My dad would have been 76 years old today. “Should have been 76,” I need to clarify — but he died far too early, eight years ago from cirrhosis of the liver. He was a wonderfully warm-hearted man with a hearty laugh, but he was also an alcoholic who slowly drank himself to death. I have countless fond memories of us over the years, but I also have nightmare memories of holding his hand as he died in the hospital, in a coma, his skin yellow and lungs filled with fluid as his kidneys and liver finally gave up from the years of toxic abuse. These are memories that no son should have, but death from alcoholism is an unfortunately common disease in all societies, and my heart aches every time I meet a patient who clearly is along this same destructive path.

Why is alcoholism such a scourge to society? When compared to many other common diseases such as heart disease, alcoholism has a much more devastating social effect — not just on that person, but also their family, who painfully watch for years, helplessly, as their loved one slides into decline. Yes, many diseases are terrible and affect others; smoking can cause secondhand smoke diseases to family members. But alcoholism is a sad disease, and it’s those bad memories that really haunt families of alcoholics — memories of being afraid as we weave across wintry roads as dad drives home tipsy; memories of mom crying as dad refuses to hand over the car keys; memories of watching his belly get bigger and his memory weakening as his liver starts to fail.

But it’s the final stages of alcoholism and liver cirrhosis that really leave their unwanted stains on their loved ones. Our modern society is now very far removed from death and dying, so it’s hard to convey to people just how awful the last months of a cirrhotic’s life can be. As the liver dies, the body can no longer process normal bodily fluids, so a person’s legs slowly fill with fluid, which slowly travels up to the belly. When their skin and eyes turn yellow, a doctor has a dread in their heart that this person is approaching no return. The final, and most disturbing part for families, is the mental confusion they get. Called hepatic encephalopathy, these patients are initially mildly confused and emotional but then can become quickly comatose. During my residency program I saw many alcoholics repeatedly admitted to the hospital for another burst of confusion; they would be tweaked up with medicines, sent on their way, and be back again in a few weeks. And there was always a last time they’d be admitted, where their liver and kidney simply ran out of steam. Their families would sadly stage a vigil at the bedside, waiting helplessly for the end.

If I sound a bit macabre here, it’s because I want to be. I want society to stop glorifying drunkenness as a pleasant diversion; I want people to take a second look at their drinking buddies and actually wonder if they aren’t really crying out for help. I want to wake up my readers and have them look at their own life and honestly answer these four simple questions:

1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If you’ve answered “yes”  to 2 or more, then you indeed may have a problem with alcoholism and may already be causing liver damage. These questions above are called the “CAGE questionnaire” and are used as a screening tool for alcoholism.

What If You May Be Alcoholic?

First of all, congratulations if you’re honest enough to admit you may have a problem. Secondly, you need to know that you are not alone, and many people and organizations can help you:

• Your family loves you and is worried about you; let them know and get them involved
• Your family doctor can check out your liver and kidney health.
• Some newer medicines may actually help you quit drinking; your doctor can discuss these with you
• Psychologists and psychiatrists can help you in many ways, from quitting drinking to processing underlying stresses and depression, to fixing family and job problems related to your drinking
• Alcoholics Anonymous continues to be an excellent source of strength for recovering alcoholics, all over the world. They have a list of sites in the US here.

My Dad’s Legacy

Clearly, living through my dad’s illness has had a profound influence on me as a doctor, and I do find myself drawn to these patients. I’m sure it’s partly an effort to make up for what I couldn’t do for my own dad.

But despite all the pain of those later years, my strongest memories are the good ones. I will always remember his laugh, and to this day I vividly remember how he could light up a room. I’d like to honor him with a poem from Ralph Waldo Emerson, which we used at his wake:

To laugh often and much;
to win the respect of intelligent people
and the affection of children;
to appreciate beauty;
to find the best in others;
to leave the world a bit better
whether by a healthy child,
a garden patch, or a redeemed
social condition; to know even
one life has breathed easier
because you have lived.
This is to have succeeded.

Happy birthday, dad. I love you, and I wish you were still here.