NewFNP is no teetotaler. Hells to the bells no. But she does generally drink in moderation. Sure, she might have tied one on at the Liberty Hotel one night and fallen asleep while sitting on BostonCNM's couch while holding a glass of water, only to awake some time later -- cold, confused, wet and holding an empty glass. But those occasions are few and far between.
Tuesday, April 13, 2010
But newFNP, thankfully, has no addictions. Two of her patients this week have been debilitated by their alcoholism. One man, newly sober, came to newFNP in follow up after having received furosemide for his bilateral pitting edema. Rather than having diuresed some of the fluid, he had gained three pounds in two days. His legs were swollen. His abdomen was taut and distended with ascites. His sclera were yellow. He felt itchy. His bilirubin was 9 point mother-effing 9. He was urinating once daily -- on Lasix! NewFNP sent him to the emergency room. But his liver is shot. And whatever happens in the emergency room won't fix the damage that decades of alcoholism has wrought.
Another patient, a man just a few years younger than newFNP, stated that he drinks at least 100 ounces of alcohol every day and has done so for the past two years. CAGE questionnaire positive 4/4. Replacing meals with alcohol. So depressed that he couldn't imagine going through life any other way. Uninsured.
A pretty decent resource in such a situation is the SAMHSA treatment locator. NewFNP printed out a list of medical detoxes for him, drew some labs, started Paxil and gave him vitamins. She called him today to see if he had had any luck getting a detox bed.
His number was disconnected.