Excerpt from chapter 2- The obsession that I was still in some twisted alternate reality strongly returned  overnight, although perhaps a bit less nightmarish ly . A historic inn in Colonial Williamsburg, packed with   alcoholics and addicts, was where the deities of my celestial temple had placed me. I was floating above my bed. The door  to my room opened and a flashlight beam stunned my eyes. The deep voice behind it asked me to report in five minutes to the nurses’ station for vital signs. What time was it? I sat up in bed, put on my psych-ward  yellow footies   and shuffled out into the hallway, moving down to the nurses’ station, which glowed eerily with nighttime lighting. I spotted the analog clock behind the desk;  it read 5:15 . Two nurses were standing behind the long counter engaging in casual,  caffeinated   conversation about Donald Trump’s election-night victory. One of them was sipping coffee out of a  royal - blue mug...

Once again I find myself in that strange semiconscious state between night shifts. Having gotten home from work at 8am and crashed until noon, I'm neither fully alert yet nor in a mood to try any more sleep. So like my other states of being, I have developed a routine that seems to work: 1. Small coffee 2. Run (more like shuffle) with the dog 3. Write something 4. Chores I don't much care to do (laundry, bills) 5. Guitar, guitar, guitar I like #5 the most, and feel I get the most out of a good practice session when I am in boxers and a ratty tee, not fully rested.  For reasons I cannot explain, during these moments I prefer to try new songs rather than play old ones. I guess that's just my brain wanting to focus on something original so there is no room in my head to rehash the previous night's ER scenes of abdominal pain and flying secretions.  Today I've stepped outside my “nineties grunge“ comfort zone and am teaching myself "Sitting, Waiting, Wishing" ...

  Excerpt from Chapter 10 I was traveling back home, looking forward to crawling into my own bed with an awaiting Cassie . It was a clear,  warm night, and within a few minutes I  was cruising on the I-581 beltway, passing the brightly lit Mill Mountain Star   and  heading  toward I-81. Traffic was  scant   .  . .   until it wasn’t. Just up ahead, perhaps a quarter mile, a trail of bright red brake lights suddenly appeared like a Christmas tree lighting ceremony.  It was a few seconds before I realized the ca rs hadn’t just slowed, they had stopped completely. Crap. Must’ve been an accident. Upon closer inspection, peering through the last of the September dusk, I saw open car doors and people on the road, running around on the highway asphalt, arms flailing. This was not good. In the same way an off-duty cop is never completely off duty, neither is an emergency worker. I slowed and veered my truck onto the left shoulder, came ...

I think the emergency departments are getting back to normal. At least, the ones I work in seem to be. For months now while I on duty I waited around aimlessly as occasional patients would trickle in here and there. Apparently, most people were choosing to have their heart attacks and strokes at home rather than come to the hospital and risk contracting the coronaplague. Although at its nadir our volume was literally cut in half, the patients that did show up were generally much further down the illness progression timeline, necessitating much more aggressive actions to stabilize and reverse the disease cascade. Sepsis comes to mind- that state in which an infection spreads like wildfire through the bloodstream so aggressively  that the body's defenses become overwhelmed and circulation collapses from an immune system gone haywire. After one hour of the "sepsis state," survival drops precipitously, often irreversibly. Avoiding the ER for these patients is tantamount to a ...

Dear Daddy I write you in spite of years of silence You've cleaned up, found Jesus, things are good or so I hear This bottle of Stephen's awakens ancient feelings Like father, stepfather, the son is drowning in the flood                -Weezer Dear Dad, It has been a while since we have spoken. I did not come to your gravesite this week but I know this would not have bothered you. You were never much on religion or spirituality; you once told me "When you're dead, you're dead." Whether that's true or nor I'm not sure, but what I do know is that you live in my heart, my sister's heart, my brother's heart. Your spirit is not underground in some grave, that I feel in my bones. We love you, I love you. I miss you. I am so grateful you never learned the truth about me, about my drinking. Your passing triggered the final chain of events that ultimately ended my old life and got me sober. I reflect on my last alcoholic bender, when I drove to your fun...

The invisible hand of my Higher Power has once again been flawless (isn't that always the case?) This road trip is looking and feeling like a divinely inspired perfect decision. I really need to shut down my thinking and listen to him more often... I pulled up to their home in central PA on day one into the welcoming arms of "Darryl and Julie."  He was a medical school roommate of mine from 1988-1991, and we have managed to stay in touch ever since. Also an ER doc, he's one of those guys who has always calmly accepted life on life terms without ever having to learn about it in a 12 step program. I arrived, they set me up in a guest room, and immediately took me kayaking on the perfect June day. As we paddled along in the calm waters, we managed to catch up on years' worth of stories, as well as pull out some oldies but goodies from the past. We laughed a lot, got some sun, and all the while a bald eagle kept us company. Yes, the gorgeous creature would perch hims...

I just finished the book Raising the Bottom  by Lisa Boucher; I listened to the entire audiobook while on my road trip. Written by a career nurse, it chronicles her spiral downward into alcoholism at a young age, her reconciliation with the disease, her relationship with an alcoholic mother, and eventual long-term success. She relates in detail about the women in her family and how the disease impacts their relationship and the family dynamic as a whole.  The book is written from a woman's perspective with the theme of how the disease affects women specifically, although I found many of the take-home points pertinent to my own recovery. She underscores how 12-Step work was essential, and how it can serve as the touchstone for all women (and men) who want to fundamentally change and have success in long term recovery. Her chapter about physicians and the medical system in general, with its institutionalized biases in dealing with alcoholism and addiction, approaching it not as ...

I've just finished a heavy stretch of night shifts in my various emergency departments, and find myself with seven days ahead of me with no work. Time for a road trip. After I drop the dog off at the kennel (poor Skipper!) I am gassing up and heading up I-81. While usually any time spent north of the Mason-Dixon line induces uncomfortable hives (with time in New Jersey tending towards full-blown anaphylaxis), I believe this time around  I am protected. Each upcoming day will be spent with a friend or family member  whom I haven’t seen in years, but with whom I have a lifelong spiritual connection. A medical school roommate. An aunt. A fraternity buddy. A high school friend. People are like antiquities- they seem to grow more valuable with the passage of time. For 1,320 days I have hunkered down, done what it takes, worked my program of recovery, and successfully stayed inside my routine. But now it is time to put Virginia in the rearview mirror, at least for a week. Recovery-w...

"All Alone! Whether you like it or not, alone is something you'll be quite a lot." -Dr. Seuss, Oh! The Places You'll Go! About an hour ago, as I was finishing my between-night-shift five-mile shuffle with Skipper, I viewed a neighbor out on her front lawn preparing for an outdoor gathering. She had a canopy set up, and was adorning it with pink balloons. "Looks like someone's having a birthday party today." I remarked. "A social distancing birthday." Three little giggling girls in pastel party dresses pranced around  the mini-shelter as baby brother looked on from the sidelines. A social distancing party for a five year-old. I'm sure a group of excited kindergartners will remember the governor's rules.  I am reflecting on my day. I will be alone for the majority of it. No big plans, since I am reporting back for duty at The Rock tonight at 11pm for the last of my five night shifts, which have been spread out between three different eme...

Excerpt from Ballad, Chapter 9: “Passions and Process Addictions”: It was early spring,  I was about four months sober ,   and   I started spending quality time with my guitar. I began with the stuff from my past: Pink Floyd, Tom Petty, and  t he Beatles. I had been hitting my meetings like clockwork and incorporating some of my AA teachings into my practice sessions: Accepting that I kind of suck. Accepting that I really only have a handle on the  open chords, and still struggle with bar chords. Accepting that my fingers are painfully sore. Accepting that the guitar that I own is badly warped and horribly out of tune from  years of  sitting in a  dark basement and  humid garage. Joe, try this on for size : Accept with gratitude  that  you are  alive, sober, and have the  luxury  to strum a guitar ,  because  you  have a good friend who let  you  move in with him rent-free while  you ...

Never in my life has my urine been so vitally linked to my career. As a medical professional enrolled in a health professionals' monitoring program (HPMP), I have become proficient at peeing in cups.  I joined  the Virginia HPMP in  November 2016, while still in residential rehab. As one part of my five-year agreement with the Commonwealth, I agreed to submit  to random urine drug  screenings through the entirety of my contract, which runs through late 2021. Every morning at 4am the program’s software algorithm decides who will be tested that day and who will be spared. I check in on my handy-dandy phone app, an early-day ritual which I have become quite accustomed to over the last 42 months. If chosen, I carve out time in my day for a trip to the closest LabCorp or urgent care center. Failure to submit a sample is tantamount to a failed drug test. On this morning I was summoned for my 126th scr...

"I told the Padre the truth, man. I like it here. You get to do what you want. Nobody fucks with you. The only worry you got is dying. And if that happens, you won't know about it anyway. So what the fuck, man." -Bunny, Platoon I arrive for shift, usually around 22:45. If it's a night at the relatively quiet freestanding emergency department and I get lucky, the evening surge of patients is waning, and I serve in a mop-up role. By 1:30 or so I might even crash in an exam room for an hour or three. If I am in one of the two other busier ERs I work, rest is not an option. I know I am gonna be hoppin' all night long...and frankly that's also fine with me. I used to dread the night shift. Even after years doing them, I never could quite acclimate. I would stress for two days in advance and it took me two days to recover. Now, not so much. I've discovered the night work to be much more relaxing than the days. Maybe it's because there are...

While working a shift the other day, I noticed listed among a patient’s allergy list, “sauce.” Interesting, I thought. I asked him about it when bedside, at the start of the history. “What kind of sauce are you allergic to?” “All sauce.” “You mean, tomato sauce or clam sauce, what specific kind?” “No sir, I am allergic to all sauce. If it is made into a sauce, I am allergic to it.” ”Are you telling me that you can eat mushrooms, milk, eggs, and flour, but if mixed, cooked, and served with a meal, you can’t have it ? “That is correct, sir.” The exchange struck me as odd. I’d never heard of anyone allergic to the blended form of certain foods but not to the individual foods themselves. Was it all that different to my alleged allergy? It has been said that the alcoholic is allergic to alcohol, which is really no more than the fermented version of various foods. As a medical professional, I always questioned the soundness of this concept. But if I put my understanding ...

God grant the the serenity To accept the things I cannot change The courage to change the things I can And the wisdom to know the difference It sounds great, every single time I recite it, think it, whisper it, or read it. If I overthink it, it loses strength and meaning. However, every day I am offered choices, which I will eventually triage into the "accept" or "change" category. Decisions to act, or not. This is where the last phrase of the Serenity Prayer comes into play, and as I continue to grow in the Program, the choice to take firm action or remain passive becomes increasingly clearer.  If I am at work, and I am "unfairly" complained about by a coworker or patient, do I defend myself? Do I fight to protect my place in the environment by pushing back, or do I apologize and recognize some failing in an open way? Or perhaps some combination of both? When is it time to defend myself for the greater good, and when is it time to eat...

I la y  there at the far end of my echo tunnel, hearing him drone on  with  verse after verse of Deuteronomy, Numbers, Revelations, whatever. My flimsy hospital gown was as thin as the single bed sheet provided me, and I felt the chill of antiseptic air. The shades, meant to block out  the  outside world, managed to have a perfectly placed tear in the fabric, letting in a single beam of light from an outside streetlamp, hitting my eyes through the night as I attempted sleep. Sleep : ha, that was a joke. My dreams or visions or hallucinations or whatever they were would build momentum and explode in a fury out of my head all night long, like a shaken-up bottle of soda.  They would reach a crescendo and bubble over, reset, give me a brief respite, and start up all over again. Wayne checked on us. Again. It seemed as if  every med tech on the lockdown unit of the Penuel  Psychiatric Inpatient Center  was named Wayne....

Alcoholics in long-term recovery maintain a keen awareness  of any booze in our immediate vicinity. Whether sober a week or twenty years, we keep a heightened sensitivity to its presence in a room. So when my hospital chose to line the hallways with it, needless to say the hair on the back of my neck stood on end. These days hand sanitizer has become as ubiquitous as cellphones, face masks, and Bradley Cooper; you can't swing a dead cat without hitting a dispenser. Companies simply cannot keep up with the demand. This being the case, a local valley distillery came up with the brilliant idea to temporarily convert its operations from whiskey to full-time sanitizer production, and began to supply local medical facilities. My hospital has been buying the stuff in bulk, restocking its depleted stores,  and filling all its dispensers with it. Here's the problem. Distilleries using equipment which had been continuously producing hard liquor for years can't magically c...

You are an incredible human being. You were born into this world naked and screaming; in recovery, you once again were exposed to the harshness of bright lights, vulnerable and shivering in your frightening new environment. As you grew, you never stopped learning, searching, discovering, erring, succeeding. You scraped along the rocky river bottom as life's current swept you along; your outer skin became chewed up and scarred as your inner constitution was put to the test over, and over, and over again. With every contusion and laceration came newfound healing methods. Some wounds infected, others festered, but all were overcome so that you could survive to this day. You recognized your flaws, defects of character, and obsessions, even when you were lost inside them and the outside world seemed so far away, like a dream almost forgotten. You struggled to stay afloat, flailing in the putrid swamps, predatory waters, and lava flows...yet here you are, reading these wo...

Eight months to the day after my return to the  Rock, I pulled my car into the hospital’s Lot C just as the first glimmer of dawn, purple and pink, appeared  over the Blue Ridge. Two  freshly assembled  white  biohazard tents,  each the size of a tour bus and  erected in the adjacent parking lot to screen the less severe patients, obscured my regular view of the ER’s rescue squad entrance. I sat in the driver’s seat for an extra minute, listening to the finale of  t he Foo Fighters ’   “ Hey, Johnny Park! ”  and reflected on how rapidly the change  had  happened . Fortunately, we all saw it coming. Only two weeks earlier, my shifts were business as usual: fresh coffee in hand, I would put on my white coat and stethoscope, take  sign-out  from the night shift doc, and begin what I had done over  four thousand  previous times in my life — see and treat a full shift’s worth of acutely ill patients until my r...