I seldom go to bed hungry or cold, oh I’ve done it voluntarily, camping in the Rockies or trekking in the Himalayas. It’s not so bad if you know it’s not going to be your whole life and you have no choice. In fact it’s kind of spiritual this chosen temporary denial of comfort. I’ve wondered about why we humans flagellate by choice, why, if at all, that propensity makes us more evolutionarily successful. It’s not a hard call, the ability to survive through some tough times without giving up is indeed a survival of the fittest strategy and hence we presume hard wired within us.

But for those who have no choice, for those without resources to come into comfort, to take charge of their lives and who go to bed hungry and cold, I feel a grief. There are those that have little comfort by no choice of their own, who are hungry and cold by no particular fault of their own, but by fault of a society not yet perfected to do no harm.

(“Cocaine Bill and Morphine Sue, strolling down the Avenue Two by Two…” An old folk blues song; they die and are buried together, the moral is don’t do that shit; just for fun that is.

Morphine continues to be the drug of choice for the most intractable forms of pain, particularly terminal cancer and post surgical. Morphine is an extract of the dried milky exudate of the unripe seed capsule of the opium poppy. It was first isolated by the German chemist  F.W.A. Sertürner in 1806. Owing to its power to reduce the level of physical distress, morphine is among the most important compounds used in the treatment of cancer pain and other cases where other analgesics have failed.

In the 19th century morphine was widely used to treat everything from menstrual cramps to epilepsy and was even referred to by the turn of the century physician Sir William Osler as “god’s own medicine” and by early 20th century American Hematologist Francis W. Peabody as “the gift of God.”

It also has a calming effect that protects the system against exhaustion in the case of traumatic shock, internal hemorrhage, congestive heart failure, or other debilitating conditions. And besides all this, it’s a surprisingly pleasant and dreamy hallucinogenic, which probably explains about Sue.)

It’s not so hard to see the similarities between nurses and teachers. You are ill or inexperienced and not what you could be, and I, nurse or teacher, have the skills to help you become what you could be. Nurses seek to teach the ill how to return to normal, teachers seek to induct the novice into normalcy. By normalcy I mean that vast expanse of the bell curve that is not extreme, where extreme is a totally cultural moving target. What do we accept, what do we include, what do we exclude, what do we punish?

My own experience has led me to contact with community organizing, the idea that those with discomfort need to band together to build the kind of power that perfects society towards the Do No Harm ideal.

(My experiments with the drug have entirely been under the supervision of skilled surgeons, and honesty forces me to report that there are good trips and bad to be had in this fashion.

Much of the technological behind today’s surgical practices is around anesthetics; the ability to maintain a surgical state for long periods of time, and still return the patient to life at the end. It’s chemistry, drugs, monitoring in real time, and the capacities for massive interventions as crisis approaches that allow the surgeon the time to do incredibly long and detailed operations. The net result of this is a) long periods or anesthesia, and b) severe operations that have a great deal of post-operative pain. This is where mister morphine comes in; post operative pain in a body already subjected to an extraordinary long anesthesia.)

The status quo of those with comfort, and some fear that they might lose some if those with discomfort gain some, tend to have the power to maintain their comfort. Thus those in discomfort must build a power in contest.

(The patient comes out of the operating room having been maintained at vital levels simply just next to death, and severely compromised by whatever went on with the knife. They go into intensive care rather than recovery room, because that is indeed appropriate. Post operative pain control is now often PAC, patient applied dosage of morphine through a machine which lets the patient press a button when they want a hit, but the machine has had limits set by the physician to avoid overdosing. Experience has shown that this technique tends to result in lower overall use of the drug, apparently because the feeling of “control” by the patient leads to higher pain thresholds.

When the patient comes out of intensive care the major medical issue is simply getting them functioning throughout again. The kidneys are asleep, the colon is asleep and has forgotten how to do peristalsis, the legs have forgotten how to demand a fair share of blood. The anesthetist  has literally kept the heart, lungs, and brain functioning; everything else may take days to regain function.)

The nurse returns the patient to his power, the teacher empowers the students with knowledge, skills and social practice, the community organizer empowers a community, a group with commonalities, to make their external reality, their social and physical environment, more comfortable for them.

(As I listen to the patients scream, as they do, the floor nurses swarm towards the emergency, it is about recovering from the anesthetic and the morphine, not the surgery itself.)

Comfort is not a zero sum game, there’s enough if we organize, but it is played as a zero sum game; you can only gain some if I lose some.

(My time in the intensive care unit went poorly. I remember Bob giving me some instructions on how the morphine machine was programmed, I couldn’t really hear, he said either 20 mg, 20 ml, or 20 minutes, and left me with the button in my hand. Dosage is mg per minute, and it was clear to me, barely conscious, that I needed to pay attention to the clock to figure out this morphine machine; how were the limits set, by the mg or by the clock? The only way to tell was to administer shots and pay attention to the clock; which shots worked, which didn’t and so on. It seemed a calculation both necessary and possible.

There was a clock directly in front of me on the wall, and Bob I could see out of the corner of my eye, seemingly glued to his computer screen. My job was to press the button, watch the clock, and analyze the results. What happened was the clock stopped. The little vibrator things wrapped around my legs to maintain circulation would come on and off, I knew time must be passing, but the clock was stopped.)

Another side of survival is community, cooperation, being more powerful as individuals because we have built and belong to a culture, a society that provides support and comforts to those who belong. And here we find those who labor to nurture the whole as composed of the individuals.

(Check the time, push the button, as soon as I returned from the drowsy dreamy state, check the clock again, and it hadn’t hardly moved at all. Each minute lasted hours, each hour days … The clock turned the color of egg yolk and stayed that way. At about 4 am, some 12 or 13 hours into this trip, I decided that getting that clock to move was more important than anything, and that the button, the morphine, is the cause of the clock problem; the button is abandoned.)

Nurses leave no one left behind, teachers offer hope that differentiation, mediation, imagination and delayed gratification have a positive payoff, and community organizers know that unless we all pull together we’ll leave some folks behind, and one of them, I’m afraid, could be me.

(I remember that it was painful for the next 3 hours, I remember the location of the pain, right between the shoulder blades, but I do not remember the pain itself. At about 7 am.⎯shift change, doctor’s rounds?⎯things actively move forward towards getting me out of intensive care which takes about another 5 hours and includes a transition to Vicodin.

While this has not been a nice trip, the net result has been very little morphine with the result that bowels, kidney, stomach, et.al. are almost immediately in working order, and we depart the hospital less than 24 hours after leaving intensive care, which was good.

A consequence seems to have been sleeplessness; there was no sleep Monday, the night of the surgery, that time was spent watching that orange clock. There was no sleep Tuesday or Wednesday either. Wednesday night was my last Vicodin. By bedtime Thursday it made sense to pay serious attention to this sleep thing. I was not tired, not sleepy, but the intellect suggested that this is not normal and should be dealt with by a solitary Halcyon which had been stashed since 1992.

Sleep comes, but within and hour and a half I wake up with wild, confused, chaotic dreams that appear to deliver a message that, at that time, I find very clear; I am in a deeply psychotic state and if I can’t get a grip, can’t get to sleep, then its 911 and off to the loony bin. This realization, and the fear, induce great concentration and focus, which a few hours later leads to 2 hours of sleep, and that’s the end of it, the end of the trip.)

As far as I’m concerned, the quality of thinking in organizations is very, very strongly influenced by the quality of relationships. People as individuals do not create anything. Creation, or bringing some thing new into being, is always a product of human communities.

(Patti, Richard, and Deborah had been there at the hospital and I spent time checking my memory of events with their observations, and there was consistency; so I think I have this story straight now. None of the above found my behavior to be too unusual; if they had any comment it was that I was generally polite and gentle.

By these accounts, I was on a 4 ½ day weirdness inside my mind; the outside world, the involved observers, let me out of the hospital days early and declares me polite and gentle. How weird does it have to get before I get weird?)

The real appreciation of the other, and the appreciation of the quality of our relationship:
I would say the closest and simplest word that comes to mind is love.

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