An avoidable path to liver failure

This week our Health Informatics Unit launched a consultation on how alcohol and tobacco use is recorded in patient health records. For Dry January, one patient shares their journey and discusses the importance of ensuring that no-one falls through the health and social care net.

New Year’s Eve 2013 – the day I received a liver transplant for life-threatening, alcohol-related liver disease. Only in my mid-thirties, my life so far had been mired by years of poor mental health and alcoholism.

My early life was spent surrounded by abuse, financial troubles, and little warmth or support from my extended family. Coupled with a decade of school bullying, growing up presented more conflict than the joy and safety that should be every child’s right.

Alcohol had also always been a constant at home: I had experienced a liberal attitude to drink from a relatively early age. Whilst at university, I shunned social drinking in favour of drinking alone. During my third year as an Erasmus student in Madrid, with its inexpensive 24 hour drinking culture, I began to feel suicidal and some of those closest to me began to show concern about my drinking.

Returning to the UK for my final year, I was suffering from depression and sought help from a student counsellor and my GP. Surprisingly neither asked about my drinking, despite being prescribed antidepressants. However, after reading a Sunday Times article linking antidepressants to suicide in young people, I decided to stop taking them and began drinking and smoking heavily again. I tried attending Alcoholics Anonymous (AA), but it didn't really work for me, and after a series of missed deadlines and exams, I almost forfeited my degree.

Entering the world of work and still suffering with depression, I frequently drank in the evenings, bingeing privately on the weekends. On the rare occasion I saw my GP, usually about fatigue and low mood, the issue of alcohol was never raised. When it was, I either lied about how much I drank, or was instructed to seek help from AA, or to 'simply' cut down.

When my GP finally requested a blood test, my liver scores were extremely high and I was advised to attend A&E for referral to a liver specialist. When I finally did, I couldn’t face the wait, the horror of having to explain myself, or being labelled a self-afflicted time waster. My drinking continued to increase and within a year my body began to shut down.

Finally, I called an ambulance that took me to King’s College Hospital. There I spent 15 months on and off battling to stay alive, until the life-changing moment I was told that a suitable match for a liver transplant had been found.

Circumstances during my childhood had triggered the poor mental health that eventually led to alcohol addiction, but interventions could have been made sooner. Whenever I sought medical advice I felt that some doctors did not understand, failed to ask the right questions, or felt they lacked the expertise to really help.

My plea to all health professionals is this: take the time to engage your patients. Build a rapport, and be direct.

My plea to all health professionals is this: take the time to engage your patients. Build a rapport, and be direct. Ask about alcohol use and its impact on their lives; do not skirt around the issue. Be frank and honest about the consequences of alcohol misuse, including alcohol-related liver disease and cancer. Get trained to deliver brief interventions and refer patients for specialist support to help cut consumption – too often, people cannot manage this alone. Where there are signs of alcohol misuse, act early. Arrange follow-ups over the phone, in person or via Skype or email.

The problem for so many like me is the fear and shame of admitting to the extent of our misery. We have a right to be seen, and should never be made to feel as though we are wasting the health service’s time. People in my shoes should not be left to fall between the cracks. Healthcare professionals cannot change an individual’s past but they can certainly play a huge role in influencing their future.

In 2015, 31% of men and 16% of women in England consumed more than the recommended safe limits of 14 units per week. Over 1 million people in England are admitted to hospital and over 6,000 die every year with alcohol-related disease and injuries. Alcohol is the most common cause of liver disease in England, where the associated deaths are rising in contrast to most EU countries. Earlier support could have saved me and many others from needing a liver transplant; it is in society’s best interests that we help others to avoid ever needing one.

Support

If you or someone you know is struggling with alcohol-related issues, contact your GP and visit Alcohol Concern for more information about support, resources and help services.

Have your say

You can also submit your consultation response online. For more information about the work of our HIU team or the alcohol and tobacco standards project, please contact the HIU team and follow @RCPLondon on Twitter.