Or the scariest of medical diagnoses

I have a small office near the nursing unit I serve in the hospital. It’s a nice office with a couch, and the computer is usually quiet. Last night, for whatever reason, the steam pipes kept banging as steam surged in those old pipes; maybe they had the chili from the mess hall. I received a call from the emergency department about a possible admission of an alcoholic who is found by his neighbor very confused and intoxicated.

Many people would just say, “he just needs to sober up.” “Hell, I get drunk all the time and forget things.” With an alcoholic, it’s different and actually dangerous for them to sober up, or detox as it’s called, without some kind of medical management. The major reason for medical management is that alcohol acts not only on a major brain chemical called GABA, it also acts on amino acids— Minor withdrawal symptoms are due to central nervous system hyperactivity and can include: Insomnia, Tremors, Mild anxiety, Gastrointestinal upset, Anorexia, Headache, Sweating, and Heart palpitations (feels like your heart is beating out of your chest). More severe symptoms can result in Seizures, Hallucinations, and even dangerous Arrhythmias.

Treating alcoholics is something that changed based on empirical evidence based on the notion that withdrawal could be potentially lethal. When I first started as a nurse over 20 years ago, when a patient became delirious or super anxious, we just tied them to the bed to ride it out. Over time we found out that when these guys had seizures, they started dying. At that time, the going philosophy was abstinence, and in some ways, that remains the same today outside of a hospital setting. The problem is as resilient as the brain is, it doesn’t just instantly repair itself when you stop drinking. It needs time to detoxify and reset its neurotransmitters. This is why we give drugs like Ativan to patients who are having tremors or hallucinations to ease this transition because they work in the same center of the brain and we can control the taper of those medications.

So, what’s the point? Well, it’s pretty simple in the life of the nurse. We see a lot more detox patients than you would think. These people reach an individual struggle that makes anyone’s day-to-day problems look minuscule. We can’t discount these folks because we don’t know when we do start detoxifying them what their underlying condition may be. These patients can be particularly tough; many of these folks we know by name. Many times, we wonder if this is their last trip in, is the liver going to give out, is the heart just going to stop this time, or are they gonna walk out the front door only to be back in the ER in three nights. We just don’t know the answer to this, and often, this one of the most difficult things to do when dealing with these types of patients.

In the end, we decided to send them to a higher-level medical floor to be monitored and hopefully treated if any of the big symptoms of withdrawal occurred. Then, we could figure out why he thinks he still married to his wife who has been dead for five years.