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Providing non-judgmental and non-criticizing support for family and friends of end-stage alcoholics through one-on-one coaching, support groups, blog posts, workshops and public speaking.

Friday, June 24, 2011

Moral dilemma...

Anyone who is a caretaker to an end-stage alcoholic is in a moral dilemma. The dilemma is to let the alcoholic drink himself into destruction causing their own demise or continually rush the alcoholic to the emergency room for a chance to detox and possibly rehab.

If the alcoholic were not end-stage the choice would be clear – any opportunity for a chance of sobriety is a good choice. But it’s different for end-stage. Most likely the end-stage alcoholic will have already been to detox and rehab many times before without attaining long-term sobriety. Usually they make their wishes clear that they do not want to go to the hospital, detox or enter rehab.

In my opinion, at this point, the caretaker must decide if he/she will follow the path requested by the end-stage and just “leave them alone.” Or, will he/she take the path of insisting and manipulating the alcoholic in order to get them into the hospital. It’s a hard choice.

When I moved Riley to the country, I made a decision that I would no longer take any heroic measure to keep him alive. I let go of the idea of being able to control where this illness would lead by insisting on going to the hospital when he really did not want to go. I was done manipulating him into taking care of his health.

Believe me, this was not an easy decision. I wrestled with thoughts that I was taking someone else’s life into my own hands and playing God. I felt like a character in a cartoon with an angel on one shoulder and a devil on the other. Both angel and devil were whispering in my ear – telling me what I should do. But, I was confused because they would change roles – the angel would repeat what the devil said and then the next minute the devil would repeat what the angel said. It was difficult to tell them apart. So I stopped listening.

I had a conversation with my minister. I had a conversation with my lawyer. I had a conversation with my doctor. I had a conversation with Riley. And I had a conversation with myself.

I think the turning point was when Riley told me he would rather be dead than sober. It was about the same time that he started vomiting and I offered to take him to the hospital. He refused to go and I did not push him. I told him to tell me if he wanted to go and I would take him, but that going was his decision.

Fortunately, right at this minute, Riley’s health is not as bad as it has been at the edge of the end in past instances. I am thankful for that. But, it doesn’t mean I don’t have to worry about it. Well… worry may not be the right word… I still have to plan and prepare myself mentally to do what feels unnatural to me. That is I have to let someone die without doing everything humanly possible to throw them a lifesaver ring.

I’ve always said that detaching from someone we love goes against the grain of everything we learn about being a loving, caring human. Letting someone go to their death in any manner also goes against that same grain.

That last paragraph threw me back to being at my son’s bedside after signing the papers to terminate his feeding tubes and let him shuffle off this earth into the waiting arms of family who have passed before him. It was unnatural. I felt like I was murdering my own child. What kind of mother does that?? My brain knew it was the right thing to do – but my heart wasn’t listening.

My brain is talking to me again. It is telling me that Riley has used up his quota of heroic measures. It is his choice to die and I must let him do that. He has signed his own papers to terminate his feeding tubes by not wanting to live a sober life. This time my heart is listening and it knows what I must do.

I must do nothing. I must wait until he has become unconscious before I call the paramedics to take him to the hospital. He will most likely never regain consciousness. If he does that’s great, but if he doesn’t – it was his choice and I did not stand in his way.

The trick is to be able to act on that decision. That’s the hard part. The fact that I’m detached from Riley helps. It also helps that although we are married, I don’t really see him as my husband – that person died long ago. My role of caretaker didn’t come about as a means to save him but rather to save my daughter from him. All of that makes it easier for me.

On the other hand… there is the Law of Robotics that constantly plays in my head. (See The Plan is Flawed from October 22, 2010)  However, I’m not a robot and my priority is to save the savable. I no longer consider Riley to be savable after so many attempts to save him have failed and it is clearly not what he wants.


Jennifer said...

Thank you for bringing the subjects we avoid out in the open. For all the times I expected/feared my husband would die, he hasn't. Now, I'm in a state of mind (listening to that hopeful angel perhaps) where I wonder the opposite: what if he does live another 20 or 30 years? What if he outlives me? It's a scary thought to let go of the worry -- else I won't be prepared if it happens; I'll let go of the fear and BAM it will hit me unaware with the little devil whispering, "told you so." But will expecting it make it easier afterward? I'm not sure it will. The little angel side is already saying "told you so" since he's still here. So, now I'm in a place where I'm trying to focus on the good I appreciate in him (and of course, there is a lot of good to love), knowing we're on borrowed time we can't relive. It helps me see what I'd call the "real" him and keep equalibrium when his emotional pendulum swings. Though, I'm sure you know this state of mind -- it seems you've been where I am many times before.

Anonymous said...

Yes I agree they make their choice pretty clear after 3-4 times of heroic medical measures to only end up drinking again a few short months later (the sober months get shorter with each heroic measure)..
How does one handle this situation with the public? paramedics? why did I not call 911 ?..I know why. and still will question it too..I ave found that each er visit, hospital stay the staff become less and less caring which I do not blame them..My mothers last er visit..they did an xray of her swollen three times the size arm and said no fractures sent her home with percocet.not even given a sling.one week later I made her appt with ortho...it is in fact fractured severly..Ortho said radiologist report at hosp indicated fracture..er dr chose not to treat that way?..she was inebriated of course..no blaming anyone.they probably had sick people to treat!.but why keep going thru this?..thanks for the blog...timing is perfect for us! karen in fl

Alcoholic Daze (ADDY) said...

When Riley's time comes, it will be crystal clear to you what you have to do. When Greg went into hospital for that last time, it was just like every other time before, but it changed dramatically within days. Everything suddenly started to shut down, he was rushed into intensive care and it became clear as day that all his organs were failing never to recover. We basically pulled the plug on him. Had we have done everything to keep him alive, he would have been a vegetable having to undergo regular kidney dialysis and he would have hated that more. It was hard for me to pull the plug and watch him die, but the alternative was not a possibility. Let us hope Riley has an epiphany and doesn't get that far.

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Syd said...

I don't know if you have read Bill's story in the Big Book of AA or Lois Wilson's story When Love Is Not Enough, but Bill was nearly a wet brain and would be hopelessly put in a sanitarium. Then, a miracle did happen and he got sober. I still hope for a miracle for Riley. But it has to come from within him. You cannot make him sober. Thanks for your comments regarding the in-laws.

Linda said...

Syd... thanks for the comment. I always appreciated the way you make me think about things I've written.

I have read Bill & Lois' stories and I understand where you are coming from. However, Riley has had his miracle 4 times and each time in clear sobriety he has stated that he resented us for interfering and that he does not want a sober life.

I will not longer fight to keep him alive. I will not hasten it, but I will not prolong it either. If he asks for help, I will gladly give it to him. If not I'm going to do everything in my power to stick to my plan and not play the martyr lifesaver.

How many times does someone have to state what they want consistently -- in both a drunken or sober state -- before his wishes are observed?

In my opinion, if a drunk wants to be saved they are still savable. For more than 8 years Riley has told us he does not want to be saved. I will no longer feel immoral if I do not rush him to the ER after a heated arugment about him not wanting to go and me being afraid if he does not go he will die. It is HIS health, body, life, choice.

Sue said...

Thank you so much for your post. My decision as to treat/not treat is further complicated by my husband having no health insurance. He just completed a 3 week stay at rehab and was drinking within a week. He has a 40 year history with very little true sober time. His health has deteriorated dramatically over the past year and especially the past 6 months. I am so-o-o grateful for your blog. God uses it many times to confirm and affirm my choices and direction. THANK YOU LINDA <3

Have Myelin? said...

When we (my son and I) had to make the difficult decision to remove my daughter from life support I swear the floor opened up beneath me and swallowed us up whole...we are now trying to climb out.

In our case we did not know she was end-stage. We were in Colorado and she in Texas. I knew she was an alcoholic but end-stage? No, not even close. Looking back I can see it now of course.

I would have done things very differently but I don't know what I would have done...just know...if I could go back in time, I would have tried something else.

Anonymous said...

I can't thank you enough for this blog. There are many days of living with my end-stage alcoholic husband that I don't think I can go on any longer, but still I manage to get up every morning and go to work and take care of my family. My husband's health has declined considerably in the last 2years, and neither he or I believes he has much time left, but I have to agree with Jennifer, what happens if he does live another 10, 20 or 30 years? He knows he's very sick, where just a week ago he couldn't keep food down for 5 days without vomiting, yet he was still drinking the vodka. I have passed on taking him to the ER many times, since everytime we have gone, as someone else said, the care becomes less and less because they know he's intoxicated. I imagine I'll wait until he's unconsious before I do anything, and sadly, I hope that happens fairly soon. I feel awful saying that, but the sadness and frustration I have watching him kill himself is becoming more and more taxing on me. I am now suffering from daily anxiety attacks, and there are times I feel like I'm losing my mind when he won't leave me alone in the evening because his internal clock is all screwed up so he is up and down every 15 minutes all night long. I try to be kind, but there are times I am just brutally honest and tell him he needs to leave me alone, which most of the time doesn't work. He leaves mumbling and swearing, but is back 10 minutes later with no recollection that I asked him to go to bed and leave me alone. Anyway, thanks for not only giving me a place to vent, but some perspective and support knowing I'm not alone.

Linda said...

Anonymous... You must take care of yourself. Anxiety attacks are not to be taken lightly. Try to find someone who can come and watch over your husband for at least a few hours. If you can manage a weekend away -- all the better. If you have your own room -- lock your door and sleep with soft music or TV that will mask the sound of his knocking. You absolutely MUST get some rest. You don't want him to out-live you -- do you??

Anonymous said...

My end stage alcoholic husband did die this summer. He died of a blood clot to his lung. Only recently have I come to realize that while he died of a clot, he really died because of his alcoholism. Had he not been drinking, maybe he would have taken his med's and gone to the doc. Of course, he didn't want to take blood thinners because he couldnt drink on them. After several years of crazy benders, irrational behavior,and all the other things mentioned on this blog. I am now very sad and full of regrets. Maybe I didn't try hard enough to get him to aa or counseling or treatment ( though hes done all that many times before.) Maybe instead of sitting and watching him self destruct I should have kicked him out and it would have been a wakeup call for him. The sad thing is that I had given him a 'deadline". Just days before he died, we had a great weekend, he said I didn't have to worry about "drunk Bob" anymore and that he was going to straighten up and dry out. I don't know if that would have happened, but now I know if I could have turned back the clock i would have handled things much differently.

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