Tag Archives: addiction

The Expulsion

18 Sunday Sep 2022

Posted by in addiction, Catholicism, christianity, empathy, Evil, kids, love, parenting, PTSD, Rape, Sin

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Judith Herman

tells us that trauma is abandonment, being abandoned by all the people who were supposed to protect us, even ourselves, even God. to be utterly alone. when we shouldn’t be. when we least expected it. not knowing will we live or will we die, will this black hole we are falling into ever end.

In church

They tell us that Hell is the absence of God. No need for fire and brimstone. There is nothing worse than to be left by God. And so, trauma is Hell

In the Bible

Adam and Eve ate of the Tree of Knowledge and were banished from the Garden of Eden. Never to return. A life of toil and sickness and pain and death. Final. No way to earn their way back to Eden.

Our parents

Are the source of us. The holy Mother and Father of us. And when they unleash a rage that has no borders, we are Alone. we grow up and roam the earth, trying to find our way back to the Garden. But there is no going back

We cannot go back, only through. Onward into the valley of tears. Where God hears us and loves us but cannot save us. Where he gives us the ability to love one another, hear one another, comfort one another, but not to save one another.

Loving and saving are not the same thing. And that which your parents couldn’t give you will never be found in someone else. There is only one person capable of never leaving you, and that’s you.

And you

are enough

christofascism

04 Wednesday May 2022

Posted by in addiction, Catholicism, christianity, Evil, kids, love, outrage, parenting, Politics, PTSD, Rape, Sin

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Nowhere in the Bible does it say life begins at conception. Nowhere in the Bible does it say 10 year old girls ought to carry and birth their father’s baby if he chooses to rape her which fathers sometimes do. To think this is what God would want says an awful lot about a person. And it isn’t good.

Howard Zinn says you can’t be neutral on a moving train and so I want to hear from my Christian sisters today. I want to hear them screaming for the women who will die, the girls who will die, for the dreams that will die. They asked Jesus the most important commandments and he said love God and love one another. Why is that so fucking hard for so many ChRiStIaNs?

Contraception is next. Do you know I didn’t use contraception for years and I’ve never been a fan and it’s failed me on occasion and I still will give my all to defend our right to it. Do you know the horrors I have seen come of lack of access to effective contraception? Where are you my fellow Christians? With your youth groups and your worship songs and your testimony? Jesus hung with the prostitutes and the lepers. She had two beautiful kids and a hole inside of her so wide and so deep because she’d never been loved and only ever been hurt and that third baby done did her in and now all three of the babies are with someone else and she is in jail detoxing meth psychosis and I miss her so damn much. She chopped wood at 8 months pregnant to try to make enough money to keep the water on. And where were you? At yOuTh GrOuP

I sat in my car and cried for the world we’ve given our kids. I tried. I believed. But here we are. Poor lost children of Eve banished from Eden. But Eden wasn’t enough. Or maybe it was too much. We wanted that apple and who could blame us? How boring a perfect life must be. So huddle together in this Whale with me and let us tell each other tales until the light goes out.

addicted

12 Tuesday Apr 2022

Posted by in addiction, autism, Catholicism, christianity, empathy, kids, residency, Sin

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all of my patients are physically dependent on opioids. ICD 10 F11.20. some of them are addicted to opioids. a lot of them aren’t.

maybe you’re physically dependent on something. for which there is no ICD 10 code. caffeine, zoloft, dopamine, adrenaline. maybe you’re addicted. coffee, zoloft, social media, shopping, toxic relationships, speeding, gossip, little debbie Christmas tree cakes, work, success, sex, HGTV.

maybe you think I’m being cute. or metaphorical. just making a point. no one goes to rehab for gossip addiction (maybe they should). no one goes to jail for possession of little debbie Christmas tree cakes (maybe no one should go to jail for possession of anything. maybe the jails are a crime)

addiction is an escape from the pain of being human. being human is more painful for some than others. but it is painful for all of us. and if someone tells you it isn’t, that is because they are so deep in their addiction, they have lost touch entirely.

eve and adam ate that apple and it all went to shit, you see. our eyes were opened and sickness and pain and toil entered the stage. we all fell down, down, down. and ever since, we have very logically sought to numb the pain of it. because there is no way up, up, up. not in this life anyway.

we are afraid. to hope, to love, to ask for love, to speak our truth, to share our pain, to need or be needed, to want or be wanted. we are afraid to take up space and that we might disappear, to be silenced and to be heard, to be alone and that we might make a genuine connection. we are afraid we are unlovable and that to be loved would be the most unbearable pain imaginable. or perhaps, worse than that, ecstasy.

in addiction we connect with other people. no we don’t. we are with people and we are less lonely and so we think we are connecting. logical. understandable. but let me tell you a story about the time my friends let G die when he overdosed because they were high too and didn’t want to get in trouble and i knew they loved drugs more than they loved me or each other. and the time i went back to my dopamine adrenaline filled emotional intimacy free relationship because right at that moment i loved it more than my kids and i do not want to tell you that but how else can we do better?

and they told me my son played next to other children but not with other children and that he was too old for parallel play. but tell me how much time adults spend engaging with other people and not engaging next to other people? are we connecting spiritually or are we churching next to one another? and those residents we work 90 hours a week with that we save and lose lives with, do we know them at all? and so pass the pipe and hand me that spoon and we will share a hit of Netflix and yoga and pumpkin spice latte next to one another in this Fallen World.

there is no ICD 10 code for the unbearable lightness of being but maybe there should be

Drip, drip, drip (better times up round the bend)

25 Friday Jun 2021

Posted by in empathy, Evil, kids, love, marriage, my awesome husband, narcissism, PTSD, Rape, romance, Sin, Uncategorized

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Water torture encompasses a variety of techniques using water to inflict physical or psychological harm on a victim as a form of torture or execution

I’d like to start this post by pointing out the term “Chinese water torture” is racist and nonsensical actually. When this torture technique has been used, it has been mainly by Europeans and there’s no recorded instances of the Chinese ever having used it.

Ok, onward and upward.

There’s this book by Lundy Bancroft I bought years ago titled “Why Does He Do That?” It’s about abusive partners and the many myths that surround our ideas of abuse. He’s a counselor that works with abusive men who either want to change or have been forced by the courts to undergo counseling. We often say abusive men need to learn to manage their anger but Bancroft argues that abuse isn’t an issue of out of control anger. Rather, it is a systemic, deliberate process used to control for the benefit of the abuser. They don’t need to learn to control themselves; they need to learn to stop controlling their partner (and everyone else in their lives they’re controlling).

In the book, he details ten different categories of abusers. The one I am going to talk (err-write) about today is the Water Torturer.

We’re all familiar with the idea of water torture. Not the waterboarding done by the US government. Rather, this idea of tying someone down and dripping water down onto their forehead slowly, drip by drip. The drops come randomly and it induces a psychological breakdown.

Lundy uses this as a metaphor for the kind of abuser who doesn’t yell or hit. He is always calm and appears to the outside world to be a great guy. He rarely slips up and lets anyone see what he’s really like. He knows how to push his partner’s buttons and get *her* to scream and get emotional. Then he says “why are you getting so worked up?” “you really need to work on your mental health problems” “stop abusing me.” He doesn’t punch or kick but he engages in subtle physical abuse such as blocking her from leaving the room or following her around the house arguing when she tries to get away. He doesn’t engage in blatant sexual abuse such as rape but rather makes degrading comments about her sexual interests, her appearance or withholds sex. He makes extensive use of sarcasm, put downs, controlling where she goes, controlling money, undermining her sense of self worth, isolating her from friends and family, badmouthing her to other people and gaslighting. Lots and lots of gaslighting.

Because you see, like Harry Houdini who helped popularize the idea of water torture, he depends upon an illusion to keep her with him. He depends on creating distractions so neither she nor the outside world can see what he really is and what he’s really doing.

The good news, friends, is that you don’t have to remain strapped down to that table. The damage done by this abuse is extensive, but most definitely something you can heal from.

You just have to keep in mind the Wizard of Oz is not real and keep your eyes on the little man behind the curtain. It’s hard to do, but you’re a badass so you got this.

I see this a lot in my practice. I have women who come in with black eyes and broken ribs, but more often they come in telling me stories of emotional abuse like this. They’ve been so worn down by it, like a pebble in a stream that becomes small and smooth over time from the water flowing over it. They are too tired and broken to leave. And they’re in love. And they’re addicted to the chemicals our brains grow to crave when we’ve been in toxic, tumultuous relationships for so long.

The University of Illinois did some research and noticed there are 5 stages to leaving an abusive relationship. The first two stages encompass the very beginning of the abused partner noticing there is something very wrong, something that goes beyond normal relationship issues. She’s nowhere close to leaving, but the spell has started to wear off. Stage three, women start to notice the effect of the abuse on their children. They start viewing the abuser’s behavior as abuse on a regular basis. And they start preparing to leave. Maybe they tell a friend what’s going on. Start stashing away cash in case they need to run. Call a domestic violence line. Stage four is an interesting one.

Stage four is the yo yo stage. You leave but then you come back. You might end up yo yo-ing several times before you truly leave. Why? Because he says he’ll change. Because being on your own is hard, financially, logistically (with kids), emotionally. Because he gets other people to guilt trip you. Because he won’t “give up on you.” Because you’re addicted to the brain chemicals. Because this dynamic is comfortable to you. Because you love him.

Stage five is the final one. You have left and you have stayed away and aren’t going back. The researchers define this as having left and stayed away 6 months or more. The abuse can continue if there are children involved and you are forced to have continue contact with your abuser, but it’s much less than before and you can begin to heal and move on.

It’s hard as doctor to have patients in those first four stages. Hard for friends and family too. But you can’t skip stages and you can’t rush someone through them. They have to make the choice to leave and stay left. You can support them by listening without judgement and validating their feelings. If you’re a friend or family, offering help with kids and other logistics can help too. And if they yo yo back, be there for them. They may be afraid to tell you. They may avoid you. Don’t give up on them. The abuser will likely make even greater attempts to isolate his partner if she goes back, so stay in her life whatever way you safely can and let her know you’re there is she ever needs you.

A lot of doctors shy away from dealing with the issue of intimate partner violence because they find it so frustrating to have a patient that won’t leave or who goes back. There are a lot of reasons women stay or return. And the sad reality is, sometimes it’s safer or necessary for her to stay. Being there to keep her as safe and supported as possible is hard, but it can be life changing for her. If you abandon her because she won’t leave, you’re just continuing the patten of the abuser, seeking to control her.

The longer you stay, the harder it is to leave. So, if you’re in a relationship with a water torturer, don’t put off considering leaving. A lot of times the reasons we come up with to stay aren’t as convincing if we discuss them with someone outside the relationship like a therapist, domestic help line or friend. Once you’re down in his world of gaslighting, isolation and control, your sense of reality is skewed. You need someone who isn’t riding that Tilt-A-Whirl.

Once you are out, the healing is not necessarily the most fun process. It’s kind of like when someone is getting over opiate addiction. There’s a lot they need to dig out from. A lot of pain and sadness and the practical part of rebuilding your life. But there’s also joy. And as the months pass, there is less and less pain and more and more joy. And you will look back and say, how did I do that all those years? How did I survive? And you’ll see what a badass you are. And that there are far better things at the carnival than the broken Tilt-A-Whirl. And you and your kids will eat cotton candy and laugh and sleep soundly at the end of the day cozy in your warm, safe beds.

America we’ve given you all and that’s not nothing (or Narcissus needs a drink)

11 Wednesday Mar 2020

Posted by in empathy, Evil, love, medicine, narcissism, Uncategorized

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America
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
*
*
*

I have spent a lot of time reading about narcissism lately. I have my reasons I won’t go into here. An unexpected outcome of this research is the realization almost every politician in the Democratic primary is above average on the naricissim spectrum, some just as high as Trump. One in particular. The one who had to drop his bid in 1988 because he was exposed as a pathological liar and plagiarist. The one whose toxic masculinity led him to challenge someone to a fist fight recently. The one who has assured the billionaires “nothing will change.” And a relationship with a narcissist, my dear reader, only ends one of two ways: you wake up and leave or they suck the life out of you. The Democratic electorate has chosen the latter. It is narcissist versus narcissist in 2020 (it has been before, to be fair) . We will all lose no matter which one wins. If Biden wins, we are left with an America still under the conditions that created Trump and we will either get another Trump or …. Trump. Do you really think leaving the White House will make Trump go away? He has created a movement and they will follow him where he leads. The presidency,  my dear reader, may become significantly less relevant. The question is, will the movement Bernie is driving remain intact to counter it?

 

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I think of the people most affected by all this and I cry. My addiction patients in rural Pennsylvania, their children. They don’t even realize just how different much of America is living. And most of America doesn’t realize how they’re living. If they did, I’d like to think things would be different. But narcissists are very good at gaslighting and projecting and lying. Lying especially. Lots of lying. And if you’re a decent, feeling, empathetic human being, it is hard to resist. It is hard for for you to conceive that such a person could exist. Someone with no empathy and no remorse. Entirely self serving with nothing to limit what they’ll do to get it. Try to imagine. It should scare you. Terrify you.

I believe most Americans are decent people trying to get by in the face of a lot of hardship. I see it in my office everyday. Not just my most vulnerable patients, my middle class medical marijuana patients too. The cop with PTSD who had to retire because of it and now has no insurance or income to pay for the therapy he so badly needs. The single mom of an adult son with autism, trying to get services that aren’t there, trapped in her house. Chronic pain patients that were abruptly kicked off their pain meds once doctors started facing consequences for over-prescribing, not offered any help for withdrawal or to manage their pain. And I see the upper middle class patients who benefit from the system but have so much anxiety and depression, the money does them no good. And still they hold onto it tightly, unwilling to see letting some of it go would not only save so many struggling; it would save them too.

Greed is an illness. An ugly dark emptiness that cannot be filled and will not stop making you hunger for more. Like any addiction. Are the heads of the pharmaceutical companieds just projecting then? Turning so many into addicts so they can see themselves? And Trump, who will never have enough cheering angry supporters or enough money. He pulls the worst from us, feeding off negative emotions and chaos as narcissists do. Projecting onto America the darkness inside of him.

care-bears-movie-care-bears-stare-power

I do not mean for this post to sadden you or leave you feeling hopeless. Indeed, that is exactly what a narcissist wants. I want you to see that once you know you’re dealing with a narcissist, you begin your steps towards recovery. Leaving is not easy. They will try to suck you back in. They will love bomb you, bring you flowers and tell you how wonderful you are. But if you stay strong, it gets easier in time. And the best part? The thing narcissists hate most is someone who heals and is happy and strong. Our revenge would be a healthcare system that takes care of us, universal childcare, a Green New Deal, a living wage, an end to mass incarceration. Our revenge would be joy. Like an army of Care Bears shooting out beams of love and kindness and hope from our chests. They would keep trying, but with no one to reflect their image back to them, narcissists wither. Like Narcissist himself, when the reflecting pool they’re so addicted to dries up, so do they. And we, America, will have won.

***

America, by Allen Ginsburg

America I’ve given you all and now I’m nothing.
America two dollars and twentyseven cents January 17, 1956.
I can’t stand my own mind.
America when will we end the human war?
Go fuck yourself with your atom bomb.
I don’t feel good don’t bother me.
I won’t write my poem till I’m in my right mind.
America when will you be angelic?
When will you take off your clothes?
When will you look at yourself through the grave?
When will you be worthy of your million Trotskyites?
America why are your libraries full of tears?
America when will you send your eggs to India?
I’m sick of your insane demands.
When can I go into the supermarket and buy what I need with my good looks?
America after all it is you and I who are perfect not the next world.
Your machinery is too much for me.
You made me want to be a saint.
There must be some other way to settle this argument.
Burroughs is in Tangiers I don’t think he’ll come back it’s sinister.
Are you being sinister or is this some form of practical joke?
I’m trying to come to the point.
I refuse to give up my obsession.
America stop pushing I know what I’m doing.
America the plum blossoms are falling.
I haven’t read the newspapers for months, everyday somebody goes on trial for murder.
America I feel sentimental about the Wobblies.
America I used to be a communist when I was a kid I’m not sorry.
I smoke marijuana every chance I get.
I sit in my house for days on end and stare at the roses in the closet.
When I go to Chinatown I get drunk and never get laid.
My mind is made up there’s going to be trouble.
You should have seen me reading Marx.
My psychoanalyst thinks I’m perfectly right.
I won’t say the Lord’s Prayer.
I have mystical visions and cosmic vibrations.
America I still haven’t told you what you did to Uncle Max after he came over from Russia.
I’m addressing you.
Are you going to let your emotional life be run by Time Magazine?
I’m obsessed by Time Magazine.
I read it every week.
Its cover stares at me every time I slink past the corner candystore.
I read it in the basement of the Berkeley Public Library.
It’s always telling me about responsibility. Businessmen are serious. Movie producers are serious. Everybody’s serious but me.
It occurs to me that I am America.
I am talking to myself again.
Asia is rising against me.
I haven’t got a chinaman’s chance.
I’d better consider my national resources.
My national resources consist of two joints of marijuana millions of genitals an unpublishable private literature that jetplanes 1400 miles an hour and twentyfive-thousand mental institutions.
I say nothing about my prisons nor the millions of underprivileged who live in my flowerpots under the light of five hundred suns.
I have abolished the whorehouses of France, Tangiers is the next to go.
My ambition is to be President despite the fact that I’m a Catholic.
America how can I write a holy litany in your silly mood?
I will continue like Henry Ford my strophes are as individual as his automobiles more so they’re all different sexes.
America I will sell you strophes $2500 apiece $500 down on your old strophe
America free Tom Mooney
America save the Spanish Loyalists
America Sacco & Vanzetti must not die
America I am the Scottsboro boys.
America when I was seven momma took me to Communist Cell meetings they sold us garbanzos a handful per ticket a ticket costs a nickel and the speeches were free everybody was angelic and sentimental about the workers it was all so sincere you have no idea what a good thing the party was in 1835 Scott Nearing was a grand old man a real mensch Mother Bloor the Silk-strikers’ Ewig-Weibliche made me cry I once saw the Yiddish orator Israel Amter plain. Everybody must have been a spy.
America you don’t really want to go to war.
America its them bad Russians.
Them Russians them Russians and them Chinamen. And them Russians.
The Russia wants to eat us alive. The Russia’s power mad. She wants to take our cars from out our garages.
Her wants to grab Chicago. Her needs a Red Reader’s Digest. Her wants our auto plants in Siberia. Him big bureaucracy running our fillingstations.
That no good. Ugh. Him make Indians learn read. Him need big black niggers. Hah. Her make us all work sixteen hours a day. Help.
America this is quite serious.
America this is the impression I get from looking in the television set.
America is this correct?
I’d better get right down to the job.
It’s true I don’t want to join the Army or turn lathes in precision parts factories, I’m nearsighted and psychopathic anyway.
America I’m putting my queer shoulder to the wheel.
Berkeley, January 17, 1956

That’s me in the corner, that’s me in the spotlight (or, the fault in our star)

03 Tuesday Mar 2020

Posted by in christianity, empathy, Evil, love, medicine, romance, Sin, Uncategorized

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losing my religion:  southern term for losing one’s temper, “flying off the handle,” going insane  etc. Note that the R.E.M. song of this title has nothing to do with religion, despite the common misinterpretation of the phrase.

Oh, life is bigger
It’s bigger
Than you and you are not me
The lengths that I will go to
The distance in your eyes
Oh no, I’ve said too much
I set it up

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I don’t remember which one became my patient first. I think it was Him. But it could have been Her. He was initially more memorable. He liked to show me pictures. Of his woodworking and antiques he’d restored. Of his boys. Of the squirrels they’d killed that year. I asked him not to show me the squirrels but he did anyway. She was quiet. Told me about the jewelry she made and the things she grew in her garden and foraged for in the forest. I do remember the day I realized they were a couple. That he was the he she talked about and she was the she he talked about. The “Ohhhhh” moment. The “oh wait, she’s *that* She and he’s *that* He!” It happens a lot in my rural practice. Six degrees of separation is not a thing in rural northwest Pennsylvania. It’s more like two.
*
They started coming to their appointments together eventually. They would tell me about their garden and their yard and the retaining wall they were battling to put up. And they would tell me about things addiction patients in rural northwest Pennsylvania tell you about. Meth and heroin and jail and stealing from the people you love and five year old kids calling 911 when their mom overdoses. They’d both been clean a long time, but everyone had relatives and friends still lost in it. They were no exception.
*
They gave me things. A piece of amethyst they’d hunted and extracted themselves. A small glass vase with a flower from her garden. She gave me gardening tips, foraging tips, taught me some herbalism.
*
They were always late. Always. That was a given. And that was okay. As long as they came. Sometimes they mixed up their days and we’d get a call a couple days later and fit them in the schedule for another day. I always held my breath until they called. Because you never know. You never really know if something didn’t happen and if they’re really all right.
*
And so it happened that they came in a week or so after their appointment in early February. I wasn’t at my office in northwest PA so they came to my office in Verona. Sam got to meet them for the first time. They got to see my other office, which is fairy tale themed. I knew she’d like it.
*
She wasn’t herself that day, though. She was sad. So damn sad. He had to talk for her for most of the appointment because she couldn’t stop crying. She’d been depressed. But it was more than that. She’d been having pain in her side a while now and it was getting worse. She’d gone to the ER and they’d drawn blood work which came back with an abnormality but when they tried to get an IV in so they could run some imaging tests, the nurse couldn’t get it. They kept poking her over and over and she ended up leaving the ER.
*
I asked her some questions to see if I thought she needed to go to the ER right now (it had been a couple days since leaving the ER and she hadn’t gone back yet). Based on her answers I told her I didn’t think it was an emergency but she needed to go back and get the test done. I said maybe she could try going to a different ER where the nurses were better. We talked about her depression and I started her on an antidepressant and told her to email me in a couple weeks to let me know if it seemed to be helping at all so we could work on the dosing.
*
I had a crystal sitting there. Malachite. A pretty dark green stone. I’d been feeling for a couple of days I was supposed to do something with it. An odd feeling kind of hard to describe. Like, restlessness. But with a stone. And before she left I took it and said, here, I want you to have this. And she told me she had something for me too. It was a necklace she’d made but she’d felt timid about giving it to me. But when I gave her the crystal, she said, she felt okay to give me the necklace.
*
He said, (or maybe she said?) that it was fitting because it had a star on it and pointed to my walls. The room we were in has a Sleeping Beauty theme and is covered in stars. (It is based off something I wrote about kids with PANDAS battling the disorder and emerging from it, like sleeping beauties waking up). I took it and told her I loved it. And I did. When I went to put it on, the chain broke, so I put it in my pocket. My back jeans pocket. And we walked out together and said our goodbyes. And Sam said they were sweet and I said I was worried about her. And I was.
*
Somewhere between there and my kitchen, I lost it. The necklace, that is. I realized it later that night and told myself, it’s here somewhere. It’s not gone. It hasn’t fallen off planet Earth. You’ll find it (this is the same thing I say to my children when they are panicking over something they’ve lost. I find it is helpful to give myself the same talks I give them pretty often). I looked a couple places I thought it must be (the cubby over my coat hook by the front door, the back pocket of those jeans I’d since thrown in the hamper) but it wasn’t. Over the next few days I looked a few other places and it wasn’t there either. I tried to remain calm.
*
Then a week later I found it. I was trying to dig a quarter out of my left coat pocket for a cashier, in line ahead of a grumpy resentful old man in the Giant Eagle “12 Items or Fewer” lane and I pulled it out instead. I was relieved. He didn’t care. At all.
*
I went to coffee with a friend that morning (please note: this is a rare occurrence) and stopped in at the crystal shop across the street (please note: this is not a rare occurrence). It had been quite a while since I’d received that amethyst. A lot had changed. And I now frequented the local crystal shop (thus, the malachite). I was browsing on this particular day and saw a necklace with a stone in it that looked like the one my patient had given me. I excitedly drew the necklace from my left pocket and held it up side by side to the other and they were an exact match. I told the women in the shop the story of the necklace and asked what the crystal was. They told me and I asked if I could take the little card that had the name of it and its meaning and they said yes. And they said how sweet it was my patient had made me a necklace. And I said, yes she’s very sweet.
*
The next day I was answering the phone (Sam was out of town and I was like a dad on a laundry detergent commercial, drowning in ineptness with a lost look on my face, trying to perform basic office functions). I was relieved when a familiar voice spoke back to me. It was him. And then it happened. One of those moments. One of those moments that create a Before and After in your life. He told me she had cancer. One of the really bad ones. There’s no such thing as a good cancer. But there are such things as really bad ones. That’s what she had. I stopped breathing for a few seconds. Parastalsis slowed. I got goosebumps (the medical term for that is piloerection. It’s the same thing that makes a porcupine’s quills stand up when it sees a predator. It’s supposed to make us look bigger and scarier, in theory. It does not, in practice). In my head I thought, “Fuuuuuuuuccccckkkkk.” I did not say this to him. I asked how she was. I asked him a series of questions trying to get more medical type details. I tried to get him to say something that would make me realize he’d gotten it wrong and it wasn’t actually cancer. It didn’t work. He said she was resting but I should call her later. I said I would. Even though I was scared to. Because there’s nothing really great you can say. Because you’re a doctor and you’re supposed to fix people and this is not something you can fix.
*
Her palliative care doctor called a little while later while I was on the other line with someone considering making a medical marijuana appointment for anxiety. They had a hundred questions and, in the end, said they’d call back once they decided what to do. I listened to his voicemail and frantically wrote down his number and called him right back. He was nice. God help me, he was a genuinely nice, caring doctor. If you knew doctors like I know doctors, the way they actually talk when there aren’t patients around, you’d know how rare a thing that is. He hadn’t seen her yet (the appointment was for the next day) but he wanted to touch base with me since I prescribe her a controlled substance and his role was pain management (also prescribed substances).
*
When I talked to her that night (well, to her voicemail), I let her know the pain doc was good people and would take good care of her. And he did. We have texted and talked since then, each step along the way, She and I. He and I. And even the palliative doc and I. There is more to it than this, various details you might not expect. But the heart of it is this: a really beautiful human being is sick with something she likely won’t survive. She is in a lot of pain. And the man who loves her is doing an amazing job supporting her through it. He is an unlikely romantic hero. Not a sappy, trite one. A genuine romantic hero. And she is a warrior. Strong and smart and intuitive and kind and creative and honest. And she is so damn young. Too damn young for this shit.
*
And so it was that I came to wear a star necklace everyday (I ordered a new chain for it the day he called with the news. I kept it in my pocket until the chain arrived). And so it was that I came to wear that necklace the night I ran into a good Christian I know.
*
The Good Christian looked at it in horror. Genuine fear in his eyes. And he said, “Have you lost Jesus?” He was distressed. I looked at him and said, “What?” And he pointed to my necklace and said it was a witch’s necklace, a Wiccan necklace. I said, it’s a star. A patient made it for me. That doesn’t mean I’ve lost Jesus. He looked… freaked the hell out.
*
And I thought of the word the palliative care doctor had used when he told me about her CT scan. Innumerable mets. Meaning, the cancer had spread to so many spots, the radiologist gave up counting. I remember when he told me that I wondered, at what point do they stop counting? 10, 20, 100? Maybe that particular radiologist was lazy and she really only has 3. But that’s not likely. When he used that word, innumerable, the hope I’d held out faded away. And I began to focus on how we could all support her in finding peace and being comfortable and doing the things with her last months she’d like to do. Because, lets be honest, doctors very rarely actually fix patients anyway. So maybe this very nice palliative care doctor and I could help her with these things. Hopefully I could be of use.
*
I thought of that word, innumerable. And I thought of the cancer growing inside her. And about how brave she is. And how sweet her he is. And I looked at this Good Christian and saw something in him. A different kind of cancer. One with innumerable mets to the soul. Dark and sticky. Inoperable. Incurable.
*
And I thought, this patient knows more about Jesus than you ever will. Because Jesus is love. And she is full of love. And she has brought joy and love to so many people. And she will keep doing that. Despite it all. She will keep inspiring other people to love. And she knows that I love her. And she lets me love her. And loves me back.
*
And that, dear reader, is not something the Good Christian is capable of. Not something he even understands. And that is why a necklace can inspire a look of dread and disgust in him. A star. An innocent little star.
*
I told my kids a bedtime story tonight. The boy in the story was looking up at the night sky when a shooting star appeared. My daughter got so excited and was urgently shouting “make a wish quick! Before it’s gone!” She was nervous the boy in the story would miss it. Because everyone knows if you make a wish on a shooting star, it comes true. Because that is what stars are for. To wish upon, to make our dreams come true as we sleep beneath their lovely glow. They’re magical. And shooting stars? They’re actually little burning meteors,  magical, glowing rocks. Kind of like amethyst or malachite.
*
If taking comfort in that means I’ve lost Jesus, dear reader, then consider me lost. Because not every sleeping beauty wakes back up at the end of the story. Sometimes her true love kisses her goodnight one last time. And releases her to shine down on us and remind us of who we are, innumerable stars in an endless universe connected to one another always.

 

***

Oh, life is bigger
It’s bigger
Than you and you are not me
The lengths that I will go to
The distance in your eyes
Oh no, I’ve said too much
I set it up
That’s me in the corner
That’s me in the spotlight
Losing my religion
Trying to keep up with you
And I don’t know if I can do it
Oh no, I’ve said too much
I haven’t said enough
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
Every whisper
Of every waking hour
I’m choosing my confessions
Trying to keep an eye on you
Like a hurt lost and blinded fool, fool
Oh no, I’ve said too much
I set it up
Consider this
Consider this
The hint of the century
Consider this
The slip that brought me
To my knees failed
What if all these fantasies
Come flailing around
Now I’ve said too much
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
But that was just a dream
That was just a dream
That’s me in the corner
That’s me in the spotlight
Losing my religion
Trying to keep up with you
And I don’t know if I can do it
Oh no, I’ve said too much
I haven’t said enough
I thought that I heard you laughing
I thought that I heard you sing
I think I thought I saw you try
But that was just a dream
Try, cry
Why try?
That was just a dream, just a dream, just a dream
Dream

2016 was-boop!-a little-boop!- stressful boop boop!

19 Monday Dec 2016

Posted by in autism, christianity, love, special needs

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2016 was a helluva whaddayagonnado kinda year. Bernie rose and then had the election stolen from him by corporate Democrats. Trump won, ushering in an age of all out fascism. Brock Turner got a slap on the wrist for rape. Various police got absolutely nothing for murdering people of color. Aleppo. Standing rock protestors getting limbs ripped off for peacefully protesting. Global warming it is now unavoidably obvious is going to kill us all off pretty soon.

On a more personal front (hey, stick with me here. this post will take a positive turn soon. I swear), my autistic legally blind son got horribly bullied in our school district. My other son’s anxiety reached an all time high and his tics escalated to a whole new dimension. My marriage disintegrated, culminating in separation. I had a post-pregnancy hormonally induced mental health episode. My cousin died from mental health problems. A dear kind friend died from overdose. I found out some other beautiful friends from high school are on heroin (and therefore, will die soon enough. opiates are what they are). I broke off with my family. Is that enough, people? You want more? Oh yeah, our four year old still isn’t potty trained…

But here’s the thing:

Millions of people voted for, donated to, fought for a Jewish democratic socialist who demanded universal health care, maternity leave,  a $15 minimum wage and a kinder approach to Palestine. If you’d told me in 2015 that would happen, I’d have told you that you were nuts. And even though Bernie didn’t win, he’s still out there fighting like hell. And people listen.

For the first time ever, we actually talked about rape and the disgustingly low conviction rates and sentence lengths, as a nation. Some people even said “rape”. Do you realize how huge that is? (Most of the headlines still used euphemistic bullshit and called it “sex” but, hey, it’s movement).

Indigenous activists and their allies won. Won. The people who have endured the most, who have had the most stolen from them, who have suffered the most violence, in this nation won.  Did you expect that? I didn’t. They worked and sacrificed and prayed and endured and… won.

Pennsylvania (my home state) legalized medical marijuana despite the ill informed Pennsylvania medical society opposing it. I did not expect this. It’s huge.

My legally blind son with autism started at a new school (not in our district) where he is thriving. He went to an amazing therapeutic summer camp. He’s made more progress at his new school than he’s made in the past few years combined.

My son with anxiety got a great psychiatrist and got comfortable at his school and is doing a ton better. (and he doesn’t make his “boop” tic unless things are really stressful now. Boop!)

My most recent episode combined with other events from this year caused me to truly shift the way I approach my mental health. I’m now committed to doing every single little thing I need to do to keep myself healthy. No matter what. I’m working through issues I thought were un-workable. I’m feeling more optimistic than I have since I was five. About myself, my kids, my marriage.

I worked through my lack of enthusiasm for Catholicism and have started a whole new kind of Catholicism in our home. I’m reconnecting with the mystical.

My son sang beautifully in his school musical. I had one of the happiest days of my life taking my daughter to the Nutcracker. My son with autism can now get his head wet in the pool without melting down (after 8 weeks of twice daily swim classes at his awesome therapeutic summer camp). My baby turned one and still has the chubbiest most delectable thighs you’ve ever seen. He calls me Mama and loves the water like a fish.

I prescribed suboxone to a lot of patients who hopefully will not die from opiates as a result. I started at a new urgent care where I actually have time to talk to my patients. I had a paper on intimate partner violence published in American Family Physician and got invited to speak at some medical education events.

I’m not going to sugar coat things. I’ve got nothing to say to you about Trump or this country’s refusal to face the racist police violence plaguing us. Global warming’s not looking good either. But, as Howard Zinn said, pessimism is illogical. Amazing things you didn’t see coming happen all the time. Look how many in 2016 alone? And, as my old pastor used to say, God is good all the time. All the time, God is good.

Happy holidays, everyone. Here’s to finding out what 2017 holds for us.

joy is a choice

19 Monday Dec 2016

Posted by in kids

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I have been on a diet for a few months now. I’ve lost 30 pounds. Losing steadily week by week. And then a few weeks ago I began to struggle. I stepped on the scale fo r my weekly weigh-in the day after Thanksgiving and had only lost 0.8 pounds. I was upset. I was pissed. This was not acceptable.

I decided I was going to show my diet who was boss. So, I began a fast. I wasn’t not eating at all, I reasoned. And really, Advent is a time you’re supposed to fast anyway, I reasoned. I was, of course, full of shit. I ate very very little for a week and, not surprisingly, when I stepped on that scale a week later I had lost 8 pounds. Eight pounds! In a week! Woo hoo! I’ll be at fighting weight in a few weeks!

I imagine you can guess what comes next.

I continued my oh-so-religious-not-unhealthy-at-all “fast” a few more days and then I crashed. As happens. I ate a whole lotta junk. So, I told myself, well, I’ll just go back to the weight watchers. 30 points a day. fruits and veggies are 0 points. I’ll just go back to that and then I won’t regain the 8 pounds. Still dreaming of the holy grail of being at Goal Weight.  I reasoned that since I don’t have any clothes that fit me right now and since I can’t justify buying any new clothes until I am at my end weight, why it only made sense that I really *needed* to lost 3-5 pounds a week instead of that BS “1-2 pounds a week for healthy weight loss” they were always selling.

I imagine you can guess what comes next.

I didn’t stick to my 30 points. I bargained with myself further: okay, self, if you must eat more than the allotted 30 points a day, then at least *record* everything eaten. At least stay on track *that* much.

I imagine you can guess what comes next.

It’s been two weeks of my Angel making various bargains with my Devil. And the Devil laughing as she inhales candied nuts and dairy free egg nog.

I raised the white flag last night and decided to sit down and journal it out and see what’s going on. There are a lot of factors at play: my hormones are out of whack because I’m weaning my son, it’s THE HOLIDAYS and yummy comfort food is EVERYWHERE, being on a diet for 12 weeks is really hard and gets a little old after a while, I worked six days straight right as this downfall was starting (I work 12 hour urgent care shifts so this is no small thing. Honestly, working more than 3 in a row is pretty awful), and I’m pretty damned stressed since this is my first Christmas without my family. Also, my son with autism starts getting a little… shall we say, difficult this time of year because routines are getting out of whack with the holidays. Also, we’ve all been sick with colds (#UrgentCareLife).

But it isn’t just that I’ve been eating a bit more than I should or saying Yes to more cookies passed my way than I’d planned. I’ve returned to an old pattern of eating I’ve had since I was ten. (See this entry for more on that). So, I journaled away.

It’s this feeling that I have this hunger in me that will never be filled. Like I could consume the whole universe and I would still not be satisfied. It would still not be enough. I try and try to fill it. It’s exhausting. It’s a big black hole that won’t go away.

Because it is not something that can be filled with food. It’s trite but it’s true.

It is a hunger so wide and so deep. An ocean. No land in sight. And I am alone on a little boat. You can scream all you want but no one will hear.

It is something that must be filled with love and joy and speaking your truth and having someone hear and knowing you’re resilient and having faith it’s going to be okay. all of it. Filled with my son’s drawings and my daughter’s songs and my other son finally learning addition and my baby saying Uh oh! Filled with God and his saints and Hebrew prayers and oplatka and incense and chanting. Filled with the rhythm of the year and laughing when you really want to cry and doing what’s right even when it’s hard. Because life brings pain but we decide how much we suffer. And joy is a choice.

I am blessed with four beautiful children. I am blessed to be a physician. I am blessed to have been called to Catholicism. I am blessed to live in a warm home and drive a safe car and to be able to buy my children the things they need and some of the things they want. I am blessed to have grit. I am blessed because I am not alone. And it is not an endless ocean. Just puddles we’re jumping through. And in between, we laugh.

 

The demons they won’t fight

14 Friday Oct 2016

Posted by in empathy, love, Sin

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When I was fifteen, I met a wonderful, intense, intelligent. creative, amazing, intoxicating group of boys who made me feel so alive. They swore and smoked cigarettes and drank beer and smoked pot out of a Coke can bowl. They were nothing like me. I was a quiet, shy girl who’d never sworn or done anything else good girls aren’t supposed to.

I spent the next three years with them, going on adventures always exciting and sometimes terrifying. They introduced me to William S. Burroughs and Jack Kerouac and E.E. Cummings. To grunge and industrial and Irvine Welsh and surrealist art. We were so intensely alive. In love. All of us.

They also did a lot of drugs during these years. I did not. I started to swear, I’ll admit, but I wasn’t into drugs. I was the permanent designated driver for three years straight. I was into political activism and applying to college and various other positive activities they thought were a waste of time. They started out with just pot and beer. They made fun of stoners and burnouts. Kids who did heroin and crack and too much acid. But by the end of high school, they were the kids doing crack and meth and tripping on shrooms.

One didn’t graduate. Another dropped out of college the third day. Another dropped out a year or two later. They all descended into more and more drugs and alcoholism. I would see the poetry and genius in them every now and then but it became less and less common. I knew they were in there somewhere. Somewhere. Deep inside.

I wanted to help them. Wanted to save them. I tried. They knew they needed to change and they would try every now and then to quit. They would try giving up beer and just drinking liquor. Giving up pot and just drinking. Giving up alcohol and just smoking pot. Giving up cocaine and just taking pills. It never worked.

I felt bad for them. I knew there was a sadness in them so deep and so wide. They were trying to fill it with drugs. I wanted to save them from that darkness. They were capable of so much. I loved them so much. But it wasn’t enough.

I realized one day that they loved drugs more than they loved me. More than they loved each other. Maybe it was the night they let one of their friends die from an overdose rather than dump him at the ER because they were afraid of getting caught and I was the only one who seemed to care. Maybe it was no special day in particular. I looked at them and knew. Knew they loved drugs more and it was time to let them go. As much as I loved them, they didn’t really love me anymore. You can’t save someone who doesn’t want to be saved and all that. It was time to let go.

People criticized me for it. Said I should have helped them more. How could I abandon my poor lost friends like that. And I’ll admit it made me sad at the time. But I never regretted doing it. Never regretted saving myself. Never doubted the fact that they would never change.

A time like this comes to all the relationships we end in life. The day you figure out the person you love, loves something or someone else more than they love you and that’s not all right. You stop asking, do they love me or not? They do, but not enough. They do not love you more than their dysfunction, the demons they won’t fight.

When you let them go and with them your guilt, you are light. You are free. You have fought the good fight and given them your best. And now you are free. For better things.

Better Living Through Science

21 Wednesday Jan 2015

Posted by in autism, doctors, empathy, kids, medicine, parenting, Sin, special needs

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I’ll admit I spend a good amount of time on Facebook. I like to see what politcal/social justice type things my friends from college are up to. I like to post pictures of my kids for distant friends to see. Sometimes I’ll take one of those quizzes: Which Golden Girl are you? (I got Rose, in case you’re wondering. I was really hoping for Dorothy but I guess I haven’t matured to her level of sass and pith quite yet). One thing that dominates my feed is posting from my fellow doctors and nurses bashing parents who don’t vaccinate their kids. And yes, I mean bashing. I don’t mean expressing concern for their children. I don’t mean seeking to find ways to turn the tide of increasing numbers of people not vaccinating their kids. I mean, bitching about them and how they’re screwing up herd immunity for the rest of us because they are bad people who ignore science.

I have issues with this.

Ironically, these people of science are not being scientific at all. The whole argument is that these crazed non-vaccinators are ignoring science. They’re irrational. They’re backwards. They’re stupid. They’re ignorant. The problem with this argument is that the accusers here are ignoring the fact that *they* themselves are not being scientific. Let’s look at the facts:

-By and large, non-vaccinating parents are highly educated with average to above average intelligence. That’s what the research shows us. Most of them have read everything their doctors have read and come to the decision that it’s not compelling evidence to them for one reason or another. So, calling them stupid or irrational simply isn’t accurate.

-Most parents who do not initially vaccinate will vaccinate their children within a few years. The vast majority of patients questioning vaccination cite their doctor as their most trusted source of information. But here’s the rub: the research shows that if their doctor comes at them with the attitude most doctors hold, these parents actually become *more* likey to not vaccinate. What has been shown to work, scientifically, is for physicians to engage in respectful, open minded dialogue with them and not engage in scare tactics etc.

We have an obligation as physcians to pediatric patients of these parents and also to the greater community and society. We’re tossing aside evidence based medicine and compromising both with our attitudes towards these parents.

Why? Basically because this topic makes most doctors really really mad. And we allow really really mad to get in the way of our obligation to these kids. We find it emotionally comfortable to get angry and make it into a moral failing in these parents. Some of it is righteous anger in defense of community health. Some of it is control issues. We don’t like it when patients don’t do what we say. We got into medicine to help people and now they’re not letting us help them. Maybe it makes us sad to see them hurting themselves. Maybe it pisses us off they’re messing up our plan.

I was discussing a law recently with some fellow residents that I read about going into effect recently in a southern state. They were starting to arrest mothers who did illegal drugs while pregnant once the babies were born. Two of us thought it was a terrible law because addiction is a disease and criminalizaing it really wasn’t the answer. Putting a baby’s mother in jail soon after birth is incredibly obviously not good for a baby. Knowing she’ll go to jail if she delivers her addicted baby in the hospital will inevitably lead to some of these mothers delivering their babies at home and not getting proper medical care. They’re certainly going to be more likely to lie to their physicians about what drugs they’ve been doing. The resident in favor of the law was adament that these women must be punished. They’ve harmed their child and they must be punished. The fact that this law was only going to hurt these babies further was not the issue here. Addiction was not a disease, it was a moral failing.

The truth of it is, it is simply easier and more satisfying to write these non-vaccinating parents off as kooks and lost causes. But if you truly believe not vaccinating their children (your patient) puts them at risk, you have a moral obligation to not write them off as a lost cause. You are that child’s advocate. You are a physician practicing evidence based medicine. So act like it.

Parents who are simply questioning vaccinating may or may not know much about it. So, guage how much they know and offer them education in a respectful way. Talk when appropriate and listen when appropriate. Don’t engage in scare tactics. Show them some compassion. This will maximize the chances they will vaccinate today or soon therafter. In case we’re not clear on this: making them sign a release recognizing they’re placing their child’s life at risk by not vaccinating is not productive in this regard.

Some parents are at the point where they are refusing to vaccinate and have probably read up on a lot of what you have to tell them about vaccine safety and efficacy. If you can tell they’re already familiar with the information you have to offer, it’s time for you to sit and listen. Ask them why they don’t want to vaccinate and listen respectfully and compassionately. If they’re open to your responding, then go ahead and respond. If they’re not, then thank them for sharing with you and let them know you truly believe vaccination is the best thing for their child and that you hope the dialogue can be kept open at future visits.

If the above approach chafes your chaps, if it seems just plain wrong, that’s a perfectly valid feeling you’re having; but it certainly isn’t scientific.

Instead of reading self-congratulary after self-congratulatory article on how awful these non-vaccinators are, you’d be better served to read up on why parents make that choice. Better yet, try talking to a few of them. As a mom of a child with autism, I can tell you there are plenty of parents in that community who would be more than willing to talk to you about it. Step back from the moralistc thinking and consider all the psychological and social reasons parents might have to make this socially unpopular choice. What life experiences have they had that have led them down this path?

One thing I try to stress to my interns starting out in residency is that there’s a place for book knowledge but most of what you need to know about being a good doctor comes from experience. Your experience as you go along and learning from the experiences of the doctors teaching you who’ve been at it so much longer than you. If you’ve seen a child suffering from a vaccine preventable disease, you’re most likely eager to share that with your patients. But, you’re better off trying to find out about their experiences affecting this decision. Scientifically speaking.

One common misconception amongst the American public that upsets physicians is the idea that vaccines cause autism. How can so many people believe this stil?! It’s been scientifically disproven! Heck, it’s even been anecdotally disproven in the case of thimerosol. Let’s get rid of the exclamation points and ask that question for real. Why is it that people still believe all vaccines or MMR or vaccines containing thimerosol cause autism? Is it all due to that villain Dr. Wakefiled who published that now discredited study in the Lancet? Has he mesmerized these foolish parents? Or could there be a more logical explanation. Perhaps one explained by medicine?

Let’s set aside the vaccine facts for a minute here and consider some facts that are at the core of every family’s life who has a child on the autism spectrum:

1. Doctors do not know what causes autism
2. They’re pretty sure it’s a genetic predisposition that gets triggered but they don’t know what’s triggering it
3. But they’re pretty sure it must be mulptiple things because they can’t really find any one thing these kids have in common
4. Doctors have no cure for autism
5. Doctors don’t even have a very good treatment for it
6. Most PCP’s don’t know nearly as much about autism as an informed parent. As PCP’s, we’re generalists and it’s not something stressed in med school
7. The rate of autism keeps climbing and the truth of it is, scientifically speaking, we don’t really know why

Can you honestly tell me a parent in this situation would be irrational to question things that are dogma to modern medicine such as vaccines? Modern medicine has failed them. What they need from you is not a lecture or an anecdote of what can happen to unvaccinated kids. Assurance of the rarity of adverse events from vaccines (and yes, there are rare but quite serious effects at times) will not comfort them. They need their trust in medicine restored. And that begins with you, the PCP. I say begins because it is a process that can’t be rushed. You have to sit with them, sit with the uncertainty and anger and helplessness that comes with special needs parenting. You need to show them their child is your patient who you care about. That you see the challenges and the joys of their life. To show them that this isn’t about a battle for control. That you want what’s best for their child. And that you’re open to learning from them. That it really is a dialogue and not a lecture.

Only 1% of parents in Pennsylvania choose not to vaccinate their child, but the lessons we can learn from this issue will make us better doctors in a lot of ways. And better people for that matter.

Listen. Empathize. Validate. Assert. Repeat.

I often tell my kids: it’s okay to get angry. It’s not bad to feel angry. But when we get angry, we have to make good choices of what to do with that anger. I think we could all stand to hear that on a regular basis. So, my fellow physicians: it’s okay to get angry about vaccination. It’s not bad to feel angry. But you need to make good choices.

You’re a physician practicing evidence based medicine. So act like it.