Though it’s Wednesday morning again, I’ll avoid quoting from She’s Leaving Home…

Though it’s Wednesday morning again, I’ll avoid quoting from She’s Leaving Home, or referring to my tied-for-favorite of Charles Addams’s characters.  I’m back at the bus stop, just as I was yesterday and the day before, of course, and I still feel very tired.

In fact, I feel a bit more tired than I did yesterday, though I had a nominally better sleep last night—almost five hours (it wasn’t uninterrupted, though).  For me, that’s middling to decent, but it’s very clear from the inside that it is not the amount of sleep my body requires for optimal, let alone maximal, function.  It may, however, be the most sleep my nervous system is able to accomplish without pharmaceutical intervention.

But, of course, with such interventions, I always feel more tired even after a long sleep than I would normally.  Actually, come to think of it, last night I took half a Benadryl™ before going to bed, so I did have some slight pharmaceutical influence, perhaps accounting for the fact that I got all of five hours of sleep.

Jeez, that’s all really boring, isn’t it?  I’m so sorry.  My life is boring, unfortunately, so if I talk about my life, things are generally going to be boring.  I appreciate your patience.

I also appreciate the people who commented and responded and so on to my previous two blog posts.  You’re greatly appreciated, I want that to be very clear, even if in supporting me I fear you are throwing pearls before swine.

I’m considering going back on Saint John’s Wort, which is an “antidepressant” that worked for me in the past, when I first took it (along with therapy, so it isn’t easy to separate variables).  I wouldn’t expect much from it.  I’m actually almost hoping to get that little bump in motivation that sometimes comes at the beginning of antidepressant treatment and puts a depressed person at increased risk for suicide, because before, they were too crippled by lack of energy to take action, but now that the will is growing, they can do it.

The last time I took it, though—which was far from the first—I just felt worse overall in general, even after several weeks, so I don’t even know that it’s going to do anything if I take it.  I can hardly be certain that the first time I took it the beneficial result was anything more than a placebo effect.

I’ve been on other antidepressants, of course, from Paxil to Celexa and Lexapro, to Effexor and Wellbutrin, as well as more old-school ones like Amitriptyline.  They clearly had effects (including benefits), of course, but I don’t know that they were for the better.  Coming off Paxil led me to experience the only two episodes of sleep paralysis I’ve ever had, which were utterly terrifying but still quite fascinating, at least in retrospect.  So in that sense it was worth the course of treatment.  The side-effects weren’t good, though.

I can’t really take prescription antidepressants now, though, because I don’t have a doctor to prescribe them, ironically enough.  I have neither a general practitioner nor a psychiatrist (nor psychologist or social worked, either, but they can’t prescribe anything, anyway*).  I don’t even have a dentist.  My only interaction with any medical care since 2015 or so has been the time I went to an urgent care place with a respiratory infection/complaint and was sent to the ER and admitted because I was de-satting, and they thought maybe my congenital heart defect had reappeared a bit (based on an echocardiogram, not just my symptoms and the drop in oxygenation).

That was maybe five or six years ago.  They wanted me to get follow-up, obviously, but I have no interest in pursuing it, and certainly cannot summon the motivation to do so.  For one thing, I’m unconvinced that they’re correct, though that in itself is not a good reason not to pursue more information.  For another, I have no health insurance, and I certainly have no money to be able to get involved in paying for significant healthcare myself.  Also, I don’t want to have any more cardiac interventions of any kind, frankly.  I went through all that when I was 18, and I don’t want to go through it, or anything like it, again.

I also don’t have the mental resources—in terms of will, executive function, whatever you want to call it—to be able to seek out any kind of state or federal healthcare assistance.  I’m in Florida, anyway, and the public programs here suck.  Anyway, I’m no good at taking care of myself; I see myself as a nuisance, and I really want me to leave myself alone, but that’s obviously difficult.

Yeah, Florida really doesn’t make much very easy.  But, hey, at least there’s no income tax, so people like the Donald can enjoy living here.  The government is dicey at best, of course, at state and local levels, even relative to many other states and the national government—though our representatives there also aren’t exactly the cream of the mental or moral crop.  We really are the Mordor of the United States, in many ways, and not merely because it’s down here in the southeast.  Unfortunately, there are no volcanoes, and though we have big spiders, none of them are Shelob-scale ones.

Anyway, I probably won’t take any antidepressants, and I don’t expect to seek out any healthcare or mental healthcare.  It’s too much trouble, it’s too difficult, I can’t focus or concentrate on things like that.  I’ve been dealing with that shit too often in my life, and for too long, and despite my best previous efforts, I’ve ended up here in Mordor, all by myself.  I’m sick of it.  It’s not worth the effort.

I’m not worth the effort.

*I did get on BetterHelp for a bit, and it was okay as far as it went, but some difficulties arose, not anyone’s fault, certainly not my therapist’s, and I was off it after a little over a month, I think.

I blog not you, you elements, with unkindness

Hello and good morning.  It’s Thursday, February 2nd, and the day of the week on which I’ve long done my semi-traditional blog posting.

I don’t know whether I have the energy to hunt for a Shakespeare quote to alter and/or a picture to put at the bottom, both vaguely related to whatever “subject” I address in the blog.  But, of course, by now, you readers will know what decision I, the writer, will have made, even as you read the words I’m writing while I do not know.

It’s a bit wibbly-wobbly, timey-wimey, isn’t it?

Of course, the biological experience of time is much more malleable and irregular than the actual nature of time, but time is not a simple, straight, linear dimension.  It’s warped by the planet beneath your feet, among many other things.  Your physical body’s tendency to want to follow the most “direct” path through it‒and the fact that the planet is in the way, preventing you from following that path‒creates what we call gravity, locally.

When you’re free-falling, you’re coasting through time (and space, of course), and it’s the ground that actually accelerates you once you reach it.  It’s a hell of an acceleration if you’ve been pursuing your geodesic unimpeded for long by the time the ground throws itself into your path.  Human’s aren’t built to withstand that kind of acceleration.

I’m writing with my smartphone again, today, by the way.  It’s just too annoying to deal with the laptop at the bus stop.  I also wrote more words than I really had meant to write yesterday, probably because I type faster on the laptop, but I don’t think the increased number of words was associated with an increase in actual content.  I think the signal-to-noise ratio, if you will, of my blog post yesterday was lower than it has tended to be with the phone.  That’s not an objective measure, however, and others may disagree.

As for my thumbs, they already feel a bit better than they did, and they’re not giving me too much trouble now.  I have some Voltaren cream (or is it an ointment?) that I can apply to the joints if necessary, though I already take round-the-clock NSAIDs every day for my chronic pain, so it’s not really recommended that I add the Voltaren, a strong NSAID in it’s own right.  It increases the risk for kidney damage and liver damage and stomach issues and so on.  But I’m already at risk for those things (though I take Omeprazole for my stomach protection) and I don’t see easy short-term solutions to the problem.

This is one of the conundrums (conundra?  Probably not) that make opiates and opioids both necessary and yet culturally difficult‒our non-psychoactive pain medications are literally toxic to our bodies above a quite low threshold relative to their analgesic powers.  Yet pain does not easily just go away on its own in many cases‒biology is subject to much stronger pressures for pain to persist than to allow it easily to be relieved, and those incentives will remain so in any evolutionarily stable form of life.

Opiates and the like can work against nearly any degree of pain with limited direct toxicity, but with diminishing success and tolerance, requiring increasing doses over time*.  But they do affect neural circuitry, reward, and motivation, among other things, and so their use is complicated‒and it’s additionally complicated by the fact that the treatment of pain, physical and psychological, is somewhat taboo in our society.

The use of various substances in one’s own body is even criminalized, and so black markets arise to take advantage of the inevitable demand.  And without matters being out in the open and subject to expert scrutiny and monitoring and education, various abuses and issues relating to lack of access to appropriate guidance and treatment and support arise and worsen.

And they will persist.

Do you think continuing to criminalize the use of drugs of various kinds will decrease abuse and death and even violence related to the drugs?  You hypocrites!  I say to you that it is the criminalization of that use that created the black markets and abuse and danger and sordidness‒and, indeed, the majority of the deaths‒in the first place!

You punish people for trying, however imperfectly, to treat chronic pain and those who suffer from it from addressing it, and are surprised that sufferers turn to the market you have created for illicit meds.  You have the temerity to be “shocked” that people die from the unmonitored, unregulated, inexpert use and manufacture of these things which you have removed from the bailiwick of expert awareness and oversight and monitoring.  You took an area that should have been medical and made it criminal and are stupid enough to be surprised that opportunistic criminals (whether they be gangs or governments or otherwise) are not as careful and caring as actual medical professionals.

And sometimes you are so hopelessly moronic as to imagine that further punishments of both producers and suppliers‒and even users‒of drugs will change the problem or decrease it or make it go away.  As if making an already suffering person’s life even more difficult and miserable is going to diminish their urge for relief and escape from at least some forms of pain, and their willingness to risk the permanent end to their pain that is death by overdose.  I’d need to exist macroscopically in all the ten spatial dimensions of M Theory to be able to give that the eye roll that nonsense deserves.

Phew.  That was a heckuva tangent.

I don’t actually use opioids or related medications, though I have been prescribed them in the past.  They interact with my rather peculiar nervous system in ways I find truly unpleasant, though they can help with pain.  So, instead, I suffer constant daily assaults on my kidneys and GI tract and my liver, and I accept that.

It’s not as though I will seek treatment if my organs fail.  I have no insurance, for one thing, but also, I just don’t see any point in trying to preserve my existence.  Heck, I’ve been told I have a possible recurrence or deterioration of my congenital heart problem‒I’m not fully convinced that it’s really any kind of recurrence‒for which I had heart surgery when I was 18, but I have no interest in pursuing possible further exploration or treatment of it, anyway.

Let my kidneys fail, let my liver fail, let my heart fail!  Blow, wind, and crack your cheeks!  Why would I try to preserve or prolong my existence when I don’t even like myself, let alone have anyone else nearby who likes me and spends time with me***?

Anyway, that went off the rails pretty quickly, didn’t it?  It also got longer than I expected.  Sorry.

I still don’t know the answer to my initial wondering about titles and pictures‒but you all do.  And I love you for it.



*Though at least they don’t directly poison livers and kidneys, and the needed doses don’t keep going up without limit, though they are nevertheless often higher than most doctors are willing to prescribe.  This is largely because doctors fear having what happened to me happen to them, and who can blame them?  The only exception to this general hesitancy is with cancer.  People with cancer are allowed to be treated with whatever level of pain medicine it takes to reduce their pain, because in the typical human “mind” having cancer pain is different, and people with cancer are special.  They’re allowed to be dependent on pain medications, because surely they have the only type of pain that can go on and on without resolving and can steal all the joy from their lives, eventually killing them.  Anyone else is just a disgusting drug addict, a scum of the Earth, and deserves merely contempt**.

**The latter portion of the above paragraph is sarcastic.

***I cannot blame them, so don’t be defensive on my behalf.  I find myself infuriating and disgusting.

Bus stop, waiting, she’s there, I say, “I think you’ve mistaken me for someone else.”

I considered writing this post this morning directly onto my WordPress site, which is something I almost never do.  But that would require a change of pace from my usual practice, so I’m not going to do it this time.  That’s largely because I have an already existing “change of pace” today, in the form of some person yet again lying down on the bus stop bench.

It’s very annoying.  I mean, I’m sure it’s probably annoying for that person, too, but I’m not the one that put them in that position‒I am all but mathematically certain of that‒but that person is the one who put me in the position of having to stand at the bus stop (and finally sit cross-legged against a tree, which put one of legs to sleep) with my back and hips and knee and ankle really giving me trouble already, writing my stupid ass blog post that maybe 5 people will actually read if I’m lucky.

By the way, there’s even someone at the “alternate” bus stop as well, apparently.  It never rains but it pours, as they say.  They talk too much.

I don’t know if anyone has actually read The Dark Fairy and the Desperado so far yet, but I’ve seen no feedback on it.  Maybe it’s so bad that no one can get through even the modest part that I’ve written so far.

I’m still struggling to find interesting things to read; most of the science books I have are dull to me now, though I reread The Coddling of the American Mind recently, almost all the way to the end, and it was good again.  I also got a new “biography” of Radiohead, titled Radiohead: Life in a Glasshouse after one of their songs, but it took me less than a day and a half of highly interrupted reading to finish‒maybe three hours, tops‒so it was engaging, but very brief.

I’m trying to start rereading Stephen King’s 11/22/63, which I remember being quite good when I read it once before.  So far it’s not bad, but I don’t know how long I’ll stick to it.

I have a modest amount of trouble with the premise.  Not the time travel thing, even in the atypical way King sets it up.  That’s fine.  It’s imaginative, and he recognizes and has the characters recognize‒and mainly just shrug in confusion, which is appropriate‒the apparent paradoxes.  It’s a horror story, not science fiction, so it’s not important to get into the nuts and bolts of this curious phenomenon.

No, I have trouble with the notion that changing any event in history could have any impact on any cosmic level of stability whatsoever.  I think the question of whether JFK hadn’t been assassinated only seems Earth-shattering to people who lived through it, and for the most part, the course of events doesn’t change much in any case.  I suspect most Gen Z “kids” barely know who JFK was, any more than they know who Andrew Johnson was, or Pepin the Short, or Phillip of Macedon.  Really, why should they know or care?

I mean, yes, history can be quite interesting, and it is good to know history, so we can try to see‒to the best of our ability‒the way events have flowed, and the sorts of mistakes and failures and successes are possible.  But this is all still parochial knowledge.

The universe wouldn’t care at all if the Cuban Missile Crisis had led to World War III or if a much more devastating all-out global thermonuclear war had happened at the peak of the arms race in the 80’s and wiped out civilization*.  Frankly if another asteroid the size of the K-T asteroid hit and drove 70% of all Earthly species extinct, including humans, it wouldn’t matter to the universe…indeed, if another huge impact such as the one hypothesized to have created the moon literally wiped out all life on Earth and reduced the surface to a new, partly molten “Hadean” phase again, the universe would not notice.

Probably.  Very probably.

I think this notion that human deeds could endanger some kind of cosmic balance is just hubris and delusion, harking back to pre-Copernican worldviews, though I’m quite sure King is not literally so deluded.  But this focus on humans (and human-like) things may be why King can never quite pull off the Lovecraftian, cosmic type horror, in which humans come to realize just how tiny they are and that even the “gods” of reality are not in any way anthropomorphic.

Though even in Lovecraft, having such “gods” is a bit of anthropomorphizing of the universe.  But then, a merely dead and bleak universe does not make for a very interesting story.

Still, maybe that’s one of the reasons Stephen King is so much more generally popular than Lovecraft‒because in his worlds, the deeds of humans are not only important to humans, but they can have cosmic significance.  And his bad guys are mostly very much human as well, in their character and motivations‒even the Crimson King and It.

His scariest stuff, to me, anyway, is his material along the lines of The Shining and Pet Sematary, where the evil forces are quite otherworldly, quite different, and though they certainly have malice toward humans‒the Overlook does, I’ll be bound‒even the “ghosts” in the hotel are not really the source or center of the evil.  They are, if anything, just the spiritual husks of souls that the hotel‒whatever it is‒had devoured in the past, like the empty carcasses of insects in a spider web, or perhaps like trophies on a hunter’s wall.

Well, that was a meandering and surprising turn through my head.  It’s curious sometimes to see what will trigger what.

By the way, I think that was the same woman from before who was sleeping at the bus stop, because she woke up just before the bus came, and she asked me something.  I thought she was seeking bus fare at first, and I had to tell her that I use a monthly pass, so I don’t have any cash, but then she said something about needing to stop the buses running because of something to do with a wedding.  I tried to tell her I didn’t understand, and she repeated part of it and then asked if I had heard from the children about the bus and the wedding.

All I could do was tell her I think she had mistaken me for someone else.  As I suspected before, I’m pretty sure she is mentally ill, with some manner of schizophreniform disorder.  Though I’m not a fan of interacting with strangers, she certainly didn’t make me feel frightened at all.  She just made me feel sad.

It’s very sad to think that not only is there nothing I could do for her in my present state, there would be little anyone could do for her even in the best of circumstances available in the modern world.  Mental illness is terribly difficult to treat, and it doesn’t get nearly as much scientific interest and resources as it should merit, as with so many other things.

It’s far more “important” to humans to have brand name shoes and mocha lattes and Frappuccinos from Starbucks** and to own the newest iPhone (same as the old iPhone), and to follow “celebrities” and to buy their ghost-written books.

That’s probably part of why even “cosmic” level horror stories, with rare exception, make humans so important.  Humans are delusionally self-important in reality, and want even their fictional horrors to be likewise.  And so, humans will continue to deceive themselves about their inherent importance, and vanishingly few of them will realize that, if humans want to become cosmically important, it’s going to be up to them to make it happen.

They aren’t inherently important, except to themselves (which is perfectly reasonable), and it seems vanishingly unlikely that any space faring, extraterrestrial civilization (if such a thing exists) will come to save humans and show them the way.  Why would they?  At most, they might send some disguised observers, anthropologists in the literal, outside sense.  Xenobiologists, from their own point of view.

All right, that’s enough for now.  It’s too much, actually.  I don’t have any idea what my point is.  Which may, ironically, be the point.  Or maybe I’m crazy, even beyond the illnesses of which I’m aware, and this is all just a hallucination.

What a dreary, disappointing hallucination that would turn out to be.  It’s not even scary.  Even the truly dangerous things in the universe are banal, dreary, and not all that impressive.  One would expect paranoid delusions to be frightening.  But I guess that would depend on how much the amygdala and related structures are involved in the disease process.

Enough.  ‘Tis done. 

*That’s the sort of thing I grew up being afraid of and feeling completely powerless to prevent.

**Why is there no apostrophe in the title of the coffee giant chain?  Is it meant to imply that there is more than one Starbuck, or indeed that each customer is a Starbuck?  It strikes me as lazy and slipshod.

I’m under the (warming and improving) weather

I’m really going to try to make this short, if not sweet, today, because I’m laden with a respiratory virus that hit rather suddenly and progressed very quickly yesterday afternoon.  I’m feeling quite under the weather, however much better the weather is than it was only a few days ago.  How under the weather, you ask?  Well, I woke up to my alarm this morning rather than hours before.  I guess my body is awash with enough immune cytokines and interferons and interleukins and related crap that they were able to suppress my insomnia.  I guess that’s a good thing, in its own way.  At least my system is smart enough to force itself to go into rest mode in certain, relatively extreme circumstances.

Of course, I’m going in to the office today, though ideally, I should not.  Indeed, I would not if it were not Wednesday.  But on Wednesdays, the payroll has to be done, so I’ll do it as soon as all the reports arrive.  But after that, I mean to leave the office.  It’s just too ironic that I’m sick enough that I’m able to sleep, but I can’t because of work.  I’m sure there are millions of people who can relate to that.

I’m writing this on my phone, by the way, because I deliberately chose not to bring the laptop with me yesterday when I left the office.  I felt like crap, and I just didn’t want to have anything extra to carry.  I will try to remember to bring it today, though.  The Thursday blog post is easier to write‒and feels more natural‒on the laptop.

I’ve been feeling an added impetus to do a “podcast” if you will, what I call an “audio blog” post, relating to sugar metabolism and its issues, since I uncovered how apparently insulin resistant I have become.  It seems appropriate.  Of course, right now I am just too hoarse and ill to consider doing such a thing.  But I will try to get around to it soon.  Obviously, it’s been something I’ve been thinking about quite a lot, both lately, and in the past.  Diabetes and related matters comprise a big chunk of the work of a typical general internist in the modern world.

Then I guess I’ll try perhaps to do an audio blog on Parkinson’s disease and/or on the whole cybernetic future thing.  I’m not, for the moment, planning on doing any specific outline of the subjects before doing the recordings, but obviously, I’ll think them through a bit ahead of time.  I’ll see how they do, audience reception-wise, before deciding whether or not to do more.  But I’m not likely to record anything before the new year.

Wow, “the new year”…just think about it:  within a few days it will be the beginning of 2023.  It seems like barely 12 months ago that it was the end of 2021.  How did 2 years pass in just over 12 months?

Ha ha.

Of course, now that Christmas has passed, the Tri-rail has, as I suspected they would, put on the automated message that, yes, they will be operating on a Sunday schedule on January 1st, New Year’s Day.  Which is a Sunday, so of course they are on a Sunday schedule.  The saddest part of that announcement is that there probably really are a few people out there who need to be told that information.  But I can’t help thinking that a person who requires that announcement to know that the trains will run on a Sunday schedule on a Sunday will probably still not get the idea.

I wonder how long it will be before they start auto playing the announcement about the next holiday that applies.  I’ll probably let you know when it happens.

Anyway, I think that’s about it for now.  It’s been difficult enough getting the post to be this long.  Stay well and healthy.  And wear masks if you have to go out in public when you’re sick.  That’s what I’m doing.  Or, well, I’m wearing a mask; more than one at a time is rather stifling, and probably doesn’t confer significantly greater benefits, though it may perhaps give some improvement.

Bad memories, Good memories

It’s Wednesday morning, and not even really close to five o’clock yet.  I’m early enough to be the only person yet waiting for the trains.  I woke up this morning quite early‒obviously‒and though I briefly watched part of a lecture on exploring prime numbers and the Fibonacci sequence, I couldn’t really rest, and I’ve felt angry since pretty much when I woke up.  I’m not angry at being awake, though that is irritating.  I’m not even particularly angry at me, though I’m almost always at least a little pissed at myself.  I was angry and thinking about a stupid exchange from my first medical practice after residency, with one of the partners in the practice.

The substance of it isn’t important, it’s just odd that it came into my mind.  I mean, yes, it pissed me off at the time and I think I was not irrational to be pissed off (though I held my tongue), but it was more than twenty years ago.  Why is that making me angry first thing in the morning?  It is fun to imagine things I might have said then, had I been the person I am now.  I take far less shit than I used to take, largely because I have very little left to lose, and much of what I have‒indeed, sometimes all of it‒I frankly want to lose.  At least, I don’t feel that what I have is much worth fighting to keep.

It is quite amazing to think that it’s been more than twenty years since I finished residency and moved to Florida and started in private medical practice.  It’s been about thirty-one and a half years since I got married…and slightly more than half that long since my wife divorced me.  And it’s been about ten years since I’ve seen either of my kids in person or since my son has spoken to me in any way but via a semi-formal E-mail.  A lot has happened in the last 20 years, I guess; I’ve barely hit the highlights here.  But it still has passed rather quickly on the subjective level.

I’m saddled with a good memory, so I recall a lot of the things that have happened in my life, even going back to quite a young age.  I remember the very bad leg aches I used to get as a child, which make my current chronic pain almost feel nostalgic.  I remember really hating the noise of the cannons (and presumably, though to a lesser extent, the muskets) at the musket festival at Greenfield Village, but my memories of that place are otherwise extremely positive.  There were great molasses cookies from the old-fashioned bakery and candy sticks from the general store, and beeswax candles that my sister loved, and of course all the old rebuilt buildings and roads and horse-drawn carriages…it really was (and presumably still is) an excellent place.

gfield village

An evening at Greenfield Village


That’s better stuff on which to dwell than on the sometimes irritating personality of a former senior doctor.  I’ll say this, though:  he took good care of his patients, and he also made them feel well cared for, at an above-average level.  Respect is due.  Those things are not as common as they ought to be.  He was (and presumably still is) a good doctor.

I had a positive moment yesterday, which came at the end of a long, fairly frustrating process.  The details aren’t important, but basically I was trying to do something that in the past has always ended up requiring a few hours on the phone with tech support and with them remotely controlling our computers to do what needed doing.  I was trying to do it on my own without contacting them, and I followed the basic steps‒the good thing about computers and related systems is that they have internal logic that is consistent and explicable.  Still, I hit an impasse, and knew I was missing something that the tech support people had always needed to pull off in the past, sometimes with difficulty, but I hadn’t been able to see it, and it wasn’t part of the standard steps of the whole process.

I tried watching some videos but they were superficial, and I was steeling myself to get in touch with “the IT crowd”, when something clicked, and I thought I realized what to do.  It took about twenty minutes of watching to see if I had succeeded, but turned out that I had.

Such moments are remarkably euphorigenic.  I mean, I know I’m reasonably “smart” about some things.  Certain types of endeavors have always been easier for me than they are for most people, though there are other things that other people do readily that I find all but incomprehensible.

But every now and then one does something that was difficult, and it brings a joy along the lines of having solved a difficult puzzle, but with the added benefit of being useful, and of being something many other people wouldn’t have seen, or not as readily, anyway.  It’s particularly zingy when it happens in a field in which one is not actually an expert, but it can even happen in cases where someone is.

For instance, there was a case in residency in which a code was called for a man in respiratory distress, who was having “Cheyne-Stokes” respirations.  Without intervention he probably would have died, but such situations are run-of-the-mill in a hospital, and he was being intubated before immediate danger of death threatened.  He wasn’t my patient, but it occurred to me that he was a relatively young man to be in that situation, and from group rounds I thought I remembered that he had a drug problem.  So I asked if anyone had tried Narcan*, and they hadn’t.

They got the Narcan out of the crash cart, gave him a shot of it in his IV, and Wow!  He practically exploded to life.  I’m sure it was unpleasant for him, especially since he was already intubated, and abrupt opiate withdrawal is not pleasant for anyone.  But he was alive, and now it was clear that some “friend” had brought this patient‒who had been put in a corner, single room somehow‒a dose of heroin or something similar, and he had overdosed while in the hospital.

I had a slightly different type of feel-good moment as the Senior Medical Resident on a nighttime consultation in the Rehab wing of Jacobi Hospital for a patient who was having palpitations and a very fast heart beat.  A quick EKG revealed a benign kind of supraventricular tachycardia (SVT).  I tried a quick vagal maneuver that didn’t work, and then gave a push of adenosine to the patient and the rhythm broke.  The patient was very happy**, as was the rehab resident, who began almost deferentially calling me “Dr. Elessar” after that, though she was just as much a doctor as I was, and certainly just as expert in her own field.


SVT – Supraventricular tachycardia

And once, during an ICU/CCU rotation***, I helped nudge an obviously dead-on-his-feet Cardiology fellow (they have a very rough schedule) by asking if maybe we shouldn’t quickly cardiovert a patient who was intubated but conscious and was now going into ventricular tachycardia****.  He sort of blinked as if he didn’t even know what language I was speaking, then shook his head and said, right, yeah, that’s what we should do.  We did, and it worked.


V-tach – Ventricular tachycardia

I can tell you, there’s nothing quite like the facial expression of someone who’s being externally cardioverted at bedside‒this is basically the same as the defibrillation scenes you see in TV and movies, and it uses the same equipment‒while conscious.  It’s not a pleasant thing for a patient to experience.  However, she converted immediately to sinus rhythm, and afterward grabbed my hand and squeezed it before I stepped back, showing her appreciation, so I guess it was worth the moment of extreme discomfort for her.

It’s one thing to know intellectually that one is reasonably intelligent, but these little events that demonstrate competence and success, however inconsequential (or sometimes quite consequential), really do give a person a boost.  The opportunities don’t come as often now as they used to come, so I have to relish them when they do.  I was rather giddy for a few hours at work after my minor success yesterday, and jokingly said to my coworker, paraphrasing Apollo 13, “I…am a steely-eyed missile man.”

It’s silly and unimportant, of course, but I rarely feel good about myself, so I’ll cut myself a bit of slack.  it didn’t help me sleep any better last night, though.  And then I woke up in an angry mood, but I guess it was ego-syntonic anger, in that I wasn’t angry at myself but at the memory of a twenty-year-old, unimportant interaction.  Beggars can’t be choosers, as they say.

*For those of you unfamiliar with it, this is a drug that blocks the action of opiates and related compounds, and it does so quickly and strongly.  It’s not fun for the patient, but it can be life-saving and more.

**I don’t recall if we transferred the patient directly to a medical floor or merely continued to consult and ask Cardiology to take a look‒in a public hospital, we didn’t necessarily get to follow up on particular patients long-term.

***I think this was the rotation in which once while on call I literally did not sit down for thirty hours straight, and in which, due to the call schedule, I worked 21-days in a row, had a day off, and then worked another 10 in a row.  It was a busy month, but a hell of a learning experience in many ways.

****Much more acutely dangerous than SVT, especially in a critically ill patient.  It can easily progress to ventricular fibrillation and even of itself can cause cardiac arrest.

You’ve got some nerve!

It’s Saturday, the 19th of November in 2022, and I’m going in to the office today, so I’m writing a blog post as well.  I’m using my laptop to do it, and that’s nice—it lets me write a bit faster and with less pain at the base of my right thumb, which has some degenerative joint disease, mainly from years of writing a lot using pen and paper.

The other day I started responding to StephenB’s question about the next big medical cure I might expect, and he offered the three examples of cancer, Alzheimer’s and Parkinson’s Disease.  I addressed cancer—more or less—in that first blog post, which ended up being very long.  So, today I’d like to at least start addressing the latter two diseases.

I’ll group them together because they are both diseases of the central nervous system, but they are certainly quite different in character and nature.  This discussion can also be used to address some of what I think is a dearth of public understanding of the nature of the nervous system and just how difficult it can be to treat, let along cure, the diseases from which it can suffer.

A quick disclaimer at the beginning:  I haven’t been closely reading the literature on either disease for quite some time, though I do notice related stories in reliable science-reporting sites, and I’ll try to do a quick review of any subjects about which I have important uncertainties.  But if I’m out of date on anything specific, feel free to correct me, and try to be patient.

First a quick rundown of the two disorders.

Alzheimer’s is a degenerative disease of the structure and function of mainly the higher central nervous system.  It primarily affects the nerves themselves, in contrast to neurologic diseases that interfere with supporting cells in the brain*.  It is still, I believe, the number one cause of dementia** among older adults, certainly in America.  It’s still unclear what the precise cause of Alzheimer’s is, but it is associated with the development of “cellular atypia made of what are called “neurofibrillary tangles” within the cell bodies of neurons, and these seem to interfere with normal cellular function.  To the best of my knowledge, we do not know for certain whether the plaques are what directly and primarily cause most of the disease’s signs and symptoms, or if they are just one part of the disease.  Alzheimer’s  is associated with gradual and steadily worsening loss of memory and cognitive ability, potentially leading to loss of one’s ability to function and care for oneself, loss of personal identity, and even inability to recognize one’s closest loved ones.  It is degenerative and progressive, and there is no known cure and there are few effective treatments that are not primarily supportive.

Parkinson’s Disease (the “formal” disease as opposed to “Parkinsonism”, which can have many causes, perhaps most notably the long-term treatment of psychiatric disorders with certain anti-psychotic medicines), is a disorder in which there is loss/destruction of cells in the substantia nigra***, a region in the “basal ganglia” in the lower part of the brain, near the takeoff point of the brainstem and spinal cord.  It is dense with the bodies of dopaminergic neurons, which there seem to modulate and refine motor control of the body.  The loss of these nerve cells over time is associated with gradual but progressive movement disorders, including the classic “pill-rolling” tremor, shuffling gait, blank, mask-like facial expression, and incoordination with tendency to lose one’s balance.  There are more subtle and diffuse problems associated with it, including dementia and depression, and like Alzheimer’s it is generally progressive and degenerative, and there is no known “cure”, though there are treatments.

Let me take a bit of a side-track now and address something that has been a pet peeve of mine, and which contributes to a general misunderstanding of how the nervous system and neurotransmitters work, and how complex the nature and treatment of diseases of the central nervous system can be.  This may end up causing this blog post to require at least two parts, but I think it’s worth the diversion.

I mentioned above that the cells of the substantia nigra are mainly dopaminergic cells.  This means that they are nerve cells that transmit their “messages” to other cells mainly (or entirely) using the neurotransmitter dopamine.  The term “dopaminergic” is a combination word, its root obviously enough being “dopamine” and its latter half, “ergic” relating to the Greek word “ergon” which means to do work.  So “dopaminergic” means those cells do their work using dopamine, and—for instance—“serotonergic” refers to cells that do their work using serotonin.  That’s simple enough.

But the general public seems to have been badly educated about what neurotransmitters are and do; what nerve impulses are and do; and what the nature of disorders, like for instance depression, that involve so-called “chemical imbalances” really entails.

I personally hate the term chemical imbalance.  It seems to imply that the brain is some kind of vat of solution, perhaps undergoing some large and complex chemical reaction that acquires some mythical state of equilibrium when it’s working properly, but when, say, some particular reactant or catalyst is present in too great or too small a quantity, doesn’t function correctly.  This is a thoroughly misleading notion.  The brain is an incredibly complex “machine” with hundreds of billions of cells interacting in extremely complicated and sophisticated ways, not a chemical reaction with too many or too few moles on one side or another.

People have generally heard of dopamine, serotonin, epinephrine, norepinephrine, and the like, and I think many people think of them as related to specific brain functions—for instance, serotonin is seen as a sort of “feel good” neurotransmitter, dopamine as a “reward” neurotransmitter, epinephrine and norepinephrine as “fight or flight” neurotransmitters, and so on.

I want to try to make it very clear:  there’s nothing inherently “feel good” about serotonin, there’s nothing inherently “rewarding” about dopamine, and—even though epinephrine is a hormone as well as a neurotransmitter, and so can have more global effects—there’s nothing inherently “fight or flight” about the “catecholamines” epinephrine and norepinephrine.

All neurotransmitters—and hormones, for that matter—are just complex molecules that have particular shapes and configurations and chemical side chains that make them better or worse fits for receptors on or in certain cells of the body.  The receptors are basically proteins, often combined with special types of “sugars” and “fats”.  They have sites in their structures into which certain neurotransmitters will tend to bind—thus triggering the receptor to carry out some function—and to which other neurotransmitters don’t bind, though, as you may be able to guess from looking at their somewhat similar structures, there can be some overlap.







Neurotransmitters are effectively rather like keys, and their functions—what they do in the nervous system—are not in any way inherent in the neurotransmitter itself, but in the types of processes that get activated when they bind to receptors.

There is nothing inherently “rewarding” about dopamine, any more than there is anything inherently “front door-ish” to the key you use to unlock the front door of your house, or “car-ish” to the keys that one uses to open and turn on cars.  It’s not the key or the lock that has inherent nature, it’s whatever function is initiated when that key is put into that lock, and that function depends entirely on the nature of the target.  The same key used to open your door or start your car could, in principle, be used to turn on the Christmas lights in Rockefeller Center or to launch a nuclear missile.

Dopamine is associated with areas of the nervous system that function to reward—or more precisely, to motivate—certain behaviors, but it is not special to that function.  As we see in Parkinson’s Disease, it is also used in regions of the nervous system involved in modulating motor control of the body.  The substantia nigra doesn’t originate the impulses for muscles to move, but it acts as a sort of damper or fine tuner on those motor impulses.

Neurotransmitters work within the nervous system by being released into very narrow and tightly closed spaces between two nerve cells (a synapse), in amounts regulated by the rate of impulses arriving at the bulb of the axon.  Contrary to popular descriptions, these impulses are not literally “electrical signals” but are pulses of depolarization and repolarization of the nerve cell membrane, involving “voltage-triggered gates****” and the control of the concentration of potassium and sodium ions inside and outside the cell.


A highly stylized synapse

The receptors then either increase or decrease the activity of the receiving neuron (or other cell) depending on what their local function is.  It’s possible, in principle, for any given neurotransmitter to have any given action, depending on what functions the receptors trigger in the receiving cell and what those receiving cells then do.  However, there is a fairly well-conserved and demarcated association between particular neurotransmitters and general classes of functions of the nervous system, due largely to accidents of evolutionary history, so it’s understandable that people come to think of particular neurotransmitters as having that nature in and of themselves…but it is not accurate.

Okay, well, I’ve really gone off on my tangents and haven’t gotten much into the pathology, the pathophysiology, or the potential (and already existing) treatments either for Parkinson’s or Alzheimer’s.  I apologize if it was tedious, but I think it’s best to understand things in a non-misleading way if one is to grasp why it can be so difficult to treat and/or cure disorders of the nervous system.  It’s a different kind of problem from the difficulties treating cancer, but it is at least as complex.

This should come as no surprise, given that human nervous systems (well…some of them, anyway) are the most complicated things we know of in the universe.  There are roughly as many nerve cells in a typical human brain as there are stars in the Milky Way galaxy, and each one connects with a thousand to ten thousand others (when everything is functioning optimally, anyway).  So, the number of nerve connections in a human brain can be on the order of a hundred trillion to a quadrillion—and these are not simple switching elements, like the AND, OR, NOT, NAND, and NOR gates for bits in a digital computer, but are in many ways continuously and complexly variable even at the single synapse level.

When you have a hundred trillion to a quadrillion more or less analog switching elements, connecting cells each of which is an extraordinarily complex machine, it shouldn’t be surprising that many things can go wrong, and that figuring out what exactly is going wrong and how to fix it can be extremely difficult.

It may be (and I strongly suspect it is the case) that no functioning brain of any nature can ever be complex enough to understand itself completely, since the complexity required for such understanding increases the amount and difficulty of what needs to be understood*****.  But that’s okay; it’s useful enough to understand the principles as well as we can, and many minds can work together to understand the workings of one single mind completely—though of course the conglomeration of many minds likewise will become something so complex as likely to be beyond full understanding by that conglomeration.  That just means there will always be more to learn and more to know, and more reasons to try to get smarter and smarter.  That’s a positive thing for those who like to learn and to understand.

Anyway, I’m going to have to continue this discussion in my next blog post, since this one is already over 2100 words long.  Sorry for first the delay and then the length of this post, but I hope it will be worth your while.  Have a good weekend.

*For instance, Multiple Sclerosis attacks white matter in the brain, which is mainly long tracts of myelinated axons—myelin being the cellular wraparound material that greatly speeds up transmission of impulses in nerve cells with longish axons.  The destruction of myelin effectively arrests nerve transmission through those previously myelinated tracts.

**“Dementia” is not just some vague term for being “crazy” as one might think from popular use of the word.  It is a technical term referring to the loss (de-) of one’s previously existing mental capacity (-mentia), particularly one’s cognitive faculties, including memory and reasoning.

***Literally, black substance.

****These are proteins similar to the receptors for neurotransmitters in a way, but triggered by local voltage gradients in the cell membrane to open or close, allowing sodium and/or potassium ions to flow into and out of the cell, thereby generating more voltage gradients that trigger more gates to open, in a wave that flows down the length of the axon, initially triggered usually at the body of the nerve cell.  They are not really in any way analogous to an electric current in a wire.

*****You can call that Elessar’s Conjecture if you want (or Elessar’s Theorem if you want to get ahead of yourself), I won’t complain.

Some discussion of cancer–not the zodiac sign

Yesterday, reader StephenB suggested that I write about what I thought might be the next big medical cure coming our way—he suggested cancer, Alzheimer’s, and Parkinson’s diseases as possible contenders—and what I thought the “shape” of such a cure might be.  I thought this was an interesting point of departure for a discussion blog, and I appreciate the response to my request for topics.

[I’ll give a quick “disclaimer” at the beginning:  I’ve had another poor night.  Either from the stress of Monday night or something I ate yesterday (or both, or something else entirely) I was up a lot of last night with reflux, nausea, and vomiting.  So I hope I’m reasonably coherent as I write, and I apologize if my skills suffer.]

One hears often of the notion of a “cure for cancer”, for understandable reasons; cancer is a terrifying and horrible thing, and most people would like to see it gone.  However, my prediction is that there will never be “a” cure for cancer, except perhaps if we develop nanotechnology of sufficient complexity and reliability that we are able to program nanomachines unerringly to tell the difference between malignant and non-malignant cells, then destroy the malignant ones and remove their remains neatly from the body without causing local complications.  That’s a tall order, but it’s really the only “one” way to target and cure, in principle, all cancers.

Though “cancer” is one word, and there are commonalities in the diseases that word represents, most people know that there are many types of cancers—e.g., skin, colon, lung, breast, brain, liver, pancreatic, and so on—and at least some people know that, even within the broader categories there are numerous subtypes.  But every case of cancer is literally a different disease in a very real sense, and indeed, within one person, a single cancer can become, effectively, more than one disease.

We each* start out as a single fertilized egg cell, but by adulthood, our bodies have tens of trillions of cells, a clear demonstration of the power of exponential expansion.  Even as adults, of course, we do not have a static population of cells; there is ongoing growth, cell division/reproduction, and of course, cell death.  This varies from tissue to tissue, from moment to moment, from cell type to cell type, under the influence of various local and distant messengers, ultimately controlled by the body’s DNA.

Whenever a cell replicates, it makes a copy of its DNA, and one of each copy is sent into each daughter cell.  There are billions of base pairs in the human genome, so there are lots of opportunities for copying errors.  Thankfully, the cell’s proofreading “technology” is amazingly good, and errors are few and far between.  But they are not nonexistent.  Cosmic rays, toxins, other forms of radiation, prolonged inflammation, and simple chance, can all lead to errors in the replication of a precursor cell’s DNA, giving rise to a daughter cell with mutations, and when there are trillions of cells dividing, there are bound to be a number of them.

The consequences of such errors are highly variable.  Many of them do absolutely nothing, since they happen in portions of the genome that are not active in that daughter cell’s tissue type, or are in areas of “junk” DNA in the cell, or in some other way are inconsequential to the subsequent population of cells.  Others, if in just the wrong location, can be rapidly lethal to a daughter cell.  Most, though, are somewhere in between these two extremes.

The rate of cell division/reproduction in the body is intricately controlled, by the proteins and receptors in that cell, and the genes that code for them, and that code for factors that influence other portions of the genome of a given cell, and that make it sensitive or insensitive to hormonal or other factors that promote or inhibit cell division.  If a mutation in one of the regions of the cell that is involved in this regulatory process—either increasing the tendency to grow and divide or diminishing the sensitivity to signals that inhibit division—a cell can become prone to grow and divide more rapidly than would be ideal or normal for that tissue.  Any given error is likely to have a relatively minor effect, but it doesn’t take much of an effect to lead to a significant increase in the number of cells in a given cell type eventually—again, this is the power of exponential processes.

A cell line that is reproducing more rapidly will have more opportunities for errors in the DNA reproduction of its many daughter cells.  These new errors are no more likely to be positive, negative, or neutral generally than any other replication errors anywhere else in the body, but increased rate of growth means more opportunities** for mistakes.

If a second mistake in one of the potentially millions (or more) of daughter cells of the initial cell makes it yet more prone to divide rapidly than even the first population of mutated cells, then that population will grow and outpace the parent cells.  There can be more than one such daughter populations of cells.  And as the rate of replication/growth/division increases in a given population of cells, we have an increased chance of more errors occurring.  Those that become too deleterious will be weeded out.  Those that are neutral will not change anything in the short term (though some can make subsequent mutations more prone to cause increased growth rates).  But the ones that increase the rate of growth and division will rapidly come to dominate.

This is very much a microcosm of evolution by natural selection, and is a demonstration of the fact that such evolution is blind to the future.  In a sense, the mutated, rapidly dividing cells are more successful than their more well-behaved, non-mutated—non-malignant—sister cells.  They outcompete for resources*** against “healthy” cells in many cases, and when they gather into large enough masses, they can cause direct physical impairments to the normal function of an organism.  They can also produce hormones and proteins themselves, and can thus cause dysregulation of the body in which they reside in many ways.

Because they tend to accumulate more and more errors, they tend to become more dysfunctional over time.  And, of course, any new mutations in a subset of tumor cells that makes it more prone to divide unchecked, or that makes it more prone to break loose from its place of origin and spread through the blood and/or lymph of the body will rapidly become overrepresented.

This is the general story of the occurrence of a cancer.  The body is not without its defenses against malignant cells—the immune system will attack and destroy mutated cells if it recognizes them as such—but they are not perfect, nor would it behoove evolution (on the large scale) to select for such a strictly effective immune system, since all resources are always finite, and overactive immunity can cause disease in its own right.

But the specific nature of any given cancer is unique in many ways.  First of all, cancers arise in the body and genes of a human being, each of which is thoroughly unique in its specific genotype from every other human who has ever lived (other than identical twins).  Then, of course, more changes develop as more mutations occur in daughter cells.  Each tumor, each cancer, is truly a singular, unique disease in all the history of life.  Of course, tumors from specific tissues will have characteristics born of those tissues, at least at the start.  Leukemias tend to present quite differently from a glioblastoma or a hepatoma.

Because of these differences, the best treatments for specific cancers, even of classes of cancers, is different.  The fundamental difficulty in treating cancer is that you are trying to stop the growth and division—to kill—cells that are more or less just altered human cells, not all that different from their source cells.  So any chemical or other intervention that is toxic to a cancer cell is likely to be toxic to many other cells in the body.  This is why chemotherapy, and radiation therapy, and other therapies are often so debilitating, and can be life-threatening in their own right.  Of course, if one finds a tumor early enough, when it is quite localized, before any cells have broken loose—“metastasized”—to the rest of the body, then surgical removal can be literally curative.

Other than in such circumstances, the treatment of cancer is perilous, though not treating it is usually more so.  Everything from toxic chemicals to immune boosters, to blockers of hormones to which some cancers are responsive, to local radiation are used, but it is difficult to target mutated cells without harming the native cells to at least some degree.

In certain cases of leukemia, one can literally give a lethal dose of chemo and/or radiation that kills the bone marrow of a person whose system has been overwhelmed by malignant white blood cells, then giving a “bone marrow transplant”, which nowadays can sometimes come from purified bone marrow from the patient—thus avoiding graft-versus-host diseases—and there can be cures.  But it is obviously still a traumatic process, and is not without risk, even with auto-grafts.

So, as I said at the beginning, there is not likely to be any one “cure” for cancer, ever, or at least until we have developed technology that can, more or less inerrantly, recognize and directly remove malignant cells.  This is probably still quite a long way off, though progress can occasionally be surprising.

One useful thing cancer does is give us an object lesson, on a single-body scale, that it is entirely possible for cell lines—and for organisms—to evolve, via apparent extreme success, completely into extinction.  It’s worth pondering, because it happens often, in untreated cancers, and it has happened on the scale of species at various times in natural history.  Evolution doesn’t think ahead, either at the cellular level, the organismal level, or the species/ecosystem level.  Humans, on the other hand, can think ahead, and would be well served to take a cue from the tragedy of cancer that human continuation is not guaranteed merely because the species has been so successful so far.

Anyway, that’s a long enough post for today.  I won’t address matters of Parkinson’s Disease or Alzheimer’s now, though they are interesting, and quite different sorts of diseases than cancers are.  I may discuss them tomorrow, though I might skip to Friday.  But I am again thankful to StephenB for the suggestion/request, and I encourage others to share their recommendations and curiosities.  Topics don’t have to be about medicine or biology, though those are my areas of greatest professional expertise.  I’m pretty well versed in many areas of physics, and some areas of mathematics, and I enjoy some philosophy and psychology, and—of course—the reading and writing of fiction.

Thanks again.

*I’m excluding the vanishingly rare, and possibly apocryphal, cases of fused fraternal twins.

**There are also people who have, at baseline, certain genes that make them more prone to such rapid replication, or to errors in DNA replication, or to increased sensitivity to growth factors of various kinds, and so on.  These are people who have higher risks of various kinds of cancer, but even in them, it is not an absolute matter.

***Most tissues in the body have the inherent capacity and tendency to stimulate the development of blood vessels to provide their nutrients and take away their wastes.  Cancer cells are no exception, or rather, the ones that are do not tend to survive.  Again, it is a case of natural selection for those cell lines that are most prone to multiply and grow and gain local resources.

Blow, winds, and crack your cheeks…yadda, yadda, yadda

Well, it’s Wednesday morning, and it’s sloppy and wet, but the trains are running on time and so is most everything else here in southeast Florida, though the wind is a bit irritating.  Because of it, I was only able to write that first sentence while at the train station, then I had to close up the laptop to protect it from water damage, even though the train stations have roofs.

I’m sure it was a sensible decision for them to make the Tri-rail stations basically open-air with only an overhead covering.  This is south Florida, where it’s rarely so cold that heating is an issue, but on days like today—when it’s wet and windy because a hurricane is approaching the other side of the state*—I do curse the decision.  But I only curse it half-heartedly, because I can’t in good conscience really hold it against someone for doing something efficient and long-term sensible.

There are almost no courses of action, even ones that are clearly the best choices in the long term, that don’t have occasional drawbacks.  Life is complicated.  The universe is complicated, at least if you look at it very closely.  Actually, I guess you don’t have to look all that closely.

I thought about not riding the train today, but I couldn’t justify it.  The Tri-rail is running, and at a normal schedule, so I could hardly give myself an excuse for slacking off in any way.  Also, given the weather, there are a certain percentage of other people who will not go to work today, and that means the trains will be less crowded than usual—which, so far, mine is—and that’s kind of nice.  It’s not as though one gets any kind of extra service, since there is no “service”, but there’s less worry about not getting one’s usual seat, and it’s just generally less crowded.  I don’t know if this will be the case on the way home, but it is right now.

I was weirdly pleased to have a reason to get out my rain jacket, which is designed to be worn while riding on a motorcycle, and so is quite snug and water-repellant.  I don’t wear it much anymore.  I came close to wearing my long, black duster, which is also quite good against the rain (contrary to its name).  But the duster is cloth, and it’s heavier, so it’s likely to have been hotter to wear.  It is a very nifty coat, though, and I’m slightly sad that I don’t get to use it more often.

I got a slightly better sleep last night than the night before—maybe as much as four hours, though not continuous.  There were no issues with power or with cable, but then again, I didn’t honestly expect any.  This is south Florida.  The state and its utilities are far from beyond criticism, but rainy, windy weather—yeah, they’re pretty well used to handling that.

It’s a bit like Houghton, Michigan, which is on the upper peninsula of the upper peninsula of Michigan, and is where Michigan Tech is located.  They get absurd amounts of snow and cold every year, jutting as they do out into Lake Superior, but I’m told that Michigan Tech never closes for snowy weather, despite a reputed more than 16 feet of snowfall every year on average.

I can only imagine what would happen if any significant snow fell down here in the Miami area.  If any snow at all fell, it would be remarkable, but if it was a lot, well, it would be stunning in many ways.  One thing it would also be would be a problem for heating, since, basically, houses down here don’t have furnaces of any kind.  There are a few days early in most years where that actually becomes an issue, and it honestly gets too cold at night.  This is made worse by the fact that many of us don’t really have extra-warm blankets or the like.

And, again, here I am “talking about the weather” like the absolute cretin that I am.  I suppose that it can be excused a bit, given that there’s a hurricane passing near, but I’m embarrassed.  Still, embarrassment is a fairly normal state for me.  I’m almost always tense and anxious and uptight.

Twice in my life, while I was still a teen, I was given Valium, the actual name-brand pharmaceutical, for medical procedures—once for a heart catheterization, once when I had my wisdom teeth taken out.  I remember feeling ever so remarkably at ease and comfortable, even with my mouth full of gauze and blood, or with a wire going into my femoral artery and snaking up to my heart.  I wondered—and still wonder—if this is how some people feel all the time, or more of the time.  I basically have never felt anything like that way except on those two occasions.

I almost hit on the hygienist at the dentist’s office after my procedure.  I didn’t, but the fact that I even had the urge and would have been able to do it if I had so chosen is so unlike me that it’s astonishing.  And while I was having my catheterization, apparently the catheter bumped against some part of the conduction system of my heart and I had a very powerful double-beat, one so strong I could literally feel it up into my neck.  The cardiologist was plainly mortified and apologized sincerely, but I just smiled and said, “That was cool!”

This is how I knew I must never, ever get a prescription for Valium, despite chronic anxiety and stress.  It would simply be too easy for me to become psychologically dependent on it, for one thing, and for another, I know it would inevitably have diminishing returns, and stopping it would then make me feel worse than before.  That would be a true, ironic Hell.  No, thank you!

Drugs in general seem to affect me differently than most people, which may be a good thing.  I took opioids for chronic pain for some time, and they definitely worked to help the pain, but never for as long as hoped, and the side-effects were trouble, so eventually I had to wean myself off them, though not without some regret for the worsening pain.

I also do enjoy a rare alcoholic beverage—someone as tense as I am would be prone to, wouldn’t he?  However, I tend to feel rather unpleasant almost immediately after, and since my back problem, I’ve noticed that alcohol intake makes my pain flare up afterwards.

And I think I’ve mentioned the time I tried a hit of a friend’s marijuana hoping it would help my pain, but instead it left me vomiting for about two hours (and still in pain, though I was at least distracted).  THC is supposed to suppress nausea most of the time, for most people.  I really am alien, it seems.  At least, I’m atypical.

I will admit that mindfulness meditation does help my tension and anxiety in the short-term, but it seems to make my dysthymia and depression worse.  Maybe being too aware of my own thought processes makes me realize how unlikeable I really am, I don’t know.  It’s weird, but apparently there is some literature about Vipassana not being too useful for actual depression, though it may decrease the risk of relapse in people who are in remission.  I’m not up to date on the latest research, but it does disappoint me, because I’m fairly natural at meditation and self-hypnosis and the like.

Anyway, that’s enough for today, I think.  I’m getting close to my stop, and that seems like a good indicator that I should stop writing.  No, not for good—don’t get your hopes up—but for today, anyway.  I’m also, by the way, going to try to stop commenting at all on other people’s blogs and websites, after something that happened yesterday.  Apparently, I give minor offense or am rude, even when I certainly don’t mean to be, and then I feel both stressed and mortified as well as angry about being misunderstood.  Oh well.  Life is hard, but there are alternatives.  At least there’s one.  It becomes more enticing by the day.

*I added this footnote later to note that, as I walked from the train to the office, the clouds overhead were all moving consistently and rapidly west-northwest, which seems to indicate, if my reasoning is correct, that the center of the hurricane is still southwest of here, probably out in Gulf of Mexico for the moment, though I haven’t checked the reports yet this morning.

[Added note:  Since there’s a hurricane a-blowing, I decided to embed my cover of the Radiohead song “How to Disappear Completely” below, because the third verse includes the words, “Fireworks and blown speakers, strobe lights and hurricanes.”  I’ll also embed the original below that; it’s one of Radiohead’s most beautiful songs.]

Imagine this post to have a title with a quote from a song about eyes.

I’m not sure how well this is going to go today.  Last night, sometime not too long after midnight, maybe, I must have done something to scratch the conjunctiva of my right eye behind the middle of the upper eyelid, and it wasn’t long before I woke up with real, sharp pain.  I haven’t been able to see anything in there, such as a foreign body, despite mirrors, lights, and bright flashlights, and a complete lack of squeamishness about looking around under my own eyelid.  All I can see is that it’s irritated, though it feels as though there’s a needle in it.  But, of course, I can’t see very well in there even with lights and flashlight and lack of squeamishness, because the eye in question is impaired by the irritation, so there are limits.

I would offer to take and include with this post a picture from my cell phone camera, but I don’t see how that would help.

It’s so bad that I was tempted just to stay home from work, but the problem is, there are too many things in and around the house that are irritating to my eyes in and of themselves—dust from work that’s being done, residual cat dander from the people who used to live in the room in which I’m currently staying (and who had two cats), the general feeling of being annoyed because of where I live…these are all reasons not to want to lie around the house.  Anyway, I would probably just feel guilty, even if I had a good reason—which I I do, in a way.

I suppose I could claim to have—or fear that I have—“pink eye”, but even if I had it, it would be bacterial conjunctivitis, since it’s entirely unilateral; the viral form spreads so easily that it frequently occurs in both eyes.  Also, I just don’t have any other signs or symptoms that go with pink eye.  I am shedding a lot of tears—ironically, not because of my mood—but they are not tainted with pus.  Conjunctivitis tends to produce a greenish discharge.  Mine is as clear as more ordinary tears.

Nevertheless, those tears are annoying, as is the process itself.  And it’s not as though I could just pop into my primary doctor’s office to get it looked at, and maybe get some prescription eyedrops; I don’t have insurance, and I don’t have a primary doctor.  This is what comes from a combination of apparent “neurodivergence”, dysthymia, possible other neuropsychiatric issues, chronic pain, a completely ruined life, a comparative lack of higher-level self-preservation drive*, and a near-total lack of social supports (a complete lack, locally speaking).

So it’s not as though anyone else is going to take care of me when I’m not feeling well.  That’s not surprising, really, and it’s probably no more than I deserve; I’m not the sort of person other people seem to want to take care of, and I usually have been better at (and preferred) taking care of other people than the reverse.  I’m still the one to whom people at the office always come if they need band-aids, or antiseptic, or Tylenol, or to have an MRI report explained to them, all that kind of stuff.  I’m a bad patient, but I’ve almost always been considered a good doctor by those who are qualified to judge.

Anyway, my eye is really annoying me, and I want to give it a rest, so I’ll draw to a close here for today, and also for this week.  If this post is too short, well, at least yesterday I wrote a longish one, with pictures and video and everything.  Feel free to check it and/or any of my other, older posts out.  Have a good weekend.

*Though, as I’ve commented before, here and on Twitter, even if one is intellectually okay with the fact that one is going to die, it’s hard to ignore the fear of death that evolution has baked into us.  “And thus the native hue of resolution is sicklied o’er with the pale cast of”…well, instinct, not thought, in this case.  But terminologies change over time, and I think Hamlet was basically saying what I mean.

Who would fardels blog, to grunt and sweat under a weary life?

[The initial part of this blog post was meant to be published a week ago, as will become clear.]

Hello, good morning, and good Thursday (it’s also the day before “Good Friday”).  I’m feeling rather poorly this morning, and I am, in fact, going to the doctor before work today.  Yes, I’m planning to go to work afterwards.  It’s not as though I have health insurance or anything, so if I’m going to go to the doctor—ironically—I needs must pay for it out of mine own pocket, even though I’m a qualified medical doctor myself.  This is the eminently sane and rational society in which we live.  Isn’t it grand?

As per last week’s posting, I’ve been focused almost entirely on editing this week, so I’m making significantly faster progress than before, though the road is long.  Also, I’ve just not felt well at all for a while, now, and it’s taking some of the wind out of my sails.  Ordinarily, it’s difficult to get me to slow down and shut up, and I can’t completely rule out the possibility that I’m being subtly poisoned by someone (or more than one) who finds me too annoying.

I’m kidding.  I really don’t suspect some nefarious plot.  It’s just the sort of thing that crosses my mind when I think of myself, so I occasionally imagine that other people might feel similarly.  Actually, other people tend to be more patient with me than I am with myself, but then again, they can get away from me, can’t they?  No matter where I go, as they say, there I am.

I have a few things in the works for IoZ, which might or might not be interesting.  I have an audio blog still to post, and I’m trying to write some posts long-hand (in first draft) to see if that makes me produce them more often.  I also have plans for another post that began its life as a response to a Facebook meme about the tides, stating that, since the moon affects the oceans, there’s no reason to think it wouldn’t affect us since we’re 70% water.  This meme was so misguided and riddled with misunderstandings about basic physics that I couldn’t resist going through the whole Newtonian universal law of gravitation, why there are tides, why they are not dependent upon water, and how tiny the tidal differences due to the moon are from one end of any given person to  the other end.  Yes, I did the math, and shared all the numbers (to significant figures, or thereabouts).  And I’m going to post a version of it on Iterations of Zero once I tweak it a little.

That notion of someone poisoning me doesn’t quite sound so crazy and paranoid now, does it?

I haven’t been promoting my already-published books much lately.  I’ve felt a bit of aversion to Facebook and so haven’t much wanted to give them money, but they really are the best venue I have through which I can promote, unless anyone out there has any better suggestions.  I ought to get back into it.  I just feel kind of obnoxious pushing my own stuff overtly.  I suppose this is why people hire agents and advertisers and marketing firms, but I don’t have that kind of money to spare.

Anyway, the editing of Unanimity and on Free-Range Meat is going well.  As far as short stories go, I still plan both to publish the stories from Welcome to Paradox City as individual Kindle editions and to eventually release a new collection, in hard copy and Kindle, of such “short” stories, so that’s something for you all to look forward to.

Always assuming I live long enough, of course.





Okay, well, as you might have noticed, I didn’t, in fact, publish my blog last week, so I’m just going to do a follow-up now and continue the story, as it were, where I left off.

The reason I never posted last week was because, after going to the walk-in clinic and telling them my symptoms and my history, and after the doctor there gave me a once-over, he said (more or less), “Look…I can do some tests here and charge you for them, but unless they show a clear and easily treatable cause of your symptoms and problems, I’m going to recommend that you go the emergency room anyway.  So, let’s skip a step, I won’t charge you for this visit, and I’m going to give you a referral to the ER.”

I thought this was, perhaps, a little alarmist, but I was persuaded—not happily—to follow his advice, and I went.  I guess the ER agreed with the clinic doctor’s assessment, because they admitted me for about thirty or so hours, ruled out heart attack and DVT/pulmonary embolism, and did an echocardiogram (among other things).  They also, thankfully, gave me some antibiotics for a chronic/recurrent ear infection, which quite temporarily relieved it…though it’s already recurring even as I write this.

Then, at the beginning of this week, after a reasonably restful holiday weekend in which I neither celebrated any of various potential causes for celebration nor had any interactions with those with whom I would have wanted to celebrate, I got calls from both the cardiologist who read my echocardiogram and from the attending physician who managed my care during my brief hospitalization.

Before I get into what they said, let me give you a bit of back story:

When I was eighteen, I was diagnosed with an atrial-septal defect, secundum type (read about it here if you like), quite a good-sized one, with a greater-than-two-to-one shunt.  This was promptly evaluated, and I had open-heart surgery to close it, performed at Children’s Hospital in Detroit by the man who wrote the textbook on the surgery.  This experience, which was quite painful but at least interesting, was influential on my decision eventually to go to medical school.  Subsequent follow-up was unremarkable, the surgery was a success, I was discharged from ongoing care, etc., etc., etc.

Anyway, it turns out, based on this new echocardiogram, that my previous defect did not remain completely closed through the intervening years, and that I have some equivalent of a patent foramen ovale with, apparently as indicated on the echo, a shunt that is sometimes reversing…i.e. some blood from my pulmonary circulation is shifting to the systemic circulation without having passed through the lungs to blow off CO2 and get oxygenated.  This is why (as was the case before my initial surgery) I seem to have a high resting heart rate (or did when checked at the clinic and the hospital) and now tend to have a lowish oxygen saturation, at least in the right circumstances.

This is all not imminently life-threatening, but as I know, the fact that there is even occasional right-to-left shunting means that there is a potentially serious problem.  And the attending internist recommended that I start seeing the cardiologist before even coming to her for general medical follow-up, with plans for eventual intervention and closure of the defect.  But, of course, as stated above, I don’t have health insurance right now, and as it is, I’m going to be paying for this hospital visit for quite some time to come.  It is true that closure of such PFO’s nowadays is much less of an undertaking than it was thirty years ago, but I still don’t think it’s going to be cheap.

And, finally, what’s the point?  Apart from the inherent drive to stay alive that’s been beaten into my genes by hundreds of millions of years of multi-cellular evolution, I honestly don’t have any compelling reason to try to improve my health and/or prolong my existence.

I have neither colleagues nor close friends with whom I can really have any enjoyable conversations, or with whom I ever do anything fun…mainly because the things I think are fun are rarely what those around me find enjoyable, and vice versa.

I have a housemate who’s a good guy, and we get along well, but we don’t have a great deal in common (though I’ve bought some great guitars from him).

I’m a divorced, ex-con, MD who can’t practice medicine anymore, whose son won’t talk to him, and who is only able to interact with his daughter through Facebook and similar venues, who works merely to stay alive so he can write and publish sci-fi/fantasy/horror stories that few if any people will ever read, and who occasionally diddles around with writing, producing, and sharing songs, and drawing pictures, and stuff like that.

Oh, and I also make blog posts like this one.

I come from a line of people who tended to be somewhat socially restricted, by nature and choice, but my mother and father at least had each other through their natural life-spans, as was the general rule in the past.  I, however, am a card-carrying inhabitant* of the easy divorce era, bereft of my chosen and beloved family by the will of the love of my life.  I have no strong desire to go through the gauntlet of trying to find some replacement love who is no more likely to have a sense of enduring commitment than the one who came before her, especially when I have so little to offer anymore.

I’m inclined to think that this story’s gone on well past any reasonable degree of interest.  I guess I might change my mind; who knows?  But for now, it’s hard to see the point of bothering to go through all these medical processes again, even if the interventions are less severe and relatively less expensive than they were in the past.  What, as they say, is the point?  I’m basically a weird, weary, and alone person in a world in which the forces of stupidity seem not only to be ascendant now but always to have been so.

It’s enough, I’m thinking.


*I don’t actually carry a card