Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Query

Query

CMAJ June 22, 2004 170 (13) 1992; DOI: https://doi.org/10.1503/cmaj.1040846
  • Article
  • Responses
  • Metrics
  • PDF
Loading
  • © 2004 Canadian Medical Association or its licensors

Ms. Ste-Marie smoked and drank most of her life. Many entries in her chart attested to expensive stints in detox; she even had an extended stay at the Betty Ford. Her wealthy family had long since abandoned her; her ex-husband provided her with a divorce settlement exhausted long ago, and her three daughters no longer spoke to her. Liver ultrasounds, enzyme counts and skeletal x-ray reports told the sorry medical tale of the alcoholic: at first an absorbent sponge, her liver was now a shrunken pumice stone, and her osteoporotic bones were cobbled from many drunken falls.

Figure1

Figure. Photo by: Anson Liaw

I had just assumed care of Ms. Ste-Marie, an orphan patient. Notes made by previous physicians commented on her relentless decline; over a period of twenty years all remarked on her general good cheer and willingness to forswear booze altogether — for as long as she was in the office. The strategy of her last few doctors had been simply to listen, they coming to the realization that any attempt to arrest her descent would be futile. The net effect of this strategy was that over the past two years her appointments were whittled down to fifteen minutes apiece. They were documented only very briefly, always using the same billing code.

Ms. Ste-Marie had begun to grow depressed. She longed to renew contact with her ex-husband, who never remarried, and whom she read about in the business section of the newspaper. She had tried to locate her daughters, but they skillfully avoided her. She was lonely and hopelessly addicted; the most sober moments in her life, she told me, came when she abstained for a few hours in anticipation of a doctor's appointment.

I'm not sure my predecessors appreciated this fact. In her chart there were records of referrals made and lab tests ordered, but no mention of the sacrifice she made in order to converse with her doctor.

“I'm an old drunk,” she told me, “and I've been drinking longer than you've been alive!”

It was hard not to believe her. Alcohol had taken its toll: her complexion was sallow, and she shook as she sat. Her birthdate lied about her age: she looked eighty, not sixty-five. I asked, “Why do you stop drinking before you come to these appointments?”

She said, “Ever try to talk when you're drunk? I've had doctors carry me out of here and order a taxi to take me home. Women have taken their children to the other side of the waiting room because they smelled me and were scared.”

I looked at the last billing code: Supportive Psychotherapy.

“Is that the only reason you stop for a few hours?”

— Dr. Ursus

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 170 (13)
CMAJ
Vol. 170, Issue 13
22 Jun 2004
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Query
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Query
CMAJ Jun 2004, 170 (13) 1992; DOI: 10.1503/cmaj.1040846

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Query
CMAJ Jun 2004, 170 (13) 1992; DOI: 10.1503/cmaj.1040846
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Query
  • Query
  • Query
Show more Query

Similar Articles

Collections

  • Topics
    • Medical careers

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire