In reading Nick's abstracts for this week, I was struck particularly by one of the entries, relating to the pharmaco-economics involved with the use of heroin versus prescribable pharmaceuticals; in sum, that it’s cheaper to get drugs (colloquial) than to get medications.  It put me in mind of two earlier ASAMW editorials relating to market forces and the almost-astonishing mundanity of illicit drug distribution.   That thought put in train a series of others, reminding me that I have been editing this periodical in what was originally intended to be a stopgap measure of several months, for over 3-1/2 years.  

And those were only the thoughts that proceeded fairly logically from the original item of interest. They take no account of the momentary tangents that my mind pursued, nor of the feelings and sensations that arose apart from coherent thought. Visual impressions, vague auditory memories, aromas, tastes, all waiting to be solicited and some actually experienced. Marcel Proust made a reputation out of this with his  Remembrance of Things Past; and so to some extent did Oliver Sacks, that neurologic wizard whose experiences even more closely paralleled our own, as physicians:  in The Man Who Mistook His Wife for a Hat, On the Move, others.  Professor Harry Lee Parker, at Trinity College, Dublin, in the 1930s and 1940s, and after at Mayo Clinic, loved the tangents, the circumstantial tours that a thought or a case could engender (Clinical Studies in Neurology).    

Where it took me, in an effort to return this commentary to relevance, was the importance of experiential associations to our population of patients.  In a personal journey through addiction/alcoholism, all memory of events while intoxicated was not erased by a tsunami of alcohol washing over the hippocampus.  And perhaps it was fortunate that this was so.  Some of the memories need to be elicited, in service to remaining recovered, particularly if they prepare us for hazards that will recur.  Nostalgia is not reminiscence alone, it is a yearning, and is important to distinguish from a true history; for this, we rely at least equally on how others saw us.   Thanksgiving arrives unbidden this week, which for our patients begins six uncommonly perilous weeks, in a life with peril enough.  No longer a hike over rugged and uncertain terrain, it is a climb up the vertical face of El Capitan with old pitons, in a storm. An unanticipated noise, a falcon brushing overhead, a sharp pain however brief, and suddenly everything relies upon the ropes.  We will ask them afterwards, did s/he remember to bring ropes?  

- W. Haning, MD