"I know, but I can't tell you, Dr. Johnson." she said through the speaker on his cell phone. His ears blushed as he shifted on the exam table and pulled his gown over his knees. "Did he tell you? It's not just about the sex."

"Arthur, are you there?" Jessica said (names and details changed for privacy)

"Yes, Jessica. I'm still here" sighed Arthur. His face, a pencil sketch of the old west cowboy, fell. The tan drawn up wrinkles sagged everywhere except around the eyes. He always squinted as though smiling into the sun. Maybe his Duchenne's contractions were in spasm. Those subtle movements that show "smiling-with-the-eyes" were no help in this former Army Ranger. 

"The doc wants to tell you how I'm quitting, Jess" Arthur continued. "He says I can do it outpatient, so you don't have to go." Almost a crack in his gravel voice. "Come back Jess." 

Arthur had just agreed to wean off opioids and participate in the partial hospital behavioral medicine program.

A colleague referred Arthur to me because he knew I like talking to patriots who fought for our country. I'm grateful to and facinated by our citizen soldiers who physically go in harms way. I want to understand how they survive horrific events. Many whose bodies are broken heal and go back. Arthur did that. His body was broken again. Surgeons did their best to repair his shattered bones and clean out his abdomen of schrapnel. Infections delayed healing more than a year. The pain set in like a concrete foundation to his mental house. He didn't just live with it, he built on it. For years he refused pain medications.

"I didn't deserve them," was his explanation. "After all the killing I've done." He became a counselor.

Married over ten years, he talked about Jessica the same way. "She can smile and all the men in the room want her. She's so out of my league." The screen on his smart phone showed a brunette in tight T-shirt and jeans with that winning smile.

Jessica was on her way to a good time in Vegas. 

A year earlier she warned Arthur that if he didn't get his s#*t together she would leave him. His gallbladder had to be removed and there were painful complications with emergency repeat surgeries. New Sciatica from a herniated disc piled on top of the old pains. The pain medications they gave him were opioids. No problem at first but now a year later he was eating them like a major food group without relief. 

Since Arthur continued to spiral down, Jessica told him she couldn't help him. She still wanted companionship. She would not divorce him if he got help and accepted her decision to have other companions until he got better. 

"Doc, I was so relieved" he said and squinted harder to control the pooling in his eyes. "She needs to be happy. I'm OK with that stuff. She doesn't love them. Please help me kick these pills. I used to make her laugh." The slight quiver of his square jaw barely registered.

Jessica kept driving but listened to my explanation of the program to help get Arthur free of opioids. "Well, you know he has tried several times already." she said, "I'll check in later."

I took Arthur to the fluoroscopy suite and gave him a nerve block that helped reduce his pain quickly. Since he was alone I encouraged him to do the inpatient Chemical dependancy program. He did.

Several months later, free of opioids, he explained to me that his Sciatica was coming back and he wanted another injections. He did not know where Jessica was or when she was coming back. You don't have to be John Gottman to know their marriage was not likely to survive.

John Gottman, one of the most famous therapists of our time, is known for his research in marriage stability and prediction of success. He found that a key factor in marriage stability was respect for one's spouse. Among many measurements he monitored his subjects eyes for the tell tale contractions of genuine commitment.

Arthur's injuries were never going to change. His perspective could though. Over two years I saw Arthur several times for repeat injections. Although I injected the same medicine to the same nerves each time he got longer relief.

"I know she's not coming back Doc," he said the last time I saw him, "but it's for the best. I need some time then I'm gonna find someone that wants me as much as I want her." He told me his group classes had been more helpful than anything. He especially liked that they hugged a lot. "Hugs are even better than your injections!" he said. He planned to continue group support because "they helped me get my self respect back."

A colleague, Paul Zak, PhD, precribes eight hugs a day as a basic of health in his TED talk. (http://www.ted.com/talks/paul_zak_trust_morality_and_oxytocin.html) Dr. Zak Zak graduated with degrees in mathematics and economics from San Diego State University before acquiring a PhD in Economics from the University of Pennsylvania. He is professor at Claremont Graduate University in Southern California. He has studied brain imaging, and was the first to identify the role of oxytocin in mediating trusting behaviors between unacquainted humans. An easy way to stimulate the brain to release Oxytocin is hugging. Although his research focuses on the trust boosting effect of Oxytocin release I've found that hug comment by Arthur to be common.

I've been away from this blog for awhile but am glad to be back. I am reminded by Arthur to get and give hugs, attend to self-respect hygiene and surround myself with others doing the same. 

When people believe in themselves they have the first secret of success. ~Norman Vincent Peale

About the Author

Vance Z. Johnson

Vance Z. Johnson, M.D., is the medical director of the University Spine Institute.

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