I’m embarrassed. Yesterday I did something stupid and foolish. I have a Picassa-album-type-thing for photos from my various travels that I share with my meatspace family and friends. I don’t share it here or on twitter because, well, I dunno exactly. I just don’t. Let’s call it non-overlapping magisteria, or something. But I shared my Bermuda pictures with my colleagues at work. Including my boss, who is a friendly, affable, pleasant man and an effective leader. And that album included this picture:
Well. that pretty clearly identifies that I went to an AA meeting while in Bermuda. If anyone took more than a second to look at the picture, they’ll know I’m an alcoholic. What they won’t know is how long I’ve been in recovery, or what my history with alcohol is. Or why. People have their own biases and impressions of AA. I’ve had people tell me that it’s a cult, that it’s a Christian Church, that it’s the best thing that’s ever happened to addiction, that it’s the worst. I’ve had people tell me that it works/doesn’t work/should work/shouldn’t work/can’t work. I’ve had people tell me I’m lying to myself because I think AA works. I’ve had people tell me that if I have stopped drinking it means I was never an alcoholic in the first place.
Unless you’re a member, chances are, you don’t know what AA is or how it works. And that’s fine. If you don’t have a desire to stop drinking, AA isn’t for you. You don’t need to know. Feel free to go on about your business. We’ll handle ourselves. I’ll keep my side of the street clean, and your side is your side, and not my business.
But now I’m suddenly worried that any time I’m not perfect at work, my boss (who looked at the pictures and commented on them, though not on that one specifically) will be suspicious that it means that I’m drinking. I don’t know how to address that. So I did what every alcoholic-in-recovery should do when they feel panicked and confused and upset. I called my sponsor. He told me that I should drop it. Just don’t say anything, and if people ask, address it honestly and straightforwardly. And essentially to say, “I’m in recovery. What’s your point? How does that affect my job in any way?” But not as aggressively as that seems in print.
Because here’s the deal: I’m not ashamed. I’m an alcoholic. I’m an alcoholic for many reasons. Mental illness, probably genetic. I’m an alcoholic because I like to treat discomfiture with alcohol. I like to anesthetize myself against things that make me unhappy. I like to drink, because I like the effects produced by alcohol. Left to my own devices I will drink, rather than do any other thing. And I’m not ashamed of any of that. It’s just who I am. It’s an irremediable defect of my brain and my genes.
I am not ashamed, because I don’t drink anymore. I have made, or offered, amends to everyone I’ve harmed in my life to my knowledge. And I continue to do so as I continue to harm. I have examined the faults that I have and take daily steps to ameliorate them. I go to bed each night sober, and I wake up the same way. I have done this without fail for 2,118 days in a row. I am not ashamed, because I tend to my responsibilities and I care for the people who matter to me. I acknowledge the contributions that others make to my life, and I endeavor to repay those efforts.
Sometimes I am fearful. Sometimes I am stupid. Sometimes I am thoughtless. Sometimes I am regretful. Sometimes I am resentful. I have done many things in my life I am not proud of, and some people have been hurt in ways that I cannot repair. I have harmed people – even in sobriety – through bad decision-making, selfishness, and anger. I have attempted to amend those harms. I have not always succeeded. Sometimes I am lazy, and slipshod. Sometimes I am dishonest. But I work daily to say what I mean, and do what I say.
I am a work in progress. I have never claimed, nor will I ever claim, perfection. I do not do these things alone. I am not sober by my own strength or efforts. I am sober because I follow a program of moral accountability and spiritual seeking, guided by the wisdom of the many millions before me who succeeded at this task. My best efforts lead me to despair, desolation, inebriation, and moral destitution. The efforts of something much larger than me, this massive network of sober people who form the net into which I fell, which caught me, are responsible for my sobriety. I have done only what I was told by those who went before. I cannot claim authorship of my recovery.
I cannot control what others think, or do, or say. I have only the power to manage my own reaction, and my own feelings, and my own behavior. Because of AA, I have dignity and personhood. Because of AA, I understand my place as a man in the world. I am not ashamed of my alcoholism. But alcoholism has consequences. Part of my recovery means accepting all of the consequences associated with my disease, fair or not. Because it does me no good to rail against the world. I am no crusader. I have stopped fighting.
I doubt that there will be any consequences in this case. Hell, I doubt anyone noticed before I took the photo down. What happens will happen. I’m angry with myself. I’m fearful of becoming the subject of gossip. I am an alcoholic. But I am a sober member of Alcoholics Anonymous. And I am not ashamed.
The past four days and nights I have been in Bermuda. I suppose I could tell you I was soaking up the beautiful sun resting languidly on a beach, but those of you who’ve read about my previous travels will know that that isn’t really how I roll. I need to keep moving, seeing things. And luckily, that appeals to my new girlfriend as well. It was exciting to discover that we traveled well together, and enjoyed doing a lot of the same things. And that we also agreed on the things we didn’t need to do, like stay out late or push ourselves to see every last thing on the island in four days.
Bermuda is a great destination because there are easy, quick flights from ECC and just about every other major city on the Eastern Seaboard. We stayed in a charming little bed and breakfast run by a cute couple who provided nice continental-style breakfasts (granola, fruit, fresh roasted coffee, scones, yogurt, etc.). Harry was loquacious and affable, and sailed for Bermuda in the 1976 Olympics. We rented a scooter and tooled around the island trying not to die. It was more precarious than it might’ve been because the Bermudians were playing this joke where they all drive on the wrong side of the road. The refrain for the trip became, “Left turns are easy. Right turns are hard!” I only killed us once.
The city of Hamilton, which is the capitol, is a surprisingly bustling small city. Considering the island’s entire population is somewhere between 50,000-65,000 full-time inhabitants, Hamilton feels like a city for a much larger constituency. The city was decked-out for Christmas, which is a little disorienting for me considering I’m used to associating it with snow and misery. But they did a nice job of it, and everything was elegantly done, which is inspiring considering the ludicrous vapidity we’ve achieved here in the States.
Bermuda is quite wealthy, and free from the slums that are found in other tropical destinations once you venture out past the heavily-protected ring around the resort communities. Bermuda has beautiful architecture, everything white-roofed and stuccoed in colors that ride the line between pastel and primary. Because there’s no source of fresh water on the island it all comes from rain, and so the roofs are fascinatingly-designed water entrapment devices, and every home has a cistern.
Our first trip on the scooter was to a nature preserve called “Spittal Pond”, so named because you’re supposed to.. no just kidding. I’m not sure why it’s named that because it isn’t really out on a spit, or anything. But there’s a beautiful nature trail and a bunch of rocks to climb on. The rocks, volcanic limestone slowly deteriorating under the ruthless assault of the sea, was covered in little limpet-like things, inspiring BB to point and exclaim: “There are CREATURES!!”
The next day we visited the village of St. George, which has a fabulous abandoned church. The great part is, it was abandoned before it was done. Only politics can achieve such a result. The bones of this would-have-been-stunning cathedral remain exposed to the elements after, more than 100 years ago, everybody just said, “Fuck it, we quit.”
From there we scooted past Tobacco Bay and visited the amazingly preserved and picturesquely located Fort St. Catharine, which defended Bermuda from invaders from the north. It’s a squat, imposing, serious military outcropping looking out onto the world’s bluest water.
Which reminds me: you know how they say that the water is that color because of the sky? Well that’s bullshit because the water is that color even when it’s entirely overcast. It’s uncanny. Strange and beautiful and alarming and amazing. Right next to Fort. St. Catharine there’s a little beach where we went swimming. Because it was only 70 degrees and late November, we had the beach to ourselves. It was fabulous.
Saturday morning we went to the Botanical Gardens, so that I could go to an AA meeting. They’re beautiful, and like everything else in Bermuda, tiny. There’s a little aviary with a few parrots and peacocks, and a bunch of fiery-looking tropical foliage. Because we were there early, it was almost abandoned, and we were able to walk around the perhaps-10-acre grounds undisturbed, and uncrowded.
Then we went along the South Road, seeing a number of beaches and realizing why they call it pink sand. It’s because it is! You can’t see it in the photos, but the sand has little pink flecks of shell in it, about the same size as the sand-grains. We visited Warwick Long Beach and Horseshoe Bay, before having a lovely little lunch at a restaurant opposite The Reefs timeshare community.
And that, basically, was our trip. Add in a few nice dinners (Eating in Bermuda is not cheap. To eat on anything like a budget, you will need to go grocery shopping and even then, plan on it costing as much as eating out at home.). There were a lot of overcast skies, but that’s ok. We actually had the best weather of the trip in our last few hours before leaving.
But this wasn’t ever really intended to be a beach vacation. It was to explore a new place, with the new love in my life. And that was quite thoroughly accomplished.
Did you know, dear reader, that your humble narrator has had an official finding of research misconduct levied against him? I was guilty too. Let me go back and describe it:
I was a newly hired engineer at my previous institution, prior to my promotion to PI. I was working directly for the Chief of Staff, who is kind of a “Big Science Deal”. More than twenty years of uninterrupted funding, hundreds of papers in very good journals. Contributions to both medicine and engineering. Full professor in both a medical school and a school of engineering. That sort of thing. He hired me to be his concierge engineer solving problems for his medical center. I worked on quality improvement. In fact, I had essentially the same job I have now.
One of my first projects, which was only very peripherally related to the patient experience at all, ended up with a neat little result. At this time in my career, I had published only one paper, and though I was first author, I didn’t write it, or submit it. The senior author did all that. I just did the work. So I really had no idea whatsoever how publishing worked. And, since I was trained as an engineer – even though I had been working in health care a long time – I had no understanding of human subjects research. I was always strictly on the quality side of things. I’d had HIPAA training, but no research training.
When we came up with the neat little result, my boss told me we should publish it. It was exciting. I’d never been interested in publishing, really. I had no designs, at that time, on being an academic at all. So I wrote a paper about what I did, and submitted it. Well this set off klaxons of alarm. Publishing is research! Manuscript preparation is research! The Institutional Review Board (IRB) sent me a grim memo. I went to my boss. He took responsibility for it. It was his fault I hadn’t been oriented to research; if he wanted me to publish, he had a responsibility to ensure I knew the rules.
The project and the paper involved only retrospective, deidentified, aggregated data. Those reading this familiar with human subjects research will immediately recognize what that means: it’s exempt from IRB review. There was no harm, actual or potential, to patients or to their protected health information. But because I had prepared and submitted a manuscript prior to securing a decree of exemption, I had technically engaged in research misconduct. The official finding was that the misconduct was neither serious nor continuing, and a memo was placed in my file. And I believe it has since been expunged.
I tell that story because I want to emphasize that I understand that IRBs are imperfect instruments. However, they are the fundamental structure we use to ensure that research is conducted ethically and safely. So that research subjects are informed about the risks and benefits of the research. So that research is carried out only on subjects who consent to be researched. It’s not a small thing.
I’m not a lawyer, and I’ve never served on an IRB. But I have had multiple protocols reviewed and approved, and multiple protocols reviewed and exempted. Most of my research is exempt from review, because it is quality improvement work based on retrospective, aggregated, deidentified data. But even then: only the IRB can determine if the IRB needs to review the protocol. That means that your protocol must be reviewed in order to determine if it must be reviewed.
Yes it sounds circular and silly. But this is how we do human subjects research. Scientists have biases and blinders. If you’re a scientist, you have them. Hell, if you’re a person, you have them. We all like to believe we would only conduct safe and ethical research. But when we think we have great ideas, we all – every one of us – will rationalize a little bit about it. I do it. You do it. That’s why we have systems for independent oversight.
The IRB is intended to safeguard patients’ persons, and their information. The basic document regarding ethical research, sort of like a constitution and bill of rights for researchers and subjects, is The Belmont Report. IRBs use this document and the principles found therein to guide them when reviewing proposed research. IRB oversight of research is required for all federally funded studies in the United States, and nearly every institution requires IRB oversight whether they receive federal funds or not.
I had a long conversation on twitter yesterday in which it was asserted that “IRBs are only for publication.” This is not only wrong, it is dangerously and disturbingly wrong. Yes, in order to publish the results of research respectable academic journals will require a statement of appropriate IRB oversight. No, that is not what IRBs are for. IRBs are to protect patients so that Tuskegee doesn’t happen again.
My opponent in last night’s debate laments that this essentially prevents private citizens from conducting and publishing research. Well, sort of. As a researcher at a medical center, I have access to a large and streamlined IRB which reviews all of my work so that I can do my work as research and publish the results. Private citizens don’t have that. There are, however, IRBs-for-hire. They may be expensive, or they may be free of charge, but they exist.
But I am unmoved by restrictions upon private citizen-science when it comes to human subjects (or animal subjects, for which the equivalent body to the IRB is the IACUC). Human subjects research has a deplorable history of subjects ending up as victims. Doing ethical research requires oversight, standards, ethics, and accountability. All of those things cost money. And if you can’t afford appropriate oversight and accountability for your research, then you can’t afford to do research. And that’s a good thing, not a bad thing.
The idea that IRB oversight is simply a regulatory hoop that a scientist must jump through in order to publish their results in a peer-reviewed journal is, frankly, vile. It was asserted in the argument that if a citizen (or corporation!) wanted to conduct their own human subjects research and publish it on a blog, that that would be fine, ethically. That is absolutely, categorically untrue. That is exactly how excrescent lapses in ethical behavior result in serious harm to research subjects.
When safety, ethics, and oversight are seen as regulatory impediments to science, instead of part of the core principles of scientific research involving human or animal subjects, humans and animals suffer. Those who see regulatory oversight as bureaucratic box-ticking reveal themselves bereft of the concern for respect, beneficence, and justice which must be at the core of medical and scientific exploration.
AA has saved my life. And when I say that, I don’t just mean that people in AA threw me a life-preserver when I was drowning. They did. But that wasn’t all. AA took me, a 33-year-old man-child – incapable of operating in the world, utterly baffled and perplexed by the nature of society, by what it means to be a man, by employment and responsibility – and slapped me around, straightened me up, dusted me off, and set me right. Because of AA and the program that I work in sobriety, I am a capable and effective human being today. In the first place, the opportunity that AA gave me was to live, instead of not existing. As I matured in the program, it gave me the opportunity to live, instead of merely existing.
What do I owe to AA in return? What debt have I incurred to this organization that has saved my life, redeemed me, and put me back into a state of manageability? There is a plaque on the wall at many AA meetings that says:
Whenever anyone, anywhere, reaches out, I want the hand of AA to be there for them. For that, I am responsible.
I believe that. And I believe that I live that. If you, out there, cannot control your drinking and cannot manage your life, reach out to me. If you can’t go on living like you’re living, but you don’t know how to stop, reach out to me. If you want to find some other way, some other path, anything but this blistering misery of alcoholism, reach out to me. I know how to help. Wherever you are, whatever your condition, there’s a path for you out of where you are. And I can either help you find it, or I can put you in contact with local resources who can.
But AA isn’t perfect. And any organization will drift from time to time. I oppose, for example, the signing of court slips and the sentencing of drug/alcohol offenders to AA. I think it violates the spirit of our laws (in the USA), and I think it violates the traditions of AA. And here’s what I intend to do about it:
Nothing about the program of Alcoholics Anonymous requires me to be involved in AA policy. Nothing obligates me to participate in organization. In management. As I’ve written many times, there’s precious little organization or management, and I generally think there’s too much as it is. A troll who happened across my blog recently took me to task, calling me “startlingly self-centered” for not being interested in guiding policy in AA.
In fact, I think it’s quite the opposite. Self-centered would be to believe that my ideas are so important that all of AA must be made beholden to them. Self-centered would be to insist that other people work the program of AA the way I believe they should. Self-centered would be to demand that everyone agree with my opinions about court-ordering alcohol offenders and signing court slips.
I have an opinion. It’s not particularly well-informed. I don’t have any data about whether signing court slips is good for people. I don’t understand constitutional law. I haven’t really studied the traditions of AA. I just have opinions. And the height of arrogance is to form an opinion based on precious little information and then assert it as if it is the best or only way to approach an issue. My gut reaction is that AA and the courts should not have any official relationship. And that’s where it’s going to stay.
My obligation to AA is to be there, and be available to other drunks. People who need help ascending from the cellar of misery we carve for ourselves in the midst of our addictions. My responsibility is to the AA members in the groups I attend. To my sponsor, to any sponsees I might have. I have no obligation to AA World Services. Nor to my local Intergroup. I think it’s probably a good thing that people volunteer for those things, and take up roles that sustain the minimal level of organization that we have. But even there, I’m not sure.
I don’t know that AA and alcoholics in general wouldn’t be better off if AA World Services went bankrupt. And I personally won’t give a shit if they do. Because that’s not where the program lives. My AA meetings would keep going right on if AA World Services vanished tomorrow. AA doesn’t need a structure. All it needs is the book, and people who intend to congregate to recover. And the rest of it could all burn to the ground, and it wouldn’t make a bit of difference to the program of Alcoholics Anonymous.
We don’t recover because we have a carefully manicured institutional policy. We recover because one drunk talks to another. And leads them through the steps. Quit fighting. Acknowledge something bigger than you. Clean your house. Help others recover. If you let someone lead you through the twelve steps of Alcoholics Anonymous – someone who’s done them themselves – with honesty, openness, and willingness, you can recover from alcoholism. I know because I did.
And in general: no one, anywhere, is morally obligated to adopt and promote anyone else’s political agenda. Vilifying or castigating anyone for failing to endorse a particular orthodoxy reveals a lamentable poverty of spirit. We cannot control how others think. We should not demand that others work toward our own goals. It is precisely that thought which offends, which dissents, that needs and deserves defense. There is no need to defend the right to inoffensive opinion. But each of us will find at some time that our own opinion offends someone with more power than ourselves.
Yesterday I gave a 20 minute talk to the bigwigs at MECMC. The talk went very well, and my boss was quite pleased. And our chief bigwig was saying that I need to be cloned so that we can get more work done for the hospital using the tools I employ (I’m essentially the only person doing what I do here.). So it was nice to be told I’m useful and hopefully there will be senior support for me to hire some post-docs, data/stats folks, and implementation specialists and set about doing a lot of good work here. That would put me at sort of an associate-professor-level position, with a lab and hard money and grant submitting and publication privileges. And if I get there, I’ll have exactly what I’ve always wanted career-wise. I think.
I was talking with BB last night about it. It does seem that every time I achieve a new goalpost in my career, one that I’ve said: “When I have that, I’ll have what I want!”, I’ve been wrong, and wanted more. Is that dissatisfaction? Or is that ambition? Is not wanting more just complacency? Where is equilibrium? Where is the point where I say: “I am satisfied rising no higher. I have my life’s work to do here.”? I am not sure. But I truly do feel that I’m close right now. I am doing what I trained to do. People are pleased with my work and want more. I feel good.
But I have been working hard for a long time without a break, and I am really looking forward to my tiny vacation next week. BB and I are winging away to a foreign land for four nights over the holiday. (Email me an address if you want a postcard!) It will be good to check out, and relax, and not think for a while. I also booked our spring trip. To celebrate my whole first year on the job here at MECMC, I’m taking two weeks off and going very, very far away indeed. Close to as far as it is possible to go. At least while staying in the northern hemisphere.
My mind is checked out already, and I have three-and-a-half more days of work before I get to leave. But soon I will be far away, with my new love, recharging. I am enchanted by the prospect and having difficulty thinking of any other things. Luckily, I don’t have too much else to do until after the holiday. Work has slowed a trifle, and I’ll be ready to go when I get back. In the meantime, life is good and I’m happy, and I think that in about three weeks I’ll own a new house. Probably.
I have written journals for many years, and now I’ve been blogging since the end of 2008. Almost all of my writing in these venues is characterized by questioning, and struggling. Especially blogging, I have written mostly about my journey in sobriety, and then as I have become more settled, my journey in my professional life. Sobriety will always be the cornerstone of this space. I have reaped incredible benefits from the effort I’ve put into this long-rambling catalog. Several times a week, I wrestle another barrowful of words to the lip of this digital canyon and dump them in. Hoping they fall in some useful order.
When I began, my questions were existential. How do I live as a sober person? Can I contribute to the world? And through living and writing, I answered them. Deliberately. Most days.
Now, my questions have less urgency. I know how to live as a sober person now. I take the days from morning to night essentially as they come. I do today what I can do today to make my life better. Most days. And today, contributing to the world feels like something I do both personally and professionally. My life’s labor is useful. I am a part of larger things. I give back to communities I care about.
Today I have a new love in my life. A flock of birds at sunrise. Vast surfaces in constant flux, vibrating unpredictably, but along smooth, familiar patterns. Exciting and sudden, spontaneous. Ancient in the same moment; a thing that’s happened unchanging for eons. The undulations of the natural world flung suddenly into startling presence. This is the respiration of nature: the long breath that sustains the palpitation of thriving life.
It is the first time in my life that I am going into a relationship fully present. This is the best time in my life. When everything is warmly lit. While I face east into a limitless dawn.
Well, friends, here’s a new one. My first research paper for MECMC was rejected by the first two journals I sent it to. Not surprising in either case. It was well reviewed both times, but at glam journals where the reviews need to be spectacular to have a chance. So I resubmitted to a well-respected second tier journal, in a field appropriate for the work. I settled on this journal after emailing a bunch of EICs asking if the topic was relevant to their journals. Most never responded, or responded saying that they don’t respond to such questions.
But this journal sent me back a nice reply from the EIC’s personal email address (stamped with that guarantee of authenticity “Sent from my iPhone”), saying that he would like to review the paper and to please submit it through the website. So I did. Fast forward a month, and today I got the review. Drumroll…
“Accept after Major Revisions.”
Um. I’ve never seen that before. I’ve seen “Accept with minor revisions.” I’ve seen “Revise and resubmit.” I’ve seen “Reject and resubmit.” I’ve seen “Major revisions.” I’ve seen “Reject.” (I’ve seen a lot of “Reject.”) But I’ve never seen any “Accept after Major Revisions.” I’ve never heard of it.
Now, the letter from the editor seems to suggest that this is a standard revise and resubmit. Please make the following revisions and we’ll reconsider it, you have one month. Comments from two reviewers, who had some thoughtful and serious things to say. So, I’m hopeful. I’m hopeful that the “Accept” part comes true, anyway. I think I can respond to the review.
Does anyone have any experience with this editorial decision?