Delirium tremens

Last week I helped care for a Vietnam vet who had come to our unit with an extremely high blood alcohol level. High enough that most people would be in a coma, or even dead with a level as high as his. He was a chronic heavy drinker, consuming approximately 4+ cases of beer per week. He has end stage liver disease, and because of the DT's he was sure to face and a GI bleed, he was admitted to our unit for close monitoring.

We talked with him about all of his options. He knows he is going to die. He openly told this to us. His wife divorced him, his daughter doesn't speak to him, and he is sure that his liver won't last the amount of time required for him to be "dry" before he could even become eligible for a transplant. He recognizes that he could have done things better, but his feelings on the matter? "If I'm going to die anyway, I might as well keep doing the things I enjoy". At this point, I'm not sure I could blame him for not wanting to quit. Despite the hell he was going through, his cravings for a cigarette and a beer, his hunger from being NPO, and the pain he was in, he had to have been one of the nicest patients I had cared for. Always polite, respectful, and appreciative. I'm not sure I could have been as nice as him if I was feeling only half as crappy.

Today he was readmitted back to the hospital, though not in my unit. His blood alcohol on admission was only around 0.08 or so. I was amazed, and I paid a visit to him during my lunch break. He looked awesome! I couldn't believe it. He just looked healthier and in better spirits. He informed me that he had just had approximately 4 liters of fluid removed from his abdomen. He told me that he was really trying, and is currently down to about 4-5 beers a day. He looked very happy to see me, and told me how much he appreciated me coming to visit him. I think it's important to show people you DO care, and it can be doubly important for someone who doesn't have that family support system and believe that nobody cares about them.

He will have to continue to have fluid drained from his abdomen every 4-6 weeks. I hope he continues to try to improve his health. I wish him all the luck.