My supervisor and I are sitting in her office and I meet the guy that manages the morgue. Creepy. He’s dressed in a sharp black suit, appropriate, I suppose. He asks my supervisor for some transportation forms. He’s got about 40 dead bodies that need to be moved to the morgue across the street. He’s going to have them transported by ambulance. Why not put the bodies on gurneys and move them that way I ask? It seems crazy to have an ambulance literally go from one side of the street to the other. He says by law they have to go by ambulance.

40 dead bodies that no one has claimed. They will be buried in paupers graves, unmarked.   

I get paged by the psychiatrist. He asks me to see a young Hispanic man who he says is an alcoholic. The shrink blithely asserts, if the patient doesn’t stop drinking he will die. Yeah right, heard that one before. It’s bullshit. Most people who drink heavily don’t die from drinking heavily because they stop drinking heavily. Only a tiny minority literally drink themselves to death.

I have so little respect left for psychiatrists. They have no interest in helping patients. Psychiatry sees patients as pathological and push pills for every problem. They especially hate working with alcohol and drug users. They don’t understand addiction as a biopsychosocial problem and instead, view it as a disease/pathology.  With this group of patients they have a strict division of labor. They do a brief, uncomprehensive assessment as quickly as they can and then page the social worker. We are supposed to help the patient get into treatment. The psychiatrists want nothing to do with this part, it’s beneath them. But you can’t separate the two. If you diagnosis an addiction you need to know what treatment is appropriate and what is available. Why bother talking to drug using patients if won’t get them into treatment?

I meet the man in the hallway and say hola. I had a feeling he didn’t speak much English even though the psychiatrist said he did. That’s another reason he turfed the patient, he didn’t want to get an interpreter. He didn’t spend any time with the patient, couldn’t communicate with him, and yet made the dire pronouncement that the patient was going to die if he didn’t stop drinking. Wow, medical school really paid off, you’re clinical skills are brillant, doctor….

The patient is still drunk, not drunk enough that he can’t talk or think, but the alcohol coming off his breath is powerful. He’s short, clothes are dirty, he’s 22. He smiles a lot. I ask a bunch of questions and he tells me his mother is a Christian and they don’t get along. I ask about his father, he says he died. And then he starts to cry, but he stops himself and says estoy bien, I’m okay, and I say no you’re not. The tears well up in his eyes again and he wipes them away and pushes the pain back down. He can’t go there. Alcohol is an interesting drug – it medicates the pain but it also disinhibits enough to let the pain out. Crying in your beer sums up the idea.

He drinks tequila and says can down two large bottles in one night. His girlfriend is a heavy drinker, too. He shares that she gets “caliente” (sexually turned on) when they are drunk.

He works 7 days a week in construction and goes to work even if he has a hangover.

I happen to love tequila. It has a narcotizing quality that is totally amazing. Two margaritas are therapy for me. Crying into a cactus-stemmed glass of lime green liquid.

The guy likes to drink and fight. He’s definitely 22. He’s in the precontemplation stage of change so nagging, threatening, or scaring won’t work and actually, it never does. I tell him I have some free advice if he wants it, he says he does. I recommend he talk to someone about why he cries when he thinks about his father. And I suggest that 1 or 2 nights during the week he do something else after work besides drinking. And por favor, use a condom. But it’s his life, his body and he can do whatever he chooses.

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