The Value of Sponsorship.
I am beginning to feel a tiny bit odd about my sponsorship situation. My sponsor is in St. Louis. I’m living on the East Coast. It’s not an ideal situation. But it’s also not awful, theoretically. I know people with out-of-town sponsors, and they do just fine. But I also know that I need to have regular contact with people in the program and someone who I’m directly accountable to in order to work the best program I can. And I’m not 100% certain that I can do that with a sponsor who is something like 1000 miles away. I’m also not sure that I can’t. But I’ve met a couple of men at my men’s meeting Wednesday nights that seem like they might fit the bill for a sponsor “in loco parentis” even if not the real full thing.
So, what is a sponsor? What to they do? When someone is new to AA we tell them to get a sponsor right away. We tell them that getting a sponsor and doing what they say will help them stay sober. Does it work? Well, hard to say. Now, obviously, if you get a sponsor and do what they say, you’ll stay sober, because one of the first things a sponsor tells you is: “Don’t drink.” But of course, the research is conflicting. A recent study suggests that meeting attendance and sponsorship are quite important, while noting that previous research has not shown the same[1]. But, as I’ve noted many times, I don’t know that we understand how to research recovery very well. So even when the research supports my own view – meetings and sponsorship matter – I remain skeptical.
Fundamentally, a sponsor is someone who has what I want. Long-term sobriety. A pleasant countenance. And optimistic view of the world. And the supposedly superficial things too. I wanted a sponsor with a family. A nice home. The things I wanted to have or to keep. AA allows us to engage with the world, and live good lives, while being of service to others and to fellow alcoholics. So I found a sponsor who had those things.
But I feel like I may need to adopt a local sponsor. I don’t want to risk my program getting out of whack. I’ve missed a few meetings lately, and I need to make sure that that doesn’t happen regularly. If I miss a meeting, I need to make up a different one. I need to talk to my sponsor more, or get a local one. It’s too easy for me to become complacent. Then I begin remembering my drinking differently from how it really was. I remember the euphoria. Not the misery and compulsion. My disease will use whatever tricks are available to satisfy its needs.
But I know the tricks. I know the score. I understand the consequences. And I know what I need to do. I need to engage with the program here, in ECC. It’s not enough to do what I’ve always done when my circumstances have changed. I need to take new measures. Life is too precious. And my sobriety is the cornerstone of my life. If I lose one, the other will follow shortly. This is how I work my program. But understanding the dire circumstances of my disease. And by being willing to do the things that are required to forestall it.
Which means understanding that I cannot relieve my alcoholism if I see it as a battle. I cannot approach my sobriety as if it comes from some inner strength in fighting my addiction. My war has been over for years; all my strengths and weapons lie broken on the field. I am lost. I am defeated. And so, I fight no more. Such freedom there is in true surrender. I do not have to struggle any more. I am unbound.
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[1]Zemore SE, Subbaraman M, Tonigan JS, Involvement in 12-step activities and treatment outcomes. Subst Abus. 2013 Jan;34(1):60-9.
My first project here at MECMC is to develop a discrete event simulation (DES) of the surgical core. It’s a cool project that I can’t get into all the details of, but suffice to say that there’s a lot of interesting work to be done and much of the work is brand new to me. Obviously, I’ve specialized in DES for many years now. It’s my wheelhouse. I enjoy it, I’m pretty good at it, and I was hired specifically for this skill.
But operating rooms are a whole different world from my usual areas of application. DES is, in large part, a system for building very intricate networks of queues. Queues in parallel and series that interact with each other in peculiar ways. This allows us to model real-world Complex Systems and make predictions about their responses to perturbations. Perturbations might be to arrival rates, service times, or the flow of objects from one queue to another. But fundamentally, it’s about things lining up for service by other things.
This makes it ideal for healthcare delivery systems. Because we have servers (physicians, nurses, and facility capacity, etc.) and we have customers (patients, but also supplies, and phone calls, and other demands on resource time and attention). So healthcare delivery is well-modeled by queueing systems. This is especially true in the environments I’ve worked in in the past, like emergency departments and telephone systems.
However, there are challenges when writing simulations of systems which use scheduled arrivals. Queueing theory was developed with random arrivals in mind. All the math is done for random arrivals. But when we’re modeling elective surgeries, the arrivals aren’t random. Sure, they might be if you go far enough back in the chain (i.e., the ‘arrival’ of a person discovering they need surgery), but for my purposes, I need to model the patients from when they are scheduled for surgery. And that schedule is a rigid object, with particular timed events associated with it.
It would be far easier if the operating rooms were for emergent patients. Then, you just feed them in according to their interarrival time. But when dealing with scheduled patients, you have to devise a different kind of arrival system. What I’ve done, is build a separate “patient creator” entity, which looks at OR availability each day, and iteratively fills the OR with patients until there’s no capacity left using a greedy algorithm. I could simply have generated a bunch of patients and stuffed them into the rooms until there was no room left and then sent the rest home. But this way is far more elegant.
I would say that in general, DES is not necessarily the best tool for the optimization of appointment-based healthcare delivery systems (Mixed Integer Programming, for example, may be appropriate.). It’s far better for systems where the random arrival stream is a feature of the system being investigated, like the ED. In order to treat appointment-based systems with DES, you need to rig it like I described above. But in the position I’m in, I don’t necessarily get to choose the approach to the problems. I’m the simulation guy, and they want a surgical simulation. So I took the challenge to build something, and I think I came up with something kind of elegant.
Now I’m hoping the IRB decides it’s exempt.
Ego Inflating Propositions.
After a very good weekend with lots of sunshine and exercise (I ran 10.22 miles and walked about another 9. I even did a 17 second plank balanced on three medicine balls. It’s hard. Try it.), I had a difficult conversation first with a friend and then with my sponsor. The essential gist of it was: I don’t always behave well when I find my ego being stroked. It’s easy for me to get a big head. I start to feel important and then indispensable and then I can justify just about anything. My friend very rightly took me to task about this. I talk a lot about gratitude here, and other essential things about the program, but I rarely talk about humility.
Because humility sucks. I’m not good at it. And I’m bad at it in two ways. When my ego is up, I feel like I’m the best there is. I’m handsome and virile and important! I work at a prestigious institution and do important work that saves lives! Women are attracted to me! I have incredible talents and I’m eager to tell you about them! When my ego is down, I’m stupid and vile. I’m ugly and fat and repulsive. I’m a fraud and a charlatan. I’m useless and ashamed. I want to slither into dark corners and be avoided.
Both of these modes are bad for me. The first mode is also bad for other people. When my ego is stroked, I will seek more of what feeds it. Often knowing that this can lead me to behave in ways that I shouldn’t. And that leads to having to make amends to people. Or, sometimes, those amends we don’t make because making them only hurts a person again.
In sobriety, I’ve learned how to deal, largely, with the second type of ego problem. I know how to responsibly drag myself out of the modes of thinking negatively. I’ve learned to accept that I am probably not the worst person ever to walk the earth. But I have real difficulty with the first kind. Especially in relationships, but also at work. I don’t know how to handle positive attention, and I can end up saying and doing stupid things, and acting like an ass. And I can end up doing things that hurt other people.
So my friend, aware of this behavior of mine, gave me some well-earned correction. And when the concept of ego was brought up, things clicked into place for me. I then called my sponsor and discussed the same issues with him. He told me the same things. “Avoid ego inflating propositions.” I don’t behave well when I’m convincing myself I’m great.
These issues are hard to write about. I don’t like admitting publicly that I’m not necessarily working the best program. And these are sobriety issues, not just humanity issues. If my ego gets misaligned too badly, I will end up feeling the same old shame and self-hatred and fear and rage that I drank over. For an alcoholic, these are often life and death issues. So I’m grateful to have been admonished. Even if I’m ashamed that I let my ego get out of whack. Or rather, because I let my ego get out of whack. It’s good to have people who will remind me. Bring me back.
That’s how the program works. I can’t do it alone. I’m not good enough. I’m not strong enough. I don’t have the gift of perspective. I need others’ experience to help me see my errors. I’m so glad I know people who will hold me to account.
Excitement!
Yesterday I was informed that my first paper from my first grant was accepted. The paper was first submitted last June or July. At one point, it was rejected because the associate editor couldn’t find reviewers. Which frustrated me a great deal at the time. The paper is a methodological piece about using agent-based modeling (ABM) to create a simulated cohort of patients for in silico randomized trials.
Now, obviously, the state of the art in ABM is such that we can’t model drug effects or new interventions like surgeries and expect to trust the outcome. But what we can do is use simulated cohorts to test the effects of changes to policy, or flow, or capacity, in the health care system. And these types of trials are not possible to perform in vivo. To do so, we’d have to, say, build two identical hospitals and have one adopt one policy and the other another. We can also test policy changes which might, if they don’t work, result in dangerous or unethical conditions for our cohort.
Because this work was interdisciplinary and unconventional, it was hard to find a good place to publish it. Medical journals saw it as computer work, or as too naive with regard to the epidemiology. I submitted to a computer simulation journal, who said that it wasn’t novel as a simulation piece, but was “just” a medical paper. Eventually, I settled on submitting it to a well-known open access journal, which takes as its mission the review and publication of all quality science it receives. There are arguments – which I’ve discussed here – about how valuable, or prestigious, this kind of publication is. But it is excellent peer review, has a good impact factor, and is indexed by the major science search-engines. It puts good science in the public record, which is what matters.
So I’m very happy to have it published. I have a second paper which I need to respond to review. Then, that will close the door on my first grant. I did real science, the way it is done in America today. I wrote a grant, was funded, did some work, wrote a manuscript, and published it. That feels pretty good.
All This Glorious Sunshine.
It’s been raining for days, off and on. Today it is cloudy, and the asphalt was wet this morning. The forecast calls for storms throughout the afternoon and night. I love the rain lashing the windows of my apartment. I sit at my piano and channel the rhythm of the tempest.
I keep telling my stories because I need to remember them. Time becomes a long bridge. The rift between what I was and who I am widens. Becomes nebulous. Menacing presences fade to smudges on pebbled lenses. Urgent pain subsides to low and vague aches; endurable unpleasantries.
When everything shattered, I felt like I was frantically grasping at impossibly edged shards. Desperately I tried to reassemble facades of what was, as blades of the past slit to ribbons the soft flesh of my hands trying to hold everything together. It was all too present. To immediate. I couldn’t see the picture for scrutinizing the details.
I had to let it all fall down. Crush glass to sand beneath my feet. Sweep it all away. Abandon all the glittering images I’d built to conceal the sickness of the core of a self that recoiled in horror from truth as a reflex. Crack the seal and let it all dissipate in wind and rain.
I’ve started building again. With bandaged hands I’ve taken up new tools and raised new edifices. Stronger ones. Plainer ones. Built on foundations of simple bedrock.
I will never be what I was. And I will never be what I might once have been. Those persons are lost to me by time and chance and unknowable potential. I am what I am now. I cannot be made perfect. Nothing can unmake the pain. But I have beautiful scars.
I have come blinking out of the dark. Look at all this glorious sunshine.
The Poverty of AA.
Today is open enrollment in MECMC’s health plan. I get to choose my various medical and dental plans, and decline a bunch of coverage that doesn’t apply to me. I got the Cadillac health-plan, because why not? It’s cheap when it’s just for one person. It costs about $175/mo, and I get $76 a month discount because I don’t smoke and did all the mildly invasive and privacy-stripping health assessments that MECMC offers to incentivize health awareness. I also declined supplemental life insurance coverage, because I have no dependents and I’m 38 and in good health. But I get one year’s salary as basic coverage and there’s nothing I can do about that. So I needed to choose a beneficiary.
I went to twitter and asked who wanted to be my beneficiary. Nobody pounced. But I was asked if it were something I could donate to charity. It is. But my immediate thought was Alcoholics Anonymous. And of course, they won’t take it. I mentioned this on twitter, and people were very surprised. Why wouldn’t AA accept a gift of that sort? Well, the reasons are myriad and compelling. To me at least.
When AA was founded, Bill Wilson and Bob Smith had some grand designs. They thought of building AA hospitals and sending out AA evangelists. All those ideas collapsed, and thank goodness they did. Instead, AA adopted a principle of disorganization and poverty. And I think that this has saved millions of lives. If AA were an organization in the traditional sense, with the kind of membership it has (Two million? More? It remains unknown.), it would immediately be a major player in the healthcare foundation world.
But it isn’t. AA doesn’t fund research. It doesn’t lobby congress. It doesn’t take positions on health care. It doesn’t take positions of any kind. Because as soon as the organization has an opinion on anything other than how to stop drinking and live a better life, it opens itself to controversy. And then, alcoholics who have different opinions about health care delivery, or alcohol research, or congressional funding, or anything that AA might take a position on, will have reason to say: “Those people can’t help me.”
This is why AA has never taken an organizational opinion on any topic other than recovery from alcoholism. And even there, it’s not a hard opinion. It’s not: “AA’s way is the only way to recover.” It’s: “We think this way works for people who dedicate themselves to it. Our evidence for that is that millions of people have succeeded.”
We maintain our effectiveness at helping people recover by refusing to participate in all the distractions that divide people. AA’s institutional vow of poverty is written in our traditions. The sixth: “An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.” The seventh: ”Every A.A. group ought to be fully self-supporting, declining outside contributions.”
You cannot go in to a AA central office, tell them you’re not an alcoholic, and then give them money. They will decline it. (At least, they should. The lack of organization means that you can never truly predict what will happen.) We are self-supporting. It’s important. Each of us contributes because each of us benefits. We are our own benefactors. We all have skin in the game. If we accept donations from non-AA members, we’d eventually likely have to cede some influence over our program to them.
There’s even a famous story of a very rich AA member leaving more than a million dollars to AA in her will. It was declined. We do not have any desire to be wealthy, institutionally. I believe the current limit on posthumous donations is $3,000.
Our poverty is a source of unity. Strength. Investment. Solidarity. We don’t want money to corrupt the individuals who have positions of service and responsibility. We don’t want prestige to seduce us into policy and program statements. We are simply a loose-knit band of drunks. Saving each other’s lives. It’s all we do.
Run Like Hell.
Saturday I went to New York City and met up with several people from Twitter that I’ve known for a long time, and several people I was meeting for the first time. It’s hard for me to emphasize just how positive a factor in my life Twitter has become. I’ve met dozens of people, in real life, who have become true friends. I’ve met people who’ve reached out to me for help with alcohol. Or with their marriages to alcoholics. I’ve met scientists who study fascinating things. And I’ve come to see the true face of science in America, and in other places, today. The passion, the pain, the heartbreak, and all the challenges. I see how the system churns in the background, and I wonder what can be done to save it. The rotors of this machine are about to bite into the soil, and this massive apparatus could all come spinning apart.
There are huge, terrifying challenges in life. This should be news to no one. I’ve faced some, and surpassed them. I’ve faced some, and been beaten. And I’ve only survived some because I’ve been beaten. If I hadn’t abandoned my battle with alcohol, if I were still trying to fight and hadn’t surrendered, I can’t imagine the straits I’d be in. If I were even alive. Alcoholism cannot be beaten. We can only surrender. If I hadn’t given up fighting for my marriage, I’d be trapped in bitter loneliness. Sometimes, surrender is the only route to relief.
Yesterday, I got up at 7:30 on a Sunday morning and made coffee. Had cereal. And then I ran 10.67 miles. Well, I ran 6.21 miles, and then I did walk/run intervals for 4.46 more miles. I ran that first 10K in 61:53. I ran, at a 10 minute per mile pace, for more than an hour without breaking stride. I know I’ve written before about my amazement at my running accomplishments. I won’t rehash it all now. But I have to comment that, this is what I love about being an alcoholic. I love that I can go out, and run myself like hell into the ground, and it feels like a privilege. I drank and I smoked and I nearly killed myself. Now, I am healthy and free and happy.
A lot of alcoholics in recovery end up running marathons. We’re people driven to excesses of all sorts. When we leave drugs and alcohol behind, sometimes we replace it with other obsessions. But being driven to run, be healthy, surpass goals and achieve big things, these are not destructive obsessions for the most part (Though, of course, anything can be destructive when it is used to the exclusion of important aspects of life.). These are healthy dedications. Dedications to life, and freedom, and to the exuberance of experience.
I used to use alcohol to run from things. I hid, and slithered into bottles of shame and degradation. I used to travel in order to feel like I was out of myself. Far from the life I didn’t want to be living. I spent most of my third decade running from myself.
Now, I run toward things. There’s nothing I need to run from anymore. I know how to face difficulty. I know how to give up my illusion of control about outcomes. All I can do is show up, do the best I can and give the most I have. And I will be all right, most of the time. The times I’m not, I’ll cope with. With help. Because if there’s anything that my forays into both Alcoholics Anonymous and Twitter have taught me, it is that I am never alone. I am buoyed by a throng of supporters. And I am a voice in the chorus of support for others.
There’s nothing for me to run from anymore. But here I am. Running like hell. Toward a bigger life.
