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Four Weeks to the Half-Ironman.

21 August 2017

My training has stepped into a different gear, and I am feeling more confident. The big thing I did last week was a 50 mile bike ride. It was long, and difficult, and actually a lot of fun – at least in retrospect. Sure it hurt at the time, and it was a lot of work. But I rode 50 miles! By myself! At almost 16 mph average!

It was a warm, but not hot, day. But it was almost 100% humidity. So my sweating didn’t cool me off at all and didn’t evaporate. So by mile 20 my shoes were puddles and I was sloshing through. It had rained heavily earlier in the day, and each way there’s a 2 mile section of the path which is hard-packed dirt and sand. I was coated in filth. It was awesome.

Last week I also did a 1.5 mile swim, which is 25% further than I’ll need to go on race day. I hit my race-distance split (1.2 miles) in 54 minutes. And I think I swim a little faster in the open water. So I’m feeling prepped for that. I have a 60 mile ride upcoming too. This week is a “cutback” week, which means I’m doing silly amounts of work but not ludicrous.

This weekend I had a 25 mile bike ride on BB’s heavy mountain bike, and an 11 mile run. My legs felt heavy, but I got it in in exactly 2 hours. Not bad considering the path we took finishes on a 5 mile uphill. I’m beginning to feel like I can complete this race. Which is all I want to do. Finish.

I am just hopeful that the weather cooperates, and we get to swim. Think kind thoughts of the mid-Atlantic in September, people. Think cool and dry. Think still. Think calm. Think peaceful. Radiate that out into the weather. I’m pretty sure that works.

The Public Health Catastrophe of White Supremacy.

16 August 2017

White supremacy comes in many forms in the United States. We recently saw an emesis of it in Charlottesville, ending in a terror attack that killed one and injured 19 others. Other associated acts of terror injured many more, as self-proclaimed Nazis rampaged against peaceful protesters, and police largely looked on and let it happen. It was horrifying, appalling, and deeply disappointing.

But it was not shocking. White Christianist terror has been part of the United States’ story for centuries. As some forms of it became socially unacceptable – like the KKK – it was driven underground, only to resurface in forms like Timothy McVeigh, George McGovern, and the NRA. The mass incarceration of black non-violent offenders – a new slavery quietly persisting today.

Our president, Donald Trump, has now openly embraced the rising violent tide of white supremacists, saying many of them are “very fine people”. While he did specifically condemn the driver of the car, he embrace the reason that these neo-Nazis were assembled, and defended their motives and character. He equilibrated the violent white supremacists and the peaceful protesters there to confront them.

There is a terrifying and rising tide of white Christianist terrorism in the United States, but that is only the tip of the iceberg when looking at how white supremacy harms us all. White supremacy has more insidious tendrils which infiltrate systems and laws and culture in ways that cause terrible economic and health damage to all of us. Primarily and egregiously to the minorities that are oppressed, but with negative effects on the privileged as well.

It starts with historical injustice and inherited wealth. Few non-white families in America have much of that. And it doesn’t take much. It doesn’t even have to be wealth in terms of dollars inherited when relatives pass away. Inherited wealth includes parents being able to help pay for college, or school supplies. For health insurance to the age of 26. Whites have much more access to these kinds of wealth. Which result, at the level of public health, in an ability to participate in the economy in greater proportions.

Lack of inherited wealth results in ghettoization of minorities into areas with substandard housing, schools, and services. This results in poorer education, less access to health coverage and care. We see exactly how serious it is in cases like Flint, Michigan, now years without lead-free water. And that isn’t isolated to Flint. Dozens, perhaps hundreds, of poorer communities have lead-contaminated water. Flint is famous because it was a cover-up.

The effects of white supremacy do not stop there though. Biased behavior – which everyone exhibits – conspires to diminish opportunity and outcome both for minorities once again. Minor scrapes with the law – common for persons of all races – result in warnings and small fines at much higher rates for whites than for other races. Black men especially are incarcerated for minor offenses at extremely high rates. Wealth again is a factor – the ability to hire one’s own lawyer is a major factor in the severity of punishment for minor crimes.

Once a person has been incarcerated, it becomes incredibly difficult for them to find housing, employment, or access to social services. And poverty claims another generation when those people can’t provide good educations and health care and housing for their families. The cycle continues.

Even those minorities who escape all that face greater obstacles in terms of biased hiring and promotion. Stereotypes of racial labor create barriers to entry in many types of industry. Hiring managers often worry that a candidate may be the “beneficiary of affirmative action” and thus unqualified. When in fact, affirmative action helps prevent the hiring of unqualified whites over qualified minorities.

These biases – which are often small and clandestine – are difficult to prove in any individual case, but have profound effects to the public at large. Lower wages, fewer leadership positions. Resultingly, the problem of inherited wealth perpetuates. Less access to high quality educations, more debt, less health coverage.

Each step is relatively small by itself. They combine to create a system which promotes whites and represses minorities. Minorities have worse health outcomes in nearly every measurable category. Because they have less coverage, less ability to attend preventive care, and because doctors are less likely to provide them with high quality care – there’s bias in the doctor’s office too. Worse treatment, and worse access to treatment.

The pernicious effects of this system result in shorter lives and worse quality of life. Not for any intrinsic reason. It is a function of wealth, access, and bias.

And it harms everyone. It is easy for white people to ignore these problems – our privilege lets us. But we do so not only at great cost to our own moral condition, but also at great harm to our own lives. Systematically oppressing some 39% of the population (the 2016 estimate from the US Census Bureau is that 61.3% of the population is non-Hispanic white) has profound consequences on many things.

We sacrifice equal participation of almost 40% of our innovators. Of our inventors. Of our professors. Our leaders. Our artists. Talent, drive, intellect, ambition – these things are not based on a person’s “race”. What we call “race” is not supported by genetics in any meaningful way. It is a way of looking at people that pigeonholes them into various boxes far more closely associated with economics than with genetics.

The United States is much like a large swimming pool, one we all wade in. We have selected a large group of people based on their skin color, fired all their swimming teachers, and pushed them into the deep end. And then we blame them for drowning.

Five Weeks.

14 August 2017

Well, I have five weeks until the biggest race of my life. Certainly up until now. Possibly from now until forever. I would be lying if I said I felt ready. But I had a good training week this week. The only major problem is that it’s been at least a month since I had a good long swim. My last several swims have been cut short due to cold, and rage. The pool has been so overcrowded and annoying that I haven’t been able to get in good workouts.

Luckily, the swim is the part I’m least worried about. A 1.2 mile swim is a long way, but it’s not the huge daunting distance for me I know it is for some.¬†Tonight I’m supposed to swim 2400 meters. I’ll do my best to get it in and have it mean something. That’s after a 1 hour tempo run, which will just be a 1 hour run. In the heat, for me, “tempo” just means “whatever pace allows you to keep going the whole time.”

But my past week was a good week for training. The weather has been agreeable, and my fitness is at least nominal. I had a good 10 mile run, a hard 30 mile bike ride on a mountain bike on a wet dirt/gravel trail. I did a 12.5 mile ride/5 mile run brick. And I did a good hard 10 km run. I also threw in a couple days of strength training.

My X-wing has been out getting repaired. Now it’s back and I have a 50 mile ride tomorrow. The longest since I was about 13. I’m excited to do it. There’s something amazing about riding a bicycle 50 miles. It’ll take me more than three hours and leave me exhausted and sore. And I’ll be thrilled to have succeeded at it.

This is the time I have to really buckle down and do the work. I am by nature a procrastinator. But you can’t procrastinate fitness. It takes time to develop it. It’s not like I can wait until the week before the race, do a hard swim, a hard ride, and a hard run and my body will just go, “Ah, yes. We need to be in good shape now. GO!” I have to build slowly.

I’ve been doing that. But I’ve also been eating too much and I find myself in decent fitness but significantly overweight. I want to try to lose some of the weight before the race so I’m not dragging extra around with me the whole distance. Losing weight while building fitness is really hard, because running and biking and swimming long distances all make you really hungry.

So I have to figure out a better way to eat and train at the same time. But if I have to pick one, the one to pick is training.

I really am nervous. It’s going to be a long, hard day. I’m going to be really challenged by this. I think I’ve got it inside me to do this. But if the day ends up defeating me, well, I’ll have given it what I’ve got. After a week like last week, I feel like there’s a chance that what I’ve got will be enough.

The Gifts of Warning.

8 August 2017

The saga with my father continues to unfold. He remains in the hospital as of now, in a stepdown unit. He remains “difficult” and “agitated”. He asked my sister for “whiskey and a shotgun.” But he has also apparently been flirting with the nurses, and doing better from a withdrawal-detox perspective. He may be medically ready for discharge soon, which means he’ll need to go to a psych unit for evaluation. I think. Things are confusing.

The facility that we had gotten him approved to move into doesn’t take people who don’t want to be there. And dad won’t accept placement in any place except home. But home isn’t a safe environment for him, and his “wife” can’t take care of him anymore. So we’re having to look into other options. The social workers at the VA have been fabulous, but there’s only so much they can do. My sisters have been even more fabulous.

So I don’t know what’s going to happen. My father is not well, mentally or physically. I understand why so many people express relief when a long-term ill person dies. Not only for the person, that their suffering is over, but for themselves. I’m doing very little from a practical perspective. My role has been to offer a pressure valve for my sisters and cover some of the costs of travel and attorneys. But I’m emotionally exhausted by it all. I can’t imagine how the front-line lifters must feel.

The situation though, gives me gratitude. My father is an excellent example of what happens when alcoholism, diabetes, and depression go essentially untreated for a lifetime. Sure, he’s had doctors, and he’s abstained from alcohol from time to time, and he’s taken anti-depressants. But he’s never been invested in good health, physical or mental. He’s simply persisted. He’s found ways to get other people to take care of him, rather than making the decisions to take care of himself. Now, at the end of his life, he’s made it incredibly difficult for anyone to do so.

I have all the same genes and problems. I am alcoholic. I am insulin resistant trending eventually toward diabetes. I have been diagnosed with major depression. And I certainly suffer from serious anxiety, even though I don’t recall any healthcare professional ever officially diagnosing me with an anxiety disorder. I have tendencies toward isolationism, self-destruction, entitlement, and self-medication.

But my father shows me where that leads. A life of poverty, frustration, illness, dependence, and infirmity. Eventually, involuntary commitment and recalcitrant self-pity. He has shown me very little about how to be, but much about how not to. I thank him for that. I can learn what there is to learn, and let go of the rest. None of my father’s deficiencies are rooted in malevolence. Only illness and indolence.

I wonder sometimes, if my father’s failures as a father are born of insecurity. His own father was a vicious drunk. Violent, abusive, and dead at a young age. Surely my father feared being like his father. Surely he reacted against that. Drunk and lazy perhaps, but my father was never violent. Perhaps he never attempted to be a real father to me for fear of damaging me the way his father damaged him. I don’t know.

But I know that one of the reasons I don’t want to be a father is that I don’t want to pass on what my father passed to me.

Emotionally I have worked incredibly hard to overcome the pitfalls and lessons I was taught by both my parents. Neither was ever really fit to be a parent. Neither had parents fit to be parents, with the possible exception of my father’s mother. But I cannot overcome the diseases wound into my genes.

I have made the decision to end the line with myself. I am too broken to make and prepare a new generation of humans for a planet that will need resilient denizens to make the next way forward. I am grateful for the lessons I learned.

Returned to ECC.

3 August 2017

I have returned home to ECC after a weeklong trip to Seattle. It was a good trip, full of way too many things to recount here. The big ones were, of course, seeing my family and going to my 25th year high school reunion. I took my sisters out to a truly fabulous dinner at Altura. If you’re ever in Seattle and looking to spend three hours and a couple hundred dollars a plate on dinner, it’s where you go. They even had a non-alcoholic beverage pairing for dinner, so I was able to experience that as well as the food. That’s a nice touch I hadn’t had before.

My sisters deserved it. The situation with my father has gone from bad to ridiculous. He refused to listen to anyone, and dug his heels in, and kept insisting he would kill himself. So we called his psychologist, and his doctors, and they said, well, hospitalize him. Dad of course, refused to go. So the doctors sent an ambulance and police car, and they dragged him out.

He was put into the emergency room, and obviously unstable and agitated. The police had to stay there with him to keep him from fighting the medical staff, and then finally they just had to sedate him. Soon after, his stats began dropping and people became concerned for his physical health, rather than just his mental health. It was soon determined he was in acute alcohol withdrawal.

As I’ve written here many times, acute withdrawal from alcohol can be a life-threatening situation. It’s not something that heavy drinkers should just do alone. If you drink a lot every day, you probably need medical help to quit. Involuntary withdrawal with no preparation and no understanding of what’s going on is particularly dangerous. So they put him on high doses of Ativan and sent him to the ICU, where he spent several days.

After this, they’ll try to find a geriatric psych bed for him. Sadly, those are in very short supply. He still needs to be held for suicidalism. In the meantime, he’s been put in a medical bed, because his orientation has not resolved with alcohol detox and he doesn’t seem to know where he is or when he is. He’s asking for his brothers. The nursing home is ready for him (possibly pending a payment hiccough that should be manageable). But if he refuses, well, it’s a longer road.

Luckily, I got to speak at an AA meeting in Seattle. I needed it and my talk was well-received. It was nice to put it out there and just let it all go in the room.

I also spoke at Seattle Children’s hospital, which was very well received and I may end up with job offers, though if they don’t have anything wonderful for BB too, there’d be no chance of my going back there. So they’d need to be ponying up two great positions. I doubt that that will happen. But life is weird and you never know anything for certain. I do love the weather out there. But living that close to family would be emotionally challenging too. I left Seattle for a reason – it didn’t just happen.

I got in a lot of great exercise too. Hill training – nothing like Seattle for hills. A long run with my niece, who is a budding athlete at 13. She joined me for 5 miles of a 7.5 mile run. Hilly and difficult. I swam 1200m in Puget Sound, which is 52 degF. My cousin Sam is sending me a “Notorious Alki Swimmers” swim cap. Even though I only got about 3/4 of a mile in, it was a strong swim and only took me 26 minutes. I felt good. Cold water swimming is extremely challenging but a lot of fun. And finally, I did a 14.4 mile hilly bike ride with my friend Yoav, up in the foothills of the Cascade Mountains.

This was my longest trip “home” since I was 19. It felt nice. I enjoyed it. But now I’m back in ECC, back at work, and looking forward to exploring my new responsibilities as a research scientist with our public policy group. I’m excited to have new colleagues and new opportunities. It’s a good position. I’m happy. Lots going on but serenity is attainable.

Home Again.

25 July 2017

I’m on my way home to Seattle for a week tonight. I’m going to a high school reunion, giving a talk at a hospital, and taking my sisters out to a fancy restaurant. They deserve it. They’ve been in Arizona for a week trying to figure out how to get my father into a nursing home he doesn’t want to go to. But he can’t be safely cared for anywhere else. And he’s awful to the people who love him.

My dad has many good qualities, but they are fading rapidly as they are replaced by a cantankerous Trumpkin with little regard for anything but his own immediate needs. It’s wearying. He has heart failure, can’t use the right side of his body, and doesn’t understand how much effort and money others put in to his care. His memory, and therefore mind, is in and out.

But I can’t do much about any of it. I spoke to him and added my voice to the chorus explaining that living at home is no longer an option. He refuses even to consider that others have a point. He’s obsessed with minutiae and missing the big picture. It’s sad, but we’re all sick of his bullshit. He’s fake-threatening suicide as a means of manipulating us. I outright told him that that’s bullshit and no one believes him.

Nevertheless, we are calling his mental health provider and asking that he be evaluated for suicidal intentions. In the very slight chance it’s real, it’s the right thing to do, and in the much more likely situation that he’s faking it, a 48 hour involuntary hold might just make him stop threatening and take us seriously. It’s hard not to laugh at a man who puffs out his chest and petulantly says, “Well, I’ll just kill myself then,” in the same tone as someone sending back soup in a deli.

I’ll do a lot of outdoors work while I’m home. I’m going to swim across Green Lake and run the path around it. I’m going to bike with friends. I’m going to do hill repeats in the city. I’m planning on running with my niece and maybe nephew for three miles. I’m looking forward to a good time at home. I’m hopeful that that will be something of a relief from the stress of work and dad.

 

Are All Addictions the Same?

14 July 2017

No. In fact, I’d guess they’re all different. Meaning, being addicted to a particular substance (say, alcohol), has different feelings, sensations, consequences, treatment, and prognosis than addiction to a different substance (say, tobacco/nicotine). In my life, I’ve been addicted to two substances. Those two substances. And I’ve quit them both. I’ve written about both, I’m comfortable with my “expertise” on discussing cessation techniques and treatments for both.

But that doesn’t mean I know much about quitting, say, heroin. I suspect I know a bit more than someone who’s never been addicted to anything. I know I can talk about it from a place of empathy and shared experience, because I have. I know I can help people with addictions to substances other than alcohol, because I have. But that deep-in-the-bones feeling? I don’t know much about it. The best way to deal with cravings? I don’t know.

Especially for the initial detoxification period (this has nothing to do with the new-agey bullshit “detox” regimens that are so popular these days but actually do nothing at all), it is important to consult physicians, when giving up alcohol or many other substances. If you drink like I drank, sudden cessation of alcohol can be lethal. Sudden cessation of nicotine will just make you feel awful but do you no physical harm. And I don’t have any idea what sudden cessation from heroin or alprazolam will do. Talk to a doctor who specializes in addiction.

But beyond the physical effects, I have good evidence that the actions and program of recovery for pretty much any mood-altering substance is pretty similar. Once an addict is beyond the acute detoxification stage of relinquishing an addictive substance, that is when the work begins, and that is when we have to disengage from a purely medical treatment.

Medicine cannot cure us. Doctors and psychologists love to think they can, but they are wrong. Often arrogantly so. But that’s not their fault. They’re just ignorant, with no way to learn what we in recovery know. That recovery, long term sobriety, must be a program of personal responsibility. That relying on doctors or mental health professionals to manage us is a recipe for failure. Physicians have an important role to play in recovery, but it is not a lifelong one. Nor is it a curative one.

The hard work of recovery is personal, and shared among addicts. It means looking at why, once sober, we choose to return to our drugs of choice. The deep, “spiritual” work of of changing ourselves internally, so that we become people who do not treat spiritual and emotional angst with anesthesia. So that we learn the courage to face life on life’s terms.

So no, addictions are not all the same. Cravings are not all the same. Detox is not all the same. I may have less to contribute to discussions of people who are addicted to things I’ve never tried. But that deep part of our souls that’s broken? That we need to repair to become people who can live in the world? That’s similar to all of us. And I know how to face that. And I know how to fix that.