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.

Truth...

Deliver me...

from the cowardice of avoiding new truths,

from the laziness of accepting half truths,

from the arrogance of believing I have all truth.

I've searched high and low and cannot find the source for this prayer/aphorism. I'd like to think that it belongs to someone like a great philosopher (Lao Tzu), politician (Gandhi), poet (Eliot) or religious man (St. Francis). But, I haven't got a clue. Regardless, this has been posted in front of my work space at my home and office for many years. It is something I look at continuously and try to practice in my life.

If I dissect this prayer I learn how I might best function in the world. First, I see that I must have the courage to face new truths that arise in my life. One of these in my life right now is the truth that not everyone will see the value of my dissertation research study and clamor aboard as a participant. Not even all the sources for participants I have will see the value in it and help me obtain participants. It is a truth I must not avoid that most people are indifferent to research projects like mine. Second, I see that I must not be lazy when it comes to the truth and accept just anything that someone tells me as being authentic, genuine and real. I've been burned far too many times by false promises in the workplace and even in some personal relationships. I must be vigilant to see falsehood for what it really is. And, third, I see that I must not assume I have all the answers. This is particularly difficult for me right now as I feel I have been arrogant about certain things - my profession, my knowledge base about psychological information, and my knowing what the right thing to do is.

This is all especially true today after learning that a 21 year old former patient of mine died of alcohol poisoning last week. He was a big, brawny and loud young man. He came to my treatment center because of an intervention by his family and stayed for four months of treatment despite threatening to leave every day. He was hurting badly, and in a few private moments when he broke down and cried he would talk about being lonely and sad and feeling lost. But, he hung on to the idea that alcohol was his friend and that when he turned 21 (which he would a few days after his discharge) he was going to get good and drunk and celebrate his emancipation. He did. But, it wasn't but a few months later that his friend, alcohol, bit him in the ass and killed him. As obnoxious as he could be some days, this young man did not deserve to die so early, and many of us will miss him.

The new truth that I seem to learn every day is that I - and every other counselor treating alcohol and drug addiction - is totally powerless over the disease that afflicts the people we treat. There is nothing, absolutely nothing I can do to prevent the inevitable and, the ugly truth is, I often know what that inevitable outcome will be like for many of the patients I have. Sure, there are seemingly hopeless cases who recover, but that is looking more and more like a half truth to me. Many do recover but it is only when they come to grips with some spiritual need within them that they do decide to stop using drugs and get well. Sadly, the truth is that we sometimes know deeply within that some people are not finished with their drinking and drugging careers and they will soon die.

The arrogance I have to fight against is this seeming certainty that I know who will and who will not recover. It's a character defect of mine, but I am not alone. It is a constant battle for the alcohol and drug counselor to remain open to the possibility of change and that some people who look hopeless now might actually be able to overcome relapse pressures and survive the disease. I ask to be delivered from that arrogance every day.

All the best, Roger W.

Handling bad news...

I've recently been told that a close friend's wife was diagnosed with ovarian cancer. This comes as a shock, not only because she appeared to be a healthy woman, but also because my friend - who has major chronic disease - always assumed he would die before his wife would. It doesn't look like that's the plan and this comes as a big, painful surprise to everyone.

Bad news, no matter what shape it comes in, is never expected. We can train ourselves to "hope for the best, but expect the worse", but, somehow when it strikes, truly bad news is never easy to deal with. This is the way this news is for my friend and I today. He feels "this is not the way it was supposed to work out" and this sadness over the unexpected turn of events in his life causes him a great deal of grief. But, under the surface of this is an anger...a righteous anger that things ought not go the way they are going and that someone (God) is at fault for this.

Whenever I come in contact with this kind of sadness, I am reminded of the book by Rabbi Harold Kushner called When Bad Things Happen To Good People. This book, that chronicles the struggle his own family went through when their young son was diagnosed with progeria (a disease of rapid aging and premature death). Kushner could hardly stand it. He watched as his son suffered and died way before his time, and he railed against a God who would do such a thing to his small son. In fact, such an event was for Kushner - who was trained as a rabbi and became a spiritual leader for many people - something that shook his faith and forced him to question everything he had ever thought or believed about God.

I will not be ruining the book's experience for anyone here by giving away a central discovery Kushner came to that helped him through this experience. In effect, Kushner challenged the common concepts of an all-knowing and all-powerful God by suggesting that, perhaps, God is no more powerful to correct the course of life than we are. He argued that it could very well be that, once he set the world as we know it in motion, forces took over that were greater than even God's power to control or influence. Once sickness was introduced into the human system, even God could not forestall it's inevitable conclusion.

It's in times like these that I remember Kushner's words. It is somehow consoling to me to know that God is no more capable of taking away ovarian cancer from a relatively young woman than her doctors are. It is somehow satisfying to me to realize that we men and women do what we can to alleviate suffering and hardship, but that there is only so much we can do against forces that seem to live on their own. And, it is enormously comforting to feel the presence of a God who weeps alongside of me as I suffer these things.

I cannot yet tell my friend this...the wound is too raw. But, at some point I will and hopefully, God willing, he will feel the same level of comfort knowing that a very powerful entity walks with him through this pain and grief. This is what I pray for these days.

All the best, Roger W.

Another celebrity death...

Actor Corey Haim recently died and speculation immediately started that this long-time addict had succumbed to a drug overdose. I do not know if the coroner's office has made a final ruling as of today, but there has been an arrest in the case and Haim was known to have been involved with illegal prescriptions in the past.

Regardless, this is another case of young people dying too soon from either the direct or indirect effects of drug abuse and dependence. I know of three adolescents who died of overdoses last year. They had been treated where I work. It never gets easy hearing that news. Especially when we know it is a preventable death because we know that treatment works.

A colleague was recently asked if treatment works for young addicted people on CNN's American Morning show. I think his answer goes a long way to again inform people that treatment is not a quick, spin-dry operation of 30 days or so. Treatment takes many forms but certainly one of them is that it can last a while depending on the person's individual needs. Clearly, a fella like Corey Haim had problems that were missed in any of the 15 treatments he had for his disease. Perhaps he could have used more.

All the best, Roger W.