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Editorial Comments 11/19: Preface to Thanksgiving Week
EDITORIAL COMMENT: Preface to Thanksgiving Week
Although September is Recovery Month, among those in recovery that part of the calendar most venerated and most feared is this interval of November-January. For here coincide holidays and inaugurations, periods of revelry and of reverie, rehabilitation and regrets. While the season is a less official celebration of recovery, it is certainly more visceral. Continuing the past two weeks’ characterizations of addiction and recovery, it is right to give examples of both those with and without the disease, “Donna” and Ahmed, who serve those with it.
Those with addiction who care for the patient with addiction:
A friend, “Donna”, an active member of Alcoholics Anonymous, had developed cancer. For quite nearly a decade, she had been the most diligent of servants in that tribe. Managing the literature for a region of one million people, never complaining when someone needed a gentle hand or a strong back, she had a fine education and had spent many years abroad. When anyone was in doubt as to the proper use of an English phrase or word, she could be counted upon to provide it. Accurately. She loved conversation; when she spoke, her speech was eloquent and meaningful.
As this cancer advanced, it slowly deprived her of her speech. It quite nearly killed her on several occasions until she was willing to give up her larynx, by then a mass of necrosis seeding frequent infections into her lungs. But over time she moved from bereavement for this loss to a practical appreciation of how it allowed her to listen more carefully; essential communications could be conducted with paper and pen. And, despite a future which will have been abbreviated as a result of metastatic disease, Donna remains cheerful and encouraging to all around her. So, one day, a meeting secretary asked if she would like to share her story; only moments later realizing the obvious. He was chagrined, but this was short-lived, as I proposed that she use her writing skills to auto-biograph. Another, I, would read it aloud at the meeting. I became thus her avatar, and in the course of that duty paid more attention to her story than I can recall having done at any time in the past, to any personal account. It was a lovely story, even while it held elements of tragedy mitigated by an uncommon capacity for tempering those elements with humor. As the word had spread that she would be sharing the story of a decade’s recovery embedded in a half-century of life, the reception hall had filled. We sat at the speakers’ table, she dressed elegantly for a mild tropical evening, bringing with her a small stuffed toy animal to act as her auditor. Fascination lay upon audience. I began reading. No eyes were averted from her for fully 40 minutes. She confessed that writing the story was arduous, for committing her disclosures to paper could not be retracted. She also felt that it was a gift, both given and received.
The audience included some who did not directly know the principal, but all knew of her reputation as someone who relentlessly gave, and gave. And they understood that even without training in the management of illness, this was someone unequalled in her capacity to recognize those areas of risk and of opportunity which accompany long recovery.
Those without addiction who care for the patient with addiction:
For the many in our Society who also have addiction, much of the willingness to serve comes from one’s own experience. Ahmed was one of those normal, good-natured if pensive professionals who loved his patients even while not suffering from the same illness as they. His empathy derived from a concern for all with illness or disability. He was an example of the sort of professional who does his best work exactly because of not-knowing. He desired to understand what impels such a painful illness, superficially bearing elements of volition yet which is surely anything but voluntary.
On August 5th of this year, Ahmed Elkashef, M.D., Psychiatrist and addiction physician, died. He had long served with the US Public Health Service Commissioned Corps, ultimately retiring as a Captain (O-6), most of his career within the research arms of the NIH. This was far from the extent of his service, however. From his several obituaries and biosketches:
… Ahmed Elkashef was an Addiction Psychiatrist Board Certified in General Psychiatry and Addiction Medicine. He received his medical degree from Cairo University School of Medicine. He completed his Internship and Residency Training in Psychiatry in 1990 at the University of South Carolina and the University of Maryland, followed by Neuropsychiatry Fellowship at the National Institute of Mental Health, Neuropsychiatry branch in 1992, where he stayed on as a Senior Staff Fellow till 1996. In 1997, he moved to the National Institute on Drug Addiction (NIDA) as the Chief of the Clinical Trials branch in the division for Medications Development till 2010.
In 2011, he joined the National Rehabilitation Center in Abu Dhabi as the Head of Research and Studies section. He was also an Assistant Professor of Psychiatry at George Washington School of Medicine. His research focus and publications are in addiction, psychopharmacology and neurobiology of mental illness. He published extensively in peer-reviewed journals and authored many book chapters and scientific reviews. He was an active participant and presenter at ISAM meetings including his role as Chair, Scientific Organizing Committee for the ISAM 2017 Annual Meeting and Scientific Conference in Abu Dhabi.
Ahmed’s patients understood him not as a fellow patient, but as a consummate professional who would bring the best possible knowledge to bear, with as much time as he could devote, to the service of treating an illness. They could not expect him to have had the same subjective experience as they, but it was not for experience of the illness that they came to him; but rather, for the quality of his objective understanding and for his unstinting and exhausting efforts.
- Editor-in-Chief: William Haning, MD, DFAPA, DFASAM