Vishnu Girish, MD, DM

_{Alcohol liver disease treatment in Kochi can be a lifesaving intervention for families facing the challenges described below}

The call came at 2:47 AM.

I saw “Meera” flash on my phone screen, and my heart sank before I even answered. Somehow, I already knew.

“Doctor…” Her voice cracked. “It’s my mother. They’re saying… they’re saying it’s end-stage. Hepatic encephalopathy”

Meera was 34 years old. She was a software engineer, a marathon runner, someone who had her life together. But for the past six years since her grandfather died she’d been watching her mother slowly drink herself to death.

And tonight, in a hospital room in Mumbai, that slow death had finally reached its conclusion.

“I’m so sorry, Meera,” I said quietly. “How is she now?”

“Confused. Jaundiced. Her belly is so swollen with fluid she looks pregnant. She doesn’t even recognize me half the time.” Meera’s voice turned sharp, angry.

I could hear her crying now. Not soft tears, but the kind of raw, guttural sobs that come from years of exhaustion and helplessness.

“I’m more angry than sad right now,” she whispered. “Is that terrible? I’m angry at her for not stopping. Angry at myself for not… I don’t know… doing more.”

Six Years Earlier: When the Drinking Started

Meera’s mother—let’s call her Anjali—had never been a heavy drinker. An occasional glass of wine at parties. That was it.

But when her father died suddenly of a heart attack, something broke inside her.

The first few months, it was wine with dinner. “I’m just taking the edge off,” she’d say. Then it was wine before dinner. Then vodka. Then drinking alone in her room at 3 PM.

Meera tried everything. She poured bottles down the drain. She begged. She cried. She researched rehab centers and left brochures on the kitchen table.

But Meera knew she wasn’t fine. Her mother’s eyes were yellow. Her belly was bloating. She’d stopped going to work.

And then came the diagnosis: alcohol-associated cirrhosis.

The Diagnosis: A Year of Denial

The hepatologist not me, but a colleague showed Anjali her ultrasound. A shrunken, nodular liver. Splenomegaly. Ascites.

“Ms. Anjali, you have cirrhosis. Your liver is failing. If you continue drinking, you will die. It’s not a question of if—it’s a question of when.”

Anjali nodded. She cried. She promised to stop.

She didn’t.

Meera watched her mother’s platelet count drop. Her albumin drop. Her bilirubin climb. Child-Pugh A became Child-Pugh B. Compensated became decompensated.

And through it all, Anjali kept drinking.

“Addiction isn’t about wanting to live or die. It’s about a brain that’s been hijacked by a substance. Alcohol changes the way the reward centers work. It becomes the only thing that makes the pain bearable even though it’s causing the pain in the first place.”

The Descent: Hepatic Encephalopathy

It started with confusion.

Anjali would forget conversations they’d had an hour earlier. She’d get lost driving to the grocery store she’d been going to for 20 years. She’d call Meera by her dead father’s name.

“It’s the ammonia,” I explained when Meera brought her mother in, finally, after weeks of begging. “Your liver normally breaks down ammonia from your gut. But your mother’s liver is so damaged it can’t do that anymore. The ammonia builds up in the blood, crosses into the brain, and causes confusion, personality changes, and eventually, coma.”

The Hospital Room: End-Stage Liver Disease

When I walked into Anjali’s hospital room that morning, after Meera’s 2:47 AM phone call, I barely recognized her.

Her skin was deep, unnatural yellow. Her abdomen was distended with 8 liters of ascitic fluid. Her legs were swollen, weeping edema. Her arms were covered in bruises from low platelets.

She looked at me without recognition.

“Mom, this is Dr. Vishnu,” Meera said gently. “Remember? Your liver doctor.”

Anjali smiled and went back to picking at the bed sheets – asterixis, the liver flap.

I pulled Meera into the hallway.

“Her MELD score is 28,” I said quietly. MELD is a scoring system for liver disease severity. Over 15 means transplant evaluation—if the patient is a candidate.

I put my hand on her shoulder. “I’m so, so sorry. But yes. Without stopping alcohol and without a transplant, with a MELD this high and ongoing drinking… she has weeks, maybe a month or two.”

The Anger, The Grief, The Guilt

Over the next two weeks, I watched Anjali deteriorate. There was no transplant option available. She was not listed on the transplant list as she had too many relapses of her drinking disease.

Her kidney function worsened hepatorenal syndrome, where the failing liver causes the kidneys to shut down. Her blood pressure dropped.

The Science of Why She Couldn’t Stop

“Alcohol addiction is a disease of the brain, not a moral failing,” I said. “When someone drinks heavily for years, their brain chemistry changes. The reward pathways – the parts that make us feel pleasure – become dependent on alcohol. Without it, they feel unbearable anxiety, depression, physical withdrawal.”

“But she knew it was killing her.”

“She did. But addiction overrides survival instinct. The addicted brain prioritizes the substance above everything – above family, above health, above life itself. It’s not that she didn’t love you, Meera. It’s that her brain had been hijacked.”

The Final Week

Her MELD was now 35. She was in and out of consciousness. Her kidneys had failed completely. Her lungs were filling with fluid. We’d stopped all aggressive treatments and focused on comfort.

Meera sat by her mother’s bedside, holding her hand.

“I’m sorry I’m angry,” she whispered to her unconscious mother. “I’m sorry I can’t just be sad. I’m sorry I wasn’t enough to make you want to stop.”

Anjali died on a Saturday morning, three days later.

She was 58 years old. She’d been diagnosed with cirrhosis 14 months earlier. She’d never stopped drinking.

What I Wish Every Family Knew

If you’re reading this and watching someone you love drink themselves to death, I want you to know:

It’s not your fault.

Addiction is a disease. A cruel, devastating disease that doesn’t care how much you love someone. It doesn’t care how hard you try. It doesn’t care how many times you beg or cry or pour bottles down the sink.

The only person who can stop an addiction is the addicted person themselves. Even then, they often can’t do it without professional help, medications, therapy, and immense support.

You cannot love someone sober.

No amount of pleading will override the brain chemistry that makes them crave alcohol more than air. No amount of anger will shame them into stopping. No amount of ultimatums will work if their brain is still hijacked.

Enabling is not kindness.

If you’re giving alcohol to an addicted person because you “can’t bear to see them suffer,” you’re not being compassionate.

It’s okay to be angry.

Grief after addiction-related death is complicated. You’re allowed to be angry at them for not stopping. Angry at yourself for not doing more. Angry at the unfairness of watching someone choose a substance over life. You’re also allowed to be sad, relieved, guilty, and numb – sometimes all at once.

Get help for yourself if required

The Medical Reality of Alcohol-Related Cirrhosis

Let me be brutally honest about what happens when someone continues drinking with cirrhosis:

Stage 1: Compensated Cirrhosis

The liver is scarred but still functioning. No symptoms yet. If the person stops drinking now, they have a chance.

Yes cirrhosis is reversible to and extent.

Stage 2: Decompensated Cirrhosis

Ascites (fluid in the belly), variceal bleeding, encephalopathy. MELD scores rise.

Stage 3: End-Stage Liver Disease

Multi-organ failure. Hepatorenal syndrome. Hepatopulmonary syndrome. Infections. Bleeding. Coma. Without transplant, death is certain.

Alcohol withdrawal can be deadly. Seizures. Delirium. Hallucinations. Severe autonomic instability. That’s why medical detox is essential—but the addicted brain often chooses alcohol over medical help.

And even after successful detox, the psychological dependence remains.

Without ongoing therapy, support groups, sometimes medications like naltrexone or acamprosate, relapse rates are over 60% in the first year.

For the Person Who’s Drinking

If you’re reading this and you’re the one with alcohol-related liver disease, still drinking, I want to say this as clearly as I can:

You’re not a bad person. You’re a sick person. And you deserve help.

But you need to ask for that help. You need to accept that help.

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In Memory

This blog is dedicated to everyone who has watched someone they love die from alcohol-related liver disease. To the daughters and sons who tried everything and couldn’t save their parents. To the spouses who pleaded and cried and ultimatum-ed to no avail. To the siblings who poured bottles down drains and researched rehab centers and attended Al-Anon meetings.

It wasn’t your fault.

And to anyone currently drinking with liver disease, reading this and recognizing yourself:

It’s not too late. But it will be soon.

Please. Get help. Today.

Dr. Vishnu Girish is a hepatologist practicing in Kochi, Kerala. He specializes in alcohol-related liver disease, cirrhosis, and end-stage liver disease management. This blog aims to raise awareness about the devastating impact of alcohol on the liver. It also highlights the struggles of families who watch their loved ones suffer. If you or someone you love is struggling with alcohol addiction and liver disease, please reach out for help. It’s never too late—until it is.