If symptoms
persist.. .
I WALKED on to the ward last week to see an old friend of the hospital lying tri- umphantly in bed. I say triumphantly because, during his last admission, he behaved so objectionably that Sister told him he would never be allowed back. Though no intellectual giant, he was shrewd enough to realise that this was a threat she could not carry out: that when he needed the hospital, it would still be there for him.
He was in his late 30s and his work record was — perhaps 'short' is the kind- est way of putting it. He lived with his parents still, and they supplied him with money for the drink to which he was addicted. This was prudent of them, because he was exceedingly unpleasant when thwarted, and they were aged. He also indulged in LSD from time to time, buying it in his local, because — he said — he found reality so boring. He had collapsed in the pub after taking an overdose of painkillers at the bar. The landlord finished serving and then called an ambulance.
By the time the patient reached hospi- tal, he was seeing centipedes and worms crawling all over him. A few injections put paid to the worms, but when I saw him the next day he had the morning shakes. He was so accustomed to them, however, that they did not ruin his moment of triumph over what he called `the system'.
`So you see, doctor, I'm back,' he crowed.
It is a poor life in which getting back into hospital constitutes success. In exculpating himself, the patient cited the pressures on him which made him drink. Chief among these, he said, were the omnipresence of pubs and the ubiquity of advertising: 'Everywhere you look, doctor, it tells you to drink beer.'
`But you don't have to obey,' I said. `After all, you resist the temptation to obey me successfully enough.' In four days' time, he was due to go to another hospital nearby for an operation on his Dupuytren's contracture, a fibrous growth in the palm of the hand which causes one or more fingers to flex into talons. It is a condition rare in anyone but heavy drinkers and its cause is unknown. Eventually, it incapacitates the hand. 'Can you keep me here till then, doctor, to dry me out?' he asked. 'If I leave now. I'll just go back on the beer and I'll miss the operation.' My inclina- tion was to refuse. Was he not an adult, able to make his own choices? If he pre- ferred beer to operations, who was I to interfere? Let nature take its course.
In such situations, however, I often hear myself saying things which are con- trary to my innermost thoughts and feel- ings. Despite myself, my voice becomes soapy, my manner unctuous.
`Yes, I think that would be best. If you go home, it's quite likely you won't turn up for your operation, and then you'll never get it.'
The patient smirked. The contracture was in his right hand, and he had experi- enced difficulty of late in raising a glass with it.
Theodore Dalrymple
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