chronic pain

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Why would mice and men plan things together? Small wonder such plans go awry.

It’s Friday, as you know if you’re reading this on the day it’s posted.  I’m writing this on my smartphone because I didn’t feel like bringing my laptop computer with me when I left the office yesterday, but I’m beginning to regret it slightly.  My thumbs have still not completely recovered from their inflammation.  Perhaps they will never fully recover.  Who knows?  But it’s certainly the case that writing on the computer is much easier and more “natural” for me.

I will be working tomorrow if the office is open, and if so I will probably write a blog post.  For the past two weekends the office has not been open, since we had so few people willing to come in.  But maybe this weekend will be different, though we still have a lot of people out of the office.

As for anything else, well…I haven’t backslid on what to eat so far, in that I am following a path that should be good or at least useful.  I must say, though, there were times yesterday‒there are such times many days‒when I thought that maybe what I ought to do is just lock myself in the house and eat ice cream and cookies in huge quantities until it kills me.

Unfortunately, it takes a very long time to kill oneself that way, I’ll wager.  The body has a very high capacity to store calories before it completely breaks down and falls apart.  Individual mileage will vary, of course, but the mileage is long.  Such a course might be enough to make me stop liking ice cream and/or cookies, but that’s not the specific goal.

Yesterday I was also contemplating, both to myself and with my coworker, what I might be like if I had not had my back injury a little over 20 years ago.  I think I said something like, “You should see what I would be like if I didn’t have chronic pain.  You have no idea.”

I don’t have specific ideas myself either, but I do know that I used to be someone who‒when not suffering from too much chronic depression and apparently autistic burnout‒could do just about anything to which I put my mind.  For instance, I decided to apply to medical school more or less as an afterthought, but I never doubted that I could get in or that I could become a doctor.

It’s not that I was cocky.  Self-confidence of that sort has been something I occasionally pretended to have, but it’s not my natural state.  I just considered medical school an eminently soluble problem and proceeded to solve it.

Medical school does not involve a mentally super-challenging curriculum.  There’s a lot of information to internalize, of course, but none of it involves dealing with any counterintuitive notions.  There are rarely any complex numbers or linear algebra or calculus or differential geometry involved in medicine!  Quantum mechanics essentially never comes into play, except perhaps in describing vaguely how MRIs and PET scans work.

Anyway, things being so stochastic, it’s very difficult to imagine what I or my life would be like if I had never developed my chronic pain and back problem.  I might still be working in Winter Park as a doctor; I might still be married; and I would be much more likely to be with my kids, or at least to be able to see and interact with them.  I would also probably be much less grumpy than I am.  I don’t know how my autism itself would change its presentation.  Maybe I never would have sought out or even considered the diagnosis.

I guess it’s pointless to contemplate these things.  We cannot change the past.  Still, one of the big strengths of the human brain (or a pseudo-human brain) is the ability to contemplate counterfactuals as simulations so one can make decisions based on assessment of potential outcomes, colored by past experience and knowledge, rather than having to do everything trial-and-error, with death weeding out the worst local failures.

Still, all I can see stretching before me if I cannot reduce my pain and try to get better sleep at the least is loneliness (which is what I deserve, I guess) and pain and never-ending fatigue, with intermittent forced distraction.  That’s not worth the risk, especially since, in that scenario, an accidental or medical death would be one of the better outcomes.

Anyway, my resolve hasn’t changed since I discussed it earlier this week.  In the meantime, I hope you have a good day.  If I work tomorrow, I will probably write another post.  If not, I won’t.

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I’m sorry, I don’t have the energy for a Shakespeare based title

Hello and good morning.  It’s Thursday, and though I don’t particularly feel like it, I’m writing a blog post because it’s Thursday.  This doesn’t necessarily mean I’m going to write one tomorrow or Saturday (assuming we* are open, which we probably will be, since it’s rare to be closed two weekends in a row).  As far as I know, I will not.

I don’t really have any energy or impetus to write much.  I’m trying.  I’ve been rereading my fiction to try to stimulate myself, but so far it’s obviously not doing the trick.  I reread first The Chasm and the Collision, then Son of Man, then The Vagabond, and just yesterday finished rereading Mark Red.  I’ve also reread a few of my short stories.  But, though I’ve enjoyed rereading my stuff as far as it goes, it’s not really doing anything as far as catalyzing any desire to write, whether fiction or nonfiction.

I think things would be much more positive if I were able to get a good sleep (at least one night) and especially if I weren’t in daily, increasing pain.  I’d be tempted even to try ketamine if I thought it would really help, though there are some cautionary examples in the mainstream media that would give me pause.  Heck, I’d practically be willing to try full-on PCP if I had good reason to think it would provide lasting relief without causing worse problems.

Of course, there’s the rub.  All of these things that can provide even temporary, real relief have a range of side-effects that would make my situation even worse than it is.  Yes, I freely admit that my life could get worse.  It’s almost always true that things could be worse than they actually are.  But that doesn’t mean they’re good.

I’m just so weary, so tired of every day being dominated by both physical and psychological pain.

Actually, I feel that the last adjective there should be “psychical” not “psychological”, since the latter term refers to the study of the psyche, and I don’t have pain or suffering that involves the study of my psyche, just pain in my psyche itself.  Still, the common usage, for what it’s worth, seems to lean toward “psychological”.  Then again, current common parlance refers to psychological problems as “mental health”, as in “Are you suffering from mental health?” which makes little sense.

I wish I could wrap myself in some kind of life-support cocoon and undergo some form of metamorphosis, like Adam Warlock in the comic books.  Hell, just being able to sleep for a while seems like it’s a ridiculous, superstitiously foolish notion, on a par with the expectations of the Heaven’s Gate cultists, who thought a space ship was coming to gather their souls (and was supposedly hiding in, I think, the tail of the Hale-Bopp comet).

I want to rest.  I want to stop being in constant pain.  It’s been going on for more than twenty years, and it’s tainted every aspect my existence.  It has contributed to everything from the breakup of my marriage, to my arrest and incarceration, and to my inability to sustain or create any kind of close relationship of any kind.

The people “closest” to me are hundreds to thousands of miles away, and I have no doubt that if they were physically closer, a kind of Uncertainty Principle-like process would occur, such as what makes the momentum/energy of, say, an electron greater and greater the more tightly you try to pin it down, until more and more of its wave function leaks out and the probability of it being elsewhere‒even on the other side of the universe, so to speak‒dominates over any local presence.

I’m probably not explaining that very well, I’m sorry.  But I don’t even have any will to watch science videos or to read science books or what have you, let alone to go into any rigorous discussions thereof.  I’m just making the point that I’m much better for other people from a distance than from up close, with the function approaching a singularity (of negative infinity) as the distance from me shrinks toward zero, rather like some logarithmic function.  This graph (of log base 2) demonstrates why, from a certain distance, it can start even to be pleasant to interact with me, though with diminishing returns…but woe betide anyone who drops below one unit of distance.

Okay, that’s enough for today.  It’s probably much more than enough.  I’m sorry to be so tedious; believe me, no one gets more tired of me than I do of myself.  At least all of you can just go read something else by someone else, or do something else entirely.  Not I.  I am stuck with being and enduring the miserable git that I am every waking moment.  And waking moments make up far too great a proportion of the times of my life.

Have a good day, if you can.

TT…FN, I guess.

*By we, I mean the office at which I work.  While I have no problem joining with you, my readers, into a collective, first person plural pronoun, I simply have no idea what y’all’s work schedules are.

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Well, here we go again

It’s Monday morning, again, and I’m starting another week writing a blog post in the morning instead of doing something productive or creative or whatever.  Or, I suppose one could also say I am doing this instead of sleeping, though it’s not as though I really had a choice about that.

Oh, and the reason I didn’t post on Saturday was because the office didn’t open on Saturday, since everyone kind of needed a break.  It wasn’t because I died sometime after my Friday morning post, unfortunately.

Anyone who thinks that dying would be the unfortunate thing clearly hasn’t wrestled with and internalized the fact that everyone is going to die anyway, and that chronic pain makes the process of being alive a form of slow torture.  And as some famous person from the time of the inquisition said, if anyone has not confessed themselves a witch or a heretic, it is merely because they have not been subject to torture.

He was commenting on the fact that, unless there is truly some greater purpose motivating someone, torture works on essentially everyone, eventually.  Now, I don’t know if it’s melodramatic of me or if I exaggerate in calling 20+ years of chronic pain (while still trying to live a gainfully employed, productive life) a form of torture.  Maybe I’m just a wimp.  I do know that I do not have that greater purpose, that goal on which to keep my gaze fixed.

I used to have something or some things like that.  One of the thoughts that helped me get through prison was that I could look forward to seeing my kids again when I got out.  The whole point of accepting a plea bargain, even though I consider myself innocent, was that I didn’t want to take the chance of being in prison any longer than I had to, because I wanted to see my children again as soon as I could.

Of course, that turned out not to happen, because they didn’t actually want to see me.  It turned out that their lives were at least simpler when I wasn’t around, just like their mother’s was, just like pretty much everyone else’s life is simpler when I’m not around.

That was about 10 years ago, and I still haven’t seen either of them since.  I ask you, what’s the point of enduring anything in that situation?

I have a lot of endurance, I think‒mentally, anyway.  I can put up with a surprising amount of stuff just out of general pig-headedness.  But after a while it all gets annoying.

And lest anyone be under the mistaken impression that I am someone who has not sought help or not allowed people to help me when they tried:  I have gone through years of therapy at various times and of various kinds, I have taken various types and brands of antidepressants and related medications, I have called the suicide crisis line more than once and have very briefly been hospitalized because of it.  I have taken various kinds of medications and have tried numerous interventions including surgery to address my chronic pain.  I don’t easily let problems go.  I don’t tend to give up easily, at least not at things that matter to me.

But I am tired and I am in pain and I am alone.  Also, it turns out I am autistic.  That would, of course, be nothing new, just newly discovered, but it does make it very hard to make new friends or new connections with people, especially now that I am no longer in an environment where there are people around who are interested in at least some of the things in which I am truly interested or who have shared backgrounds.

I would like to do good in and for the world in some fashion.  I would at least like to bring original creations into the world that make some people happy, at least for a little while.

I know we’re all just animals, muddling our way from the womb to the tomb, acting in ways shaped by natural selection’s effects on our ancestors.  There need be no deeper point to life than that to keep everything rolling.  But it’s not very interesting after a while.

I don’t know.  Everything is getting boring.  It’s hard to bother keeping oneself alive when everything is either dull or irritating or painful.  There is such a thing as learned helplessness, even for the very stubborn.  All creatures have their limits.

I don’t know what I’m trying to say or do here.  I don’t know what the point is.  Probably there is no point.  I know that I am pointless, at the very least.  So I’ll draw this to a close again, and start yet another pointless, unpleasant, idiotic day.  I’m stupid that way.  But maybe I’ll get smarter someday.

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Udaimonic so-and-so, U.

It’s the last day of February, everyone.  It’s also Friday, the last day of the “typical” work week, and it is also the last day of my work week, since I am not working tomorrow.  It’s not as though I have anything particular to which to look forward this weekend, but I do need the rest.  I’ve been feeling exceptionally exhausted lately.

Alas, as you know, exhaustion does not translate into sleepiness for me, just weariness.  Somewhere in the neurologic centers and relays that connect such things as fatigue and sleep, I have a short circuit, or at least one that doesn’t perform up to spec.

Of course, my pain continues, though as always, I have tried to adapt my activity, my posture, my exercise, my shoes…even my underclothes to try to decrease my pain.  I have put a tremendous amount of mental energy into this over the years.  If I had devoted that time/energy/effort to the study of any abstract problem‒say, the dynamics of an accelerating near-light-speed spacecraft approaching its local Schwarzschild “radius” as length contraction and “relativistic mass” take effect and bring GR into play‒then I would have made significant, possibly really important, advances.

Alas, when one’s problem is chronic pain (coupled, causally or otherwise, with insomnia), it is very difficult to focus enough mental acuity upon other things.  The very nature of pain as a neurological process in animal systems does not allow it to be easily ignored, or indeed to be ignored at all for any length of time.

Those creatures which can readily ignore pain for long, or who don’t experience pain*, don’t tend to leave as many offspring as those for whom pain is both present and urgent.

It’s a similar problem for those rare people who don’t experience fear, though clinically this seems more likely to happen as a result of damage to the brain rather than being congenital, possibly because children without fear really don’t tend to reach adulthood.

It’s interesting to note that, anecdotally at least, people who don’t feel fear tend to be quite frightening to would-be bullies and predators.  They don’t behave like others do in response to potential threats, and predators tend to rely on fear in others.  A person who looks at them with no more fear than they would at a tree or a rock can be quite disconcerting for someone who has become dependent upon the fear of others.

This is one of the reasons it can be good to have dogs present if you’re guarding something.  They don’t fear guns (generally) so one can’t exactly threaten them with firearms.  And if they attack, they don’t hold back.

That was quite a series of little tangents, wasn’t it?  I think they were interesting, but then again, I was the one who brought them up, so that shouldn’t be surprising.  Whether or not anyone else is interested is difficult to guess.  It’s rather akin to the way things are with humor‒it can be very hard to know consistently what other people will find funny, or for them to know what you find funny, so you might as well amuse yourself.  Then, at least, you can watch to see who enjoys your humor, and those people are the ones with whom you can enjoy such things in the future, at least in principle.

I am horribly tired, and I’m in a great deal of pain as I write this, though for the moment at least I don’t notice any fear that might be present.  Time’s been my way when I’ve been so tired and depressed and in pain that I had no reaction to and felt no fear toward things that would normally have made me quite afraid, from minor things like wasps and bees all the way up to oncoming cars and trucks.  I don’t tend to be afraid of people much, never have been‒at least, I’m not afraid of them physically.  Socially, they can make me quite tense.  In that case, though, the tension is not the same as fear, though I guess it qualifies as anxiety.

Speaking of fear, I fear this is it for this week.  I truly hope that you all have a wonderful day and a wonderful weekend and that you are healthy and safe and eudaimonic**.

*There are people who have a genetic disorder called CIPA:  congenital insensitivity to pain with anhidrosis (i.e., they don’t sweat), and they basically don’t experience pain.  They also don’t live very long, and before they die their bodies tend to be quite damaged, often by such simple things as standing in one position for too long, since it doesn’t feel uncomfortable to do so for them.  They also don’t notice infections, and they don’t tend to get fevers.  It occurs to me, however, that though their lives are short, people with CIPA might well have significantly longer pain-free lifespans than, say, I have had.  I had pain issues starting at a pretty young age, after all.  Still, if I could be cured of all pain at this stage of my life, when I am hardly worried about my longevity anyway, I think it would be worth it.

**It’s interesting to consider the prefixes “eu” and “u” in words of Greek origin.  “Utopia”, for instance, literally means “no place”, making it clear that an imagined perfect society does not exist and may be impossible.  Whereas, if one were to write “Eutopia”, one would mean “true place” or “good place”.  Thus, my middle name “Eugene” means “true born” and is etymologically related to the term “eugenics”.  Mind you, only a fool would believe that I was actually the product of some eugenics program, that I am some true-life Khan Noonien Singh***.  “Eugene” was just my paternal grandfather’s name.  On the other hand, while eudaimonia means “good spirit” and refers to a state of general emotional and mental well-being, “udaimonia” would mean “no spirit”.  That sounds more pertinent to me, don’t you think? 

***Though I suppose one could speculate that I was a failure of such a program.

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The blog of death is as a lover’s pinch, which hurts and is desired.

Hello and good morning.  It’s Thursday, of course, which is why I’ve greeted you as I have.

I slept worse than usual even for me last night, and yet I’m wired and tense, not at all sleepy.  I cannot go on this way.

I’m once again writing this on my phone.  I got at least a few days’ rest for my thumbs, and it has seemed to help.  But mostly, I just didn’t want to carry my mini laptop back with me yesterday, because I’ve been having a rather severe exacerbation of my chronic pain, worse than usual, and it’s just a lot of work to deal with it and with extra weight.

I suspect that the various little things I’m trying to do to improve my strength and health are actually backfiring and making my pain worse rather than better.  It’s frustrating.  I really don’t like to give up on things and I am terribly stubborn, but it’s getting to be just too much.  Every day veers between tedium and stress and exhaustion and pain, and there is no evidence of any light or even rest anywhere along this tunnel.  There certainly doesn’t appear to be any exit other than the obvious one.

I’m still waiting for the results of my autism assessment, which is not any surprise; it’s not technically “due” until tomorrow, so I’m just being overanxious in hoping for it sooner.  Still, I’m not sure what difference it’s going to make, one way or another.  It’s not as though I’ll be able to avail myself of any services for adults with ASD or anything.  This is Florida, America’s limp and syphilitic penis, and there are no real such health services of which I’m aware.  Also, I have no insurance; I cannot seem to manage to keep track of and maintain such things.

I really don’t feel any hope for my future.  I’m just tired and sore and tense and adrift, and I don’t fit with anyone or anything else in the world.  You sometimes hear someone talking about trying to find one’s “people” as it were‒the people who share similar interests and characteristics‒but I don’t think I have a “people”.  I’m pretty sure that anywhere I go I will be a weird outsider who never really fits in.

To be fair, when it comes to most groups I don’t particularly want to fit in.  Many things that other people find interesting don’t grab my attention at all.  I don’t begrudge people their interests, of course, as long as they’re not harming anyone else.  The more joy in the world the better, I would say, ceteris paribus.

But I can’t seem to form joy.  I am at best capable of momentary distraction.  Okay, new science knowledge can sometimes make me feel actual joy, albeit transient.  But that’s about it.  Even that is losing its charm, especially since there’s no back and forth with anyone about it.

So, I don’t know what I’m going to do, but I feel that I’m barely making it through to the end of each day.

I’m sure this is really getting old for all of you, and I’m very sorry about that.  Believe me, I know I’m a miserable person with whom to interact.  I try not to be.  I’ve been trying to be a positive presence, a useful, productive, and positive force in the world, because at least then I can justify my existence.

But it’s exhausting to try to act upbeat and funny and energetic and clever and enthusiastic when you’re just trying to make yourself stop feeling horrible, even if for only a brief time.  I know there exists the famous saying‒admired by many because it rhymes, as if that were a legitimate measure of intellectual quality‒that one should “fake it ’til you make it”.  But I’ve been “faking” it, or trying to do so, for as long as I can remember, and it has not brought about any significant change.

It’s no more effective than was my long experiment in which I applied autosuggestion to myself, repeating the mantra “I love my life and I love myself” (in my head) any time I was walking anywhere or when I was idle.

I almost always have some such message on repeat, trying to accomplish something.

But as far as I can tell, all I’ve accomplished is maybe slowing my descent and degeneration.  I don’t see any way to turn this around‒and I’m pretty smart, and I have been trying to find answers for almost my entire life so far.  Trust me, the obvious ones that tend to spring to mind have not succeeded.

The good news is that, if I were suddenly to disappear‒say, for instance, if after I post this blog entry, no one ever hears from me again in any way‒no one would really be affected.  It would not change anyone’s day-to-day life (other than perhaps a few of my coworkers).

Not to say that no one will mourn me in principle, much as Adam Smith recognized that a European person of learning would feel a rather abstract sense of mourning if all of China were wiped out by some massive earthquake.  I would certainly not be a loss for which any sensible person would be willing even to risk losing their little finger.

Frankly, I doubt that I’m worth someone stubbing their toe.

Anyway, that’s it for now.  I work tomorrow, so I expect I’ll write a post then, but I am off this weekend.

TTFN

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I could a blog unfold whose lightest word would harrow up thy soul

Hello and good morning.  It’s Thursday, of course‒Valentine’s Eve, if you will.  I don’t mean to imply that every Thursday is Valentine’s Eve (which would imply that every Friday is Valentine’s Day).  No, no.  For the sake of any future archaeologists who might be trying to piece together tattered bits of our civilization, among which is this blog post*, I’ll point out that Valentine’s Day falls on February 14th (every year, without even any breaks!), and today is February 13th.  I’ll also point out that I am probably the only one who would think of it as Valentine’s Eve.

As you may be able to tell, I have nothing about which to write, today.  Don’t worry (as if you would), that won’t stop me from writing.  But I am distracted by mental exhaustion and rather severe pain that’s been bothering me and exacerbating my depression all week.  I know that my depression is not dependant on or caused by my chronic pain‒I know this because it predates it by a good twenty years‒but Batman knows it doesn’t help.

I mean, think about it:  you have dysthymia (aka chronic depression, with dips into full-on major depression), probable undiagnosed ASD with all its associated difficulties, you had a congenital heart defect (also called an ASD!) requiring open-heart surgery at 18, and now you have chronic back pain from a disk rupture/tear and “failed back surgery syndrome” for about 20 years (so every day for 20 years has been dominated by pain), and your career is wrecked, you’ve been to prison, you have no social life, no friends (outside of work), no romantic attachments for more than a dozen years (after having been divorced after your marriage of 15 years and then having only one, short and ultimately rather catastrophic, relationship after that) and you strive for self-improvement‒which you stubbornly keep trying to do, because you’re stupid that way‒but each time run into the barriers and obstacles and quicksand of your mood disorder, chronic pain, and probable “neurodivergence”, sending you what feels like three steps backward for every one you took forward.  Why would you not want to give up?

What, other than foolhardy stubbornness (and literally mindless biological forces), could drive someone to keep going and keep trying when there is no point, no goal, no reward, no aspirations, and no significant amount of even transient joy (though there is some)?

Whatever it is, it’s associated with such a high degree of tension that I cannot even sleep at night without waking frequently and early as if I were a soldier in the jungles of wartime Vietnam or something.  It’s really stupid.  I’m very irritated by and with myself.

But I have not yet been able to find effective solutions.  This doesn’t necessarily mean that there aren’t any‒the potential solution space might just be very large, and the subspace of workable solutions much smaller‒but it also doesn’t give any reason to be convinced that there are effective solutions.  There may be no answers, there may be no “right” way to go.

Oh, well.  What was I writing about…or, rather, what was it about which I was writing?  I don’t know.  Valentine’s Day, future archeologists (perhaps virtual beings?) trying to find clues to the attributes of our civilization, the pointlessness of continuing to live without connection or companionship or activities, no full escape from pain (ever), no good nights’ sleeps, all these weird things were matters about which I wrote above.

Enough.  I’m annoyed by myself; I can’t even imagine how annoyed you readers must be.  Really, I can’t.  My apologies.  I don’t know what I’m trying to accomplish.  Nothing, really, and possibly nothingness***.  But I have nothing else to write right now.  I hope you all have a good day.

TTFN

*This, of course, raises the question of how future archaeologists would even be able to see my blog without having already understood much of our civilization.  After all, unlike paper artifacts such as books and magazines, every written thing on the internet and web requires functioning computer systems, including processors, storage, internet protocols, languages from html to Java, C+, Python, Pascal, Fortran, Cobol, I don’t know what, as well as all the necessary hardware.  This is something people who say stupid things like “online is forever” don’t seem to grasp:  if we lose electrical power or some other process interferes with electronics, all the data on the internet is useless.  Hard copy books can decay of course, but that is much slower; they are much more self-contained stores of information, much less contingent.  That’s something about which to think, as the world approaches the brink**.

**Yes, I did that on purpose.

***That was a deliberate sentence fragment, used to convey a sense of drama and intensity.  I don’t know if it worked.

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The Day of the Moon and Guy Fawkes Eve

It’s Monday morning‒the first Monday in November.  It’s also my mother’s birthday, though since she’s no longer with us here, I doubt that she celebrates it any more.  Nevertheless, it’s still worth celebrating.  The world is a better place, I think, for having had my mother in it.  True, she did give birth to me, but you can’t hold that against her too much; nobody’s perfect, and the positive things she did (including my brother and sister) outweigh the negatives, both literally and figuratively.

I felt really horrible last week, physically and mentally (and not just because of my ongoing acute viral illness).  That’s part of why I just did my little sarcastic, blah-heavy blog post.  I had no interest in doing anything more.  What, indeed, would have been the point?  I doubt that I have anything useful or entertaining to say, even today.

Of course, the big election is tomorrow, but honestly, that whole shit show is thoroughly contemptible at nearly every level, and it’s hard to feel good about it in any way.  Of course, one of the presidential candidates is clearly the ethically superior person, but neither is particularly impressive.  I look back with real nostalgia on the Romney-Obama election.

Oh, well.  It’s probably appropriate that it’s Guy Fawkes Day tomorrow.  Penny for the Guy?  Remember, remember the fifth of November, the gunpowder, treason, and plot.  Let’s set this thing alight.

I have been rereading (and even editing) Outlaw’s Mind after removing the opening scene, thus making it into a story without that constraining ending.  I think it’s a good story; better and more involved than I would have expected when I started it, with a tone that reminds me, oddly, of Stephen King’s Revival, though I’m not at all sure why.

It seems very unlikely that I will finish it, though.  I would need to find some new lease on life, somehow, and right now my life credit score is abysmal, and the only existence I seem able to afford is metaphorically even more dreary and gross than the room in which I spend my evenings and weekends.  I live alone in a single, cluttered, old place, but my mental and “spiritual” existence makes the physical location seem like an all-inclusive paradise vacation with one’s closest and dearest friends and family.

It’s all I deserve, really.  I don’t want you to think I pity myself.  I mean, I guess in a way I do, but it’s a contemptuous sort of self-pity, a kind of “look at that pathetic, pitiful, putrid excuse for a person” feeling.

I really could use some help‒some serious help, some professional help, probably some emergency help.  But I know that I don’t deserve any help, I’m not worthy of help, I don’t merit any help.  It would almost certainly be a waste of resources.

I’ve also had a huge back and leg pain flare-up this weekend, of the cause of which I’m far from certain.  It has, however, made this last weekend almost anti-restful, even though I had Saturday off.

I did nothing to celebrate Halloween this year, despite the fact that it’s generally my favorite holiday.  Then again, I did nothing to celebrate my birthday, either.  As I said in a post on Facebook, I have no interest in anything.  Everything is uninteresting.  I would just like to stop being in pain, to stop feeling like I have to keep pushing forward, to keep moving and doing, just because that’s what one is “supposed” to do.

I can see, more and more, that the current shape of my life is the shape of the rest of my life.  This is the landscape of my continued existence:  doing an okay job that doesn’t involve my medical or scientific skills, working with people with whom I can’t really have conversations about anything that interests me, leaving work to commute to a dreary old room where I try (and fail) to get a decent night’s sleep, then spend the weekend basically doing nothing because there’s nothing interesting to do, and if there were, I would be too tired and in too much pain to do it.

This is all some of why I didn’t really write a post last Thursday.  I don’t know if I will write one this week.  But no matter what, one of these days (and it probably won’t be very long) there will just stop being any blog posts from me, and none of you will ever hear from me again.  And your lives will probably be somewhat happier because of that.

Most people seem to be happier when I’m not around.  Most things tend to go better.

Meanwhile, I can only try to distract myself from my chronic pain by inflicting other, more immediate pain upon myself.  Nothing else does an adequate job, but even so, it’s not really enough.

That’s it for today, I guess

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Late-arriving, futile “justice” and reminders of a life that has been all but annihilated

I read the news yesterday, oh boy.  And yes, it was about a lucky man‒luckier than I am, anyway, at least in some ways.

There was a doctor in the heartland of America somewhere, I don’t recall where, who had been convicted of, apparently, inappropriately prescribing very large amounts of pain meds, the report quoting the number 500,000* (It seems unlikely that there were 500,000 prescriptions**, so it probably was that number of pills).

Anyway, his conviction was overturned on appeal, because apparently, in 2022, the SCOTUS handed down a ruling that the prosecution had to prove in such cases that there was “intentional or knowing” inappropriate prescription for it to rise to the level of a crime, and the jury hadn’t been appropriately instructed regarding that fact.

I looked up the case, and I’ve even downloaded the PDF of the case.  Although I haven’t read through it yet, the summaries make it clear that, yes indeed, this is a new and specific requirement.

Silly me, I had always thought that mens rea was a crucial requirement for nearly any criminal case, certainly one that rises to the level of a felony charge.  I brought that up with my (public) defense attorney, trying to point out that I shouldn’t be convicted of a crime since I literally had never intended to do anything but treat patients who had chronic pain‒which I did because I had chronic pain, and it had already severely harmed my life.  I knew how hard it was for even a physician, who at the time had good health insurance, to be able to get adequate treatment and even to get his prescriptions filled by often-judgmental pharmacists who looked at him as if he were a criminal just because he wanted to try to mitigate his pain with the most effective medicine that was available.

But no, apparently, according to my attorney, the prosecutor didn’t have to prove any such thing specifically; it could just be inferred.  And apparently I’m not exactly the sort of person to elicit sympathy from a jury in south Florida, because my voice tends to be monotone and my face tends to be expressionless and I don’t look like someone who is frankly worthy of sympathy.

All the charges against me were created by the PBSO, who sent in undercover people with (evidently) faked MRIs and fake complaints, who complained of chronic, severe pain and said they were in pain when I examined them***, and whose own secret recordings and records showed that there were often only one or two other patients in the whole office when they were there‒hardly what one would call a “pill mill” I should think.

Anyway, I was offered a plea bargain and I took it, because unless you’ve got a lot of money or you literally have nothing to lose, you will take a plea bargain in the right circumstances, even though you know you’re innocent.  I’ve written a blog post about how the plea bargain system is an extortionate game slanted against especially the underprivileged.

The statutes involved in my charges were designed by that <sarcasm> bastion of intelligentsia and morality, the Florida State Legislature </sarcasm>, to give judges no leeway, and to grind away maximally at anyone charged with “trafficking”.   If a jury decided that they should convict on at least one charge, since the state had created so many charges against me (each prescription being a charge, and twenty something having been conned out of me by various lying police officers over time) and the number seems impressive, I still could have faced a minimum of fifteen years in prison.

In retrospect, I think I would have been little worse off if I had, given the mockery and shambles my life has become.  But at the time, I hoped to see my kids again, perhaps sometime before they were adults.  Three years was better than fifteen (or potentially the rest of my life), and I had no one else to help me with a legal fight, and certainly no reservoir of money, so I took the deal.

The way things are now, though, I might not have been charged, or might have been offered some misdemeanor plea deal.  Or I might have gone to trial and won with relative ease, since the fact that I never knowingly or intentionally mis-prescribed medicine was a fact I knew for certain, at a Cartesian, cogito ergo sum sort of level, since it was a fact about my own mental state.

I may be naïve, and I often do not understand humans.  I am often easily misled and manipulated and used and misused and probably abused, because I am socially and emotionally very clueless and believe in giving other people the benefit of the doubt (to hold them innocent until proven guilty, in other words).  But I have never been greedy or unscrupulously opportunistic, and I took the practice of medicine and my duty and goal to relieve suffering very seriously.  I was never into making a lot of money, though it was good to be able to buy books I wanted and to take care of my kids.  I lived in a one-bedroom apartment and drove a ten-year-old Toyota Sienna.

Before yesterday, it had been a long time since I’d bothered thinking about what my life might have been like if things had not gone the way they did.  There didn’t seem to be any point.  I was a lost cause and that was that.  But this has made me feel acutely once again the cut of all the lost time with my kids and my lost ability to practice medicine, and all the other losses I’ve experienced as part of this debacle of a life.

What’s more, there’s been salt and vinegar rubbed into the wound by the fact that it took a Supreme Court dominated by many justices who’d been appointed by The Donald to require courts to require prosecutors to prove something that was supposed to be a necessary element of almost any serious criminal charge:  actual criminal intent.

That’s all leaving aside the un-ethics and illogic of the government of the “Land of the Free” dictating what people can put into their own bodies when it doesn’t directly harm other people in the first place.  I won’t get into that because it had no bearing on my medical practice‒I was not in the business of dealing in euphoriants, I was trying to relieve actual suffering.

One cannot really apply new jurisprudence to old cases in which a sentence has already been carried out and finished, and when the consequences thereof are already irrevocable.  I cannot regain the time I have lost with my children or the time I have lost when I could have been practicing medicine, or the time I spent at FSP West or in the Palm Beach County Main Detention Center, where even the people who worked there frequently asked why the hell I was there, or still there (I spent 8 months in the place, on the mental health floor, because I couldn’t make bail, but finally my former girlfriend’s mother helped secure it‒at least she got all her own back after I was sentenced, and I appreciate her very much, though I might as well just have stayed in jail, since at least the whole sentence would have ended earlier given “time served” and I was basically homeless when out on bail, having lost everything I owned and relying on the generosity and kindness of friends/former coworkers).

So I am stuck with a ruined life and a twisted mockery of myself.  The fruits of a considerable number of years of time and effort and thought and creativity on my part**** were all taken away by the mindless grinding of a huge stupid machine of “criminal justice” that has little to nothing to do with the latter part of the term.  I don’t claim not to be stupid or foolish or not to have ever made mistakes in the whole situation.  I make many mistakes.  But it is maddening to see how misapplied the law can be and to experience it for oneself, especially when one is now by oneself, partly thanks to that misapplication, and then to learn that now the law is changed (or correctly applied) such that I could have been in a better situation had that change come sooner.

I often consider the possibility of going to the Palm Beach courthouse, dousing myself in various flammable liquids, and turning myself into a “bonfire of the unsanities and inanities”, to bring attention to some of the costs of misapplied “justice” and to bring an end to my own mis-called life.  I even have two gallons of paraffin lamp oil and six liters of charcoal lighter fluid and a big enough backpack to carry them all, in case I decide to do it.

Death by fire is intimidating, though‒I am no Buddhist monk by any means.  And I also dislike causing inconvenience to other people, even those involved in an institution that had no qualms about recklessly “judging” me and ruining my life.  But it is tempting, and I feel right now even more than usual the utter pointlessness of continuing, even while stupidity in the office in which I work grinds away at me further (though, to give him credit, my boss tries hard to keep things as sane as he can).

I feel rotten enough and alien enough even at baseline, and all this doesn’t help.  I have lost almost all that mattered to me, and I live alone in a stupid one-room (plus bathroom) “in-law” suite that is smaller than many hotel rooms.  All my previous friends are far away, and most are doing much better with their lives than I am and don’t really have much in common with me anymore.  In any case, I don’t really talk or otherwise communicate with them, though it would be nice.

There are also plain few people where I am now who have anything in common with me.  Very few people have much in common with me:  a disgraced physician unable to practice, with a love of math and physics and biology and of Shakespeare and horror fiction and science fiction/fantasy (reading and writing it) and of science and rationality-oriented podcasts and books and videos, who wants to learn or relearn more about modern physics at a deep level and whose brain doesn’t seem to run the same operating system as most of the people around him‒a Linux in a world of iOS, or worse.

So, I don’t know what I’m going to do.  Knowing me, I’ll probably just grind along until I’m worn to a nub and then tumble into the trash can, unmarked and largely unlamented.

I know that I won’t be sorry‒not about that.

*This sounds like an awful lot of pills, but it’s deliberately chosen to sound that way in a manipulative, rhetorical tactic as used by reporters and prosecutors alike.  Let’s run the numbers, as I am wont to do, to see how impressive they really are.

Now, if there were one patient, taking one pill per day‒perhaps the person only takes one prescription, say an antidepressant or a cholesterol med or a long-acting antihypertensive‒it would take nearly 1400 years to use that many pills.  Plain few patients live that long (see my recent blog post), and most pills would long since have expired and become inactive before the end of that time.

Still, the average physician is responsible for the care of 2,000 to 3,000 patients (see here and here), meaning that if, on average, their patients each only took one prescribed pill a day, they would go through 500,000 pills in 6 to 9 months.  But many prescriptions call for more than one pill per day, and uninsured patients cannot tend to afford the long-acting pain meds that claim to allow for steadier doses and thus slightly less risk of rebounds and escalations and all the horrors involved in that.

Now, presently, I take three to nine aspirin a day, sometimes more, and I also take two naproxen and some supplemental Tylenol as well, all of which are more directly toxic to the body than opioids, but are nonetheless over the counter (as they should be).  If I averaged ten total pills a day, then it would take me only 137 years or so to take 500,000 total pills.  That’s longer than I’m likely to be taking pills, but I’m only one person (that, as Dave Barry said, is the law).  An average practice of patients who took only six pills a day would go through 500,000 pills in one to one and a half months.  Many ordinary, non-pain-specific patients, especially those middle-aged and older, take that many and even more prescription meds a day.

In any case, an ordinary general practitioner with a light patient load of two thousand patients, each taking only an average of two pills a day, would prescribe 500,000 pills in 3 to 5 months.  So don’t be too impressed by the carefully curated numbers that prosecutors and media choose to elicit your alarm and disgust.

**Even 500,000 prescriptions, in a modest 2000 patient practice, would require only 250 prescriptions total per patient.  That would certainly take quite a bit longer than 500,000 pills would take, but given an average of only one prescription per patient per month (counting refills) it would only take a bit over 20 years, a decently short length of practice.  Many doctors see more than 2000 total patients and many patients get more than one prescription per month.  And, of course, one cannot even apply refills on “controlled substances”, they have to be literally re-written every month, and patients have to come to the doctor’s office to get them, assuming they can even get them filled.  Monthly doctor’s visits can be hard for someone trying to work a regular job while dealing with chronic pain.  Thus, the whole “mill” part of the “pill mill” trope is created by the law itself, leading to greater costs in time and fees for the patients who are trying to survive after job-related and other injuries or conditions that have caused them chronic pain and make it difficult for them to find consistent, gainful employment or to sustain health insurance.

***Pain is a symptom, not a sign, in medical terms.  We have no reliable ways of testing it, beyond patient report.  We try to find physical correlations when we can, often to see if we can find some treatable cause, but even Harrison’s Principles of Internal Medicine (I think it was on page 80 or 81 of the 14th or 15th edition, whichever one I had at the time) has clearly stated that, for instance, back pain does not correlate well even with specific injuries noted on MRIs and the like.  As large a number of people without pain will have nerve root impingements and bulging discs and the like seen on spinal MRIs as do have pain.  NO ONE KNOWS all the wherefores of this situation, but there is no serious doubt that such pain is quite real.

****It did not all happen during medical school or residency‒one does not coast along from K-12 and undergraduate college and only then start to work hard in med school, especially if one grew up in a blue-collar, factory town outside Detroit.

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The title of this blog post is unrevealing

It’s Tuesday morning, and this is my first post of the week‒which I guess is not so bad, since a few weeks ago I had said I might not write any more at all.  I’m not sure why I am still writing, other than simply as a matter of habit, which tends to be strong with me.  Perhaps that really is the only reason.

I was not out “sick” yesterday in any traditional sense, but was instead out with a severe exacerbation of pain in a slightly unusual distribution: left foot, knee, and hip/iliosacral areas in addition to a bad flare up in my back.  Every kind of movement was painful for me, so I mainly just laid around taking aspirin and Aleve and Tylenol and trying to give my body a break.  It’s a bit better now, though by no means ideal.

I fear this pain was because of riding my new bike, even though I didn’t ride it very far or very long over the weekend, and it felt okay while I was riding it.  That latter bit is typical, though.  Things that trigger exacerbations often don’t do so right there at the moment.  They take time to build up and catch one by surprise, so one is never quite sure what the real cause of the flare-up is.

For instance, a cold front came in over the course of Sunday afternoon, and the temperature dropped by nearly thirty degrees (Fahrenheit) by Monday morning.  That brought it down to about 50, which is quite chilly for south Florida.  That may have contributed to the increased pain, but I’m pretty sure it wasn’t the main cause.

I did at least get a bit of rest yesterday, napping whenever I could, which is nice.  But I’m quite frustrated to get pain flare-ups from riding the bike.  It’s very discouraging.  I was hoping the bike would give me more freedom of movement, not less.

I did get to talk to my daughter on the phone on Sunday.  We’d been planning to talk for a few weeks but stuff kept getting in the way on her end, but finally she was able to call me yesterday.  It was very nice.  I hadn’t heard her voice in about 8 years or so, and it has changed, since she was a teenager the last time we spoke.  We had a nice conversation, at least for me.  She seemed to be enjoying herself, also, but one can never easily be sure, especially when someone is talking to me.

Also, I spoke to my sister last night, but it hasn’t been nearly as long since I last spoke to her‒about a week, in this case.  We had a nice conversation, though, as always.  As for everything else, well…there is nothing else, really.  I haven’t written any new fiction or played any music or drawn any pictures or anything else of value.

I’m taking an Uber to the office because it’s still pretty painful to move and I want to keep it to a minimum.  It’s also hard on the bases of my thumbs, writing this in the back seat using my smartphone, but I don’t know what else to do about that.

Honestly, I don’t know what to do about much of anything.  I’m still very much at a loss about life in general.  I still haven’t been able to bring myself to look into health insurance.  I don’t have any future plans, really.  I’m basically empty‒except for pain, obviously, but I already mentioned that.

I also have a lot of free-floating anger a lot of the time, I guess that’s something.  At least, it is if you like being angry.  I never really have enjoyed it, though; it makes me feel guilty, even if I don’t act on it.  It’s not pleasant.  Maybe I should learn to embrace it, and all that.  At least it’s slightly energizing, temporarily.

Oh, well.  It doesn’t matter, I guess.  I’m not sure that anything does matter.  I guess that’s all a matter of perspective, so to speak.

That’s it for today.  Try to have a good one, if you can.

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…sore labor’s bath, balm of hurt minds…

It’s Friday, but I work tomorrow, so the fact that it’s the last regular workday of the week means little to me.  I hope all of you (or y’all) are looking forward to the weekend.

Thanks for the kind words about my taking the day off from doing any writing or speaking yesterday.  I had a weird Wednesday afternoon to Thursday morning, so I was not really up to trying to write anything other than my note about how I wasn’t going to write anything.

I felt a strange surge of somewhat reckless energy on Wednesday afternoon‒possibly because I had finished payroll, possibly for some other reason‒and decided that it might be neat to try to walk all the way back from the office to the house.  It’s 30 miles, so I didn’t expect to be able to make it the whole distance, but I figured I’d get as far as I could and then Uber the rest of the way.  I really meant to do it.

Then, late in the afternoon, my sort of subacute-bordering-on-chronic lower GI discomfort came to a head, and I had to use the head several times in quick succession.  I realized that this would not be a good time to attempt my feat of endurance; I had no wish to be “caught short” on the streets of south Florida…or in some poor Uber driver’s car, for that matter.

So, instead, I waited at the office even after everyone left‒the train also not being a good place for GI emergencies‒and took some Imodium.  By the time everything settled, it was quite late, and so I just slept at the office.

Oddly enough, I slept better there than I usually do, and I half hoped that I might feel pretty good for the day.  That didn’t really pan out, and as you know, I didn’t even feel enough energy to write a post or do a voice recording.  I know I had already said that I’m not sure I’m going to continue this blog at all, but since I have been tending at least to post something on these days, I figured it would be polite to give notice.

It all just seems quite futile, though.  Of course it seems futile.  Everything seems‒and it may turn out to be feels‒that it will undoubtedly looks‒futile.  I don’t see any point in my continued life whatsoever.  I still haven’t gotten or even seriously investigated health insurance, partly because of the very severe tension and anxiety I have about initiating the process, but also because of my lack of desire to protect my health.

I really didn’t expect to be alive to see this year‒I didn’t plan to be alive, anyway.  Several times in the relatively recent past, I made plans to enact the end of my life, but one thing after another has gotten in the way.

I suspect there will be people who will say that I let things get in the way because I didn’t really want to die, and of course, at some level that was true.  I didn’t so much want to die as I wanted to be dead, but since there’s no quantum tunneling-style option, the one has to lead to the other.

I’ve often pointed out that the biological drive to survive can be absurd but is doggedly persistent, and it is very difficult to overcome via conscious thought.  I’ve tried.  I threw away a bunch of things I owned, I gave away some other things, and just in general attempted to put my house in order, so to speak.  I even wrote a draft of a will, of sorts, which I’ve updated a few times since.  But many things got in the way, not least the simple wish not to make things too inconvenient for other people.

And there’s the fact that, as I noted earlier, rather than say “I want to die”, it makes more sense to say “I want to be dead.”  If I had an “off” switch that could just be flipped, that might be the best thing.  But, of course, that’s not how biological organisms tend to operate, and the process of dying tends to be extremely unpleasant, for good, sound, biological reasons.

Sometimes I think if I could just get actual, restful sleep, that might be enough.  The last restful night of sleep I remember happened in the mid-1990s, and I remember it because it was such an outlier.  I was not used to waking up and feeling refreshed and rested and alive.  It was glorious.

Sleep clearly serves some important biological function; probably it serves more than one.  What it does is clearly complex, but I sometimes imagine it as a kind of automated pipe-scrubbing system in some intricate network of steam-punk machinery.  Every day, the system goes into idle, and the pipe-scrubbing/exhaust clearing system goes to work.  But my auto-maintenance, pipe-clearing system is faulty.  It doesn’t ever completely clear out the day’s accumulated debris and grime.

When the system is relatively new‒when one is young‒it’s possible for things to work relatively well, even if all the grime of a given day is never quite cleared away.  But the grime accumulates, the system accrues varying levels of obstruction, its auto-repair doesn’t work as well as it should, and gradually, over time, everything builds up, pipes get leaky, some junctions and connections get severely constricted and some fail altogether, and it gets harder and harder for the system to continue to function well.

People think I’m fairly smart; just imagine how clever I might be if I could just get a decent night’s sleep once in a while.

Probably the lack of sleep contributes to my chronic pain‒and then, of course, the chronic pain contributes to my sleep problems, which is not a paradox, but is actually an almost predictable occurrence in such spontaneously self-assembling, complex adaptive systems with all sorts of internal feedback systems and self interaction and all that.

“For want of a horseshoe nail, the kingdom was lost.”

“For want of the price of tea and a slice, the old man died.”

Oh, well.  Since I work tomorrow, I think I might try my walking home quest after work, then.  I have new socks that I ordered for just such a thing after Wednesday.  It would be cool if they help.  Perhaps I would sleep really well afterwards.  Or, hey, who knows, maybe I’ll get hit by a car (or other vehicle) on the way, and this will all be taken out of my hands.

There are worse things I can imagine.  One of them is simply my life continuing, as it currently is, indefinitely into the future.  The prospect of facing several thousand pounds of rapidly moving metal, perhaps steered by someone who has been drinking, seems much less unpleasant than that other, more banal and yet supposedly desirable alternative.