substance

Alcohol, cocaine and vitamins: the kind of mix seen in places like San Francisco, and in the course of a clinic day at the General Hospital. Over the course of a few hours, I see an alcoholic faced with the possibility of liver cancer; a recovering alcoholic who is so meticulous about his health that he has come up with every way possible to be medication-free; a woman asking for prescription pain medications which I can't give because last month her urine contained cocaine and this month she offers urine with a cool temperature giving away its falseness; and a woman with crippling headaches who has transitioned to an entirely yogurt-based diet with a variety of supplemental vitamins and herbs to help her pains. All this natural and unnatural (something I have to group because so often I can't tell what falls into one or the other) makes me think of the human body as more of a garden than as a laboratory. As I try to explain why I can't mix cocaine with oxycodone, this metaphor floods my brain and I think of all the plants I've killed (or let die?) in my life. In medicine we're not taught to reflect much on how we treat people like soup, throwing in spices here and there and adjusting to our taste. It's something that M has often brought to light, with his careful thoughts on how we carelessly alter physiology. Sometimes as I'm prescribing or not prescribing I realize this, and often when I'm speaking to patients about what they use I realize that we all do this to some degree. Patients are doing something to themselves with all of these substances, we are doing something to them with ours. And with what knowledge, what understanding of what soil is best? How do we even choose a soil when there's so much disagreement on what comprises growth? This isn't to say that everything is gray; I really don't want any of my patients using cocaine. At the same time, I hope I don't lose a sense of the substance that lies in what each person cultivates.