Special Victim's Unit

Last night, much to my horror, I became obsessed with evil, uncharitable, unshakable thoughts.  Right -wing thoughts.

         My dark side conversion began, strangely, while watching a PBS special, the kind Rush Limbaugh claims to be part of a Zionist- led  disinformation campaign  to  destroy  our way of life.  He may be right. Perhaps we should stop funneling money to PBS. The funds could be better used to lower Rush’s tax rate, unleashing his job-creating skills to increase employment at Purdue and Eli Lili  pharmaceuticals, makers of Oxycontin and the anti schizophrenic drug, Zyprexia,

                  The documentary was heartbreaking. One third of all Americans are overweight or obese.  Diabetes is an epidemic and this generation may have a shorter lifespan than their parents.  The documentary interviewed a stout teenager, wailing about her weight. “I walk into a room and everyone stares at me! I hate the way I look!” Implied in her wailing was the unasked question,  “Who is going to help me? Who is responsible? ” Cue the Harvard nutritionist who solemnly explained that obesity is a public health crisis, like cholera, and the government has an obligation to protect both its infected and rotund citizens.

         The overweight teen tried dieting, but the documentary explained the American food industry has devised food so addicting and deadly that our hapless teen has been rendered helpless.

         Who is responsible for her obesity?  Her well- dressed, Caucasian, parents were interviewed over dinner. “There’s nothing we can do,” the mom wailed, as she ladled what looked like ½ pound of spaghetti onto her daughter’s plate. I couldn’t help myself. “You’re killing your child with that spaghetti,”  I howled to the television. "Don’t you know anything about nutrition?” Spaghetti: A nutrition-free simple carbohydrate. A bowel of sugar. A Snickers Bar:

Spaghetti:

Nutrition Facts
Serving Size 1 cup of cooked
Amount Per Serving
Calories from Fat 12 Calories 220
% Daily Values*
Total Fat 1.29g			2%
	Saturated Fat 0.245g		1%
	Polyunsaturated Fat 0.444g
	Monounsaturated Fat 0.182g
Cholesterol 0mg			0%
Sodium 325mg			14%
Potassium 63mg
Total Carbohydrate 42.95g			14%
	Dietary Fiber 2.5g		10%
	Sugars 0.78g
Protein 8.06g
Vitamin A 0% Vitamin C 0%
Calcium 1% Iron 10%

Snickers  Candy Bars

Amount per serving
Calories 266		Calories from Fat 98
Hide Daily Values		% Daily Value*
Total Fat 11g			17%
	Saturated Fat 4g		20%
	Polyunsaturated Fat 2g
	Monounsaturated Fat 5g
Cholesterol 8mg			3%
Sodium 130mg			5%
Total Carbohydrates 37g			12%
	Dietary Fiber 1g
	Sugars 28g
Protein 5g
Vitamin A	1%	Vitamin C	0%
Calcium	6%	Iron	4%
Thiamin	2%	Riboflavin	4%
Niacin	10%	Pantothenic Acid	3%
Vitamin B6	3%	Vitamin B12	2%
Folic Acid	1%	Potassium	5%
Phosphorus	11%	Magnesium	10%
Zinc	10%	Copper	8%
* Percent Daily Values are based on a 2,000-calorie diet.

Unnervingly similar, especially when you consider no one eats  just a cup of  spaghetti.

           They interviewed a morbidly obese 4 -year older. “There is nothing we can do,” the dad said. “He cries if he don’t give him snacks.”

         I had the feeling the program was a scam, a put- on, an Andrew Breitbart hoax, except, of course, Andrew is dead.

         “Who buys your food?” I howled at the small innocent rotund child.  I had my first right- wing epiphany: We are responsible for our health, and for the health of children. We are responsible for our weight.          My inner liberal was appalled.   “You insensitive bastard,” she growled. “You know the poor live in food deserts, areas where healthful food is unobtainable.”

         My newly empowered inner Rush snarled back. ” You know that’s not true, even your New York Times has proved   “Food deserts” are a myth  created by the liberal media. The poor have equal access to healthful foods.

http://www.nytimes.com/2012/04/18/health/research/pairing-of-food-deserts-and-obesity-challenged-in-studies.html         Why my sudden, irrational, channeled anger? Victimhood, yet another Right wing issue. I thought of the Chicago  “Why Me?’ women, whose shirts imply victimhood.  “Why You?” Because shit happens.  It’s nothing personal.

         Victimhood.  Have people been coerced to eat themselves to death? I think of the Devil’s Gourmand by John Gouriet:

There once lived 'Pere Gourier' He indulged in murder for amusement, but not by conventional means; such as weapon, poison or suffocation. Gourier wined and dined his victims to death with notable 'sang froid' and entirely legally.

Each 'guest' was gorged daily with rich heavy food at the most expensive and cerebrated restaurants in Paris. This tale of gluttony and greed continued at a rate of about one victim a year until… Gourier then chose for his ninth 'guest', an opponent by name Ameline. He was reputed to have hollow legs which served as reserve stomachs. For two years these two champions battled daily at the table. Ameline, had decided to try to beat him at his own game. He resorted to disappearing for two or three days to purge his body with castor oil and other laxatives.

The end came abruptly one night. Ameline was tucking into his fifteenth sirloin steak, when Gourier struggling one steak behind, suddenly went deathly pale and slumped forward into his plate. The gourmand murderer expired with an sardonic smile on

 his lips, perhaps feeling it fitting he had met his just dessert at the table!

In this story, Mc Donald’s plays the part of  Pere Gourier, offering an endless supply of cheap, toxic food.

         Another food victim is poor Fortunato, from Poe’s Cask of Amontillado, who is rendered senseless by wine,  then entombed in a  wine cellar for all eternity.

He had a weak point -- this Fortunato -- although in other regards he was a man to be respected and even feared. He prided himself on his connoisseurship in wine.

         In this  analogy,   the Amontillado wine represents that  Golden Corral Buffet.

         I wrestle daily with victimhood.  I hate playing the role of victim, it’s demeaning and depressing. I think of friend X.  X means well, and yet I dread X’s frequent phone calls.

         “How are you doing?” X asks in a mournful voice. “You OK?” How are you holding up? Are you in much pain?” Suddenly my mouth throbs, my head hurts. I am being victimized.

Poor, poor pitiful me!

Poor, poor pitiful me!

Oh, these  young girls won't let me be

Lord have mercy on me!

Woe, woe is me!

---Warren Zevon

 X means well, but X’s call leave me shaken. I don’t want to be the victim,  no cancer patient does. I want to be taken seriously.

         Which brings us back to obesity.  Mc Donald’s and the US corn industry have unfairly conspired to produce cheap toxic food. No question.   You should read Michael Pollin,  whose philosophy is encapsulated in his three greatest quotes:

1) Eat food. Not too much. Mostly plants.

2) Don't eat anything your great-grandmother wouldn't recognize as food.

3) “He showed the words “chocolate cake” to a group of Americans and recorded their word associations. “Guilt” was the top response. If that strikes you as unexceptional, consider the response of French eaters to the same prompt: “celebration.”

         One cedes control when one becomes a victim whether one is morbidly obese or a patient with cancer.  Victimization is ineffectual, and the PBS documentary shifts blame away from the obese to the  food industry. No one is forced to overeat.

         I treat the morbidly obese at work. Many are in denial, demanding I test and retest their thyroid function. They don’t think they over eat; they believe themselves victims of thyroid failure which does occur, but rarely.

          I sound insensitive when I say, ”You need to eat less and exercise more,” but perhaps no more insensitive than telling a patient,“ you may die of colon cancer if you don’t have a colonoscopy. Think of you wife and children.”         I keep forgetting people who didn’t want to be told what to do founded this country, and their descendants don’t want to be lectured by some smarty-pants doc.  The New Hampshire license plate sums it up. “Live free or die,” It just as well could read “eat freely or die.”

          Rush is right, at least in this respect We are responsible for our own health, and insisting the government, the folks who run the TSA and the  post office,  manage our health is  illogical.

         I hate when the bad guys are right.

            

Why Me?

Why Me?

         The Chicago sojourn continues.  I love this city of broad shoulders for many reasons, chiefly because it’s not an Eastern city, It’s Carl Sandburg’s town.

Come and show me another city with lifted head singing

     so proud to be alive and coarse and strong and cunning.

         We leap on the Midway Airport subway, bulky luggage in tow, to travel to the hotel.  A transit worker ambles over to  inform us our subway car is not attached to the rest of the train and we’d better move up to one of the departing cars.  In New York or Boston, a group of transit workers would gather silently outside the subway car, waiting to guffaw at the tourists too dumb to ensure their subway car was connected.   

         I can’t visit Chicago without taking a lake-side jog.     Weekly festivals are held at Grant Park, the central greenery born from the debris of the 1871 fire, of Ms O Leary’s cow’s fame.  Today, the Park is a field of pink tents and tee- shirt- wearing participants, proclaiming today is a  breast cancer something-or-other athon.  I run south and am confronted by a sea of pink women, all wearing shirts that read:

         Y -ME.

          They look wildly happy, these women locked in Cancer’s embrace.  I frown. I should be sympathetic, but the effect is like confronting a sea of whining 4^th graders, all asking,

           “Why do I have to go to bed early? Everyone else gets to stay up late. Why am I being punished?”

         I instantly feel bad for these poor women.  But why? For starters, the shirts strike me as uncharitable.  “Why me?” Implies “Why not you?”

         No one should contract cancer.  On the other hand,  I am grateful I have been allowed to take a bullet for the team. It’s like the old joke, “Always carry a bomb on airplanes, the chance that TWO people carry bombs is very small.”

         In the cosmic scheme of things, in a universe where God doles out disease, I  am  sometimes glad he picked me for special treatment. I’d feel much worse if the kids contracted cancer, They’re just starting out. What could be worse than being singled out at 24, with a cancer diagnosis? I think of my friend Jeff, diagnosed with  Hodgkin’s Disease in med school.  We once  made  cheesy jokes about his having to visit the  sperm bank, where his semen was stored, if a particular date turned hot and heavy.

Hey baby, I got something for you that’s rock hard,  346 degrees below zero, and in this stainless steel  thermos.

         Thank God Abby, Jeff and Daniel have been spared...so far. ( excuse me. Ptoo Ptoo Ptoo. Ask your Italian or Jewish friends about the Malochia) Thank God Cyn remains disease free.  I would gladly  assume her burden if she developed cancer.

         I think of a whole community  I would gladly take a cancer bullet for.  Thank God Judith remains disease free.  She’s raising small children. They need her.  Why me?  Thank God it’s me.

         Forgive me Father, I have sinned. I too have committed the deadly sins of  envy, pride, and of being uncharitable.  I spent three years as a Why me? Before realizing everyone is a me. I am grateful I was able to take some of the psychic pain and channel it into self-discovery.  Perhaps that should be one cosmic criteria for being granted disease:  Those capable of  benefiting from Cancer’s chaos should be first affected.  Why me?  Of course, me.  I’ve spun 300 pages of either self-indulgent doggerel or insight, based on who is asked exactly because of my mutated genes.

         My “Why me”  pals would  tell me they wear pink for cancer awareness,  so that others will  be aware of cancer and act accordingly.  Honestly, is there anyone on the planet not aware of breast cancer and the need for screening/ research/ support?   What about men with breast cancer, 1% of all breast cancers occur in men ( 1,800 a year)  who should be aware that a breast lump is a breast lump,  regardless of sex.  I didn’t see any men walkers…. I suspect they might feel humiliated wearing all that pink. Wearing shirts to raise male breast cancer awareness makes sense.

         Aside from male breast cancer,  skin cancer is another disease  lacking awareness. Please check out  any new, non- healing lesion anywhere on your body,  I diagnose skin cancer in teenagers with surprising frequency.  

         I will be accused of insensitivity, of ignoring the obvious, that breast tissue is intimately linked to body image and sexuality  in this boob-obsessed and run country, and that  the  disease   leaves unique scars,  both psychological  and  physical. True. On the other hand, investing copious psychic energy on one  sensitive body part  might make matters more uncomfortable.  Breast Cancer Tee shirts send the perverse message:  

         Don’t look me in the face, stare at my breasts and wonder what’s beneath my shirt.  Hey!  I’m down here!  Why are you ignoring my breasts… do they embarrass you?

         Throughout the  day, I pondered my unease with the Breast Cancer community, wondering why the Tee shirts struck such a dissonant note.  Later,  we drove to the  Botanical gardens, a wonderful  green  refuge where we once escaped when the rigors of medicine became overwhelming.  We passed a sign for the Chicago Holocaust Museum and I  realized a  striking similarity between  breast cancer patients and  those  who memorialize the Holocaust.  There are some who feel the Holocaust  grants them a pass on needing to be concerned about others’ pain.  The Nazi horrors  have given some people what I consider to be a useless moral  superiority.  They become dismissive when confronting  the miseries in Uganda, the former Yugoslavia, and, of course, Palestine. There is no way to reply to  
Suffering? What about my family's  suffering at  Treblanka?

           Jews take the  Holocaust personally. Why Me? We wail, knowing  torture and cruelty is  the perpetual, universal  human condition that didn’t end in 1945.  The Holocaust teaches a powerful lesson: Even the most civilized people can become barbaric and insensitive and we need to be alert  in our own savage society for  abuses  and ways we can help.

         So be it with the Why Me? people.  Breast cancer is universal as is all disease, suffering,  and misery.  The Why Me crowd could use their condition for introspection.  The message should be “Why Us?” My pink- clothed sisterhood should, of course, continue to raise money for breast cancer screening, research and patient support.  But, in a larger sense, they should use their disease as a reminder, that everyone is a “Me” and that everyone has SOMETHING.

         I am never so happy as when I am grateful. I am grateful  family and loved ones have been so supportive. I am grateful   my treatment, although painful, appears to be working.  I am grateful I woke pain-free this morning.  I  am grateful I don’t have any number of truly terrible diseases.

         I am grateful because Cancer has expanded my world in too many ways to count, I  am grateful this  all happened To Me.

Chicago

From Shakespeare in Love: 

Philip Henslowe: Mr. Fennyman, allow me to explain about the theatre business. The natural condition is one of insurmountable obstacles on the road to imminent disaster.

Hugh Fennyman: So what do we do?

Philip Henslowe: Nothing. Strangely enough, it all turns out well.

Hugh Fennyman: How?

Philip Henslowe: I don't know. It's a mystery

---Tom Stoppard

It’s 5:45 AM In Chicago.  I stand in the Michigan Avenue Walgreens Pharmacy because Cynthia thinks she is pregnant and I have dashed out to buy a pregnancy test. We’re proud of our careful planning.  If Cyn is pregnant, she’ll deliver our first child at the start of our third, quieter, residency year.  We’ll finish our Chicago sojourn  and move back East, to rejoin sarcastic, fast -talking, family and friends. Cyn can start her job search with an Au-Paired one-year older. I’ll start my Oncology fellowship at U Conn. The plan is fool proof.

         To this day, Walgreens spooks me. I am disturbed by the shiver of memory, of seeing, month after month, the little blue negative sign that didn’t just mean, “ Not Pregnant,” but, more specifically, “You foolish, infertile, elitist, pigs. You will never have a baby, you should adopt. God never intended female physicians to give birth, what did you expect?”

         Negative.  Not this month.  Cyn is heartbroken,  “I’ll never have a baby,” she sobs. We   comfort ourselves by attempting  to adopt a cat, to be rejected by the Chicago humane society because, as physicians, we would be absentee  pet parents. Cyn is heartbroken. “ I’ll never own a cat,’ she sobs.  We return to the humane society a week later, claim we are both unemployed, and are promptly given a cat.        

          We  celebrate the following month  with a positive pregnancy test. We don’t know it yet, but things will  soon go horribly wrong. Cyn’s HCG,  the pregnancy hormone level, will skyrocket.  Her ultrasound will show a non-pregnant uterus. We will be told she might have a choriocarcinoma, a tumor that mimics pregnancy. This was not in our plans.  I remember examining Cyn’s X ray for metastases, thinking  I didn’t care if we ever had children, I just wanted my wife to live.

    We’ll  spend the next 6 months consulting specialists,  Cyn will endure painful tests, and eventually undergo surgery  for what  turned out to be an ectopic pregnancy.  

         This was 22 years ago.  Son Jeff graduates from Brown next week. Apparently, one can lead a normal life with one fallopian tube.  

         It’s 5:45 AM in Chicago and I am standing in the same Michigan Avenue Walgreens Pharmacy . I’m here because I apparently left my medications at  Bradley Airport Security and I need to replace them, fast.  I am panicking.  What about my insulin? What about my steroid mouthwash?  Will mouth pain ruin the weekend?  My insurance card is declined. I  swipe  my  VISA card for the $429  bill.  The machine considers my request.   CALL YOUR CREDIT CARD COMPANY.   My attempted purchase has triggered  software somewhere which has determined a customer who just  spent  $12 at the Dana Farber parking lot in Boston 17 hours earlier  should not be buying  $429 worth of anything in a Midwest Walgreens, especially at 5:45 AM.

         I really should stop shopping at Walgreens, it provokes disaster.

         Now what?  We’re here because we had originally planned a ski trip before my GVHD flared and  my father-in-law died.  We were  anticipating a quiet, drama-free few days in our beloved Chicago. It’s not fair. It just isn’t fair.

         I return to our hotel room realizing that, for the first time in a long while, I am pain free. I take a few tentative, but painless sips of  coffee. I check my sugar. It’s normal, 95, despite the fact my insulin now sits in some  biohazard disposal bag at the Hartford airport.

         We had a memorable weekend.   I  had  a little discomfort around the edges, but Hopper’s Night Hawks still hangs at the Art Institute.   We biked along the lake,  and had a wonderful time visiting our old friends, Juan and Michele,  who still laugh at my jokes. 

         We spend our lives making plans, only to watch in horror as fate scrambles our strategy. As Robert Burns wrote

But little Mouse, you are not alone

,
In proving foresight may be vain:


The best laid schemes of mice and men


Go often awry,


And leave us nothing but grief and pain

,
For promised joy!

I want to tell that 30 year older, weeping over his wife’s X ray, not to worry, that everything will be fine.  I want to tell that 52-year-older not to worry that your pain will never end. Your mouth will heal.  I want to tell that 48-year-older that Cancer is not necessarily a death sentence and that the next few years will be strange and horrible but wonderful, too.

         If you want to make God laugh, tell him about your plans

--Woody Allen. 

French Lessons

         I find today’s salvation in French kitchens and conference rooms.

         I confess a petty annoyance at most things French.  My aversion is neither unique nor sophisticated.  The French have an unsettling history of pointless anti Semitism ( see the Drayfuss affair). France and Boston are the only places  I have been mocked for attempting to speak the language.  Add to this the recent spate of articles praising French  parenting style, which, although  laissiez- Faire,  produces a  society of  men who cannot live without mistresses and women who accept their husbands’ infidelity.

         The French have always been considered odd. Winston Churchill  once referred to French kick boxing and the French desire to  be… experimental in the bedroom:

         The French they are a curious race

         They fight with their feet

         And make love with their face.

--it’s not  “make love,”  of course.

French Kick boxing

          I was therefore surprised taking comfort from a most unlikely source.   My new-found  Francophillia  is  food- based.  My diet has recently evolved into a science experiment, a search for painless food that won’t rile my GVHD- ravaged mouth.               Exposure to ketchup or bagels provokes pain, while mayonnaise and potato bread soothes the savage tongue.  Our pantry is filling with peanut butter,  jello pudding and  Constant Comment tea. I have lost 10  pounds but, due to our French cousins, all this is changing.        

         I am not the first to fall in love with French cuisine, but suspect I may be the first to realize the French knew, centuries before  Allogeneic stem cell transplantation,  that  their foods were  created with Graft Versus Host  disease in mind.

          Crusty bread is a problem.  Croissants are a revelation, characteristically French because xenophobia   lurks at the center of their creation.

         The French conquered  (now there’s a rarely-used phrase) The Ottoman empire and decided to humiliate the infidels by creating a  food that mocked  Islam.  Hence, the croissant, made to resemble the Muslim crescent moon.

http://www.pprune.org/archive/index.php/t-86461.html

I’m not sure which the French considered more insulting,  the  pastry’s consumption or elimination  but I’m certain that, were the French to create this gastronomic  delight today,  Paris would be a radioactive,  mistress and adulterer-filled bomb crater.  

         The Croissant’s secret, indeed, the  key to most French delights,  is  Butter.  As Amy Adams said in Julia and Julie:

        

I cooked artichokes with hollandaise sauce 

which is melted butter that's been whipped

into a frenzy with egg yolks

until it's died and gone to heaven. 

And let me say this.

Is there anything better than butter? 

Think it over.

The day there's a meteorite heading toward

the earth and we have 30 days to live, 

I am going to spend it eating butter. 

Here's my final word on the subject. 

You can never have too much butter.

My new- found joy goes beyond the realization that  butter helps heal the ravaged palate.   The combination of butter, eggs, milk  and air gives us soufflé. Heaven.  Removing the air but adding onions and mushrooms yields quiche.  I  feel myself healing,  better, I am cooking again.  To cook is  to heal.

          The sudden discovery of pain-free food has coaxed me back into the kitchen, which, until this week,  has been a torture chamber of horrors.  Rooster sauce lurks on  the refrigerator door, a bottle of delicious, red death.  I avoid  the  Asian condiments  and  instead, beat egg whites into submission,  enjoying  the distraction. I’ve never enjoyed cooking as much as I have this week, routine  activity is helpful in disorienting times.  Act normal and life becomes normal.

         I was reminded of this truism yesterday when I attended my first medical staff meeting in seven months.  An activity both routine and dreaded has become therapeutic. 

         One benefit of my recent oncological struggle has been my  exemption from staff meetings.  For physicians, the very term,  “ mandatory staff meeting” strikes terror in the heart.   Medical Staff meetings are where one learns 1) There is no future in internal medicine  2) You will have to work harder and 3)  You should anticipate  a salary reduction soon.

         I attended last night’s staff meeting to explain our new diabetic registry, a method of providing better care for  our  diabetic patients.   I have been reviewing patient care data from the safety of my study, and  now need to  face the  bacteria-breathing  staff in person.

         I didn’t want to attend.   I feel as if I have risen from the dead. Someone will ask, “ Shouldn’t  you be wearing a mask?”   I should be, but I am now seven months post transplant, at this point,  I’m not sure wearing a mask would be helpful.

         I stand at the head of the conference table and am seized by the urge to pull up my shirt, show everyone my mottled,  piebald  skin.  I have an irrational need to prove my disease is not an elaborate scam, although I could have achieved the same effect with a sun lamp and a tube of zinc oxide. I am posting a pic of my chest, to prove  my probity to you.

GVHD. There will be a quiz next period

         The meeting progresses  and I suddenly feel ... Normal.  I’m not an outcast freak with peeling skin, I’m just an overworked physician  presenting  hemoglobin A1C data, answering questions about  follow up and  mico albumen. I remember   exalted days in Chicago as medical resident.  The  hospital was alien,  over lit,  but it felt like home.    Running through the  halls,  pushing a  dying patient to  the ICU felt natural, normal.

         Thus it is with  the meeting. Pretend you haven’t missed a single conference. Pretend  your mouth is fine and that  you’re making quiche tonight because  you have mushrooms about to spoil,  not that your diet choices are limited.    Eating pudding and being home bound feels like prison.  Cooking and attending meetings feels like freedom.

         

Back on the Horse

         The restaurant is crowded and lively. I am in Providence, Rhode Island to dine with extended family and to hear son Jeff’s final acapella concert.  It could be a magical, memorable evening,  Jeff graduates this month, and I worry that my father in law’s recent death will give us fewer opportunities to assemble.

           The question is, who do I want to be tonight, the stoned uncle who wants to hear, in great, joyful detail, about Audrey’s  duct tape wallet, or do I want to bask in  the  harsh, cold  nobility of sobriety?  Two day ago, I had gone cold turkey, stopping my narcotic pain meds, unable to bear the thought I am an addict, a junkie, some pathetic soul whose inability to handle a little pain demonstrates a severe character weakness. The Graft Versus Host disease persists, creating a dry mouth of glass and sand.

         I hear the little red pills call from my courier bag:  Take me! Take me!  I sit in a lovely restaurant, knowing that, without medication, any food not bland, room temperature and soft will cause involuntary tears of pain to run down my cheek.  Without oxycodone’s opiate support,  I will  struggle to sit through Jeff’s concert.  Martha will turn to Cyn and ask, “what’s up with Steven? Is he mad at me?”   I think of Lewis Carroll, who clearly knew something about addiction:

It was all very well to say `Drink me,' but the wise little Alice was not going to do THAT in a hurry. `No, I'll look first,' she said, `and see whether it's marked "poison" or not'…she had never forgotten that, if you drink much from a bottle marked `poison,' it is almost certain to disagree with you, sooner or later.

         Poison.  The oxycodone causes constipation, fatigue, and dizziness. To a writer struggling to find the right word,  the narcotics make writing much easier, and much worse. When I stopped the medication, I entered withdrawal: headaches, muscle pain, nausea. I am poisoned on or off oxycodone, and I  hesitate restarting the vicious cycle.

         Chronic pain is fascinating.  Every medical student should be required to experience a week of constant discomfort, to learn a better perspective on pain. The only question is: would the experience lead us to narcotize our entire practices?   We are all better people when we are pain free. Why should any of us suffer?  Donald Fagan of Steely Dan fame wrote of opium’s beneficial effects

Children we have it right here

It's the light in my eyes

It's perfection and grace

It's the smile on my face…

Time out of mind

         The evening  required a little light in my eye.  I took 10 mg  of oxycodone and the night was memorable. The  Steak Frites were delicious and pain free. The Bear Necessities, Brown  University’s only  all-suspendered accapella group, were  superb.  

         And so I remain under oxycodone’s  persistent  but pervasive influence. I re read today’s blog and shudder.  The medication has changed me, changed the way I write, think.  I spin an addict’s tale. I’ve always been struck, when listening to patients explain how they lost their medications or need an increased dose,  that   their tales of woe are poignant, personal,  painful  and  rambling. Sounds like today’s blog.  I didn’t need to mention  Audrey’s  duct tape  wallet or Jeff’s concert, this is a blog entry about  oral Graft Versus Host Disease which requires opiates for pain control.  I felt the need to involve my innocent family  because my behavior must embarrass me, I must feel the need to justify taking medication, the possession of which without a prescription is a felony.

         Cyn has been invaluable in all of this, she tells me to take the lowest  beneficial dose and to be patient, I will not always need the medication.

         I am back on the horse. Oxycodone is an opiate related to  heroin,  nicknamed “Horse,”  possibly because  race horses ran faster when given heroin.  I too am more effective with  opiates in my blood stream.

On the other hand, the message behind today’s blog is obvious:  All addicts have an excuse, some are just more eloquent than others.