Generalized Anxiety Disorder, A Narrative
Wake up call: fatty liver disease.
How much do you drink?
My doctor is of Scandinavian descent. She keeps her questions short and to the point.
“What sort of time period are we talking about?” I ask.
She’s steady, waits for me to continue. Like many doctors around the world, she’s been trained at med school after the bedside manner course was dropped from the curriculum. If there ever was one.
I straighten against the back of the flimsy doctor office chair, cross my arms and gaze as if I’m pondering some sort of complex calculation in my head.
“Well, Dr. Svensson, to be honest, I drink wine every day. Two or three glasses, say.”
I’ve decided to be somewhat honest. Why not?
I sense she knows that, from where I am sitting, a glass of wine is a vague and highly manipulated term.
I clear my throat. “Of course, with the pandemic and all, it’s been a bit higher.” I cross my legs, not as casually as I would like. “At times.”
“How frequently is it higher?” she asks as she attends to the scribbles in her notepad.
“Hmmm. Not sure how to answer that. Lemme see, Doctor…” I search the corners of the room for an answer. “I guess I would say less than often, but more than not very often.”
The joke doesn’t take. Her eyes stay glued to the page. Then she looks up, and I know she is about to give it to me in that very unobtrusive, non-direct, beating around the bush, Scandinavian fashion:
“Your blood test shows that you have elevated ALT and GGT levels — enzymes that indicate your liver might be under strain. I now have the results of your ultrasound. I can confirm that you have signs of fatty liver disease.”
“Signs?”
“You have a fatty liver.”
“How fatty is fatty?”
“You are at risk of causing permanent, irreparable damage to your liver.”
“Ok. I see… Ww… what are the next steps?”
“I am scheduling you for a fibrosis test.” She removes her reading glasses. “Let me be clear, Mr. Verne. This is serious. You need to stop drinking alcohol… Now.”
I’ve read up on it. Fatty liver means that your liver is changing its constituency, in my case, as a result of excessive alcohol consumption. At this stage the liver can repair itself if you stop consuming alcohol.
Fibrosis, the next stage, in which the fat forms a fiber-like quality, means further deterioration, a sign that the fat content of the liver is hardening.
The final stage is, of course, cirrhosis: scarring of the liver. Irreparable damage that permanently decreases the liver’s ability to rid your body of toxins. Definitely life shortening. And very likely, life threatening.
“Stop? … Or cut down?”
Yes, I am getting a bit defensive now. After all, two or three glasses, however defined, give or take, is not that much. Not where I come from. Not how I grew up. Not where I’ve been.
And now I am a little sick of beating around the bush.
She leans back and smiles. And tries, not very successfully, to release her stern doctor persona.
“You have trouble stopping, don’t you? Why did you stop attending the downtown clinic?”
The clinic.
“That was pre-pandemic. The doctor prescribed Naltrexone, which did not agree with me. It gave me cramps, and made me feel anxious. Anyway, I’m not sure I agree with this whole medication approach…”
Naltrexone: designed to remove the dopamine effect a drinker craves. Elation, satisfaction, and a false sense of confidence. All of which wears out fast.
I look up, but no sympathy is on offer. “Anyway, the pandemic happened and I didn’t see much sense in continuing at the time… Bigger risks, I was preoccupied with. I guess.”
She waits until I stop fiddling with my phone. Then she leans forward with her hands on lap. And smiles:
“I think you need some help.”
My wife can tell in a split second when something is bothering me, without me saying a word. As I close the front door behind me, she approaches.
“So. What did the doctor say?” she asks, after greeting me lovingly.
I, as well, can tell instantly when there is concern in her voice, even when she tries to keep it safely hidden.
“The doctor thinks it would be a good idea if I attended a clinic.”
I pour myself a glass of Chablis. And swish it around. With the thought that I might not be able to do so soon, I remember what it tastes like again. I swallow, and it is silk.
And the endorphins of clarity come galloping to my rescue. I’m re-energized. I’ve got this figured out.
I join Hannah in the living room. She notices the glass, but makes no comment. She makes an attempt at relaxing back into the sofa, waiting for me to talk.
I gaze out the back window at the chunks of ice drifting on the lake. “How is this person, or anyone, really, supposed to understand my relationship with alcohol? That would take a lifetime of living with me to know.”
“I know.”
“Yes, I know you know,” I say, hat in hand. “But you know it is complicated.”
It is part of my personal and professional life. It has been part of my life since I puked at the age of 10 years on too much vodka. It was present at the best and worst times I ever had with my closest friends. It was present in high-powered meetings, like when I scored my first big deal. And nights when I drowned my stress away, by the glass.
It was present when I met the woman of my dreams. It has been present at most of our social occasions since.
It is socially condoned. Alcohol is the lubricant passed down through the ages, of historic European proportions. One that shows no signs of remission in society. Certainly not in the cool wine bars of London or New York. Not on the Mediterranean coast. Not in the chic ski resorts of the Swiss Alps.
And tastefully done, wine is the lubricant of life. Of mythical proportions.
So why should I not participate in this too? After all, wine is tasteful, elegant, glamorous. And so am…
I’ve drifted away from the conversation. I can see Hannah is saying something that matters, so I return.
“We need you to be here, Jonas. All of us in this family. Your two sons. Here, now. Here, for the long run. I need you…”
I love you.
I hope you enjoyed this article. Thanks for reading!
Tomas
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