Burnout

My patient had lit­er­ally burned a hole in his tiny, new stom­ach with a com­bi­na­tion of cig­a­rettes and alco­hol. I don’t have a moral posi­tion on this except that life is prob­a­bly worth pre­serv­ing until one can make an informed deci­sion. Destroy­ing it uncon­sciously feels arro­gant, but again, who am I to judge?
Most peo­ple can smoke and drink a whole lot with­out any prob­lems to the stom­ach, but after hav­ing weight loss surgery, a gas­tric bypass, it is really risky. The lit­tle pouch is rel­a­tively unpro­tected and the com­bi­na­tion of impaired blood flow (smokes) and caus­tic liq­uids, is a set up for prob­lems.
He was out hunt­ing. Actu­ally he was out mostly drink­ing and smok­ing and reflect­ing (dimly, I think) on why his wife wanted to end the mar­riage. He woke up with a hole in his stom­ach that felt exactly like that. He tried to drink water and the it ran out of the hole like rain through a drain pipe. He devel­oped peri­toni­tis. He made his way to a local hos­pi­tal in remote Ore­gon. The sur­geon there saved his life by sewing a patch of fat over the hole, lit­er­ally.
He then moved to Cen­tral Ore­gon where I have met him. He is a really nice guy. He can’t fig­ure out the drink­ing. He used to eat, but then after the oper­a­tion, he drank. He sits bewil­dered at night won­der­ing why he still does that, even now, after he almost died. As I talk to him I can see him there with his lit­tle glass of vodka, one then two. He is sad, misses his wife, knows it has some­thing to do with this oper­a­tion he had and how he switched to the vodka from the sugar, but it is fuzzy to him. He is relieved when I tell him there is a way to stop drink­ing that involves, well, stop­ping drink­ing. It is as dif­fi­cult and as easy as that. The miss­ing ingre­di­ent for him is other peo­ple. He needs their help. I could tell that made sense to him. I told him where those peo­ple were.
My patient has expe­ri­enced addic­tion trans­fer, a bor­ing term for what is really sim­ply addic­tion, which is the process of fill­ing our empty human-ness with any­thing other than our­selves. When we aban­don our emo­tions, numb them, the anes­thet­ics become the sub­sti­tute and they feel like home and heaven and hell at the same time. He started with his foods of choice, elim­i­nated those by hav­ing surgery but with­out under­stand­ing the empti­ness and started refill­ing the empti­ness with the next thing. He came to me from Reno. It could have been the craps table, but it wasn’t. It was this.
It is any­thing and every­thing. We are built, I think, with an empti­ness. We are forced to con­nect to some­one out­side our­selves in order to fill this empti­ness or we instinc­tively, it seems, fill it with some thing. This doesn’t work, and only when the pain of this gets very appar­ent do we change course.
Here is what I know from what I have lived and what I see in my work (and I don’t know why this is true, but I think it is): we need love and con­nec­tion (con­nec­tion also known as spir­i­tu­al­ity). We get sick alone and we get bet­ter in groups. Heal­ing lit­er­ally lives in the connection.