Primum Non Nocere VIII

(part one) (part two) (part three) (part four) (part five) (part six) (part seven)


December 5, 2007 1:02:43 PM PST

(You'll all kindly forgive me for neither picking up the phone nor writing this twice...it may very well be a tragedy, but it's no more an emergency than it has been for seven months running...)

E was admitted last night to Pomerado. As I'm sure was inferred, the chill-out in Mexico was equal parts self-detox for E and rest for Mom, which ceased abruptly upon their return Monday afternoon. Details are significant, yet at the same time irrelevant; stress triggers, a psychological demon pulling the reins of physical minions - nothing new.

Mom and I spent about three hours trying to explain why going to the ER would be a huge mistake - E, in pain, is still of the opinion that one can pop in, get enough narcotic to snap out of it, go home, etc., though that's not what happens, ever - but it was of no use. Though Mom would have kept going with the heartbreaking knowledge of what actually happens in the hospital, I finally relented, knowing that E's mind would stubbornly cling to what she regards as the only viable option, even if it meant having a stroke, aneurysm, heart attack, etc. to get there. Within a few minutes of that decision she lost almost all motor skills and had to be carried to the bathroom, car, etc. Sad. Had this been any other time and person, the level of absurdity of having a lengthy argument with someone who looks like they are having a stroke would be huge; yet, we still tried to explain logically why it will only get worse going to the hospital, bas ed on every other time before, as if this were just another family discussion. After getting the green light to go to the ER, her brain completely fogged over and she became almost paralyzed. Very telling and very dangerous.

Obviously, we didn't just pop in the ER. She is in room 2-- on a morphine / Diladud treatment plan, every few hours, with a "light" steroid (lighter than 1000mg of IV Prednisone like before) as well. If any thing's different, it's that, maybe, this time everyone named T--- is on board with dismissing the destructive labcoats posing as her physicians. Of course E doesn't see the narcotics as destructive, as they are necessary. She is better today than last night, and perhaps will be able to leave tomorrow. The realist in me thinks it might be closer to next week, when the insurance will again cover a few hundred dollars worth of Oxycontin.

Whatever the fuck it is - and I'm quite certain I know, but that's irrelevant because it's not happening to my body - it will only be undone when E stops suffering, and that may be never. I'm afraid that she will be bearing this cross (which she has the power to vaporize) for the rest of her life. She is a hairline away from somebody diagnosing this as drug addiction exacerbated by a mental/psychological disorder, and while that will tidy things up neatly for the insurance company, it will (probably) thrust E into total chaos, Mom alongside her. In just over 24 hours I watched her go from being able to drive a car Monday afternoon to sliding off a sitting position and hitting the ground with her face, unable to correct it. In between lies the state where it can still be roped in, but I just don't know how to get E to see it that way. She doesn't notice, and will therefore not admit, that she goes back and forth, from paralysis to full use of everything and back - I watched this again yesterday. And, obviously, I have been out of the loop with regard to drug dosage, etc., as my presence here is becoming one more of intrusion than anything.

The "hemiplegic migraine," as lovely sounding as that label is, may have to be replaced by "retractable stroke," because that's what it looks like. In their own way, both Mom and E know that it's the drugs talking, and that, were the opiates removed, what would then be exposed to light is even more intimidating. By staying in perpetual states of physical impairment that unpleasant truth will remain un-dealt with.

Wish I had better news...am still advocating biofeedback and hypnosis (particularly hypnosis), though only to Mom. If I want E to embrace it, I'm better off paying some yutz with a name tag to tout its virtues, and then rallying against it myself...only half-kidding...

She was speaking fairly well when I was there this morning if you would like to call - She's lucid, and "here," unlike the last visit in September.


December 5, 2007 4:09:08 PM PST

Thanks for the update. When I read the postpone lunch in an earlier email, I sort of expected this news.

I can't tell you how sad I feel at us all knowing that this episode, and it no longer matters how much is actually physically produced or psychologically as a demand for drugs; that this may be the exit strategy that she is putting in the hands of the insurance company to write her off as an addict.

You have already, probably accurately, painted that devil on the wall, and what happens when he steps out of the painting at the next episode when insurance has raised the drawbridge over the moat around Pomerado hospital and the only options are either illicit drugs or the snake pit of county detox?

I know you have tried to tell E that, and I know that she hasn't accepted it as truth.

I don't know what the depth of your resources are, yours, your mom's and Brother J's, but I'm pretty sure, that unless we're talking mid-six figures, the conclusion is foretold. Then what?

I know that none of us can accept, at this point, that there is no solution that doesn't originate within E, and sans that, no solution at all.

If she's going to be there tomorrow and not released, I may try to visit, but will call first.


December 6, 2007 12:16:25 AM PST

It is sad, yes.

The only thing with which I would respectfully disagree - if it's even that - is this roadblock present just slightly larger than some Chuy with an orange vest redirecting traffic: that a) E still considers this a disease, and is not in a place where she can comprehend this as a disorder and, b) that taking drugs while referring to it as "medicine" makes for a very difficult, perhaps insurmountable wall. I'm very concerned about her psyche makeup, precisely because she is so intelligent, and while she can appreciate that drugs are a no-no enough to self-detox last week after seven months of habitual use (to her credit), she will continue to view, and refer to, that which transforms her physically in the third person. No "medicine" is ever going to remove that, and the brutal truth is all the support by way of family, diet, exercise will help (skipping over the co-dependency part here for a sec), and that's it - it won't solve. Having the insurance pull the plug will be a shocker, and not necessarily a bad one, provided she can survive it. Beyond that, however, the actual beast resides. Psychiatry may help, but, frankly, so would internalizing good routines instead of bad ones, be they mental, physical, dietary, et-fucking-cetera (stop me if you've heard this one before...).

An old parable was written for just such an occasion:

The Westerner, having forsaken the hot wife, big house and awesome job, and having trekked across the world in search of enlightenment, finally reaches the Tibetan mountain top ragged, hungry and desperate. He cries out to the wise old monk he finds meditating there: "Oh master, I have traveled many miles to reach you. I have renounced everything worldly and stand before you a poor soul seeking guidance. I have suffered greatly, master, what should I do?!"

"Stop suffering."

The garrisons we build sometimes, and sometimes unknowingly...and what lengths we'll go to fortify them...again, nothing new...

Mid-six figure numbers are no problem, just as soon as decimal point placement becomes optional...

Seriously, she has racked up over 100k this year in the hospital charges, easy. And for what? Certainly not to get better. It was short-lived, but 50 bucks a night in Puerto Nuevo to shake, rattle and roll narcotic addiction was the best money spent in a long time. I have to believe that that time will come around again.

It is devastating to watch the (figurative) compression going on in E's skull repeatedly every few months, and I've accepted that the crap shoot that will be presented sometime in the future c/o Blue Shield may have ghastly results. She may also snap out of it and go sell entire floors of Trump condos in Baja. I'm completely serious.

She was good enough tonight to not have - for the first time that I'm aware of - my mother stay at the hospital with her all night. We'll see what's what by morning.

With hope,


December 6, 2007 2:18:17 PM PST

While I respectfully agree with your analysis, I equally respectfully submit that what you call it doesn't matter as much as what you do about it, and, with as independent a spirit as E, the only one who can do something to accept that the cart is driving the horse, is E.

Until she does, all the logic in the world is going to be received with nods of understanding and efforts to toe arbitrary lines in the sand.....until the next episode of need manifests itself.

Yes, having the wellspring of available "medicine" dry up will be a shocker, and maybe that will be the sink or swim point, though I know how heartbreaking it is to step out of the "bursting radius" of co-dependency. Been there; done that.

As for old parables, here's one I found lurking just under my starboard parietal suture:

One of the last living members of The Hohndlers; an obscure tribe of itinerant hypermerchants, often afflicted with perceived needs for substance abuse, sought solace in the advice of The Guru of Small Things, who resided in a small but lavishly furnished cave in Ojai, California.

Assuming the humble pose of the supplicant, the Hohndler said to the guru: "oh, wise guru, I can't imagine never again having access to the magic potions that, while I know are harmful to me, seem to make me forget my pains".

And the wise guru said: "well, my child. then don't imagine never having that access; just imagine not having it today...".

As basic as that may sound, it's the philosophy that has made AA and NA work, for the average and the super achiever. Just get through today, just today....but first you have to want to, and that's the trick...

I hope she does want to, if not today then soon.


December 7, 2007 11:16:25 PM PST

That's as good a parable as any, and it most certainly does work.

Keeping it brief:

E's doctors are flustered; the neurologist has conceded defeat and removed himself, and the primary is openly agitated and would like E out of the hospital (I'm sure he's having difficulty "Shielding Blue" missiles of inquiry from penetrating select orificee). He has dropped her IV narcotic from 10mg morphine every so and so to 4 mg, but has re-introduced the long-acting Oxycontins, in fact the exact same dose as in September, and July, and May, etc. It's retarded - there's really no other way to describe it.

E will leave tomorrow, and be right back in the same holding pattern, addicted to narcotics. Worse, she will continue to believe that narcotics are a legitimate headache remedy, even if at least three doctors (not those mentioned above) have said explicitly that they aren't.

As I've mentioned, if something can go on and off - instantly - then I'm of the opinion that can be reinforced, and both directions. Thus far it's only been going one direction, and (I hope) E will soon be ready to accept what is so obvious: that she makes it worse on a sub-conscious power grid that -as if that's not bad enough - is swimming in opiate dependence, reinforcing the myopic "knowledge" that this will go away if I just take these pills, and so forth...

Gently, I mentioned as much to her today, in front of my mom, and with an example of just a few minutes prior: when the neurologist was in, she looked like she had cerebral palsy or worse - barely slurring words out of the side of her mouth, her right side shot, etc. - but a few minutes later she was sitting up, her right leg normal, both eyes open and even; everything, and usually just for a sec or two and then it is sent packing. I framed it politely, of course, but how in the world can this be programmed into her skull without, well, programming? This is what I was referring to when notating the drug addiction, which is a big deal, is secondary - and, when the drugs are gone, if she doesn't have her hard drive scrubbed, then the slightest thing will bring about the same migraine-induced reaction, which will then require narcotics...

Yes, it's frustrating...and the thought of placing hidden cameras occurred to me months ago, as wacky as that sounds. E transforms; I've been biting my tongue for too long as it is, and am already complicit in perpetuating this shit. The no-diet sodas diet, the clean up your own mess and exercise daily, the question authority when it's all about pharmaceuticals, etc.; it's all ancillary, but necessary - erasing those big, unattainable plans for Where We're Going, and just focusing on How We Get There for today and today only. Like your Choo Choo of the Small Things up in Ojai: I think I can - today. Period. Cut, print, wrap; you'll know it when you can do more...

Trying to help implement solid daily habits is the best I could do without freaking everyone out with the truth, a truth that might do even more damage out loud anyway.

I'm not a Thoreau guy, but I read a blurb a few weeks ago that makes perfect sense, and is always applicable: "Do not worry about how small the beginnings. For once something is done correctly, it is done forever." Good for questioning slavery or the annexation of Mexico, or for just putting down the cheese doodles...

Pretty simple shtuff there...and yet I'm still working on my numerous One Day at a Timers myself...starting with being in the Nile about being brief...sheesh!

I set another appointment with a psychiatrist (the first was a bust) today, as well as a counselor whom Lisa has seen before, and who has experience with CBT/NLP. Lisa is receptive to trying both, and that's encouraging...


December 7, 2007 11:50:32 PM PST

Thanks for the update, however depressing it has to be for all of you and me too. The frustration of knowing that you are watching a sentient being determined to keep doing what's destructive because she has programmed herself to believe that she is treating an ailment rather than feeding an addiction must make it almost impossible to stay the course. What course? Just being there to pick up the pieces...

My silly little parable is pretty shopworn. I trotted it out for my son R for years, saying: "You don't have to not ever do drugs; just don't do drugs today". It still took years, and he only did it when I stopped being his co-dependent and gave him a card to keep in his pocket so that they'd know who to call to pick up the remains...

So what will you do at the next regression, and she wants to go back to Pomerado?


December 8, 2007 12:43:13 AM PST

That's the question...

It's late, but what comes to mind is trying to get my mother to be so incapacitated that Lisa waits on her, does her wash, listens to her moan, feeds her drugs and occasionally helps her in the bathroom when my mother can't tidy things up on her own.

It feels like crap to write that, and it's not very realistic, but in my heart I know that's one way to knock off this nonsense in a hurry. E needs to be brought back into reality, or forsake some liberties if she opts not to. I do hope it's not the latter.

I am charged with continuing to do what I am able, and that is, mainly, reminding her that she does indeed hold the power to survive without such suffering. She does not yet accept as much, thinking it is a thing-in-itself that she can neither cure nor chase away. But that's why they call it therapy, right? A little patience-in-Russian music, please...(I'll need it)...

I've accepted E's possible futures some time ago. My mother is not quite there, but does realize how being a co-dependent is not so helpful. It's tough, as I know you know...


December 8, 2007 8:00:45 AM PST

There are no good choices left, are there?

I think we are both familiar enough with addictive behavior to know that brave attempts at compliance with helpful programs will be evidenced, if only to demonstrate that relapsed needs are "real"..I don't know a way to defeat that. Perhaps it may require her needing to be the helper to your mom, but that could be only too real if you weren't there, and with tragic results.

Lisa may not be in a truth accepting mode today, but that wise guru in Ojai would say "today ain't over."


December 10, 2007 12:35:09 PM PST

Thought I'd be current and pass along a post-sibling retrieval update to youse even if there isn't one. After leaving the hospital a couple of days ago, E went into the ER Tuesday night pretty incapacitated after complaining for hours about a throbbing headache and becoming so immobile we carried her in (she had left Saturday night in a wheelchair and with her head throbbing). A (relatively) small amount of steroid has been re-introduced, along with 240mg of Oxycontin daily, which is 240mg more than this past Monday saw. She is with oxygen tank, TV remote and the occasional plate of sustenance. Last night she was walking around downstairs with eyes open and extremities in full regalia, serving herself munchies and even washing a dish, which, it would seem, lends credence to the theory that E does not go from looking like she needs her own telethon one day to...well, I believe I've covered this already...

E believes she can't control it, or at least is awash in enough of a chemical mindset to believe that she believes she can't control it. And maybe she can't. That she may very well march to her death in this fashion is almost unbearably tragic; that she will spend the next ten years taking Moms along with her is just rude, and unacceptable. But what to do? I would like to be macho enough to say that failure is not an option, but failure is a very real option. In fact it has been the primary option-du-jour out of the last seven months of "jours."

Am forwarding the links I dug up this morning (it took all of five minutes), ones I am presenting to E and Mom, in that what is blatantly obvious might sound legit coming from others (though Mom is already on board with the narcotics-only-create-headaches knowledge). Things are exactly the same here, and, undoubtedly, a little too much truth coming out of my mouth will broker exactly the same results as past attempts. Which means, at great personal sadness, that I can only back off and let others live their lives as they so wish.

I don't think it's possible for Mom to do any more than acknowledge that the co-dependence has become so prevalent it has created its own gravitational field...there's just too much heartbreak on the table for her to say "no" and "enough already." I hope I'm wrong...

There are appointments for psychiatrists and counselors this week, and perhaps something will come of that. I believe botox was also approved, and was helpful in the past.

http://abcnews.go.com/WNT/Health/story?id=1696888

http://www.mhni.com/faqs_other_head.aspx#rebound

http://www.mhni.com/faqs_opioids.aspx


Thursday, December 13, 2007 11:46 PM

E is back to being E, in that she is mobile, making plans, etc., and I think Mom is just happy that the darker clouds have blown over, even if it means round-the-clock Oxycontin. We took E to a psychiatrist yesterday, and there are possible biofeedback, CBT and disorder appointments coming up. Perhaps something will come of it that's not more tragedy, but I'm not particularly hopeful. As I said to Mom recently, you don't let the gambling junkie decide how much weekly casino time they're allowed; or, say, watch someone show up for drug counseling high and expect their sincerity to be taken seriously. I think Mom understands this...E cannot, at least not now...


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