Death and dying...

I found out yesterday that one of my patients died on Easter Sunday by a drug overdose. It's never easy when someone you know dies, but it seems so much worse when that person was in your care and you could have virtually predicted his death.

This 30 year old man came for his third treatment episode last month. He was well-known within the institution where I work because he had been treated a few times there and had always come back following another of his frequent relapses. When I first saw him I felt strongly that this was going to be a tough case. He was a gentle and kind man without bitterness toward anyone, who always seemed to have something good to say about his relationship with you. Yet, deep down, there were signs of trouble and my antennae were vibrating the first day I saw him.

He had little trouble grasping the intellectual parts of a program of recovery. He knew he was biologically addicted to heroin and benzodiazepines, and he knew he was going to go through a range of physical withdrawal symptoms in the early part of his recovery. He also believed in the 12 Step program, but there was a tragic flaw in this belief system: He felt strongly that the 12 Step program works to help some people stay clean and sober, but somehow it would never work for him. And, he had a sadness about him due to this despair. On the last day we met for a private session on March 30 we worked hard for more than an hour to identify the sources of this negative belief system where he told himself he could never get well. We labored over his thoughts and beliefs about the events that happened in his life. We challenged those false beliefs with the truth. We identified that he felt sad and hopeless when he would cling to ideas about how he might never get clean and sober, and, while he wanted to remove these negative feelings from his life, he could not feel a change in his emotions for the better when he thought about changing these negative beliefs. In other words, he had a belief that no matter what he said or did, nothing would get better.

He also proved to himself that he was an excitement junkie...he loved the thrill of the chase to get his drugs and he loved the pleasure his heroin gave him. He even admitted to me that he loved the idea that this might someday kill him...there was an exhilaration that he felt every time he thought about using. No matter how hard we tried that day, he could not remove this from his mind or see a way to neutralize the tremendously damaging effects of such thinking.

At that moment, I knew he was in deep trouble. I asked him to review his anti-depression medications with his psychiatrist and he said he would. I asked him to surround himself with positive recovering people who had been where he was and turned themselves around. He said he would. And, I asked him to talk about this to anyone he knew who might help him shed the weight of this negative, self-destructive thought. He said he would.

He didn't do any of those things after leaving me that day. Instead, a few days later, he started to use again and he overdosed on Easter Sunday morning at his home.

I resist the temptation to think of what more I could have done to help him. I understand that there is only so much another person can do when you are confronted with the disease as strongly as he presented. But...I know what I felt that day when he left my office and, as unreasonable as it sounds, I wanted to hold him there that day, arrange for him to go back into primary treatment, and protect him from himself by wrapping my arms around him and assuring him it was going to be OK. I wanted to jump up and down and tell him that this negative thinking was only going to end one, bad way. And, because a man's life was at stake and I did not do any of that, I am left with regret, remorse, and anger.

Of course, over the span of 24 years as a counselor, it is not the first time one of my patients has died while in my care. I know this will all pass as I focus on the future and the people still in my care who may be at just as much risk for dying of the disease of addiction. But, it doesn't get any easier each time it happens. I immediately think of Chris, Wendell, Becky, Rose, Bob, and, most of all, Kristine whenever this happens.

I have also become a lot more rigid in my thinking about how to treat this illness. I vow to react more aggressively toward the obvious signs of relapse, and to not allow a person to lull me into believing that extreme sadness and hopelessness will somehow work itself out. And, I plan to do more meditating and praying for guidance in how to deal with this kind of case.

So long as I follow that way, I have nothing to fear.

Roger W.

Search for meaning...

I saw  a video clip recently of Viktor Frankl, the famous survivor of the Nazi concentration camps who wrote "Man's Search for Meaning". The video is of one of his very old lectures about searching for meaning in life, and, while it's tough to make out some of the images, it's worth listening to it.

I thought it would be relevant for The Happy Hour because we here are concerned with finding the meaning in life and have discussions about this all the time through these postings.

He has a simple message, that we must aim higher than our ordinary lives in order to achieve the goals we set for ourselves. He makes the point that there are forces blowing against us everyday that can throw us off course and we might end up in a different place than we intend to go. As Yogi Berra once said, "If you don't know where you are going, you might end up there!" Here Frankl makes the same point in an interesting way.



All the best, Roger W.

Buddhism...

I accomplished another of my first-of-the-year goals today: I went to my first Buddhism temple ceremony this morning.

For many years, after discovering Buddhism as a tender undergraduate at Stonehill, I have dabbled with the idea of "becoming a Buddhist". Now, I was never certain what that meant, but it sounded very avant garde and hip at the time, so I read a few books on it and even tried meditating a few times. But, for the most part, I drifted away from that just as I had drifted away from much of my spirituality over the years. For years I've just been a Buddhist wannabe.

But a week ago, that all changed. I had set about making a list of goals for myself for the new year and found that I needed to have a spiritual goal. So I thought long and hard - you might even say I meditated on it! - and decided that now was the time in my life when I should truly explore Buddhism or forever leave it behind. As the first step, I enrolled in Clouds in Water Zen Center in downtown Saint Paul and made a commitment to myself I would go to this week's ceremony.

The first thing they teach you at the center is how to sit for meditation and I went through a 30 minute instruction with several other people (mostly students from a local seminary who were just "checking Buddhism out"). Last year I went to a three-day seminar on Mindfulness Meditation, so I was well-prepared for the process of meditating. After the instruction, we all joined the congregation of about 50-60 people assembled in a beautifully peaceful large room that used to be a storage room in an old warehouse. White walls supported by gigantic wooden beams, all painted white, enclosed a soft space where pillows where set about and people were either kneeling or sitting on them. I cannot sit on the floor well so I grabbed a small support pillow and joined a number of others sitting in chairs.

Two women priests were sitting at the front, quietly waiting for people to settle, and signaled a third to ring a Tibetan Bell, that, when struck with a wooden hammer sent out the most clear and soothing sound that lingered in my mind long after the vibrations stopped.

There we sat, for 30 minutes, in meditative silence. Now, I realize the formal meditation like this is not for everyone, but certainly everyone does meditate. All meditation is living in the present moment of your experience. When a sound intrudes, you acknowledge that sound to yourself and turn your inner attention to your breathing - in/out, in/out, in/out. When a thought intrudes your moment, you acknowledge that thought as something happening in the very moment of your experience, and then turn your thoughts back to your breathing - in/out, in/out, in/out. And when your muscles get sore, you get an itch, you ass falls asleep, your head nods, or whatever else occurs while meditating, you acknowledge this and set it aside by concentrating on the breathing - in/out, in/out, in/out.

All of us sat in silent meditation until that beautiful bell sounded again that signaled we are to come into the full expression of our moment by acknowledging our surroundings and relating to one another again.

One of the priests then spoke on a topic. Today it was about "Engaged Buddhism", which is a current within the flowing river of Buddhism that advocates active engagement with the outside world of politics, social issues, relationships and, in other words, how a person can "carry the message" of Buddhism to the community at large. It's controversial because many believe Buddhist practice is for the solitary pursuit of serenity, peace, and living in the moment of one's own existence. But, clearly, with so many spiritual issues embedded in political debate these days, Buddhism has much to say and a lot to offer the world outside the temple.

When the talk was over, there was a ceremony that was strangely similar to the Catholic faith I was raised in. There was praying and chanting, and the priests seemed to offer incense, a candle, and some (I guess it was) wine to the statute of a  Buddha in the center of the altar. This was very simple and direct and without any pomp to it all all...I saw it as just a quiet way of offering some symbol of gratitude to a spiritual leader.

Well, if you've read this far, you might be either bored with the details of a religious ceremony or intrigued (as I was) with the power that was in that room for two hours. Clearly there was something happening that was bigger than the sum of it's parts, and the power that the silence created, and the calm words of wisdom the priest delivered that were coupled with a simple offering, gave me a sense of peace and consolation I have not had in many years.

I will return to Clouds in Water again. It fuels my spirit. I think it will make me a better person to be a part of this community. And, maybe I have something to offer as well. It's all part of the recovering journey where I have now stepped onto a higher road that will lead me to peace of mind.

All the best, Roger