Meet the team
Some of the people involved in making the documentary share their experiences of treating people with alcohol addiction.
Professor John O’Grady, Consultant Hepatologist
Professor O’Grady trained as a doctor in his native Ireland, before joining King’s as a hepatologist (liver doctor) in 1984. Around a third of the patients he treats have liver disease due to alcohol consumption. This can range from those who drink too much as part of their social life, to those who have a severe dependency.
“I see patients at both ends of the scale,” explains Professor O’Grady, “those that drink too much but still maintain order and structure in their lives, and those who are completely dependent, whose whole lives are chaotic and revolve around alcohol. It’s not always obvious, either – plenty of patients I’ve seen still have jobs and families and it’s not apparent they are struggling with alcohol issues.”
The biggest change Professor O’Grady has noticed during his time at King’s is in the demographic of his patients. “I see many more women now than I did 20 or 30 years ago,” he says. “A few glasses of wine every evening can do more damage than people realise, and liver disease doesn’t usually display symptoms until it’s quite advanced. There are stereotypes about people with alcohol addiction, but it can affect almost any type of person.”
Dr Debbie Shawcross, Clinical Senior Lecturer and Honorary Consultant in Hepatology
Dr Shawcross has worked at King’s since 2007 as an Honorary Consultant in our Liver department, as well as undertaking lecture programmes and research with our Institute of Liver Studies. She treats a large number of patients with advanced liver disease.
“Most patients with liver disease don’t have symptoms until something such as an infection puts extra pressure on their liver,” she says. “Blood tests can even come back normal when the liver is actually damaged.”
Too much alcohol can be very damaging to the liver, as Dr Shawcross explains:
“Excess alcohol first makes the liver become very fatty, which causes inflammation, and scar tissue develops. Depending on a number of factors, this could happen over one year, or it could take 20, and once scar tissue has developed, the damage is irreversible. Severe scar tissue formation is known as cirrhosis.
“Patients with liver cirrhosis can experience a wide range of symptoms, such as very itchy skin, jaundice (yellowing of the skin and whites of the eyes), bruising or bleeding more easily, and swelling in the abdomen, legs or feet. They may also notice personality changes, sleeping problems, memory loss and confusion – this is when toxins usually removed by the liver start to affect the brain.”
Dr Shawcross find her job especially rewarding when patients are able to reverse the damage to their livers:
“When patients are able to stop drinking and lead normal lives again as a result of our treatment and intervention, that’s what makes my job worthwhile. As part of my research, I am also looking for ways we may be able to extend the lives of patients with advanced liver disease.”
Dr Fleur Cantle, Emergency Department Consultant
Dr Fleur Cantle has worked in the King’s Emergency Department for five years. During her shifts, Fleur sees a number of patients who attend with injuries or illnesses in which alcohol has played a part.
“If a patient is clearly under the influence of alcohol, it can be harder to diagnose any injuries they have,” she explains. “We have to be very cautious and plan their care more carefully, as alcohol can mask what is really wrong with someone. If they have a suspected head injury, we have to scan them and check – but if they attend frequently, this may happen every time, which isn’t good for them.”
It’s also difficult for Emergency Department staff like Fleur to engage with patients who have been drinking. “It can be quite chaotic when you’re dealing with a patient who is under the influence,” she says. “Most of the time they’re very reluctant to be in hospital, so just getting them to stay and have treatment is sometimes the hardest part. They can be abusive too, which is difficult to manage in an already busy department. Of course, patients who have been drinking need help like everyone else – but it can put pressure on additional resources like extra nursing and security.”
“It’s quite frustrating that we aren’t able to do more to help – many patients with alcohol issues need social and emotional help as well as physical, and it can be more challenging to provide this in the Emergency Department. That’s where other teams at King’s – as well as community organisations – can help.”
Ian Webzell, Alcohol and Substance Misuse Clinical Nurse Specialist
Ian has been at King’s since 2007, and works with patients who have liver disease and alcohol or drug problems. He provides patients with psychological and emotional support, as well as clinical treatment.
Ian sees patients according to their individual needs and can provide a range of treatment options for his patients, including assessments, counselling and medication, as well as referrals to other departments within King’s, and community addiction services.
“I see most of my patients for three months or less, but this depends completely on their need,” says Ian. “I have plenty of long-term patients who I’ve been seeing for years in my outpatient clinic.”
The treatment Ian provides also varies hugely from patient to patient. “The people I treat are from all walks of life, and some may have issues with drugs as well as alcohol – as such, there isn’t a ‘one size fits all’ treatment,” Ian explains. “Sometimes, it can be helpful to identify where they can make helpful changes to their lifestyle to give them a better chance of staying off alcohol. In other cases, patients need medication, or they benefit from attending local groups such as Alcoholics Anonymous.”
“What I really like about my job is that each consultation is an opportunity for someone to make changes and to consider what is really important to them.”
Tom Barrow, BBC Producer/Director, and Grace Hughes-Hallett, BBC Assistant Producer
Tom and Grace were part of the Drinking to Oblivion production team. Here they explain why they chose to film at King's and how they approached working with alcohol-dependent patients.
“King’s world-renowned liver unit was what initially led us to approach the Trust, but once we'd met the press office and the clinical teams, we were sure that this would be the place to make it. We knew at the start that this documentary would be hard to make, so it was very important to us that the hospital was as enthusiastic as we were about the subject matter.
“Before we started filming, we spent over a month at King’s meeting staff, inpatients and outpatients. In a hospital of King’s size, it takes a long time for people from outside the organisation to learn how things work – especially as alcohol-dependent patients can be treated in a range of wards and departments, so we needed to be clear who we might be working with, and for the staff to know who we were.
"We are very serious about informed consent with all our contributors, especially when it involves filming people at some of their most vulnerable moments, so we had lengthy conversations with every patient we filmed with beforehand, to make sure they knew exactly what they were involved with. We filmed with some of the patients over a long period of time, and consent was an ongoing process, so the option to stop filming was always there if they decided to take it.
“While we were there for some low points in our contributor's lives, we also had a lot of laughs together and got to know each other pretty well over the course of six months of filming. We care deeply about our contributors' health and happiness, and we are still in touch with all of them.
“We also worked with the King’s press office, who were integral to making the programme. They went above and beyond to introduce us to all the medical teams, and were also key in opening doors to filming opportunities across the Trust, and providing guidance around what was and wasn't appropriate to film – not an easy decision.
“We don't underestimate how much trust it takes to let a TV crew through the doors of a hospital and into your wards and clinics, so we are grateful to King's for putting that trust in us, on top of the very important jobs staff at the hospital already have to do.”