DETERMINED To DO THE RIGHT THING

Suboxone works by tying up the opiate receptors in the body with little if any of the euphoria associated with narcotics. If you take a narcotic like OxyContin while you are also taking Suboxone you will not experience the typical “high”. In order to experience the euphoria you would have to stop taking Suboxone first in order to free up the narcotic receptors.

University of Pennsylvania Program participants have to submit to weekly blood and urine analysis in order to ensure that they are taking the Suboxone and not taking any narcotic analgesics. Evidently, there is a high noncompliance rate.

 Andrew was in this program for 3 years and never had an incidence of noncompliance and eventually was able to give up the Suboxone. Dr. W, the head of the program, saw Andrew for weekly psychotherapy talk sessions Dr. W said Andrew was remarkable for his determination to do the right thing and to get better.

SUBOXONE con't

Suboxone is a narcotic medication indicated for the treatment of opioid dependence, available only by prescription. It must be taken while under a doctor's care. Suboxone contains buprenorphine, an opioid medication. 

Buprenorphine is similar to other opioids such as morphine, codeine, and heroin however, it produces little or no euphoric ("high") effects and therefore may be easier to stop taking. It also contains Naloxone, which blocks the effects of opioids such as morphine, codeine, and heroin. 

When Suboxone is injected, naloxone will block the effects of buprenorphine and lead to withdrawal symptoms in a person with an opioid addiction. When administered under the tongue as directed, naloxone will not affect the actions of buprenorphine. 

SUBOXONE

John and I went with him to the first meeting at Penn several days later. Initially, Andrew spoke privately with the head of the program, a very kind and patient psychiatrist. Then the four of us met together. 

Dr. W explained the program to us thoroughly. Andrew would immediately have baseline blood work done. Then he would begin taking a drug called Suboxone.

UNIVERSITY OF PENNSYLVANIA

     When Andrew arrived home a few minutes later, John and I told him what we had found in the bank records. It was probably me doing most of the talking—it usually was. 
    Andrew said immediately—no beating around the bush, “It was me”. Fear, anxiety and anger crazed me. I demanded to know, “What the hell was going on?” 

     Andrew was very chagrinned but also very honest. He told us that he was sorry, but that he had to get the drug. We asked what drug and he told us about the OxyContin. He said it had made him feel so much better. 
     
     We asked him if he knew the dangers of addiction and he said, “Yes”. We told him that this was out of our control but that if he wanted to stay living with us he would have to figure this out immediately. 

     The amazing thing is that he did. Within 24 hours he had found, applied for and been accepted in the drug treatment program at University of Pennsylvania. 

THINGS ARE OUT OF CONTROL

     All of my children have always had access to my ATM card that I kept in my purse. They also knew my pin number. I would give them the card to run errands for me or to use it to get cash for me or for them. 

     John and I were down at his office computer that is set up in the basement. Andrew was not home. The girls were not living at home then. I believe this was spring of 2006.  I called Andrew and got him on his cell phone.. I told him we needed to talk to him immediately and he said he would come right home.

     I believe he knew why we wanted to talk to him. I thought he was sending us a red flag that said, “Help, things are out of control”.

We found out about Andrew self medicating with OxyContin when John noticed that I was making daily $500 withdrawals using my ATM card. He asked me about it and I told him that I had not made the withdrawals.

We called the bank to report it and were told that the only way those withdrawals could be made were with my ATM using my pin number. As I was talking on the phone with the bank, it occurred to me that it might be Andrew.

      I said as much to John. He said that the thought had also occurred to him.
 I was frightened and upset that it might be Andrew.

OXYCODONE

OxyContin (oxycodone) is a narcotic pain reliever similar to morphine. OxyContin helps to treat moderate to severe chronic pain, that is, pain expected to last for an extended period. 

OxyContin is for around-the-clock treatment of pain. It is highly addictive and abrupt discontinuation after a period of use can cause strong withdrawal symptoms.

 I do not know when Andrew started taking this drug. 

GREATEST RELIEF

     I am beginning to appreciate how important it was for Andrew to take control and try to manage his illness. When Andrew would go off his meds for a few days, it would take a while for the meds to clear his system. 
     During that time, where he still had some benefit from the meds but few of the side effects was when he felt the best. However, it was a very short window. 
     This may have also been true of his use of marijuana and prescription drugs. When he was taking them, he felt better; the after effects of marijuana were an intensification of irritability and delusions. 
     The prescription drug that he used to his greatest relief was OxyContin. 

TAKING CARE OF HIMSELF

       Andrew struggled to the end with the value of taking his meds versus other ways of taking care of himself, like eating healthy, working out, and self-medicating with the ever so much more socially acceptable marijuana or other street drugs. 

       The prescribed medicines he took had side effects--weight gain, depression, and sexual dysfunction to name a few

WHOSE JOB IS IT?

     Boy, oh, boy, in writing this I realize just how little I understood of what Andrew was dealing with day to day. Despite all that he was going through he rarely complained. 

     Andrew mostly wanted to try to deal with things as he saw fit. I think we tried to let him do that much of the time. I would go along with him. The anxiety always building in the background and then I would see from the weekly medicine case that he had not taken his meds for a day or two or three and I would lose it.

He hated taking those meds. He hated being “sick” and often said that he was not sick. I think this was the part that I didn’t understand. I didn’t understand how hard it was (read that impossible on some level) for Andrew to think of himself as sick or as needing medication. It was really unacceptable to him.

IS SUICIDE PREVENTABLE

Is suicide preventable? You recall my earlier mention of suicide as a preventable cause of death. Right after Andrew died, John and I started going to the local suicide survivor meetings. One thing that had a strong impact on me was the two widows who were at our first meeting.

Our leader had lost her husband ten years ago to death by hanging. She had come home to find him hanging in the doorway of their home.

 She said she had been unaware that anything was wrong. She said that she always knew her husband was a little quirky but had no idea that he was suicidal.

The other widow who had lost her husband two weeks before we met said that she had been caring for him as he suffered from bipolar disease. She said she did everything to make sure he was getting the treatment and medications as prescribed. Her husband called her at work to tell her he had stabbed himself. He was still alive when she got home to him. She had called 911 and got to her house as they were taking him away by ambulance.

She followed him to the hospital and was with him as he went into surgery. She begged him to be strong. He did not survive the surgery.

In listening to these two survivors talk about their different experiences of the time before their husbands’ suicide, it struck me that despite the ultra-interventionist vs. the unaware approach to their spouses’ illnesses the outcome was the same. For me this begs the question, “Just how preventable is suicide?”. 10/17/14 

SELF PROTECTION

Maybe we all do go through losses like his death alone on some level.  

For me the supportive presence of my neighbors,, my family and my friends allowed me to begin to stitch together a new framework for being that was different because Andrew had died. 

I did not really understand that he was dead and physically gone forever. I do not think I understand that now. In some way he is just away. My sister Kathy died last August and I feel the same about her.

 I was explaining this way of being with death to Marnie and she told me it was the same with her. She added that she felt it was her way of protecting herself from losses that were just too big. It was as if she was describing me exactly. 

NOT ALONE

Friends and family were bringing me things, food, pictures and anecdotes. 

They were writing me notes about Andrew—wonderful notes. 

They were holding my hand and telling me by their presence that I was not alone and not the only one who had lost him. 

What all of those wonderful people did was keep me sane. Could I have gone through Andrew death alone?

MY SAFETY NET

For me, it seemed to me like the sheer presence of people held me in a safety net, prevented me from falling into a dark, empty place. 

They were holding me when I did not have anything to hold onto. They were adding their life to mine to lift me over a dangerous passage that had no bridge or guardrails. 

They were guiding, holding, running interference, and scouting ahead to anticipate rough and dangerous spots. 

BEING THERE FOR OTHERS

Of course there was also ambivalence. In some way, I wanted it all to be over and everyone to go home—but I was also aware that the line would end and it would be over. 

After thinking about folks being there for me I shifted to the thought, “Have I been there for others?”

     “Not enough” is the answer. I had not realized the importance of simply showing up. What was I thinking when I just decided not to go sometimes.
     
It seems shocking now to me that I did not realize that in some very important way each of us counts the absolute same. 
       
     

BEING THERE

Last week, June 10, 2011, I read an article in the New York Times called You Look Great’ and Other Lies, by Bruce Feiler that recants the experience of being with family and friends during his bout with bone cancer. 

The result is a distillation of do’s and don’ts for being with people in distress.

In the author’s list, things not to say included:” What can I do to help?”, My thoughts and prayers are with you”; “Everything will be okay”; “How are we today?”;  “You look great”.

 What to say included: “Don’t write me back;  “ I should be going now or I love you.” 

I wondered when I read it if I was missing something important. I was overwhelmingly grateful that so many people reached out to us when Andrew died. I was afraid no one would come. That his death and our loss would somehow go unnoticed or unmourned. 

As weary and terrified as I was of having Andrew’s wake at our house, I was more concerned that few would come. It felt right that people would not know what to say or how to be me with me. I did not know what to say or how to be with them.  My over whelming feeling was thank God you are here. 

JUST BEING THERE

As I have mentioned before, when Andrew died, family and friends surrounded us. 

We were making many decisions. I was hit full force with a terrible blow every time I had to make another choice, see another picture, read another note. 

My family and friends held me, held us. Their presence was a miracle of caring. 

I now understand what true caring is. I was literally carried along. The energy of others to be there, for whatever reason, be it love, caring, curiosity, pity, voyeurism somehow transferred to me and supported and insulated, distracted, and cared for me.

GETTING SIDETRACKED

     I am getting side tracked again. I was talking about the relief I felt. 

     Reading back over this I realize that what I actually felt was largely numb. 

     The relief was mixed together with a tornado of feeling that was simply too big and all encompassing. I was stunned, horrified, hypersensitive and on autopilot.

WE MISS YOU SO

Yesterday your dad and I were watching the last hole of the US Open being played at Congressional Country Club in Washington, DC. Your dad had been watching it all afternoon and had made us a drink and gone outside. The leader, Rory McIlroy, was ahead of his nearest competitor by eight strokes and your dad had lost interest. For some reason I wanted to see the finish. I called to your dad to come out to the den and watch with me. He said we know he is going to win. I said, “Yeah I know but let’s see it to the end”

Your Dad joined me and as Rory McIlroy played the 18^th hole the TV commentators started focusing on his Dad, as-it was Father’s Day. As Rory McIlroy sunk his final putt, he turned and found his Dad and said Happy Father’s Day as they embraced. Both your father and I started crying. 

We miss you so.

TALKING TO ANDREW

     So anyway, Andrew, as I was saying, maybe the relief I felt was real. 

     Maybe your death ended your suffering and gave me some physical relief as well. 

     In addition, it seemed I did not have to worry about you anymore. On the other hand, maybe I had just been waiting for the other shoe to drop and it finally did. Who knows?

      I would not wish this experience on anyone else. It was and is exactly horrible. 

Another thing I read somewhere, cannot remember exactly where right now, but it was the results of a study done in Russia. The idea was to try to determine the effect on the mother cat of an injury or the death of her kittens.

 The gist of the study was that the kittens were separated from their mothers and taken out on submarines to ensure total sensory isolation from their mother.

Then the kittens were killed at sea while the mother’s vital signs-- pulse respiration, blood pressure, etc. -- were monitored at home. 

The mothers demonstrated signs of distress when the kittens were killed even though there was no obvious way that the mothers could know of the kittens’ death.

This made sense to me. 

     Somehow, a mother is connected to a part of her offspring or them to her. The kittens’ pain and death is experienced by the mother cat as personal distress and  perhaps, vice-versa. Of course, I do not understand all this scientifically but somehow it does make sense

WE ARE ALL CONNECTED

 I just read an article in the New York Times Sunday Magazine about four year old twins conjoined at the head. 

They had a unique connection through a shared thalamus that actually allowed one of them to see things on the television that the other one was looking at even when her back was turned away from the TV. The twin looking at the TV received the stimulation through the eye itself and the other twin through a neural connection. 

The same was true of touches or sensation related to drinking liquids. The story resonated with me, I am not sure why. It may have to do with a feeling I have had all my life that we are all connected and constantly communicating with one another on an unconscious level. 

RELIEF FROM WHAT

     I do know I cried out to your father that I did not know it would be this hard when we knew you were missing but before we knew you were dead. 

     It was almost as if I knew it was coming and maybe wanted it to come, to get relief. Relief from what? 
     
The worst thing has happened, where is the relief? This is hard to talk about and harder yet to understand. 

      I think I may have been suffering with you. Not for you, but in some way the part of my biology--that was in you or you in me or both-- was actively suffering.  

GONE FOR A WHILE

     In speaking of not believing that you were gone, I do not know if that is true. 

     In some ways, you had been gone for a while. 

    This terrible freight train of emotion had been roaring in me for a long time.

      I now believe it was your impending death that some part of me and you were each aware of. 
    
    Who knows?  

CAN'T BELEIVE YOU ARE GONE

I was so glad I did buy you those shoes. 

At your funeral one of your work mates was talking to me about you and she said what a nice man you were, how you made everyone laugh with your rapping. 

She then related an incident of how you came into the office one day on cloud nine showing off your new shoes. 

She could not believe you were gone. Me neither.