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16 December 2015

The remedy for Elaine’s chest pains lay in a serious conversation with her son

Unless she changed tack, she was in danger of producing a young man incapable of taking responsibility for himself.

By Phil Whitaker

Elaine had been getting chest pains, and sometimes an unpleasant fluid would arrive at the back of her throat, scorching the tissues there. It was worse when she lay down, making getting to sleep difficult.

A few questions ruled out anything sinister, so I gave her my standard spiel, explaining how our stomachs are able to withstand their acid contents, but not so our gullets. When gastric fluid refluxes back up towards the throat it causes a chemical burn to the lining of the oesophagus. It’s a common problem and easy to treat with proton pump inhibitors (PPIs), medications that switch off acid production in the stomach.

Even as I rounded off my little speech, though, I was wondering why it was happening to her. Reflux is frequently linked to obesity or excess alcohol, but Elaine is pretty much the perfect weight, and she certainly isn’t a boozer.

Another explanation would be a hiatus hernia – where the top of the stomach gets displaced above the diaphragm – but a first presentation in her mid-fifties seemed unlikely somehow.

There was a moment of silence between us. Before I could decide how to formulate a further inquiry, Elaine took the plunge.

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“Could it be due to stress?”

I readily agreed: our bodies invariably find some physical way of expressing emotional turmoil, and reflux oesophagitis is as good as any.

Emboldened, Elaine began to tell her story.

“You remember I told you about my son?”

I must have looked puzzled.

“About how he’s using cocaine?”

That rang a bell. She had mentioned it in passing some months before. Patients do this sometimes – test out a doctor’s reaction to something they are troubled or ashamed about, then revisit the problem if they feel they got a sympathetic reception. I encouraged her to continue. Elaine described how her son’s drug use was out of control. In his mid-twenties, with a promising job in a light engineering firm, he still lived at home. When it first became clear that he was taking cocaine, Elaine and her husband issued an ultimatum: stop, or leave home.

To start with she thought it had worked. But he continued to come back late, saying he’d been out drinking with mates, yet there was never any alcohol on his breath, and his restlessness and inability to sleep told a different story. It was devastating for her, she told me, to see him ruining himself like this.

In desperation, she had taken control of her son’s bank card, trying to choke off his access to drugs. Initially, that tactic, too, had appeared to work. But a month ago he’d confessed that he’d run up over £700 of debt, and told her that his dealers were now after him for payment.

I knew what was coming next, even before she said it. Elaine had already paid off the first £200 for him. And she hadn’t told her husband about it all, knowing how strongly he would disagree.

It is one of the most difficult transitions for a parent, finally letting go of one’s child and allowing them to learn their own lessons. All the more so if the lessons they seem determined to learn appear self-destructive. But by failing to stick to firm boundaries; by assuming for herself the responsibility of trying to stop him buying drugs; then by bailing him out when that didn’t work, she was serially denying him the opportunity to grow and mature.

Unless she changed tack, she was in danger of producing a young man incapable of taking responsibility for himself.

We talked it through. She already knew, in her heart of hearts, what she had to do. First would be a difficult but vital conversation with her husband. Then the two of them, acting as a united front, would need to decide their boundary and unwaveringly stick to it.

I gave her a prescription for a PPI, but by then it felt almost like an afterthought. The remedy for Elaine’s reflux lay not in tablets, but in resolving the mess in which she’d allowed herself to become mired.

This article appears in the 09 Dec 2015 issue of the New Statesman, The clash of empires