One glass too many...

Wine is a mocker…’ Proverbs 20:1

Despite having lived for 34 years in Australia, Randy (or Randolph Melville de Silva, according to his citizenship certificate) still talks like a Sri Lankan. Of course, after all these years, he liberally spices his conversation with phrases like ‘No worries’ and ‘She’ll be right’ – and refers to his pals as ‘Mate’ instead of ‘Machang’. Now an avid Aussie Rules fan, he is a proud, paid up and passionate supporter of the Richmond Tigers. He gets into a bad mood, casting aspersions on the referee’s paternity and visual acuity, on those occasions when the Wallabies lose to the All Blacks or the Springboks. 

He has become so Aussified that there are even occasions when he has tried to convince me that Shane Warne is a better bowler than Muralitharan! How much more dyed in the wool can one get? 

But try as hard as he might, Randy still talks with a broad Sri Lankan accent. 

He is also the type of patient who, if he has a pain in his right big toe, starts by telling me: ‘You know Doctor, yesterday when I was going to the office – I had to go by bus because the wife needed the car. Did I tell you that she is now doing this diploma course at university? She began it three months ago, and has only one more assignment to complete the course. Anyway she starts her lectures at 7.30 a.m. and so has to take the car and leave early. So I have to take the bus. So what happened was that, just as the bus turned onto the freeway I suddenly got this severe pain in my toe. 

‘Now you will remember how I had a similar pain in my left toe a few years ago. It was about the time that we were playing the first test in Darwin against Sri Lanka (that was a good game, no – your fellows played well but came a cropper as usual to our McGrath and Gillespie) – anyway I had a bout of toe pain. That time the pain was sharp and throbbing, and woke me up in the night, about 2 in the morning. You gave me some white tablets to take for it and it went away after a day or two. 

‘Now that pain in the left toe (you remember how it was, no, Doctor?) was not like this pain in the right toe…’ and so on it would go on. Stemming Randy’s flow of words has never been easy – nor is separating the wheat of his symptoms from the chaff of his verbosity.

Just follow my instructions

I recall the occasion when he came to see me feeling quite unwell and nauseated. The blood tests I ordered to assess his liver function showed elevated liver enzymes, with a particularly high gamma glutamyl transferase (GGT). 

‘Randy’, I explained, ‘these tests show a much larger than normal amount in your blood of an enzyme called GGT that is released from liver cells when they are damaged by too much alcohol. If you want to get better, and not end up with alcoholic liver disease and cirrhosis, you will have to cut down on your drinking'.

Randy has always enjoyed a tipple – Coconut Arrack with ginger beer when he was in Sri Lanka and Scotch whiskey with water now that he is in Australia.

I explained to him the idea of the standard drink containing 10 g of alcohol – and cautioned: ‘You can have one standard drink per day. In practical terms this means you can pour yourself one finger’s level of scotch into a normal glass. Add as much or as little water and ice as you like, drink it slowly and enjoy it – but don’t take any more than that’.

Randy listened carefully. ‘So Doc, what you are saying is that I can have only one glass per day, no?’

‘Exactly’, I said. ‘Just follow the instructions and you will start feeling better in a few days. Come and see me in a month, and we can check your liver function again’.

A month later Randy came back to see me. After the usual preliminaries and social chitchat I asked him: ‘So have you been following my advice and confining yourself to just one glass a day?’

‘Sure Doc’ he replied. ‘I remembered what you said about the standard “one finger” drink. I now stick to just one glass per day.’ 

I was about to compliment him on his compliance and willpower when he added: ‘But Doc – I must admit I have been filling the glass four times’. MT