Category Archives: Beloved

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Ode to defiance

Is oppositional defiance running YOUR life?

I am oppositional defiant. I have been for as long as I can remember. I ALWAYS want to argue when someone tells me to do something or gives me advice. BUT, I have learned to work with it.

I work with it by arguing with myself.

Give me a topic. Or advice. I will promptly argue the opposite, internally or externally. Then I will argue the original side. Then my demon fights my angel until they are both tired and decide to go have a beer. Somewhere along the way I will make a decision and also I will laugh, because it’s funny.

B has figured this out. “You argue with EVERYTHING.” he says.

“Yes, and if there is no one around, I argue with myself. All the time.”

However, he is also oppositional defiant. He is smart too, and doing some self examination.

“I am thinking about my life. I think ALL of my important decisions were oppositional defiant ones.”

“Someone told you you couldn’t do that?

“Yes.”

He’s chewing on that. Heh. He accuses ME of overthinking. I replied that I am making up for his underthinking, heh. He suggests that I STOP overthinking and I say, “You want to DESTROY the SOURCE of my poetry?” Double heh.

The point is, some of us are oppositional defiant, but really, we don’t want that to run our lives EITHER. We don’t want ANYTHING or ANYONE to tell us what to do.

B says, “I think that everyone refusing the vaccine is oppositional defiant.” He has a lot of friends, both liberal and conservative.

“That is interesting.” I say. And I wonder if it is worth dying for, to be oppositional defiant. Not if it’s running your life, right? I don’t want ANYTHING to run my life except ME.

So then I spend a bunch of time arguing with myself about the causes of refusing the vaccine. And I have not reached a conclusion. Yet.

I took the photograph at the Bellevue Mall on Monday. A three story waterfall. Really? Isn’t there enough rain in Seattle? We should have a three story sun instead.

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atmospheric river

The current flooding rivers in the Pacific Northwest (1) now are ascribed to an atmospheric river. Atmospheric rivers are long narrow weather regions that carry enormous amounts of moisture from the tropics in the sky. This sky river carries water vapor and moves with the weather, “carrying an amount of water vapor roughly equivalent to the average flow of water at the mouth of the Mississippi River.”(2) When they make landfall, they can release the water in the form of rain or snow.

They can stall over watersheds and release huge amounts of wind and rain and cause severe flooding. The atmospheric river from Hawaii to the Pacific Northwest is called the “Pineapple Express”. “On average, about 30-50% of annual precipitation on the West Coast occurs in just a few AR events and contributes to the water supply and flooding.”(2) An atmospheric river is approximately 250-375 miles wide.

“Not all atmospheric rivers cause damage; most are weak systems that often provide beneficial rain or snow that is crucial to the water supply.”(2) If it were colder we would have an amazing snow pack right now.

The bomb cyclone that came through a few weeks ago caused much less damage. An atmospheric river does not sound as dramatic, but the drone pictures of houses and cars deep in water (1) tell a different story. There is road and bridge damage and already talk of Thanksgiving travel disrupted.

(1) https://www.accuweather.com/en/winter-weather/pineapple-express-pummels-northwest-british-columbia/1047699

(2) https://www.noaa.gov/stories/what-are-atmospheric-rivers

(3) Meanwhile the Olympic Peninsula still has a section cut off: https://www.peninsuladailynews.com/news/flooded-roadways-cut-off-west-end/

The photographs are of the Sol Duc River, taken by a friend. The river rising and huge amounts of debris being carried down the river. The huge log in the earlier pictures that was on the other side of the river, is gone.

Sol Duc River Tuesday Oct 26, 2021
Sol Duc River Sunday November 7, 2021
Sol Duc River Sunday November 14, 2021

Next is the heading photograph, from Monday, November 15, 2021.

Sol Duc River Monday November 15, 2021. Carrying whole trees downriver.
Rialto Beach with all of the wood washed down the rivers, November 16, 2021.
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Why care for addicts?

I posted this in November, 2015. I am reposting it.

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Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family β€œenables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act β€œnormally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words β€œheroes” underneath and β€œthank you”. I  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. β€œMy friend used meth the whole pregnancy and they never checked,” she said, β€œNow her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.