Crisis – Diagnosis Alcoholic Cirrhosis

Bozeman Deaconess Hospital
July 25th, 2009

The limp body father and son carried a couple days earlier, an arm over each of their shoulders, was jaundiced, and helpless. They were headed for Doctor Patterson’s office hastily not certain what was wrong with their load. It would only take him a moment to recognize the signs and call the emergency room. A few hours earlier the father had broken into his youngest son’s apartment to find him confused and disoriented soaked in sweat and droplets of blood.

I had been diagnosed with end-stage liver disease. I was forced to close my little bookstore I lived above. I was lying in the intensive care unit as I had almost bled out from ruptured esophageal varices, abnormal, enlarged veins in the lower part of the esophagus. My parents were moving my possessions from my apartment into storage, I was moving back in with them unable to care for myself. I was an alcoholic who had brought this on myself. I was at ground zero, I had bottomed out, my life was in shambles and I was clinging to the unknown, the long road ahead of me through liver transplant and back to life. I had screwed up, screwed up big this time. I don’t make small mistakes, I make grandiose ones. I don’t screw up my life in subtle ways, I go over the top. I hadn’t really been living for sometime, merely existing, languishing too afraid to live, too afraid to die. My parent’s worried faces were burnt into my brain as they looked down on my body love in their eyes, tubes pouring out of me to the ticking, clicking, beeping monitors that kept me alive. The doctors had poured seven units of blood into my body in an effort to save my life, with three more to come in the next few days. It’d worked. Beyond all reason, I was ready to fight!

I had known for sometime I was slowly killing myself with each drink, I was unhappy, severely clinically depressed, ready to die. I had begun passing blood two days before my thirty-seventh birthday. My stool was black, grainy, appearing like coffee grounds. I googled the symptoms. Word for word there it was on the computer screen, I was passing blood. Get yourself to the emergency room immediately. There was no grey area in the instructions. I poured myself another pint sized vodka tonic, heavy on the cheap vodka, Kamchatka. The tonic water just enough to give the hint of effervescence. I was sitting in the dark at my desk in the bookstore a half empty bottle of Jameson Irish whiskey on the desk, my vodka tonic in hand, and the computer screen screaming liver failure, alcoholic cirrhosis. I didn’t care, perhaps this would be it. I’d lie my head on the pillow and never wake, an end I was anticipating, even welcoming.

This tightrope, this cliff, this edge was the precipice where I seemed to live. The only people who truly know this precipice are those that have gone to excess. I had fallen. This was it, this is where I’d been headed for a few years. I wasn’t the heaviest drinker I knew, far from it in fact. There was Taylor who infamously in my circle of friends routinely completed the Jäger challenge. I’d watch with some perverse fascination as he’d slam down an entire pint glass of Jagermeister in one swallow. It was impressive on some level. There was Frank who was twenty years my senior and would drink pint glasses of whiskey sours with maybe a shot of sour mix. I would sit with him while he drank four, five, six or more of these in an evening, every evening. I was always the quiet one at the end of the bar, a classic novel perhaps Hemingway or Tolstoy in front of me, sipping my vodka tonic and a rocks glass of Jameson Irish Whiskey. I used to be a beer drinker, but that had changed somewhere along the way. I had built up a tolerance and needed something stronger, faster, cheaper.

I knew I had lost control about a year and a half earlier. Up until then I never drank at home, I never drank alone. Now my alarm went off in the morning and I’d pour myself a shot of Jameson and drink it down before I sat up in bed. How had I gotten to this point? The negative self talk had gotten worse, much worse. I’d wake each morning tremors wracking my hands as I needed my fix. A shot of whiskey and my hands calmed down, not steady but functional. I’d head downstairs to open my store. I’d pour myself a vodka tonic I kept in the dorm fridge behind my desk. My store that had once been doing pretty well, now the recession, a new public library, recently opened Barnes & Noble and Borders Books all cutting into the bottom line. I had poured myself into my little store and somehow I’d turn it around I endlessly told myself. I couldn’t fail at this, it’s all I had. I wasn’t ready to admit failure, not if I could help it, I’d rather die first.

Something had transpired between those last days of drinking and waking up in intensive care gazing into my parent’s eyes. It was utterly simple, for the first time I could recall in several years I wanted to live. I’m not sure at first if I wanted to live for them or myself, but unmistakably my thirst for life had returned. I had long known I needed a therapist, a psychiatrist. I desperately needed help. It had come on slow and suddenly at the same time. I guess that’s how mental illness works. It was hard to recall when I hadn’t been depressed. I was barely a teenager when I first noticed the hole growing inside me, something empty. It was small at the time, faint and lacking the substance it would develop in later years as I fed it with each cocktail. I’d learn to nurture and focus on the emptiness I felt so acutely. Did I really have it all that bad though, so many had it worse. After all I had a loving family, my own business, friends, and vodka. I’d just feed the growing hole another drink, ignore it, block it out. It was a sign of weakness to seek professional help for your problems, I could handle it myself, I’d simply pull up my bootstraps and carry on.

They say what doesn’t kill us makes us stronger. You are only given what you can handle. The cliches are endless and infuriating, but sometimes on target. I had the most difficult fight of my life directly ahead of me. I was being held together by tubes and wires, the intensive care nurse checking on me every few minutes to take my vitals. I had no idea what I had been through the last few days as I lie there fading in and out of consciousness. No recollection of what I’d put my parents through as they prayed that I’d survive. I could read the worry in their faces as the doctor asked me questions. “Do you know the date? Do you know where you are? Do you know who these people are?” I could only imagine he’d asked me these questions before and I hadn’t known the answer. Guilt was already swelling inside me, but there was a more acute emotion dominating shame. Admitting to my Alcoholism was only the final confirmation of how weak I truly felt. My natural reaction was to pour myself another shot of Jameson and bury these feelings, but that wasn’t available to me here. Instead when the doctor asked how much pain I was in, I responded with a ten. In minutes a shot of morphine was administered and I faded into sweet numbness these negative thoughts would be there when I woke. The running was over, I’d make my stand.

Top 5 Types of Distorted Thinking

1. All or Nothing / Black and White / Polarized Thinking – thinking you’re good or bad, smart or dumb. Seeing a person as perfect or completely flawed. Not seeing the shades of gray of life, the middle ground.
2. Overgeneralization – When something goes wrong you assume everything will go wrong. Someone breaks up with you and you assume nobody will like you.
3. Focusing on  the Negative – You focus on the negative and you ignore the positive. You get 2 A’s, 2 B’s, and a D. Instead of focusing on the positives out obsess on the D.
4. Jumping to Conclusions / Mind Reading / Fortune Telling – You assume the worst. You think you can read minds. People are laughing and you assume it is about you.
5. Catastrophizing – You magnify the negative. You decide a small setback is a major catastrophe. You magnify your faults and ignore your achievements.

Organ Donation: Time For An Opt Out System

On July 23rd, 2009 I was diagnosed with end stage liver disease and alcoholic cirrhosis. My journey would take me through being hospitalized every twenty-one days due to complications up until the day of my liver transplant September 16th, 2011. In that time I would relocate to Jacksonville, Florida to become a patient at The Mayo Clinic. I would be actively listed for transplant for just under eleven months. As of this writing there are approximately 120,000 people on the active organ waiting list and countless others needing to be added to that list. Another person is added to the waiting list every ten minutes, with twenty-two people dying each day waiting for an organ. This is in large part due to education of the need for organ donors and a lack of financial funding to have sign up drives.

There is an easy solution that will save the lives of thousands of Americans each year, an opt out system. Currently you have to register with your state if you want to be an organ donor. This is commonly done at the DMV when you are signing up for or renewing your drivers license. In far too many instances this option is not even brought up. This opt in system we currently use is failing this country and the need for more donors becomes more and more dire. I propose congress vote in a opt out system where everyone is automatically an organ donor unless they choose to opt out of the system for whatever reasons they have.

I’m sure you have some concerns and questions to this proposal. Is there a religious exemption? All major religions accept organ donation as a final gesture of compassion and generosity. If you however have a moral or religious objection you can simply opt out of the program. There is no cost to the donor family. There is a fear out there if you’re a donor your care in an emergency will be substandard. Your life always comes first. Only when you suffer irreversible loss of brain function are you considered clinically dead and a organ donation is possible. For those concerned an open casket funeral is still possible after you donate your organs.

If you donate your organs you could save up to eight lives, you could restore sight to two people, and your tissue could heal the lives of fifty people. In different regions of the country the level of illness you must be at are disparate and disproportional. California and the north-east are in dire need of donors. More and more people are flocking to Florida and hospitals such as The Mayo Clinic due to a larger availability of organs due largely to the procurement organizations education of students and adults alike. The time is now for an opt out system and saving countless lives in the process. I ask you to write your congressman and demand an opt out system of organ donation in this country. This is the moral, right, and sane way to save thousands of American lives every year.

Evolutionary Ethics

The following is an excerpt from upcoming memoir…

 

I find myself back in intensive care today having rushed to the ER throwing up blood. I have an endoscopy scheduled to see if they can find the bleed. I haven’t been here in Jacksonville long, but I have every faith that Mayo will discover what is wrong with me. There are a lot of medical questions I should be dominated with, but I’ll either survive this hospital stay or I won’t. There is nothing I can do about it so I am very calm. Instead my mind in preoccupied with morality. I just finished reading The Moral Landscape by Sam Harris and the questions he posits is morality defined and developed by religion or by science and specifically evolution is consuming me. It’s an interesting question and while he is firmly on the side of science, so many of my friends and family would argue the opposing point of view.

I’ve been on a religious search for meaning most of my adult life having tried on Christianity, Judaism, and finally Buddhism. Buddhist thought has carried a lot of weight with me for several years as I have an uneven practice. I will meditate and study for months on end and then nothing for a few months. As I lie here in the ICU though the desire to be able to pray to a loving God beseeches me. I can understand the comfort Christians receive
from such practices. The questions though with Christianity are too many and complex for me to find comfort. I’ve read the bible cover to cover three times, the first time back in college and the doctrine in not foreign to me in the least. The quote by an unattributed author keeps ringing in my head of the difference between philosophy and religion, “Philosophy is questions that may never be answered. Religion is answers that may never be questioned.”

Epicurus was an Ancient Greek philosopher who lived from 341–270 BC. He taught that pleasure and pain are measures of what is good and evil; death is the end of both body and soul and should therefore not be feared; the gods neither reward nor punish humans; the universe is infinite and eternal; and events in the world are ultimately based on the motions and interactions of atoms moving in empty space. Most of his writings have been lost, but among those saved was this question, “Is God willing to prevent evil, but not able? Then he is not omnipotent. Is he able, but not willing? Then he is malevolent. Is he both able and willing? Then whence cometh evil? Is he neither able nor willing? Then why call him God?”

Is there a universal morality which governs all of humanity upon which judgement can be placed as opposed to the predominantly liberal idea of cultural moral relativity? I argue yes and it is not tied to any religion, as a matter of fact religion confounds the matter and it is only through science and evolutionary theory that one might comprehend the overreaching standard of morality and how liberals, as well as conservatives, complicate this problem by allowing moral relativity to flourish. The desire not to judge other cultures and be a victim of ethnocentrism has taken on a life of its own in this politically correct world. This belief that there is no higher moral authority due to the fact that there are multiple faiths and each of those adherents believe they are living a moral life or promises of happiness and bliss in the next life. In Western culture for instance it is easy to judge Islam and their subjugation of women, gays, and infidels based on Judeo-Christian doctrine. I shall argue that it is a moral imperative to vanquish fundamentalism in all religions.

First to understand this argument there requires some understanding of some working definitions via the Oxford dictionary. Morality, principles concerning the distinction between right and wrong or good and bad behavior. Ethics, Moral principles that govern a person’s behavior or the conducting of an activity. Welfare, The health, happiness, and fortunes of a person or group. The absolute morality I am arguing is based upon the idea of that which increases the general welfare of humanity, or more simply for the greater good of society, as a whole is a moral framework. This is a human morality and not one simply for one ethnic, religious, or cultural group. You could argue for instance that slavery did indeed increase the welfare of the ancient Romans, but by all modern evaluations this is not seen as moral. For those of the Judeo-Christian faith for instance find the Old Testament of the bible is ripe with examples of God not only condoning, but embracing slavery. If God is indeed omnipotent and omniscient his condoning of slavery should be just as moral today as it was when the bible was first written. There are very few however who would argue that slavery is ethically right in this modern day.

Fundamentalists of virtually all faiths view their religious texts as the literal words of God. The prevalence of young earth creationists in Western civilization who believe the world is only approximately 6,000 years old is an example of this despite the overwhelming evidence to the contrary. The rallying cry of this demographic seems to be, “I’m not a scientist. Science and evolution is only a possible theory.” This issue stems from the ignorance of understanding the difference between the concept of a scientific theory and the common use of the word theory. According to a Gallup poll in 2014, 4 in 10 Americans believe God created the world within the last 10,000 years. Approximately 50% of Americans believe in evolution over millions of years, with the vast majority believing God guided this process. Only 19% of Americans believe in a non-God guided natural selection view of evolution. Of course this is at odds with scientific consensus which dictates the humans or those of Homo genus emerged of earth some 2.5 million years ago. When I refer to evolution I will be referring to the unguided naturalistic theory of evolution.

The forced subjugation of women in Islam and requiring them to wear a burqa by Western standards is seen as immoral. The cultural apologists will argue that you can not judge one culture by your own standards. I agree with this up to a point, you can not ethically judge Islamic law based upon your Judeo-Christian standards as intrinsically they are all flawed as morality has changed in the past thousands of years since biblical law was written. If you can not apply religious standards to morality to determine an absolute it is obvious the morality is a relative concept based upon the culture? No. Through evolution, adaptation and science we can answer some of these questions about what is ethically permissible in a modern society and world at this moment in our evolutionary journey. Can we through evolutionary theory determine an exact moral code? No of course not, but we can theorize where our collective morality is headed. An example of this is the instance of slavery and racism in the United States. It is hard for anyone to reasonably argue that we haven’t morally evolved through the dismemberment of a slave based society, through lynchings in the not too distant past, to where we currently stand in the civil rights movement. Is this to say there is no racism? Of course not, but a great amount of progress has been made in the last one hundred and fifty years or so.

How can we derive our ethics from religion when the major religions of Judaism, Christianity and Islam condone and embrace such concepts we find morally abhorrent such as slavery, severe punishment or death of an adulteress, forced marriage of a rape victim, misogyny, homophobia, genocide, etc. Is the golden rule moral because of an ancient text or do we recognize it as moral because we brought that belief with us to the reading of the bible? I argue the later. The golden rule or the ethic of reciprocity is found cross-culturally in virtually every religion from ancient Egypt, Judaism, Islam, Buddhism, Hinduism, etc. The ethic of reciprocity can not be argued stems from a Judeo-Christian worldview or even that it was borrowed from Ancient Egypt since there are unaffiliated cultures which predate Judaism in this belief. My argument is that it is basic human nature or in another words the result of thousands of years of adaptation and evolution.

I realize this belief is bound to be met with fierce opposition, but this is my personal philosophy shared by others such as Sam Harris, Richard Dawkins, and many scientists, but far from all of them. A new philosophical worldview is always met with fierce opposition, such is this case. Examples of morality derived through evolution and adaptation is ripe throughout the animal world. An example of this is monkeys will starve themselves to prevent their cage mates from receiving painful shocks. JH Masserman reported such adaptation in 1964, (Masserman JH. Wechkin S, and Terris W. 1964. “Altruistic” behavior in rhesus monkeys. American Journal of Psychiatry 121: 584-585.), “In one experiment, 15 rhesus monkeys were trained to get food by pulling chains. Monkeys quickly learned that one chain delivered twice as much food than the other. But then the rules changed. If a monkey pulled the chain associated with the bigger reward, another “bystander” monkey received an electric shock. After seeing their conspecific get a shock, 10 of the monkeys switched their preferences to the chain associated with the lesser food reward. Two other monkeys stopped pulling either chain—preferring to starve rather than see another monkey in pain.” This study is far from the only example: mice show greater distress at the suffering of familiar mice than unfamiliar ones, and chimpanzees have a demonstrable sense of fairness when receiving food rewards.

Sam Harris argued when faced with this philosophical as well as scientific point of view scientific ignorance is ripe and intervenes, “There is an epidemic of scientific ignorance in the United States. This isn’t surprising, as very few scientific truths are self-evident, and many are deeply counterintuitive. It is by no means obvious that empty space has structure or that we share a common ancestor with both the housefly and the banana. It can be difficult to think like a scientist (even, we have begun to see, if one is a scientist). But it would seem that few things make thinking like a scientist more difficult than religion.” (The Moral Landscape, p. 176). If we examine this from a Judeo-Christian perspective we are faced many inconsistencies that require answers. It is not my role here to argue whether religious faith is faulty or not, that is between you and what you believe in. It is my belief that morality is defined independent of any particular religion through evolution and adaptation.

Poetic Forms I Employ

There are a multitude of poetic forms that gave been used through the ages from a Shakespearian Sonnet to a Haiku to my favorite a Sestina. Definitions provided here adapted from poetryfoundation.org website. Here are a few of the ones I employ on a regular basis:

Ballad – A popular narrative song passed down orally. In the English tradition, it usually follows a form of rhymed (abcb) quatrains alternating four-stress and three-stress lines. Folk (or traditional) ballads are anonymous and recount tragic, comic, or heroic stories with emphasis on a central dramatic event; examples include “Barbara Allen” and “John Henry.” Beginning in the Renaissance, poets have adapted the conventions of the folk ballad for their own original compositions. Examples of this “literary” ballad form include John Keats’s “La Belle Dame sans Merci,” Thomas Hardy’s “During Wind and Rain,” and Edgar Allan Poe’s “Annabel Lee.”

Ballade – An Old French verse form that usually consists of three eight-line stanzas and a four-line envoy, with a rhyme scheme of ababbcbc bcbc. The last line of the first stanza is repeated at the end of subsequent stanzas and the envoy. An example is Hilaire Belloc’s “Ballade of Modest Confession”.

Free Verse – Nonmetrical, nonrhyming lines that closely follow the natural rhythms of speech. A regular pattern of sound or rhythm may emerge in free-verse lines, but the poet does not adhere to a metrical plan in their composition. Matthew Arnold and Walt Whitman explored the possibilities of nonmetrical poetry in the 19th century. Since the early 20th century, the majority of published lyric poetry has been written in free verse. Examples include the work of William Carlos Williams, T.S. Eliot, Ezra Pound, and H.D.

Haiku – A Japanese verse form of three unrhyming lines in five, seven, and five syllables. It creates a single, memorable image. The Imagist poets of the early 20th century, including Ezra Pound and H.D., showed appreciation for the form’s linguistic and sensory economy; Pound’s “In a Station of the Metro” embodies the spirit of haiku.

Limerick – A fixed light-verse form of five generally anapestic lines rhyming AABBA. Edward Lear, who popularized the form, fused the third and fourth lines into a single line with internal rhyme. Limericks are traditionally bawdy or just irreveren. Examples include “A Young Lady of Lynn” or Lear’s “There was an Old Man with a Beard.”

Sestina – A complex French verse form, usually unrhymed, consisting of six stanzas of six lines each and a three-line envoy. The end words of the first stanza are repeated in a different order as end words in each of the subsequent five stanzas; the closing envoy contains all six words, two per line, placed in the middle and at the end of the three lines. The patterns of word repetition are as follows, with each number representing the final word of a line, and each row of numbers representing a stanza:

1 2 3 4 5 6
6 1 5 2 4 3
3 6 4 1 2 5
5 3 2 6 1 4
4 5 1 3 6 2
2 4 6 5 3 1
(6 2) (1 4) (5 3)

Sonnet – A 14-line poem with a variable rhyme scheme originating in Italy and brought to England by Sir Thomas Wyatt and Henry Howard, earl of Surrey in the 16th century. Literally a “little song,” the sonnet traditionally reflects upon a single sentiment, with a clarification or “turn” of thought in its concluding lines.

Petrarchan sonnet, perfected by the Italian poet Petrarch, divides the 14 lines into two sections: an eight-line stanza (octave) rhyming ABBAABBA, and a six-line stanza (sestet) rhyming CDCDCD or CDEEDE. John Milton’s “When I Consider How my Light Is Spent” and Elizabeth Barrett Browning’s “How Do I Love Thee” employ this form.

Italian sonnet is an English variation on the traditional Petrarchan version. The octave’s rhyme scheme is preserved, but the sestet rhymes CDDCEE. Thomas Wyatt’s “Whoso List to Hunt, I Know Where Is an Hind” and John Donne’s “If Poisonous Minerals, and If That Tree.”

English (or Shakespearean) sonnet, which condenses the 14 lines into one stanza of three quatrains and a concluding couplet, with a rhyme scheme of ABABCDCDEFEFGG (though poets have frequently varied this scheme) George Herbert’s “Love (II),” Claude McKay’s “America,” and Molly Peacock’s “Altruism” are English sonnets.

Spenserian sonnet is a 14-line poem developed by Edmund Spenser in his Amoretti, that varies the English form by interlocking the three quatrains (ABAB BCBC CDCD EE).

Villanelle – A French verse form consisting of five three-line stanzas and a final quatrain, with the first and third lines of the first stanza repeating alternately in the following stanzas. These two refrain lines form the final couplet in the quatrain. Example “Do Not Go Gentle into That Good Night” by Dylan Thomas, Elizabeth Bishop’s “One Art,” and Edwin Arlington Robinson’s “The House on the Hill.”

The Summer Rain In Her Hair: A Sestina

The summer rain shines gently in your dark hair,
Droplets rest quietly upon your warm face,
A smile crosses my face, as you touch my hand,
I gaze long at you, becoming lost in your eyes,
I sit listening, while you tell me of your world,
I remain content, gazing at you, my love.

I think of the moment that I realized my love,
As you slowly run your hands through my hair,
I hope to introduce you to my world
I stand, looking straight at you face-to-face,
Brushing the hair away from your eyes,
A smile crosses my face, I wipe the sweat from my hand.

I still feel that same joy walking, when you hold my hand,
Acknowledging the fact you are still in love,
I notice the glimmer not lost from your eyes,
The one when you gave bathed, that remains in your hair,
It complements the tone of color in your face,
Which begs me to penetrate deep into your world.

I want nothing more than has been given in this world,
While I silently caress your sweet hand,
I notice the deep color of your face,
Knowing that I have not misplaced my heart’s love,
Learning each inch of your face and each hair,
But always returning to the life in your eyes.

The doorway to your heart rests open in those eyes,
I am an explorer of a whole new world,
Deeply in love with your stark dark hair,
As you return your grip on my hand,
I search my thoughts for my ideal love,
The image presented in my mind is your face.

The gloom filled night fades to reveal your dream-face,
Placing my heart deep in those eyes,
Smiling at you, my one and only true love,
Ending a day in the life of my world,
Wrapping my arms around you, holding your hand,
Placing my head at the edge of your hair.

I embrace those eyes, that are you my love,
Our thoughts converge, I run my hand through your hair,
A smile crosses my face, you are a part of my world.
~ Mark Bere Peterson

Memories of A Perfect Evening

We met on the steps of the Opera Bastille you and I,
I paused in admiration before you noticed me,
You were dressed all in black – sleek and willowy,
Our eyes met, a smile crossed your face with a blush,
My eyes transfixed upon you I felt strikingly underdressed,
I’d had a haircut, and my beard neatly trimmed,
I’d shopped all afternoon, dressed just how you liked,
I made my way up the stairs to meet your gazing eyes,
“You’re lovely,” I whispered with a quick kiss of your cheek,
You grow nervously flushed, nearly a dark Crimson,
I take your hands in my own giving them a tight squeeze,
Your lips part in silence as if you wish to say something,
Longingly you gaze into my eyes pulling me closer to you,
You wear the black leather choker I so adore,
Matched with your Victorian black lace gloves,
Your lips brush my own, I deeply inhale your breath,
“Come my dear you’re all mine tonight,” you deviously grin,
You take my right hand in yours’ leading me down the stairs,
Your nervous squeezes of my hand echo your excitement,
We wind through the crowds bustling outside the bars and clubs,
You pull me into a tiny club and down into the basement,
Winding your way to a reserved table in the corner,
You motion to a waitress placing our order,
I smile curious of the whole evening will be so orchestrated,
I hardly notice the waitress return as I gaze into your eyes,
“I’ve been planning this night all week,” you blush shyly,
Our lips meet in a more intimate embrace,
My heart races at the brush of your fingers over my knee.

~ Mark Bere Peterson (2011)