White Lights

In honor of Men’s Health Month, I’ve been thinking about one of the most memorable male patients I ever cared for—and the story he left with me.

Photo by Karl Hörnfeldt on Unsplash

Dave was in his mid-thirties.

He possessed the kind of humor that made entire rooms betray themselves.

Nurses trying not to audibly laugh at the desk would suddenly snort into computer monitors. Social workers would walk out of his room shaking their heads, smiling despite themselves. Even exhausted residents — dragging themselves through overnight call like dead car batteries on life support — would emerge from conversations with him lighter, shoulders shaking with giggles.

Some residents nicknamed him ‘Dave Chappelle.’ Others called him ‘The Mayor’ because every emergency department in the city seemed to know him, and because within minutes he would have the entire ED roaring.

His alcoholism was devastating. Catastrophic, really.

But so was his charm.

He lived with his father in a weathered little house outside of town. He worked part-time at a Christmas tree farm, which he described with the gravity of a war correspondent embedded in active combat.

“You ever seen suburban parents fight over a seven-foot Douglas fir?” he once asked me. “Makes the Roman Coliseum gladiator battles look like kid squabbles.”

According to Dave, the day after Thanksgiving transformed ordinary human beings into medieval blood thirsty warriors.

Families arrived cheerful and wholesome in matching flannel pajamas for approximately six minutes before descending into economic warfare over balsam pricing.

“You’d think I was selling beachfront property in Malibu instead of a tree that’ll be a pile of pine needles by New Year’s,” he said.

One man apparently spent twenty straight minutes haggling over six dollars.

“Six dollars,” Dave repeated, staring at me in disbelief. “Buddy, you drove here in a Lexus wearing a Canada Goose jacket to argue over less than what you paid for your Starbucks coffee this morning?”

Another year, a woman demanded a discount because the tree “looked asymmetrical.”

Dave looked at her and said, completely deadpan, “Ma’am. It’s a tree. Not a Labradoodle.”

He told me this with such solemn, wide-eyed sincerity that I laughed hard enough to briefly forget why he was sitting in my office.

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The tree farm itself was held together by a questionable connection of extension cords, eggnog, and seasonal optimism.

Every December they restrung the same failing white Christmas lights that had apparently survived multiple presidential administrations.

“Half the bulbs flicker like they’re actively dying,” Dave said. “The place looks less like a Christmas farm and more like a low-budget hostage video.”

He described climbing ladders in freezing weather trying to replace burnt-out strands while elderly customers shouted contradictory decorating advice from below.

“No, no, no, the warm white lights!”
“Those are the warm white lights.”
“Well they look cold.”
“Ma’am, they’re lights, not emotions.”

Once, a child vomited into the complimentary hot chocolate station.

Another time, two golden retrievers got tangled in extension cords and temporarily disabled power to the entire property.

“There I am,” Dave said, “standing in total darkness surrounded by screaming children and limp Christmas trees thinking: yeah, this is exactly how civilizations collapse.”

He told another story about a man in a quarter-zip sweater and immaculate leather boots who spent nearly thirty minutes calmly negotiating over the price of a Fraser fir as though brokering an international peace treaty.

“The guy kept saying, ‘I just think seventy-five dollars is aggressive for a tree…. It’s too bullish.’” Dave shook his head. “Buddy, this ain’t Wallstreet. You drove here in a Range Rover with seat warmers and chrome tires. Now you wanna haggle over something you’re gonna throw onto the curb in three weeks?”

The man then eventually demanded to speak to “someone authorized to make dynamic pricing decisions.”

Dave leaned forward and whispered to me conspiratorially, “Which was very exciting because technically that meant I got promoted during the conversation.”

Another customer once insisted a tree should cost less because one side would face the wall.

Dave stared at her thoughtfully for a moment before replying, “That’s actually true. We charge extra for visible branches.”

One December afternoon, according to Dave, a woman arrived wearing what he estimated was “a rent payment disguised as a fur-lined parka” and became deeply offended that the hand-tied wreaths cost extra.

“She kept saying Christmas had gotten ‘too commercialized,’” Dave told me. “While holding a purebred dog wearing a sweater more expensive than every article of clothing I owned combined.”

When he politely explained that the wreaths took hours to assemble by hand, the woman sighed dramatically, looked down at her sweatered Maltese, and asked, “Well, what are we supposed to tell the children, Princess?”

Dave blinked at her for a long moment.

“Honestly, ma’am,” he said, “if your children recover emotionally from not getting a premium artisanal wreath this Christmas, they’re gonna be unstoppable adults.”

He delivered these stories with the calm seriousness of a documentary narrator discussing wartime atrocities.

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Beneath all the absurdity, there were occasional glimpses of his life outside of the Christmas tree farm.

Sometimes he talked about stopping at the discount grocery store before heading home because his father liked a particular canned soup that only went on sale every few weeks. Once he apologized for taking a late telehealth appointment because he had spent the afternoon sewing the sleeve back onto his father’s winter coat rather than buying a new one.

“He says it still works fine,” Dave told me with a shrug. “And honestly, at this point the coat has seen too much life to quit now.”

Another time he mentioned waking up early before shifts at the tree farm to scrape ice off of his crumbling driveway so the old man wouldn’t slip walking outside before sunrise. He said this casually, almost embarrassed by it, then immediately pivoted into a ten-minute rant about wealthy customers demanding “artisan-looking live trees” that somehow still needed to be perfectly symmetrical.

“Which,” Dave clarified, “is apparently the Christmas tree equivalent of wanting a rescue dog bred by Rolex.”

Once, during a medication follow-up, he apologized for background noise on the phone because he was cooking dinner for his father while simultaneously helping him sort out which utility bill absolutely had to be paid that week and which one could “probably survive another angry letter.” He tried to make it into a joke.

“Nothing says family bonding like choosing between electricity and heating oil,” he said lightly.

Then, after a pause:

“Anyway, turns out Dad likes the house warm.”

He was one of the funniest people I have ever met.

And one of the sickest.

His alcohol use disorder behaved like a nighttime tornado: brief, periodic, violent, and extraordinarily dangerous.

Most people imagine alcoholism as a slow constant decline — a perpetual blur of intoxication. But Dave’s illness came in catastrophic waves. He could remain relatively stable for stretches of time before disappearing into days-long binges that ended exactly where they always ended: the emergency department.

Alcohol withdrawal is not merely discomfort. In severe cases, it is a profound neurochemical catastrophe capable of producing hallucinations, seizures, delirium, cardiovascular collapse, and death.[1][2] Only a minority of patients experience the most dangerous forms of withdrawal, but when they do, mortality can be staggering without treatment.[2][3]

Dave experienced the dangerous kind.

Hallucinations.

Severe confusion.

Autonomic instability so profound his vital signs sometimes looked incompatible with human existence.

He was a frequent flyer to nearly every emergency department in the region. Everyone knew him.

And despite his creativity and humor, not everyone treated him kindly.

Over time, he began telling me about the sighs at triage. The eyerolls during check-in. The subtle tonal shift that happened the moment staff recognized his name.

Again.

Him again.

One emergency physician walked into the room and said, “Couldn’t stay out of trouble, huh?”

As though alcohol withdrawal were a personality flaw that was personally inconveniencing him, instead of a potentially fatal medical emergency.

Sadly, patients with substance use disorders still experience extraordinarily high rates of stigmatization within healthcare settings, which is associated with delayed care seeking, worse outcomes, and increased mortality.[4]

Dave dreaded withdrawal.

But he dreaded the humiliation even more.

One afternoon he called me unexpectedly.

His voice sounded wrong immediately.

Flat. Exhausted. Stripped down to the studs.

“I need to stop drinking,” he said quietly. “I need help.”

Then after a long silence:

“But I can’t do it again.”

I knew exactly what he meant.

He told me he could not bear showing up as a “failure” — his word, not mine — to another emergency department full of people who were tired of seeing him. He couldn’t continue to be a “disappointment” to them.

I pleaded with him to go.

I told him I would call ahead personally. I would arrange a direct admission. The addiction floor nurses knew him well and many cared deeply about him. They did not begrudge him for his illness. I promised I would make it easier.

Safer.

Kinder.

Expedited.

He listened silently.

Then he sighed and said:

“Yeah. I’ll think about it and let you know.”

And hung up abruptly.

I called him back immediately.

Straight to voicemail.

I left a message.

Then another.

Then I sent a portal message urging him to call me back and confirm he was going to the ED, again assuring him I would arrange everything beforehand.

No response.

For a brief moment, I considered calling the police for a safety check.

But something about it felt wrong.

Not clinically wrong. Humanly wrong.

I could not shake the feeling that introducing more uniforms, more flashing lights, more authority figures into the life of a man already drowning in shame would only deepen the open wound. Too many people had already mistaken his symptoms for moral weakness instead of disease.

And besides — he knew what he needed to do.

That was the last time I talked to Dave.

The next morning, I was cc’d on his death certificate.

His father had found him lying in the driveway.

Dave had suffered an alcohol withdrawal seizure, fallen, struck his head against the pavement, and bled to death outside the home he shared with the man who loved him most.

Alcohol withdrawal seizures can occur rapidly and unpredictably during cessation attempts, particularly among patients with severe recurrent withdrawal histories.[1][3]

I remember feeling furious after he died.

Not abstractly sad.

Furious.

I needed someone to blame.

And mostly, I blamed us.

The system.

The clinicians who should have known better.

The people who treated him like an inconvenience instead of a human suffering from a deadly illness.

The sighs matter. The eye-rolls matter. The dismissiveness matters. The small acts of contempt accumulate. Repeated, almost imperceptible dismissals build a steel wall of rejection. Patients remember it. Families dread it. They carry it with them into parking lots and waiting rooms and phone calls made (and not made) in moments of desperation. And sometimes, the humiliations become heavy enough that people stop seeking help altogether.

Sometimes deadly consequences do not arrive dramatically. Sometimes they arrive quietly — in winter, in silent driveways, beside fathers forced to bear witness to what no parent should ever have to see.

And maybe it’s easier for me to stay angry at the system. Anger has direction. Anger gives grief somewhere to go. It’s easier to point at institutions and failures and cruelty than to also admit the more unbearable truth: addiction sometimes takes the best people. The gentlest people. The people who could always make an exhausted doctor laugh in the middle of terrible days.

The greatest tragedy is that only a handful of us ever knew Dave in his fullness. Knew how funny he was. How observant. How absurdly alive. We knew the man debating emotionally cold Christmas lights and the philosophical implications of tree symmetry. We knew the son who loved and cared for his aging father. We knew the patient who kept trying, long after most people had stopped seeing the effort.

But the rest of the world will likely remember only the shorthand.
The frequent flyer.
The alcoholic.
The trouble patient.

But to me, he will always be Dave: standing beneath half-working strands of white Christmas lights, making exhausted doctors laugh during long nights in the hospital. The kind of lights everyone assumes are finished because they flicker unpredictably and fail at the worst possible times — only to unpredictably flash back on again, quietly illuminating everyone around them.

Dave was like that too.

And maybe that is the part I wish more people had seen. Not just the chaos of his illness, but the incredible persistence of his humanity despite it all. The way he could still create so much warmth for other people, even while struggling to survive himself.

That somewhere, even if briefly, he was fully seen.
Not as a diagnosis.
Not as a failure. Not as just another disappointment.

But as a whole person — funny, complicated, deeply loved — whose life glowed far brighter than the final moment when the white lights flickered, dimmed, and went dark forever.

-Lauren

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References

1. Kosten TR, O’Connor PG. Management of Drug and Alcohol Withdrawal. New England Journal of Medicine. 2003;348(18):1786–1795.

2. Saitz R. Introduction to Alcohol Withdrawal. Alcohol Health & Research World. 1998;22(1):5–12.

3. Mayo-Smith MF. Pharmacological Management of Alcohol Withdrawal: A Meta-analysis and Evidence-Based Practice Guideline. JAMA. 1997;278(2):144–151.

4. van Boekel LC et al. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence. 2013;131(1–2):23–35.