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As the youngest of five children, I mostly watched the emotional
turmoil. My primary role was as witness and unless I was careless, I was
usually safe from the gorilla. My bravest sister sometimes ventured into
the gorilla’s cage. Born little more than a year apart, those two shared a
special bond. She had a way of convincing my sister to relax and breathe
and stop hurting herself and everyone around her. At one point, almost ten
years ago, she was able to tame her enough to get her into a rehab
program and save her life.
But not this time. My sister was dying and there was no stopping it.
When I arrived at the hospital, I was shocked. There she was, the
gorilla. She had a breathing tube in her mouth and she lay so still.
Although I am a critical care doctor I was completely unprepared for this
sight. I went to her and whispered, “I’m here. It’s Gwen. Please wake up.”
Her pale blue eyes fluttered open but they were empty and she did not
recognize me. Her face was gaunt but remarkably without the lines or gin
blossoms of most heavy drinkers. Her plump lips, high cheekbones and
pert nose hinted at her former beauty. I placed her frail hand in mine. It
was covered in large dark bruises, an ominous sign of end stage liver
disease. Her fingernails were perfectly manicured, but lacking her favorite
muted mauve color. When I lifted the sheet to further assess the damage, I
gasped at the sight of her emaciated legs. She had been starving to death
courtesy of chronic pancreatitis and end stage cirrhosis.
The doctor in me accepted the truth. There was nothing more to be
done. She had drunk herself to death and she was now too ill to be
considered a liver transplant candidate. Tragically, or maybe mercifully,
she was comatose. She would not regain consciousness despite the
medicines controlling the toxic metabolites spewing from her dying liver.
We would have to withdraw care and let her go.