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The Opioid Epidemic.

19 March 2018

I never abused opioids, and I almost never took any. Not even when I had a legal and appropriate prescription for them in my 30s, during my drinking period. I took a couple of pills of tylenol+codeine when I had my wisdom teeth out and I didn’t like it. I was given IM and then IV demoral when I broke my arm, and I did like it. I liked it a lot. But other than those times, opioids have not been a part of my story.

So I may be unqualified to talk about them.

But I am qualified to talk about addiction. I am an alcoholic, and and a former smoker. I remain addicted to both alcohol and nicotine. That means there is no safe amount I can use. Because of the addictions I have, I also abstain from any other addictive and mind-altering substances. I don’t use any drugs, and I will refuse narcotics or opioids for pain unless I am under the direct, immediate care of a physician.

The opioid epidemic is tragic and vexing. Most of us feel like we understand how it started now: as new classes of pain medicines became available, initially optimistic ideas about their addictive properties gradually faded into venal calculations about profitability. Patients love being pain-free. Humans love being altered. And the drugs themselves turned out to be incredibly addictive.

The question is what to do now. The instant anyone proposes restrictions to prescribing, the outrage brigades arrive shrieking that “people deserve pain management”. How dare anyone suggest that someone doesn’t need oxycontin to address their chronic back pain. How would YOU like to live in constant, soul-shredding agony!? It’s tiresome and disingenuous.

I usually wonder if these people are outraged on behalf of others (righteous indignation!) or if they are personally defensive about their use (or abuse) of painkillers. I suspect its the latter as much as the former. We react with fury against any threat to our own comfort and access to the “medicines” we “need” to “control” our “pain”. Usually that kind of defensiveness is reserved for protecting access to a drug we want to support our addiction.

The sad truth is, there’s not a lot of hope, at the population level, for the current (or any) generation of addicts. Addiction is common. Recovery is rare. Most of us die. Medicalized addiction treatment is generally ineffective, and in my experience simply trades the hell of addiction for a fresh one of withdrawal and relapse. Beyond primary detox, there’s little or no role for physicians and scientists in treating addiction. They make it worse, not better.

Only pain changes us. We need to come to the place where our pain in addiction is less tolerable that the pain we imagine the drugs are treating (but which often departed long ago). Most people never come to that point.

The solution to the opioid epidemic is not to save the addicts. That, largely, can’t be done. The solution is to stop making new ones. Stop prescribing opioids for outpatients. Stop giving people these medicines for all but the most severe pain. Never chronically. Stop making new addicts. The ones we’ve made already will either find their way to recovery, or die.

Settling In.

16 March 2018

I have finally settled in to my new job. I’m actually working, as opposed to merely getting oriented. It will take time to get the project off the ground, but the team I have is brilliant and motivated, which is nice. I’m excited by the opportunity and figure I can meet the challenges expected of me.

There was a crazy hiccough though. My first paycheck was $14,069.97 heavy. When I negotiated to come out here, I was given a $20,000 travel allowance. That’s about what it costs to have a home and car professionally moved coast to coast. But the way it was supposed to work is that MWCMC was going to pay the movers directly. I was not supposed to see the money. There are major tax advantages to me to doing it that way.

But what did happen was that MWCMC paid the movers AND they paid me the $20,000. After taxes and withholding, that made my first paycheck awfully big. I kind of panicked. I admit there was a part of me that thought I could keep it if I just kept my mouth shut, because their left hand would likely not know what their right hand was doing, and no one would notice.

Whether or not that’s true, the better angels of my nature won out and I contacted both my institution and the moving company to put the situation right. I don’t want to have anything like that hanging over me, and it would surely be a firing offense if discovered. So, in the spirit of sobriety I decided to pay the money back instead of buying a helicopter full of cocaine, or whatever.

I mean a nice oriental rug. That’s what I meant.

Sobriety requires that we do our best to maintain strict honesty. I’m not always perfect at that, but my “cash register” honesty has always been pretty good, even while I lied and lied and lied about other things. Life is treating me very well. I don’t need to try to swindle my employer.

A Glorious Weekend.

12 March 2018

The weather in Seattle this weekend was PERFECT. High 50s, low 60s, clear, sunny, crisp. Basically, what the weather is like all summer, but way early. The mountains were gorgeous, and the air was clean and dry. I’d forgotten just how wonderful the air is after 25 years in the miasmic sewers of the Midwest and East Coast. There is simply no weather in the world as nice as the Pacific Northwest.

Soon, it will be light from 5am until 10pm, and for the most part won’t get above 80 degrees. The average high in July and August is 76 degF. Whereas in Philly it’s 87, and in St. Louis it’s 90. Additionally, there’s no humidity in Seattle during the summer. And in the spring and fall, the temperature is low enough that even when it’s humid, it’s not soupy. That’s why I’m fond of saying Seattle has a “dry dampness”.

But this weekend was beyond fabulous. So BB and I went hiking. We climbed up to Kamikaze Falls on Mt. Teneriffe. We couldn’t quite summit, because there ended up being melting snow pack that was very slippery, and we didn’t have any micro spikes. Something to buy. But the views were unbelievable.

We hiked about 6 miles with 1400′ of elevation gain.┬áNext weekend we’re going to search out actual trail running instead of hiking.

Sunday, we went on a 15.4 mile bike ride. The first time I’ve taken the X wing out since my half-Ironman. We rode from home to BB’s work, then over to my work, and back home. We somehow managed to find a place almost perfectly halfway between our workplaces as measured by length of bike commute on protected paths, despite that not really being the criterion we tried to optimize.

Add in a good hard trip to the gym on Sunday morning, and it was a good weekend, fitness-wise. I’m excited about being here. I’m happy.

Painful Progress.

9 March 2018

I am slowly ramping my fitness back up. As a man now essentially in my mid-40s, my body doesn’t quite respond to effort the way it did seven or so years ago when I first decided to get into shape. But it’s not awful. Since arriving in Seattle, I’ve been running or going to the gym 5 or 6 days a week, and that’s critical to my physical and mental health.

Yesterday was my longest run since November. I ran from my house to Greenlake and then around it twice, then back home for 7.2 miles. I did walk for two tenths of a mile after hitting 10km. I did it at a good clip too. Including the walk, I averaged 10:12 minutes per mile. So when running, about 9:44. Getting back below 10 minute miles for an hour feels important. I know it doesn’t actually mean anything to a totally recreational runner like me, but there’s a mental aspect to being faster than that.

My time for the 10km split yesterday was 1:00:32. I’d have loved to hit 59:59, but it wasn’t to be. But I have to remember: when I first set the goal of running a sub-1 hr 10km, it took me about three years to get there. Now, having been all the way back at 12+ minute miles only a month ago, I’m able to brush up against that goal pace again already. Only about 5 seconds per mile. If I hadn’t done 4 miles of hill training the day before, I might have gotten there.

I also really want to get my strength up for another Spartan (or other obstacle) race. I’ve been doing a lot of upper body strength work at the gym, including my new favorite exercise: tying 100+ pounds of weights to the end of a long rope and pulling them hand-over-hand across the room. Great arm and core work. Hopefully one day I’ll be able to climb a rope. As of now? I can hang from one for about ten seconds.

But it’s ok to be bad at things. I’m working at being better and I’m excited about the prospect of improving.

I Have Begun.

1 March 2018

Well, here I am in Seattle, working at my new hospital! So far so good, but I have a lot to do in a short time. I’m excited but nervous. And I’ve had very little down time so far. Also very little in the way of planned orientation. Very few “get to know you” meetings, etc.. Which has felt very unstructured, but has required me to take the initiative some, which is good.

I have a big meet and greet with “my” team on Monday. I’m the leader, but I’m not the boss. And I’m learning a new work project system called “agile” which keeps things focused and on track, without project management. Which is weird. But what the hell, I’ll give it a shot. I kind of have to!

I’ve been going to AA meetings and I’m even speaking tonight at my men’s meeting. I’ve been exercising and that’s been good. I’m not losing much weight, but at least I’m feeling fitter and stronger after about three weeks back at it. It takes time.

I’m very nervous right now but I knew to expect that. Everything is new and difficult and confusing. New systems take time. There are different expectations here. But I’m a professional and I know how to do what I do. And they want me to do what I know how to do. So that’ll be what we do.


The End of the Interregnum.

21 February 2018

Well, I have about 5 days until my new job starts. I’m nervous of course. I have a large set of new duties and very little knowledge or understanding of the structure of the company. I will go into it consciously unafraid to ask questions, lack insight, and be stupid. I’ll have a lot to learn very rapidly. But that’s one thing I’ve always been pretty good at. I enjoy steep learning curves.

This six weeks off has not felt like a vacation. I’ve been packing, unpacking, driving, working, shopping (for boring necessities), and learning the new aspects of my new city as fast as I can. Even though I grew up in Seattle, it’s changed enormously in the 26 years I’ve been gone. And I lived on a suburb island, not the city itself. So I never really knew the “mainland” as we Islanders called it.

I like where I live. The house, the neighborhood. It’s very comforting and feels like me. It’s a little hipstery, but that’s ok. And there are things I still don’t know how to find that I want, like a little gourmet grocery. Though the basic grocery store at the end of my block is very good. There’s plenty of good coffee.

The AA here is really wonderful. I’ve been asked to speak at my Men’s Meeting already. That’s next week. The attendance is inspiring, the meeting structure is comforting. The only thing I’m not crazy about is the length. Meetings seem to be largely 75-90 minutes. I’m a 60 minute guy. But I’ll adapt.

Tomorrow I think I’m going to a meeting for a professional society. I’m interested and excited about it. But also nervous about entering a room of highly trained professionals in a field I’m only peripherally trained in. But I think it will be interesting to go and meet people and start to make connections.

I’m looking forward to going back to work. I’m ready for a new thing.

9.99 Years.

15 February 2018

Today is the anniversary of my last drink: a double shot of Maker’s Mark bourbon in an airport bar in St. Louis, MO, as I waited to board a plane to go to an inpatient rehab in Malibu, CA. I also had a couple of beers, but that wasn’t nearly enough to get me drunk. Not then. I remember being angry that I didn’t have cash for another drink on the plane. And so that was the last one.

It’s late enough in the day now that my last drink was more than ten years ago. But I won’t really feel it until tomorrow. A decade. And unbelievably long time has passed. A decade of work and joy and fear and love and pain and all the things every normal person has in their lives.

I’m normal now, on the outside. To everyone else. People look at me and see a slightly pudgy 43 year old man with a job and a partner, a couple of hobbies. I do normal things like ride my bike to work, and cook dinner, and go on vacations, and argue on the internet. I’m normal on the outside.

On the inside, I’m better. But I’ll never be normal. I’m an alcoholic. Which means I obsess about myself, and feel aggrieved and entitled. I have to work especially hard at everything to achieve what normal people can do in their sleep. Like open all the mail, or get my car retitled, or ship a package, or get to work on time. All those things can be hugely laborious.

But I’m better than I was. And I’ve come to be glad I’m not normal. I know where I belong. I know who I am. What I do. Why I do it. I love what I’ve become. I’m grateful that I’m an alcoholic, because I’ve learned how to live. How to rise. How to fight, and when not to.

I am a sober member of Alcoholics Anonymous. And I have been for ten years. Well, 9 years, 364 days. I don’t think I’ll drink tonight. Tomorrow looks good. And Sunday can take care of itself.

The Hill above the Lake.

13 February 2018

I can’t believe the things I’m feeling here.
Bewildered joy infects my cautious heart.
A sudden drop, through spaces far and clear,
and then the bounce, far higher than the start.
We find ourselves unanchored in the stream.
We’ve flung ourselves from harbor to the waves.
But clasp my wrist, and while this tempest heaves,
I’ll hold you; let the howling winter rave.
For there upon the hill above the lake,
there stands a house awaiting to be built.
And board by nail, each shingle, plank, each shake,
we’ll raise our home; a sturdy place. Not gilt
But furnished well with hope and love and light,
We’ll share a place to sleep the starry night.

The Preparations Ongoing.

12 February 2018

BB and I have landed well in Seattle. The house we’re renting is fabulous, and our landlord seems reasonably cool. We have begun our unpacking, and are probably about halfway through it. I got the TV and stereo up and running and the meditation room is already settled. Our bedroom has a bed and a chair that isn’t put back together. The piano is functional but in bad need of a good tuning. The kitchen works and we’ve been cooking.

I found a couple of AA meetings. A Saturday morning 7am, and a Thursday evening men’s meeting. I like them both so far but I’m not sure about the spacing. I may need to switch to another men’s meeting if I can, simply to get myself on a schedule that works for me. Also, the one I’ve found is 90 minutes, and that’s a long time. I like 1 hour meetings.

But I can already feel a positive change. In Philadelphia, I didn’t like the feel of the formats much. I liked my men’s meeting, but other meetings just never quite felt right to me. And so I didn’t attend them. And also, splitting weekends with BB in DC made consistency and relationship management difficult. So I never got into a groove with my meeting schedule that felt natural and good.

Now I have the opportunity to go twice a week again without my relationship suffering or feeling like I was devoting so much time to meetings that I was neglecting my other duties and interests. That feeling is a luxury of long-term sobriety. Early on, we don’t really have any other duties. We can’t afford them. But as we grow, we can take on more things, and some of us feel comfortable reducing our meeting schedules a bit. In my case, it happened naturally, rather than as a conscious decision. Now, I want a few more again.

I’ve also found a gym, and we’ve been running again. Seattle hills mean it. I live up the hill from Lake Union, towards Greenlake, and that’s a small hill in Seattle reckoning. But for me? It’s a major ascent. Just 250 feet in three quarters of a mile, but that’s a long, slow, challenging climb for me. I’ll have to work it out to get fitter. I’m up for it, no question. But it’s going to take some time for me to get back into the swing of fitness.

So, I have two more weeks until work starts. I feel like I want to go back to work now, which means that the two weeks left is a good idea for me to feel truly rested, relaxed, and ready to return. I’m excited and nervous. But I feel good about where I am.

We Are Arrived!

4 February 2018

Well, BB and I have arrived in Seattle and we are settling in to our new home. We do not yet have any stuff. It turns out that the amount of stuff that fills a Subaru Crosstrek to the gills makes very little in the way of a dent on furnishing a two-bedroom house. But we had the sense to pack an air mattress, and so we have a place to sleep. And we packed a pot and some dishes so we have been cooking. And we started a seven-day free trial at a local gym and got a workout in.

The truck with our stuff ought to arrive sometime this coming week. Then will begin a three month process of unpacking. Kidding, of course, but it always takes longer than you want it to. The drive out was amazingly smooth for crossing the country in February. We took five days, starting Sunday night and finishing Monday morning, after leaving BB’s family in Virginia. Including the drive from Philadelphia to Virginia, it was a solid six days.

We had fog in West Virginia, and we had wind in Wyoming, and we had rain in Oregon. But never any ice or snow. The car made good time and decent mileage. And we had a couple of really fun things. We met my St. Louis sponsor for burgers on our stop there. And I finally got to meet MC!! It was wonderful to meet her after more than nine years knowing each other as sober bloggers.

We found our little house and signed our lease. I found a Saturday morning AA meeting that seems like a real winner for me, in a little boat club on the north side of the lake. It’s a mixed meeting, which will be new-again for me. I have been going to men’s-only meetings pretty much exclusively for five years. But I’m looking forward to having the early-morning meeting on a weekend.

In general, I’m looking forward to doing two meetings a week again. When my weekends were the only time to be with BB, I generally sacrificed my meetings for my relationship time. It’s not something I’d recommend for someone in early sobriety, but it worked for me considering it started when I was in my 6th year. Time is not a guarantee of stability or sobriety, but I felt comfortable with my once-a-week schedule.

But now that I’m in a new place and BB and I live together, I’m looking for a weekend meeting and a weekday meeting. It’ll be good to get my schedule established and meet the community and such. I’m really eager to get into a groove that’s comfortable and meaningful for my sobriety, and hopefully be helpful to others.

Now I just have to get back into shape. We started a free trial at a gym, and I’m going later this morning to buy a pair of running shorts because I managed not to pack any. Then we’re going to do a little run on the Burke-Gilman trail and so how our sea-legs are in Seattle.