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Why Do I Blog?

11 May 2012

Last night on twitter I asked people to answer the question, “why do I blog?” I got some great responses, here, here, and @proflikesubst’s five-part previously written dissertation on the topic, starting here. So time to answer my own question: why do I blog? Why am I here? What’s all this for?

Asking why I blog is, I think, essentially asking two questions. First, “why do I write?”, and second, “why do I write here?”. I think that each of these deserves a little bit of attention. As to why I write, the answer is that I always have. My older sister was always writing stories and poems when we were kids, and sharing them with me. My favorite continues to be the story about how Gargamel caught and ate the smurfs, but then he dies. Because it turns out smurfs are poisonous. Because they’re blue. I mean come on!

So I’ve always written. Stories and poems and later a dissertation and scientific papers and a blog. I kept a journal for a number of years, but I haven’t in a decade or so. Sometimes I keep one while I travel, but I didn’t on my recent trip to New Zealand.  I did a lot of writing when I first got sober. Journaling is useful in early sobriety when one’s emotions are completely out of whack and rage erupts into elation or terror with no warning. Somewhere in my house I still have the journal I kept during rehab. I’ll have to find it sometime. It’s got my fourth step in it too.

And that’s another aspect of writing and sobriety. My sponsor had me writing for several steps. 1,2,3,4,6, and 8. It focused my thoughts, allowed me to pay attention to things in my head and heart about alcohol. Writing crystallizes my thinking on topics and helps me think more deeply than simple pondering, or even discussions with my sponsor or others. I write so that I can understand the things I’m writing about.

So why do I write here? Why keep a blog and open it up to the world to read about my private life? There are many reasons for that too. Of course, like many bloggers, I have this vague fantasy that someone is going to read my blog, and decide to offer me several hundred thousand dollars to write a book about my exquisitely fascinating life. He’s an alcoholic! He’s a scientist! He knows what semicolons are for! I was obviously born to be the next Augusten Burroughs or somebody. Or some hospital administrator will read about my simulation work and offer to pay me thousands of dollars to study his/her hospital.

But that’s a vague fantasy, and I don’t even know if I could produce a book if I was asked to. Blogging is very different from writing to a single purpose. I also write here for the simple reason that Roger Ebert described as the reason we get married: to have a witness to my life. I have a couple hundred people who read about what I’m thinking, how I’m doing, my ideas and fears and triumphs. It makes me feel part of a community. Many of the people who read and comment on my blog have blogs of their own, which I read. There is an intimacy to the community of people who write about their lives.

I write so that I can help people with addictions, and people who care about people with addictions. I try to be as honest and open as I can about my own journey, and what I’ve gone through, so that people can see that recovery is possible, and that life can get good after sobriety. I share my – as we say – experience, strength, and hope so that someone who is out there, googling “alcohol sober help”, might find this and read and realize that if I can do it, they can do it.

I write here to help to alleviate the stigma of alcoholism and other addictions. To show that alcoholics in recovery are not all constantly relapsing and miserable. We are not all people who slept under bridges and developed serious facial hair situations. We are ordinary men and women who have a mental illness. A fatal one, if it is untreated. And one which is, in many, extremely recalcitrant to intervention. One for which the scientific community doesn’t even really know how to effectively measure improvement and remission, much less promote it.

I write so that people with loved ones who are suffering from alcoholism can see that recovery is possible, but cannot be imposed. The only treatment for active alcoholism is pain. We cannot impose recovery. All we can do is decide what we can and cannot live with. And then set boundaries and enforce them. We alcoholics, while drinking, will use and abuse everyone in our lives in order to continue drinking. When our support, our enabling, is withdrawn, we have the best chance for recovery. Often, it isn’t enough. Most alcoholics will die of alcoholism.

I write because the only way to recover is to stop fighting. Alcoholism can’t be beaten. It can only be surrendered to. And I hope that I can help other people lose their battles. Give up. Let go. And then move on.

Humility, Vainglory, and the Imposter Syndrome.

10 May 2012

There has been a lot of discussion of Imposter Syndrome in the science community on twitter lately. Examples are here, here, here, and the post that started it all. For readers of my blog before the move over here to WordPress, you may remember that I’ve written pretty extensively about it. I hope this isn’t too repetitive. For people new here, I figured I’d give it another go. Because I think that for me, it relates importantly to work that I do in the program of Alcoholics Anonymous.

Alcoholics, like scientists, regularly suffer from a crippling sense of not fitting in, not being good enough, not rating well against their peers. I wonder sometimes if this is not, in fact, a universal phenomenon. This feeling of inadequacy is an existential disquiet that I attempted to treat with alcohol. Because I’m an addict. And when you’re an addict, alcohol becomes the one-size-fits-all solution to your problems. Don’t measure up? Down the hatch. Can’t solve the problem? Down the hatch.

And I do feel like an imposter in the science world. I feel like I drank a lot of my education. I don’t remember the finer points of some of the mathematics that should be second-nature. Some of it I could never really do. Just enough to get through the courses. Because I didn’t study the way you do when you are deeply serious about it. Because I drank. And I have a couple of papers in extremely marginal journals. And I am pushing 40 and I have only one serious grant to my name. And it’s not all that serious.

But then, and I’ve never heard scientists talk about this, or at least never talk about it as a problem, I will also have something flip in my head, and then I’ll feel like the greatest health care engineer that’s ever walked the earth. I’m a colossus, and everyone should be lucky to collaborate with me (people aren’t exactly beating down my door), and I feel like the best there’s ever been. I have a couple of papers in really good journals. I got the first federal grant I applied for, without revision. I get consistently excellent performance reviews.

The truth is, neither of these things is what I really am. I am not an imposter. I have earned my spot at the table in health care engineering. I know how to study delivery systems, make conclusions about them, and contribute to the field. I’m well-educated and I try to stay up on the latest developments in my field. And I produce some of the latest developments in my field. But there are other people doing great work, much of it better than me. I’m never going to be offered a position in a department of systems engineering: I’m not good enough at theory. I’m one of only a few people doing academically rigorous applied work in the area I’m in, but that won’t last long. Smart people are joining the field every day.

So I’m pretty good, but I’m never going to be great. I made a number of mistakes in my career that have held me back, mostly drinking myself into insensibility daily during grad school. I wasted a lot of years. So while I’m a new investigator, I’m not a young investigator. It’s time for me to produce some good work from the grant I won, and win a new grant or two, or I’ll need to leave the academic side of things and become a purely applied quality control engineer in health care. But I’m working hard at those things.

And this is where the program of AA helps me see my path. Being in AA has taught me about humility. For me, humility is about trying to understand where I fit in the system. What is my right size? I am a small part of a big machine. I have talents which I try to use to be useful. I am not useless, nor should I be. But I am not great. Nor should I be. I don’t do well when people start pumping me full of praise. I start to get egotistical, and then I start believing the hype. And then I end up making bad decisions.

AA does a very good job of teaching me humility. Because alcohol did such a good job of teaching me humiliation. I had allowed myself to be robbed of all of my dignity, wearing oversized red sweatpants for days at a time, wasting whole days doing nothing but drinking and reading awful entertainment novels. Hiding alcohol, being unable to look at myself in the mirror, or forcing myself to look too long, berating and excoriating what I saw.

In AA, I have learned a great deal about being right sized. Self esteem comes from accomplishment, at least for me. And in AA I have accomplished many important things. I have done all twelve steps. I have done the single most important thing that any of us in AA, indeed any alcoholic, can do: I have been continuously sober for more than four years, and I have no intention or desire to change that today. But there are still people in the program that I can admire from below. Who have been here longer and know more and have wisdom to share with me.

So, AA has allowed me to combat my imposter syndrome, and its reflection, the vanity of feeling like I’m the very best. I am neither. I’m just a man, walking through the world, who usually, but not always, tries to do his best. And that’s going to have to be good enough. Because I can’t do any better. I set intentions, and I usually, but not always, see them through. I set goals, and I often, but not always, reach them. Through all that, I constantly keep a check on my emotions and expectations. By working the program. By checking in with my sponsor, who can see things about me that I cannot. By seeking criticism not only of my work, but of my sobriety and my current condition.

I simply try to be what I can be, and not more. And I seek constant corrective guidance to know what that is. Because I recognize that I am not always good at determining where I belong, and what I am capable of. Often, others can see it better. But every day I spend sober is a day that I have achieved something important. Something crucial to my persistence. Something that has come to be at the core of my sense of self.

I am a sober member of Alcoholics Anonymous. I am an engineer. I am a scientist. Sometimes I don’t feel good enough. Sometimes I feel too big. Those things can oscillate with terrifying rapidity. But by seeking humility, I can smooth the signal.

Sustaining Communities.

9 May 2012

Humans seem, to me, to be fairly social creatures. I know I’m alone on a shaky branch here, but I’m going to go ahead and stand by that hypothesis. We operate better in groups, and are more effective when collaborating on things. Of course, there are people who do great work alone, and introverts and ascetics who shun society. But by and large, it seems we assemble ourselves, raggedly and haphazardly, into ensembles of vaguely like-minded people for the purposes of unification. Much of humanity’s problems are, of course, associated with the collision of such groups organized to cross purposes. Churches, nations, professional and charitable societies, corporations, governments, universities.

Sometimes these groups are formal, sometimes totally informal. And in my case, at least one of them is somewhere in between. Alcoholics Anonymous is a semi-formal assemblage of persons grouped to the common purpose of recovering from alcoholism. There are millions of us in hundreds of countries. But there is no list. No membership card. No leaders. No cost. We are simply a large group of people who have found a way to share our common experience to stay sober, and help others to recover. And it works. Lots and lots and lots of us have gone years and years and years without drinking.

We survive because we sustain each other. We call each other. We support each other. There are a dozen names in my phone right now, of men and women who would walk across hell to help me if I needed it. My name is in a few dozen other phones, and I’m willing to do the same. Though, I suppose it must be said that sometimes the way we help each other can be different from what an outsider might expect. If a friend from the program called me up, drunk, and said he needed help, I’d tell him to call back when he’d dried out and hang up. Just as I’d expect him to do if the situation were reversed.

The community sustains us. In walking in to the rooms of AA, we find a community that exists for the purpose of alleviating a malady that afflicts us, free from judgement. I’ve been in rooms with murderers and thieves, and worse. I cannot judge any of them. It is only fortune and grace that I have not done what any of them might have. And there are people in the rooms who may be grateful that they have not done (yet) the things that I have done. There is no stigma in AA. We are honest about our faults, so that we may find, build, and maintain this sustaining community.

Another sustaining community I have found is actually on twitter. If you’re a scientist (especially a young or new investigator), and you’re not on twitter, you’re doing it wrong. There is an enormous community of young and new researchers – as well as some old hands – who are building a truly remarkable and supportive community. In fact, it resembles AA in a lot of ways: it’s open to all, it’s largely supportive, and it’s available all the time. It is slightly more dogmatic than AA (which has no dogma at all), but I have found it to be tolerant of anyone able to rationally stake a claim to an intellectual position and politely defend it. And it’s open-minded in a truly critical way: it is permeable to evidence.

I’m fond of saying that America’s assistant professoriat is on twitter. It really is. Along with all sorts of other scientists and engineers who are working to get grants funded, papers published, classes taught and grading done. The information accessible in that group is astonishing. I have learned as much about being a scientist from twitter as I did from my advisor or my first mentor. And when grants get funded there’s cheering. And when papers get rejected there’s commiseration. I saw one tweet that simply said: “p=0.046”. And there was much rejoicing.

These communities are crucial to me. I am a better man, a sober man, because of a loose but powerful community of alcoholics who bear me up when I fall, and teach me how to be a man in the world. And I am a better scientist because of a group of semi-anonymous chatter-streams on twitter. Each of which is a person at a keyboard, with an idea. And the willingness to share it.

Which is an astonishing thing. We share. So that we may persist. And so that we may be better than we might otherwise be, alone.

Simple Simulation Example.

8 May 2012

In order to help you visualize what a discrete event simulation is, I’ve created an extremely bare bones example, and uploaded it to the web, on a site designed by the software company. The model may be found here.

This model consists of a simple discrete event system. Patients (little blue people) arrive, and then are triaged by a triage nurse (little yellow person). They then proceed to one of the six ‘exam rooms’ where they can see a physician (green person). If the exam rooms are all full, they will go to the waiting area instead. When done, they proceed to an exit.

There are sliders that allow you to control the three basic aspects of the simulation: the arrival rate, the number of triage nurses, and the number of physicians. This is the extremely simple version of what I do. I build these little semi-video games that allow us to determine things like: given an arrival rate, how many physicians do I need to keep the waiting room from filling up? Give it a try! You may want to click the little clock with the plus sign on the top bar a few times to speed it up.

It’ll prompt you to download a plug-in. It’s just Java.

A Bone-Deep Sadness.

7 May 2012

Yesterday and today I attended Gabriel’s visitation and funeral. It was good to be with family. It was good to be of service. I had an uncle staying with me. I drove to and from the airport three times in three days. My family was strong and still vulnerable. I have much to learn from them.

It was a beautiful ceremony. Catholic, but without pretense to preach dogma. Simple ceremony, simple words. When we reached the grace itself, it was in a field of children’s graves. It never occurred to me that I’d see a field of stones with only one date on them. It is among the most desolate things I can ever remember seeing.

I am tired of all of this dying; too many loved ones have gone recently. I look for something regenerative. Someone I’ve been talking to about the program is making wonderful progress, though they cannot necessarily see it yet. It is so hard to see the forward steps we make at the beginning. Sometimes our most meaningful steps forward feel like retreating: admitting failure; honest defeat; accepting that we haven’t lived up to our own expectations. I wish I knew how to convey what illimitable triumphs these are.

I hope I learn from these tremendous people in my life. From leveled, ashen-faced parents and grandparents, burying their own. From a lost and weary new traveler on the road to sobriety.

Part of me wants to rage. Part to laugh. Part to weep. Each part has had its hour. And hours will turn to days. Wounds scab and slough and scar. I share in the strange majesty of each signpost passed with a friend new to the road I’ve been walking. A head bowed by grief rises with resolve.  And I take another step. And it’s easier than the last one. I am not alone.

Another Grant Away.

4 May 2012

It seems that about 90% of my job is grant writing. I don’t teach, and I have precious little time for my actual funded research. Most of my time is spent doing work for grant submissions. But that’s how it goes. Especially for junior investigators on soft money. It’s very difficult to keep yourself fully funded. My institution shifted me from hard money to soft pretty abruptly. I have a single grant that is over in 5 months. After that, I’m on the good graces of my institution. So I need to be productive until such time as I get another hit.

So I’m submitting a lot. I put in three grants at the end of 2011, two in October and one in December. None was funded. Now I’m preparing a resubmission from the December grant, and I’ve just completed a grant with my boss. We submitted it today, and it cleared grants.gov with no errors. It’s an interesting grant, examining a troublesome population of patients. There is a lot of interesting work to be done: providing that population with good care; improving access for members of the public who are thwarted by this troublesome population, etc.. It’s a good project.

My boss (who is PI for this grant, but who is not my “PI” in the sense that most scientists mean when they describe “their PI”), is a great boss, and a good shrink. I think he’s a pretty good scientist, but I haven’t seen it in action yet. But he waited a long time to get going on this grant, and as a result I think it’s a little vague. Hopefully we clarified it enough to satisfy the reviewers. But I honestly don’t expect to be funded, because I think it’s the wrong mechanism. We applied to a funding agency that wants to fund implementation, and this is more effectiveness. We’ll see.

All in all, I’m concerned. Things happen slowly everywhere, and I’m nervous about being employed. But we’ll see. I have irons in fires, but I never know what’ll happen. I sent an email to a guy at a nice east-coast university two weeks ago and didn’t hear a thing back yet. Maybe it’ll happen. Maybe it won’t. Overall, I’m doing pretty darned well. But the horizon is looming, and I get afraid. Fear is a bedeviling emotion.

Nevertheless. The grant is away, and there were no errors, and it’ll be graded along with the others. That’s all I can do. With the limited time I had for this grant, and the minimal help I got from my boss, it’s as good as I could make it. That’ll either be good enough, or it won’t. It’s out of my hands now. Time to move forward.

Managing Emotions.

3 May 2012

Some of the signature conditions of the alcoholic are defensiveness, self-righteousness, deflection and projection. Obviously, it’s not only alcoholics who feel and behave this way, and equally obviously, each alcoholic is an individual, and expresses things a bit differently. However, my experience is tha nearly every alcoholic exhibits those behaviors in ways that are troubling to themselves and the people around them. Troubling is a vast understatement. These behaviors, while present in every person to small degrees, rise to truly toxic and destructive levels in alcoholics.

And, like most of the difficulties we alcoholics get ourselves into, they don’t go away just because we stop drinking. Our relationships don’t get magically repaired. Our debts don’t get magically paid. Our bodies don’t magically recover from the abuse we inflicted upon them. Each of these things takes time, patience, perseverance, and slow, deliberate toil. The sort of thing that humans everywhere do to negotiate their way through the world. The hardest of these things, for me, has been to learn how to manage my emotions in a new way. A manner that is of service to me, still honors the emotions themselves, and the circumstances that gave rise to them, and doesn’t alienate people I care about.

Yesterday was one of those days. I went and spent the afternoon in the hospital with my cousins, my aunt and uncle, and the two-day-old corpse of their infant son. Gabriel is a tiny, blue ragdoll. They were making casts of his hands and feet. Everyone was numb. My cousin held this tiny corpse to her body like a living child. A nurse was there. This is a new method of grieving, I was informed. It’s supposed to alleviate trauma in the parents, I suppose. I found it deeply unsettling.

I spoke to my sponsor, and to another friend. I cried. I shuddered. I took a walk and then a bath. I ate. All things appropriate for the circumstance. Then I got into a stupid debate about flirting on twitter. A debate I had no business being in. No one was looking for my opinion. No one asked for it. I was the only man in a conversation with several women. I was polite, but frustrated. After about a half an hour, I gave up. I apologized for making any comments at all.

Not because I have nothing to say on the matter. Not because I have no right to talk there. I do, and I do. But yesterday wasn’t the time. I wasn’t ably separating the spheres of my emotions. Normally, I can. I have learned to. Frustrations from work do not get taken out on people in my personal life. Personal difficulties don’t get dragged to work. Learning to appropriately manage my emotions was complicated and difficult, but for the most part I learned to do it pretty well.

I stop and think before I speak, most of the time. I don’t make blanket assertions that I don’t have evidence for, unless they’re plainly opinion. And when I am upset, I look inward rather than outward. One of the things you will hear, if you sit around the tables of Alcoholics Anonymous long enough, is, “When I am upset about something, there is something wrong with me.”

Now, that doesn’t mean that there isn’t also something wrong outside of me. All too often there is. Like a dead infant. I can’t begin to tell you how wrong that is. But what it does mean, which I think normal people learned a long time ago, is that I am, in a very important way, responsible for my emotions. I’ve been told many times “you can’t help how you feel.” But I don’t think that’s true. I can, through careful reflection, help how I feel. And I can certainly manage how I react to my feelings. I can examine the disquiet within me and slow and settle myself and look for the good in every situation.

In that conversation I had with my friend, the person so new to sobriety, I was asked a critical question. “Aren’t you glad you get to be present for all this?” I’ve made that point myself, and it’s one that my sponsor often makes. And it’s one of the core principles that good sobriety is based on: being useful to others. Being of service. Even when that is uncomfortable and confusing.

I’m grateful today. Grateful that I have a shoulder for people who are in mourning. Grateful that I can feel sick with grief. That I am not numb to the experience of living, because I am inebriated and altered. I am grateful that I can be circumspect in sadness. That while I am often distressed, I am rarely distraught. That when I do find my defensiveness, self-righteousness, deflection and projection welling up within me, I can look at it honestly, and recognize that these are emotions designed to prevent me from taking responsibility. Emotions that will lead me to selfishness and fear and isolation.

And I can forestall them. Apologize to those I’ve inflicted them upon. Correct my actions. Explore my motivation. And find the core of it.

I am incredibly sad. I am angry. I feel a sense of injustice. I am grieving.

And I am so grateful that I can be present in these feelings. That I can sensate and persist among the sloughs of this human burden. Because I am. And I am sober. And that is good.

Engineering the Emergency Room, Part IV

2 May 2012

So, I think we’ve come to the final installment here. In part one we talked about what a system is, and why an emergency room (ER) is one. In part two we described how to actually build a simulation of an ER, and in part three we discussed the validation of the model. Today, I’m going to describe how to do simulated experiments, and relate that information back to the real world.

So, if we were careful about how we built our model, and we built a fairly finely grained one, and we validated it well, then we can perform basic experimentation. Here we again have a problem with how it is done in the literature a lot of the time, because frequently, these systems aren’t used for true scientific experimentation. They’re just deployed, people fiddle around with the parameters, and then report the results of the fiddling. That’s fun, and can even occasionally be informative, but it isn’t scientific experimentation.

To do true experimentation, we need to think like scientists instead of engineers. First, we sequester one copy of our simulation, and use it as a control. We need to then formulate a hypothesis about our system, and determine an output metric which is both informative, and reproducible with the simulation we have. It won’t do to use, for example, medical error rates for our output measure unless they, and some means of influencing them, are explicitly coded into the simulation. In some cases, people get this wrong. They do things like report medical error rates as their outcome, when the simulation actually measures things like duration of average required shift for physicians as a proxy (tired people make more mistakes).

So, a well-formed hypothesis might look something like this: increasing the number of treatment beds in the ER will reduce overall patient time in system by 10%. Then, we take our sequestered control simulation, and run the simulation with varying random number seeds a large number of times. I can’t give you a particular number that is sufficient, because that’s going to depend on the dynamics of the system. In a small tertiary facility, that doesn’t see a lot of patients, and has a narrowly distributed time-in-system, it might be reasonable to run the simulation only 25 times. With a large facility with very diverse patients, more than 100 might be required.

But wait! I hope some of you have spotted some problems already. Not all simulation runs, even of the control, are created equal. First of all, there’s the problem that when the simulation begins, the ER is empty. This rarely happens in real life. therefore, generally simulations are given a burn-in period, during which no data is collected, to ensure that the system is operating at steady state rather than in the midst of a transient response. For ER simulations, three days is generally sufficient. Second of all, the need to decide how long a simulation run lasts. Do we simulate a week of ER activity? A month? A year? There’s no hard and fast answer. But generally, as in life, longer simulations will produce smoother results. If I run a simulation 100 times for a year, I’m going to get a much nicer distribution of outcome measures than if I run the same simulation 100 times for a week. Because random and rare  phenomena have a smaller impact on the output.

So. We have a hypothesis, we decide how long to burn-in, and how long to simulate (often defined as the same length of time as the duration of data taking), and how many instantiations of the simulation to do. We assiduously record all of this data (science!) and then conduct out experimental group. We modify a different copy of the simulation, and perform the same simulation runs, same burn-in, same duration of simulated time, and record that data.

So, now, we have three groups of data. The original real-world data, the simulated control data, and the simulated experimental data. Now, we can do two hypothesis tests (we should already have validated the simulation against the real-world data). We compare the simulated experimental data to both the real-world data and the control data. Hopefully, we will find a statistically significant reduction in patient length of stay at or near the level we hypothesized.

Now, this is where the vast, vast majority of papers in this field end. Because it is generally, as I’ve discussed, impossible to conduct the experiments in the real world. And even when we have a strong, evidence-based recommendation, as the above result would be, it’s often hard to get buy in from administration and staff to make the changes in the real world exactly as they were done in simulation, in order to achieve the same results. Generally speaking, when administration agrees to make the difficult and arduous step of intervening with a complex system like an ER, they want to do all their changes at once, so as to disrupt the system for as short a time as possible. This can make it hard to check our results.

So, why not just simulate the whole shebang of potential changes that the administration is interested in implementing? Why not rearrange the whole simulation, and examine the new system entirely? Well, you can. But I am much more skeptical of the results. Because these systems are very complex. And making changes to the simulation always introduces some error. The real-world intervention is never going to look precisely like the simulated intervention. And so, when we make a large number of interventions at once, we accumulate small errors, and introduce new system behaviors which may or may not be replicated in the real world. These simulations are generally very accurate for predicting the consequences of changes in isolation. They are generally less good at determining the results of wholesale reorganization.

So there. Dr24hours’s four-part primer on engineering the emergency room. I hope I haven’t wasted a lot of your time! If you have any questions, leave them in the comments, and I’ll get around to it eventually. Probably!

Elegiaca.

1 May 2012

I don’t know a great deal about life. I know there’s more grief in the world than I’d prefer. I know that sadness is visited upon good people who have earned better. I know that nature cannot make our bodies perfect. And that sometimes, because of a senseless fault in a spiral of atoms I’ll never understand, a baby cannot live outside the womb. And cannot be kept there.

Gabriel was to be the blessing to a family already beset by grief too terrible to bear. The first child. The new life bubbling up in spring after the long winter of mourning for his uncle Philip, a marine killed in action and not yet twenty. Only a few days ago, Corey and Rebekah’s grandfather passed. Rebekah’s labor prevented their attendance at his funeral. But we had known for months that Gabriel would not survive. Whatever tests physicians do and expectant mothers have had revealed this irremediable defect.

Gabriel lived for two hours and twenty-four minutes.

We are all not more than streaks of light across the sky. Celestial matter burning a path through time and space, short-lived and of questionable purpose. Most of us hope to be of account to someone. To make an impression on a heart that will make an impression on another, and on. To leave this place having imprinted something unique upon it, something of our own.

It is astonishing to me, the depth of heartbreak I can feel about a child I can never meet. The sorrow I feel for his parents, my cousins and friends. His grandparents, my aunt and uncle. For this family – suffering so much loss in so short a time. I think, maybe I should be angry; I have nowhere to put that.

Gabriel’s trajectory was short. Unfairly, randomly, unjustifiably. But it was no less bright for being so. And I’ll remember. He was here. Sometimes, the imprint is a scar.

On Maturity and Masculinity.

1 May 2012

I was talking with a friend last night about masculinity and – without saying the word – maturity, and how they relate to sobriety. For the duration of this post, I’m going to be writing about my experience, and the experience as I understand it relating to men. I can’t speak for all men, of course, but I can most assuredly not speak for women. So, to my female readers, please don’t construe anything here to suggest that I’m describing how women can/do/should experience anything. I can’t speak to that.  I’m doing the best I can to describe what I see as a common phenomenon among men in the program of Alcoholics Anonymous, but primarily only my own experience.

 In some respects, because I didn’t begin daily drinking until I was about 21, perhaps a little older, I was very fortunate. In the program, we tend to say that we stop maturing, emotionally, when we “take our first drink”, meaning, when we begin alcoholic consumption. I’ve seen this over and over and over. Grown men, physically, who are children emotionally. They throw tantrums, and have little or no control over their actions and reactions when it comes to dealing with issues that all adults have to face. So many men, when they come in to the program, have to be taught how to do things like pay bills, show up to work on time, and treat other people with basic respect. And they have to be taught to accept that when they don’t do these things, the consequences are their own faults.

Now, everyone has a different experience, but one of the things that I have seen is very, very common among men in the program, and indeed present in my own psyche, is a condition I have come to call “father hunger”. It is a basic fact of American demography that a huge number of children grew up without fathers. Wikipedia says that only 16% of single-parent households are headed by a father. Now, I’m not denigrating the efforts of single mothers. My own mother raised me and my siblings as a single mother for much of my childhood, and she did a frankly astonishing job of it considering all of the challenges in front of her. And she had absolutely no tangible support in that from my father.

And I missed having a father. Don’t get me wrong, I saw my father reasonably often. He was kind and caring. Emotionally supportive. But he was not a role model. He never held a job long. He didn’t show up for things very much. When I was sixteen and broke my arm, and needed surgery on the fourth of July, my father told me, while I was in the hospital bed, that he was glad to be there, because he really felt like a father that day. It didn’t sit well then, and it doesn’t sit well now. I shouldn’t have had to fracture a limb to help him feel paternal. It shouldn’t have been my job at all. But I don’t blame my father for these things. Not anymore. He walked his own path, beset by his own devils. I can’t grudge him his journey.

My story is not atypical. Nearly every man in the program I know has, or had, a broken relationship with his father. Some missing, some dead, some abusive, so many alcoholic. Some of these relationships, like mine, have been repaired and reconciled. So many have not. There is an unfathomably deep hunger for good fathers in this program. We seek, blindly and often enraged, someone, anyone, to teach us how to be men.

And if we do the work, if we have the willingness, we will find that. My Wednesday night men’s meeting is full of men, many of them in their mid-sixties with a few decades of sobriety behind them, who have much to offer about masculinity. Men who can teach me how to interact with the world. Men who can, as fathers should, lead by example. The process of finding myself a physical  adult – an autonomous unit out in the world – and realizing that emotionally I was still a boy, was excoriating. I was deeply ashamed to not know the things that I thought I should know. The things that seemed natural to other men. Men with fathers.

Now, a lot of the work I did to understand what masculinity is I actually did while still an active drunk. I had a wonderful therapist, a woman, who helped me experience the pain of the things I missed, and taught me how to conduct introspection. But even that professional assistance couldn’t replace what was truly missing. And maybe nothing can. Obviously, I will never know who I might have been had I had a stable home, two united parents, and an effective and robust father in my life.

But I have learned many things in sobriety, from the men who preceded me into this program. I have learned so much about being male, and what’s acceptable and not acceptable. What aspects of masculinity are challenges to control, and which are intrinsic characteristics that I don’t need to apologize for. I have learned how to stand my ground without feeling the need to stake and defend a claim. I have learned how to accept an apology, and forgive, without diminishing or negating any wrong that was done. I have learned how to make amends, how to apologize gracefully and sincerely when it’s called for. I have learned how to be grateful. I have learned how to grieve and to mourn.

I hope it’s obvious that I know and agree that women do all of these things too. I can only speak to my experience. And I experience something which I can only describe as ‘male’ about the way I have learned to do these things. By being taught by other men in the program. By being among men who have figured out how to be men in the world. I still have an enormous deficit within me. A missing piece where an effective father would go. But I have the chance, through my participation in a program of honesty, self-inspection and action, to be the man I wish my father had been.