Alisa Duran, chief of women's health and associate chief of faculty affairs in primary care at the Minneapolis VA Health Care Center, has been sober for more than three years. Writing for the Washington Post, Duran explains how an encounter with one of her patients motivated her to share her struggles with alcohol use disorder with her future patients.
The patient she wanted to help—but couldn't
According to Duran, the patient who inspired her to be more forthcoming with her own struggles was a 34-year-old mother, who often arrived for her doctor visits with her young daughter and her own mother.
At one appointment, Duran saw telltale signs in the patient, "her shallow breaths, her distended abdomen, her swollen ankles … the thickened discolored skin telegraphing the chronicity" of her struggle with alcohol use disorder. Upon reviewing the woman's patient notes, Duran noticed that the patient just three weeks earlier had been hospitalized for alcoholic hepatitis, an experience that included a two-week ICU stay for an "overwhelming infection."
"I almost died," the patient told Duran.
Duran discovered while the woman had been offered inpatient or outpatient treatment for her alcoholism several times, she declined each time. But when Duran spoke frankly about her concerns to the woman—saying she was "very concerned about [her] drinking," and that she was "advancing to alcoholic cirrhosis"—the woman didn’t seem to understand.
With a "vacant stare," the woman said only that she was "'not drinking anymore,'" and while she admitted to experiencing some "cravings," she declined Duran's suggested patient resources for combatting alcohol use disorder, such as medication, outpatient treatment, and support groups.
At this point, Duran considered opening up about her own struggles with alcohol use. She remembered how deeply ashamed she had felt at her own first AA meeting: "I am an alcoholic physician—a disgrace to my profession," she had thought at the time. "That 'A' is my scarlet letter."
But while she had since grown past these "intense feelings of shame," and had even grown more comfortable sharing her experiences with others, she had never opened up to a patient—in large part due to the way she had been taught. "When I was a student, several of my mentors told me never to share personal details with patients," she writes.Duran says that she did make an exception to that rule when talking with patients trying to quit smoking. She admitted she used to smoke herself. That was "a way of acknowledging their struggle and letting them know that I understand how difficult it can be," Duran writes.
When it comes to her sobriety, however, Duran writes that she finds it difficult to navigate the "boundary between professional discretion and personal vulnerability." And ultimately, even though she worried that the woman would die without help, Duran decided against sharing her own experience.
"Looking at her, I can feel the inner boundary line opening into a chasm that threatens to swallow me whole, and I'm terrified," Duran writes. "I open my mouth, but my shame pulls me deeper into the pit, silencing me … There's nothing else I could do, I tell myself."
'I will try'
A month later, Duran was reviewing discharge summaries in a clinic when she noticed her patient's name on a death summary.
"She was admitted again to the ICU, developed a rare lung complication and died two weeks later," Duran writes. "She never sought treatment for her alcoholism."
Duran had lost patients in the past, but she writes that "this one feels more personal. It could have been me. Could I have made a difference?"
Thinking back to the patient's office visit, Duran writes that her anxiety feels like "a weight in the pit of [her] stomach." And she thinks of the patient's five-year-old daughter who joined her at the visit.
Duran writes that, in her mind, she apologizes to the woman's daughter. "I'm so sorry, I tell her. I failed."
Duran says that, in the future, "I will try to cross that invisible boundary—I will share my own personal story, so that my patient knows that I really do understand how hard it is, and will feel supported in the struggle." It's a promise to herself, and the woman's daughter: "I will try." (Duran, Washington Post, 6/26)