Says Who??

Verstehen, through shared perspectives


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AN URGENT PLEA TO END THE WAR AGAINST PHYSICIANS AND PATIENTS

Crimes against humanity are widespread on this planet, and too many to count.  Over the past decade diligent researchers (by diligent I mean those who verify sources and results) have uncovered the roots of some of our more persistent and frightening social problems, and published reputable accounts thereof.  Many such problems are actually the result of conspiracies set decades ago, like the rise of private prisons for the purpose of incarcerating a specific race of young people because of socioeconomic issues (read racism), and calling it a War Against Drugs.  But the drugs continued to take over our nation—not just because of those young people, but because of the greed for money and power in the pharmaceutical companies, insurance companies, and politicians that has grown exponentially, unchecked.  Nixon’s intended outcome—that of getting minorities off the streets and severely impacting their ability to live normal lives outside of prison—also suited well the baser needs of other groups in our society.

Other groups, in fact, began to see the financial success and knowledge of physicians to be a major threat to their own greedy plans.  They deduced that chronic pain patients, now acknowledged and receiving treatment for their pain, could be both blamed as a source of street drugs and used to help bring down honest physicians (and to support the pill mill “doctors” who supplied the patients with enough medicine  to both use and sell).  Eventually, we begin to see “statistical reports” that “prescription drugs” were the cause of abuse and overdose deaths in specific regions of our country.   For a short time, they may have been.  But when the deaths began to occur in White Middle-Class families, the outcry to increase the efforts of the War on Drugs became deafening.  There had to appear to be some effort to control the drugs, so we see draconian measures being set—in some states by law, in others by regulation—that were targeting the legitimate physicians who prescribed for pain patients, and ultimately the patients who were frequently cut off without warning from their pain treatment.  Despite the outcry against punishing patients and physicians, and the evidence showing the futility of this approach to the War on Drugs, this situation continues to threaten the lives of both patients and their physicians, every day.

Despite scientific proof that Substance Abuse Disorder (being addicted to a substance) is an illness of the brain and can usually be well managed by an addiction specialist, legislators and law enforcement officials alike still only see “drunks and addicts” and still, after DECADES of failure, claim that incarceration/punishment is the only way to fight the war on drugs.

Despite, also, the logic that if you are fighting a War against a crime, you go after the source rather than innocent bystanders.  If we don’t get rid of the sources:  drug cartels, the dealers, and the creators of the drug,  how much good is it going to do to punish the people who use them?  Sadly, these sources have never been the primary targets.  Just as now we see heroin and fentanyl actually being the greater cause of overdose deaths (because they are cheap and much more potent than earlier versions), we still hear and see stories about prescription drugs being the cause of these deaths.  We are still subjected to so-called charts describing dubious statistical proof that prescription drugs are the main cause of overdoses, when more reliable research shows that it is street heroin and fentanyl.

To that, I would ask the reader to please follow the hyperlink below.  The author of this piece has provided a thoughtful and well researched discussion of what is really causing overdose deaths, and why the propaganda we are getting is so dishonest:

https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

Having read this article, consider well the facts that every year more than 400 physicians commit suicide;  that thousands of chronic pain patients suddenly deprived of their medication have either committed suicide or gone to the streets to get their medication; and that many of these have also suffered unintended overdose deaths.

These measures that make practicing good medicine so difficult, and the law enforcement mentality that believes physicians are guilty until proven innocent,  are not the only reasons physicians are either opting out of practicing medicine, or opting out of life altogether.  The War on Physicians and on Patients is real, and it is devastating.  The pharmaceutical houses and insurance companies may actually believe that we can survive without trained doctors; Artificial Intelligence will be just as good if not better, they believe….but check out this article:

https://www.scientificamerican.com/article/the-social-life-of-opioids/.

We read here that there is well-researched, scientific proof that a caring and trusting relationship between patient and doctor is a necessary, (but not sufficient), ingredient for best medical practice—AND for healing!  As one incredible physician has noted:  “They (the patients) don’t care how much you know until they know how much you care.”  Artificial intelligence hasn’t managed the caring part, and even if it does I don’t see much healing effect to be expected from a robotic hug.

The crime against pain patients who are now not only being vilified in news media, in pharmacies, and in social media, is certainly heartbreaking.  If you happen to be one of those pain patients, it is also a return to the terrors of intractable pain, inability to function productively in society, and a potentially horrible death.

If you are a physician who has spent at least half the normal human life span studying and preparing to make life better for those who suffer, life may be  becoming a nightmare.  Insurance companies dictate what treatments are allowable, how often, and how long such treatments will be permitted.  They do not refer to medical societies for their information.  They refer to bottom line profit indexes.  Legislators who pass laws (when medical board regulations would more properly suffice) that limit what physicians can prescribe, and how often—arrange that physician’s offices and lives will be disrupted, the physicians in question treated as guilty before having a chance to be proven innocent.  As usual, those who are charged with the felonies that have been put in place as a weapon in the War on Drugs never quite regain their previous status of innocence, even when proven so.

Does it matter to the insurance companies or the legislators that these laws have only created chaos and confusion, betrayal and mistrust?  Does it matter that physicians are already reeling from finding themselves backed into corners where they have to “sign on” to corporate health care entities that are run by non-medical administrators who decree when and how often they work, how many patients they will see for how long, and determine bonuses based on computer-run quotas and outcomes?  Does it matter that medical students are so disillusioned that they drop out, and that some commit suicide?

And finally, adding to the fears of losing their practices, their licenses, and the meaning attached to their life work, physicians in increasing numbers are being attacked and/or killed by frustrated, angry patients or their relatives.

Why is this ethically, morally, and even logically wrong approach to our drug crisis—which MUST be separated in our minds from medical care for chronic pain patients—continuing to exist as a modus operandi?  Why are physicians who serve our communities targeted as criminals at worst, and problem employees who must be managed at best?  Sociologically, physicians have historically belonged to one of the highest prestige vocations in America.  Their demotion to the present state is not through fault of their own, but through others’ sociopathic greed for money and power, combined with the attitude that allows so many to hate anyone who differs from themselves, to create this totally inhumane situation.

It is not “liberal” or “progressive” to respect and care for others.  It is Christian, and Muslim, and Hindi, and Jewish—it is a basic precept of many world religions and predates organized religion itself by centuries.  Of course, being human and egocentric, we do not always succeed in living up to these standards.

It is my opinion that the proof of our own individual humanity is the maturity, intelligence and self-motivation to care for others as we care for ourselves.

I could go on for pages about why so many people have lost the human characteristic of empathy, but there are enough people who retain it who could help our country become human again.  Who still respect the dignity of other human life, and who realize that “together, we stand; divided, we fall.”

It is definitely in our best interests to respect and protect the lives and experience of our physicians; it is also in our best interests not to stand by and leave them or their patients to live and die in misery when it is all so unnecessary.  And inhuman.

And, a last plea……

 

 

RESOURCES:

Alexander, Michelle.  The New Jim Crow:  Mass Incarceration in the Age of Colorblindness.  2012.  The New Press, NY

Bertram, Eva and Morrris Blachman. Drug War Politics: The Price of Denial.  1996. University of California Press.

Bateman, Dustin.  Neurobiological & Sociological Aspects of Addiction

Levinthal, Charles F.  Messengers of Paradise.  Opiates and the Brain.  The Struggle Over Pain, Rage, Uncertainty and Addiction. 

Meier, Barry.  A World of Hurt:  Fixing Pain Medicine’s Biggest Mistake.  2013.  New York Times Company.

Parsons, Talcott.  “Illness and the Role of the Physician:  A Sociological Perspective.”  American Journal of Orthopsychiatry 24 March 2010.  Copyright © 2010, John Wiley and Sons.

Quinones, Sam.  Dreamland:  The True Tale of America’s Opiate Epidemic.  2015.  Bloomsbury Publishing Plc.

Sternheimer, Karen.  Connecting Social Problems and Popular Culture:   Why Media is not the Answer. 2nd Ed.  2013.  Westview Press, Perseus Books Group.

Webster, Lynn R.  The Painful Truth:  What Chronic Pain is Really Like and What it Means to Each of Us.  2015.  Webster Media LLC, PO Box 581113, Salt Lake City UT 84158.

WEB ARTICLES, including peer reviewed

Pain Medicine News – How Did We Get Here? http://www.painmedicinenews.com/ViewArticle.aspx?d=Guest%2BEditorial&d_id=351&i=March+2014&i_id=1042&a_id=26043&tab=MostEmailed#.U3PLVV6vdyI.twitter

Report: Chronic, Undertreated Pain Affects 116 Million Americans http://ti.me/AAfT7q  via @TIMEHealth

New Pain Management Rules Leave Patients Hurting http://seattletimes.com/html/localnews/2016035307_pain28m.html#.U2mA77bwJzQ.twitter

Chronic Undertreated pain affects 116 million Americans: http://healthland.time.com/2011/06/29/report-chronic-undertreated-pain-affects-116-million-americans/

Our Fear of Opioids Leaves the world in Pain  http://edsinfo.wordpress.com/2014/10/27/our-fear-of-opioids-leaves-the-world-in-pain/

MT @toni_bernhard: My new piece. It should be of interest to anyone whose illness is questioned: http://www.psychologytoday.com/blog/turning-straw-gold/201410/i-m-sick-what-is-wrong-me …Dr. Paul Christo @DrPaulChristo  ·  Oct 27

California Doctor….    http://paindr.com/california-doctor-unveils-painful-abyss-facing-patients-in-pain/

Physician Suicide:  http://t.co/4vhF63eD6N

Physician Risks:

The damage done by the war on opioids: the pendulum has swung too far http://www.dovepress.com/articles.php?article_id=16781 …

Trial Verdict:  Dr. Baldi Not Guilty on All Charges http://whotv.com/2014/05/01/baldi-trial-not-guilty-on-all-charges/

What are Patients to do when Law Enforcement Closes Clinics?  http://missoulian.com/news/state-and-regional/ravalli-county-health-officer-says-patients-of-raided-florence-clinic/article_cf2e1690-bac0-11e3-848e-001a4bcf887a.html

Killing Pain in Perry county http://www.kentucky.com/2009/12/12/1056711/killing-pain-in-perry-co.html

Patient role in helping physicians:

“Unless patients wake up and fight for the providers of care, we are headed for the sickest system in the world.” http://www.kevinmd.com/blog/2014/03/dissatisfied-doctors-provide-good-patient-care.html …


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AN UPDATE FOR FAMILY, FRIENDS, AND THE MERELY CURIOUS

 

For months, now, I have neglected to write or keep up with you. There have been several reasons for this—ironically, none of them due to continued chronic pain. I no sooner reached the point of finally having my 45-year battle with chronic back, neck, shoulders, hands and feet pain under control, than I developed a cardiac problem serious enough to make normal functioning very difficult. At the same time, I had taken on three adjunct courses a semester in the mistaken belief that my new pain-free status would allow more activity. To make a long story short, my intolerance for many medications complicated everything, cost me a fortune at the pharmacy, and greatly reduced my newfound activity tolerance.   It has been one hellacious year, in other words.

Make no mistake. I still love teaching, and I still found that the time spent in the classroom or in my office with students on any given day was the best antidote to pain, and now also to cardiac problems and their side effects. It was only that the long hours of preparation and grading papers, along with the difficulties of getting around the university with a backpack filled with books, etc., rapidly undid all the good of the time spent in the classroom. Not that time spent in the classroom wasn’t worth it—but over time I developed a roller-coaster life with all the emotional and physical ups and downs.

Additionally, the rapidly increasing cost of living, plus my medical costs, had finally totally depleted my savings. Obviously, my social security and wages from being an adjunct were not going to suffice, and now the summer break without any adjunct income was looming. Should anyone ever question the fuel driving the anxiety and chronic pain cycle, I can document it, and add that the combination doesn’t do much for cardiac problems, either. By the end of the second semester I began having chronic pain from multiple arthritis sites. Thankfully, none of the nerve pain has recurred. But I knew it was time to look for more work for additional income, nevertheless.

I have always loved that verse from the Psalms that says “Weeping may endure for a night, but joy comes in the morning.” So many times past, deep into the darkness of whatever crisis was facing me, that verse would eventually be brought to my attention. And when it was, the promised joy and relief from the crisis would begin and move steadily toward resolution. Always. And it has happened again.

Strangely—perhaps even ironically—it was not my PhD in Sociology that was the sole credential for my new part time job. Most of you know how I loved working in medicine and finally being a nurse, before going back to school for my Sociology degree. It was that, and probably my experience with chronic pain as both advocate for patients and a patient myself, that resulted in my new job. For the past six weeks, I have been truly blessed to work 4 days a week in a pain management clinic. From day one, I have felt the joy and freedom of doing what I have always loved best, along with the capacity to use the sociological skills and information gained later in life. I do not have the ability to explain how richly this fulfillment has affected my life, including my physical abilities. I truly believe that every day of my life, every experience, has brought me to this time and place. And the joy is not limited to the immediate experience of interacting with the patients I have already begun to love, but it extends around the clock, and through the week. My exercise tolerance has improved; my arthritis pain has subsided; and my blood sugar is manageable again after a long period of ups and downs. My cardiac problems are no longer debilitating, and I rest better at night. Despite the uncertainty of life in our country, especially for pain patients and others who are most vulnerable, I retain the joy of this new situation and all that it means to me.

My gratitude for this blessed gift is pre-ordained, of course. My advocacy for pain patients, and for those pain management physicians who daily manage the tightrope walk between patient need and over-reaching government regulations, will be taking on a new life. Expect new articles on this site about the real history of drug abuse, pain and addiction in the future. Expect new energy to keep up with what is happening in the failed War on Drugs, and the failing efforts to kick-start it again with the scare-mongering about the prescription opioid epidemic (which, I point out frequently, is deliberately worded to look like it is caused by a. doctors, and/or b. pain patients.)

While I have not specifically stated it, I would like to assert at this point that there is an element to pain management that is sometimes ignored, sometimes over-advertised as a panacea for all ills, and sometimes actually realized in the lives of those who believe. I do believe, from vast experience, that God answers prayer—even when the answer is a firm “no.” I also believe that what we experience in life, both positive and negative, are the true elements of living that make us mature and strong, or they break us. Most of the time, that choice is our own. Especially when God says no.   He said no to me a lot, yet I have been privileged to enjoy incredible blessings, including healing from physical and emotional trauma, and experiences that have enriched my life beyond belief. I would not overlook the role of faith in healing, in guidance through life experiences, or in provision for meaningful relationships and work.

Much love and blessings to you all, and may your walk through life provide you with blessings, rich relationships, and purposeful work. And may your relationship with your God always guide you through it.

Peace,

Marylee


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PONDERINGS ON THE FIRST YEAR OF MY SECOND CHANCE AT LIFE

justinhighrockGlancing over the titles of the posts in this blog site since it began just over a year ago, I am once again amazed at where my journey has taken me. Before it began, when I no longer had the will to keep fighting the illness and pain, I thought my life was (finally) over. Pain/medical management, along with an ever-expanding group of loving friends and the patience of an understanding God, restored not only my will but also my ability to rejoin the human race. I am not the same person I was before, but then who of us can claim to be the same as our younger selves?

First of all, for example, I had to adjust to the “new normal.” It was important to regain my ability to take care of myself, while also accepting that I was still somewhat limited, physically and mentally. I read an article recently about chronic pain resulting in a loss of gray matter in the brain on an annual basis, exceeding by at least 3 times the average for a healthy aging person. Sometimes I am actually aware of my thought processes searching for a new route to the data stored in my brain–data on what I used to know, and on how to accomplish certain activities. Some data seems lost to me for good. Some activities remain beyond the scope of my physical and/or mental ability. I often think in terms of “before the end of my pain and illness” and “after I began my new life.”

Then there is the issue of anger. I don’t remember when it began, but by late adolescence/early adulthood I frequently found myself swallowing what grew from a lot of diffuse anger to a frightening amount of rage. I soon realized that my words that were intended to convey merely a little displeasure were interpreted by others as threateningly angry. I began to be afraid of letting my anger out, fearing the results for both myself and others. Not knowing what to do with the bottled up anger, which only increased at a rate positively correlated to my growing sense of powerlessness, I truly believed myself to be a terrible person.

I divorced, believing that getting out of the world to which my husband had introduced me would allow for room within which I could regain some control of my life. My only response to those with whom I had been raised and who, with me, believed divorce to be a sin, was “God and I have agreed that murder and suicide are not viable alternatives.” However, what I found was that gaining control of my life meant two important things: 1) I could no longer blame my now ex-husband for the problems in my life; and 2) the anger was still there, still threatening to me.

So I still felt like a terrible person. A very angry, terrible person. But, given the chance, the human psyche can be a wonderful thing….

One hot summer night in South Carolina, as I tried to fall asleep after coming home from an adrenaline-filled 2nd shift as the nurse in the county jail, I had a waking dream that remains as real and memorable today as it was that night 33 years ago. I was in a dark, dank underground passageway, listening to the bone-chilling maniacal laughter that seemed to be coming from everywhere. The ghostly faces of demons faded in and out of sight against the walls of the passage. I was already panicked when a strong voice announced “Follow me. I am going to show you who you really are.” My degree of panic accelerated, as I replied “Thanks, but no thanks! I already know who I am, I don’t like it, and I don’t need you to show it to me.” Despite my strong resistance, however, I found myself moving relentlessly toward the end of the passage, accompanied by the mind-bending laughter. The Voice said nothing. I dug in my heels, trying in vain to avoid the forward motion toward what appeared to be a castle-type wooden door (you know, the kind with a rounded peak on top instead of a straight edge). As I came nearer, the door began to swing open inwardly, and at first all I could see was a soft, embracing light. It was quiet and peaceful in that room—powerfully so. Still against my will, however, I crossed the threshold.

There, in the room, sat a lovely and graceful woman on a vanity bench, dressed in a floor-length layered white dress, brushing her long and lustrous hair while looking into the mirror. “Who…..” I began, and she turned to me just as the Voice returned to say “She is you.” “Impossible!” I replied. “That cannot be!”   “It can, and is.” The Voice said.

And I returned to full consciousness, in my own room, stunned. Now I know that Freudians will look one way at this story, and Christians (whether or not schooled in psychology) will have their own interpretation. Just for the record, I personally prefer the latter, with a compelling use of Jungian archetypes.

dreamer

That being said, although it did not all happen overnight, I began to take control of my life and incredibly wonderful things happened to me. Though without funds and resources, I was able to return to college and move on to earn my PhD fully funded by grants and scholarships. I did my research in South Africa, where I returned to teach for a total of seven years. What a privilege all that was, supplied for me almost through no effort of my own but because of my goals, rather than as an enticement to follow the wishes of my donors and mentors. It was incredible—unbelievable. How could I ever repay this huge debt?

I was truly a changed person in many ways. What remained with me was the anger. During the college years I could cover and ignore it because I was so blissfully happy. In South Africa, I recognized the sources of my adult anger: injustice, inequality, abuse of power, violence against the powerless–these all fueled my rage. Only now I had learned how to take the energy from that rage and use it, as an advocate and activist. I could do that whether the victim was me, or entire groups of disenfranchised people. I used the anger, but I could not use it up. It remained with me. Where could I find an antidote?

Nelson Mandela suggested an idea that stays with me. mandelaAfter being released from prison and being in the public eye for some weeks, he was asked how he could possibly not be bitter about his unjust 27 years in prison. His simple reply was “If I bring the bitterness and anger out of the prison with me, then I am still in the prison.” My problem, however, is that acting on that statement must be much more difficult than he made it seem. After living for seven years in the middle of a revolution, death all around me and immanently possible, my anger had fueled a lot of action but was still very much with me. (Along with something like a veteran’s PTSD, later). But Mandela became my first black President (I was a permanent resident of South Africa, because I did not expect to return to the States) and I realized that with the influx of well-educated exiles returning home, my role was no longer necessary. Fourteen months later I returned to my own home.

It was home, but not the home I expected. I have written elsewhere how very much like South Africa during apartheid the attitudes of my country had become. It has become even more so since that post. As I write, I am still grieving over the Charleston massacre, and what it means about my beloved country. I find that the anger I feel is appropriate to the situation, and not overwhelmed by the old, built-up rage.

It is here that I finally come to the point of this article.

I have learned that managing built-up rage as well as new anger is a skill that can be learned and must be practiced. I have my own meditation and calming exercises, others will choose what works for them. But the anger must be met first of all with my decision not to be ruled by it, followed by a plan of appropriate ways to either use it or let it go. I’m not a psychologist so I will not attempt a therapeutic explanation—it is only my need to order my thoughts by sharing them that drives me to write this article.

Letting go of the anger is not enough. The empty place that is left must be filled with something strong enough to help protect against the anger when it wants to return. Again, I had begun to see the answer in South Africa.

One day I was talking to an African lady, in one of the townships which was engaged in an uproar (euphemistically referred to as “unrest” by the S.A. media) and not really a safe place for a strange white woman to be. Our conversation, however, went something like this:

Woman: Why don’t you come in the house and stay with us? You will be safe here.

               Me: Why would you offer me safety, when my presence could endanger you and your family? Why do you even trust me in your home?

Woman: Because first you are a human being, and we only survive if we look out for each other. But mostly it is because I can see that you love us so much that you suffer because we suffer.

The woman’s ability to offer unconditional love, and to accept it unconditionally, was the antidote I sought and one that I had spent many years trying to keep from controlling my life by banishing it. I could love, on condition that it be understood as a feeling and not a commitment. I had long stopped believing I was loveable because I was unable to believe the words of those who said they loved me. Therefore I could not be in control of my life if I depended on love, right? People can hurt you. I thought I did not need love. Yet in the words and actions of the woman described above, I saw what was important both to me as a person, and to me as a social advocate. I had to learn a lot about my emotions.

I have been home from South Africa for 19 years now, 17 of those years having been spent working 60-80 hour weeks and not making much headway with the deliberation and meditation required to learn things about love and anger that would have made my life much easier. About love, I have learned that it, too can be a deliberate decision and commitment, and that it also must be practiced faithfully and responsibly. The really difficult part of love has been learning to accept it, and learning to accept caring help when I need it. A friend once described me as being “rabidly independent,” which is not really so funny, when I think about it.

It took the overwhelming pain of my arthritis and disc disease, along with several other physical problems, to make me retire two years ago. The following year was a nightmare of pain and near helplessness. It was only after the successful efforts of my physicians to restore me to functionality that I realized the gift I had been given in meeting–and surviving–my greatest fear. Thanks to the loving care of special friends, including physicians,  I know it is safe to accept help from people who care. I am slowly accepting that I am loved by people that I love. I still have a long way to go.

It is important to me, however, to acknowledge something else of great importance that I have learned. That is, in working to try to make a difference in my reachable world, I need to try to confine my anger to my own energy needs and use my love to guide my work with others. And to let the anger go afterwards, and to hold to the love unconditionally. Too much of my anger has spilled into my words and actions in advocacy, and not enough of the love that sparked my need to respond.  There is already too much anger in our nation.  I don’t need to add mine.

None of that means that I believe I should not be angry with the world that spawned a young man who would be proud to kill people at prayer. None of that means that I will just forget about it. But I am going to have to love my country an awful lot, unconditionally, to keep my anger from depriving me of seeing all of its citizens as equally deserving of my efforts to respect the spark of humanity I do not see because of my anger, even if I cannot love what they have done. My words must reflect both my anger at the injustice and my concern for all the players.

Charleston Post

It’s hard. I am not very good at it yet. But I have made the commitment to try.