CONTENTMENT

 

As I sat down to lead a meeting at the detox unit of the rehab hospital that I volunteer at, I said hello to the people filing into the room - faces dulled by draining drugs and alcohol, fatigue pulling at their limbs but faint hope in the resisting smiles at the corners of their mouths. I had seen these looks before, and one or two of them I had actually seen before, one in a previous incarnation when he had come to the unit about six months ago.

 

To the other man I offered a hearty "hello, how are you doing, I hadn't expected to see you here". To which he replied, " no, you really don't know me".

 

I was a bit nonplussed since I was sure that he was a member of one of my men's groups but I assumed he was claiming the right of anonymity and I was not going to pursue it if he wanted to remain innominate. He had his reasons.

 

When I lead a meeting among people in early recovery it is difficult to determine where to begin. Do I tell my story? Do I tell someone else's? Should I talk about AA, its history or should I discuss what I think AA has done for me and how I believe it helped me stay sober?

 

I never know and at various times I have discussed all of the above but I have recently settled into a routine of talking about the latter, particularly about how AA has taught me spirituality and how that concept is talked around, in and out but never directly about in the rooms.

 

In fact, there is one page in the Appendix of the Big Book that talks about it and it is a pretty confusing bit of verbiage, and as I have found it so wanting, I have taken it upon myself to use it, at least upon these occasions, as a stepping off point; I use its impenetrable density as a contrast to more accessible demonstrations of concepts of spirituality that have helped me to take a grasp at this ineffable subject.

 

Part of the discussion is to learn how people have used AA in their lives prior to coming to the rehab hospital (if indeed they have ever attended it) and to find out why they wound up returning to use drugs and alcohol, if they had had a program to begin with. And in fact, most people who had a program almost to a one will say that while they continued in AA with a regular attendance they had no trouble staying away from drinking and drugging.

 

And almost to a man, (person), their failures were the result of situational anxieties pressuring them to ignore their program and as their attendance dropped and reliance upon sharing their burdens with other people in the program waned, they would start to entertain the notion that drinking might not be such a bad idea, or at least not do as much harm as the dire warnings had been made.

 

And the problem is that the first drink or two or twenty or hundred might not have been disastrous but the cruel reality is that invariably they could not tell the point at which they could not stop drinking after that first or second or twelfth drink. And they would wonder, "When did that happen?"

 

The fellow who I thought I recognized spoke up and said that he had been sober and drug free for twenty-one years. He went to meetings for a long time. He stayed with the program. He was solid. Then about eight months ago he decided that he might try the drug of his choice (he did not say what that was).

 

"How did that feel?", I asked.

 

"I felt like my old self again, and that was a good feeling." he said. The siren song had begun.  And Ted, (I'll call him Ted), said that was the good and the bad of it all. The good because it made him feel like he was "whole" again; and bad because he had not realized that that wholeness that he felt was chimerical, the pipe dream of an age long gone when his acting success had not reached its peak and he had time to puff mystical dreams up in smoke.

 

(And yes, that is why I had recognized him, not realizing that because I had only recently seen him on the screen was why he was so familiar. He looked like any other common drunk in my AA meeting, hence my hail fellow well met greeting.)

 

We get too comfortable in our daily lives. Those lives, even the ones that have remarkable variety to them, are marked by typical quotidian habits and if we do not practice daily exercises in sobriety we get lazy and our sober and spiritual muscles get flabby.

 

So when I wind up introducing the subject of spirituality to newly sobering alcoholics and drug addicts, it is not such a foreign idea to a good quarter of the population who are "return engagements", those who have been sober but who have somehow, somewhere gotten off the sober path and gotten lost. And the topic is just a reminder of where they had been and a tap on the shoulder as to which direction in which they need to be pointed.

 

For those who are new to the program, introducing the concept of spirituality is important because it needs to be distinguished from religion. I readily acknowledge that I have a very poor understanding of a religious understanding of God as a higher power but I do consider that I have a spiritual higher power in the fellowship of AA. I use it every day to stay sober, I speak to other drunks daily and I help other alcoholics and drug addicts both in the rooms and in my practice as a physician.

 

I have found, finally, that my medical calling has required me to incorporate people in recovery into my primary care practice.  And I find it more rewarding than ever. I have finally found my niche in medicine and as a result have become quite content.

 

© res 6/19/2013

   rev:  9/1/2013

 

 

 

THIS THING CALLED SOBRIETY

THIS THING CALLED SOBRIETY

 

There was a palpable melancholy in the room when we noticed the empty chair, day after day, a void that seemed all the more regrettable since our company knew the risk. And the vacancy was all the more obvious yesterday that it spurred an hour's discussion on the evils of drug and alcohol addiction and how their siren  song is so tempting that we have to be on guard against it rearing its ugly head in our most unguarded moments.

It was Ralph who was absent and we should have known how likely this was to happen. He told us how frightened he was of this occurring. So agitated was he that he postponed needed hip surgery for years. And this forced inactivity caused him to gain so much weight over the years thus worsening the degradation of the hip.

Finally he consented to the hip replacement because the pain was so great that he had been reduced to a supervisory role, one which he loathed since he prided himself as builder of the first order.

So after the surgery proved a success and his rehabilitation proceeded without any major stumbling blocks, it seemed as if his prolonged consternation and reluctance was a phantom anxiety, more a matter of a mental fear than a reality.  But we were wrong and some saw the turn of the screw when they thought they noticed him slurring his speech when he finally returned to the rooms.  But Ralph denied the accusation maintaining that his sobriety had remained intact.

But yesterday after an absence of a week, the discussion in our "Living Sober" meeting turned to that empty chair and to Ralph's  sad absence. And, coincidentally, Manny's vacant seat too, a man who continued to struggle with his sobriety despite all the daily support that got from the men in the room.

Sentiments of worry about whether Ralph would find his way back to the meetings, whether we were at fault because we did not take his anxiety as seriously as it apparently was. And I, particularly, felt as if I had let Ralph down when I visited him shortly after his transfer to the rehab facility where he was learning how to walk again.

As Ralph and I talked, it was clear that he was frightened about his ability to get off the opiates that he was prescribed and as a result he held back on the pain medication so that his rehabilitation was more painful than it needed to be. And my advice to him was that he should take as much pain medication as prescribed so that his pain would not intrude upon his rapid recovery.

I mentioned that one of the problems with opiate addicts was their sense of heightened pain and that they were less sensitive to opiate analgesics than the normal population thus requiring greater doses than the typical patient. That if he under dosed himself he would get none of the benefits of the medication and all of the dependency problems both psychologic and physical. For if he did not take away the pain, all he would get were the stimulative effects of the drug without getting analgesic benefit. He would remember nothing but the fact that he would need more and more of the drug in order to gain the benefit. Psychologically this would be a set up for readdiction. But if he took the medication as indicated, much of the psychological component would be quashed and he could more consciously resist the drug's addictive properties when the time came for him to wean himself off of the medication.

As I explained this to him, he appeared to be relieved. Relieved of the necessity for vigilance, and finally getting permission to take the medication that he needed.  Whether he followed my suggestions is difficult to say given the outcome.

So I blamed myself, and I said so to the group.  But Max pointed out that as addicts and alcoholics, we must take responsibility for our own recovery. None of us can assume the role of mentor without a certain sense of powerlessness. That is, we are as powerless over the addict in getting him to stay sober as anyone of our families were for us in our own recoveries.  We had to take our recovery seriously.

The fact that this is a disease is no excuse for not putting in the mental energy to actually fight it.  The disease may drain us of willpower and the fact that AA says that willpower alone will not avail us any capacity to recover, is no reason not to try. We cannot stand aside and just say that this is a disease and therefore we play no part in our own recovery. That is patently false, for the treatment of this chronic disease as well as all chronic diseases.

We have to play our part, otherwise we would feel justified in blaming our lack of control over our diabetes on the treating physician.  And if we do not curb our appetite for fats and sugars we equally are undermining our treatment of our heart disease and hypertension.

Where does this lead the recently relapsed? Well, there are many options, but despair seems to lead some to the most radical choices. They go out never to return to the rooms and ultimately expire from the disease or, in the depths of their depression, choose to end their lives.

But how do we reconcile this, that a man who has lead a blessed existence after becoming sober can find himself only with two solutions, when neither to live or die seems like a reasonable choice. That choice being that if he lives he ultimately dies an addict or alcoholic, or taking the unreasonable choice of taking his own life.

After all, we are looking at someone who might find a permanent solution to a temporary problem. If he will only find that "other solution" to return to the rooms where he is missed so much.

So this morning Ralph returned with his head down, abashed at his behavior but with the possibility of personal salvation.  However, he was greeted with backslaps and handshakes and even a hug or two.  We delighted in seeing him. So many of us had worried that we would not see this day.

During the past four years, he used to credit his recovery to the look of love and appreciation on his children's faces. And while he was detoxing this time they visited him and in that moment he gained the strength to return to the rooms and start all over again.

He knew we all loved him and wanted for him to succeed. He saw how his children still needed him. And when he came back he said that he was sorry that his behavior  had so disappointed the men in the room.

But he had to acknowledge that it was the love he found in the rooms that finally gave him the courage to return and make another go at this thing called sobriety.

 

© res 3/14/2013

THE SURPRISE OF DEATH

 

When death comes it is always a surprise to us. Even when we are expecting it, when it is impending, it seems to catch us unawares. We think that he or she is so young, even as we are waiting for the curtain to fall for people for whom we know death is near, our minds reject death as a reality. He or she is too young to die and we resist the knowledge of approaching mortality.

Last week, hearing of D.'s death, whom I did not know, was an astonishing bit of news. Jack was relating that he and D. were having a cup of coffee together just on the Friday before his suicide, and they were discussing the fact that neither had been attending to their meetings quite as regularly as they should have. And they agreed that doing a ninety and ninety was the remedy for the creeping chaos in their lives and so they committed themselves to the task.

And then D. killed himself and Jack asked what this was all about. Why did he get to live and D. decide suddenly that life was not worth living? Had D. not had a gun, would the outcome have been less dire?

I suspect that when we are very depressed we all have tendencies to think about suicide at the point when we feel most useless and cannot see a way out. But a gun is so final that its ready availability makes its employment an instrument of remedy that permits no retreat.

The week before D.'s suicide I was speaking to a patient at the rehab facility where I volunteer. She had been addicted to narcotics and in her despair and desperation with the direction of her life, she took an overdose.  She was awakened in the emergency room when the doctors gave her a medication to bring her back from the overdose. Her first words upon awakening were "I don't want to die, help me!"

With a gun around, there is no moment of reprieve. We just die without the chance to come to our senses to ask, to plead for another chance.

Then there are those of us for whom death is an expected outcome. And leaving aside the idea that life itself is a death sentence, some of us get there sooner than others. Those who have terminal illnesses would like reprieves. With death knocking upon our door post, we have had the time to consider where we might have changed what we did with our lives and how we might have done that.

Regrets come all too easily.

There are a few who, having faced death, realize that although there is much that they could have done, they are nonetheless satisfied with what they have accomplished. And I have heard that story over and over again from friends who had relatives and sponsors and colleagues in the AA program who, having righted the course of a life gone so wrong, accept the coming of the end with equanimity.

The act of sobriety is sometimes accomplishment enough to feel that one has lived a complete and satisfying life. The alternative, which is to use impending mortality as an excuse to "go out", is an insufficient option. It serves no purpose other than to make one oblivious to everything around you and to withdraw, once again, from the society of human beings.

But for those left behind, there is a loss. Whatever the expectations of the dying and dead, in the end they knew what was happening and perhaps had a personal knowledge of where they were going. For the mourners, it is most often an incomprehensible finality because we feel that we have been left behind.

I have fantasies as to where these "souls" go after death. I even fantasize about my death and wonder at the pity of not being with my loved ones anymore, never to be able to sit down to a nice chat with friends, nevermore to be able to embrace a loved daughter and wife.

It seems, such a waste.

But how much more of a waste to have built a lifetime of trust in one's recovery to end it all in a blaze of drunken "glory".  All of the trust that we have squirreled away in getting sober will be lost and that memory of our battles with the grape, and thus  our legacy of sobriety, will have been squandered.

In the end, it is only the memory of that legacy that we can take with us so that we can die with a dignity of a life lived well.

© res 3/3/2013

THE REALITY OF SOBRIETY

A cold and dank morning and getting up in this weather usually provokes a few twinges of regret about having to pull myself together to get to a meeting. With weather like this I wonder about the necessity of attending my daily sorties to the rooms because my lazier self would prefer that I just stay in bed at let the warmth envelope me until I return to sleep.

But whatever the urgency was that nudged me out of bed, into the shower and then impelled me through the door of my house to my daily 7:30 AM meeting, I felt that if I missed today's assembly I would feel sorry and empty for the remainder of the day. 

However, my typical feelings of welcome came over me as I entered the hall where more than thirty five alcoholics had gathered to enjoy each other's company. There is something warming, welcoming and exciting in coming to a meeting each day to a space that Ray Oldenburg calls a great "Third Place" which he describes as "neutral ground [that] provides the place, and leveling sets the stage for the cardinal and sustaining activity of third places everywhere. That activity is conversation."   (p. 26, The Great Good place (Third Places) by Ray Oldenburg.)

Conversation is the main activity in the rooms of AA and they are often held in community places, in this case the "Servery" of our local Episcopal Church.

Today's reading spoke about the "reality of sobriety", a phrase that struck me as particularly germane to my feeling about today and apposite to the events that happened to some members over the past several days. For over the weekend one of our members took his own life.  He took a gun and just shot himself!

How does that happen? Especially when one of our other members said that a few days before the two of them were musing over the uses and misuses of split infinitives! How indeed?

More than twenty years sober and despite how well some members knew him, they just were not up to speed on his most dire despondencies, dejection and desolation. How could we have known or helped?

No one knew the answer because no one knew whether he was sober or just so depressed that just sobriety was not enough. Because we do know that staying sober, doing the program is sometimes insufficient for those of us suffering from deep and untreated depression.

The reality of sobriety is that we cannot take for granted our lives. They need nourishment from sources beyond the satisfaction of not taking a drink today. The reality of sobriety is that we must attend to all of the environmental impingement upon our psyches; when that lays unattended for too long, much of the detritus of our lives can return to strike us as we wallow in a sea of despair.

The reality of sobriety made some of us thankful to be able to come to a meeting like this and share our amazement and disbelief at such an irretrievable act. And to be grateful that we are able to apportion our sorrow among other like minded individuals.  We mourn together, and with men, this is often not something that we usually permit ourselves to do in such a public place.

Nevertheless, we have learned, through bitter experience, that not sharing these feelings can lead to no good end. Here was our venue today to partake in distributing our collective grief.

Upon hearing that phrase, "reality of experience," I thought about a meeting yesterday that I had with a physician who had asked me to work in his office. His curiosity about my situation, the sanctions upon my license and the concurrent requirement by the state Department of Health to continually check up on my sobriety by regular drug and alcohol testing, made him query me about what I had done to deserve such a fate.

When I told him that the deterioration of my family life led me to volunteer for help in the professional medical society's physician's health plan, he was stunned that I should "turn myself in" to a  sanctioning regulatory authority. "Why would you do that to yourself? Surely you did not drink on the job. That would not be right, that's what I would call a doctor who had a problem with alcohol".

All I could answer was that indeed I had "turned myself in" but for the purpose of finding help. And maybe I hadn't considered the severity of the sanctions that would be laid upon me and my ability to practice but I acknowledged that I knowingly flouted my alcoholism even though I was well aware of the restraints upon me (I referred to the weekly drug and alcohol testing). If I could not remain "sober" in the face of all of that, regardless of whether I drank on the job or not, how could my sobriety be counted upon at any particular time?

"I have given up my right to drink", I said, "and I proved that to myself time and time again. I know now that if I have one drink, all bets are off for me to stop just there. Most likely I would follow that by three or five more drinks. Then where is that sobriety?"

"I don't know that I could give up my nightly whiskey," he said. "But, I countered, you could stop at that one drink?" Which he readily admitted was the case. "I cannot", I reminded him. And with that some recognition of the depth of the problem became evident.

Somehow, the discussion of the "reality of sobriety" moved to the sometimes equally difficult problem of trying to not get addicted to medication that our physicians, chiefly psychiatrists, prescribe in order to treat co-morbid conditions of bipolar disease, anxiety and depression. Many of us have found ourselves addicted to the class of drugs called benzodiazepines. Those were drugs which we felt, (early in my medical career), to be non addicting when they originally came out and became popular to prescribe as an alternative to barbiturates.

Little did we realize how devastatingly addictive they were. And Joe was telling us how upon weeks of investigating places that might take him where he could safely go for detoxification, he realized that there were no institutions where his insurance would pay, that would be able to admit him. They just don't do this anymore on an inpatient basis. The only place willing to take him on as a patient was a rehab facility and that was not covered by his insurance and he could not afford the eight weeks and eighty thousand dollars that it would cost him.

Jack admitted that many years ago he also had the same prescribed addiction to benzodiazepines and the only reason he was able to get into that same rehab institution was that his grandfather had been its founder and that he himself was somewhat of a celebrity in that hospital.

And so the discussion jumped about from one topic to another finally lingering on the subject of tobacco dependence. With that my first sponsor admitted that he was really trying to get off of nicotine which he had been sucking up like candy for the past twenty years in one form or another. Most lately he was popping nicotine gum and sucking tablets.

The withdrawal has been brutal which is why he came to today's meeting in order to share the experience and to get support.  A number of the members joined in the discussion to add their experiences in how they stopped smoking or how they used the AA program to achieve this result. Some ventured that doing a 90 and 90 was the best thing to do.  Others suggested other methods but all agreed that the process was long and difficult and harder than stopping alcohol.

Pete recalled that his wife had been after him to stop smoking since their kids were first born about twenty years ago.  He recalls saying in his inimitable way, "I told my wife that I would do it if every time that I had an urge to smoke we would have sex. The next day I found a carton of cigarettes on the kitchen counter. With that kind of encouragement it took me twenty more years to finally stop smoking one day at a time."

It is refreshing to hear how others have tried to deal with these problems. Had I listened to my inner, lazy, irritable morning self, I would have missed this and all of the other stimulating conversation that I find in this, my daily, " great third place".

© res 2/26/2013

THE CURE

THE CURE

She was looking pretty puffy this morning, this 31st of December 2012. And tired. And a bit restless and fidgety. But at least she had gotten herself to the meeting. She had been absent for the past three months and then had, after a few meetings in September, been absent for a month in August. After having been a regular at this meeting  at which we celebrated one year this Christmas in this room, she seemed to disappear from regular attendance.

Today the room  filled up with peripatetic members, some of whom I knew from other meetings and because of the holiday had suddenly become available for this  New Year's eve morning meeting. This was similar to last week for the Christmas Eve day when we were inundated with apprehensive partygoers hoping for a bit of AA fortitude before packing off over the river and through the woods to grandmother's house festivities.

It was gratifying to see how the group had grown and how our presence was useful as a stopgap for those who knew they needed a shot of what we had to give, which was to brush up on beginner's AA principles. So there were several men and women there with a few days of sobriety and then others with several years up to 21 years. A good range.

And then she came in, late, as was her wont, to take her seat, finally after all those months of being gone from this room. And she didn't have to say that she had gone out because it was written all over her swollen features and bloated body. She clearly  had gained some 12-15 pounds and her face had that rounded swollen feature of the worn out alcoholic. Luckily, the color of her skin was still good.

The meeting is for beginners and it follows a structured format. She is used to that format but it I could see her squirming off to the side of my vision, the antsiness of trying to wait until the sharing began being evident from the body language.

Finally, when the organized part of the meeting was over and calls for sharing to begin were made her hand shot up and with barely a moment's hesitation she started in: "I've been away I know, and I know you know, and I suspect you know why. I always was someone who really loved drinking. I liked to drink, I like the atmosphere of drinking the sounds of drinking, the glasses, the everything about drinking.

"But I forgot that I can't stop drinking. I know I should remember those things because I have a daughter, and I always have to stop because of her. That's why I always have to stop. I want to be a sober mom. I don't want her story to be that she had a doped up father and a drunk for a mother.  

"But when I last got sober there was something missing, I don't know, I was just not feeling right. I did not feel good about myself but I did not seek out the help of anyone to see what might be wrong.  So I worked two then three jobs to put those feelings out of my head. And finally when I stopped to consider what might be wrong and I had enough time to think about it, I felt sad and I drank.

"And you all know that when I drank I could not stop. But then DCS started to ask questions to my daughter because she was missing school because she was staying home to make sure that I was OK. 

"And I lost my job...Did I mention that I lost my job? Of course I lost my job! They sent letter after letter which I didn't open because I was afraid they would confront me with my habit. They had been so good to take me back the last time. But this time, of course, they had to let me go.

"So this time I went to an outpatient drug facility where they started treating me for depression and alcoholism. I had always tried to avoid being dual diagnosed in the past. I wanted to be the only "sane" drunk in my family, but guess what, I'm not."

Finally, she appeared exhausted and stopped.

I was happy to hear from her. I was happy that she came because I had wondered where she was, missing her every Monday, waiting to see if at about 7:45 AM she would wander into the meeting, abashed at her tardiness but usually pleased that she was able to get to the meeting saying that "the only bad meeting is the one that you missed".

She sure did get that right.  And just the other day last week I saw her sister, also in the program, and wondered when I would see her again, fearing what I had long suspected and as she admitted today, that she had gone out.

And it is interesting that one of the topics that we talk about in a beginner's meeting is "getting proper medical and dental care". Part of that medical care is to get proper "psychiatric medical care".

I remember when she first came in to our group over a year ago, when we went over that admonition it was to assure people that visiting a physician to determine the extent of damage you have done is meant to help you chart a course of recovery. She was excited with that news and promptly saw her gastroenterologist to determine that she was alright.

The same holds true for dental and mental care.  You may need medication for depression or in the special case of bipolar disease, special medication for each of those conditions. AA can help with controlling alcoholism but it cannot help very much with mood disorders in which alcohol is used to modify the pain of the mental anguish in the absence of appropriate and correctly taken medication.  

Perhaps this detour has demonstrated that imperative of a sober life. For her, child services and her daughter, all need a rest from the shadow of volatile spirits. And the realization that her mood disorder may be the culprit undermining previously tentative sobriety could be a boon and with the help of medication, bring about the desired outcome.

But the rest is up to her, and the acknowledgement that the other right medications are AA, persistence and time.

© res 12/31/2012