WHAT’S YOUR POI­SON?

A wife on the long, slow, heart­break­ing dam­age a part­ner’s daily drink or two, or four, can do…

North & South - - Contents - ANONY­MOUS

A wife on the long, slow, heart­break­ing dam­age a part­ner’s daily drink or two, or four, can do.

Idon’t know how many steps it was from our TV room to the fridge in the garage, but some sounds can travel quite a long hall­way. And I heard it so of­ten – that tiny, gritty sound of a metal cap com­ing off a wine bot­tle.

I once met a woman who had writ­ten a book about how she left her al­co­holic hus­band af­ter years of wait­ing and hop­ing he would change. Back then, I was in the early days of wrestling with the same sit­u­a­tion. The blurb on the back of her book said, “To me the sound of a metal bot­tle cap un­screw­ing against a glass bot­tle is the worst sound in the world. To my hus­band it is heaven.”

As author Cherry Parker talked about heart-sink­ing mo­ments of dis­cov­er­ing hid­den sup­plies and her de­spair over fail­ing to di­min­ish his long­ing for a drink… all the time I was think­ing, “Me too, me too. This is me, too.”

Some peo­ple liv­ing with al­co­holics have a truly ter­ri­ble time. For them, booze can bring anger and vi­o­lence. An­gry scenes can lead to rage, punches, bruises and blood­shed and – at the lesser end of the scale – door-slam­ming, shout­ing and nights spent on the sofa. When sto­ries about the down­sides of drink hit the head­lines, it’s the noisy, hor­rific ef­fects we see. And yet, the quiet, con­stant con­sump­tion of co­pi­ous amounts of “sav” and “beer­sies” in our homes and at ev­ery­day fam­ily par­ties is also do­ing deep dam­age in our so­ci­ety.

It’s done dam­age in my house. Maybe it’s hap­pen­ing in yours and you just don’t know it yet.

My hus­band John used to be one of the le­gions of quiet drinkers out there who go un­no­ticed. There’s never any news about peo­ple like him; it’s only the loud, an­gry ones who get the head­lines. John wasn’t vom­it­ing in the street or hit­ting any­one. He never went out booz­ing alone or with rowdy mates. There was no need, as he had plenty at home. Courier vans were al­ways drop­ping off an­other car­ton of wine at the door.

He was what is called a high-func­tion­ing al­co­holic. He suc­ceeded for years in a very de­mand­ing job in­volv­ing lots of travel, where drink­ing in ho­tel bars af­ter work was just what ev­ery­one did. When at home, he’d have a Scotch (or three) be­fore din­ner. Then wine with din­ner. And a late-night one or two as well. And be­cause he’d start pour­ing at 5pm or so, I’d have a few, too. But there was a dif­fer­ence. I could stop. His cut­off switch slowly be­came un­re­li­able and then failed to ex­ist at all.

And so my wor­ry­ing be­gan. I be­gan cut­ting tiny nicks on wine bot­tle la­bels so I could check by how much the level was sink­ing when I wasn’t look­ing. I be­gan to find stray bot­tles and half-full glasses in odd, se­cret places. I harped on about how we needed to have more AFDS ( al­co­hol-free days) or should

drink only at week­ends. Funny how week­ends could start on Thurs­day nights and run through to Mon­days.

For years, I tried talk­ing to him about coun­selling and he did once go and stay at a re­treat cen­tre. Af­ter a week of fast­ing and talk­ing and be­ing talked to and hav­ing mas­sages, he came home very sober. But only for a while.

He wasn’t obliv­i­ous to his prob­lem and knew he needed to slow down. Even­tu­ally, af­ter years of my nag­ging, he swore off his beloved Scotch. But that just opened the door for yet more wine. Then there was a time I be­came aware he was slip­ping vodka into his break­fast or­ange juice. That wasn’t good.

There was a time when I knew I no longer wanted to travel with him be­cause he wasn’t in­ter­ested in see­ing things or go­ing places, just in where the near­est wine shop was. That wasn’t good.

There was a time when, on a fam­ily week­end away, one of our grown kids saw him stand­ing in the kitchen of our rental apart­ment at 10am, swig­ging sau­vi­gnon blanc straight from the bot­tle. That wasn’t good.

But mostly he seemed all right, stayed up­right and con­tained. We’d have lunch with friends and go to fam­ily par­ties. With a glass in his hand, he was okay. I’d al­ways drive home.

The thing is, he re­mained po­lite, made no fuss. A shy man, he was of­ten anx­ious but hid it well. We had quiet ar­gu­ments as op­posed to rag­ing rows. There were lots of fun times. But even early in our mar­riage, go­ing to a party meant he first had to bol­ster his con­fi­dence with a drink or two be­fore we left home. Then the par­ties were, of course, booze-fu­elled.

Many peo­ple drank too much then. Many drink too much now.

And many peo­ple’s mar­riages do not sur­vive the stress it brings. Per­haps I should have left, walked away and carved a free, new path for me. But de­spite the shame and worry, I never did. I’m a stoic and hope­ful sort of per­son. And I still cared for him. In­stead, I coaxed and threat­ened and fumed and ar­gued and some­times cried. With­drawal be­came my refuge.

We al­ready lived pretty sep­a­rate lives be­cause his job took him away so much. I had my own busy life. I mixed with friends he didn’t re­ally want to meet and had in­ter­ests he knew lit­tle about, and so I took the route of sim­ply do­ing my own thing and hop­ing he would even­tu­ally come right.

All his work­ing life he had reg­u­lar check- ups. Some­times, af­ter blood tests, his doc­tors would men­tion his “fatty liver” and tell him to “ease up” on the al­co­hol. As is well known, the liver is fa­mously good at com­ing right if you treat it well. And he would, for a few days. But as far as I knew, no one ever told him he might be head­ing for cir­rho­sis, which is ir­re­versible. But then, he prob­a­bly never told the docs how much he was drink­ing.

Af­ter he re­tired, John had time to drink more. His phys­i­cal shape grad­u­ally changed as he de­vel­oped a ruddy face and a pot belly. Have you no­ticed how many older blokes be­gin to look like that?

Then last year, he be­gan to look re­ally ill. His en­ergy flagged. He was sleep­ing ev­ery af­ter­noon and de­vel­oped swollen an­kles. He had so much fluid on board that one of his legs be­gan to leak. While his stom­ach was bloated, the rest of him was get­ting thin­ner. He ate al­most noth­ing. His skin was yel­low­ish-grey. His men­tal state was slow and dull. Once, out in the car (with me driv­ing, as usual), we passed a po­lice car ablaze with flash­ing lights and he hazily asked, “What is that?”

Even then, he was telling me that he needed his wine be­cause it “set­tled his stom­ach”.

He made an ap­point­ment with his GP. And this time, I went too. It trig­gered the start of much med­i­cal test­ing to check out heart, lungs, every­thing. The re­sults all pin­pointed the liver. Now he can’t drink again. Ever.

Cir­rho­sis makes the liver go hard and shrunken. It’s caused by scar­ring that leads to re­duced blood flow. The liver’s like a big red sponge and if the blood can’t fil­ter through it as usual, then the rest of our sys­tems go down­hill.

Livers do a lot for us. Among other things, they store fat, sugar, vi­ta­mins and min­er­als as re­serve en­ergy sources, detox­ify chem­i­cals, metabolise drugs, se­crete bile, make blood-clot­ting pro­teins and reg­u­late the amount of blood in the body.

As this cri­sis came upon us, I re­alised I knew next to noth­ing about the liver – and couldn’t find much on­line about cir­rho­sis.

I went to see John’s spe­cial­ist gas­troen­terol­o­gist, Dr Ali Jafer, to find out more. Jafer sees many pa­tients whose al­co­hol abuse has brought on cir­rho­sis. But there are no sim­ple ex­pla­na­tions as to why some peo­ple can drink for years with­out ap­par­ent liver dam­age while oth­ers go down­hill, be­cause al­co­hol’s ef­fects dif­fer so much from per­son to per­son.

“It has to do with the bulk and size of the liver, the amount we drink, its con­cen­tra­tion, and the pat­tern of how we drink it – whether in slow and grad­ual amounts or in week­end binges,” he says. “All those are quite vari­able fac­tors.

“Then there are pos­si­ble other in­sults to the liver. Do you have a fatty liver as well? Do you have hep­ati­tis B or C? Hep­ati­tis B is quite preva­lent in South­east Asian and Poly­ne­sian peo­ple, so there are other fac­tors in­volved. Re­ally, to try to cal­cu­late the bur­den of al­co­hol on the liver specif­i­cally and the body gen­er­ally, based on the amount we con­sume, is false. We are never go­ing to achieve it.”

Warn­ing pa­tients about their al­co­hol in­take can be dif­fi­cult. “I have to be diplo­matic in how I tell peo­ple to stop drink­ing. Peo­ple get of­fended and may not be­lieve me when I say that al­co­hol might be their prob­lem. Quite a few of them don’t come back. They can see it as a blas­phemy for me to say it, be­cause they may not be drink­ing a lot – but in

Af­ter he re­tired, he had time to drink more. His phys­i­cal shape grad­u­ally changed as he de­vel­oped a ruddy face and a pot belly. Have you no­ticed how many older blokes be­gin to look like that?

re­al­ity how much is a lot and how much is a lit­tle? That’s the most im­por­tant ques­tion. We don’t know the amount that will poi­son you be­cause there are no good stud­ies.”

Min­istry of Health guide­lines rec­om­mend no more than 15 stan­dard drinks a week for men, and 10 for women. “But where did that come from?” says Jafer. “Who did the stud­ies? And in which pop­u­la­tion?”

We don’t think of In­dia as a drink­ing na­tion, says Jafer, but it’s the largest pro­ducer of whisky in the world. “It all gets con­sumed lo­cally. Bil­lions and bil­lions of litres. So how many al­co­holics are there in In­dia? I bet you no one knows.”

A Bagh­dad-born spe­cial­ist who’s been work­ing in New Zealand since 1994, Jafer has a keen eye for al­co­hol’s global ef­fects. Men­tion Mus­lim pro­hi­bi­tions and he laughs. “Iraqis drink arak [an anise-flavoured spirit]. It’s em­bed­ded in our psy­che. The an­cient Egyp­tians had beer. Al­co­hol con­sump­tion prob­a­bly started when civil­i­sa­tion be­gan.”

And it’s not just hu­mans who like it. As a lit­tle boy, Jafer used to watch how nightin­gales would peck at ripe figs to in­ject a lit­tle saliva, and then re­turn a few days later when the juice had fer­mented to “drink, get pissed and start singing”.

My John had been drink­ing for decades be­fore his cir­rho­sis be­came ob­vi­ous. The trou­ble is, early on it’s largely un­de­tectable. That’s a shame be­cause our livers are so es­sen­tial. Those big, red, glossy or­gans, vi­tal for our im­mune sys­tems and meta­bolic func­tions, are tucked un­der the right side of the rib cage, ex­tend­ing from about the fifth rib down to the lower edge.

As you read this, about 13% of your blood is fil­ter­ing through your liver while it screens, sorts, stores and works in many ways to keep your sys­tem in good nick. If scar­ring makes it go scle­rotic (or hard) it se­ri­ously messes with the good func­tion­ing of your body.

We might take more care if we could see what a bad liver looks like, says Jafer. “A healthy liver feels smooth and soft. A scle­rotic one feels quite firm, al­most like an over-cooked piece of eye fil­let.”

Once cir­rho­sis takes hold, the liver be­comes stud­ded with nod­ules and its usual ma­roon colour turns a light yel­low­ish brown. But be­cause we’re blithely un­aware, it’s out of sight, out of mind.

“Peo­ple can look nor­mal, feel nor­mal, blood-test nor­mal and have ul­tra­sounds and CT scans that look nor­mal and still have cir­rho­sis,” says Jafer. “They might go to their GP and say, ‘I drink too much, can you check me out?’ But a blood test isn’t go­ing to be enough. To tell some­one who’s been hav­ing four drinks a day for 20 years that their blood test is nor­mal and there’s noth­ing hap­pen­ing, is wrong. There’s al­ways some­thing hap­pen­ing. The prob­lem is you can­not see it.”

A biopsy can re­veal the truth, but they’re not done early in a drinker’s life. “It’s very in­va­sive, very un­com­fort­able; you’re stab­bing some­one in the liver. At a rou­tine check-up, we don’t say, ‘Well, you’ve been drink­ing for five years now so we’ll do a liver biopsy just in case.’”

It’s only in ad­vanced stages that tell­tale symp­toms show up. They may in­clude fa­tigue, jaun­dice, loss of ap­petite, short­ness of breath, con­fu­sion, itch­ing and a cer­tain body shape – a swollen ab­domen ac­com­pa­nied by skinny arms and legs.

Jafer would love to be able to de­sign a study where peo­ple of dif­fer­ent sizes, gen­ders and back­grounds were re­cruited to drink the same amount of al­co­hol each week and un­dergo a biopsy ev­ery five years to see what would hap­pen. But it won’t hap­pen.

“No eth­i­cal com­mit­tee in their right mind would ap­prove a study like that. There are cer­tain ques­tions we will never have the an­swers to, sim­ply be­cause we can­not ex­per­i­ment that way.”

It’s hard to es­tab­lish how many New Zealand deaths a year are caused by liver dis­ease re­lated to al­co­hol. Ac­cord­ing to al­co­hol.org.nz, be­tween 600 and 800 peo­ple die an­nu­ally from causes re­lated to booze, though that in­cludes fatal in­juries, falls, drown­ings, ve­hi­cle crashes and fires. But there are many other down­sides to too much drink­ing. Few of us know how al­co­hol is im­pli­cated in var­i­ous cancers and how it can af­fect heart, nerves, brain, spinal cord and pan­creas.

John’s con­di­tion has sta­bilised, but hav­ing cir­rho­sis is no fun. In his 70s now, it’s too late for a trans­plant. So he must put up with it. All those years of “hav­ing a quiet drink” have dam­aged his liver so badly that even a small amount of al­co­hol would now be lethal.

He’s not had a drop in a year, ever since Jafer told him this: “You must now re­gard a glass of wine as a glass of cyanide. You can never have a drink again.” So, there is none in our house. I was told I must not drink around him ei­ther, be­cause even the smell of it might tempt him to take a sip or two. Our fridge now con­tains only juice, milk, wa­ter and soda. He still misses his wine but is stay­ing staunch and man­ag­ing ( just) to get through fam­ily oc­ca­sions and Christ­mas with­out a sip of any­thing lethal.

When he got the bad news, he stopped cold turkey, just like he’d done years be­fore when he gave up cig­a­rettes. “I al­ways thought I’d stop drink­ing that way too,” he told me re­cently. “I just didn’t do it early enough.”

One day, I stood in the laun­dry and poured the last of our sup­plies down the sink. We had a cup­board full of left­overs. And out it went, glug, glug. Gin, vodka, brandy, and an­cient bot­tles of var­i­ous liqueurs. No more Bai­ley’s or Kahlua. Bye-bye Li­mon­cello. There was a great crash of glass hit­ting the bot­tom of the re­cy­cle bin.

As I did that, I won­dered about how much al­co­hol might have af­fected my own health. I was hit with breast can­cer a few years ago, and re­search says my own lik­ing for wine might have helped cause that as well.

John is far from his old self. He has only about 10% of nor­mal liver func­tion. He feels cold even when it’s hot, sleeps a lot, has lit­tle en­ergy, gets breath­less with even slight ex­er­tion and does lit­tle but nap, read, pot­ter in the house and watch the news on TV. He is in­dif­fer­ent to so­cial life, rarely goes out. There is lit­tle joy within our four walls. That’s odd when you think how drinks are mar­keted as a nat­u­ral part of hav­ing good times. We see drink­ing as an up­per, not a downer. As Jafer says, we rarely stop to mea­sure how it wrecks so many lives: “The ef­fects on work and in­come and so­ci­ety are im­mea­sur­able.”

So here we are, awash in an ocean of booze. There are few bar­be­cues with­out wine, wed­dings with­out bub­bles, car- race fin­ishes with­out sprays of Cham­pagne, or roofs raised with­out the builders get­ting stuck into a beer.

Why the com­pla­cency? “Drinkers like it,” says Jafer. “They think they ben­e­fit from it. They say it’s not like smok­ing

All those years of “hav­ing a quiet drink” have dam­aged his liver so badly that even a small amount of al­co­hol would now be lethal.

be­cause there are no sec­ondary drinkers, but in fact there are. Fam­i­lies get af­fected, peo­ple get ru­ined, busi­nesses get lost be­cause of al­co­hol. It is a drug. You’d think see­ing we’ve used it for 6000 years, we’d know more about why peo­ple get addicted. But ac­tu­ally we don’t.”

Af­ter all this, you might think I’m right off wine now, but I have an oc­ca­sional glass when out with friends. Jafer does too, though he’s care­ful not to ex­ceed two glasses over din­ner.

Abol­ish­ing al­co­hol is never go­ing to hap­pen, he says. “To be hon­est, we don’t need to. It’s an en­joy­able drink in small quan­ti­ties and we are so­cial an­i­mals, but the thing we re­ally all have to be blamed for is that we’ve never stud­ied it well. We have no idea what it’s do­ing to so­ci­ety over­all and that’s what we need to work on.”

As some­one af­fected by “sec­ondary drink­ing”, I try not to dwell on how much I’m to blame for the state John got into. How com­plicit was I? I’ve beaten my­self up for years over con­cepts like “en­abling” and “co- de­pen­dence”. Should I have yelled more, begged more, raged more? If I had, would it have helped?

The other big downer about too much al­co­hol is how it takes an emo­tional toll on ev­ery­one around the drinker. I’m still feel­ing a churn of re­lief, sad­ness and guilt. I’m re­lieved be­cause at least I no longer have to worry about John’s drink­ing, sad his life has come to this, and guilty over some­how not man­ag­ing to fix things.

But then I think back to an Al-anon meet­ing I once went to, where some­one looked at me with kind eyes and of­fered good ad­vice. (Al-anon is a group that sup­ports the fam­i­lies of al­co­holics.) She said I needed to be aware of the Three Cs – which means re­al­is­ing you didn’t – Cause your loved one’s ad­dic­tion, can’t Change it and can’t Cure it.

We can do as much as we can for friends and fam­ily who might be at risk. But the most im­por­tant thing, for all of us, is to take care of our livers – and our­selves. +

• The book ref­er­enced in this story, Liv­ing with an Al­co­holic Hus­band: A true ac­count of liv­ing with and with­out a hus­band addicted to al­co­hol, by Cherry Parker, is avail­able as a paperback and Kin­dle edi­tion on Ama­zon.

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