ON EMPATHY

ON EMPATHY

It’s important to get all of my prejudices out on the table. And being an admitted alcoholic bears no relationship to my own sense of hopelessness, depletion, exhaustion and yes, disgust when I have been required to take care of alcoholics during my stints as a resident many years ago. And then when I was out in private practice, this was replaced by an overwhelming sense of helplessness when alcoholics would ask if I could help them to get sober. I never learned how to do that. My initial training was only geared to “tuning ‘em up and getting ‘em out”.

Francisco was  twenty four when I first saw him in the emergency room more than thirty years ago. Through repeated admissions for the same diagnosis, decompensated liver disease, I got to know him pretty well.

He was a handsome guy, with a fine physique, well muscled and a winning smile when he wasn’t all tanked up and bloated with fluid retention from his diseased  liver. Twenty four and he had liver disease that caused him to accumulated fluid in the abdomen which we call ascites.

Ascites is the serum part of the blood  that gets exuded into the abdominal space as a result of the normal osmotic shifts of fluid. And each time Francisco (Poncho, for short) was admitted, his abdomen would have achieved such distended proportions that the fluid would push up against his diaphragm decreasing his ability to breathe. So he would be admitted for shortness of breath and acute liver failure until we could stabilize and then discharge him.

It became almost a ritual that for the first few hours of Poncho’s admission to drain a few liters of fluid out of his abdomen just to make him more comfortable, make it easier for him to breathe and to decrease the chance of him coming down with a hospital acquired pneumonia. And in the meantime we placed him on fluid restriction to reduce his fluid retention, give him good food, vitamins and especially vitamin K to prevent him from  vitamin K deficient bleeding disorders that attended his liver disease. And I dwell on this aspect of Poncho’s care because that is the kind of care that I could give him.

Each time he came in. Every 2 to 3 months.

And with each admission, the level of emotional involvement of the nursing staff of the emergency room (and me, to be sure)would drop. His admissions and reports would become “routine”- his admitting history and physical would be “routine”, and the empathy quotient for him dropped until he became a cipher, a boring copy of himself, an annoyance even. For Poncho never got better.

Because we could never treat his real problem, just his acute problems, which sooner or later we would be unable to treat at all. His trajectory would ultimately lead to acute pancreatitis and death, or acute heart failure and death, or cirrhosis and death, or portal hypertension and finally death. And that death would come sooner rather than later.

What of AA or a Twelve Step Program? Well what of it? Thirty years ago I was only vaguely  aware of it except to know that AA was for drunks; and I was as ill informed about AA as anyone else; for I believed that this meant that AA had active drunks in it. So why would I send a hopeless alcoholic patient to AA?

I’m sure that part of my ignorance was self willed because even at that early time, when my drinking was quite under control, I still had my concerns that perhaps I liked my wine a bit more than the rest of my peers.

My point is that as Poncho became a regular, our familiarity with him wore thin. We got tired of him, less tolerant of him and his treatments became like a revolving door. And although his care was not at the expense of anyone else, the services spent on his behalf were legion.

During my time there alone he probably racked up more than two hundred thousand dollars in hospital expenses in 4-6 admissions (in 1978 dollars).But Poncho’s wasn’t the most devastating case of alcohol abuse that I took care of.

Sam was a forty-five year old accountant who was as affable as they come. A family man, he had success written all over him – Until one day when he started to vomit up coffee ground blood. And then he had runny black stools. And before you knew it, Sam was vomiting up lots of red blood and he was rushed to our hospital and admitted to ICU where he was endoscoped and found to bleeding esophageal varices.

Varices are like varicose veins of the esophagus which result from the buildup of pressure in portal venous system which drains the liver. The chronic ingestion of alcohol causes scarring of the normal tissue of the liver as it tries to metabolically detoxify the alcohol that is ingested. The scarring causes the blood to back up from the liver to the esophagus causing the swelling of the veins around the esophagus. Any minor trauma or sudden rise in blood pressure can cause fatal GI hemorrhage.

Even nowadays, with improved treatment, it often takes heroic efforts to stop such catastrophic bleeding and save the patient. In the 1970’s these methods were just being developed.

Not in time for Sam, however, and he died from circulatory collapse from the acute blood loss.

I felt badly about Sam. Was that because he was white and middle class and not a young Hispanic  or was it just that in him I imagined that I saw a reflection of myself; and if this disease could take out Sam, then perhaps I should  have some guarded concern for me?

But true alcoholic that I was, I waved away danger with the flick of hand.

Time has passed and of course I am one of the lucky ones, here with my diagnosis, alive and intact and my health still preserved. No major crises or hospitalizations… yet. But I still wonder about that notion of mine and my colleagues’ ebbing empathies about treating chronic relapsers. I always had the notion that seeing so many drug addicts and alcoholics just depleted all the stores of feeling that I had for their suffering. They just seemed not to want to get better.

At  a meeting in the rehab center I brought up this inconvenient and uncomfortable truth to the group who seemed to think that they could continue to be brought to busy emergency rooms, either strung out or actually OD’d on some drug or alcohol and command the attention and sympathy of the medical staffs. I tried to warn them that even the most empathetic of medical caregivers can shrug at the hopelessness of the situation and finally become inured to the pain that is out there. It is a protective mechanism for them.

 And as they do not know that I am a physician, my news may not have carried as much impact as it might have, had I revealed my profession. But I said that if they did not wise up to the fact that repeated visits to the ER can result in the battle fatigue of these staffs, then they had no right to expect the unwavering compassion from people who do not understand the way they think, the way they act and what they are doing to their minds and bodies.

I was roundly criticized for this and deemed to be “non empathetic”. And perhaps this might not have been the wisest news to present to patients in the first few days of their detoxification or recovery from substance abuse or from being brought back from a suicide attempt or accidental overdose.  This is, after all, a sensitive time for them.

But reality is reality. And within days, they are going to be thrust out into that real world; that uncaring, uncompromising, cold and critical and un-empathetic world.

Perhaps they should understand that they might pull the overdose stunt just once too often to pray upon the sympathies of those in whom they entrust with their care.  And who could blame someone for thinking that sneaky, insidious, almost frigid thought of “why should I care for someone who has so little regard for himself? ”

© res 8/8/2011

AMAZING GRACE

AMAZING GRACE

I approached the detoxification unit with trepidation, as I did each Wednesday, always wondering the same thing. What did I think I had to offer these early recovering alcoholics and drug addicts that they might not have gotten from the institutional sources that they were already attending? What was indeed the point of it all?

Of course, that was not the point at all. What I had to offer was irrelevant. All I served was as a conduit for ideas that flowed in and around the rooms of AA, notions that I channeled with the aid of one of the approved AA literature books called “Living Sober” which I used as a guide for this meeting. 

But I must confess that each week that I enter the ward, I feel I am in a place where ‘raw’ is an adjective that just scratches the surface as a description for the pain that seethes below the emotional surface of the patients here. And when you sit at the ‘head’ of the circle of the group, paradoxically placid faces stare at you which you feel at any moment will metamorphose into the most bizarre masks of emotion the moment you turn away.

And then you begin to read some chapters in the book so that when they finally leave this cocoon, they will have some tools with which to deal with the world they are facing when they step to the other side of the locked doors. And we read “Looking out for over elation” a chapter that seems preposterous on the face of it when looking into these masks of distant reserve.

Yet somehow this strikes a chord; yes, they recognize the incongruity.  One says that he would drink when he was happy, and another, when he was blue. Still another drank when he was angry and another when she was ecstatic. I said I drank when I had a particularly satisfying day at work… or not!

Obviously, we drank over anything or nothing at all. But we drank and it took only just a bit of being “off the beam” over or under the beam, to be off it.  In fact I said that a friend of mine liked to say (sardonically) that “I only drank when he was alone or with somebody”. It is all an excuse, so beware of the circumstances that change feelings for they make us want to drink. Hunger, anger, fatigue, or loneliness, those are the culprits.

And then this was followed by “Easy Does It”, clearly a nice sequel to the previous chapter to remind us not to get upset by situations that could get us “off the beam” either too hi or too low. We should avoid extremes of emotional engagement in most situations and certainly for the first year that we are trying to get sober. It is during this period, when we are most vulnerable to irrational thinking, thinking which is more magical than real, more fanciful than solid, more fancied than well thought out.

“Being Grateful” followed and in it we are reminded to take one day at a time, live in the day and not to worry about tomorrow and project about all of the horrible things that could befall us, or to stew about all that has happened to us in the past. Being grateful for the present’s goodness and serenity should keep you in the moment dealing with the here and now so that the future can take care of itself when it arrives.

And then the big, one “Remembering your Last Drunk”. That got the room talking.  J recalled that his last big drunk was not his last drunk ever but the most memorable one and one that scared him into his current detox/rehab. He was found head down on the marble floor of Penn Station sent to the ICU of NYU with a frontal lobe traumatic brain injury from a contusion to the head. With a .45% blood alcohol level – when found he was nearly dead.

After multiple reversible organ failure, the toxic alcoholic insult to the brainstem  left him unable to walk without an unstable gait, but he was finally discharged to a neuropsychiatric  rehabilitation center and then home for a six month recovery period. 

“And whatever I was thinking when that drunk happened, when I next went out, I never wanted to go back there again; but I tell, you, I’m scared to death that I might yet go there and that’s why I am back here.” 

For J hadn’t just lost much of his physical well being during that last drunk. He lost his job, his car, his house is now in foreclosure as is his marriage.

He figures that he can recoup everything if he reminds himself to stay sober one day at a time-not to get his job back, not to get his car or his house or even his marriage back. But to get his sobriety back.

Because if he strays from attending to his sobriety in the mistaken belief that attending to his marriage, job, finances or family  should somehow  be a priority, he realizes that he will have neither sobriety, family nor the rest.

Which led M to speak about his current reason for being here for this detoxification, as he sighed a weary and breathy sigh of resignation. “I had been taking care of my girlfriend’s sobriety first and not paying attention to my own.  I made sure that she went to her meetings, she had her job taken  care of, she got to the bus station on time, and all of my needs were secondary.

“My support system was to support her and when she went out that left me without a support system. And boy did I lose it all, a car, a bank account, an apartment, everything! Do you know what it meant to me to have a bank account?”

And in truth I could not understand what such a simple and commonplace convenience such as a bank account could mean to this guy but he was clearly upset by the loss of the account. He was more upset by the loss of the account than the money in it! The account meant stability, validation, being someone. It meant that he was reliable and an upright member of the community; and now he had blown that all away for some crack cocaine.

“I can never go back to that woman. I have to get myself sober and take care of myself before anyone else. I am too old to be doing this over and over again. I want to be  normal  again; but I can’t until I am sober. And I can’t get sober unless I put my sobriety above everything else in my life; other people, other things, jobs, family and friends. It has to be me first!”

And then M turned to me and asked me for a copy of the Living Sober book. He needed all of the tools to get it right this time.

Then GC piped up to say how she thought she had understood clearly how to maintain her sobriety. That whenever a drugging situation would present itself, (she used cocaine), she would stop to think about her motivations as to why she wanted to use or why she was even considering using. “That works best for me – if I understand what I am doing. Self knowledge, that really works!”

 And I indicated that it was well and good to be analytical in trying to understand motivations and changing behaviors. But when you need a solution at the moment that the problem hits, analysis is not going to do you much good.  You must be prepared to act in a different mode of behavior first and analyze the situation later.

The time it takes between the presentation for a drink, (such as a hearty greeting of long missed friend), and the opportunity and time to examine the motivations and reasons for not engaging in that behavior, especially for the alcoholic or drug addict in early recovery, may be seconds. And without pre thought out strategies, you may be lulled into the false notion that “oh just one can’t hurt”. Even though you know that it's the first drink that counts,  after that, all bets are off.

As for myself, I can say unequivocally, I never had just one drink. And I can say that in any room of alcoholics they will confirm that too. Which is why we have to do whatever it takes to stay away from that first drink one day at a time.

I find it difficult not to preach to the “young people” in the program. And by “young” I mean those who have tried and failed and then tried and failed  again and again to get sober “their” way.  And "their" way consists of first not admitting that they have a problem at all. We all do that.

Then we think that we can get sober by ourselves and, then we think, by some form  of “self knowledge” discovery,  as if knowing that we are alcoholic will change our behavior,  we go on to believe that we can lick it – by ourselves.

 We have behaved alcoholically for so long that it is automatic and those automatic responses must be interrupted with some strategies to short circuit that conduct with new alternatives for dealing with situations that would ordinarily cause us to partake of a drink.

So to the "young people", the uninitiated, or those who have not yet been willing to adopt the program, I urge that they try to put some new AA arrows in their quiver. Even while on the path to “self exploration” just so that they will have quick and ready options to follow when “their best thinking” leads them to choose  a course that got them into this situation in the first place.

So the purpose of using a book like “Living Sober” is to be able to gain that automaticity of behavior long enough to get past the most dangerous period of early sobriety. It gives us the breathing space to get to that place where we can  discover just what it is about ourselves that makes us drink; to have that clarity of thought to fend off those temptations in early recovery and have the unfettered time and attention to stare at our navels to learn just who we are and how to go about mending our broken selves.

© res 8/8/2011

CHOKING

CHOKING

In a world where responsibility for things is so routinely shucked, regardless of whether the shucker is truly the responsible party, it is refreshing to find a place where accountability for deeds is eagerly, (if not misplaced), taken. Yet it may be pathognomonic of the alcoholic that when things goes awry, regardless of the outcome, he thrusts the blame of the situation squarely at his own feet. He may admit to mitigating circumstances but as the chips have fallen at his doorstep, he accepts the blame regardless of whether fate has delivered circumstance into his hands and yet it was his yea or nay that determined the outcome.

And so it was this morning with Frank who, having waited with an almost irritated reserve, related yesterday’s horrifying and gut churning situation with his eight month old granddaughter.  And it is this young baby who he was instrumental in having seized from his son and daughter-in-law who ignored his pleas to get sober. And yet endangering the welfare of their newborn daughter, continued to use dope, and he was forced to have CHPS intervene.

The upshot is that he has had at least partial custody of the care of this beam of light but it is one more responsibility in a life filled with burden upon burden that he must deal with daily, all of which are challenges to his sobriety of over sixteen years.

Frank has had to deal with a lung neoplasm issue which has been stable over the past eighteen months but which requires constant and diligent surveillance. He is responsible for running his construction business and the welfare of his employees in some of the hardest economic times in the past twenty years. He is trying to mentor numerous sponsees and act as a beacon of sobriety for them and for the many members of his own family who have to deal with the issues of alcoholism and drug addiction.

And then this. All he was doing was playing with and feeding his granddaughter. Just playing at giving her a slice of a tangerine but not actually letting her have it because of the size.  But he placed it on the high chair for a moment while he turned around and in a split second when he turned back he saw her turning blue and choking.

Now imagine a five foot six, two hundred and twenty five pound solid muscle man as he by hand tears apart this high chair because as he described it “the way she was strapped in there these days, I couldn’t get to her to work on her”. So he by hand tore  the high chair apart in seconds and simultaneously dialed 911 and somehow was able to dislodge the tangerine wedge from the kid’s throat and her color returned.

But over the past twenty four hours Frank has been beating himself over the head for being so “stupid” for turning around for “just that split second”, for having so much responsibility that he should have been able to make this mistake in the first place. “I’m too old to be taking care of kids that age, I shouldn’t be allowed to feed such a little kid”.

Yet he never considered that he also saved the child’s life, that had a 14 or 16 year old baby sitter been watching the child, maybe the outcome would not have been so sanguine. And had he not intervened in the life of this child in the first place, would she be alive at all?

We drunks go down the most viciously personal dark paths when things like this happen, even though the outcome may turn out alright. For instance for Frank he thought that maybe he should just stop worrying about his own health and just let things play themselves out “and let the chips fall where they may”. Maybe others should take care of the child.  But what would then happen to his employees and his sponsees?

And I know just where Frank has been because just moments  before him, I shared some incredible good fortune with the group, clouded with thoughts of how I believed things would inevitably turn out.  And the thinking goes as follows:

In an effort to reconfigure my career I have applied for and interest has been shown in my candidacy in an Addiction Medicine Fellowship.  Which would mean incredible good fortune for me and bright sunshine at the end of a pitch black tunnel I have been traveling through for the past year and a half.

The fellowship, however, is in a state in which I have a license but where I had (foolishly, I find) signed a consent order to not activate it in order to avoid penalties.  Now how improbable is that? To have been offered such good luck only to have it dashed upon the shoals of my disease!

For I had signed that consent order during the most cloudy thinking period of my recovery, and in the depths of depressive haze, scrambled alcoholic recovery thinking, I signed a document without fully being aware.

Of course, this is where my thinking has gone. That I could be rewarded on the one hand and then have that reward snatched away on the other. Alcoholic thinking for sure, perhaps real but in the absence of full proof that this will happen I have established the outcome before the events have occurred. And this has almost precluded me taking any action to remedy this development in the first and last place.

I see this clearly in Frank, and I see this clearly in me. And I see this as behavior that I have displayed throughout my life but never recognized it for the alcoholic behavior that it represented. It is that brand of magical thinking that precludes logical action to actually produce the needed result instead of forcing the unwelcomed outcome through inaction.

So by the time I left the meeting I finally understood that I needed to first actually get the position before I conjure an outcome. And perhaps if I were a lawyer I would understand that in law, nothing is permanent or irreversible if it can be written on paper, if it can be argued, if it is written by human beings. I may be wrong in this but at least it will keep me trying so that my thinking wont foreclose the possibility of action.

For Frank, well two women AA’s and I went up to him at the end of the meeting to help him look on the brighter side of things. Such as it was lucky that he was there to tear apart the high chair, that only a few seconds actually transpired between his noticing the choking and his action, and the fact that his remorse made him a better person just for entertaining the notion that he might have been inadequate to the task, whereas the baby’s “natural” parents probably would not have given it a second thought.

That Frank never once in all his self doubt and anger about this incident never thought about drinking or drugging, well, that is the program at work.

And that’s not choking by any stretch of the imagination.

© res 7/27/2011

THE TRANSACTION

THE TRANSACTION

I have spent over eleven years trying to get sober and if I have learned anything it has been that staying sober is a constant negotiation with yourself.  At the beginning you are trying to convince yourself that you really are not that bad; that is that you really are not either an alcoholic, or even that you don’t drink that much. Moreover, you try to believe or convince yourself that your behavior is as sane and calm while drinking as when you do not.

But as the truth sinks in, after hours and days are lost in blackouts and you find you can no longer account for the time that you can no longer account for, you have to finally face the fact that your drinking is not normal. So starts the first round of negotiation.

You first start to cut back on the drinking, either in the amount or the volume.  Or in a crazed notion that one alcoholic drink is somehow different from another you substitute wine for beer, and then vodka for the wine, each time believing that the decrease in the volume of the first  will somehow compensate for the fact that the actual alcohol content of the second has been multiplied by a factor of two or three.

You then slowly start to drink more each time you switch and somehow convince yourself that the accumulation of bottles is not a sign of abnormal consumption, until your behavior takes on that furtive character of hiding bottles not in the recyclables bin but goes straight to the garbage where the  recyclable collectors, not to mention the neighbors will not be aware that your bottle count appears to be larger than any of the others on the block.  And whether the collectors or the neighbors even care to notice at all may be just a product of our guilty imaginations, but that is indeed the progression of the sick thinking of this disease and the crazy negotiations that go on in this brain.

At some later point then we find that we no longer feel very well in the mornings and may be late to work; or we may lose work days. Or we may find that we need to take a shot of some liquid “courage” to calm the morning jitters just so that we can function.

And as work attendance begins to suffer, productivity slacks and we may find our jobs in jeopardy. Bosses begin to notice and performance reports are downgraded. When promotions do not materialize, these disappointments are brought home and are added to the already accumulating tribulations that have arisen between spouses and the children. Alienation, loss of physical and sexual intimacy and maybe even physical blows become routine occurrences and marriages approach dissolution.

Negotiations on how to ameliorate these failings may already be in motion at this juncture but acknowledgment of the disease may yet be still one of those recognitions remaining on the back burner. Until the breakup of the household  is either imminent or in the process, steps to face the problem may not have been taken and those steps require the quitting of negotiation as a tactic and an admission of the real problem, that the disease of alcoholism is present and is the culprit in the string of events that led to this sorry outcome.

Unfortunately, recognition of the disease does not release the sufferer from the trap of trying to negotiate his way out of the work in becoming sober.  I remember in particular how it was like pulling teeth for me to say that I was alcoholic. And for years I mouthed the words, at meetings and professional groups, to myself and to the group at large. But until there were real consequences, I would fail to believe that I was truly a drunk.  What price must be paid for self realization to become honest, unembellished and uncorrupted?

It’s different for different folks, but in my case I had to lose most of my wealth, my self-respect, my marriage and the respect of friends and family for me to be able to actually look at myself in the mirror and say honestly that I was an alcoholic.  But even then that wasn’t enough.  How was I then to become and remain sober? And that is the key question for every wannabe recovering alcoholic.

Admitting you are alcoholic may in fact be the easiest part of alcoholism, even, as I have described, it may be a long road to travel to get to that point.  But I think that we  recognize our disease long before we are willing to do anything about it; or more to the point, long before we have either the fear or the courage to do anything about it - courage and fear being two sides of the same coin each requiring the support of the other, without which nothing much worth doing would have any meaning at all.

So after I admitted my alcoholism, what did I need to do? I needed to surrender my self-will; that will to “except” things in my life.  Such as I would do anything to get sober “except”… This is, of course, conditional thinking. There can be no exceptions, because the minute I except a condition to my sobriety, that condition becomes the very risk that will bring that sobriety down in a moment of weakness.

There can be no exceptions.  And to that end I have to be willing to give up that “will”, that self-will, to the care of a higher power, or any power, but my own self-will. It is an admission that my will got me to be a successful alcoholic. Some other power, not of my own will would have to help me to get sober; and I would have to scrupulously follow the suggestions of that other power.

Each time I run a meeting at a rehab center I am reminded of this simple, yet poignant task required at the beginning of each drunk’s journey back to sobriety.  It is only your self-will that is stopping you from staying sober. It is that will that is tempting you to not take the suggestions of the program rather than believe your own worst thinking that the desire to drink is too over- powering to not take that first drink. And this evening’s meeting rudely reminded me of that rutted, raw thinking of the newly detoxed individual.

We were reviewing the suggested methods of staying sober in the first ten chapters of  “Living Sober”.  I try to be patient because, for me, sitting in a room of about ten newly detoxed individuals is like sitting in a carnival hall of mirrors; each person a different distortion of my own story and each with a similarly twisted reason for “excepting” himself from why the suggestions in these chapters would not work for him or her. 

And like me when I was in their situation, arguing like I was in a philosophy class trying to disprove a particularly arcane bit of esoterica, several ready for discharge folks were stating how difficult it would be for them once they were out in the community.  And each time when I would point to a chapter with the suggestions that worked for me and hundreds of thousands like me, there would come back this staggeringly puny argument why in this person’s particular case it might not, would probably not work. Because they were so ‘terminally unique’.

That is also part of this affliction, that the disease that has stricken millions of others and in whose stories you can see your own, you somehow feel that their salvation could not possibly apply to your own situation. What colossal hubris!

But when you dig down and ask the questions, did you go to more than just a few meetings? Did you go to ninety meetings in ninety days? Did you get a sponsor? Did you use the telephone? Did you get a commitment to do service? Did you do something to keep you busy with other alcoholics in the program and working the twelve steps? The answer is invariably and resoundingly a no! To be followed by protestations of “Yes buts…”

Yes but nothing!  The truth is that if you know a system that works, do it and don’t complain that you always fail. But if you know of a system that has worked for millions but you refuse to use it because of pride, sloth and shyness, you are only kidding and fooling yourself. And you have not yet gotten close enough to death to be willing to do anything to get and stay sober.

All else is an excuse.

Because you can recognize that you are an alcoholic. You can say you want to get sober.  But until you can see yourself too frightened to take just one more drink, you may not yet be willing enough to do anything to stay alive. 

Until all those fun house mirrors reflect just another image of your death, you may not find the courage to walk through that mad house to find the true reflection of your salvation.

© res 7/20/2011

HOPE'S HILL

HOPE’S HILL 

It was a cold January morning when I first slip- slided up that “Hill of Hope” and my mood inside was as gray as the sky above.  “Hill of Hope”, (if you’ll pardon the expression,) was more a hope of faith-filled expectation rather than an expected outcome at the end of a month of what was immediately perceived of as an indeterminate and perhaps interminable incarceration.

I arrived at the gates of this retreat established by the famous Bill W. himself, at the behest (or rather the dire warning) of my sponsors who felt that another month or two out in the world would inevitably leave me as close to death as one could come without actually summoning up Charon himself.  These direnesses were pronounced by practiced AA hands, but from my own besotted viewpoint, I felt they were well off the mark.  However, there was ample precedent on their side, if anyone was keeping a tally.

The grayness of my mood, the coldness of the weather, chilled me to the very core right to my bones. And I continued with that chill for the remainder of that first week. My mind was a haze, one day seeping into the next, me not noticing where the night became dawn. Was it cold in the room or outside? Was that my mood thawing or just the ground? Was I warming to the people around me or were they just beginning to realize what a pleasant guy I was all along?

It is often a sign of how self important we take ourselves to be when we start immediately writing our thoughts down, as if what we have to say as our besotted thoughts ooze away will be so insightful that once forgotten, if we do not record them for posterity, they will be lost to the world  with the consequent immensity such privation of what so much brilliant philosophical musings would mean. Think of all of those characters who upon their arrival at the doorstep of history, started to take or caused to have taken, copious notes and copies of their correspondence, letters and thoughts  about anything from grocery lists, to ammunition to sewing needles. This was typical of all of the giants of our great revolutionary war among whom we certainly count Adams, Washington, Jefferson and Hamilton. Each of whom had meticulous notes of their comings and goings during the heyday and any day of the revolution.

So I said “Why not I?” After all, I was undergoing a sort of revolution myself! So I started to take down my brilliance and by the end of the first 10 days, I had a substantial set of what I think I considered perceptive insights into my personal evolution, how I got to where I was, what I thought had happened and what I thought I could do about it.

So imagine how crestfallen I was when someone stole my notebook! Yes stole! Well it could not have been anything else could it? How could I have misplaced it, right? There were only 8 rooms in the “Bunk House” and I stayed in only two, so where could it have gone, so it must have been stolen!

That I could have misplaced it in some area where I would not be able to find it never once occurred to me.  That I may have even suffered a blackout in this recovery never occurred to me either.  Any other type of temporary amnesia? Unlikely.

But it may have been a good thing that I did lose this book in which for the first seven to ten days I vomited all of the random garbage that projected from my mind. Kind of like that vomiting that occurs as the result of menningeal irritation; convulsive, uncontrollable irresistible projectile vomiting that winds up feet from the mouth. That’s what happened except what got projected was all of the mean, low and sick thinking that was roiling in my mind for the past thirty years. The muck that had been stirring between my ears, fueled by alcohol and ignited by rage and anger and fear.

So the loss of that book was probably not a bad idea, maybe even fortuitous. Leave behind all of those bad feelings and start with a fresh less agitated palate cleared of the years of bitterness. 

Slower breathing, with the nostrils cleansed of the stench of anger and fear.

So by the end of the first ten days I was prepared to finally listen to the message of recovery, not rebreathe the effluvium of anger, rage ,defeat, hate and fear.  I could listen to a message of faith, spirituality and hope.

And maybe it was best that this transformation had occurred in the winter. In fact it was more likely to have occurred in the winter with all of the elements of the world symbolically opposing my recovery. That was OK. I live for symbolism.  And it is better than dying for symbolism. 

So when I returned to the “Hill of Hope” this past Thursday, and it was 85 degrees out, the sky blue and clear and a gentle wind and the smells of honeysuckle on the breeze, it was like walking onto an Elysian Field. A place of peace. As much as any ‘institution’ can be called home, it felt like I had returned to a place of intimate comfort. This Hill was where I had spilled my most private thoughts and fears, the worst of me. And sometimes when one revisits the scenes of ‘degradations’ like that, one may be wary of what the result will be.

But there was definitely a calm as soon as I stepped out of my car. The quiet, the trees, the birds and the breeze.

And then there was that chapel where Bill W wrote the big book.  Yes this place had history, but for me, it had my history. My recovery. It is where I finally realized that if I wanted to live, I had to give up the drink. I could no longer fool myself that I was anything but an alcoholic and that I had to finally face that fact and do something about that. And stop kidding myself that anyone else was at fault for anything about that sobriety except me, regardless of what little niggling thing about some resentment I had about a small part of my story someone else had played in it.

It did not matter. I was responsible for the outcome. Nobody put a glass of booze to my mouth and browbeat  me into drinking it.  I drank it and only I could have taken that glass and put it down.

So on this sunny Thursday, despite my reason for returning to the “Hill of Hope”, it is clear to me that Hill “saved my life and then gave me a life”. 

“There are no coincidences in life”,  goes the AA credo, and I suppose my visit to the “Hill of Hope” demonstrated that. I learned a great lesson in humility that day . You may be dragged kicking to what you perceive as an abattoir where you think you hear the screaming of the damned.  But the squeals you hear turn out to be your own.

But when you can finally see through the doped haze of addiction, you will no longer be in thrall to those fears and will look back on them as quaint and misinformed notions of a sick mind. And you learn that with an open mind, unmediated by alcohol or drugs, even the most obdurate deniers of reality can be taught.

© res 7/7/2011

ELEGY

ELEGY

When you are away and “healing” the world out there kind of fades in both time and space. In some ways that is not very different from the manner in which you have treated that very world for these past many months or years while you were cradling the bottle, lost in an alcoholic haze unreachable to the wife, the child the family and, of course, the friends.

In my case it is even more amazing how much time and distance I have placed between me and everyone because it has only been upon  my return that I have begun to appreciate how the closeness I had with family and friends has dissolved and how I now feel that distance that I myself put there between us in the first place. And it is a shame how I am not able to revel in the joy of having been welcomed back into the family fold by those whom I have hurt the most because it is those who suffered to most from my having “been away” and are not so eager to forgive and forget. Well, even forgive, if not to forget. For there are many in the family whom I have not alienated and whose open armed welcome is so loving that it makes the loss of that welcome from those closest to me all the more obviously absent.

I so understand this that it goes without saying that it should be a long haul for that recognition to be realized, if ever. It takes more than just a little work to patch that up.

But I didn’t realize just how long I had been gone until just the other day when, through a set of serendipitous circumstances having to do with trying to repair that very relationship with the closest of those I have hurt, the spouse, failed. We have been trying to get back together but an argument forced us to cancel a date and I went alone to a jazz concert in NYC.

At that concert were many jazz notables whom I have come to enjoy over the past thirty years, and whom I have seen in performance, some many times over. One in particular whom I originally met through a mutual friend and has since become a casual acquaintance, was also playing that night. It so happened that I went to medical school with that mutual friend, as I did with that friend’s wife.

Ordinarily, I do not bother performers whom I assume do not like to be pestered. But on this occasion I met Jay backstage and he was as gracious that night as he always was on every occasion in which I reintroduced myself to proffer my appreciation of his playing and his music.

And as a reminder prompt I mentioned the mutual friend, and after he accepted the thanks, he got quiet and said “I have some sad news. Steve left us this year.” And my jaw dropped. “You knew about his heart valve problems?”, as indeed I had.

When we were finishing up our last year in medical school in Baltimore, Steve had enrolled in an experimental program at the NIH and received one of the first porcine aortic valves, back in 1977 when it was still a new procedure. 

For the past thirty plus years, since the time we spent in medical school, he and I, my wife and his were fairly close friends, despite the fact that they were ten years our senior. They were a couple with zest, humor and joie de vivre that my contemporaries in medical school were missing and that was what drew me to them and kept us as friends all these years.

Except during the storm that were the last years of my drinking, when I was licking my wounds in recovery, I pulled in my emotional antennae and pulled in the “friend feelers” and surrounded myself with only those folks who could easily cocoon me. Somehow, for some reason they did not fall into that category and for two years I remained incognito to them. But their lives did not remain static, as mine ground inexorably to its first deadly and then hopeful destination.

“Steve had had two more operations on that valve”, said Jay; I had known about one of those and I guess the last was new to me. “He finally gave up and decided not to fight anymore and he gently passed. I would not have mentioned this except I know you were friends, as were we all.”

And I thanked Jay and he added, “and Barb, well you know she has been suffering from memory loss for some time now and she has gone to live in the west with her daughter.”

As I left, the loss was palpable and I felt this immense sadness and tightness in my chest. I had to lean against a building for a moment while I wept, for the loss was so sudden and so great and I was immediately so angry with myself that I had been unavailable. I had been gone; out of touch; I had not kept up! I felt empty.

That biennium of living angrily had left me untethered from those for whom I cared and now I paid the price. And part of that price was that there are mutual relationships that the spouse and I share and whose mutual grief I am now responsible for because it is I who am responsible for having created, in  a sense, some tethered relationships, Steve and Barb being two of them. And it was I who caused that breach of continuity so that when that all important time came, when people were in need, I was not available. Just as I was unavailable to those even closer to me.

But I suppose there is a peculiarly optimistic way of looking at this whole episode, perverse as it may seem. Had the spouse and I  not been in the midst of a reconciliation, we would not have been at each other’s throats, emotionally speaking while trying to work out our admittedly rough, tense and difficult attempt at familial reintegration.  Had we not been as fragile as we were at this particular juncture, that date would not have been cancelled.

Had the date not been cancelled and we had gone together to that concert, then our typical shyness would have overcome any desire to go up to Jay and we would not have found out about Steve and Barb for a long time.

And it does turn out that we are just six months late since the funeral, not years late. There is still time for redemption. There is time to make amends. More importantly I hope, while Barb still has cognition, there is time to express condolences to a dear friend and perhaps even to see her while she can still recognize me.

There is a way to extract the positive out of this whole situation. I cannot dwell on the past which I cannot do anything about. I can’t plan on a better tomorrow without doing some good today.

There is a crude AA slogan that opines, “if you have one foot in the past, and one foot in the future, all you can do is piss on the present.”

So I have my work cut out for me for a better today.  

© res 5/16/2011

LUMBAGO

LUMBAGO

I awoke to a backache. The room was dark and even through the eyelids I couldn’t make out any hint of light which usually seeps through even in the darkest of dens. Pitch black. I Spocked an eyebrow but even that narrowest of eye slits permits no light to hit the retina. Blackness.

It occurs to me at last that there is no light in this abode and I have to recall just where I am; and I panic just a moment as if suddenly coming out of a blackout crazily disturbed when I find I am not where I last thought I was.  And where that was I do not know but the panicked thought that I might have been drinking is wild and unnerving and my heart is racing and the sweat is already trickling down the small of my back as my other eye pops open still to confirm the pitchness of the surroundings.

The ache reappears but it is much less and now I realize it is not the back at all but the neck, and it is not a new sensation but familiar neck  pain that I wake up with every day and as I arch my back I find that the disconcerting lower back pain that I had misapprehended that awakened me was truly a misconstruction, a symptomatic dislocation brought on by  environmental anxiety the solution of which I still have not accounted for.

Yes, things are beginning to make sense. I recall finally, that I haven’t had that back pain for two years now, ever since I changed that mattress to that support foam, one of the “Tempurpedic” mattresses.  That backache that I used to complain about all the time; the excuse for pain pills, inability to sleep and nightcaps.

So that must mean… I’m in that apartment, that basement apartment, practically so at least, dark most times of the day, musty, dusty, depressing. On the longest day of the year it gets an hour of light. Otherwise it, like the Antarctic’s winter, remains in months of perpetual twilight or darkness the remainder of the year. It matches my mood too.

It’s a marvel that I was able to get sober here at all. I guess that’s because I forced myself to get out of here daily, get out, go to a meeting, see people, write, go to meetings, socialize, write, and go to another meeting. I’d say work, but that territory has been severely circumscribed, first by my recovery and then by the restrictions placed on my license by the state.

So, in many ways, the terrain of the apartment pretty much mirrors the terrain of my recovery.  It is mostly pitched, umbral and penumbral.  

And the fear and discomfort of that wakening anxiety slowly drifts away as knowledge seeps into my consciousness. Ah. Now I remember. It was that dark that tricked me, not a real black out, just a figurative one.

So it is rather strange to be awakening to a real lumbar pain these past five days, with true bright light stabbing through the eye lids, and the requirement of a second pillow to squinch over the head to block out the offending rays and the pounding incessant travel alarm alerting me to the 7:30 meeting this morning, this Independence Day. The “Posturepaedic” mattress in the family house is so hard that it not only causes searing lumbar pain but has actually caused a bruise to form on the right hip which I presume I slept on last night.  This, the result of that Berkowitzian trait of loss of gluteal adiposity after the age of sixty; a trait that is highly sought after in many quarters but is literally sorely missed in mine.

Yes I said the “family house”. That house that I was exiled from two years ago for sins against a particular humanity; and towards which I have been diligently working for reinstatement into that “humanity”.  I suppose the fact that I was asked to watch the “kids”, (that is the two aging dogs), is a sign that I can be more or less trusted or that we are both so low on funds that hiring a dog watcher is so out of the budget that it would preclude her vacation in the first, second and third place.

But I am happy to do this if only to get the heck out of that dungeon that I have been holing up in for the past two years. I have been wanting to spend time wandering about a house in which I could stay in a different room for an hour each, ten hours out of the day without even going into the basement, whereas I could not do that for even an hour in my cave.

I can spend hours listening to the birds on the porch, listening to music while reading books, magazines; and being out of doors, without having to get out of a bathrobe. I can talk with extraordinary company, like Chessie and QTPI and get thoughtful, quiet contemplative replies back. Mostly in the form of slobbering and snoring but I get their attentions nonetheless. Of course, it helps to have a biscuit also to start the conversation.

The joy of light is wonderful. Light makes the mood… well, light. Light symbolizes optimism. Light implies less weightiness. Light, being the opposite of dark is the opposite of oppressiveness, depressiveness, evil, bad thinking and… stasis.  

When I think of pathology in humans I view stasis as a pathological phenomenon. When stasis occurs, bad things happen. Stasis of the blood causes clots. Bad if it is in the middle of the circulatory system say in the heart (infarct) or the brain, (stroke). Or, biliary stasis will cause jaundice and mechanical hepatitis and gallstones. Or urinary stasis will cause infection. Bowel blockage, untreated, will cause a rupture and death.  

Nothing good comes from stasis.

So I have really enjoyed coming out of the dark as a reminder of what the light is and always has been. I also have to remember that light and dark are complementary. My appreciation of the light was never so great as when I had to slog through this dark; my understanding of my alcoholic effect on my family was never so deep as when I had to live with the consequence of that action.

I lived with severe lumbar pain from a “Posturepaedic” in the light. But the relief of the back pain from the “Tempurpedic”  had a quid pro quo with it, …….

I had to live with that relief for sometime in the dark.

© res 7/4/2011