• Rebuilding a shattered life
• Anatomy of a disease
• Fetuses especially vulnerable to harm from alcohol
• Alcohol's heavy toll on the brain
• Alcohol-related deaths in 1992

For Kady Kilpatrick, a recovering alcoholic now living in Maine, the lure of escaping through alcohol abuse led to a prolonged nightmare of medical problems.Staff photo by David A. Rodgers

Two years ago, weary of life and wrung out by her compulsion for booze, Kady Kilpatrick boarded a Greyhound bus in California, drunk.

Four days and five liters of vodka later, she got off in Portland, drunker.

It was the last leg of a two-decade journey with alcohol that left Kilpatrick with a ruined pancreas, a raw stomach, the beginnings of diabetes, a scarred psyche, and a tendency to turn black-and-blue even from the friendliest touch.

It also left her with about $100,000 in medical bills, much of which she couldn't pay.

Whether it is a chronic abuser like Kilpatrick or a weekend binger who ends up in the emergency room, the medical bills of people who abuse alcohol are an overlooked burden on the medical system. Kilpatrick's long struggle with the bottle illustrates how we all ultimately pay the price for addiction.

Take alcohol out of the picture, some experts say, and a large chunk of the country's health-care crisis would simply disappear. National studies have estimated that 20 percent to 40 percent of all patients admitted to general hospitals are there because of alcohol-related problems.

At Maine hospitals, the number of discharges for alcohol abuse and dependence increased by 19 percent from 1991 to 1995, according to hospital discharge data. The estimated cost of treating those problems increased by 50 percent, from $5.4 million in 1991 to $8.1 million in 1995.

But those figures don't even begin to tell the whole story.

''To abuse alcohol is to really sort of set yourself up as a disease tar baby,'' said Dr. Erik Steele of the emergency department at Eastern Maine Medical Center in Bangor. ''It all sticks to you.''

Alcohol abuse is frequently the hidden cause of dozens of medical problems, from gastrointestinal problems and blood disorders to heart disease and cancer. But its link to those illnesses often can be left undiagnosed or underreported.

In 1995, 94 percent of the people entering Maine's alcohol addiction treatment system said they had been treated at least once in a doctor's office during the previous 12 months. Thirty-six percent said they had been taken at least once to a hospital emergency room.

One of those people was Kady Kilpatrick.

More than 40 percent of adults in this country have had some kind of close brush with alcoholism or problem drinking. Kilpatrick, 46, was born into it.

She is the daughter of a woman who married seven times and had five children. Two girls were adopted, another was raised by an aunt. Kady and an older sister stayed with her mother and father, and stepfathers.

So many different environments, but one common denominator: They all, Kilpatrick says, ended up with an addiction of one kind or another.

Kilpatrick didn't like drinking in high school. But the roots of alcohol were buried deep in her genes and her childhood. Inside, where she buried agonizing memories of abuse, she burned like a slow fuse.

She started drinking regularly in her mid-20s, for the same reasons most people do, if they are honest. She drank to cope. To celebrate. To relax. To escape.

Slender and skittish, Kilpatrick freely admits she is by nature a person who ''makes getaways'' from life. During her 20s and 30s, she lived all over the West, jumping from Montana to Nevada to California and back again, always looking for a fresh start.

Over the years, that desire to escape nudged her drinking closer to the blurred line that separates normal from need.

Then chemistry took over.

It was in Reno, when she was 29, that things took a bad turn. It was the beginning of the '80s, when binging on cocaine was blossoming into a national pastime. Kilpatrick, working as a bartender, moved in the right circles and got introduced to the drug.

''And I just skidded,'' she says. ''It was amazing how fast.''

Snorting coke made her ''way, way, way too shaky and hyper,'' so she drank to calm herself down.

''What's your poison?'' goes the old bartender quip.

For Kilpatrick, the answer was: ''One of everything.''

Staff art. Sources: "Alcoholism and Potential Health Care Cost Saving," Medical Care, 1987; "The Utilization of Medical Care by Treated Alcoholics," Journal of Substance Abuse Treatment, 1991

As her drinking problem escalated, so did her body's protests.

One of the reasons alcoholism is so hard to diagnose in its early stages is that the first changes that occur in the body are changes in thoughts and feelings, not physical symptoms.

But drink long enough, and the physical ailments start to appear.

Alcohol is so irritating to the lining of the stomach that doctors can peer down through a scope and see nothing but a field of red. Gastritis, which causes stomach pain, nausea, vomiting and bleeding - along with other gastrointestinal problems - is often one of the first physical consequences of prolonged alcohol abuse.

As people drink more, they eat less, or at least eat poorly. Some alcoholics get as many as half of their daily calories from alcohol, and they develop vitamin deficiencies. Like many heavy drinkers, Kady Kilpatrick let her diet slide. She lost weight and developed reflux esophagitis - damage to the esophagus resulting from a backwash of acid from the stomach - that required medication.

She also may have been damaging her liver, though it's difficult to predict who will develop serious liver problems and when.

Loss of liver function, along with decreased production of platelets in the bone marrow and impaired function of platelets, can cause clotting problems.

Kilpatrick developed problems with her platelets and found she began bleeding more than usual, even with minor injuries. She also bruised so easily that when she took a trip to Martinique, she wouldn't let anyone near her. Just a simple touch could give her black-and-blue marks, and she wanted to look good in a bathing suit.

Eventually Kilpatrick made her way from Reno back to Montana, where cocaine was harder to get, and had to start dealing it to support her habit. She also got married, to a man who didn't drink at all.

She went into her first rehab at 32. Once she sobered up, she realized it probably wasn't a good idea to pick a lifetime mate while under the influence of alcohol and cocaine, so she got a divorce.

After rehab, Kilpatrick didn't drink for a whole year. She worked three jobs and did some catering, all of which left no time for Alcoholics Anonymous meetings.

Then she decided to open a restaurant in Missoula with a partner. The restaurant, located next door to a flower shop, was called City Food, and Kilpatrick recalls it as a ''beautiful'' place.

But it was also stressful, especially coming on the heels of a divorce, ''and I was just plain scared,'' she remembers.

Overwhelmed, she followed her old pattern and walked away from the restaurant.

She began drinking again, and by the time she was 35 it was a major problem. She met a guy in Helena and got a job cooking ''at this really terrible place,'' but got fired because she showed up drunk one too many times.

Next, she tried going back to college. Much to her surprise, she thrived academically, maintaining a 3.9 average even though ''I would be just blotto sometimes in class.''

She got her first OUI when police stopped her for driving too slow, a common symptom of drunken driving. But even they couldn't believe it when they saw that her blood-alcohol level was 0.37 percent. She was still articulate, walking around without stumbling.

That's not unusual for someone who has been abusing alcohol for a long time and has built up a tolerance.

''I've seen them come in with alcohol levels of 0.60 and ask me for a ham sandwich and something to drink,'' says Dr. Anthony Tomassoni, an emergency room physician at Maine Medical Center and director of the Maine Poison Center. ''And they're very conscious, but there's just that little bit of them that's semifunctional. They can't really walk, they can't really see very well.''

The police were so incredulous when they saw Kilpatrick's blood-alcohol level that they tested her three times, just to be sure.

The judge was appalled, said he'd never sentenced a woman with a blood-alcohol test that high. So he took her license away for six months and sent her to jail for four days. In her cell, she started going through withdrawal and had to be tended to by a doctor.

When Kilpatrick got out of jail, she went through intensive outpatient treatment. This time, sobriety stuck around for a few months.

Kilpatrick was 39 and going to school in Bozeman when she had her first pancreatic attack. She had no idea what was happening, only that she was experiencing the worst pain she could ever imagine.

''The doctors said that night that they didn't know if I would make it until morning because it was so severe,'' she says. ''The pain was excruciating.''

The pancreas produces powerful digestive enzymes that help the body absorb fats, carbohydrates and proteins from food. But drink too much alcohol, and those enzymes turn traitorous. They leak into the pancreas itself, and the organ starts digesting itself.

The pain is so unbearable that just one attack is enough to make most people think twice about pouring that next shot of vodka.

But not Kady Kilpatrick.

Inevitably, she would start drinking again and end up back in the hospital. She did that 15 times over a period of five years. Each hospital visit made her feel ashamed because it was like admitting outright to the doctors that she hadn't been able to stop. But she liked the feeling of being taken care of, even if by strangers.

She estimates that each hospital stay, about two weeks each, cost an average of $10,000. And she had no health insurance.

During the first week she couldn't even drink water. She was allowed only to eat ice chips, and she was hooked up to IVs for nourishment and pain relief.

The second week, she graduated to Jell-O.

Staff art. Source: Maine Bureau of Health. Only Androscoggin's rates were significantly different from the national rate of 2.9 (1992) and the overall Maine rate for the period of 2.8. Unless noted, differences in rates are not statistically significant, i.e. they could be accounted for by chance alone.

That first bout with pancreatitis put the fear of God into Kilpatrick. For a while, remembering the pain, she managed to fight the temptation to drink. She really believed what the doctors had told her before she left the hospital - that if she continued to drink, she would surely die.

But then, one day, she took a sip of something. Then she let herself have a whole drink. And she couldn't stop.

Weary and scared at the same time, Kilpatrick started visualizing her impulse to drink as a monster that lived inside her.

Recently, she wrote to a friend and described her ''commandments of the drinking life'' during that period.

FIRST COMMANDMENT: drink drink drink all evening drink drink till I passed out drink when my body woke me four hours needing some more drink in the morning to neutralize the hangover but drink, drink, drink past the hair of the dog right to his rear-end drink some more cause I hate myself for being so weak to drink.

SECOND COMMANDMENT: Kill thy rancid and ruined self.

Five times during her battle with alcohol, Kilpatrick has tried to surrender by ending her life. Some attempts to stop the pain were more halfhearted than others, what doctors coolly term ''suicidal gestures.''

The one that almost killed her happened in Berkeley, Calif., when she overdosed on a quart of vodka, 30 Percodan pills and 300 milligrams of Valium. Her stomach was pumped and filled with charcoal that turned her stool black.

Doctors hooked her up to a ventilator ''because I was pretty much dead,'' she says. ''I was in a coma for three days.''

Kilpatrick was committed to a psychiatric wing for two weeks against her will ''and then,'' she says scornfully, ''they sent me a bill.'' What nerve, her eyes flash in chorus.

But her insurance wouldn't pay, and she had no money.

''When I got out of the hospital, I had all these people I was supposed to be in touch with - psychiatrists and psychologists and la-dee-dah,'' she says. ''And within 40 minutes of being released under a friend's care - he dropped me off because he thought I was just fine - I immmediately had a triple Stoli screwdriver under my care. (The bar) was right across the street, and it was like I was on automatic pilot.''

She plunged right back into the drinking life, and she continued to do things to hurt herself. Terrible things.

She burned herself and cut her wrists and arms. She scraped her cheek with a brick until it was raw and bleeding; when people asked about it she told them she had been mugged.

''When I saw it I was just horrified, and so I did it again,'' she says. ''It was just nuts. I think it's probably difficult for a lot of people to understand.''

Kilpatrick's tales of depression and suicidal tendencies, fueled by alcohol, are old news to people who work in emergency rooms.

''We perform the social biopsy of the community, and we are always amazed at the creativity of human beings to engage in new, different and varied forms of self-destructive behavior,'' says Dr. Norm Dinerman, chief of emergency medicine services at Eastern Maine Medical Center in Bangor.

Most of the people who come to Maine Medical Center's emergency room in Portland who are obviously drunk are ''mentally upset,'' says Dr. George L. Higgins III, chief of the department of emergency medicine. They're suicidal, aggressive or exhibiting psychotic behavior.

''The police will drop off a couple of thousand patients a year to us in that situation,'' Higgins says. ''They get into the system often because they're depressed or they feel hopeless when they're intoxicated. They don't necessarily have a mental disorder. Their problem is alcoholism.''

Others exhibit sociopathic behavior when they get too many drinks under their belt. They show up after the bars close, when they get into fights.

''They've been thrown around, they've been punched, they've been kicked,'' Higgins says.

Her use of alcohol ravaged her body and led Kady Kilpatrick directly to the hospital emergency room. By her own estimates, Kilpatrick says her drinking has cost the nation's health-care system in the neighborhood of $100,000.Staff photo by David A. Rodgers

After she got out of the hospital, Kady Kilpatrick thought about returning to Montana but decided against it. She's not sure exactly what it was that made her think of coming to Portland on that April day. Her mind wasn't at all clear. Maybe it was the long-ago, casual invitation of friends who said ''come and visit'' that was bouncing around in the back of her head.

Whatever it was, she found herself on a Greyhound bus one day, headed east.

She was drunk when she got on the bus, and in the four days it took her to get to Portland, she ate nothing and drank five liters of vodka.

Her friends were shocked when they saw her skeletal form, 30 pounds underweight. One of them, a doctor at Maine Medical Center, insisted she go to the hospital not only because of her pancreatitis ''but also because I hadn't eaten . . .'' She pauses, remembering. ''. . . in a long time.'' She sighs as she says the words, sounding tired.

Within two days of her arrival in Portland, she was in Maine Medical Center, where she stayed for 10 days. Then she transferred into the Recovery Center program at Mercy Hospital.

This time, something clicked inside. She even remembers the moment it happened.

About two months after leaving Mercy, she had an episode of post-traumatic stress disorder, a result of the abuse in her childhood, and ''freaked out.''

She was staying in a house that had alcohol in it. She thought about the movies and how, after some traumatic episode, some great drama, one character will say to another, ''You need a drink.''

She stood up from the sofa. She thought, ''This is where they would offer me a drink.''

She looked at the cupboard where the liquor was kept and visualized walking over to it and opening the door.

''And it was almost like I got hit by a freight train,'' she recalls. ''It just suddenly dawned on me that, no, I could drink like any other person would, but they wouldn't be setting themselves up for the next time they can drink. And the time after that, and the time after that. If you allow yourself a reason to drink, it just comes crashing down.''

That was 2 1/2 years ago.

Staff art

Kilpatrick now volunteers at Mercy Hospital's Recovery Center, working with other alcohol addicts, because she believes that people in recovery have a responsibility to help other lost souls find their way.

''They don't know if they can spend the rest of their lives without a drink,'' she says. ''They don't know what they're going to do with themselves. I'm here to say there's lots you can do with yourself.''

She also knows that if someone else cares, it's a little bit easier to care for yourself.

In addition to her work at the Recovery Center, Kilpatrick has been involved in a workshop on child abuse at the Family Crisis Center. In her spare time, she bakes cookies and makes jewelry and other crafts, and she's looking for a boyfriend.

She's also preparing to go back to work, at least part time.

Kilpatrick has been on disability for the two years that she's lived in Maine. In January, a new federal law cut off many substance abusers' monthly Supplemental Security Income checks. Supporters of the law claimed that some alcohol and drug addicts were using the money to buy liquor and drugs, and said that the government shouldn't be subsidizing their habits.

Staff art

''It really is, in my opinion, discrimination against people with addiction, saying that it's not a legitimate illness,'' says Dr. Scott Treworgy, medical director of the chemical dependency unit at St. Mary's Regional Medical Center in Lewiston. ''But it's a serious illness that's affecting large amounts of people in our country. If they don't get treatment, they're not going to stop the addiction, they're just going to break the law, steal, prostitute themselves and things like that to get the drug, whether it's alcohol, cocaine or heroin.''

Kilpatrick was able to remain on the government rolls because she's been diagnosed with two other serious, disabling illnesses: post-traumatic stress syndrome and dissociative personality disorder, both associated with the abuse from her childhood.

She says the disability checks, though technically not for her drinking problem, have allowed her to devote herself completely to staying sober. Every day she goes without a drink is like money in the bank, and now she feels her spiritual nest egg is large enough to support her entry into the work force again.

''I'm afraid because I've tried so many times to work and be normal,'' she says. ''I always start out really well, but I always just fall apart.''

Staff art

Although alcohol no longer plays a direct role in Kilpatrick's daily life, in a way it will always be with her because of what it has done to her body.

Since she stopped drinking, she doesn't have pancreatitis attacks anymore. But all those shots of Stoli messed up her pancreas so badly she's now diabetic. She controls her fluctuating blood sugar by watching her diet, but her doctor has told her she will probably have to go on insulin one day.

She takes Pepcid to calm her ruined stomach and Prozac to ease her depression. She's also on medication for fibromyalgia, a neurological condition unrelated to her alcoholism.

Her prescriptions alone run about $500 a month.

She estimates her medical bills in Maine have totaled $15,000. Medicaid paid most of her last hospital bill here, but she's still getting collection notices for the rest, and for the trail of unpaid bills she left scattered across the country as she searched for her salvation.

She hasn't saved all her bills, but she figures that her drinking has cost the nation's health-care system somewhere in the neighborhood of $100,000.

She's ''hopefully confident'' she won't fall into her old patterns again, ''but I also know that just the desire to stay sober isn't what's going to keep me sober. I have to work at it.''

But along with the struggle, there is pleasure in each day.

Shedding her coat of self-destructiveness has been something like returning to childhood - a happy one, that is. So many experiences are brand new.

In learning how to be her new self, she's discovered that happiness ''isn't like a state that you drive into and you'll be in Happyland.'' It's something that swells up from the rhythm of a day-to-day life lived sober. It sneaks up and surprises you.

This is what she wants five, 10, 20 years down the road: still to be looking at life through the eyes of a child, still to be surprised by happiness, ''still growing and experiencing that delight.''