Random Thoughts from a Restless Mind

The Extras. OUR Extras. That’s what Dilly (my daughter-in-law) calls all of the kids who were not our natural born children but who nonetheless lived a substantial percentage of their lives in our house. All three of our own had several friends who became Extras. Over time Beth and I morphed from Mr. (or occasionally Dr.) and Mrs. to Mama and Papi for these kids. Many of them are still very much a part of our lives, reunited with our odd little extended family by weddings, christenings, holidays and the like.

Tragically, one of our favorites is now no longer.

My oldest son Dan and I attended Bobby’s memorial service yesterday afternoon. Bobby was once so close with my two older kids and so comfortable in our home that I vividly remember coming home one day to find him at our kitchen counter doing his homework. All alone. No one else in the house. He lifted his head, smiled his trademark goofy smile and flicked the largest, heaviest bangs in the history of banghood out of his eyes, said “hey Papi”, and went back to his books. Neither one of us thought there was anything remotely odd about it at all. Bobby was not one of the Extras who stayed in touch. He drifted away from us as he fell further and further into his addictions and died of an accidental overdose last week.

It’s hard to describe how awkward, how awful the service was yesterday. We recognized almost no one. Dan only knew Bobby’s parents, and I’d never met either one of them. What could I say to them at a time like this? I was really only there for Dan (and by proxy “Lovely Daughter” Megan). There is not a single language in the world that has a word or a name for what we would call a parent who has lost a child. Nothing like “orphan” for the parentless, or widow/widower for the surviving spouse. I’m not sure if either of Bobby’s parents even know that he was our Extra, or knows how much we cared about him once upon a time.

Have you been to a funeral or a memorial for a young one who succumbed to his addiction? To the great credit of everyone in Bobby’s family they didn’t evade the issue at all. Three significant figures from his unsuccessful attempts to leave that life spoke. All of the happy memories were of his very young childhood, as if the Bobby who’d lived so much of his life at Casa Blanco had died at high school graduation. What can you say about a life that was 10 years shorter than the number of years one had lived? The other funerals of youngsters who have died have been filled with the lament of potential left behind. There was none of that for Bobby, only the memories of the child and the struggle of having watched 10 years of pain.

What is it about opiate addictions in our country now? We have had other substances that have been a scourge on our society, notably crack cocaine in the 80’s and 90’s, but this is different somehow. For one thing, while crack destroyed lives it didn’t end them. 30,000 people died from inadvertent opiate overdoses in the U.S. in 2016, most of them under the age of 30. For whatever reason 1/9 of them occurred in Ohio where we live. It seems like rather a bad business model–don’t you think?–to pump up the purity and strength of your product to the point that you kill off a meaningful percentage of your customer base. And yet here we are, more and more people dying each year from overdoses.

What is in the news on a daily basis is the problem of addiction created through the prescription of opiates by physicians, addiction which must then be addressed on the street if or when the prescriptions end. While that scenario is certainly real and needs addressing, we hear more about it because of the irresistible angle of big Pharma companies and their profits, and the equally irresistible urge to find someone or something to blame and punish. This is not Bobby’s story. Bobby, like so many, many of his peers today and for literally centuries of todays, fell prey to an illness that could only have been treated by prevention. There are those among us who cannot resist the siren song of any number of substances once they’ve had their first taste. I do not know what gateway drug it was that walked Bobby into that world; it was an opiate that escorted him out of our world in the end. A pox on the cretins who opened the exit door.

I am left grasping at straws. What can we do to prevent these senseless deaths? While I am a physician and a student of health policy, nothing in my training or experience is helpful here. Why is there so much “hot” product out there on the streets? What is it about this substance that makes it so difficult to leave behind once the addiction sets in? Our society is one in which we are convinced that someone is always to blame, hence the vitriol directed at the manufacturers of the legal version of the opiates that so many young people are abusing. I’m sorry, but it’s not intuitive to me that going after them is going to help the Bobbys of the world stay alive. The feeling I have is one of utter helplessness.

Message? Lesson? Sadly, I’m afraid, I have neither to offer. Bobby is gone and I am sad. Had he not been lost to us, had we remained a part of his life would there have been a different ending? Well, the story arc would likely have been different, but history has shown that the ending would likely have been the same. You never know, though, and that makes me sadder, still. You never really know, right? We would have tried, Beth and I, because he was one of ours. He was one of our Extras. For many years, he was one of mine.

It seems only yesterday that he’d found us, and we, him. Now his is lost to all of us. Forever.

To the victors go the spoils. History is written by the victors. Truer words, eh?

I find myself turning off all manner of information outlets of late because they are all just so many repeats. The other side of that victor coin is that the vanquished simply repeat the lines of the victor when s/he was losing. Look no further than the kerfuffle about the Accountable Care Act. If you remove time stamps and the naming of characters what one hears or reads is essentially unchanged today from what was said or written some 7 years ago.

Try it.

My sense of ennui is so strong that it is fairly paralyzing. Is there no one out there who is willing or able to propose something that is truly new? Can we not even even come up with new or original complaints and criticisms? Must we be doomed to this endless cycle of sameness about seemingly everything?

It’s almost as if the vanquished do not so much fail to learn from history but that they work very hard to faithfully replay history in exquisite detail, dooming us all.

We are looking at a true health crisis in the U.S. In 2016 some 40,000 Americans died from opiate overdoses. This is more than the number of deaths by firearms by a factor of 4, and is similar to the number of deaths in automobile accidents. This morning I read a startling statistic: 7 million working age men are out of the employment market, and 1/2 of them take painkillers on a daily basis. Crazy, huh?

On CrossFit.com we agree that there is a general crisis of health in the American populace stemming from over-consumption of calories (most of which are high glycemic index carbs) and under-consumption of physical activity. Another equally startling story in this week’s news is the growing acceptance of excess body weight fat as some kind of new normal, a normal that should somehow be institutionalized.Total capitulation, that.  In this discussion one must add the over-consumption of alcohol, because countless studies have shown that this legal substance is responsible for all kinds of negative health effects, both direct and indirect. (As an aside, it does give one pause when one considers the possibility of legalizing another neuro-depressant, marijuana). As if this isn’t enough, we now must add to this toxic recipe the ingestion by any route of opiates.

The U.S. is regularly taken to task for its failure to sit at the top of the world’s life expectancy leader board despite spending the largest amount per capita on healthcare in the world. This criticism becomes more and more unreasonable as we dive further into what it is that actually drives statistics such as life expectancy. Deaths from overdoses are illustrative of the folly of conflating health and healthcare: there is nothing in the healthcare system of treatment that drives this statistic, and the death of these primarily young people has a disproportionate effect on the life expectancy statistic in which it is years lived that we are counting (and losing).

What, then, is to be done, especially in the setting here of health-conscious individuals? It behooves each of us to take a bit of personal responsibility in the discussion and pledge that we will utilize accurate nomenclature, and in turn demand that everyone else in the conversation do likewise. Health and healthcare are not synonyms. Likewise, healthcare and health insurance (itself somewhat of a misnomer) are not the same; one does not lose healthcare when one does not have health insurance, and for certain the ownership of a health insurance policy does not guarantee one access to healthcare. Indeed, because the outcome was inconvenient to the majority of entrenched healthcare interests, the landmark study of Oregon Medicaid recipients that showed no improvement in health outcomes in those with Medicaid compared with those without has been mostly ignored and purposely forgotten. We need to engage in this conversation, but do so with strict fidelity to meaningful terms.

From there we should lead in whatever way we can. This effort is not at all about the treatment of disease, at least not as far as we here are concerned, but rather one of Public Health. There are quite specific areas to be addressed if we wish to effect change. Each area must be subjected to a root cause analysis. Over-consumption of low-quality carbs is near and dear to CrossFit, Inc., and the battle against “Big Soda’s” influence has been engaged. Other influences such as agricultural subsidies should have a similar bright light shined in their direction. How is it that the dramatic reduction of drinking and driving has failed to render deaths from drunken driving a statistical anomaly? Perhaps someone can convince one of those know-better do-gooder billionaires globe-trotting in search of a trendy problem to throw money at to look a bit closer to home when they apply their famous intellect to new thinking about old problems.

As to the tragedy that is opiate overdose deaths, can we please have someone with no skin in the game be given no-risk access to any and all applicable data and just turn them loose? Some guy did a deep dive into the issue of scrubbing the internet of all vestiges of child pornography using a combination of massive computing power and an outsider’s view. Give someone like that the ability to examine the entire opiate ecosystem to uncover some of the hows and whys so that we can make some decisions of the whats of our response with more than just our typical SOP of some self-designated, conflict-of-interest-infected expert who declares that his/her solution should work because of what they are sure must be going on. This seems to be a new thing, after all, and rather young, too. Prior opiate societal infestations surely share some aspects with our present crisis, but I don’t recall the opium dens in the days of the Crusades so routinely offing their customers.

Anything that can be measured can be analyzed. Anything that can be analyzed can be altered utilizing the results of that analysis. What is needed is the double-edged sword of courage to uncover an unpleasant truth, and strength to set aside all manner of short-term personal gain in favor of a long-term solution for societal benefit.

We ought not let 40,000 lives representing hundreds of thousands of years not lived to be lost in vain.

Some time ago I wrote about creating a way to measure health. Real health. Health that encompasses every aspect of what it means to be alive and well. As a CrossFitter I definitely included Coach Glassman’s Disease -> Health -> Wellness continuum, and I also acknowledged the critical importance of his concept of “Fitness over Time”. As a classically trained physician/scientist there is clearly a place for more traditional metrics like blood pressure, serum lipids and the like, although they may, indeed, be an variable that is ultimately tied to fitness.

Where my thoughts on defining and measuring health seem to depart from most current trends is in the recognition that mental health–emotional wellbeing—is as much a part of being healthy as any other thing we might examine.

Think about it for just a moment. Most of what we would classify as mental illness has as many outward signs that we can see as diabetes and hypertension. Which is to say, none. Yet we—all of us, not just CrossFitters—see nothing but the good in treating diseases like diabetes openly and aggressively. There is no stigma attached to seeking care for your hypertension or your elevated LDL. To the contrary, if someone who loves you discovers you quit measuring your glucose before you bolus your insulin, they are for sure gonna get in your grill.

For whatever reason, mental illnesses, including addiction, are looked at quite differently. No one is asking the person with chronic depression whether she is taking her life-saving medication, for example. We might notice an insulin pump on a friend or family member, but then it’s quickly forgotten. Everyone seems to be very uncomfortable around the young man who has very obvious hand tremors from the life-saving medication he takes for his Bipolar disease. We all seem to be so much more understanding when we have to wait for a response from someone suffering from Parkinson’s Disease than from the young women who has the same symptoms as a side-effect from the medicine that quiets the dangerous thoughts in her head from Schizophrenia.

It’s not even necessary to look only at these kinds of severe mental illnesses when we are examining the importance of mental or emotional wellbeing as an integral part of being healthy. What good does it do to have a 5:00 mile, a 500 lb. deadlift, and a 1:59 “Fran” if it was self-loathing that drove you in the gym to get there? You may be quite accomplished, the envy of your peers, at the peak of whatever life mountain you wished to climb, and yet you cannot feel joy. How is it possible to be healthy without joy? I look at Usain Bolt and what I see is quite possibly the healthiest man alive. My friend Tim, the writer, tells me that Justin Gatlin has nearly everything that Bolt has—youth, fitness, wealth—but the combination of failure to knock off Bolt, and the public disapproval reigned on him as boos from the Rio stands has left him emotionally broken. It’s subtle, but if you look at his face in the blocks of the 100M Final it’s there.

Our complex and conflicted attitudes and feelings about mental illness are especially evident when the topic of suicide comes up. Just typing the word makes me uncomfortable. Even how we describe suicide is fraught with hidden meaning that reflects our discomfort: someone has “committed suicide”. Right? Someone committed an act that we simply cannot fathom, one that leaves the survivors completely without any understanding whatsoever. How could someone DO that? It’s as if every suicide is the same as the suicide of the crooked prison warden in The Shawshank Redemption when he looks out the window and sees his fate arrive in the front seat of a State Trooper’s car.

In reality most of the time it’s simply not like that at all. Nothing about it is simple at all.

The outer walls at the periphery of my world have been breeched by suicide twice in the last couple of months. One of them actually does feel a bit like that prison warden. Frankly, I am too conflicted, too aware of the external circumstances and not enough aware of the internal life of the deceased to offer much right now. The other one, however, just stopped me in my tracks when I heard. The loss was profound.It has also introduced to me a new vocabulary that I truly believe provides a starting line from which we can change how we think about not only suicide, but all of mental illness. A friendly acquaintance lost his wife when she was killed by suicide.

We don’t need to know all of the details of the story. Suffice it to say that in the face of a child’s illness she suffered quietly. Too quietly to be noticed. Perhaps she didn’t realize how badly she was suffering, or maybe she was like so many of us and couldn’t bring herself to see her illness for the life-threatening entity that it was. No one will ever know. What is clear, though, is that this was not anything about commitment. Kidney failure may be cause of death in a diabetic, but it is diabetes that kills him. There is no difference here. The cause of death was suicide. Her disease, her depression is what killed this young woman.

Each of us has a very few moments in our lifetimes that forever change us. On the second Tuesday of July in 2006, unbeknownst to me, one of those moments was transpiring in a lonely, dark corner. Joyfully, the moment was a beginning, not an ending. Regardless, once learning of the moment I was changed forever. Now I knew. You cannot see any marks from mental illness, no swollen appendage or insulin pump. But it is there all the same, and it must be acknowledged and accorded the same degree of care as any other disease that may take our loved ones from us. Mental illnesses are real, and they can be deadly. There ought not be any conflict or discomfort in treating them.

We may stop losing so many of our loved ones when start to see emotional wellbeing as part of being healthy.