The Unwelcome Intruder
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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," 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 don’t want to end up the same way. I have decided to stop drinking completely.”
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 don’t have an ulcer!
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By Dennis
N. Marks, M.D., F.A.A.P.
