Life as an Extreme Sport

Category: Academics

Classes and coursework.

The Daily [05-08-06] – Dependency vs. Addiction

...and everything else, 2006, Academics, House MD, Pop Culture, The Daily

If this looks familiar to some of the longer-time readers, well… it was a busy week. And besides, the original was pretty good in and of itself.

Dependency vs. Addiction
Publish Date: 2006-05-08

I meant this column to be about the idea of informed consent. It’s a subject both House and Grey’s Anatomy have covered in their last couple episodes; something I would call a coincidence if they hadn’t been doing this back and forth of show themes for two seasons now.

But one evening I managed to find myself on the Television Without Pity Web site, in theory rereading the details of those pertinent episodes of Grey’s and House, when I decided I wanted to read recaps from earlier episodes.

That decision led me back to a first-season episode of House titled “Detox.” The theoretical point of this episode was a teenager with bleeding of unknown origin, but the actual point was to examine the vicodin use of the main character, Greg House.

For the few of you who’ve managed to miss this show, the character likes to discover novel ways to take vicodin.

In his defense, he’s missing a good part of one of his thigh muscles and has severe nerve damage from various complications of a blood clot and surgery years before.

House is accused of being a vicodin addict, and is challenged to go a week without taking any. He accepts the challenge, and during the course of the show appears to go through withdrawal, going so far as to break his hand to force his body to pay attention to different pain.

The result? Everyone crows that House is a drug addict.

I don’t agree.

Addiction is a biological and psychological condition that compels a person to satisfy their need for a particular stimulus and keep satisfying it, no matter what the cost.

Dependence is a physical state that occurs when the lack of a drug causes the body to react.

Physical dependence indicates that the body has grown so adapted to having the drug present that sudden removal of it will lead to withdrawal reactions. This can happen with almost any drug.

House is in constant, chronic pain. The physical dependency on vicodin is one that allows the character to maintain a normal lifestyle.

To use analogy to illustrate the point, imagine that a normal, healthy person is akin to a full glass of water. Someone who is in chronic pain is only half a glass of water without pain medications.

Add in a bunch of ice cubes, and the person in chronic pain is brought back up to the normal and functional level of everyone else.

In the case of the addict, toss a few ice cubes in a full glass of water, and watch everything spill everywhere in a mess. That’s addiction.

The chronic pain person needs those ice cubes of vicodin on a daily basis to provide what the body needs to function, but it’s not a situation where they would actively seek out, need, or desire any more than necessary to achieve that state of near-normalcy.

Regular use of some medications is necessary for some people to live a normal life. A diabetic is not addicted to insulin, nor is someone taking medication to control high blood pressure addicted to it.

They are, however, dependent upon it, as a person in chronic pain is dependent upon their drugs to function normally.

Perhaps that’s the thing one needs to consider when weighing notions of addiction or dependency — the person who is addicted does not have improved functionality with their addiction, while the dependent person does.

The writers of House have been irresponsible in how they’ve portrayed the character of House’s dependency, and this causes a lot of grief for actual living and breathing people with chronic pain.

There is a stigma associated with needing pain medicine every few hours. This stigma, shame and fear prevents many doctors from properly treating pain, and prevents many people from seeking out the relief they need.

You’ve Got Potential…

...and everything else, Academics, life and living, The Past Resurrected, Thesis

Here’s where you tell me it’s ridiculous to talk about my potential when I’ve never made an effort to use it. If I had an ounce of real potential, I’d get off my dumdum and do something. Go to school…buy an apprenticeship…or just start incanting on my own. Something. Instead, I’m squnadering my existence. On parties and fine food and umty-tiddly, as Zunctweed says. Doing nothing, day by day.

Do you know what it’s like to have dropped out of life? To have had a hundred chances to be special, but you avoided them all? Or just botched them up because you were a horrid coward, afraid of letting yourself change. You clutch your comfortable excuses, saying, Someday I’ll be brave, it won’t take a lot, just give me one more chance and this time I’ll grab it. But chances come and go. It would be easy to do something, but you don’t. You just don’t. Do you know what that’s like?…

Maybe it’s time. This time it’s time. To see if I’m somebody, or just a middle-aged slut who lies to herself about being gifted.

James Alan Gardner, Trapped

I have one singular bad habit. I procrastinate. It’s an old bad habit, and perhaps more insidious than a simple bad habit, it’s a habit borne of self-defense.

If I don’t lose weight, people will be forced to deal with my brain and not my body, and then the horrors of my early teens won’t be repeated.

If I don’t achieve what I can if I actually make an effort, people won’t then come to expect greatness from me. More importantly, they won’t be disappointed in me, and I’ll never again let anyone down. There is safety in mediocrity and being average, and I am as average and mediocre as I can stand to be.

But it’s not who I want to be, who I dream of being. And I am guilty of the above quote, of thinking that if I just had another chance, if I could just have that moment to prove myself and shine, I would shine. Oh, not shine the way you see me shine, but shine the way I know I can shine.

I would be brilliant. I would be breathtaking and brilliant.

In order to do that, though, I have to stop being afraid. Of consequences, of what will be, of what people will see. Of risk and failure.

The only way to be great is to work hard and take risks, and procrastinating protects me from both. And so I am safe, sheltered, bored and unhappy.

I took risks, once. The last one I took was four years ago, and it blew up in my face. It took me a long time, but I started taking tiny risks again, here and there. Getting in front of a class. Teaching. Applying for scholarships, grants, funds. Each time, I’ve done it, achieved what I set out for, and every single time, I’ve looked for the damned bomb that was going to blow up and ruin all the risk-taking and show everyone not for the fraud I am, but for the fractured, scared soul I am.

I thought graduate school was going to be that bomb. I thought I had finally found my Achillies heel, the thing that was going to neutralize all the risk. And at the seemingly last moment, even that proved untrue.

Which in some ways might be ironic, since now it leads all the potential for explosive failure back to my feet. Not that I failed to win or achieve, but that I will fail to do.

I’m scared of a lot of things. But it’s finally reached thet point where I’m more afraid of not doing anything than I am afraid of failing.

I’m tired of shooting myself in the foot. I’m tired of failing to live up to expectations at the last moment because it’s safer, and I’m disgusted with making excuses for the failure.

It’s time. Not to show you that these visions I have of myself are true, but to show myself.

The Daily – Toward Insuring Immigrants

...and everything else, 2006, Academics, Spring 06, The Daily

Toward insuring immigrants
2006-05-01

The older Asian woman tugs insistently at the young blonde doctor’s coat, pulling her out into the pouring rain, talking in a foreign tongue.

The doctor, a new intern, is confused but following. What she finds shocks her: a young woman by the dumpster, face lacerated and in need of stitches.

The intern tries to convince the young woman to come inside, but in broken English she refuses. She’s afraid. She’s an illegal, as is her mother. There was an accident in the factory, could she please be stitched up?

Time slows and the intern faces her options. Just as fast, time snaps back into place and the intern slowly moves around the hospital, gathering the supplies she’ll need to stitch the laceration in the parking lot.

She gets the young woman, now her patient, to promise she’ll come back to have the stitches removed. The woman promises and disappears. She never comes back.

Chances are good that if you’re a fan of the television show Grey’s Anatomy, this scene is familiar to you. After all, it played out during a first-season episode, with Dr. Izzy Stevens as the young intern treating the illegal Asian immigrant.

Chances are also good that you’re aware that there is a large immigration rally this Monday afternoon.

Smell a coincidence? I didn’t think so.

Immigration — legal and illegal — is a contentious issue in our country. So it only made sense to talk about the issue of illegal immigrants and the strain placed on our medical system.

To be very clear on my position, I support immigration.

I think it should be easier to immigrate to this country. I think that if people honestly believe that if those farm and sweatshop workers just weren’t there Americans would step up and harvest those berries in the burning sun or spend hours a day over a sewing machine for low, low wages, they are, in a word, delusional.

No offense.

Illegal immigration does more than impact the theoretical jobs available for Americans (legal immigrants or those born here).

It seriously impacts our hospitals, in two ways.

First, I suspect we have all been in the situation where we’re in the ER because we’ve been sick, or injured; perhaps you were kicked across the room during a slightly rowdy party, breaking your wrist.

But I digress. You sit in that waiting room, and you wait. Depending on what’s wrong, you wait.

Depending on the time of the day, and where you’re located, if you’re a non-emergency case, you can wait for quite a long time.

As many before me have pointed out, waiting often happens because people who don’t have insurance are using the ER as a place to receive basic medical care.

Any hospital in the United States that receives funding from Medicaid is required to treat any patient who appears in the ER.

What this means, practically speaking, is that anyone without insurance tends to end up in the ER to have non-emergency issues treated.

That person’s lack of payment is ultimately passed on to those who can pay. This is the second significant impact illegal immigrants have on our hospitals.

I don’t think this translates into throwing all the illegal immigrants out, locking down the country and building giant walls, and not just because it’s not terribly practical.

What I think this means, at least from a big and cuddly humanist point of view, is that we need to fix the system so illegal immigrants can pay into insurance policies and, even more importantly, not be afraid of accurately reporting address and other information to the hospital itself.

It might be woefully idealistic, but I believe that if we remove the fear of deportation, illegal immigrants will be more inclined toward providing accurate information and working with the hospital to cover medical costs.

The Daily – Pharmacists’ moral acumen

...and everything else, Academics, Spring 06, The Daily

Pharmacists’ moral acumen
2006-04-24

One of the more interesting and underrepresented facts about many women’s health providers — places that are routinely targeted because they provide low- or no-cost birth control for women, as well as access to abortions — is that they often offer other health services, such as flu shots and general health exams.

Sometimes, antibiotics are prescribed.

Most of these clinics don’t have on-site pharmacies, so it is up to the patient to go elsewhere to have the prescription filled.

Or, as was the case with a patient from the Cedar Rivers Clinic, which has facilities in Renton, Tacoma and Yakima, Wash., the prescription is called into a pharmacy for pickup.

Unfortunately, in May 2005, a pharmacist at the Swedish Medical Center outpatient pharmacy took it upon him or herself to decide it was morally unacceptable to receive antibiotics from a clinic that provides access to birth control and abortion, and refused to fill the prescription.

That’s right. A pharmacy refused to fill a prescription based on who prescribed it.

“Well maybe,” you try to rationalize to yourself, “the pharmacist believed that it was an abortion-related complication and they felt complicit?” Ignoring the logic behind that, which basically says that someone deserves an infection, let’s move to another example.

At a Safeway in Yakima, Wash., a pharmacist refused to fill pregnancy-related vitamins for a pregnant woman who was receiving healthcare from Cedar River Clinic. This is a woman who was making an active effort to have a healthy pregnancy.

The Safeway pharmacist reportedly repeatedly quizzed the woman why she needed the pills (seems obvious to you and me, eh?), and then launched into why she was going there.

There.

As if the woman should be castigated for receiving healthcare for her pregnancy.

My friends know that I often play devil’s advocate for pharmacists who decline filling Plan B or chemical abortificant prescriptions on moral grounds.

My reasoning for this is that in some ways you can argue that the filling of these prescriptions does directly force the pharmacist to participate in the providing of a service they morally oppose — what they view, rightly or otherwise, to be abortions.

We do not force doctors to perform abortions on women who want them, and I think it’s reasonable to extend this logic to pharmacists.

But these pharmacy moral-police are overstepping their boundaries when they begin denying prescriptions based on who writes them.

If a pharmacist decides he or she has the moral acumen to decide if someone should or should not have access to antibiotics, what’s next?

Denying someone their AIDS cocktail?

Refusing to fill someone’s prescription for methadone, since maybe they’re lying about having chronic pain and they’re really a heroin user in recovery?

Maybe these morally righteous pharmacists will determine that you shouldn’t have access to any “Class II drugs,” or that you’ll need to provide documentation of your illness before they release the prescription to you.

The potential nightmares can be spun out for a while.

Thankfully, the Washington State Pharmacy Board realizes the potential for abuse, while also recognizing the right of the pharmacist to conscientiously object to some prescriptions, such as Plan B.

Late last week, the board released its first draft of a new rule outlining a pharmacist’s right to refuse prescriptions.

While the exact wording of the rule remains uncertain as it undergoes further revision, so far the indications have been pretty clear: Pharmacists have the right to a conscientious clause only so long as there is another pharmacist on site or closely nearby who can fill the contested prescription.

Which is how it should be. Pharmacists dispense medicine, they don’t practice it.