The Thirst

CW: Substance abuse, self-harm

Raymond Givens had been drunk for most of the last 27 years, which meant he knew the difference between withdrawal and dying. Doctors did not seem to understand that. They saw the drinking first. Everything else came second. Ray knew what withdrawal felt like. He knew the shaking, the sweating, the nausea, the irritability, the strange crawling sensation under the skin, the insomnia, the pulse pounding in his throat. He knew the fear that arrived when his body realized the alcohol was gone and decided to punish him for it.

               This was not that. He had told them four times. Nobody listened. “This isn’t withdrawal.”

               The emergency room physician glanced at the chart. “You drink daily?”

               “Yeah.”

               “How much?”

               Ray closed his eyes. Here we go. “A fifth.”

               “Of?”

               “Bourbon.”

               “Every day?”

               “Most.”

               The doctor nodded like Ray had just solved the case for him. “And when was your last drink?”

               “Yesterday.”

               “That fits.”

               Ray opened his eyes. “No. It doesn’t.”

               “You’re tremulous. Your heart rate is elevated. You’re sweating.”

               “My stomach feels like somebody buried a knife in it.”

               “Withdrawal causes abdominal symptoms.”

               “I know.”

               The doctor looked at him. Ray hated that look. Not disgust. Worse. Patience. The look people used when they had already decided he was unreliable and were now waiting for him to finish talking. Ray had seen it from cops. Judges. His ex-wife. His daughter. Now doctors. He rolled onto his side and immediately regretted it. Pain tore through his upper abdomen and into his back. “Jesus Christ.”

               The doctor leaned closer. “Where exactly?”

               Ray pointed. “Right there.”

               “Any vomiting?”

               “Yes.”

               “Blood?”

               “Not yet.”

               “Any hallucinations?”

               Ray laughed. “No.”

               “Confusion?”

               “Not unless you count being confused why nobody is listening.”

               The doctor straightened. “We’re listening.”

               “No. You’re hearing ‘alcoholic.’ That’s not the same thing.”

               Ray lived outside Camdenton, Missouri, in a one-story house he had built 20 years earlier when people still returned his calls. He had been a commercial contractor then. Successful. Not rich, but close enough to feel like he was headed there. Hotels. Restaurants. Two banks. A medical office. He had 26 employees at one point. Then drinking stopped being something he did after work and became something he needed in order to work. Then something he needed before work. Then something he needed instead of work.

               The company disappeared. His wife disappeared. Eventually, so did his daughter. Not literally. Emily still existed. Kansas City. Thirty-two years old. Married. One little girl Ray had met twice. Emily sent birthday texts. Christmas texts. Nothing else. Ray did not blame her. That was the problem with finally understanding what you had done. Understanding did not fix it.

               The ER gave him fluids, lorazepam, thiamine, folate, and something for nausea. Standard alcoholic package. Ray knew the routine. He had done it before. By evening, the shaking improved. The pain did not. Neither did the thirst. That part was new. Ray drank six cups of water. Then eight. Then another bottle. Still thirsty. Not dry-mouth thirsty. Not hungover thirsty. Something deeper. His whole body felt empty. He pressed the call button. A nurse came in. “I need water.”

               “There’s a pitcher right there.”

               “I drank it.”

               She looked at the empty pitcher. “That was full 20 minutes ago.”

               “I know.”

               She frowned. “You nauseous?”

               “No.”

               “Pain?”

               “Eight.”

               “I’ll see what you can have.”

               “And water.”

               “I’ll refill it.”

               Ray watched her leave. Then licked his lips. His tongue felt swollen. His throat felt raw. He could smell something metallic in the room. He looked around. Nothing. The smell got stronger. A nurse walked past the doorway carrying a red biohazard bag. Ray sat up. The smell was coming from that. His mouth filled with saliva. He froze. “What the hell?”

               They discharged him the next morning. Diagnosis: Alcohol withdrawal. Gastritis. Dehydration. Ray argued. The doctor listened. Then sent him home anyway. He made it two days. On the third, he collapsed in the parking lot of a gas station after buying bourbon he no longer wanted. That frightened him more than the pain. He had opened the bottle in his truck, raised it to his mouth, and nearly vomited from the smell. Ray stared at the bottle. For 27 years, bourbon had been relief.

               Medicine.

               Food.

               Sleep.

               Company.

               Now it smelled rotten. He poured some into his mouth anyway. His body rejected it instantly. Ray spat onto the pavement. “Bullshit.” He tried again. Same result. Then the pain hit. Ray fell against the truck. The bottle shattered. A woman pumping gas screamed. He woke in another emergency room. This time in Columbia. Different hospital. Different doctor. Different outcome.

               Dr. Naomi Kessler was the first person who listened. Ray noticed because she did not ask how much he drank until nearly five minutes into the conversation. She pressed on his abdomen. Ray swore at her. “That hurt?”

               “No, I just like yelling at strangers.”

               She smiled slightly. “Fair.” She ordered imaging. Bloodwork. More tests. Ray expected the same answer. Instead she came back two hours later looking serious. “You were right.”

               Ray stared at her. “About what?”

               “This isn’t withdrawal.”

               Something cold moved through him. “What is it?”

               “Your pancreas is badly inflamed. There’s also evidence of necrosis and a fluid collection.” Ray said nothing.

               Kessler pulled a chair closer. “You have severe acute pancreatitis, and it looks like this has been progressing for a while.”

               “How long?”

               “Hard to say.”

               “So those other visits?”

               “I can’t speak for another hospital.”

               Ray laughed. “Of course not.”

               “We need to admit you.”

               “Am I dying?” Kessler did not answer quickly enough. Ray nodded. “Got it.”

               “You’re very sick.”

               “That’s doctor for yes.”

               “No. It means we need to treat this aggressively.”

               Ray looked toward the window. Rain streaked the glass. “Can you fix it?”

               “We can treat it.”

               “That wasn’t my question.”

               Kessler held his gaze. “We’re going to try.”

               Ray spent nine days in the hospital. The first three barely existed. Pain medication. Antibiotics. Fluids. Procedures. People entering and leaving. He drifted in and out. When he was awake, he was thirsty. Constantly. The nurses limited how much he could drink at first. Ray hated them for it. He understood why. Still hated them. By the fourth day, the pain eased. By the fifth, they told him the worst had likely passed. On the sixth, a surgeon drained the infected collection. On the seventh, Ray realized he had not thought about alcohol once. Not once. That had never happened.

               Even during previous detox admissions, some part of him had been counting time until he could leave and drink again. This time, nothing. No craving. No longing. No mental negotiation. Just thirst. He called Emily. She answered on the fourth ring. “Dad?”

               “Hey.”

               Silence. “You okay?”

               “Not really.”

               Another pause. “Where are you?”

               “Hospital.”

               “What happened?”

               “They missed something.”

               “Who?”

               “Doctors.”

               “What?”

               “Pancreas.” Ray rubbed his face. “Apparently I’ve been trying to die more efficiently than usual.”

               Emily did not laugh. He had expected her to. “Do you want me to come?”

               Ray closed his eyes. “Yes.” He almost said no. Would have, once. “Yes.”

               Emily arrived the next afternoon. She looked older than Ray remembered. Not old. Just adult. There was a difference. For years, his mind had preserved her at 22, standing in his kitchen crying and begging him to go to rehab. Now she was 32. Married. A mother. Ray had missed most of it. She stood beside the bed awkwardly. “You look terrible.”

               Ray smiled. “Runs in the family.”

               She laughed despite herself. Good. He needed that. She sat. “What happened?”

               Ray explained. Most of it. He did not explain the thirst. That sounded stupid. Instead, he told her something else. “I don’t want a drink.”

               Emily stared at him. “What?”

               “Bourbon.”

               “You’re in a hospital.”

               “No. I mean I don’t want it.” She waited. “I tried before I collapsed. Couldn’t even swallow it.”

               Emily’s face changed. Hope. Ray hated seeing it. Hope was dangerous. “You mean it?”

               “Yes.”

               “Maybe this is it.”

               “Maybe.”

               “You could go to treatment when you get out.”

               Ray looked at her. “I might.”

               Emily smiled. That hurt worse than the pancreas. She opened a plastic container of fruit. The lid cracked. A sharp edge sliced her finger. “Shit.” Ray smelled the blood before he saw it. His whole body reacted. Not emotionally. Physically. His pulse jumped. Saliva flooded his mouth. The thirst exploded. Emily sucked her finger. Ray stared. “Dad?” He looked away. “You okay?”

               “Yeah.”

               “You look pale.”

               “Fine.”

               She wiped the blood onto a napkin. Ray could smell it across the room. Not metallic now. Sweet. Warm. Impossible. His stomach tightened. Emily tossed the napkin into the trash. Ray watched it fall. “What?”

               “Nothing.”

               “You’re staring at the garbage.”

               “I’m tired.”

               She stayed another hour. Ray barely heard anything she said. All he could think about was the napkin. When Emily left, Ray waited. Five minutes. Ten. Then he climbed out of bed. His legs shook. He walked to the trash. Stood over it. “No.” He turned away. Made it three steps. Stopped. Turned back. The napkin sat near the top. A tiny smear of red. Ray reached down. “What the fuck are you doing?” He froze. Nobody there. Ray laughed quietly. “Exactly.”

               He dropped the napkin. Then the smell hit again. Ray closed his eyes. Picked it back up. Touched the blood with his tongue. The thirst disappeared. Instantly. Completely. Ray opened his eyes. His entire body relaxed. For the first time in weeks, he felt full. Satisfied. Peaceful. He stared at the napkin. Then vomited. Ray told nobody. Not Emily. Not Dr. Kessler. Nobody. He spent the night convincing himself it had been coincidence. Salt. Iron. A psychological response. Medication. Anything.

               The next morning, he bit the inside of his cheek. Hard. Blood filled his mouth. The effect was immediate. The thirst vanished. Ray stood in the bathroom staring at himself in the mirror. His eyes looked clearer than they had in years. His skin had color again. He felt good. Not drunk. Better than drunk. He touched his tongue to the blood inside his cheek. A thought arrived. Clean. Calm. Certain. “There’s no going back now.” Ray whispered it to his reflection. He expected to feel afraid. Instead he smiled. That scared him.

               The hospital discharged him two days later. Emily drove him home. She stopped at the grocery store on the way. “You need food.”

               “I have food.”

               “You have mustard and beer.”

               “Bourbon.”

               “Not anymore.”

               Ray smiled. “Not anymore.”

               She bought groceries. Chicken. Bread. Fruit. Soup. Coffee. Normal things. Ray watched her pay. At the register, the cashier had a Band-Aid on her thumb. Ray could smell blood through it. He turned away.

               Outside, Emily hugged him. “I’m proud of you.”

               “Don’t be.”

               “I am.”

               “You should wait.”

               “For what?”

               Ray looked at her. He wanted to tell her. Almost did. Then he remembered the relief. The thirst disappearing. The peace. “Nothing.”

               Ray poured every bottle of bourbon in the house down the sink. Three unopened. One half-empty. He watched the amber liquid disappear. No hesitation. No grief. No craving. Twenty-seven years gone down a drain. He laughed. Then he cut his palm with a kitchen knife. Not deep. Just enough. Blood welled. Ray drank. The thirst vanished. That became the routine. Small cuts. Controlled. Clean. He told himself that made it okay. He knew better. The problem was volume.

               Each day took more. A drop became a teaspoon. A teaspoon became more. Ray’s cuts stopped healing properly. His arms became difficult to explain. He started wearing long sleeves. Then one night he woke at 3:00am with the thirst so bad he thought he would lose his mind. He cut his forearm. Not enough. Again. Still not enough. Ray stared at the blood. Angry. His own blood no longer satisfied him. That was when he understood. The thirst had changed again.

               The first animal was a deer. Roadkill. Fresh. Ray found it on Highway 5 just before dawn. A truck had struck it minutes earlier. Steam rose from the body in the cold air. Ray stopped. He sat in the truck gripping the steering wheel. “No.” He could smell it through the windshield. He got out. He told himself he was only looking. Then he knelt. The blood was warm. Ray drank. It helped. Not enough.

               By December, Ray looked healthier than he had in 15 years. That was the sick joke. He lost weight. His hands stopped shaking. His face stopped swelling. His eyes cleared. Emily noticed. “You look amazing.”

               Ray almost laughed. “Yeah?”

               “Seriously.”

               “No drinking.”

               “Three months.”

               She smiled. “You should be proud.”

               Ray looked at his granddaughter playing on the floor. “Maybe.” The little girl scraped her knee on the coffee table. Started crying. Emily picked her up. Ray smelled blood. He stood immediately. “I have to go.”

               “What?”

               “I forgot something.”

               “Dad.” Ray grabbed his coat. “You just got here.”

               “I know.” His granddaughter cried behind him. Ray reached the door.

               Emily said, “Are you okay?”

               He did not turn around. “No.” Then he left.

               That night Ray drove for hours. No destination. Just distance. Away from Emily. Away from the little girl. Away from anything warm. Alive. Human. By morning, he was outside Springfield. He pulled into a convenience store and bought coffee. The clerk smiled. Ray smelled blood. A paper cut. Barely anything. Still enough. He left without the coffee. Back in the truck, he gripped the wheel until his hands hurt. “I’m not doing this.” The thirst burned. He started driving. Ten miles later, he saw the van. White.

Red cross on the side. A mobile blood donation vehicle.

               Ray slowed. His heart pounded. The thirst became unbearable. He passed it. Kept going. One mile. Two. Three. Ray laughed. Then started crying. He turned around.

               The van was parked behind a church. Volunteers unloaded boxes. Ray sat across the street. He watched. People came and went. Donors. Nurses. Coolers. Blood. So much blood. Ray closed his eyes. He thought of Emily. Her hope. His granddaughter. The bourbon going down the sink. Twenty-seven years of destroying himself. Now, for the first time, he did not want alcohol. He was sober. Completely. Finally.

               Ray opened his eyes. A volunteer carried a red cooler toward the van. The thirst screamed through him. Ray started the truck. He could leave. He knew that. Drive home. Call Emily. Tell someone. Check into a hospital. Chain himself to a bed if necessary. Anything. The volunteer opened the rear door. Ray watched the cooler disappear inside. He remembered the bathroom mirror. His own voice.

               There’s no going back now.

               He put the truck in drive. For one moment, he hesitated. Then he followed the van.