Apologia Pro Vita Sua

I do occasional work for my hospital’s Addiction Medicine service, and a lot of our conversations go the same way.

My attending tells a patient trying to quit that she must take a certain pill that will decrease her drug cravings. He says it is mostly covered by insurance, but that there will be a copay of about one hundred dollars a week.

The patient freaks out. “A hundred dollars a week? There’s no way I can get that much money!”

My attending asks the patient how much she spends on heroin.

The patient gives a number like thirty or forty dollars a day, every day.

My attending notes that this comes out to $210 to $280 dollars a week, and suggests that she quit heroin, take the anti-addiction pill, and make a “profit” of $110.

At this point the patient always shoots my attending an incredibly dirty look. Like he’s cheating somehow. Just because she has $210 a week to spend on heroin doesn’t mean that after getting rid of that she’d have $210 to spend on medication. Sure, these fancy doctors think they’re so smart, what with their “mathematics” and their “subtracting numbers from other numbers”, but they’re not going to fool her.

At this point I accept this as a fact of life. Whatever my patients do to get money for drugs – and I don’t want to know – it’s not something they can do to get money to pay for medication, or rehab programs, or whatever else. I don’t even think it’s consciously about them caring less about medication than about drugs, I think that they would be literally unable to summon the motivation necessary to get that kind of cash if it were for anything less desperate than feeding an addiction.

There’s a rationalist saying about making a desperate effort, as if the life of your child was at stake. Nowadays I tend to think of this in terms of “Make a desperate effort, as if you were a heroin addict and your next fix depended on it.”

Anyway, it might sound like I’m mocking my patients, but I’m not. I’m meandering my way into an apology.

I have had a really busy few months. I think it will be letting up soon, but I’m not sure. And I’ve told a lot of people who needed things from me, for one reason or another, “I’m sorry, I’m too busy to take care of this right now.”

And I worry that some of those people read my blog and think “Wait, if you have enough time to write blog posts nearly every day, some of which are up to six thousand words long, why don’t you have enough time to do a couple of hours work for me?”

And the answer is – you fancy doctors with your mathematics and subtraction might say that I could just take a couple of hours away from blogging and use those free hours to write that one thing or analyze that one study or whatever, but you’re not going to fool me.

Just as drugs mysteriously find their own non-fungible money, enjoyable activities mysteriously find their own non-fungible time. If I had to explain it, I’d say the resource bottleneck isn’t time but energy/willpower, and that these look similar because working hard saps energy/willpower and relaxing for a while restores it, so when I have less time I also have less energy/willpower. But some things don’t require energy/willpower and so are essentially free. Writing this is my addiction, so it’s free. Doesn’t mean anything else is.

This is unfair to you guys, but I should be substantially less busy in the next couple of weeks and we can see what happens.