Turn

I want to write about being tired, and about being on call for months now with­out a day of not being on call. I want to focus on that, because I am sim­ply tired. I am in a self abu­sive state over it all and I am com­ing to the end of that too.

But the story today is about Adam (name changed). Adam sat in his wheel­chair in front of me yes­ter­day, tears rolling down his face. “If I stop drink­ing I start eat­ing again.” “It has always been some­thing, even before the chair.” I can‘t stop. I know that feel­ing, inti­mately. Adam is really tired of the merry go round (his word). When he said that I was reminded of a thing called the addic­tion cycle, which I am also familiar with.

The addict uses and feels good for dimin­ish­ing lengths of time and imme­di­ately feels shame, some­times while using, usu­ally while using, once the new wears off, which hap­pens at an alarm­ing pace when one is using. It is always such a sur­prise, that. Like, “really, already the dark side of this lovely high has shown up” and the pipe/spoon/glass/dice are still in my hand. The shame is the killer. The shame fol­lows the use in the cycle. The belief that I am sim­ply made wrong, bad. You know, the Orig­i­nal Bad­ness. To get out of that the addict engages in fan­tasy about some­thing pleas­ant, like drugs/sex/rock and roll/sugar/dice. The fan­tasy makes the illu­sion of the orig­i­nal high, the one where every­thing truly was great, truly, come back like dawn after a cold night. This fan­tasy part is very pow­er­ful and works like a charm and in a very charm­ing way. Feels like vel­vet. The brain is already using at this point. Dopamine is being dumped in to fill in the cracks between the unhappy places in my/your/our brain. Dopamine is the brain candy. It is why we take the cocaine. The dopamine is released and washes over our unhap­pi­ness like 8 wave sets on Oahu‘s north shore. That is the fantasy part.

Next comes the rit­ual. Gather the toys, get in the car, make the call, get the works lined up, see the man, pay the money, cut the line, crush the pill, buy the paper go to McDonald‘s, visit the wood shed, debate with your­self at the strip club (know­ing the con­ver­sa­tion is over), get in line, line it up, clean the pipe. Once the rit­ual starts it won‘t mat­ter if the man knocks on the door. The née­dle is going to plunge. It is an over­whelm­ing promise that must be kept, pretty much no mat­ter what. Brain is rac­ing and no risk is unrea­son­able dur­ing the ritual phase.

Then the use itself. At first it is every­thing and noth­ing, a church not made with hands, the real­iza­tion of com­fort and love and hope and the dark­ness comes as quickly as this sen­tence changes course. Like that. The words “oh no” come to mind. The merry go round spins faster and faster until you die or some­one helps you off. With­out help it is nearly impos­si­ble to get off. I am sure it hap­pens but “rare” is a gen­er­ous descrip­tor of its frequency.

So there is Adam telling me about it. He wants off. He is ask­ing, sim­ply, for help. And in all this story, the part that finally makes the tears stream is when he asks me what he and his ther­a­pist have been work­ing up to him ask­ing me…“Doc are you ashamed of me as as patient because of all these struggles.”

No. Adam, no. I am your brother in this. This is the jour­ney of our human lives. This is your day of heal­ing. I am wit­ness­ing your birth and your death. The cycle, the merry go round has the chance to stop when you/I/we get help from some one other per­son, some­thing out­side of our closed loop of lies. It is our poor, piti­ful, incred­i­bly pow­er­ful brains that our looped up in the itchy hunger. The way to stop the cycle is a brief reprieve in which we allow a lit­tle of some­one else‘s power/love to creep in and help. A brief and hon­est reprieve allows a lit­tle self esteem to root. That can actu­ally grow as the reprieve is main­tained. My brain still wants dopamine, but I am now not in the cycle alone. Someone/thing has inter­vened. That brings hope in to a dis­mal real­ity and bal­ances the mind. It allows an alter­nate end­ing. For the addict the inevitable end­ing is the relief of death. For the recov­er­ing addict, death is no less inevitable, but between now and that moment is one price­less gift: choice.

Adam is my Mon­day at 11am hero. He is fol­lowed by another and another and I am in that line too. My own hero, help­less, ulti­mately alone in the world except for the thin thread of love between you and me that is so frail and yet strong enough to hoist me from wells of despair. And still we are alone, even with the love, but the love makes it ok, bear­able, pos­si­ble to come off the merry go round.