Sunday, April 16, 2006

Alcohol, Jesus, bulldozers and ice.

A lighter post today, after the grimness of last post, and one that even touches on the story of the Christ, this Easter Sunday.

But first: I do not have a drinking problem.

Nope, not even close. Never did. Not even that summer ten years ago back on the coast where I woke up in that girl's garden holding a broken garden gnome, or the times I rode my bicycle home drunk. By the Driver's Clinic guideleines, the closest I ever came to was a category called "Episodic Hazardous", into which a surprising number of men in their early twenties often drift.

But actual alcohol abuse or dependence? Not even close.

Lest you think I have judged myself too lightly - and if I could travel fifteen, twenty years back in time now, the first thing I'd tell myself if don't drink and drive/cycle/ride a horse/even walk. No, I tell a lie: the first thing would be "Here's a phone number. Ask to speak to Sarah Barret and tell her you love her truly and madly and deeply and want to marry her, so perhaps you should arrange to meet. Trust me, it'll cut out a lot of crap." And a list of Grand Final winners for the next twenty years - lest you think I have judged myself too lightly, here is a few fragments from what I remember of my conversation with a man in the Driver's Clinic last week.

Again, notes, in this case liberally sprinkled with exclamation marks and underlinings, were taken.

Mr Parch was a thin man, with a long moustache and an unshaven chin, who wore his thinning hair in ringlets. He sat uncomfortably in the chair and stared out over my head, snapping the answers to the questions almost before I'd finished asking them. He was a UFO - someone disqualified from driving "until further order" - and had been through this process - I riffled through the notes - more than five times in the last ten years. Always unsuccessfully.

I proceeded. The litany - have you ever caused serious embarrassment to yourself or others while drinking? Has anyone ever annoyed you by criticising your drinking? Do you ever drink first thing in the morning? - was probably more familiar to him than to me, and he knew as well as I knew that most of his answers were indicative of alcohol dependence.

When it came to the question about limit setting, he snorted. "You can't answer that" he said.

I nodded. "Why's that?"

"Well, who sets a limit? You just drink what's in front of you, and that's it."

"But how much do you put in front of you?" I asked. I hate doing driver assessment clinic, for about forty different reasons, and one of them is this constant niggling at what is essentially a hostile witness.

He grinned and tilted his head, managing somehow to look both conspiratorial, contemptuous and cocksure at once - and with only the same number of facial features as everyone else. "You wouldn't believe me if I told you."

"I'm fairly new at this" I said. Impress me with how much you drink, mate. Make my job easy.

"One time there was seven of us in a house in Innsmouth Bay. Seven people. Seven days. Me and Riley Rollings and Mark O'Neill and Charley Carpany and Mick O'Neill and Wendy the Witch and Joe Duzanski... guess how much we drank? Seven people. Seven days. Guess?"

No idea.

"Forty two cartons. In a week."

A carton is twenty four cans of beer, at mid-strength that's thirty six standard drinks - three hundred and sixty milligrams of alcohol in a day, a dose that would kill most people... and he was drinking close to that, every day. I start to do the maths, but he's not finished.

"Forty two cartons, twenty one bottles of wine, six bottles of spirits. Seven days. Not a mouthful of food between us."

I give up calculating and start guessing. That's kilograms. More than a kilogram of alcohol a day? fifty six kilograms of alcohol? You could run a Brazilian schoolbus on that.

"Course, Rileys dead now. Rileys dead, and Charley's dead, and they reckoned Mick was dead, and I took Wendy the Witch into the liver clinic, drove her in myself. Psychosis of the liver, had to have a transplant".

I stared. His gaze snapped back to mine. "Hey, here's another one for you, quack. Do you reckon Jesus Christ walked on water?"

I nodded.

"Well, it was all a scam. I saw it on the telly a few nights back."

Well, that proves it, then. "Really?"

"Yeah. See, what most people don't realise is that the water he walked on... it was a lake!"

"Okay". You're saying that the lake of Galilee was acutally a... a lake? But this revelation will surely overthrow the Papacy!

"And the lake at that time, it was frozen. All frozen."

"Interesting". Not as interesting as a lake near sea level in the Middle East freezing solid, but interesting.

"And all the ice, it was at the bottom of the lake, and he knew there was ice on the bottom of the lake, and thta's what he was walking on. The church can't explain that."

"Probably not." Mate, Archimedes can't explain that. Ice floats.

"And the other guy, Peter somethingorother, can't remember his last name, when he jumped out, he didn't know where the ice was, and he sank. So, when they say he walked on the water, he did... but it was frozen water!"

"It's all in the details, I suppose" I said.

He did hhave more theories, theories about women and about how most people don't know how to drive a bulldozer (no arguement from me there), and his overarching one, his Grand Unified Theory that seemed to tie together George Bush, South America, the Cronulla race riots and "the towelheads", but I did not have time to document all of them.

Anyway, I collated the answers, did the physical exam (bulging liver, muscle wasting, fine resting tremour, the beginnings of loss of sensation in the lower limbs) and documented the one point in his favour - his one hundred days of abstinence. Both he and I knew it was unlikely to be sufficient - the Minister requires a minimum three month abstinence, and up until New Year's Day he had been drinking a carton of beer a day, "easy". And I sent him off to my boss, who would almost certainly classify him as UFO for the sixth time.

And after that was a man who'd found God (six months back, no longer dependent) and a man who'd found a good woman (a similar outcome) and a man who needed his licence back so he could keep coaching the state fencing team or something (sorry) and a man who offered me discount oysters (and was no longer dependent anyway).

Anyway, today is allegeldy the first day of study. I shall retire to grapple with my physiology textbook.

Thanks for listening, and for the remarkably kind comments from last post, to which I shall reply soon.



Blogger Benedict 16th said...

Congrasts on Dockers winning
I picked them in the footy tips too!
(against my own team)
Once they reached top top top they stop stop stopped...

As for the alcohol dependence - why don't you order this test
per cent carbohydrate deficient transferrin (%CDT), (Available thru path testing company Gibblers.)
It seems far more sensible a measure of someone not being dependent....
Haven't drunk anything for 3 months honest.....
I'll send you the paper (pdf) BMJ, doi:10.1136/bmj.38743.421574.7C (published 17 February 2006)

Oh and isn't 100 days about 3 months?
Were off overseas (well KI - where there aren't any Kangaroos*)


* Technically they are wallabies I think

11:29 PM  
Blogger Bronze John said...

I'd love to use anything other than the interview. But it works best (unfortunately): "The alcohol use disorders identification test exhibited significantly higher sensitivity, specificity, and positive predictive value than all of the biochemical markers...The questionnaire was also more cost efficient, with a lower cost per true positive for all consumption outcomes."

I don't know if they factored in the fact that most doctors really hate doing it.

9:18 AM  
Anonymous Camilla said...

Carn the Mighty Dockers! :D

5:07 PM  
Blogger Benedict 16th said...

You didn't read that paper - it is far more specific and higher sensitivity than the
adorable test you are talking about. The only reason you don't use it is it would cost DASSA
$50 per patient to do the test!

9:46 PM  
Blogger Bronze John said...

Now you've confused me. I know piss all about maths, but what do you make of the table on page 4? Sensitivity, specificity, positive predictive values for hazardous, weekly binge, monthly binge and dependence are all higher than %CDT... and we use the Chick, which I believe is better than the Audit.

Believe me, any alternative to this mutual duplicity is welcome. I am contemplating just making everyone wait in the waiting room for two hours then inviting them in, cracking two cans of Foster's in front of them and offering them one. Should sort the alcoholics out pretty damn quick.

Sarah has been told of people scurrying out of the driver assessment interview and having a celebratory drink on the front lawn.

One thing I've worked out is the neater dressed a patient at the driver clinic is, the more likely they are to lie to you...


10:42 PM  
Anonymous Anonymous said...

So that's why lawyers are always so neatly dressed?

Let me look up some other literature (at home) and I'll get back to you about the "accuracy" but what is Chick? The other thing, I was trying to simplify variables to dependent or not dependent. If %CDT raised on presentation to DAC some months after knowing they have to front up, then they can't stop drinking therefore likely dependent, ditto with breath alcohol being positive, seems pretty straight forward to me.


2:22 PM  

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