Monday, February 23, 2015

By Joan R. Shepherd, FNP

Several people completed opiate detoxes last week, and we even bumped some along more quickly so they could get back to their home states before the “Blizzard of 2015” kept them trapped in Richmond.

All my patients move me in some way, but I was particularly touched by a young man this week from the New England coast. He is a commercial fisher; young, strong, already his body bears the marks of a man who has one of the hardest physical jobs there is. He will probably always have some degree of physical pain because a regular part of his day job is pushing his physical body to extremes.

He told me that he’s never run his boat without being high. I was kind of stunned-even though I thought I stopped being surprised by drug stories a long time ago.

“Never?” I asked incredulously.
He dropped his head for a moment, then looking me in the eyes. “Never.”


He has pretty much convinced himself that without being on opiates, he can’t do this job. I understand from a physiologic perspective what he’s saying. When a person has been using opiates for as long as he has, his brain no longer manufactures dopamine. It’s kind of like, why bother? The brain can’t manufacture enough dopamine to compete with the overload of dopamine that comes from using opiates. When a person who has regularly been using opiates stops, his energy is going to plummet until the brain restores itself.

And that can take a long time.

But, the truth is, this guy—battered as he is—is young and strong and has an incredibly specialized skill. He’ll be able to pull off anything he needs to do, physically. His muscle mass isn’t going to deteriorate just because his dopamine is low, as long as keeps exercising those muscles.

It’s the self-defeating thoughts that are going to be his big problem.

I suggested he get a tattoo across his left forearm so whenever he’s about to do anything at all on that boat (or anywhere else for that matter) and his crazy thoughts start harassing him, he can read on his arm the same simple question Zen Master Rinzai asked to a room full of monks long ago:

What at this moment is lacking?

If our fisherman can be in the precious present moment, not dwelling on choices made in the past, or anticipating future suffering, he can bear anything. It’s a matter of putting one moment after the next, then the next, and the next. And being there for each one.

Everything any of us need is present for us in this moment.

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