert venue in Mansfield, Massachusetts. Alcohol is in bars on every corner, it’s at restaurants, its in grocery stores. It’s everywhere along the California coastline. It’s grossly abused in colleges and universities throughout the country. In some states it’s readily available in grocery stores and drug stores like CVS and Rite Aid.

 Having grown up in Rhode Island I always believed you had to go to a liquor store to purchase alcohol but now I know I can’t even go grocery shopping in California or New Hampshire without it being blatantly in my face. I’ve come to believe that alcoholism is an epidemic because the habit of frequent drinking is not only socially accepted, but also socially encouraged. All too often I hear friends asking their peers or guys asking girls to spend time together, “let’s get a drink,” or “let’s do drinks.”

 If a guy asks me to go get drinks now on a first date, I can’t really help but have my first thought be, “Drinks? I have a million other things I’d rather do than go get drinks. But if you would like to challenge me to an epic game of laser tag, a day of hiking, go camping, invite me to volunteer somewhere, attend a concert, see a play, rent jet skis, go surfing, or anything else that may not revolve around what’s in my glass, I’d be happy to maybe make some room in my schedule for you.” Drinking in many instances is commonplace, but the chronic overuse of it does eventually kill people.

When I was a little girl, I used to go complete errands with my Dad in South Attleboro, Massachusetts. I always saw this one particular liquor store that was near the BJ’s Wholesale club we frequented. The sign said, “Wine and Spirits.” I never really understood that terminology. Wine and Spirits…it just always seemed odd to me. And now, as an adult, I wonder if the intention is to raise spirits or depress them.           

Spirits in theory should be used to lift the human experience, but too often I have seen this depressant bring my family members and friends crashing down. Alcohol in its nature has anxiety relieving effects. It’s easy to come home from work and want to unwind with a glass of wine or a beer. And that’s how the addiction cycle starts.

            Genetically predisposed people begin to self medicate their anxieties, stressors and emotions with a substance that is not only easy to obtain but also blatantly marketed. Not to mention, it’s one of the cheapest ways to alter oneself.

 Eventually, it leads to needing more than one drink to unwind and maybe a drink to “take the edge off” in the morning. And then the problem starts to become noticeable to family and friends; the alcoholic becomes slower with their recall, they slur their words, drinking brings them down emotionally and more often than not, their spirits are not being lifted but enslaved to gravity. Alcoholics, at least in my experience eventually start to get angry.  It may even get so bad that an alcoholic would drive their car into their own house…that’s a story for another time.

From my own life experience, I have learned that if you drink enough alcohol, it will make you say and do things you’d never do sober, it will make you sad, it will make you mean and it will make you numb. It will make you count your problems instead of your blessings. If you rely on it, it will cripple you. And if you allow it to grip your existence, it will kill you spiritually, emotionally and physically.

 I see beer company ads, a lot of them, and they all say, “Drink Responsibly.” I think that phrase is…well, it leaves too much room for error.  A company that makes money off the public buying and consuming their product wants the public to buy as much of it as they can. That’s the basic principle in business after all; if people buy a product, then the company providing that product makes a profit. So essentially, lots of alcohol distribution companies around the globe say they want us all to drink responsibly but they also want us to buy as much of their product as we possibly can.

For the most part, the process works like this; when people purchase alcohol, they drink it; then they run out and they need to go buy more of it. So does “Drink Responsibly” mean “Don’t drink and drive?”  Perhaps, it could mean, “Drink Responsibly: we recommend no more than 2 alcoholic beverages for women over the course of a two hour time period and no more than 4 alcoholic beverages for men in the same amount of time.” However, I haven’t seen that particular explanation in any advertisements lately.

 The other flaw behind the phrase “drink responsibly” is that it leaves too much room for interpretation. “Drink Responsibly” is relative for the person drinking.  To the alcoholic who typically can crush an entire bottle of wine in one sitting alone, two glasses would be more responsible the following night.  To the alcoholic who usually drinks a fifth of vodka per day, 4 shots the following day would be an improvement.  I suppose we could start saying “Drink Reasonably,” but that’s relative too, not to mention ambiguous.

I urge beer and liquor and wine distributors to start thinking about the term “Drink Responsibly” from the perspective of an alcoholic or someone who has a history of alcoholism in their family; after all, those who are addicted to the substance they sell are their most loyal and frequent customers. It’s only fitting that their advertising language and their drinking suggestions should cater to them.”

 I put a period on the end of the above sentence and closed my journal shut.

“Don’t be concerned for your own good but for the good of others.”- 1 Corinthians 10:24

“Be strong and courageous!”-Deuteronomy 31:6

You know I love you, right?!

“One of the bravest things that a human being could ever do is go through something absolutely unbearable and then share their experience with the world.”

Taylor Swift at her show in Glendale, Arizona during her 1989 tour

            In the following days after the wedding, I returned back to Boston for two shifts at my night nursing job. I worked the overnights of August 25th and August 26th 2015. I called my Mom every day that week and on Sunday evening and Monday she seemed to be in high spirits. But on the night of the 26th before I went into work I called my parents house phone several times and she didn’t answer. When I called her cell phone she finally picked up. She sounded really weak, sleepy, and fatigued but she still seemed oriented. I asked her to put my Dad on the phone and I could immediately tell he was worried.

“I already called the ambulance once Kris. She refused to go with the EMT’s to the hospital.” He went on to tell me that she had been sleeping a lot that day and that she really hadn’t eaten anything in two whole days.

“Call again. I’m coming home as soon as I’m done here in the morning. Call the ambulance again.”

My Dad agreed and called again, but once again was met with defeat. My Mom had refused the ambulance a second time. I knew that as long as she was oriented to person, place and time, she would refuse an ambulance. If there was one thing I knew my Mom hated, it was hospitals. My Dad sent me a text to inform me that she wasn’t budging on her decision. She would stay at home until I arrived the next morning.

When I was in nursing school, I briefly read about a term called hepatic encephalopathy. On August 27, 2015 I finally had my own personal example of what hepatic encephalopathy truly looked like.

On this day my Mom had in fact been sober for an estimated ten days.   I finished my twelve-hour overnight shift and then drove home in the morning hours from Cambridge, Massachusetts to Rhode Island. I felt like I had been holding my breath the whole drive home only releasing it to talk to my Dad or my Aunt Marie while I navigated the highway of 95 south.

Knowing that my Mom had refused the ambulance the night before, I pulled my car up into the driveway and tried to parallel-park next to my childhood home front door. I positioned my passenger side door so that I could easily ease my Mom into my Toyota Camry. However, when I walked into the house, I quickly surmised that I would not be able to physically help her walk out of the house. She was no longer making sense. From the kitchen, I could hear my Mom calling out from the upstairs bathroom. She would say one or two words at the most. I realized that she no longer had the mental capacity to make her own decisions without having yet laid eyes on her; she could no longer refuse an ambulance.

“Dad, call the ambulance.”

“Well, Kris what if she refuses again?”

“My plan was to get her in my car and I’d drive her there myself. But we’re past that point now. She’s beyond refusing. Just call them and Aunt Marie and I will handle her in the bathroom.”

The mid morning sunlight was starting to make its way towards our upstairs bathroom window when I walked around the corner. My once gorgeous, robust and active Mom was sitting on the toilet and she was yellow. Her jaundice was widespread. It was on every inch of her skin and through her blonde hair I could see the golden tone on her scalp while she tried to adjust her Nike dry fit running hat. Her abdomen was distended so much that she looked about eight months pregnant. Although her abdominal ascites had worsened over the past year, it was evident that her liver had now secreted enough enzymes to make her more than visibly uncomfortable. Her breath was sweet and musty and so strong that I could smell it from the hallway.

When my Aunt Marie and I tried to stand her up from the toilet, the smell of her urine told me just how dehydrated she was and that her kidneys were undoubtedly affected by her liver failure. She was in multi-organ system failure. She could barely stand on her own power; my aunt and I had to help her sustain her weight so she could take multiple breaks just to pull her pants up to her hips.

The thing I most distinctly remember about her physical appearance was the story her eyes told. Her light brown eyes held vast and mysterious pupils. She looked weathered, confused and distant. Her eyes said it all, and as they met mine I realized her sclera, the white parts of her eyes, were the color of dried yellow highlighter. Her eyes told a story of a loss of control, of a once functional alcoholic now entirely debilitated.

I believed that the soul of the loving woman who raised me was still within her body, but she was now only a delicate shell of a role model who once was. Her confusion was obvious. She spoke with only one or two words at a time and one of the most articulate women I had ever known was now unable to speak a full sentence. She recognized me. I knew she knew who I was, but she couldn’t say my name. She would look right at me and in her confusion she would call me by my Dad’s name, “Mike!” she’d exclaim.

I heard the EMS team arrive at our front door and my Aunt Marie left the bathroom to answer the door with my Dad. In that brief span of time I took my Mom’s hands into mine and sat on the edge of the bathtub, facing her as she sat on the cover of the toilet.

“I love you,” I said, as my own eyes welled up. My Mom’s eyes informed me that she registered the message but it was far too much of an effort to form the sentence “I love you too.”

I squeezed her hands hard, as if to say, “Did you hear what I said? You know that I love you right?”

My Mom’s deep, dark, pupils met mine and for an instant I forgot how yellow the rest of her eyes were. Her gaze was to me and me alone. Her breath desperate and gravely sweet, she would gaze at me a moment more.

“Yes!” she exclaimed with every effort she had. She squeezed my hands back in such genuine concern; the love between a mother and a daughter experienced, felt, absorbed, and in that juncture we were infinitely intertwined.—-

“When you go through deep waters, I will be with you.  When you go through rivers of difficulty, you will not drown.   When you walk through the fire of oppression, you will not be burned up; the flames will not consume you.”-Isaiah 43:2