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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.

Saturday, May 17, 2014

The end questions...

How long until?   How will I know?   What can I do?

More than any other questions – these are the ones that seem to plague my readers more than any others. What are the answers? There is no cut and dry equation that leads to exact answers to specific questions. There is no secret algebraic formula in the journey through alcoholism. There is no map with pushpin indicators as to the road stopping anywhere. Alcoholism is a crap shoot as to specifics. It’s a spin of the roulette wheel because no one is certain when it will stop.

There are charts that can give us an idea for a specific moment in time. But, that is the key “specific moment in time.” When Riley was at the “end”, I kept extensive records on either his decline or progress, whichever the case may be at that time. I created and used faithfully, The Workbook for Caretakers of End-Stage Alcoholics. I used every bit of information I could get to keep the book updated. I calculated his MELD and Child-Pugh Scores every time I got the results of his blood tests. I dutifully gave all my information to the medical doctors who were trying to keep him alive. And yet, he ended up in hospice after a major heart attack and stroke. Hospice was short lived because – as we all know – Riley is the Immortal Alcoholic.

How long? The difference that was made by keeping records and doing the charts was that I was prepared. The MELD and Child-Pugh Scores told me an approximation of how long he might live if nothing changed. That is if he drank the same amount consistently and made no improvements to his situation. For the most part the scores were right on point. If you want to know how long, my answer is to learn to use the MELD and Child-Pugh Scores. That can usually tell you if the time limits are in the years or the months.

If you ask a medical person the answer you will receive will probably sound like a sermon from the pulpit – especially here in the south. You will hear, “No one know how long a person will remain on this earth. Only God can say for sure.” Even though some doctors consider themselves “God”, they do not like to give even an approximation of time left. I believe it is possible for them to give a “ball park” in terms of months or days, etc., but then I’m not a doctor. I’m just a survivor who has seen the alcoholic’s immortality in action.
Some alcoholics, like Riley, seem to be blessed with more lives than a cat while others go quickly and without a lot of warning, like my son. There doesn’t seem to be a lot of middle ground as far as I have seen and heard. When a person starts drinking in excess that roulette wheel starts turning and no one really knows where it will stop.

How will I know? This isn’t so hard to answer because there are visual signs that tell us to beware. The color of the alcoholic’s skin and eyes will be more yellowish. He will sleep most of the time and the time when he is not asleep, he will have a drink in his hand. He may vomit blood or have bloody diarrhea. He will have tremors which increase as his drinking lessens. He may hallucinate or have night terrors. Paranoia may become his friend as his in-the-flesh friends fade away along with any hope for employment. There are more details and explanations in page on Stages of an Alcoholic Life.

What can you do? What you can do is dependent on what you want the outcome to be. Some caretakers want to hold on to the alcoholic’s life with both hands and feet. They want to keep them alive so they can pray for a different ending – an ending that includes a continuing life of sobriety, family and true love. Those endings do happen – not as much as we would all like them to happen, but they are possible. There are lots of side-effects to trying to obtain the utopian ending including the deterioration of the health of the caretaker. So the alcoholic may survive while the caretaker may not. If the caretaker can remember to take heed of their own well-being while nursing the alcoholic into sobriety – there is an opportunity for them both to share a long and blissful sober life.

The reality is that most alcoholics and their caretakers never get to the point where they can share much of anything except an argument. But, if you have chosen (somewhere in the far distant past) to stand firm by your alcoholic’s side, it is the caretaker who must decide how long they want to keep the circus open. While the caretaker can go the route of attempting to get medical care for a chance at survival, they can also attempt to get medical care for a chance at hospice. I believe most caretakers have a unique instinct about when the route goes from one point to the other.

In either case, what the caretaker can do is almost nothing once all the medical / detox / rehab options have been exhausted. Again I believe the caretaker will have a little voice in their head telling them when to step back. At that point the focus should shift to getting affairs of the alcoholic in order.  Get a General Power of Attorney and a Medical Power of Attorney; Living Will and Advance Directive; a Last Will and Testament; and possibly a DNR. Keep all these documents together in a safe place. I keep Riley’s in the back pocket of the workbook.

I remember asking my son’s doctor – what I can do to help. His answer was not satisfactory to me. He said “NOTHING” – there was nothing I could or should do. All I could do was wait. For a mother, I felt there must be something I could do – some little something that would keep him with me for even a day longer. There was nothing I could do because he was gone within 24 hours of asking the doctor how I could help. I didn’t make that decision because I would have done anything I could to keep him alive. His roulette wheel didn’t land in a positive place for me.

I take care of Riley just as I would any other elderly sick person who cannot take care of himself. He does not drink because there is no booze available to him. He has made it clear that he would be drunk if he had the opportunity. I made a choice the last time I called 911. I choose to give him a chance to survive. At this very moment (because it could change in a heart-beat), I do not regret that I made that call. I can live with myself. Today, and today only, I do not know how long Riley will last and I don’t know how to determine how close he is to the end. That is only because there is no alcohol involved.


At the end of all this the answers to the questions are all – it depends, I’m not sure; I don’t know. All I can suggest is use relatively rational logic and the tools, i.e., the MELD and Child-Pugh Scores, the workbook (either mine or make up your own); and you’ll be better prepared no matter what the answer.

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