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Spoiler Alert: It Wasn't Just Dehydration

 I didn't see the triage note.

I saw 31 weeks pregnant. Nausea and vomiting. Heart rate of 130s.

Easy. Check electrolytes. Hydrate. Give meds to stop the vomiting. 

Easy peasy.

Nope!

So this poor woman was an alcoholic. She was withdrawing.

Before you get on your soapbox or look down your nose... Alcoholism is real. It, like other addictions, is a real beast. I did my best to pump the patient full of zofran, pepcid, ativan and IV fluids. Her CIWA (Clinical Institute Withdrawal Assessment) was as high as 34. She was at a very high risk for seizures. To give you an idea of the severity of her condition, she was admitted to the ICU - where the sickest of patients go.

Inexperienced me would have had a lot to say. My perspective has changed a lot since then. In nursing school, we had to attend an Alcoholics Anonymous meeting. Eye opening. I have had so many patients on the spectrum of intoxication and with varying degrees of cooperation vs belligerence. I've had encounters with alcoholics as patients. Begging them to please just take your medicine (for hypertension, diabetes, seizures, etc), knowing that the chances of compliance are slim. I've had 30 year olds in liver failure from alcohol abuse. Yup, I've been the messy drunk girl. I've seen firsthand what alcohol can do to careers, relationships, families.

How do we curb alcoholism? We can't beat genetics. Do we over glamorize drinking? Does it have to do with a drinking age of 21 as some sort of rite of passage? Is it our culture? Do we overuse alcohol (and yes, other substances but we're talking about alcohol) to inhibit our inhibitors? To numb our senses? To not feel? Does it go back to our culture and our suck it up buttercup mentality instead of dealing with feelings and issues? Is it an escape? Is it because we associate it with good times like vacations, holidays, celebrations?

There's a difference, an enormous difference, between someone drinking too much with their friends once in a while, a glass of wine with dinner, a couple of drinks at a work function, etc. and someone who is an alcoholic. It is a paralyzing disease. The good news is that there is help for those who want to put in the work. There is physical, emotional and mental healing that can take place.

The weather is changing, becoming cooler. To me that's pumpkin beers, red wine and old fashions. You may be looking forward to the same with outdoor fires and cozy sweaters. If you do not have a problem with it (poor decisions, drinking and driving, wanting to fight, etc) and are not someone who has a drinking problem or is an alcoholic... ok. But to our fellow humans who struggle or who have been cursed with alcoholism, let us be more understanding. 

The good thing that I came up with regarding my pregnant patient going through withdrawal: she went to the hospital. She was given emergent care and was admitted to the hospital where she can get further care. Let us hope that her baby has minimal to no complications because of it. We didn't judge her. We get that alcoholism is a disease. However, I think it can be agreed upon that it is a very, very sad situation all the way around.

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