Almost a year ago I was working briefly as a roving consultation-liaison psychiatrist in primary care clinics. I was called by a family physician in despair about a middle-aged man with a drinking problem. The patient, a skilled technician, had been repeatedly sacked and was currently unemployed. His wife was at her wits’ end. The family physician and I agreed to see them together.
When I arrived, an air of defeat already pervaded the room. Yet Mr. A himself seemed a really sweet person. His wife did her best to be helpful and factual, rather than angry and judgmental. We reviewed the facts: Mr. A had only begun drinking noticeably in his early 40s: first it was social drinking, but then he would drink more than his friends; then he began to drink alone on his way home from work, then on the way to work as well. He had already had convulsions during withdrawal, and his “liver enzymes” were elevated.
Mr. A, who showed problems with short-term memory, alternated between trying to minimize the problem and promising to reform. The physician had clearly been through this before. Mr. A: “Doctor, I’ll come every other day to the clinic so you can smell my breath; you’ll see I haven’t been drinking.” Dr. B: “Oh, Mr. A, how many times have you made me these promises?”
Suddenly I had an idea. I said, “Mr. A, I like the idea of your coming to the clinic every other day, but I do not like the idea of your reporting in disgrace. How about if you learned to bake a little? On every visit you could bring the team a cake or cookies you’d made.” (The clinic had about 15 staff members.) “You could also do a little clean-up in the kitchenette, or sort some mail. That way we could all pretend you were volunteering, and not just on parole, as it were.”
The couple agreed to try, and I went back to a regular clinical and administrative job and forgot the incident. The other day, at a professional meeting, I ran into Dr. B. He told me enthusiastically that Mr. A had been sober for 8 months and had a new job. His wife was thrilled.
I felt a real rush of warmth. It is not every day we see a “quick cure” in psychiatry. Even if this one is not long-lasting, the patient and his wife will have enjoyed a few more good months or years together. But why was the intervention helpful (if it was the intervention that helped)? Was it my empathy with his status as “the accused”? Did the family physician’s despair finally break through to him? Was it some combination of these? Perhaps it was the cookies.
