Hospital detox

Ben is still in hospital. They are doing a quick and cheerful detox (not sure he’d describe it as cheerful). He’s lying in an acute medical ward, sharing a room with five other men – all of whom are fragile and elderly. He’s got one line going into his hand, is given two injections (one of which is in the stomach), and is on a round of tablets.

Hospital detox is boring. Ben is still shaking and not allowed to walk very far on his own. The drip is what keeps him tethered to his bed, otherwise he’d be roaming the corridors, looking for a place to smoke.

One of the other patients – also an alcoholic – has already broken the rules and had a cheeky cigarette in the ward toilet. He denies it. ‘So, who did?’ presses the nurse. ‘A spirit?’ I can’t stop laughing. Even Ben smiles. The culprit (as the nurse calls him) says, ‘No, no, I didn’t, no.’ He is smirking (although, to be fair, he has looked this way since he was transferred to this ward room). His face is lined, he wears a tuque and his legs are bloated.

When the other nurse arrives, the culprit is upbraided again. Nurse 2 brings a can of something and sprays it here and there, leaving a synthetic sweet vapour surfing on top of the noxious cigarette odour. The windows are promptly opened to let the fumes out.

‘You’re lucky,’ I tell Ben. ‘You’ve got some ready-made entertainment here.’ He nods. ‘At least I got a small hit, eh nurse?’ he jokes. She’d earlier told him he couldn’t go out for a cigarette because he was shaking too much, and because wheelchairs are like ‘gold dust’ at the hospital, and if anything happened to Ben, it would be on her head.

I have little sympathy for Ben’s need in this case. I can’t see why precious resources should be diverted – even temporarily – to satisfy his nicotine addiction. So, I’m with the nurse. Poor Ben looks defeated.

His request for a cigarette break was prompted by a visit from the consultant. Over the course of 4.5 hours, Ben is visited by three people: two from the local drug and alcohol liaison service (they are there to liaise with Ben’s drug and alcohol service) and the consultant. The consultant is firm but honest, dispelling any hope we might have of getting Ben straight into rehab. But before I am destroyed by this news, I realise that he knows little of Ben’s case and does not know that we have already made significant inroads on our journey towards treatment.

In my desperate state of mind, I prefer to hang on to the words of the first specialist. He seems to know a few people at Ben’s local drug and alcohol service and seems willing to endorse his request for quick admission into rehab. It’s a long-shot, but not impossible. I want to believe it is possible.

So tomorrow, I am back to work, but also, back on the phone to all these various pieces in the treatment puzzle: Ben’s key worker, his community care assessor, the two people from the local alcohol liaison service. I’m fed up of being fed a line. I’m going to keep badgering until the wall crumbles and the lines are reeled back in.

 

 

 

Accident and emergency

Ben was admitted to hospital. It wasn’t planned.

He woke up shaking, but determined to get to his regular psychology appointment at our local NHS drug and alcohol service. I stayed home from work to make sure he got there without injury. Today was also going to be the day he would finally be assessed for rehab. I was going to accompany him to that appointment, too.

While Ben was with his psychologist, he took ill; he was in acute withdrawal. They called an ambulance. His psychologist, Jane, came to get me (I was waiting outside). I found him sitting on the floor of one of the consulting rooms, his face grey, his body trembling. We ended up in A&E at a hospital an hour away from us.

There was a lot of waiting. We waited an hour before a nurse showed Ben to his own little curtained cell. About 30 minutes later, they wheeled a bed with a filthy mattress into the cell (Ben was sitting on a plastic chair until then). Another 20 minutes went by before they disinfected the mattress and bed frame (with a disposable wipe), dried it and put a sheet on it. The fitted sheet kept springing off at the top, bunching up behind Ben’s head. The bedding looked grey and dirty, even though it had been cleaned.

About 20 minutes later, an A&E doctor came in to speak to Ben and me. She asked us all the same questions the ambulance staff asked us:

  1. how are you feeling?
  2. what brought you here today?
  3. when was your last drink?
  4. is it normal for you to vomit if you haven’t had a drink?
  5. how long have you been drinking for?
  6. blah,blah,blah.

This doctor ordered several bloods, two x-rays and said she was admitting him to hospital for a couple of days. While she was taking his history, Ben vomited. A nurse, who seemed to have been beamed in from a planet far far away, took several vials of blood and put a line in. She pumped some medicine into a vein in his forearm, then attached two drips. Ben was also given four colourful capsules, with no water. The water took another 10 minutes to arrive.

Once the doctor left, we sat in silence. I read through a 4000-word document on my mini smart phone. I listened to the doctors’ and nurses’ banter. ‘Are you normally constipated?’ asked the doctor in the cell next to us. The patient had severe abdominal pains, which the consultant declared were either:

  • appendicitis, or
  • constipation.

Ben was wheeled away briefly for his x-rays, then wheeled back. He wanted to take out the line so he could go and smoke. I told a nurse he needed the toilet… and that he might need a cigarette. The nurse brought him a pulp-paper cardboard gourd to pee into. And said ‘too bad’ when Ben said he wanted a cigarette. Inside, I was cheering.

A few hours later, a consultant from the medical team, where Ben was destined, came to speak to him. She asked him questions 1-5 several times, and each time, Ben answered slightly differently, before I corrected him. It wasn’t until I was on a bus going home that I realised the consultant was testing his memory.

I stayed with Ben for nearly four hours. He still hadn’t been given a bed when I left to pick up Rosie. I think it was probably around 8pm when they finally sent him upstairs.

Our local NHS drug and alcohol service rang up Ben several times while he was in the ambulance and once in the hospital. It was more times than they have rung him about anything before.

 

Step 4 – What if your key worker is unresponsive? Talk to your GP

Once Bianca retired, Ben was in free-fall. He was seeing a different key worker for post detox support – part of the after care package put in place before he went into detox – but he wasn’t being seen regularly by an alcohol nurse/key worker at the local drug and alcohol service that was following his case. This went on for two months. By then, he was back to drinking heavily. Eventually, the post detox key worker had to stop seeing him, because Ben was clearly back on the drink.

Eventually, a new key worker replaced Bianca, but he left before he even had a chance to see Ben. Some weeks later, he was replaced by Sara.

I telephoned Sara to discuss Ben’s case, before she met him. She seemed distant and uninterested, and bent on ending the conversation as soon as possible. I was telling her that Ben was drinking again, that he was heading down the same path he had been on earlier in the year and would end up back at zero if he wasn’t sent into rehab or something similar immediately. I also said that he was talking about suicide. ‘What’s his name again?’ she asked, 15 minutes into our conversation.

That set the tone for her interaction with Ben – and me. She even stopped seeing him for about a month, because he “kept saying the same things to her”. It was precisely during this time that his conditioned dramatically declined.

Whenever I spoke to her, she displayed the same disinterest. She even laughed when I told her that the only food he was eating at the moment were an apple and a few chocolate digestive biscuits. She made appointments with Ben which she didn’t turn up to. I know this to be a fact, because I was present when she made one of those appointments, and I accompanied Ben on the assigned day, only to be told that she wasn’t there. Unlike Bianca, she made no attempt to keep me abreast of developments. If I didn’t ring her, I wouldn’t hear from her.

Fed up with the lack of progress at the service, I accompanied Ben to his next GP appointment (this must have been about a month ago) and complained bitterly about what was happening.

The GP rang them up and queried Ben’s case. I don’t know what he said to them, but a few days later, Sara filled in an application form for detox for Ben, and the alcohol team had decided that detox should be followed immediately by a residential rehab programme – pending an appointment with the community care assessor. (Prior to this, all talk of rehab was firmly discouraged by them.)

Once that was done, they said, a recommendation for detox and rehab would be put before the funding panel. If they okayed it, Ben would be sent immediately into detox.

Last week, Sara left the drug and alcohol service and Ben’s case has now been transferred to a new key worker – Marc. We only found out about this after I complained to the GP again because the community care assessment appointment still had not been made despite promises that it would be made last week and the week before that.

Marc and I have spoken about Ben’s case. He appears to be concerned about Ben’s condition, and insists that they are working as fast as possible. I see him later this week. The thing is, Ben is so ill that I doubt he will make it through another week, let alone two. I feel like I’ve hit a dead end.

Still, the lesson in all this is, if your key worker isn’t responsive, request a new one (in retrospect, I don’t know why we didn’t). At the same time, keep your GP updated on any progress. Your GP is just as much an advocate as a good key worker can be. 

Step 2 – Build a relationship with your alcohol key worker

The key worker is key. This is what I learnt from nearly a year of engagement with our local drug and alcohol service. Your key worker is your advocate. If she or he is not behind you, actively engaging not just the alcoholic, but you, the carer, then things can fall apart rapidly (more on this in a later post).

The first thing I did when Ben was admitted to the service was ring them to speak to the person who assessed him. Ben had given him permission to share any information with me – a boon, as this has allowed me to keep tabs on how his treatment has been progressing (or not). It has also allowed me to intervene when necessary. When I phoned the first time, I asked about their methodology. I wanted to know what we could expect from the service, projected timelines for treatment, types of treatment, etc. And they told me.

Ben and I were lucky at the beginning. His first alcohol nurse/key worker – Bianca –  was passionate about getting him healthy again. Both she and Safar, the alcohol worker who assessed Ben, were very concerned about him. Ben was thin, quivering and completely devoid of self-confidence (sadly, nothing has changed).

Bianca made a point of speaking to me and keeping me informed of Ben’s case. Whenever I phoned, she gave me as much time as I needed to vent or ask the questions I needed to. She breathalysed him every time he went in to see her and reported his readings to me each time we spoke. From the beginning, she said he needed to be sent into detox. She was – rightly – extremely concerned for his health and she wasted no time in getting him prepared for treatment.

One day, she found he was over the limit when he drove in to the clinic, and confiscated his keys. Ben rang me at work to tell me that the car was at the hospital where the alcohol service is based. He said he thought the reading was wrong, but Bianca had taken his keys anyway. He sounded genuinely puzzled – but this was just another manifestation of his delusional mindset.

When I went in to collect the keys, Bianca took time out to speak to me. She wanted to know how much I knew about his drinking (not all that much, as it turned out). At the time, Ben used to keep his cases of beer in a padlocked shed outside. Only he had the key to the shed. He never let me go in there – and perhaps I didn’t want to. Anyway, it was she who insisted that I demand the key to the shed as a symbol of his commitment to being honest with me from that point forward. She also suggested I hold on to the car keys. I followed her advice and it worked.

When I asked Ben to show me the shed and insisted he be honest with me from that point forward, he agreed – and he stuck by that… well, sometimes. I also took the car keys, although even then, I was stupid enough to believe him when he claimed he didn’t drink during the day time, and that he rarely drank and drove (“and certainly never with Rosie”). He was still taking care of Rosie at that point. So, I guess I was suffering from my own delusional mindset.

That would soon crack and peel away, like paint on a bathroom ceiling. But it would take a few more weeks before I finally accepted how serious his condition really was.