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.

Denial of family...

It’s funny how you can know something but not really KNOW it. Maybe it’s that we don’t really acknowledge it rather than know it. Maybe it’s a form of denial.

I grew up in a large family that was greeted each other with hugs and kisses. In the summer, the kids were exchanged back and forth between aunts and uncles so the children could bond with their cousins. We were family.

I remember how my father doted on all the new babies that came into our house. I remember him literally bouncing them on his knee and kissing them a million times before handing them back to my mother. Since that was my “norm” I believed all fathers were like that.

When my son, my first child, was born, I remember how distant Riley seemed to be. Oh, we had a baby, isn’t that neat – I think that was his first reaction. But, he didn’t seem to care if he held him or not – never asked if he could – never just did it because he wanted to. He was not projecting any sense of a need to protect, no kissing, no touching… just OK we have another mouth to feed. I remember feeling very disappointed, but thinking he would change as Brian became more and more a part of our life.

He didn’t change. He had two other boys before Brian that he ignored and I should have seen that as a red flag. In my heart I believed he ignored them so they could have no complications with their new step-father. That was what he had told me. I thought it was admirable – a true sacrifice for his boys. I was young – just barely 18 – what the heck did I know?

As I said, I was only turning 18 years old when I met Riley and outwardly he fit into the format of the man I thought I wanted in my life. I was too young to realize that what I really wanted had nothing to do with outward appearances or occupation or knowing where to get the best scallops. When he described his childhood as Donna Reed Showesque, I thought of a loving family that expressed emotion. I guess I was watching a different “Donna Reed Show” than he was. I believe my denial started right then and there. Isn’t hindsight great?

This morning, during our usual “over coffee” talk, the subject of family was brought up. Riley told me that “I love you” was not something that he ever heard as a child. That there were few, if any, hugs and kisses. There was support and accolades given for excellent school work and tasks, and there were handshakes – but not much emotion.

This morning he was more detailed about the events inside his childhood home. He’s relatively sober today, I think what he says is believable. It felt as though, in his house there was just a safe place to physically grow and get out. I could be wrong – but that was my take anyway.

I asked him if that was why he was so distant to our children, grandchild and great-grandchildren. I asked if he felt a real sense of love towards them. His response was that he loved them, but was not emotionally connected with them. He said that he never felt a real connection with any of his kids. That’s why it would be so easy to just leave North Carolina and go back to California where he could be closer to his brother – the only real emotional connection in his life.

So now… more than forty years later… I realize that he never really cared whether he was a father or not. In fact, he could have done without fatherhood all together. He had no sense of “family” and that didn’t bother him in the least.

I had always known that Riley did not have a family life as a child that anywhere resembled mine. This morning I finally realized how much his childhood was opposite from mine. I had always known this but maybe I had denied how it would have a negative impact on his own children.

My denial is over. It took me 40 years to realize that my husband doesn’t really care about any of us – the people who have protected and cared for him in spite of every awful thing he has done to us or around us. It explains a lot.

I never really was in denial over Riley’s alcoholism. But I have been in denial as to how his emotional disconnect has contributed to his desire to not stop drinking. In a world where you don’t care if you are “loved” or not, I would imagine that there is no real reason to quit. That fuzzy world of insanity might provide a blanket between him and the rest of the world. I can understand that.

My first instinct is to say “screw him” and send him packing. But, I can’t do that because whether he loves her or not, my daughter loves her father. She will not abandon him – like an abused child protecting the abuser – she will protect him at all costs. In turn, I love my daughter fiercely and won’t allow her to pick up where I leave off.

Riley skirts the edge and believes he is the winner. I skirt the edge and know that Alea is the only one who wins. I’m not in denial about that and it makes me happy.

Witch hunt...

I wanted to write a post on drunk driving this morning. I had just settled in front of the computer armed with my morning coffee and my trusty old dictionary. But, just as I was getting my creative juices flowing I heard a loud screech of skidding tires on pavement. I looked out the window and saw a car had gone off the road and into the ditch. It had been raining earlier and the roads are slippery. There’s a small curve right at that point and if you’re going too fast, it can be problematic.

Riley heard it too. I wanted to hop in my car and go down to see if anyone was hurt. I had my keys in hand and was almost out the door, when Riley insisted he come with me. But… he had to get his shoes on first. I waited… I waited some more… I hope I’m never in an emergency situation and depending on him for timely action. Finally, with shoes on his feet, we went to the crash site.

The car had gone over the ditch and was in the field. It had turned all the way around before stopping. The air bags had been deployed, the engine was still running, and there was no one inside. There were people tracks from the car going toward the street. We went back to our house and called the state troopers. I had not wanted to call when we first heard the screaming tires just in case it was a simple little thing. I suppose we should have called right away.

Of course, I have a very creative and active imagination and there could be a very reasonable explanation as to why the driver would leave the car and disappear. I’m thinking another passing car stopped and picked up the driver to transport him to the auto shop which is just up the road a couple of miles. That’s the logical answer. But, why leave the car running? And that imagination of mine has another idea.

My theory of this morning’s accident goes something like this… the guy was a drunk driver and was either trying to get home – it was 5 a.m. – or he was trying to get to work. When he careened off the street into the field his first instinct may have been to flee so as not to get caught and cited for a DUI. The next passing car’s driver simply wanted to help a fellow out of a bad situation so he picks up the driver and takes him to wherever the accident victim needed to go. Because the driver was still in a soggy state of mind, he never thought to turn the car off.

I do have another theory that doesn’t involve alcohol and that is that the car was stolen and the thief didn’t want to wait around for the troopers to show up.

Of course, in all reality it was probably just someone on their way to work who got surprised by the small curve in the road and the slippery pavement. Everyone knows everyone out here, so the passing good Samaritan probably knew the accident victim and just wanted to help him get to safety. No malice, no foul play, just a simple accident.

Something happens to us non-alcoholics when we are involved in an alcoholic world. Our radar goes up and we see alcoholics everywhere. Alcohol is such an intricate part of our lives that the first thought of something amiss is almost always blamed on alcohol.

When I watch certain television programs where there is a lot of partying and heavy drinking, my first instinct is – just a bunch of alcoholics. I’m not interested and will quickly change the channel. I find no amusement in watching people destroy their minds and bodies. Never mind, that it could be a one-time or seldom-time thing and the participants are not really alcoholics – just people acting like fools. I won’t stick around to find out. It’s so offensive to me that I won’t give the program a chance.

Alcohol consumption at any occasion or celebration causes me to go on red-alert. I love a glass of champagne or wine – maybe even gin & tonic at a barbeque. But, my limit is two. I know my limit because before Riley came back to my house, I exceeded my limit at many social functions. Everyone loves it when I get tippsy – I become very happy and will laugh at almost anything. I dance and I will even sing if the opportunity presents itself. But, I don’t drive. Even then, before I have that third drink, I make sure that I won’t need to drive. Now that Riley is back, I have no desire to exceed my limit and I only drink at very special occasions. Over the past year, I haven’t found any occasion so special that it warranted me to raise a glass in a toast, dance or sing.

Riley says that I’m on a witch hunt. Not all car accidents are alcohol related. Not all partiers are budding alcoholics on their way down the drain. Not every glass raised in celebration is a slippery slope. Even with his unclear, alcohol-soaked brain, I know that he is right.

I wonder if I’ll ever be able to go to a nightclub again and just enjoy the music and lively atmosphere. When someone tells me they don’t drink, will I ever believe it is because they don’t want to or will I assume that they are in a 12-step program? Have I come so far into the forest that I can only see the drunks of the trees?

Alcoholism has far reaching consequences for more people than just the alcoholic. Life with Riley has changed me and how I perceive the world. I’ve always considered myself to be an optimistic realist. I’m beginning to think the optimistic part is becoming less and less as I continue in the journey.  At least as far as the outside world is concerned. Inside the walls of my home and within my family, I’m still extremely optimistic – but outside that there is danger.

I’m not hunting for alcoholic witches… I’m just aware so I can avoid them.

Daddy's girl...

To every man who is father… To every woman who is a single parent… to every brother and sister who watches over their siblings… to every teacher and pastor who has mentored a fatherless child…  and, to anyone else who has ever provided fatherly support to another person… Thank you. You make life easier for kids on the bumpy road from newborn to adulthood by giving them a role model to emulate. Adults need fathers too – just to keep them on track and provide understanding and support. Again, thank you… you are very special people.

My father was my Daddy. He wasn’t Father or Pops, he was Daddy. In adulthood, I usually called him Dad when other people were around, but he was really still my Daddy. I was the only girl child in a family of five, so I was the only one who called him that. And he was different with me than he was the boys. Ohhh… don’t say that to him because he will deny it vehemently, but I have proof.

In California in the 1960’s a teen could get their driver’s license at the age of 16. When my day came, I asked Daddy if I could get my license. His answer was “NO”. I was a little surprised because my brother and the cousins that were residents of our home all had their license within hours of their 16^th birthday. My older brother didn’t go to school just so he could go to the DMV. So I was a bit miffed as to why I couldn’t do the same.

“Why?” my tiny voice asked.

“Because your grades will go down if you start driving.” Good answer I thought. But, the boys were always just barely passing. So… if I start failing, maybe I can have my license??? I didn’t say the words out loud. On the other hand, I was proud that Daddy was concerned about me as a student. Arguing with Daddy was never fruitful. So I accepted his answer.

Years later, after I had left home, I found out that Daddy’s statement ended up being an argument between my parents that lasted for years. I got past it. I still didn’t have my license because I had moved to the city where public transportation was excellent. Cars were costly and I didn’t need the expense.

On my 21^st birthday, Daddy surprised me when he came to my house, picked me up and took me to DMV to finally get the coveted privilege to drive. I was married and had a baby by that time. I wasn’t really missing my license. But, he took time from work and that was quite a birthday gift from my work-a-holic father.

We spent the afternoon together and over lunch I asked him why I had to wait five years for him give me permission – which I no longer needed. He looked a little sheepish while the words spilled out…

“Several reasons – first I was afraid you might stop focusing on school and your grades would suffer.

Second, I can’t protect you from other drivers.

Third, I couldn’t let you take the next step in the ladder to growing up.”

I told him about how unfair it was that he treated me differently from the boys. His response was simple –

“But, you ARE different from the boys.” How can you argue with logic like that? I didn’t care. He was my protector. He was my Daddy.

Happy Father’s Day to all Daddys out there!

Do you have a “Daddy” story? Please post it in the comments so we can celebrate fatherhood together.

Immunity...

One of my readers commented on the amount of time her husband spent sleeping. If you’ve been reading my blog, you know that alcoholics sleep more in the daytime than they do at night. It’s just a fact of alcoholism. It has to do with the alcohol saturation in the front lobe.

The reader’s alcoholic husband does not understand why he is sleeping so poorly at night. He was so concerned that he mentioned it to his doctor and the doctor sent over a sleep monitor to try to discover the cause of his sleepless nights.

Of course, the wife was shocked and confused as to “why” the doctor could not figure this out without the assistance of a monitor. She knew the reason he did not sleep at night was because he sleeps all day and is an end-stage alcoholic. It didn’t seem so complicated to figure out. If the doc really wanted to know what was going on – why didn’t he just ask her???

To prove her point, she kept track of her husband’s sleeping hours and came up with a total of 12 snoozing hours every day. It would vary at times – sometimes nine, sometimes 13. But it all seemed to average out to about 12 hours.

Now she started doing the math. If an adult human requires between seven and eight hours of sleep a night and her husband is sleeping 12 hours a day, he would be sleeping 24 hours each day!!

Her response to this discovery was:

“I think when you reach 24 hours of sleep in a 24 hour period, they call that DEAD.”

So now the doctor is going to spend insurance money on trying to figure out the WHY of the sleeplessness?? She could have saved him a lot of time and money, if he had just asked. But, as is most often the case, the doctors don’t ask the person who is the most knowledgeable and clear headed in the household. Caretakers’ opinions are often discounted especially when the alcoholic appears to be relatively cognizant.

I know I often give doctors a bad time on my blog. But, really, come on, would you ask a person who is dying of cancer and on a morphine drip – how they are sleeping? Of course not. The doctor will ask the caretaker for an update. Maybe it’s an extreme comparison – but in my opinion – an end-stage alcoholic is always on a morphine drip called liquor.  The last time any alcoholic can give an accurate description of his/her condition would be the last day of sobriety. After that, things get muddled.

Anyway… this gets better… I was so amused with the e-mail that my reader sent to me, that I was in my office heartily laughing at my computer screen when Riley walked in. He sat down and just watched me for a few minutes. I was typing a response and snickering. Finally, he asked – “Did Georgia sent you another joke?”

I felt compelled to tell him, but I assessed his state of mind first. He seemed pretty clear at the moment – it was early morning and he was usually at his most sane during that time. So I told him about the alcoholic husband who sleeps the entire day and doesn’t know why he can’t sleep at night.

I should have known better than to share. This was a mistake.

We had a little discussion and it seemed harmless enough. But, when he went to take his first nap of the day he asked me to write down the time so I could keep track of how much time he spends sleeping.

WHAT??? Why would I want to do that??? He angrily stated that if I was going to accuse him of sleeping 16 hours a day – he wanted to prove that I was wrong. He continued by saying he was 70 years old and it was OK for him to nap during the day.

I guess he wasn’t as clear as I thought he was. I quickly replied that I NEVER said he slept 16 hours a day. I told him I wasn’t talking about him – I was talking about my reader’s husband. Then I went on to explain that alcoholics sleep more during the day and alcohol often prevents alcoholics from sleeping at night. It was a fact that I did not manufacture.

Again he protested with something about being 70 years old and taking naps when he was sober… blah… blah… blah…

I asked if he considered himself to be an alcoholic. His answer was YES.

So why did he think that he would not have the some symptoms and conditions that were common to an alcoholic, such as, the inability to sleep at night? His answer was MAYBE THERE IS SOMETHING ELSE GOING ON LIKE DEPRESSION.

I agreed, but depression combined with alcohol only makes the sleep factor worse. Alcohol is a depressant when consumed by someone who is already depressed it can be extremely dangerous. In my opinion, most alcoholics have underlying depression. But, that doesn’t eliminate the fact that alcoholics have sleep issues. I reiterated – he is not immune to these issues.

At that he turned around and went to his room for a nap.

Thank you...

I want to thank each of you who commented on my last post. Your support and stories touched my heart. I wish I could take away everyone's pain... but all I can do is thank you for sharing.

I AM NOT ALONE. WE ARE NOT ALONE. We are a strong group when we stick together and help each other.

Please keep reading and please keep commenting.

Linda

Alone in a crowd...

When I started this blog I felt that I must be the only one going through this and that the writing would help me get my thoughts and feelings down on paper – well – computer screen – it is the 21^st Century after all. I was angry at myself, Riley, everyone around me because no one person really understood my dilemma.

Before Riley came back, I was happy. I was in a relationship. I had a great job, a cat, and lots of friends who were not related to me by blood. It was a good life. I had my share of trials, but nothing seemed to be able to keep me down for long.

When I made that long drive up north to move Riley back to my home, I knew things would change. I wasn’t really sure how they would change, but change was certain. I was no stranger to Riley’s drunkenness. I listened as his roommates told me of some of the bizarre behavior exhibited over the past few months. What they described didn’t sound like the drunken Riley I had shared my home with previously. I was in for a very rude awakening.

At first, I just treated him like I had before. But, I quickly realized that I needed to change my approach. As the changes took place in how I treated Riley, changes were also taking place in my personal life. There was no time for a relationship and no time for social gatherings with my friends. I still had my job – telecommuting was my lifesaver there. With the exception of a few friends and family, who I now communicated with via e-mail and phone calls, I was alone with Riley. None of my friends wanted to be in the presence of a man who has a tendency to ogle, make rude comments, pee on myself, and unable to string three words into an understandable sentence. Well… my cat didn’t care – I still had my Jax Cat.

Alone with Riley.  Hmmmm… I remember days when that phrase would have put a twinkle of delight in my eye and make me tingle with anticipation. I would have had visions of a romantic dinner and a walk around the lake. But now… it sounded like a prison sentence. I had to remind myself over and over that my reasons for doing this were to save my daughter from this very same sentence. Just like a criminal who knows there’s a possibly that he may have to do time for the crime – I knew for a very long time the possibly of having to be Riley’s caretaker. I knew I would have the support of my family and a few friends – but that in the end – this would be MY prison term and I would have to serve it ALONE.

Riley’s behavior was so outrageous that I was certain no one on the face of the earth was experiencing anything like it. I went to Al-Anon, but the other attendees’ stories just weren’t relatable to mine. Everyone thought they knew what I needed to do but none of them ever once described anything like what was transpiring in my house.

Al-Anon is a good source for support. I recommend it. But, I find that the issues of end-stage are very different from that of alcoholics who have not encountered extreme physical dysfunction or near fatal detox. The physiological changes magnify the amount of effort needed to maintain a clean and healthy household – avoiding such things as salmonella. The personality changes make it seem that there is a stranger in the house. I believe in the principals of Al-Anon, but I think it may be difficult to really relate them to actual experiences – especially at end-stage. Sometimes, we end-stage caretakers must go against what is taught at Al-Anon meetings.

From the very beginning, I did research on end-stage alcoholism. There wasn’t much out there, but I kept digging. I learned about different alcohol-related illnesses and what I could expect if Riley had one. I’m a firm believer in knowing what you’re up against – and the internet was very helpful in educating me on alcoholism in general. Finding out about end-stage issues was a long and circuitous route. But… the good news… it kept me busy and between Riley, research and my real job… I didn’t have time to focus on how alone I felt.

I wrote in my blog, but there weren’t many comments. That is – until – I heard from a woman who was going through exactly the same thing I was. She wrote that her alcoholic husband had the same traits as Riley. He even watched similar TV programs and made the same demands. I was elated – I’d found a kindred spirit. I felt a distinct bond with this person.

To stay informed and understand Riley better, I continued with my research and I shared what I learned on my blog. After that, I started getting more comments and e-mail began to arrive in my virtual mailbox. Many people were uncomfortable with posting a public comment and preferred the anonymity of e-mail. I was OK with that. I try to answer each one personally and try to be there to listen (or read) and provide support. I can feel the pain and isolation in each note and I wanted to reach out and say – you’re NOT alone. That’s when it hit me – I am NOT alone.

For every note I receive, I imagine that there are thousands more that have been enduring the life that I find myself living with Riley. And I wonder how many have no support system at all? I have my daughter and family and a few friends, but who do they have? I wish I could visit each and every one and give them the comfort of a giant size hug, a bowl of macaroni and cheese, some homemade chicken soup, and, a plate of freshly baked cookies. But, instead, I just keep writing in my blog and answering e-mails. I hope that they feel my support being transported over the invisible waves of virtual reality.

I no longer feel the loneliness of being alone in this prison. Because of that, it doesn’t feel so much like a prison anymore. I have a life, happiness, and last but not least – my cat.

End-stage definition...

Most alcoholics never reach end-stage. They drink and they fall victim to an alcohol related death such as a car accident, a fall down the stairs, foul play, accidental drug/alcohol combination overdose, undiagnosed conditions, or many other situations. An end-stage alcoholic is one that has the advantage of avoiding the previous mentioned downfalls either by luck or a very astute caretaker.

An end-stage alcoholic is an alcoholic whose body and mind have degenerated to the point where the detox process is just as dangerous as continuing to drink. That’s a quick and simple answer to a complicated question that is asked frequently. If a medical professional tells you to continue to give the alcoholic booze because to be without it, outside a hospital environment, would mean certain death – that’s end-stage. Here are other factors in making the determination.

Most end-stage alcoholics have already been through the detox and rehab process several times. The end result is often a return to the bottle within a short time – sometimes just days after discharge. On the good side, sometimes the alcoholic will wait months before getting drunk. That is good – the longer the time between detox and drinking the more of a chance the body has had to recover. But even then, a return to an end-stage condition, after post-detox drinking, will happen at a more rapid rate than it did previously.

I want to stress here that some end-stage alcoholics never get into detox or rehab. They are so adamant about drinking that they never entertain the thought of a possible better life. They like things the way they are and refuse to change. Riley, even after numerous rehab and detox, has stated that if he has to choose between sober or dead – he chooses dead.  

I’ve written before about the Child/Pugh and MELD score which is determined by using information from a blood test. The two tests are designed for ranking the status of people who are waiting a liver transplant. (See my post Information please... in March 2011) A Child-Pugh score of Class C and/or a MELD score higher than 30 would make the alcoholic at end-stage.

There are a host of alcohol related diseases that also contribute to the determination. How far advanced these diseases are can give you an idea of how much time an alcoholic has left. But, in true end-stage, that really doesn’t matter because the only way to recover from any of the diseases is to quit drinking. That is not likely with end-stage alcoholics.

An end-stage alcoholic will drink anything containing alcohol if traditional sources are not available. This can include, Listerine, vanilla extract, cough syrup or even perfume. Anything else that contains the word alcohol in the list of ingredients is a potential beverage for the end-stage alcoholic.

Because of the amount of alcohol saturating the frontal lobe of the brain, the end-stage alcoholic personality, most often, is not the same as the personality of the same person without the alcohol. Some traits may include: easily angered; unrealistic demands; lack of determining appropriateness of actions; loss of short-term memory; highly emotional; easily confused, and; inability to determine night from day. Alcoholics are subjective – what’s important to them revolves around drinking. At end-stage this is magnified and the end-stage truly wants everyone to “mind their own business” and let him/her do whatever they want – even if it impacts on other people’s lives.

Stomach issues are very common at end-stage. The end-stage alcoholic may demand dinner at a certain time, but will probably not eat much, if any. Often, whatever is eaten will be vomited. Because of that the alcoholic becomes malnourished and will often become very thin. But, this isn’t always true because sometimes the alcoholic will appear to gain weight. Unfortunately the weight gain is usually a result of advancing cirrhosis.

At end-stage the alcoholic has worn away large amounts of the mucus membrane lining the esophagus as well as the entire digestive system. The esophagus will split and bleeding will occur. Sometimes the esophagus will actually “blow out” and can cause almost immediate death. The force of vomiting alone is enough to cause a bleed in the esophagus or stomach. Alcohol is a natural blood-thinner. At end-stage the blood doesn’t coagulate. I’ve seen a bleeding cut or sore on Riley’s last for hours and even a whole day before the bleeding stops. Anything bleeding becomes a potential life-threatening occurrence.

The stomach may develop bleeding ulcers – a painful hole in the tummy. Imagine having a cut finger and pouring isopropyl alcohol directly onto it. It would be the same thing for an alcoholic to drink when he has a bleeding ulcer. And that condition, added to the lack of food and proper nutrients, as well as the inability to coagulate, can be fatal. Diarrhea occurs almost daily and the further along the alcoholic the more explosive the pooping.

Some physical traits of the alcoholic are the yellowing of the eyes and spider-like veins in the fact. At end-stage the skin may turn a fluorescent yellow/green, the nose becomes something like Rudolph’s, the scalp is itchy and flaky, and fingernails have a tendency to split.

If you are afraid to leave the alcoholic in your house alone because you don’t know what he will do – you’re probably in end-stage. The loss of memory can mean leaving a stove burner on under an empty pot. The lack of judgment could mean lighting a candle and placing it next to the curtain. The loss of balance can mean a fall and combined with a hit on the head – the results can be fatal.

Determining whether or not an alcoholic is end-stage is often easier for the caretaker than it is for the medical professional. That’s because the determination is based on what happens in daily activities and bodily functions. The caretaker can TELL the doctor, but to see it and live it gives a better perspective on reality.

Detach...

With very few exceptions, as parents we want our children to grow into loving, caring, responsible, productive adults. We teach them right from wrong. We encourage education. We convey our spiritual beliefs. We teach them to help those who are less fortunate. We instill a sense of compassion and understanding. And, in my family, we took care of those who were ill and unable to take care of themselves.

Our development is furthered from outside sources – mainly the entertainment industry. We see moral values defeat evil doings. We watch lovers overcome such malady such as cancer or life-altering accidents. Romance is everywhere and implies that it is something that MUST be attained in order to have a full productive life. We’re left with the idea that marriage/partnership is the primary goal. And, once found, that it should last forever and ever until death we do part. Well – that’s the plan anyway.

For the most part, it is possible. But, when one of the partners has an addictive personality, things get complicated. Our first instinctive action comes from all our moral value teachings – we must help the person who is the Ying to our Yang. It’s reasonable. It’s expected. It’s perfectly normal. Sometimes it even helps.

As time goes on, the addiction becomes the third party in the relationship. The alcohol becomes the mistress with a locked-on hold over the couple. The alcoholic begins to change in personality and values. There comes a point in time when the alcoholic is no longer recognizable to the non-alcoholic spouse. Now there are four people in the group – the two spouses, the alcohol mistress, and the alter ego of the alcoholic. That’s too much and no one is having any fun.

You’ve tried everything and don’t know what else to do. There is really only one thing to do. Most people consider that the title alone could be classified as obscene. Detachment. Just the word alone implies that you should stop having any compassion or concern for the alcoholic. Many people think that it means not caring. This is far from the truth.

When you think about detachment, try thinking about the detachment only being for the alcoholic’s alter ego. You still love and care for your spouse. That’s undeniable. But that other person – the insulting one who embarrasses you and complicates your life – that is the person from which you must detach. If you can do that, you will be much more at ease and able to cope with whatever is taking place around you.

If you are at the stage in the alcoholism where the spouse is so consumed in the disease of alcoholism that they become totally unrecognizable – it is time for drastic measures. The spouse you loved, the one you promised your heart to forever and vowed to support until death – is now dead. Even though he/she may be walking around and breathing the air in your space – that person is lost to you forever. It’s time to grieve. Allow yourself this. Go to a grief support group (I wish there were ones specifically for loved ones of alcoholics – but there is not) and tell it like it is. Cry. Get angry. Eat gallons of Ben & Jerry’s. Cry and then cry some more. And then you may find that you can accept the fact that your beloved no longer lives in your house even though the alter ego is still present.

Now what?? You’ve cried, etc., etc. and what’s next? Do everything you would do if there were an actual death. This is the practical stuff – let an attorney advise you as to how to handle the finances, etc. Hire a housekeeper (if you can afford it). Do whatever it is you would do if you suddenly found yourself as a single person. I don’t encourage dating – that just further complicates things because the spouse you love is really still there – but just gone on some sort of mental hiatus. When/if that person returns you want to be emotionally available.

The alcoholic alter-ego is now a roommate and not a spouse. You may not like this roommate, but you provide everything necessary for a safe haven. That’s how you fulfill that idea of taking care of those who are sick or unable to care for themselves. It doesn’t mean you lie to his/her boss – that job is not your business – just as any roommates job would not be your business. It is not your responsibility to see to it that the alcoholic stays sober. It is none of your business if the alcoholic seeks treatment or not. While you can be supportive – let things happen as the play out. Don’t answer questions for the roommate or make commitments – it’s not your place. Put those responsibilities squarely back onto the alcoholic’s plate.

Of course, you must consider children – if there are any in the household. That’s a whole other post. See my page Leave or Stay?

Re-discover your own life. Did you like to play golf before you were afraid to leave the alcoholic at home alone? If so – go play some golf. Develop new friendships -- if they are also spouses of alcoholics, that’s even better. You are in there somewhere – you’ve just gotten lost and now it’s time to be found. Stop spending all your time thinking, hoping, and doing for the alcoholic. Focus on your needs and what you want.

So are you thinking… it’s dangerous to leave the alcoholic home alone… what if something happens while I’m gone? If it makes you feel better, find a cooperative friend that can stay with the alcoholic while you are out. But, don’t let that stop you. If you have no support system, try attending some Al-Anon meetings. You may not like everything they say – but there are people there who understand what you are going through.

You’ve grieved over your loss. You’ve found yourself again. It’s time to find some humor in your situation. Let’s face it – as sad as it is there are aspects of alcoholic actions that are funny. Looking for the milk in the oven – putting a jacket on upside down – illogical conversations – all good for a laugh. When you find yourself getting angry with the alcoholic – stop and ask yourself… if this were on a sitcom… would it be funny? If this were not happening in your house – would you laugh or at least chuckle?

I used to get frustrated at Riley when he would insist that a program from season one of NCIS had never been seen on television before. Especially when I knew he had just watched it a few weeks before. I used to try to tell him it was not new… it was a re-run—again. Now I just smile and say… Oh that’s nice. That smile leads me to thinking how fortunate I am to have that program be his big issue of the day.

Instead of thinking of detachment as distasteful… think of it as a life saver – your lifesaver for your life. Not the alcoholic’s because the alcoholic must find his/her own lifesaver.

I’m not saying this whole thing is easy because it most certainly is NOT. I consider that I’m fairly well detached from Riley – but there are days when I have to just get through each minute. I still get angry. I still yell. But I also laugh and always remember – this Riley is not MY Riley.

By the way… I had a friend who was the spouse of an alcoholic. She gave a specific name to her alcoholic’s alter-ego. It helped her keep her perspective about who was with her at any given time – her husband, Henry or the alter ego, Hank.

99 bottles of beer...

I have noticed that Riley has been having a lot of intestinal issues over the last month. They seem to be increasing in frequency -- daily vomiting and explosive diarrhea. During his last drinking session before detox, he had issues, but they were different. Last time he didn’t start vomiting until the very end – just before Alea and I took him to the hospital when we suspected he had had a stroke. He had bowel issues for many months prior to that but not like what he is experiencing now. His alcohol of choice during that time was vodka.

I don’t consider him to be as close to the end right now as he was just before the last detox.  He still has some reasoning capability and although a lot of the symptoms have reappeared, they don’t seem to be as intense. Except – for this intestinal thing which I felt was out of sync with the rest of his issues. This time he is drinking only beer and I have attributed his slower rate of decline to the fact that it has less alcohol content than vodka.

I was concerned so I did some research and discovered that drinking beer in excess creates a whole new set of complications. Beer has been linked to cancer in the large intestine, rectum, and esophagus while other alcohol doesn’t increase the likelihood of these cancers. This is referring to CANCER rather than the normal errosion of the lining of the intestines. I didn’t know that.

What I do know is that beer (also known as liquid bread due to the high yeast content) is high in calories and will cause weight gain. Since any alcohol prevents the burning of fat, once a “beer belly” settles in the mid section it can be difficult to get rid of. This is especially true since the alcoholic is no longer able to exercise and burn off the extra calories. As a result, that belly can quickly turn into a high risk cardiac situation and even diabetes.

There is an increased opportunity for the beer drinker to experience gall stones or gout. Beer contains chemicals that double the uric acid content in the body and promotes gall stones and gout disease. I had heard this before.

The liver can detoxify about 12 ounces of beer per hour. That’s one can of beer per hour. If Riley drinks 12 cans a day it will take 12 hours for his liver to detoxify the alcohol.

There’s as much alcohol in a can of beer as there is in a shot of hard liquor. Beer is no better for the alcoholic than a shot of whisky or vodka. They can get just as drunk and do just as much damage as with any other type of booze.

Something else I found on the internet was that beer brewing material contains lead – which, of course, can cause lead poisoning. In elderly drinkers this can lead to senile dementia. I don’t know about that one. I found this in only one internet article and could not find anything else that would substantiate this theory. If anyone knows anything about this – please post a comment of send an e-mail. This interests me, but I doubt that it is in fact true.

However, the lead poisoning thing would make yesterday’s conversation with Riley more understandable. It went something like this:

1. Riley doesn’t really like the taste of beer.
2. Riley doesn’t get the desired level of float-y-ness as he does with vodka.
3. Riley knows that drinking a beer has the same alcohol content as drinking a shot of vodka.
4.  My question is – considering all three points – why doesn’t he just drink vodka since it is all going to kill him anyway?
5. His answer – he just wants to drink beer right now even though he doesn’t like it and it doesn’t give him the effect he wants.

OK – it’s his choice – I won’t argue the point with him. Maybe that internet article about lead poisoning and dementia is true after all because this just doesn't make any sense to me. I can find no viable reason why someone would kill themselves by overindulging in something they didn’t like. But, I don't have an addictive personality and maybe I just don't get it.

Anyway, I can guarantee you that if I’m going to kill myself with a substance; it will be one that I like and makes me feel warm all over. I think it is Sara Lee that makes a Chocolate Mouuse Pie – give me about 100 of those babies!!

Imagine the headline – Woman dies from overdose of Chocolate Mouuse Pie while in bubble bath, sipping on Benedictine Brandy and reading the latest Janet Evanovich novel while listening to Nora Jones. She was surrounded by pictures of her children and grandchildren while her cat sat on the edge of the tub. What a way to go!!