Dual Diagnosis


Set Sail For the Heart of the Sun (for David)



Dual Diagnosis

The men met
At the corner of Cherry Street and Terry Ave.
The one with the dog
Was dapper, groomed, face washed,
Warm in his Sherpa jacket
A dog in tow on a retractable leash.

The one with the deeply lined face,
Puffy eyes, 3 day old scruff on his jaw,
Missing several teeth, others in dire need of repair,
With no coat, wrapped in a 12th Man flag,
Spoke with the strong odor of ethanol and decay
Emanating from that disheveled gob.

That’s a fine-looking dog.
I’d love to have a dog like that,
But I’m not responsible enough
To have one.
What’s his name?”
Felon,” the other man answered.

The man with the dog noticed a puzzled look on the questioning man’s face.
This happened ALL the time.
The man with the dog noticed it, expectantly.
Must be his pronunciation.
Felon…like a criminal,” said the dog handling man.
That man saw the light go on in the other man’s face and eyes.

What a COOL name!” said the snaggeltooth.
He’s a fine animal.
You see, I’m an alcoholic,
And bipolar.”
No news flash.
I have a dual diagnosis. May I pet him? I always ask.”

Sure! Fel…come here and meet…ummm…”
“…Gary. Come here, boy”
The drunk reached out a trembling, weathered hand,
And gently stroked the dog’s wide,smooth head.
The dog’s tail wagged as it always did when shown such affection.

He’s a fine dog,” he murmured breathing out fumes.
Maybe someday I can have a dog like him.”
Well, I hope so,” said the dog’s owner.
I wonder what you’d have to do in order for that to happen?” he asked respectfully.
Well…stop drinking, get a job, and a place of my own.
But that’s really hard.”

Yes, Gary, it is.
It can be done tho.”
The dog’s chaperon thought back,
Twenty five-odd years earlier,
His own drinking and cocaine use brought him to his knees.
Couch surfing after a hospitalization, faced with the same dual diagnosis.

So bewildering…the dog walker had made it through
The maze of the strong pull for release promised by substances,
The seemingly endless maze of one set of meds
After another, and another, and another.
And yet, here he was
Just doing the next best right thing after the next best right thing.

How would Gary do it?
Without even a couch to surf from?
Burned bridges strewn in his past.
Burnt out friendships and relationships.
No job, no anchoring to any semblance of reality
That the man with the dog had found, after much searching.

Well, I’ve gotta go,” said Gary.
You have a good day, Gary”
Thanks!” And Gary shuffled off, body lurching from impending DT’s.
Right down the street, Straight to the convenience store
To get that “magic potion”
That would set him aright for a few more hours until he required another dose.

So bewildering.
I guess not today, Gary,” the dog’s owner thought,
As he headed home.
Still puzzling.
Why me?
And not him?”

© Richard A. Martin, Jr., MD, CPC, 2016


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The needle slipped in so easily
And created a profound change.
I was sickened first from the hepatitis my patient transferred to me
But there was more.
A madness that turned me from normal
To having long periods where no rest could be found
Despite the narcotics, the barbs, the benzos.
My unwanted companions for 13 long years.
And between the hyperactivity,
Bone-crushing depression for which I sought help
From amphetamines, cocaine, meth.

 Over that decade plus,
I treated myself, a fool for a patient,
Having more and more trouble
Modulating these foreign moods
Which had become commonplace and routine.
4 marriages, 3 divorces,
Another marriage on the rocks.
And becoming habituated to my chemical compounds
At one time thought of as friends but now enemies.
It was this fourth marriage on the skids
And my separation from my son that wore me out finally.

I chose the barbs as my exit tool.
Lying there conscious of the fact that I needed to remember to breathe.
Somehow a friend I had known from years’ back
Just happened to show up,
Just happened to find me in a stupor,
Just happened to act rapidly to call 911,
Just happened to.
I was comfortably numb during the resuscitation,
Thank God!
I really have no recall until I was transferred to Rehab
For detox and a 30-day drug and alcohol program.

After detox I was diagnosed…
Bipolar 2 was the name they gave me.
And, oh, by the way, you have AIDS, too.”
I recall the perfunctory way the doc
Just slipped that test result in front of my face
And said only, “Don’t do any more drugs.”
Not noticing how dumbstruck I was
Offering no compassion.
Perhaps he knew the relationship of AIDS to Bipolar?
Maybe not…
But I uncovered it and thought back to 1977.

That gave me insight.
Whenever I’m sick
It’s best for me to create a mental picture of my illness.
So now I had one.
A link back to that patient in 1977
The one with dementia
And weight loss
And cryptococcal meningitis
After all those years I had, unknowingly,
Made one of the very first AIDS diagnoses.
A dis-ease I had given myself!

Despite tremendous personal, financial and professional issues,
Despite the cognitive impairment that went with that diagnosis,
Despite the endless array of varying combination of pills and potions,
I aligned myself with the BEST practitioners I could find.
I followed treatment plans to the very letter.
I enrolled in experimental protocols.
I struggled to survive
Not one, not two, but three
Life-threatening illnesses…
After 25 years, it finally paid off.

The lynchpin was dumping the “drug of choice”
And starting an atypical and two antidepressants-
I suddenly became calm
And normal like I hadn’t been since before the fateful day
Back in 1977.
It was almost as dramatic as flipping a light switch
And flooding an unfamiliar room with light.
To see the unseen for those thirty plus years.
To be back in my own skin again.
To achieve normalcy.

After those eighteen years of work

The rubrics cube of me was finally aligned correctly.
Today, I’ve been in the same relationship for over a decade.
Today, I’m residing at the same place for fourteen years.
Today, I’m an effective father and spouse.
Today, I have personal responsibility for myself
And my remission.
Today, I engage in activities that are congruent with my nature,
Which is that of an intelligent, empathetic, resourceful person,
Able to deal effectively with life on life’s terms
And share my successes with those who would have them.

The takeaway?
Recovery IS possible
As long as one has the capacity to work hard
With themselves
And their healthcare team
IF I could do it
That means it IS possible
Like anything of value
It requires effort
And courage
And, I’d guess, a bit of luck.

© Richard A. Martin, Jr. MD CPC, 2016


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Set Sail For the Heart of the Sun (for David)

Oh, Captain…
On our trip to the Island
We talked about many things.

We smoked Marlboros, ate sandwiches,
Did sailing things, talked through the tequila.
It was fun when the boat passed so close by, with the “horny” sailors…
Sharing with us the secret contents of their pants.

The talk that followed was so natural, to me.
It was about the most sensitive of issues,
But our discussion was as natural as my motion tonight.


The call came at evening.
I had to go to confirm his death…
That was my job.

When I saw him, I recognized that he was in that place-
The place we discussed on the boat.
My charge would have to be one of protection for him
As he tried to die.

He had already lived his life when he decided to let go.
We talked about his perception that life had become more of a hassle,
I argued successfully, for a few times, that it had not…
but the topic came up more and more,
Better argued each time.

I could see by his bony frame and mottled skin this was going to be my last visit.
His body felt so cold, so distant…not like living flesh…more like the best of impostors
His jaw slacking so…just severe enough to turn his face into a masque,
Unreal…but real enough…actually, as real as it gets.


I have served my Captain as valiantly as I could.
I have no such servant…my route is up to me, alone,
Searching the grimy walls of backrooms and johns in bars
They promise to show you a way to paradise…
But more often, they cannot deliver their promises
Unless there is someone as connected as we were…

Now *I* is all alone.

© Richard A. Martin, Jr., MD CPC, 1996


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Hope is definitely not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.” – Vaclav Havel


When the days were dark
With illness and death all around,
Hope lay dormant - 
A lamp hidden under a bushel
Of despair.

But it still gave it’s light
To allow the man to go on.
How this happened
Was that the man was certain
There was meaning in the meaningless.

He often created his own meaning,
Certain of that hidden light.
The light waiting to be uncovered,
Placed on a lamp stand
To light the room of his life.

There was a certainty that the light was there
Just unseen - like a tree might make a sound 
As it fell in a forest
Although no one was there to hear.
A light of potential.

Love removed the bushel.
Time and blessings upon blessings
Acted as that lamp stand.
Faith kept the feet of his life
Plodding one step ahead of the last.

And when that light shone
All of those blessings
Culminated in a cacophony of grace
Abundantly poured out
Flowing like honey

Into every crack…



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