“My name is Bill, and I’m an alcoholic. My sobriety date is July 16, 2001. Since that date, by the grace of God, I have not had a drink, nor any mind- or mood-altering substance of any kind. One day at a time.”
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November 2022I have spoken those words literally hundreds of times in meetings over the past 21 years that I have been sober. I was lucky because I got sober at age 35 when I was early in my career, and even more so because it stuck—and I have never relapsed … yet. The reason I had to get sober was very simple: I drank too much. I was (am) a routine, run-of-the-mill alcoholic and drug user, and I had to get sober to save my career and marriage and life. And I did.
I’ve spoken to many groups of students, residents, and colleagues on the topic of physician health and wellness over the past 21 years. I’ve served on the Alabama Physician Wellness Committee since 2005, and I continue to serve today. I’ve sponsored hundreds of alcoholics attempting to get sober, monitored scores of physicians, attended countless meetings across the country, and gone to more than 40 funerals for those who didn’t make it. I’ve paid my dues, and I have hopefully earned my seat at the table whenever physician health, wellness, and burnout are discussed. I have no formal education in any of this, but I have enough on-the-job training for a PhD.
But I’m writing this now because I’m not well, and I’m far from okay. I have written extensively about my father in many articles and posts over the years, but I have rarely written about my mother, who I loved dearly. And now the opportunity to do so during her lifetime has passed; the most recent thing I wrote about her was her eulogy.
A Medical Emergency
Mama seemed to be okay until very recently. She was 82 years old, but in reasonable health and had few significant ailments. My wife Meredith and I spent the day with her on July 3 this year, and we looked at her old family photo albums and giggled and laughed for hours. She was tired and a bit unkempt, but I thought only that she was going through a spell, as she has been prone to since I was a child, and I didn’t think much of it.
Two days later, she was short of breath and couldn’t get out of bed, so I arranged to have her admitted to the Internal Medicine Resident Service at my hospital, under the supervision of my longterm friends and colleagues. Her oxygen saturation was in the 80s on admission, which was surprising to us all.
After her admission, she seemed to rally briefly, although she required oxygen continuously. On the second day, she underwent a chest computerized tomography scan, and it was shockingly nasty: There was severe interstitial lung disease and inflammation, the dreaded “ground glass” appearance that we have all come to fear. She tested negative for COVID-19 and every other respiratory pathogen, but I remained skeptical. She was treated aggressively for everything we could think of—diuresis for possible congestive heart failure, steroids for interstitial lung disease, antibiotics for atypical bacterial infection—but she only worsened.
I am certain that everyone gave my mother extra-special care and went out of their way to communicate because of who I am. But they also deferred decisions to me and asked for my approval on treatments, which probably wasn’t the best approach for my mother. —William R. Blythe, MD
I have tremendous confidence and trust in my colleagues. All the subspecialists saw her, including cardiology, pulmonary, infectious disease, and cardiovascular surgery. We have a relatively small medical staff of 230 physicians, and I have been in leadership positions for two decades and am a past chief of staff. I know all her doctors well, and they know me. Having a physician son is a double-edged sword. I am certain that everyone gave my mother extra-special care and went out of their way to communicate because of who I am. But they also deferred decisions to me and asked for my approval on treatments, which probably wasn’t the best approach for my mother.
And that’s where we found ourselves on the morning of July 15. Mama was struggling to breathe and was on 100% oxygen by bilevel positive airway pressure (BIPAP). She was miserable and parched from diuresis. She was breathing 40 times per minute, and she kept begging for something to drink. But to remove her from BIPAP for even a minute for mouth care dropped her oxygen saturation into the 70s, and she was slow to recover. It was human torture, albeit well intended. I could not bear to witness it.
A Horrible Decision
After discussions with many doctors, I said to her, “Mama, we’re going to put you to sleep and help you breathe. You need to rest, and what we’re doing isn’t working.” And for the first time she asked me, “Am I going to die?”
So, I lied to her and said, “No, Mama, not today. I’ll be right here the whole time. One way or the other, I’ll see you on the other side. I love you.”
And she said (moaned, really) “Okay. I love you too.” Those were the last words she ever spoke to me.
The intubation was tough because she had dried secretions in her throat. Her oxygen saturation dropped immediately when they removed the BIPAP. My friend got the tube in after a struggle, and she recovered briefly, and then her oxygen saturation and blood pressure plummeted. Her stiff lungs betrayed her for the last time, and she developed a tension pneumothorax. Then came the chest tube, and, although this process is a blur in my memory, the reality is that she was hypoxic and hypotensive for far too long.
I was surrounded by an army of my most well-intentioned colleagues, and they all had ideas and suggestions. Predominantly, they had questions as to how I wanted to proceed and what I wanted to do next. But I was shell-shocked and unable to think or make decisions. It was awful—the stuff of nightmares. And somehow Meredith got up the courage to go look at Mama in the eyes, and she looked back at me and shook her head and cried, and I knew that Mama was gone. After what seemed like an eternity, I managed to mutter through my tears and anguish the following words: “Pull the tube.”
That’s what they did. My mother died right there in my arms, and I cried like a child.
One Day at a Time
So, no, I’m not okay. I am riddled with grief and guilt and shame. I have second- guessed everything I know, every decision I made, every action I took, and every word I said. I feel like a fool and a failure. And the worst part is that a thought lurking in the back of my mind wonders if perhaps it was me who needed the relief. Maybe it was me who couldn’t endure watching her linger. Perhaps somehow the decision we made to intubate her was motivated by my own selfish desire for relief from witnessing her struggle and suffer. And I did want her to stop suffering, but I did not want her to die.
My mother is gone now, and that cannot be undone with any number of second thoughts. There is no do-over. There are no second chances. But there are a million “what if’s” circulating throughout my brain and keeping me from sleeping. They also keep me from thinking. I’m incapable of feeling anything other than remorse, guilt, and shame. Guilt, fear, and shame are the shackles of addiction, certain poison for alcoholics. The day my mother died I had been sober for 20 years and 364 days, and I wasn’t sure I would make it to year 21.
I am blessed to have a truly amazing wife, a large family, two wonderful partners, an abundance of good friends and colleagues, and legions of people who know and love me. It is a credit to their love and support that I did make it through that day and found myself sober on my 21st anniversary, made it through that day. And the next, and the following week, and even after her funeral, until today. It gets a little better every day, although the setbacks are real.
I’m reminded of a passage on grief that was shared with me by my father’s best friend and roommate at The Southern Seminary in the 1950s. The original source isn’t known, although it made the rounds on Reddit several years ago, and is a response of an old man to death:
“I am old. What that means is that I’ve survived, so far, and a lot of people I’ve known and loved have not. I’ve lost best friends, acquaintances, co-workers, grandparents, mom, other relatives, teachers, mentors, students, neighbors, and a host of other folks.
I’ve never gotten used to people dying, never have, but here’s my two cents about losing those whom we love. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don’t want it to “not matter.” I don’t want it to be something that just passes. My scars are a testament to the love that I had for that person. And if the scar is deep, so was the love.
Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love.
As for grief, you’ll find it comes in waves. When the ship is first wrecked, you’re drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it’s some physical thing. Maybe it’s a happy memory or a photograph. Maybe it’s a person who is also floating alongside you [and you hang on to one another, floating together so that neither of you sinks]. For a while, all you can do is float. [All you can do is keep on keeping on. All you can do is walk and not faint.]
In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don’t even give you time to catch your breath. After a while, maybe weeks, maybe months, you’ll find the waves are still 100 feet tall, but they come farther apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function.
You never know what’s going to trigger the grief. It might be a song, a picture, a street intersection, or the smell of a cup of coffee. It can be just about anything … and the wave comes crashing. But in between waves, there is life.
Somewhere down the line, and it’s different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come farther apart. You can see them coming: an anniversary, a birthday, or Christmas. You can see the pain coming, and for the most part, prepare yourself. And when the wave washes over you, you know that somehow you will, again, come out on the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you’ll come out.
Take it from an old guy. The waves never stop coming, and somehow you don’t really want them to. But you learn that you’ll survive them. And other waves will come. And you’ll survive them too.
If you’re lucky, you’ll have lots of scars because you will have had lots of loves.”
Many times, we physicians aren’t very good at acknowledging our feelings, our failures, our grief, and our scars. I, for one, have never admitted to anyone that I’m far from okay, until now. But it’s the awful truth. Yet, I do know that between the waves there is life, that life is wonderful because of the people and relationships who make it so. And one day, before I know it, I will indeed be okay again.
Dr. Blythe is an otolaryngologist practicing in Opelika, Alabama, and is affiliated with East Alabama Medical Center. He is also on the board of directors of the American Academy of Otolaryngology–Head and Neck Surgery and is president of the Alabama Society of Otolaryngology.