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What is real
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I look at your numbers and my mind jumps ahead.

It is what I do. I can’t help it.

When I saw the pregnant-like curve of your belly (except you are a man), the firm bounce of the skin like a water balloon, I thought cirrhosis. I thought can I give you naltrexone? I thought, will it work if I can?

I thought in a month, we’d be having a conversation about how your liver is knotting up, shrinking. How it’s been so bruised by your years of drinking that it’s forgotten how to make things. That sometimes your blood won’t clot. That sometimes, your wounds will take twice as long to heal.

I thought we’d be checking to see if you did, in fact, stop drinking this month as you said you would. We’d talk about how maybe things can’t be totally saved, but you can not get worse if you stay sober. Since you’ve been ok so far, no symptoms except maybe feet that are a touch swollen, maybe you could avoid all the complications. Avoid the vomiting geysers of blood, avoid the round and taut belly surrounded by shrunken, cachexic limbs. Avoid the death I would not wish on anyone.

Instead, I look at your numbers. You did as instructed; you went to the lab.

Now, I can give you naltrexone. See if it helps your cravings.

Except…something in the pattern of your numbers is off. Perhaps…perhaps it isn’t cirrhosis at all.

And so my mind jumps ahead. Perhaps a tumor growing on your liver. Perhaps that’s what the belly of fluid is from—not cirrhosis ascites but cancer ascites.

I picture the tumor marker coming back as 200, if the lab gets added on to the orders. I envision the liver ultrasound telling me what I already know. The CT scan that will follow, praying your kidneys get through the contrast ok. The referrals. The discussion while you sit across from me, anxious, folding and unfolding your hands, the pain in your foot forgotten. The places you have to get to, the appointments in the city, though you don’t have a car. The biopsy that puts you at risk of bleeding, but the only way to know. The treatments you’ll have to take, or at least that we’ll recommend you take, from the various friends’ couches you’ve been living on. Who will take you in for chemotherapy? For surgery?

If you have cancer—does it even matter if you stop drinking, if drinking makes you happy? Or at least keeps the pain at bay?

Stop. I hear my therapist’s voice in my head. You don’t know. You don’t know yet. My mentor echoing her.

What is real are the numbers in front of me, meaning something but we don’t know what yet.

What is real is you, sitting in front of me today, tears flashing through your face for a moment as you speak of grief and alcohol. The dirt under your fingernails. Your gnarled, numb toes. How you tell me you’ve never withdrawn before, even as your hands imperceptibly tremble. How I tell you to tell someone, anyone, how you can’t do sobriety alone.

How you look at me and reply, I know.

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