Some version of me that felt slightly foreign got out of bed that Thursday morning. My phone slept in, still sleeping in rice from the night before. The death of my phone really bothered me, but not because of the phone itself, more because it was a direct repercussion of my inability to remain calm in the face of stress. I had been so turned inside out by everything that I didn’t have the presence of mind to put it in my rainproof bag. A black cloud took residence over my head and I felt it as the backdrop of everything else I did that morning.
I was bummed.
I did my usual routine, lathered up in bug spray, put on my hat to protect my scalp from the chitras, and moseyed over to the bathroom to brush my teeth. An hour of phone calls (using the company phone now) to arrange HIV follow up for patients took up the first part of my morning until Alison arrived for base clinic. It was always nice to talk to Alison, she was like my mother away from home; she always wanted to know everything.
‘So tell me about your week how did it go!?’ She said. ‘How about that water last night? I was watching out from our dock last night… I have never seen the Ocean so rough here before’
‘Well…’ I said, and then proceeded to vomit everything from the previous two days. The patients, the exams, the longest day of my career, ‘Oh and about that weather – we sailed through the Canal de Tigre with an acute abdomen in the boat.’
She listened closely and we talked. I told her about fear, about the waves. When our conversation started, I probably resembled my normal self, but as I brought myself back into that boat recounting with vivid detail what I felt, I think she saw it in my eyes that I looked like I had seen a ghost.
‘Oh my goodness…’ She said. ‘Did you sleep alright?
Why do mothers always ask that?
I was fortunate enough that base clinic was slow. We spent most of the morning sitting around and chatting about everything. The Ocean, parenthood, relationships, radiation, health, politics, and the rest. I always enjoyed my conversations with Alison. When the buck dropped that nothing much was going on, I realised my time might be better spent presenting our patient files to Nicole (the new medical lead still in isolation) and being productive. We started slowly, I moved at a turtles pace, still positively hungover from the adrenaline dump I had lived the day before. I took a minute when we finished to call the girl from last night, our patient who was admitted to hospital – or so I thought. When I got her on the phone she told me that she’d been seen just after we left, and discharged at ten o’clock last night. Hearing that made my heart dropped down into my stomach.
They hadn’t even admitted her overnight? What the hell? I asked her what they had done for her. She said she had gotten an ultrasound and told her there was nothing there. She was put on three different tablets, told to take them for a week, and had gotten two injections in hospital. Presumably this meant she had been treated for pelvic inflammatory disease, something that we had the capacity to have done ourselves without bringing her to hospital at all. I was completely shocked. I thought this girl was at risk of dying. We had put her life and ours at risk because I was so concerned, and now I was finding out she wasn’t even sick enough to be admitted. I was disappointed in myself, but also with the world. I thought I had made the right decision; she looked completely unwell, objectively. Was it messed up that I wanted her to be deathly ill to justify my actions? Thankfully they had a distant cousin that lived in Bocas town and were able to stay for the night after discharge, so they weren’t stranded at the very least.
I spent the afternoon sleepwalking through other tasks while cognitively digesting everything leading up to our voyage. I was now seeing understood with more clarity how on edge I was before we even left, when I made the decision to end the clinic early. It was almost miraculous to suggest that I was thinking clearly at the time. That was before I got into the boat and met God. The reality I came to grips with is that even if I wasn’t thinking clearly, I was still thinking. This might sound insane but it’s something that I learned about myself when I was in my late teens and early twenties experimenting with Cannabis.
Cannabis has been around forever and used by close to everybody. The Greeks of Aristotle used it to dress the wounds on humans and animals because of intrinsic antibacterial properties. In India it was used for centuries in Ayurvedic circles to treat insomnia, headaches, and as an analgesic during childbirth. Ancient Egyptians even put it up their butts to treat hemorrhoids. Hindu Kush, Acapulco Gold, Jamaican bud, and Afghan Diesel are all strains of cannabis domesticated in different parts of the world by vastly different cultures. After many years spent as public enemy number one during the War on Drugs of the Nixon era, it’s now being used in occidental medicine as an alternative analgesic for neuropathic pain, anti-emesis in chemotherapy, and as a very potent anti-epileptic for refractory seizures. Even recreationally, for years now been legally available in Canada where I grew up. That is in addition to Uruguay, South Africa, and Georgia where it also completely legal for recreational use.
I am not saying that is without impairment because it certainly is, a series of studies at Yale University in the 2000s showed that it increases psychotic symptoms, increases memory impairment, perceptual alterations, and serum cortisol levels in the acute setting. We also have very little data on the toxicity of the other 143 cannabinoids that are produced by the plant other than THC. This is without considering that most strains 30 years ago topped out at 1% THC, and now it’s easy to get your hands on bud with up to 30%, which might be enough to make a normal person’s brain explode into a million pieces and turn to pure energy in front of them.
In my opinion, the thing about cannabis that makes so many people uncomfortable is that it brings an odd sensation that we aren’t in control of our own thoughts. For people who manage their anxieties through micro management and control, this can be very jarring. Even though the data indicates fairly clearly that cannabis and alcohol are equally impairing drugs cognitively, alcohol doesn’t give us that ethereal sensation that our minds have spun out of our control. As a matter of fact alcohol seems to make people paradoxically feel more in control, even when that very control has been crumpled into a ball and thrown out the window at 97 miles per hour. One of my favourite illustrations of this is a paper in the American Journal of Addictions that directly compared driving on cannabis versus alcohol, the following is a one line summary of the study
Drivers that are high are actually less likely to crash than those that are drunk because they know they are impaired, drive more slowly, and take less risks
Sewell, R. A., Poling, J., & Sofuoglu, M. (2009). The effect of cannabis compared with alcohol on driving. American journal on addictions, 18(3), 185-193.
More than once I worked myself down from the precipice of bugging out just by comprehending that I was still in control, only impaired. Don’t get me wrong, I’ve bugged out completely a few times in my day, but I got older and got wiser with my use. Even when it seemed like someone else was at the controls, I learned a certain degree of comfort in that impairment. I learned to understand that although on the surface of my mind all I felt was fireworks, the inner machinations were still at work keeping the clock running. That ability we have to auto-pilot, to react intelligently without taking presence of all the information synthesized and acted on, is a product of these machinations. In sport, sometimes you make decisions in a split second without even thinking, because the thinking has already been done by the little green men at the controls somewhere deep inside your skull – I once heard someone say that ‘skill’ is just technique under pressure. The same thing goes for moments of hyper-stress in the workplace, or during moments of intense fight or flight. I can imagine this passage will resonate most with others who have used cannabis, and what I am trying to articulate will be difficult to flesh out for those who haven’t gone down that hole themselves.
Regardless, my history with the herb is one of so many things in life that gave me more experience. Experience is having been there before, and the value in that is priceless. I had experience now making hard decisions under stress, and facing the mammoth of the ocean toe to toe. I had experience with fear. I’d argue at times this is a double edged sword however. With experience can come baggage, and walking around base I felt the baggage of my experience in that boat weighing on me like a sack of bricks. I was positively exhausted, living in a post endorphin state that extended until well into the evening. I had a call with Dr LaBrot regarding our patients, and he echoed positive sentiment and support. The entire team supported me, regardless of the outcomes for the girl and her discharge. Our own thoughts about her management in hospital were irrelevant; at the time with how she presented, that was what she needed. Sometimes you think a patient is going to crash and then they don’t – that’s part of this business. Our chat made me feel much better.
After that I called my parents. I was tired and they could tell. Still, I felt like they deserved a full rendition of the story and so I told them everything that happened, starting from the morning of the first day of our clinic. I told the story with as much drama as I could (perhaps one can tell that I enjoy the storytelling art-form). My mom at one point asked me to stop, she was getting too stressed.
‘Just tell me now, did anybody die?’ She said.
‘No mama, nobody died. If you want I can stop’ I answered. Maybe I should have given them a watered down version. That’s not right I thought, they can tell me if they don’t want to know. They would have to get used to this. We talked it all over. We were finally looking to move on and my mom interjected again.
‘Did you sleep alright?’
