This Too Shall Pass

   In this life we all experience times of challenge. . .

Some of us carry in our DNA a propensity to develop episodes of major depression that is most often triggered by prolonged stressful events. Such individuals cannot always control how things happen to them but they must realize that they are in full control of the response to a situation. There are always things one can do to battle the stress response. It is possible to teach oneself a form of maintenance cognitive behavioral intervention once the concept is learned through a competent therapist and enhanced through ones own self education and practiced through repeated life experiences.

Our very reality as humans is driven by constant battle between our limbic system of the brain, where strong emotions are generated, and our cerebral cortex (gray matter) which we use for reasoning and logical thinking. From an evolutionary survival standpoint the drive from the limbic system has a propensity to override the logic and reasoning in times of stress, or perceived threats, which can result in periodic lapses in judgment and emotional over reaction or emotional shutdown. Our fight or flight response is a gift from our ancestors that when correctly working increases our probability of survival. Adrenalin can be quite helpful in an emergency but over utilization tends to result in mental problems, especially if a change in environment or detrimental behaviors is not achieved.

Yesterday I felt myself consumed by an almost overwhelming feeling of frustration and sadness. Over time I have learned that the key to getting through such an emotional state is basically not allowing myself to shut down or to over react because the result of such behaviors is usually self defeating. A friend once offered me a phrase to use that I find quite helpful, "This too shall pass." Lately, my life has entered a place that seems like a bad episode of "The Twilight Zone." I'm hoping it will all start to get better once I have this situation settled with the Medical Board. I really don't quite understand what they really want or what they are really trying to prove. If surrendering my DEA license would make this nightmare end I would be willing to even do that. If I can prescribe ADHD medications and benzodiazepines, I can practice fine without the use of other controlled drugs. There is no point in attempting to punish me because, short of not letting me practice at all, I can be hurt no worse than by what has been done to me by the news media. It is not easy listening to rumors and lies daily that are based on absolutely nothing. Some of my patients have been told that I was led off to jail in handcuffs, others that I have been shut down or that the state is going to use patients discharged from my practice for violating their contracts to turn states evidence against me. This is totally ridiculous and much more than I ever bargained for.

The irony of this whole thing is that I have never tried to do anything short of help others. I finally have my practice at a place where that can happen and is happening. I will have to start turning patients away soon because I won't be able to see them all and 90% of them are not pain patients or seeking drugs that can be abused. I like to think that it is because I am a competent and caring provider of mental health care. Neither me nor my patients deserve the bad publicity that has occurred. I think of all the good I have tried to do in my career and rarely has it been given the slightest notice. As I have said repeatedly, I will continue to let my conscience be my guide and do the best I know how.

On the lighter side, I'm going to enjoy watching my four new kittens develop. I've found future homes for two already. Though she will definitely be spayed in the future I have no regrets for allowing my cat to experience reproducing. There is nothing more natural. Sometimes mistakes can turn into blessings if we just look for those blessings. I love my new Al Green CD. It takes me back to a more carefree time in my life. I always wondered what his singing would sound like with the benefit of modern recording technology. To me he is the greatest ever, and I love every single cut. He has some help from John Legend, Anthony Hamilton, and others who help transition the '70s style to contemporary. The horns, percussion, and strings really make the music live. It talks to my soul. Thanks Al.

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The Lighter Side

Had a few days off for the 4th. . .

It has been really hard getting back into the swing of things. Lots of bad news lately, but I try to find silver linings where they exist. It's a bit more difficult to make fun of myself lately in my posts I suppose out of fear of how it could be perceived by some. There is another side of me that really doesn't care that much what negative people think of me. My involvement with most of the patients I see continues to be as strong and positive as ever. That keeps me going from day to day as I seek additional ways to enrich my life and find the fulfillment of self sought by all humans. I find that adversity often challenges one to reconnect with or strengthen ones spiritual being and can provide enough humility to help one find perspective in ones life. So true yet so boring to write about.

I'd much rather write about my new fun activity of pulling stumps out of the ground with my 4 Runner. I never knew something so primitive could provide such exhilaration. Yee-haww! Or I could write about my newest restoration project of the spring and the little stream where I used to retreat to when I was a kid and in trouble for misbehaving. It was always such fun to capture the tadpoles, crawfish, minnows, or salamanders. Once I got into even more trouble for capturing a baby snake in a coffee jar. My aunt gave me a scolding and made me throw the poor thing away with the lid still on. I worried about that snake for a long while. Snakes just seem to have always gotten a bad rap. Even today, they are the only creature that I instinctively kill, even though they probably represent no harm to me. It's somewhat interesting that I found myself retreating to that same little stream now over 40 years later when I'm involved in a much different form of adult trouble.

I could probably write a pretty good story about my cat giving birth to kittens last week, as well. I think that's an experience everyone should have at least once, but probably not in the way I chose to allow it to happen. In 2 months I have become experienced in feline sexuality, labor and delivery, and the behaviors of early nursing. Nature did all the work with minimal assistance from me. I had barely finished reading my online article about cats in labor before I actually accepted the fact that my cat Oreo was showing exactly the signs I was reading about. Before I knew it there was a piercing scream coming from the bathroom followed by a higher pitched squeal. As I rushed in and peered into the tub we both looked at each other dumbfounded as the 1st born lay helplessly at her side. It had been almost 18 years since my OB-Gyn rotation. (not that it would have made any difference) Too late for hot water, the cat had already beat me to thinking of that commonly suggested first maneuver. So I ran to get towels and a box. I was too slow. She had already taken the baby kitten to her secret hiding place. All I was really needed for was to help clean up. So I'm just staying out of the way until she brings the kittens out of hiding. Her behavior is totally back to normal other than her having less time for me. She actually talks to me when she needs something, so I don't fret. So far, I've found a future home for one kitten. And yes, my cat will be spayed before having the chance to go into heat again. I have definitely learned my lesson there.

As many people already know, nature provides endless opportunities for escape from the stressors of ordinary life. The Serenity Prayer teaches me to ask for the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. These are two of my current coping tools that I look forward to putting to additional use in the future.

psychiatry

Cut and Run?

  This has been one of the weirdest weeks in my life. . .

as far as the thoughts and feelings I have experienced. The predominant feeling has probably been fear and I know that if there were no fear at this time I would truly be out of my mind. The thought has dawned upon me that it isn't too late to cut and run. I could just tell every patient that I prescribe a pain medication to that I can't treat them anymore. I would still maintain over 80% of my practice. I could walk in to my hearing on August 20th and state to my accusers that the problem is solved, goodbye, hope I never see you again. No hard feelings, right? That could be the beginning of the end of my nightmare. I could then try and slip back into anonymity, even though there would still be many who would see me as that bad doctor from the smear attack who did all of those terrible things that time. At least my livelihood would be protected.

I have seen during the week that the vast majority of patients, pain and non pain related, continue to support and believe in me and actually do understand how the government and the media work together to exert their will and control for their own causes. Even those that don't understand things that clearly do understand the concept of standing for a principle and know the difference between right and wrong. I saw a patient a couple of days ago who had been referred to me from a local pain clinic to help him cope with the loss of his ability to earn a living and other stressors associated with having a chronic pain condition. This was the third or fourth time we had talked and he trusted me to manage all of his pain medications along with his antidepressant treatment. We ended up on the topic of illegal substance abuse and the negative impact it has on us all. The conversation ended with him commenting about that Dr. Evil that was on the news last week who had been dispensing narcotics to all of those patients without seeing them. That's when I realized how insane this whole thing has been. How could the very same patient entrust me with his very life and at the same time have a fear of a despicable monster that is also me?  I think that moment reassured to me what is truth and what is not truth. It is not I who is the real enemy.

I contacted a leading expert in the War on Pain Doctors and educated myself more through his website and have begun to understand more about the politics of this whole thing. I don't really know how I got here and I'm not sure if I want to be here or not, but I am here. I was most disappointed from the learning that the Medical Board is not an organization of peer physicians but more so an organization more loyal to the DEA and the government. I realized that I walked right into their trap without any legal representation three years ago. I also realized that it's not much of a war when one side has all of the ammunition. At least the side of the doctors has truth with it when it isn't allowed to be smeared or tainted, which has become the primary job of the media. There are hardly any journalist who investigate enough to really seek the truth. At least the newspaper did make an effort to get my side of my situation. The TV news did no such thing. They just used the press release in the manner it was intended to be used, assuming the accused to be guilty as charged. That type of thing is scary enough when thought of as conspiracy theory. It can take on another dimension when it really happens.

Should I cut and run now and leave 20% of my patients to make it the best way they can? This could all be over in less than two months if I do. My self preservation instinct says that is absolutely what I should do. My core values and moral obligation, however, would never allow me to do such a thing. If I were truly a corrupt individual I would have money to buy fine lawyers and wouldn't really need to work anyway. Since my situation is quite the opposite I am going to conclude that maybe I am not wrong in taking a stance here. My patients have stood by me and I continue to pick up new patients daily. They are the reason I do what I do. I have to continue to let my conscience be my guide. Dr. King once said that a man not willing to die for something isn't fit to live. I don't plan to die but I think that phrase symbolically captures how I feel.

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