The Unwelcome Intruder

By Dennis N. Marks, M.D., F.A.A.P.

Fairly early in my practice, a couple brought in their baby for her first check-up. As the months went by I would increasingly detect alcohol on the mother's breath. The baby was doing well, and the mother never seemed intoxicated. After the adoption became final, a couple of appointments were missed. It was the father that accompanied the baby for her one year check-up. He explained that his wife had left them and moved back East. He went on to say that his wife adopted the baby after hearing that occasionally women seemed to improve their chance of becoming pregnant after adoption. When this did not happen, she increased her drinking. When this became serious she left the family. A few months later he reported that she had committed suicide.

Naturally, this devastating news had me wondering what I could have done. I remember thinking about the odor of alcohol and wondering if I had an obligation to report it to the adoption agency. After all, she was never drunk. Would I have the right to jeopardize the adoption if she were a social drinker? So many questions raced through my mind as, yearslater, history seemed to be repeating itself.

It is three o'clock in the afternoon, and Mrs. Bane has brought in her 17 month old son Joey (names changed). On the third day of his umpteenth cold he has turned feverish and fussy. Joey is a very affectionate boy, and the examination proceeds easily. He sits on my desk and plays with my stethoscope as I tell Mom that it is another ear infection.

"What am I doing wrong?" she asks pleadingly. "You're not doing anything wrong," I reply. I treat more ear infections than all other infections put together. But I am not totally comfortable because there has been an unwelcome intruder into this familiar physician-patient scenario. There is the odor of alcohol on Mrs. Bane's breath. After she left I checked with Gai, my long time medical assistant.

"Did you notice?" I asked. "Yes,"
she replied, "She has been drinking, hasn't she?" Mrs. Bane wasn't obviously intoxicated, but it was about the fourth time that I had detected the odor of alcohol in the room. Often times she had overreacted to Joey's illnesses. An undercurrent of tension had been interfering with her full enjoyment of this delightful little boy.

A dilemma to doctors, drinking parents seem to think they are acting normally and nobody notices the alcoholic breath. The doctor often encounters denial and even antagonism if he confronts the drinker. However, my previous experience with a drinking mother could not be ignored. It was a passive approach I vowed never to follow again.

Ten days later, Mrs. Bane brought Joey in for a recheck and his 18 month exam. Although she and Joey seemed O.K., his ear had not completely cleared up and we continued his medication. Toward the end of the visit I told Mrs. Bane that something was bothering me. "I like you and Joey and if something bothers me I want you to know about it, so it will not interfere with our relationship. Besides, I don't want to get an ulcer." "Sure," she said, "go ahead." She seemed a little surprised and apprehensive, but genuinely willing to listen. "On a number of occasions," I went on, "I have detected the odor of alcohol on your breath, and it worries me. The disease of alcoholism has struck so many times in my family that I felt I had to speak to you about it and I hope you won't be angry with me." "No, no," she protested, "but it is just that my husband sometimes comes home for lunch and I have a glass of wine with him."

"Ok," I said. "I just wanted you to know that I care for you and that I was worried. "Sure, Sure," she said, "Yeah, thanks." "Come back in another 10 days," I concluded, "we will need to check Joey's ears again." As the 10 days went by I often thought about the situation, hoping Mrs. Bane had not been `blown away'. When I walked into the room, I was relieved to see a healthy Joey and a smiling mom.

After the examination I pronounced Joey's ears well and prepared to leave. She stopped me, saying, "I want to thank you for talking to me last time. I thought about it a lot and talked to my husband. I have a couple of uncles who ended up alcoholics and I donít want to end up the same way. I have decided to stop drinking completely.Ē Physicians know that alcoholism is a highly complex disease. It has many antecedents and many consequences. Mrs. Bane might have been able to handle the amount of drinking she was doing for many years. The fact that she plans to give up drinking completely indicates an awareness of a potentially serious problem. Several months have gone by since we discussed the drinking. Mrs. Bane seems more relaxed and Joey is well. And more good news--I still donít have an ulcer!

Dr. Marks received his BA from Columbia College, his M.D. from New York University and his pediatric training from the Yale University affiliated program at St. Raphaelís Hospital in New Haven, Connecticut.