We Are Your Support

Logline: Lilians husband of 45 years has been admitted to the hospital with several different

symptoms. He is nauseous, achy, has pain in his upper right quadrant, fatigued and anorexic. Test

are being run on him for a diagnosis. Lilian must contact her daughters but first wants to know

the diagnosis in order to mentally prepare herself. The possibility is hepatitis.

Cast of characters:

George: Husband to Lilian and father to Lana, Liz, Lisa and Lila, 65-year-old male

Lilian: Wife of George, mother to Lana, Liz, Lisa and Lila, 62-year-old female

Lana: Daughter to George and Lilian, 32-year-old female

Liz: Daughter to George and Lilian, 31-year-old female

Dr. Wilson: MD (gastroenterology)

Sara: Registered Dietitian

Scene One: Georges hospital room

Dr. Wilson: Good morning, how is my patient feeling?

George: I still feel very tired, achy and sick to my stomach.

Lilian: Good morning, do you know what is wrong with my husband, have any of the test results

come back?
Dr. Wilson: Yes, the test results have come back and the majority of them are normal, that is a

good sign. On the other hand, the test results for Georges liver enzymes are a little more

complicated.

George sighs and looks at his wife.

Dr. Wilson: Your Bilirubin, ALT and AST results are all high indicating a liver virus.

George: So, what does this mean a liver virus? Cut to the chase and tell me what is wrong, I

dont really understand what you are getting to liver virus!

Lilian: George, calm down and let the doctor finish what he has to say.

Dr. Wilson: At this point the tests are inconclusive, in order to establish the real diagnosis, we

need to do another test.

George: Look, Im just tired of feeling this way. I dont want to be here so just give me some

medicine and send me on my way.

Dr. Wilson: Alright, alright lets take a deep breath and slow down. If it was a simple as that I

would not have had you stay for more tests. We really need to figure out the source and then we

can treat it.

Lilian: Do you think it is from his drinking. He has at least four to six beers every night when he

comes home.

George: Lil! I work hard and look forward to my beer. I dont bother anyone that is my way of

relaxing and no one is going to take that away from me. Not you or any doctor.

Dr. Wilson: George, I understand how you feel but we are talking about your health. A person

who drinks everyday damages their liver and it eventually catches up with you. Let me order the
other test and we will go from there, but George please take some time to think about some

possible life changes.

Dr. Wilson: (looking at Georges breakfast tray) Still no appetite I see. Im going to send in a

dietitian and have her help you with your nutritional needs, we need to build up your strength. I

will be back later when I get the test results from your HCV RNA.

Exit doctor

George: Liver virus, what does he know. Im not going to stop drinking my beer and that is that.

Lilian: George, listen to me and stop being so selfish. I had to make several changes in my life

when I was diagnosed with breast cancer. You and the girls were there for me and helped me

through some really rough times.

George: But, but that..

Lilian: George be quite and let me finish. We are getting older and things change. If you have a

liver virus due to drinking and there is a chance to get better you need to take it. The girls, your

grandchildren and I need you. Its not fair to us if you wont help yourself.

George moans!

Scene two: Patient lounge, George and Lilian are sitting in chairs, enter Dr. Wilson. They are the

only people in the room.

Dr. Wilson: Hello again, I have your test results. Are you comfortable discussing them here or

would you like to go back to your room?

George and Lilian look at each other and both respond: Here.

Dr. Wilson: The results from your tests state that you are testing positive for Alcoholic Hepatitis.

George: What! Thats not possible I am not an alcoholic. I just have a few beers when Im at

home to help me relax. Ask my wife. I am not one of those drunks who drinks a fifth of whiskey

a day. I just have a few beers.

Dr. Wilson: George, let me explain this to you. Alcoholic Hepatitis is when the liver becomes

fatty. This happens because liver functions have been disabled. Drinking for an excessive amount

of time or genetic factors cause this. Part of the liver function is to break down fat. Alcohol

inhibits that function. I have to tell you that you are a lucky man. The liver is one of the organs

that can regenerate itself. The only way this can happen is if you can commit yourself to stop

drinking. If you dont the next step is either hepatitis C or cirrhosis. The progression to one of

these diseases is not irreversible. Imagine how you feel now, it will be much worse. I am not

lecturing you on how to live your life I am just telling you the facts in hopes that you will make a

good decision. You are in the prime of your life and can live a very productively for quite some

time. I want you to stay for a couple of days so we can monitor the nausea and other symptoms. I

am going to let the dietitian know your diagnosis so she can work with you on a nutrition plan.

We want to get you on the right track before we let you go home. I also want to monitor you for

any signs of withdrawal from the alcohol. Well George with a little help you will be fine but you

need to make some lifestyle changes and your liver will be able to heal itself in time. Do you

have any questions?

George and Lilian looked at each other and shook their heads.

George: Not at this time. Thank you

Dr. Wilson: Alright then, George, I will see you in two days.

Exit Dr. Wilson

Scene three: Georges room Enter Registered Dietitian.

RD: Good morning, my name is Sara. Im the registered dietitian and Im here to give you a little

insight on the nutrition needs. I understand you are feeling nauseous and not able to eat. If we do

not get the nutrients in your body that you need at this time we might have to tube feed you, but

lets try getting some food in you for now. In order for you to fight any kind of virus you need to

eat. Im going to start you out on some protein shakes and some softer food that will be easier on

your stomach. Do you have a flavor preference?

George: Hmmmmm I think vanilla would be fine. What do you mean by tube feeding?

RD: We inset a tube in your nose down to your stomach, then we attach a feeding bag. This is

how to get nutrients if you are unable to eat orally.

George: No that will not be necessary. I am really going to try to eat.

RD: It is a resort that will need to be taken if you cannot tolerate your food, right now you need a

certain number of kcals and at present you are not meeting the necessary goal.

George: If only I did not feel sick to my stomach.

RD: Lets start you out on a milder diet and go from there, but we need to get you nutritionally

stable. If you are not able to eat at least four small meals by tomorrow evening I will have to

order a feeding tube for you.

George: Alright I can deal with that.

Exit RD

Scene four: cafeteria

Lana: Hi mom, whats up?

Lilian: Hi, Im at the hospital with your dad.

Lana: What?

Lilian: Slow down and let me explain, Im trying to be calm so I need that from you.

Lana: Ok mom, sorry. You just took me by surprise. Everything seemed fine when I was at the

house for dinner last weekend.

Lilian: Well he wasnt feeling well but did not want to let you girls know anything was wrong.

Your dad has a liver virus, the doctor says he has alcoholic hepatitis. I dont know anything about

the disease and I would like to get as much information about it as possible. Your dad is having a

fit about not being able to drink anymore. I feel that that is going to be our biggest obstacle about

him getting better. If he does not stop drinking this will not go away but will progress to a worse

disease.

Lana: Mom, stop there. Im on it. I will get as much information as I can and bring it up to the

hospital later on. Have you called my sisters?

Lilian: No, they are at work and school I will call them a little later, I dont want to leave a voice

mail. This is something that needs to be said.

Lana: As soon as I put the twins down for a nap I will look up some information and make some

phone calls.

Lilian: Thanks, Im going back to your dads room.

Lana: Bye mom.

Scene four: George and Lilian are at home. Their eldest daughter is coming over to visit.

Lilian and Lana are in the kitchen.

Lilian: Its been a rough couple of days. Your dad has been a real crab since he came home

especially in the evening when he is usually drinking his beer.

Lana: It has to be tough for him but it has to be hard on you too mom. I have some information

for you. I was thinking that maybe you should read up on Al-Anon, you need as much support as

dad. Here is the information, you can go on line and read up on it and if you decide to go to a

meeting I will gladly go with you.

Lilian: That sounds like a good idea, I never thought of me getting help to deal with your dad. I

can do that later tonight. What about your dad? He really needs some kind of a support group and

he will not go to AA or have anything to do with something like that. He is so convinced that he

was just an evening drinker and never had a problem.

Lana: I found quite a few on-line support groups for people with alcoholic hepatitis. Dad could

go on by himself and read up on it. He might really get into other peoples stories about how hard

it was for them to stop drinking when they were diagnosed with this disease. I read quite a few
interesting stories myself. Who knows instead of drinking he could go to one of these web sites

and keep himself busy? It really is worth a try.

Lilian: I really think he needs that. He needs to listen to what others have gone through and how

they manage the disease. If he goes back to drinking even if it is less than what he used to drink

who knows when he could get cirrhosis and then what. I could not bear that.

Lana: If we stick together and support him he should be fine

Lilian: My biggest fear is that he drank for so many years how is it going to be that easy for him

to quit. I hope being in the hospital and feeling so sick was scary enough for him. He knows we

love him and dont want anything to happen to him

Lana: I know mom. Get him on a support group web site and see how that goes. Lets just take

things a step at a time.

Lilian: Let me see what you have. The American liver foundation and what is this one?

Lana: this one is the site I went on, the alcoholic liver disease support group. I actually read some

really interesting stories. I have to get home, just wanted to bring you by this information. Dont

forget we are each others support through thick and thin. BYE

THE END
 References

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Ournal.2 (5260)113. Retrieved from: http://dx.doi.org/10.1136/bmj.2.5260.113

Friedman, Sl. (2015). Alcoholic hepatitis: Clinical manifestations and diagnosis.

Retrieved from: http://www.update.com/home

Maher, J.J. (2002). Treatment of alcoholic hepatitis. Journal of Gastroenterology and

Herpetology. 17 (4), 448-455.

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Ohnishi, K. (1997). Alcohol and liver disease. Asian Medical Journal, 40 (8), 389-395

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Ramond, M.J, Rueff, B., & Benhamou, J.P. (1993). Medical treatment for alcoholic liver
 Disease. Baillieves clinical Gastroenterology, 7 (3) 697-716.

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Spengler, E.K., Dunkelberg, J. & Schey, R. (2014). Alcohol hepatitis: Current management.

Digestive Disease and Science, 59 (10) 2357-2366

Retrieved from: http://dx.doi.org/10.1007/s10620-014-3173-8