2 minute cocaine talk

HISTORY

Caca-Cola® contained 0.75 mg of cocaine per ounce until 1903 when increasing knowledge about stroke, heart attack lead to discontinuation of cocaine. Cocaine received little public or medical attention for the next 70 years, until the "crack" cocaine epidemic of the 1980s. Cocaine is schedule II substance; can be prescribed in 4-10% solution for topical ointment.

CRACK, POWDER, FREEBASE?

Salt form is more water soluble at room temperature. Therefore, it dissolves in mucous membrane and can be absorbed directly through the nasal epithelium. This is the snorted cocaine. Can also be injected. Like chewing tobacco.

Base form is water insoluble and will not be absorbed across the epithelium. It cannot be injected either because it remains as a precipitate in most solutions. However it has a low vaporization temperature and is thus smoked and absorbed in vapor form through the lung epithelium. This form is only smoked. Like cigarette.

$ TO $$$$. HOW IS AN EXPENSIVE DRUG LIKE COCAINE MORE PREVALENT IN A POORER POPULATION?

Cocaine really is expensive in any form. However the salt form usually requires a higher dose per use than freebase form. Crack cocaine is usually sold in smaller quantities (1/10th gram 'small rock' costs ~$10) and anybody can afford it at this level.

WHERE DOES THE NAME "CRACK" COME FROM?

The freebase cocaine crystal has small amounts of water. As the crystal heats, this water boils and makes crackling noise.

HOW DOES COCAINE WORK? Dopamine, serotonin and NE reuptake inhibitor. Ventral tegmental area to nucleus accumbens reward pathway is activated.

USEFUL INFO ON URINE SCREEN TEST: Benzoylecgonine is the major metabolite of cocaine and is present in urine for 2-3 days. Chronic users therefore cannot escape detection if they present to ED or clinic after this window.

WHAT SHOULD I BE CONCERNED ABOUT?

Body: STROKE, AMI (beta blockers can precipitate AMI in cocaine OD), SEIZURE, WITHDRAWL (pains, tremor, chills, involuntary muscle movements).

Mind: Psychosis, mood disorder, motor disorders (akathisia "crack dancers"), SI.

Relationships: Money, significant other (trading sex for crack), legal issues (arrest due to possession; violence or stealing stuff. see money).

Taking care of patients who abuse or are dependent on cocaine (may not resemble reality)

Approach to patient: First remember countertransference. This patient is not the crack cocaine patient from yesterday or the neighbor who stole my beloved playstation. Even if the patient is unreasonable, looks dangerous (and may well be dangerous), and/or smells bad, patient could still use an advocate - especially now in the hospital when they seem to have no control in their lives.

Decision to admit: Remember cocaine abuse or dependence is just as much as a social condition as a biologic disorder. Let the axis guide your decision on whether to hospitalize the patient or manage them in outpatient setting. If you send them out, make sure they have social support that would encourage the patient to stay sober.

Gather collateral information. Once admission was decided, collateral is going to be useful in understanding and management of patient as well as discharge planning.

Nursing Supportive environment with diet and sleep ad lib

Bio

Take care of existing medical conditions.

Benzodiazepam may be used in SEVERELY agitated patients or sleep issues.

Depression longer than 2-3 weeks or SI may require antidepressant treatment.

Risk of relapse is highest in early withdrawl; craving is easily triggered by stress or other drug-related triggers (like a spouse on crack). Patient should be referred to treatment program for ongoing care.

Social

Wounded soldiers aren't told back to go back to battlefield after their trauma, so why should this patient go back to the place that traumatized them? Think about relationships, family, money, work, education, Vocational rehab. www.ca.org.

Therapy

No one therapy is better than another. High intense and long durations are associated with better outcomes. Treatment of other psychiatric comorbidities.

Credits to wikipedia and uptodate articles on cocaine.

The Lotus Touts

ONE. Give people more than they expect and do it cheerfully.

TWO. Marry a man/woman you love to talk to. As you get older, their conversational skills will be as important as any other.

THREE. Don't believe all you hear, spend all you have or sleep all you want.

FOUR. When you say, 'I love you,' mean it.

FIVE. When you say, 'I'm sorry,' look the person in the eye.

SIX. Be engaged at least six months before you get married.

SEVEN. Believe in love at first sight.

EIGHT. Never laugh at anyone's dreams. People who don't have dreams don't have much.

NINE. Love deeply and passionately. You might get hurt but it's the only way to live life completely.

TEN.. In disagreements, fight fairly. No name calling.

ELEVEN. Don't judge people by their relatives.

TWELVE. Talk slowly but think quickly.

THIRTEEN! .. When someone asks you a question you don't want to answer, smile and ask, 'Why do you want to know?'

FOURTEEN. Remember that great love and great achievements involve great risk.

FIFTEEN. Say 'bless you' when you hear someone sneeze.

SIXTEEN. When you lose, don't lose the lesson.

SEVENTEEN. Remember the three R's: Respect for self; Respect for others; and Responsibility for all your actions.

EIGHTEEN. Don't let a little dispute injure a great friendship.

NINETEEN. When you realize you've made a mistake, take immediate steps to correct it.

TWENTY. Smile when picking up the phone. The caller will hear it in your voice.

TWENTY- ONE. Spend some time alone.

I get many annoying forward emails, but I actually liked this one. I am posting it for your peace of mind. At least I didn't forward it to your inbox.

Care Too Much to Care Just Right.

When I was reading Patch Adams, I wondered why countertransference was such a big contention for him. After all, if an idea is so widely accepted in a profession, there must be a good reason for holding it true. Yet the person I admired as a buddying healer was behemently against an idea designed to protect patients. I held this thought in my head for the first two years of medical school until I met my first patient, Sarah - a cystic fibrosis patient who passed away from a fungal infection.

I had met Sarah four weeks earlier while I was on the infectious disease team. She was my first patient as a clinical medical student, so the experience was special to me like most first experiences are. After a long hospital stay, she left with a fever that kept coming and going because she was feeling fine otherwise. Soon after her discharge, I went on to a different medicine team, but the resident would often keep me updated on the patients I cared for. I had this sinking feeling when I heard that Sarah was back in hospital.

I was extremely busy with all of my patients at that time and kept putting off visiting her until I heard that she was in the ICU. She was already intubated and out of it. I talked to her parents in the room and apparently they had heard of me from Sarah. They explained that Sarah felt bad because she was harsh towards me about her frustrations; she would often get frustrated when plans changed without a clear reason for such changes. I will not say whether those were reasonable responses or not because I don't think I am objective in this case, but I reassured them that I understood and was sorry to be tardy to say hello. I went up to her, held her hand, closed my eyes and said a quick prayer in my head. And left the unit to attend to my other duties.

It was two days later. I remember it was a post-call day when I visited Sarah before I headed out the giant hospital doors. It was a bright sunny day with beautiful weather such that I had to stop myself from smiling as I walked through the ICU door. Immediately, I realized what had happen as Sarah's mother was sobbing in front of Sarah's room. It must have taken me only ten steps from that moment to when I walked up to the room, but I immediately visited a long past when I was crying endlessly after a child's funeral. I lived the whole experience again from hearing the news of the child dying to the moment when I wept without control. I also remembered an uncle's funeral and how we went out to the lake that night to drink together. I remembered how I felt in those moments with that tight sensation in my chest and a dull remorse for nothing specific. The doctors had already pronounced Sarah dead. I felt my body feel unreal as I watched Sarah still pink and breathing through the tube. Held her hand and said another prayer which was a bit longer this time. I listened to Sarah's mother for a while.

I went home after that on my bicycle. I spent that afternoon thinking about Sarah out in the back yard. It was such a beautiful day and the sun was setting and happy when I stopped crying. My neighbor and I often build a bonfire in that yard. We built a fire that night and I talked about Sarah. I burnt an incense to signify the passing of a life that night.

Her funeral was held in Charlotte which coincided with a study day; I drove early in the morning. As I sat and watched Sarah's relatives and family, I realized how I felt when the boy and the uncle passed away. I thought I saw part of me and the funeral attendees of long ago in each of the attendees now. I wondered what my attendings would think of me sitting there stupid in a crowd of strangers crying about a patient I've known only for three weeks. I didn't even know if it was proper for me to be there; I was there because I wanted to be human.

After saying goodbye to the family and friends of Sarah, I drove back home in my happy yellow convertible car. I remembered Patch again. I thought how he would have done the same, but I thought some of what was going on was countertransference. Then I started laughing and crying at the same time with the wind in my face! It was a ridiculous sight really. It was counter transference, and it was OK. Actually, it was countertransference and it was necessary. The whole stupid thing was just simple empathy! Of course Patch was against a device which in some light suppresses a gunuine human character. I relate to others. They relate back. We relate. There's nothing wrong with that, is there?

Countertransfer, to me, assumes that doctors and patients are inseperatively devided in the roles of healers and persons needing to be healed. This is true sometimes. I surely don't want to fall in love with a patient whom I seek to serve. If I were to hold this type of healer role always, I do not know if I would want to live as a doctor. Such doctorhood would be too lonely, too removed, and too .... above all.

I understand Patch now. I understand, too, why countertransference is important. I could eventually hurt a patient because my empathy is exactly what hurts them. For that patient and others, I hope I can shake the idea of being a total healer. Otherwise, I may care too much to care just right.

This is the story of my first hitchhiking trip. I visited my friends in Germany winter holidays of 2007 and read "Dharma Bums." The book was very much in line with what I had been wanting. I wanted simplicity all over again. I wanted sangha. So when I got back to US and found myself some time, I decided to explore and become free. This was the last of three days.

When I woke up - must have been about 8AM - I noticed there was frost inside the bivy from my breath condensating against the coldness outside. When I opened the bivy I was confused because more ice flakes came through. Soon, I realized that it was not more frost from the outer surface of the bivy but snow! My stupid luck! With only my upper body out of the bivy, I wolfed down half-rotten banana, pieces of bread, a krispie, a scone, and milk.  I was so cold that I was only occupied with moving myself again to generate some heat. I packed everything in the sack and left the site only to realize 10 minutes later that I had left my glasses somewhere back at camp. Frozen, I moved back towards the Lodge.

    I found my glasses in a repairable fashion about two feet away from where I had slept. As I got back on the trail, there came this gentleman with a husky and a boxer my way. I asked him for directions and he sent me straight back down to the parkway where I started walking towards my origination. The wind blew strong against the side of mountain and the snow still continued to come down though not heavily. Aside from the wind, the experience of walking through winter mountain was new and beautiful. The snow flakes gently swept across the parkway as birds might fly over black winter seas.
    I walked about two hours when this machinist from Black Mountain, Roger picked me up and gave me a ride to Black Mountain. He said he wouldn't have picked me up if it wasn't for the fact that it was so cold outside to be walking for anyone. He figured even if I was a no-good bum, I didn't deserve to be suffering that cold. I was thankful for his compassion. He dropped me off at Denny's where I had two eggs, grits, biscuit and two cups of coffee. It was the most expensive meal through the whole trip at $7.60. After the meal I felt nirvina flushing my cheeks in the warm air. You can probably imagine that I took my time getting up from the chair. I drank that coffee real slow like life.
    I started hitching with a new energy and a new message on the whiteboard: SMILE. I listened to Jack Johnson, bobbed my head to the beat, and waved the sign and my big ugly smile to the drivers heading towards I40 east. A lot of people cheered me on.

    The next person to pick me up was Mr. Tom Snickers, an USMC veteran. He was in MC before Vietnam era and had a step-son who worked at UNC hospital. Really nice guy. Told me to look up the Everley brothers; which reminds me that I still haven't done that. He was on his way home from the VA hospital where I had sttarted my hike the day before; he had a pacemaker. His home was in Morganton and that was where I stopped next.
    Next was July. She was on her way to her hypochondriac sister who just said her goodbyes on the phone with the plan to swallow a fistful of pills. July didn't seem too worried about her sister; I assumed that her sister had been doing this kind of stuff in the past. She was taking care of her mother who suffered episodes of stroke. July herself suffered from Sjogren's disease with arthritis. She confided to me that she hopes not to die before her mother does because she was not sure if there was anyone else who would take care of her. In the end, she thought it wise to drive me 5 miles further than her sister's place just so I can collect from the 77 traffic as well. She was really sweet.
    Unfortunately for me, the location was bad to hitch from as the onramp traffick from highway 77 was too fast. I improvised and got a ride from a couple of brothers who had a flat tire. I got to the next stop with them and their spare tire. I thanked them at the gas station and walked towards the onramp again. They probably thought I was crazy, and I think I would have to agree most of the time.
    The next hitch was from this unlikely couple of dudes. One was a middle aged white guy and the other a teenager of southeast Asian complexion. The old guy must have been like a Big Brother because he had this mentor's tone the way he talked to the kid. He told the kid about his San Francisco days when he would hitchhike everywhere. Drove me 5 miles or so to a lazy exit where a ride proved to be difficult to find again. I lost one of my two canteens in that car. I sat down and wrote some of this journal and ate some bread and the sardines. After about an hour of fail, I decided to walk with my rucksack on I-40 East. It would seem difficult at this moment, but I had a decent whistle tune to keep me going for a while.
    I couldn't have been but 10 minutes on the highway when Keith picked me up. He told me he used to hitch daily to his work. One trick he taught me was to hitch around the signs that have place names with the distance written on them. We talked about world affairs and the meaning of Hitler. He believed that Hitler went to Heaven because he taught the rest of humanity an important lesson. He reasoned it would be illogical for God to decide to make him the way he was and then punish him afterwards. Of course, this was an old arguement, but I understood what he meant. Keith handed me a bottle of water which I assume he bought for himself. I thought about this bottle of water for few seconds and realized that it symbolized the goodness of people I met on this trip. I've not done anything for the people I've met, but they have taken it upon themselves to share with me their life stories, their car, and their goodness. I told Keith about this and how this trip has helped me solidify my belief that the world is full of good people with just few apples. That hitchhiking is still possible in this age of war on terror. He seemed real happy when I shared this.
    Next generosity came from Mr. Whitehead, an ex-furniture and textile salesperson. Man, he was a talker! He told me from A to Z about his life, marriages, his wives, Christianity, his home, and everything Jon Whitehead. But I didn't mind because he told them so well. After about 40 minutes of this, he asked me if I would like to join him and his beautiful Wife, Susan for dinner. Feeling rather hungry and slightly wary of the road, I readily took his offer. At Chez Whitehead, I had two servings of rice and stir-fried chicken and a blueberry muffin. Susan had a bypass surgery in August last year and was trying to eat right and exercise much, so she gave me all the food that she wanted to eat herself.
    Susan must have been around mid-60s and was showing so much grace and beauty such that I imagined I would have asked her out if I was her contemporary. Or would have thought about asking her out but never do it because I am a chicken reincarnate. After dinner, Jon dropped me off by the nearest I40 onramp which sucked because there was no traffic nor light. I must have looked pretty unfriendly in that dark corner with my jacket hood on my head. I decided to walk to the next exit. I figured someone would have picked me up out of pity or that the next stop might be a better place from which to hitch. I am a man of faith, you know.

    I walked for the next 30 minutes with much fail when I saw my shadow grow in front of me. I turned around in eager anticipation only to be let down by flashing blue lights from a police cruiser. I guess I could count that as a hitch, too? I was promptly transported to the next exit at a gas station where another bum was trying to hitch. Poor guy was so cold and out of fortune. I would have given him a ride myself if I was driving. After brief exchanges about our hitches of the day (it was funny how we talked like two fishers might talk about their day's work), he walked off into the darkness and I was again left to myself and the road home.
    This - the last stop - was the most trying. I walked to the onramp which had a street light, but it was not bright enough to dispel the distrust of the late hour (9pm in January). I left the ramp and tried my luck at a gas station with McD's. I talked to a few patrons there but no one was going East. Soon there weren't any customers, so I walked to across the street to a bigger gas station where the lights were brighter. Initially I stood in front of the store but was told to stay inside because it was too cold out. The store clerk - Christine - had a sweet southern drawl and was pregnant to 7 months or so. I was encouraged by the fact that so many truckers came through the station but I saw the west-bound trend of the trucks and learned that some gas stations serve one direction better than the other. It might also have depended on the time of the day as well. I put the rucksack on a chair and the placard on the table, "RALEIGH," so the drivers can see them as they walk in the store.
    I was feeling a bit hungry again. I think the cold makes it a necessity to feed constantly because it was only two hours after the large dinner at Whitehead. There was a hot water spigot for tea, so I bought a dollar can of Vienna sausage in the station. Dunked that and ramen into my metal pot with hot water hoping it would slowly cook. Hopeful planning. My impatience got the best of me; I started picking at the sausages with plastic-straw chopsticks. Man! They were sofa-king delicious! Of course, I couldn't stop eating. I nibbled on the noodles which were still uncooked. The broth was damn good. I gave in and ate the hard noodles in the lukewarm broth with mucho gusto. After feeding my tummy, I tried to read the book but I was too tired. I felt asleep hunched over the book and the table.

    I was awakened by this Mexican guy, José. He blurted something to me about witness and driving but I couldn't understand because I was still trying to figure out what was happening and where I was. There's this 15 second period after waking up when I can't understand or speak any language. Soon, I realized he was trying to give me a ride. Life came back to me and I quickly gathered my things together, threw the rucksack in the back of his GM truck, and jumped into the cabin. About five minutes into the ride, my driver tells me that he was going to Raleigh because he needed to see his probation officer. Gahaha! Imagine my apprehension, right? I started wondering what he did when he told me about getting caught for driving without license for three times. I was ambivalent about the situation because at least it wasn't assault or drugs or something, but that probably meant that he was driving without license again. Perhaps I should have offered to drive for him?

    José and I shared few stories about immigrant life. I told him my stories about working with guys on contruction yard after high school and he told me about his children. He told me how he wanted to get a job and get back on track with life. I wished I knew how to console the guy, but I thought it artificial to try. I just acknowledged his story and looked at the early morning I-40 traffick. It was sparse and José drove with speed. José was a good guy in a bad situation. I felt sorry.
    In the end, everything turned out well. He dropped me off where I had left my car - my yellow sports car like hotwheels. I thanked him like a brother and watched him drive off in his old black Ford truck. It was 5 AM. I got into the car shivering and drove home. I took a scalding hot shower once home to get all the road grime off me. I turned my computer on to play some music and laid in my bed - my mind still wired from the road but my body so tired and ready for rest. I thought about each and everyone I met on this trip. Faces after faces of smiles and concerns, and life meshed with health and relationship problems and hopes and dreams and everything in between and outside. I thought it so comfortable to be sleeping in a bed again. Then went to sleep with so much gratitude and warmth in my heart for the people who cared for me these past three days.

This is the story of my first hitchhiking trip. I visited my friends in Germany winter holidays of 2007 and read "Dharma Bums." The book was very much in line with what I had been wanting. I wanted simplicity all over again. I wanted sangha. So when I got back to US and found myself some time, I decided to explore and become free. This was the second of three days.

Next morning, I got up, took a hot shower.

    I think I was munching on some trailmix, Jay handed me his handheld GPS unit to use which was surprising to me because I didn't think he knew me enough to trust me with it. He told me to keep it for the whole week! And this proved to be a handy device - but more on this later. He also invited me to a tea party (with BBC and everything) on Saturday 4 pm. As Jay had a 9am class, Bob and I just sat around browsing internet and writing email. When Jesus came back with sniffling nose, our hunger moved us outside. We walked through the dead winter garden and the rest of UNC-A where you could sense that it was the first day of the school and people felt fresh. We even took a picture in the quad where someone had written down "Today, we all get A's!" At the school cafeteria, Jay paid for my meal and I made sure I made every penny count. I hurt a lot of food: apple, sausage, pancake, hot salad (with beef steak), rice krispies, coffee, scones and milk. I pakced some of that left over food into my rucksack and told Jay and Bob about my first time eating krispies in the States and how I thought it rocked my world. How rice krispy had changed my life. By the end of that epic brunch, my belly was very full; my rucksack, too. The sun cold sunlight flushed the cafeteria as I sat there with a cup of mediocre coffee and excellent company of two young gents.

    Originally, everyone was planning to head out downtown, but Jay wasn't feeling well - a cold coming on. He stayed behind at school. Bob still wanted to check out downtown (or maybe Bob just wanted to make sure that I wasn't alone), so we got on this bus which took us away from downtown - making the foot trip even longer than it would have been otherwise. We tried to hitch a ride downtown but no success. We walked an hour to downtown.
    Once we made it to downtown Asheville, B and I visited a map shop and an art gallery where I snapped a picture of a bronze man. The French Broad Food co-op was pretty disappointing but I picked up two Thai Kitchen ramen noodles for the next two dinners. We walked to the bus station and said our goodbyes. He seemed sad; and me, too. I took Bus 13 to the VA hospital where I walked to Blue Ridge Parkway and to the Folk Art Gallery. There, I found out about the Mountain-to-sea trail. I hiked about 5 minutes out of the parking lot when a character named Duncan caught up to me and told me about the trail and the Rattlesnake lodge. I figured I would camp there althought it seemed like a long hike - especially since I left the Folk Art Center around 5pm. He invited me to his house but I didn't like the vibe I got from the dude so I "no thanks"ed him and rushed against the setting sun and the darkness veiling the mountainscape.
    Of course, I got tired quickly and found a slower pace my heart could keep up with. As Duncan said, there were three hills and a trough but the distance was truly understated. He told me about 3 to 4 miles, but I walked for two hours before I came off the trail and back onto the parkway before the last ascent to RSL - which was surely more than 4 miles by my estimation. I was wet, tired, thirsty (I had less than a liter of water for the next day). The sun disappeared quickly and I was soon walking, hiking under the moonlight - the same ambience as the night when I slept with a girl for the first time. But no need for reminiscence at that dangerous cold hour. I saw the lights of Asheville far in the distance and the occasional cabins somewhere down in the valley to the left. The shadows were tricky because I would sometimes mistake them for rocks or tree roots. Several times I almost ate dirt but managed without falling or breaking a bone. I started using my Bob Marley-playing Ipod to light the difficult parts of the trail but still was very slow through the elevation changes and where the vines were thick overhead. At about 8PM I stopped and had two krispies and a sip of water. It was starting to get real cold and I was feeling pretty exhausted from the weight on my back. I had packed entirely too much of the wrong stuff. I decided that I would hike till 9PM and if I was not at Rattlesnake Lodge, I would just camp the nearest place without the wind. Over the next hour, I felt the temperature drop more and realized that my waterbottle was starting to make a slushy noise from the freezing water.
    Not having arrived at Rattlesnake Lodge by 9, I sat on a log about 50 feet off the trail. Called Jay to say my thanks since I haven't talked to him after brunch and Renée just to check in before our weekend trip(originally she and I were supposed to meet up in Asheville to check out Biltmore and rest of Asheville until I decided to come back home early). It was good to talk with people as it helped me feel less lonely up in the cold mountain. I checked the GPS for the last time before I completely gave up on Rattlesnake Lodge. By stupid luck, I saw Rattlesnake lodge on the screen which was only .2 miles Northeast from where I was. I found new strength and motivation and stood up again. I practically jogged in the dark trail - if anyone was there to watch me, I must have looked like a madman running through the trail at night like that!
    Once I got to the lodge - which only took 5 light minutes - I gathered enough wood to start a fire so I can cook a can of sardines with ramen I had bought earlier. Except I realized that the lighter was completely shit and I couldn't build a fire. I was horrified and dismayed. I cursed Andy for giving me this piece although I knew I had no one else to blame but myself for not having prepared adequately. Imagine my disappoint after all that walking and cold and realizing that I have to go to sleep cold and hungry. I was shivering violently by this time and I wasn't going to get any warmer by crying about the lighter. I quickly set the bivy and jumped in with the rucksack in my sleeping bag under my foot to keep the water from freezing.

It was fucking cold!

    I had too few layers of clothes, and my toes felt frozen the whole night; my fear of hypothermia was real. I started to shiver voluntarily whenever I woke up just so I could get warm enough to fall asleep again. I must have woken up 5 times because of the cold except this one time when I realized I have to pee! This time I cursed myself and stood over the bivy and peed right next to myself. I must had stepped on my glasses at this time and not notice it because when I woke up, I didn't see it where I usually leave it in the bivy. 
    Anyway, I went back into the sleeping bag before the coldness robbed of any warmth I had built inside the bivy. I distracted myself from the cold by listening to podcasts of medical lecture. Who would have thought it? An ipod is a great survival tool - provides light and mental solace! I don't think I will ever go hiking without it. I fell asleep listening to anesthegiology lecture about airway management.

    

This is the story of my first hitchhiking trip. I visited my friends in Germany winter holidays of 2007 and read "Dharma Bums." The book was very much in line with what I had been wanting. I wanted simplicity all over again. I wanted sangha. So when I got back to US and found myself some time, I decided to explore and become free. This was the first of three days.

I started the first day too late because I was waiting to borrow a camping equipment. When I realized that the gear would not come through, I borrowed the camping gear from my neighbor and bud, Andy. I packed the usual camping stuff, four cans of delicious sardines, and a book. Drove my car by Trader Joe's where I bought a pound of trailmix with chocolate pieces, a bread, and salami. Then parked my car at a friend's apartment which was only a mile away from exit 270 on I-40. I walked over to the exit ramp with courage and ambition.

    I wrote "California" on my little whiteboard and made some drivers laugh. After about 30 minutes a lady, who used to work for my medical school, picked me up. We talked about relationships and life. It was great; I talked about Marie - a French girl and the recipient of what will be my life-log infatuation. Apparently, she also knew a thing or two about French women because her husband had an affair with one whilst they lived in France. I shared my disdain for the way Marie teases me and left things at that. She asked me what religion or beliefs I held, and I gave her my quintessential "Jesus not a Christian, Buddha not a buddhist, I just walk this life." She told me she understood and told me that she was a unitarian. In fact, she was just coming back from church in Durham to her home in Mebane when she saw me by the onramp. We were at Mebane too soon. She dropped me off at a gas station and wished me good luck for the journey and also for my future career. 
    I didn't have to wait but 5 minutes when a dude that looks like Jesus drives up in an old Toyota Camry. I waved at him; he responded with an are-you-serious type of look on his face and pulled over. I asked him, "where are you going?"

    He thought about his answer and then decided that he should find out first where I was going, "wait, where are you going?"

     "Asheville."

     Jesus says, "Oh.. well, get in! I'm going to Asheville. I guess I'm your ride."

     I threw my rucksack in the back seat and got in the passenger seat with stacatto beat. We shook hands and drove onward. The guy's name was Jay and he was very much interested in what I was doing. I explained to him that I wanted to try something new which would help me become a stronger person. I also explained to him about the downfall of internet social interactions where there's actually very little human contact (i.e. facebook). He understood and reciprocated his story about trying to get a party going with his friends via facebook and finding out that no one came except for the ones that he called on the phone. Yeah, about that.....

    Jay was a thin guy with stubbles on his chin and long brown hair to the effect of looking like the white Jesus on bathroom walls. He's from Raleigh but is a student at UNC-Asheville. He hold several creative interests, especially in digital media. He taught me a couple of things like Creative Commons and chip music. Pretty cool stuff. Another idea he shared with me was the difference between art and music. He reasoned that appreciation of "art" is usually 2-3 generations older than music and is therefore more "difficult" unless one has studied to appreciate art. He said music is just simply appreciated when it comes out. I saw some logic in that. Jay asked me if I had plans to sleep anywhere and I told him, "no." I told him I wouldn't mind sleeping on his floor if he had some space which was readily cool with him. I grinned as Jay's Camry zipped on top of the wet asphalt towards my destination.

    When we got to UNC-Asheville, I met Jay's roommate, Bob from Hickory. He was an art major - giant, tall with glasses. The kind that you know he's always in his head because he doesn't say much. He was playing a video game on his computer which was interesting enough to watch for hours except that Jay and I were hungry. All three of us drove out to the grocery store and bought rice noodles, rotisserie chicken, cilantro, lime, bell pepper, zuchini, broccoli, chicken broth and hot sauce. We came back and cooked bowls of hot rice noodle soup with chicken and all those vegetables! After dinner, I was very content and felt like smoking a cigarrette - except that I didn't have any and it would make me smell bad. Overall, the day was good and I felt asleep hoping that the next day would be even better.

Last night, I dreamt about my parents with whom I don't associate much. I don't associate with them at all. In fact, I changed my name a year ago to signify that I no longer belong that family anymore. You can say that I've disowned them.

In that dream, my mother was not around because she had died after many years of psychiatric illness. This had taken a huge toll on the youngest brother. He was growing up without someone who tended to him after school. I thought briefly about children who grow up without a parent and how much they are likely to get in trouble. I felt sad at the thought of my little brother who would always have an unfulfilled yearning for the motherly care.

    My father had opened up a Chinese restaurant where he wasn't doing quite so well. In fact, his health was so deteriorated it pained me to see him work in the kitchen. My brothers and I were on our holidays from work and school, and we helped him at the restaurant that day which was busy only because it just opened. At the end of the day, we all got into the family van and drove to a church friend of my father. The drive was uneventful - which is an excellent situation given the recurrent fights my father and I have in the car. When we got to the destination, I got out of the car and started walking towards the friend's aparment when I realized the old man was still struggling to carry his weight off the car. Breathing congestive heart failure, huffing years of physical self-inflicted abuse and neglect, he dragged his feet slowly across the black parking lot asphalt. His sunken eyes showed no hope and only remorse for life. I saw death in his eyes, but he was never ready for it. It would not be dignified.

    The sight of him, neither actively living nor preparing for his death, was such that I began to cry. I felt sad and compassionate towards this human being and understood his suffering. I began sobbing heavily and my brothers noticed this. They came around and asked why I was crying as children would ask innocently. I didn't answer because it wasn't their burden to know the suffering of others; it was enough they grow without worries for now. I told them to go help Father carry himself.

    Feeling sick, I sat down on the curve and continued to cry. My heart was constricted; I stared at him through the tears. Born during the war and raised in harshest conditions, malnourished throughout childhood lived all his life try not to repeat the mistakes of his father. Failing at this, produced a son who hated him for what he did and didn't do - me. I drifted into my thoughts.

Was this why you had told me about your childhood? How you had to eat locusts in the field because you would never have meat to eat? So I can understand, forgive and forget your transgressions against your own life?

Yes, I understand your demons. I know your father had been harsh to you. I know that you didn't know better. I know you regret it. And I've forgiven you a long time ago. But you still continue to be the person that you were - the same person you hate. It is dangerous for even for a nation of people to forget the aggressions of others - so it is more so dangerous for me to forget about your beatings and words of angry blame. Because survival of my psych depends so much on holding you accountable, I cannot afford to let you know that I care much for you and your peace. Because you are dangerous to me and your other children, I will remain hard and strong against your fits of rage.

My brothers, still innocent from this samsara, carried father with concern on their forehead. I sat down and sobbed. It was more than just me versus my father; my experience not being unique. I wondered how many fathers and sons, mothers and daughters experienced this sadness and gridlock relationship where we loved each other but had to keep knives at each others' throat just to survive and breathe. I felt sicker and tighter in my chest - a migraine coming on.

This is where I woke back up to reality where despite differences in situations, the essence of relationships and our nature was still the same. I laid in my bed alone and still, feeling the warmth of my body reflected by my comforter. A slow, quite classical music comes on and I turn the light on. I contemplate about my family. Remember how I didn't answer my mother's phone call because I held her accountable for always running away from home. I think about my father and count his years. He'll be 60 in a few of years; I'll be training to become a surgeon then. I wonder if I will have children then? Am I going to be a benevolent father?

I am awake now. The dreams of the dark night is no longer on my mind and this music lifts my soul. I hear a nameless morning bird outside. The calendar shows ECT observation at the hospital today. I'm going to help children feel better today on the psychiatry ward - some of which experience the same sadness I occasion. I wash, get dressed, eat a banana, and walk outside to the cold dry air. I give a brief compassion prayer to the sky asking the world to be just slighly more peaceful and less pained.