8.20.22: Watched ‘Fall’ at a matinee this afternoon: https://youtu.be/aa5MXOMN1lM

Took a couple pictures in case you don’t want to watch the trailer:

Probably broke a dozen California laws posting those pictures so I hope you all appreciate them!

Bored as heck. All I need to do before Tuesday is a COVID test on Monday, and then finding a notary to get my Advance Directive completed. Supposedly they have notaries at the UPS store.

Nancy has been very patient with all of this. She is stuck here for weeks too, and she doesn’t even get any narcotics!! That’s a JOKE by the way….

If anyone has a great series we should watch, send me an email and let me know. Finished Fleabag last night, and I give the series a couple thumbs up. But maybe don’t watch it with your mother (unless she is extremely sexual, in which case she might like it!).

Oh…. here is something to mention… in ‘Fall’, the big message was that ‘life is short, so take on challenges and live it out as big as you can’. But then at the end, they repeat that and it isn’t clear whether they are only messing with the audience, or whether the suggestion is intended to be taken seriously. Personally after watching the movie I don’t feel like doing anything at all beyond sitting in a chair at home! Let me know if you got something deep out of it.

BUT.. I will go off on a message that I hope most of my patients get from me, either now or from appointments in the past or future: Most of the people I’ve seen over the past 15 years have made amazing changes in their lives. Society still puts a scarlet A on people who go through a bout of addiction, but those who judge have little or know idea of how well many people do. The reason I like addiction medicine so much is because it is a specialty where I see people start from a horrible place, and progress to a much better place.

But there are people who, for whatever reason, do not use their ‘second chance’ as I wish they would. I mentioned Woody Allen… in ‘Annie Hall’ he says that relationships are like sharks in that they have to keep moving forward, or else they die (he described his relationhip in that movie as a ‘dead shark’). Recovery is like that too. BTW the word ‘recovery’ is so overused and stigmatized that I wish I had something better to describe the process… I wish we could just see addiction the way we see ANY illness, and talk about ‘being sick’ and ‘getting healthy’. Maybe once we figure out which pronouns everyone should use, we can work on other terms…

Some people go through a course of addiction, get treatment, and do better. I find those people to generally be better off psychologically than they would have been, had addiction never entered their lives. After all, the experience teaches us who are real friends are, and who they aren’t. It washes away all of the superficial BS that most people obsess over. And it leaves a person acutely aware of how easily things that we value, can be lost – and never gotten back again.

I was a Bio major in college but a few other topics stuck with me… Diane Arbus was a photrapher whose last works were about ‘freaks’ — dwarfs and other circus performers who were born with horrible deformities. One of her more-famous quotes was that ‘Most people go through life dreading they’ll have a traumatic experience. Freaks were born with their trauma. They’ve already passed their test in life. They’re aristocrats. More here: https://www.artsy.net/article/artsy-editorial-revisiting-diane-arbuss-final-controversial-series

I”m not saying addiction patients are ‘freaks’… or that their experiences are the same as the people referred to by Arbus. But there are similaries in the way they are viewed by society. Frankly, I’ll never interact the same as I did a month ago when I come across anyone in a wheelchair, for the same reasons. I think you all get my point…

I have to add here that Woody Allen (gosh, why am I so stuck on this guy??) said that the world consists of ‘the miserable and the horrible’. The horrible are people who suffer from the worst diseases, who are born and raised in horrible conditions… and the miserable are everyone else…

Back to my point… but some patients, a minority, don’t seem to learn as much from their experiences. I have had patients who did great for years, who I came to respect in many ways… who got caught up in methamphetamine (which from what I’ve seen is the fastest way to lose everything). Relapse to opioids has been extremely rare in my patients — maybe 1% at most (of about 700 patients). But some of my current patients still have friendships with ‘active users’, and even hang with those people. You know who you are, and I do too… the people who end up having meds stolen, who go from one crisis to the next, who can never come up with money for an appointment at a time when starting pay is well over $20/hr in our small town.

Don’t be a dead shark! Move forward. If you’re young and healthy, get to work! Yes, I realize what a judgy post this has become, but some people really need to get this message. A recession IS coming, if it isn’t already here – and the people who are satisfied right now be working part-time so that they can ‘focus on their lives’ are going to be the first to be laid off next year. Should ‘doing better in life’ really require that a person WORKS a JOB?? I don’t know if it ‘should’. But it DOES. My patients who work hard almost never slip backwards. Those with lots of idle time? THOSE are the patients I always worry about. If you are reading this, and having trouble moving in the right direction, let’s talk about it when we meet later this year.

Looks like pizza tonight. Did Uber eats for the first time a couple days ago… are you supposed to tip the restaurant? or just the driver? or both??

8.21.22: A long, boring Sunday… Nancy has read 3 books in the past week. I tell her to think of this as being in prison, with only a few days to go. I worked in a max female prison (TCI) for few years btw… I was surprised that the new ‘residents’ (they were not called inmates) all had to be in the max unit for at least the first month, and they had no ability to use a phone or see visitors. The worst thing (besides being stuck in a room, bored for most of the day, over and over) was the lack of privacy. Women who ‘acted out’ would end up in the ‘obs’ unit – a line of cells aross the hall from the guard unit, with the facing cell wall entirely glass and transparent. Women were often there on suicide watch, so they were not allowed clothing. Entrants to the unit walked down that hall, pass the glass walls, to get to the other cells, including ‘isolation’, where some people were held as long as a year, entirely alone. One hour per day to stand in a concrete-walled square room, with a view of only the sky. The women got clothes during a brief time during a lawsuit, when inspectors would visit.

I know I can be over-dramatic. But this is a tough operation — tough for the surgeons I mean. I have a lot of peripheral disease, where the vessels are tiny. In the past few years they have attempted to work on smaller and smaller vessels, but that’s where the risk is with this operation. I’m not afraid of death, although I know many of you are afraid of my death, given the horrible options for people on buprenorphine. If I die, I’m truly sorry. I’m not joking. I feel guilty about this situation, and I wish I’d been able to provide more warning. I’m realizing that I thought I was healthy until July 19th, when I had the stress test! Even after that, I assumed they would just dissolve the clot. I hadn’t even heard of ‘CTEPH’, but I know all about it now!

As an aside, if I die, you all know, hopefully, that there is nothing that Nancy can do. She is my employee, just like an employee at the hospital or any office. She has been able to call in a prescription if I tell her exactly what to order — but if I can’t tell her what to order, she cannot call a pharmacy from my office for any reason. I am the sole owner of the practice, so the practice will cease to exist if I die. I’m sorry, again — but I also want her to be with family, focusing on whatever she needs to focus on to move forward – and that will not include FDL Psychiatry. Please use NAABT.org to get a new doc; they are out there more and more, and hopefully you’ll be OK. I also suggest checking here, and if you don’t see anything from me a week from now, reduce your dose of buprenorphine by half. Consider a reduction in dose even now.

My PLAN is to be back at work by October. They tell me that the recovery will be difficult, but they won’t what the difficulty will be because there are so many different things that can happen. If my lungs bleed, I might need reoperation. Infection or sternal dehiscence would keep me hospitalized. My biggest fear is stroke, after recently reading about actor Bill Paxton’s family’s lawsuit after he death a few years ago (heart valve/aorta repair and a stroke 11 days later).

But if I die, I’ll either be in a better place, or I will cease to exist. I read a great deal about consciousness research… an article came out recently about how understanding consciousness depends on understanding theories of relativity. I’ll let anyone interested look it up from there…. another recent article discussed theories about WHY our universe exists, and how odd it is that we have just the right quailities in this universe, this galaxy, and this solar system to allow for carbon-based life forms. Y’know, if it wasn’t for the giant planet Jupiter, Earth would be inundated with meteors that would have made the planet a mass of dead rock, millions or billions of years ago.

8.22.22: Mojo day! No more morbid stuff. I posted some thoughts about death last night but Nancy read them and asked me to remove them. I think she was correct. I don’t want to go into all of this with a negative attitude.

I’m so appreciative of your emails. All of you who’ve written have expressed yourselves so well. One of you even went through emails I’ve sent over the years, and turned them around toward me — which provided me with a slap of insight that I really appreciate. Funny how it is so much easier for me to offer suggestions for others than to remember them myself!

Did the third COVID test. I have tested negative through the whole pandemic despite living in rural WI, where we ditched masks well over a year ago, while sitting in a small room with most of you numerous times, shopping in grocerty stories, going to Menards and Fleet Farm, etc. My 89-y-o mom tested positive at her assisted living place despite their crazy lockdown procedures, and I sat with her, maskless, for an entire day on a Tuesday, before the result from Monday’s weekly tests came in (she was asymptomatic but tested positive for a couple weeks).

I’m not a fan of broad orders from the government, especially when it isn’t clear how the order will impact society, and when half the country isn’t on board. If find it bizarre that the half of the country that valued free speech and freedom of thought now favors the opposite. If one Googles masks now, you’ll find tons of weak studies claiming that they are ‘effective’ – but that effectiveness varies widely from study to study. Studies comparing Eastern and Western European countries with varying mask usage found little or no value to masks. The problem with science, in general, is that studies that find the ‘popular’ results are much more likely to get through peer review than those with ‘unpopular’ findings. That bias impacts every branch of science, and since the academic community is so uniformly on the left of the spectrum, the bias is magnified.

Obviously, masks are a good idea on a person who is sick and coughing or sneezing. Of course, that masked person is going to be completely covered in active virus from wiping his/her nose, sneezing when the mask was not on earlier in the day, etc — so everything touched by that person will be covered in virus for a day, maybe longer. The person who wipes it down will have areas on the rag that don’t have sufficient cleanser to kill virus, so that rag will likely spread virus to other places. The silliest part of masks is putting one on to get in a restaurant, than taking it off to eat… then putting it on again to walk to the restaurant bathroom. And we all know by now the outcome of the lockdowns and shutdowns – including more suicides and overdose deaths, more mental illness, more division in the country, and who-knows-what horrible impact on the education of young children. I’ve personally heard from so many of you, about your children going from A students to C or D students when classrooms closed.

Of course writing anything but the media line would label me a ‘Trumper’ or a ‘white supremacist’ or worse… no matter what I think about Trump or minorities. A poll last week showed that almost no left-identifying college students would be willing to room with someone from the right. On the other hand, most righ-identifying students WOULD be willing to have a roommate from the left. And that’s frankly been my experience…. I’ve never heard a racist comment from my patients, who talk about all sorts of feelings and thoughts, and who are mostly on the right. I hear complaints about how things have changed so fast in so many ways, but I don’t hear expressions of hatred for people who think differently.

Just realized that the last paragraph is what I get when looking for mojo….

But seriously, people need to spend more time thinking about how to get back to the country we all loved. If your kid can’t interact with other kids in a way the respects diffent ideas, then shame on you! My dad, rest his soul, was firmly on the left. A good man, and a product of his youthful experiences (very poor, raised by a single mother since birth) – so I can’t blame him for this – but sometimes our kids see us more clearly than we even do ourselves – and I noticed how he assigned a group of characteristics to people of a different political party before he even met them. I remember saying in my teens — ‘but you don’t even know him!’ Politicians and the media, have very strong interests in protecting their ‘sides’ – so I long for a day when we all turn them off and tune them out.

I started talking to a guy at the UPS store this AM who was also waiting for a notary. He had a mask on and I didn’t, so I was worried that he would run away… but he talked with me. He said ‘I love Wisconsin- my company did business in Milwaukee and the people there were so friendly and welcoming… it isn’t like that out here.’ I haven’t been here long enough to judge, although I notice that I am always the first one to say ‘hi’ in the hall (or UPS line) and people often look surprised when I start speaking with them. In the Philly suburb where I once lived, people would talk with each other in the park – but that was in Bala Cynwyd, a very close-knit, wealthy community (I lived in an apartment on the outskirts at the time). When we moved back to WI after 11 years away, I was disappointed that people 1. didn’t go to parks, and 2. didn’t interact much if they did. But despite the media narrative, things seem much more integrated in WI (I haven’t seen more than three Black people in La Jolla since I came here, and the three were in the movie theater where ‘Nope’ was playing — honestly!!).

And over the last 30 years I’ve had so many experiences with people I didn’t know, offering to help me out in one way or another — as all of you have. And ‘white supremacists’? Seriously? There were Klan rallies when I was a kid — even the ACLU protected them and the six idiots who marched in them. I’ve never seen an actual swastika tatoo – has anyone? There are idiots on both sides — Antifa on one, Proud Boys on the other. Never met either, but the media seems to elevate them – at least one of them. Why?

Ugh. Politics.

Sorry about the diversion. I spend so much time reading — always science or news. I read the WSJ, NYT, and NY Post mainly. I encourage people to try to understand each other – even when it is difficult or you feel ‘provoked’. Stay calm, and be nice. If the discussion gets heated, don’t do what has been suggested by our ‘leaders’ and go ‘low’. Just wish the person well, and move on. Some and maybe most minds can’t be changed these days. I try my hardest to keep an open mind, and use my knowledge to decide what’s true and what isn’t, what’s best for America and what’s not, what’s good for the human spirit and what destroys that spirit, and what allows people to live with a sense of freedom — and what doesn’t. I’ve stopped reading politics lately because it is truly a waste of time.

I will close with pictures from La Jolla Cove, about 10 minutes from my ‘dorm’. I parked the car and walked down to the ocean, where there were tons of people in a nearby park and others swimming in the ocean — surrounded by sea lions and seals. Then had sushi, which I must admit is pretty incredible out here. But struggled to get back to the car, as I didn’t realize the trip had been all downhill and was uphill going back. I realized that I NEED this surgery.

I don’t know when I will post again. I don’t know if they will let me have my laptop in my room. But a friend will update my progress when I’m unconscious. We’ll talk soon.

La Jolla Cove
La Jolla Cove
Birds in the distance
Entrance to Pacific Ocean
Seals or Sea Lions?
Park, La Jolla Cove
Categories: CTEPHUncategorized


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