BMJ 2003; 327 doi: (Published 04 September 2003) Cite this as: BMJ 2003;327:569
  1. Claus A Pierach, professor of medicine (
  1. Abbott Northwestern Hospital and University of Minnesota Medical School, Minneapolis, USA

    The call from the emergency department came in the wee hours of the morning: the young woman was in. Again. Lynn. She was a frequent flyer, so often in the hospital that many staff members knew her and, unfortunately, sometimes despised her. Incurable. Never a triumph. At best, one heroic stabilisation before the next downfall.

    My patient was an alcoholic. Her cart slithered deeper into the morass, finally sinking, leaving just tears behind. What medicine can do for alcoholics seems peripheral—a few drugs, some procedures to prevent or to stop bleeding, and, ultimately, forced sobriety in an institution.

    Lynn was in her late 20s, looking like 50-something and wheelchair bound after falling down a flight of stairs years beforehand. On this dreaded morning she had thrown up. Puked blood. Again. Friends had dropped her off like a foundling, with her wheelchair as her cradle. A heap of misery, guilt stricken and avoiding eye contact, quivering and crouching in her dilapidated chariot that looked more like a theatrical …

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