Friday, August 27, 2010

club drug as antidepressant

Good morning. I would like to expose myself. No, wait, there's more!

I would like to expose myself as a person who knows and understands things scientific in a very limited and prejudicial manner. It's just the truth --my capacity is in the realm of the pseudo-, of pretense.

Of course, this being my blog, and this blog representing my real interests, when I present medical information pertaining to CRPS/RSD, I try to educate myself enough that I am not, at the least, being irresponsible.

Okay, okay, except perhaps as pertains to Jose Ochoa, who is clearly a turd but I don't see passing that fact on to my few readers as even remotely irresponsible. It's more like a Public Service Announcement.

I am trying to say that I am more humble than you might think when I set about to read and digest medical studies/announcements.

Even so, sometimes I just want to scream, and possibly shake someone silly.

On the off chance that some CRPS-related information is listed under the search term ketamine, one of my medical feeds checks for daily references to the drug. Most studies relate either to abuse of ketamine, its deleterious side effects, or to proposals of novel uses for the anesthetic.

Today? Well, there is something on the harmful effects of ketamine on the urinary tract ("a new radiological challenge"!), a bit about partial tripolar cochlear implant stimulation in ketamine/xylazine anesthetized guinea pigs, a veterinary medicine label update for KETAMINE HYDROCHLORIDE injection,/solution ("for Intramuscular Use in Cats and Subhuman Primates Only"!), and something about how ketamine can reverse "the expression of tolerance to the anticonvulsant effects of morphine."

Not stuff terribly applicable to CRPS;  Not stuff terribly accessible to a non-medico such as myself.

But then there was this -- An article in Nature, titled Neuroscience: Quick mood lift, with this come-hither statement serving as tantalizing abstract:  Patients taking traditional antidepressants have to wait several weeks for the drugs to kick in. However, a few severely depressed patients taking ketamine, an anaesthetic and recreational drug, have shown improvement within hours.

Okay, so I don't have a subscription to Nature... and cannot access the current edition without forking over $32.  By a search of the terms ketamine and antidepressants, limited to the past week, I feel pretty confident that I understand the claims of the Yale researchers.

A quick search of the journal finds this Nature article -- from 2006, about another study (at the National Institute of Mental Health) that revealed the exact same results and engendered the same excitement:

Club drug finds use as antidepressant:  Psychedelic ketamine hits the blues surprisingly fast

The 'club drug' ketamine may be the fastest-acting antidepressant ever tested, researchers report today.

A team based at the US National Institute of Mental Health (NIMH) in Bethesda, Maryland, studied ketamine in 17 people with major depression. All the subjects had failed to respond to treatment with standard antidepressant drugs or more drastic methods, such as electroshock therapy. But 71% felt better the day after taking ketamine, and 35% still felt better a week later. None improved when dosed with a placebo.

Most striking, the scientists say, was that some patients felt better less than 2 hours after taking ketamine. Currently approved drugs can take weeks to remedy depression. The work is published in the Archives of General Psychiatry.

"It's almost like there's a sound barrier for those us who do depression research, and we have not been able to break it," says Carlos Zarate, chief of the mood and anxiety disorders research unit at the NIMH, and first author of the study. "That's the exciting part of this — now there is evidence that we can."

Zarate and his colleagues are not advocating that doctors start giving depressed patients ketamine right away. Large doses of the drug can cause brain damage in rodents, and its long-term health effects have not been studied in people.

"We don't want to give anyone the message to run out on the street and use ketamine," says Nuri Farber, a psychiatrist at Washington University in St Louis, who was not involved with the work. "It makes you crazy — that's why it's a banned drug."

Scientists are currently testing a wide range of recreationally used-and-abused drugs, including ecstasy (MDMA; see 'The ups and downs of ecstasy') and psilocybin, the active ingredient of magic mushrooms, as potential therapeutics.

Ketamine, invented in 1962 as an anaesthetic, is chemically related to phencyclidine (PCP), also known as angel dust. Both induce hallucinations and out-of-body experiences, hence their use as illegal psychedelics.

Ketamine has milder psychotic effects than PCP and is therefore also used as a legal anesthetic and horse tranquillizer. Scientists are studying whether it can be used to treat alcoholism and chronic pain, as well as depression.

Ketamine targets a brain protein called the N-methyl-D-aspartate (NMDA) receptor. Existing antidepressants target brain chemicals such as serotonin, but there is growing evidence that these drugs eventually affect NMDA receptors. Ketamine may work so quickly because it takes a short-cut straight to this part of the brain.

The psychotic effects of ketamine, such as euphoria, wore off before the antidepressant effects kicked in, Zarate's team found, suggesting that the drug's psychotic and antidepressant effects are separate. One surprising aspect is that other drugs that induce euphoria, such as cocaine, usually lead to a depressive crash once the high wears off.

Zarate's group is looking for substances with some of the chemical properties of ketamine, such as the ability to target NMDA, without the psychedelic effects.

Oh, well, good.

Worried about, ummm, side effects?  No sweat!

Other scientists, including Farber, have developed drugs that can be taken with ketamine to damp its side effects. Giving these drugs together might help patients feel better without getting high.

Of course, in the same issue, there's an article about "what it means to be an ant."

"It's like a magic drug — one dose can work rapidly and last for seven to 10 days," said Dr. Ronald Duman, professor of psychiatry and pharmacology at Yale University, who led the study.

Oh, dear Lord.

One final admonition -- to myself. Keep an open mind. The Ketamine Coma protocol for intractable CRPS has actually allowed some people to mumble the C-word -- cure.

Remember, too, though, that there have been deaths and other bad outcomes in both the Mexican and German research sites.

That ought to attest to the horrors of this disease, that people are willing to be injected with ketamine in an amount sufficient to maintain a coma for 5-7 days, risking their lives to have a chance at lessening the pain of CRPS.

Hmmm.  Here's a thought:  Maybe I should try putting myself in the place of someone so depressed, clinically, that they, too, would choose ketamine...

But I would still find this research more bother than boon.

I still want to shake someone silly.

Wednesday, August 25, 2010

Stephen Bruehl, Rock Star

Stephen Bruehl is fast becoming a rock star in the world of CRPS research. Here is an excellent review article, available in its entirety here.

[This article may be accessed for personal use at no charge through the Journal Web site.  Hooray for free access to all!]

rock star Pictures, Images and Photos

September 2010 - Volume 113 - Issue 3 - pp 713-725

An Update on the Pathophysiology of Complex Regional Pain Syndrome
Bruehl, Stephen Ph.D.

Complex regional pain syndrome (CRPS) is a neuropathic pain disorder with significant autonomic features. Few treatments have proven effective, in part, because of a historically poor understanding of the mechanisms underlying the disorder. CRPS research largely conducted during the past decade has substantially increased knowledge regarding its pathophysiologic mechanisms, indicating that they are multifactorial. Both peripheral and central nervous system mechanisms are involved. These include peripheral and central sensitization, inflammation, altered sympathetic and catecholaminergic function, altered somatosensory representation in the brain, genetic factors, and psychophysiologic interactions. Relative contributions of the mechanisms underlying CRPS may differ across patients and even within a patient over time, particularly in the transition from “warm CRPS” (acute) to “cold CRPS” (chronic). Enhanced knowledge regarding the pathophysiology of CRPS increases the possibility of eventually achieving the goal of mechanism-based CRPS diagnosis and treatment.

Articles in PubMed by Stephen Bruehl
Articles in Google Scholar by Stephen Bruehl

Correspondance:  Dr. Bruehl: Vanderbilt University Medical Center, 701 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, Tennessee 37212.

Monday, August 23, 2010

WTF, squared

U.S. Court Rules Against Obama’s Stem Cell Policy

Published: August 23, 2010

WASHINGTON — A federal district judge on Monday blocked President Obama’s 2009 executive order that expanded embryonic stem cell research, saying it violated a ban on federal money being used to destroy embryos.

Regula Benedicti: Ora et labora

We've requested a Special Mass to be held at the Monastery-Down-The-Road on behalf of my brother Grader Boob (his preferred form of address). We do this every year on the first day of classes at his university.

Of course, we haven't always had the luck to live next door to a Catholic Prayer Factory. Back in the States, we sometimes had to improvise. The things we had to do to get the Jehovah's Witnesses on board! Only for Grader Boob would I deny Plato and my firm belief that I will suffer the fires of Hell.

On the other hand, it was hard to get the Presbyterians to stop hosting Prayer Vigils for Beleaguered Educators every hour, on the hour -- once they get stuff out of committee, Presbyterians are a fearsome force.

One year we were kind of in a religious snit, and went with the Council for Secular Humanism. Okay, so they kicked us out when I began screaming "What do you mean there’s no such thing as spirit? And Grader Boob, he's undesigned, unintended, and responsible for [himself]? Since when? I don't think so! And, furthermore: Harrumph."

Since we've been in occupancy at The Manor, and since Marlinspike Hall borders the monastery, Fred and I have been treated to catechisms and concordances, hagiography and the Regula Benedicti, The Rule of Saint Benedict.

The Rule of Saint Benedict is my Bible -- and in so saying, I am not cracking wise. I mean, who needs a little structure, some guidance to monastic life in community, more than Fred, La Bonne et Belle Bianca, The Remnant Felines {waving to Celestial Sammy} -- and myself? Who needs help in the practice of hospitality more than Manor Mavens? And who has benefited from the commandment to welcome guests to the monastery more than I have -- a woman choosing monastery over easily accessible convents? Receiving the stranger as Christ -- now *that* is a huge break and boon for the visitor such as myself.

[Once-upon-a-time, I developed the habit of vacationing at monasteries, staying between 7 and 10 days, usually silent and observing the hours.  Very refreshing, envigorating.  I hope to have shown sensitivity as a lone woman visitor to the manly monks.]

Ora et labora, people, ora et labora!

The monks, for this year's celebration of Grader Boob and the return to school, have decided to go with the theme of Patron Saints: Whose Your Daddy? (The Brother-in-Charge of Event Planning just blinked when we pointed out the sexism of that title. He'll regret that when the Militant Existential Lesbian Feminists show up in their picket gear, with chains and styrofoam coolers full of Evian, Power Bars, the leftover canapés from Joan and Karen's Commitment Ceremony, and huge chunks of dark chocolate [made from fairly traded, organic cocoa].)

Turns out the traditional choice for Patron Saint of Teachers is St. John Cantius. No problems there. No, the problem came from my request to include, for parity's sake, the uppity Ste. Catherine of Alexandria. I've been pretty insistent that she be included in any rite performed for the benefit of educative souls. 

Okay, so The Church denies her existence, claiming she is but the Christianized version of the amazing Greek philosopher/scholar Hypatia who, as it happens, was killed by a mob of Christians.  Monks, to be specific.

Called "premodern," Saint Catherine of Alexandria, before being shuffled off to Buffalo, was the patron saint of "royal" women, professors, scholars, libraries, archives, Balliol College, and the University of Paris -- as well as patron to milliners, millers, potters, spinners, tanners, a whole host of important crafts.

She is supposed to have been a babe, too, which is probably why we are blessed with a rich iconography:
Her principal symbol is the spiked wheel, which has become known as the Catherine wheel. Saint Catherine is also represented in Christian Art with a wheel. The wheel is generally broken, because, after she was bound upon it, by the intervention of Heaven it was shattered, and the flying fragments dealt death to her executioners. Under her feet is seen the turbaned head of the tyrant Maximinus, symbolical of the triumph of Christianity over the Infidel. Instead of the sword, the actual instrument of her martyrdom, a book is placed in her hand, in token of her learning. The crown upon her head bespeaks her royal dignity. As a noble's daughter she is patroness of princesses and ladies of noble birth. She is patroness also of students, philosophers, and theologians, because she put to confusion all the rhetoricians and scholars who came to dispute with her from all parts of the empire.
You can read the texts for her feast celebration on November 25 here.

St Catherine of Alexandria: Scenes from Her Life
Donato D' and Gregorio D' Arezzo, about 1330

Those Cistercians! All you have to do is cross their palms with silver and presto! Special Mass!  Just kidding -- I think it is less that I have convinced the good brothers of Catherine's perfect fit, religiously, and more the living expression of the Rule of Saint Benedict.  Always looking for the easy way to be kind, these guys.

So we're going to walk over to the Abbey Church about 5 -- provided I charge my wheelchair battery -- and commune with some living saints, while raising for God's consideration the difficulties of teachers, everywhere, but especially the challenges faced by the one, the only, Grader Boob.

With incense wafting (our inhalers at the ready), royal purple and insouciant pink tapers lit and in full flicker, we place Brother-Unit Grader Boob under the protection of St. John Cantius, professor of Scripture and Physics at the Kraków Academy noted for his good cheer and humility -- traits that also leap to mind about GB.  We will further invoke the fiery, feisty St. Catherine of Alexandria, intellectual superstar, not afraid to speak truth to power, calling out emperor Maximinus Daja when he went against the faith.  We hope for Grader Boob a semester without the need to face off against an administration that would compromise academic standards and impede the free application of earned grades!  Rah!

Much thank to The Cistercians for the Annual Blessing of the Prof!  In return we usually participate in the Annual Hiding of the Abbot -- he gets fed up once or twice a year, so we stash him in some regal suites and pamper the hell out of him, until he is ready to square off against eager airhead postulants and ancient wrinkled scholar monks fallen prey to Alzheimer's.  Last year, after the warehouse fire (they run a lucrative internet business), after they discovered that mild-mannered Father Clem was a pyromaniac, Abbot Steve came and hid in Marlinspike Hall until the Papal Envoys returned to their palatial digs.

Have a great semester, Grader Boob -- We love you!

Sunday, August 22, 2010

beggars *can* be choosers: repost

Perhaps you are in denial, perhaps you were brought up in a barn: whatever, as the kids say, in a tri-syllabic and weirdly stressed fashion.

what-ev-er. {roll eyes::purse lips}

I'd never heard it codified, or even noted an attempt to put it into words, before attending the memorial service for a homeless man named Joe who managed to touch many lives in the large city where we lived and slaved -- back in 1997, the Pre-Marlinspike Hall years.

Yes, his name was Joe.

Every charitable institution and person in the area wanted to claim special status for having known, loved, served, worried over, and self-defined by... Joe.

I was Homeless Guy Joe's best bud... Homeless Guy Joe came to me first when in need... I volunteered to be Homeless Guy Joe's payee back when we knew where he was most of the time... And so on, and so forth.

It turned out that Homeless Guy Joe made out like a bandit. Or perhaps it is better put that he made out like Robin Hood, for he was a generous fellow, was Joe. Very polite, unless agitated, sometimes by circumstances apparent only to his psychotic self. Good table manners.

I am going to stop italicizing "Joe" because, well, because it really was his name. Joe Coppage. He lived in our neighborhood long before we did -- an intelligent and, by all accounts, normal young man who went off to college to study architecture, only to be cruelly consumed by the sudden onset of schizophrenia. He was a slender white man, very unkempt, and was probably in his mid-40s when he died. Ah, wait. I have a photograph, famous now among my particular do-gooder group. It was taken by Charles Hinkle, who likely would bop you one if you intimated that he did any good for anyone, ever. You'll find his photo next to "curmudgeon."

He was beaten to death -- Joe, not Charles!

What Joe could possibly have possessed that would prompt someone to rob him -- or what he might have said to so enrage another -- is impossible for me to imagine, because Joe was decidedly mild-mannered and certainly destitute. We don't really know the scenario, the context, for his murder -- he was found on the sidewalk. I believe he spent about a week in the ICU, on a ventilator, without ever regaining consciousness, before one of the nurses recognized him. I am sure he was hard to recognize at that point.

[Wow. I just flashed on the memory of another man, John, who died of complications from AIDS. We managed to get him into a marvelous hospice -- and it was shameful how relieved and delighted he was by having his own room, a view of the courtyard full of flowers and a large fountain -- but mostly? Mostly he cried over having clean sheets and enough blankets, and over being clean between those sheets, under those blankets. After admission, John was only cogent for a day or two and spent the rest of his time hallucinating. He incorporated birds from the courtyard into his visions and seemed to consider them potent omens. He told me what bird I would see before I died. (I keep an eye out.) The day he died, he was demanding and yelling for an Arby's roast beef sandwich, which we got on our way to see him. You could say we were in denial -- we knew the state of his mouth, his esophagus, his stomach -- we were, in fact, intimately familiar with his entire gastrointestinal tract. You could say we were desperate to assuage our feelings of guilt and shame. You could even say that the only real grief we felt was for ourselves.]

Speaking of do-gooder guilt and shame, the opportunity to speak was extended to everyone at the memorial and Celebration of Life for Joe Coppage, and it took a long while to work through the apocrypha. Almost everyone shared a funny or touching anecdote -- Joe's life story was full of them:

In the early hours of one Christmas morning, Joe found a suicidal man huddled on the floor in the communal bathroom, heroin at the ready. The man told us later that day that Joe went to the bathroom, then turned, as if in afterthought, and said "Jesus was homeless, too." [If I hear this story again, I may be ill. It's true, though.]

Joe sat down at the piano one day and riffed off a jazz improvisation that left jaws hanging lax. And ask though we did, he wouldn't play again.

Then there were all those cute occasions when Joe refused to take his clothes off before showering. He always wore a donated suit, although he eschewed vests. His clothes ended up encrusted with the stuff of life -- feces, cigarette ashe, highly sugared coffee. Pellets of that ubiquitous non-dairy creamer stuff.

My most special memory of Joe? That would be the last time I saw him. He had not been around for weeks, but showed up for a hearty evening soup (plus salad and bread sticks!) on a night so cold that all the city shelters agreed to function over capacity. For some odd reason, I remember that we were "over" by five. Joe had frostbite on the very tip of his nose, and on his ear lobes. I did not get to see his feet, but I suspect they might have been bitten too. He was more cogent than he had been in years and we talked as he ate, the conversation being so normal that I don't recollect it. This memory is very visual -- my eyes kept straying to his ear lobes, black and swollen. A couple of the volunteers physically struggled with him after dinner to get him out of his nasty suit, into the shower, then dressed in a brand new ensemble, complete with fresh newspaper -- he liked to wear layers of newspaper with his clothing -- a common enough practice and wise, as it insulates against the cold.

There were two people who spoke the night of Joe's well-attended memorial whose words profoundly impacted me.

The first person, although unknown to you, needs no introduction. He knows best and has always known best. He walks the talk and disdains those who just sort of stumble along the roadway. He is a prophet, and looks down on the rest of us confused do-gooders, down the length of his long, long nose. (I'm implying that he fibs.) I'll call him Ed because that's Ed's name.

There were a lot of preachers there, and he was one, as well, although he is loathe to lump himself among his fellow sermonizers. You see, he left mainstream pastoring in order to live in community and among the poor, hungry, homeless, sick. He can be very annoying because he makes my conscience hurt.

He spoke near the end, after all the feel-good Joe stories that had people sniffing and dabbing at their eyes while gently laughing about the good old days.

Ed told us that we had helped to kill Joe, that we used him up like some lucky totem. Never once in all the years of "ministering" to him had we seen to it that he get consistent treatment for his severe mental illness, that he take the meds to counteract his psychoses.

Ed said that we wanted Joe to remain sick, that the Joe we liked was Crazy Joe. When Joe was medicated, he wasn't really all that cute, he didn't say the darnedest things.

Ed said that Joe was the city's homeless mascot and that we had used him as publicity, a white man from the neighborhood being a better emblem for fundraising than the black crack addict with HIV who was our more representative guest.

The second person who spoke to my heart was Marilyn. She is a complicated thing, is Marilyn, but that is a separate blog entry.

She told us a story of long ago -- maybe 20 years ago or more. Like Joe, she had lived in the neighborhood most of her life. For a while, he would wander among the streets, remembering who knows what, and looking for God knows whom. As time went by, his behavior became more and more erratic and he began to do things like gift his former neighbors with piles of excrement, neatly deposited by their front doors.

In those days, the shelter staff held informal weekly meetings and potluck suppers at Marilyn's house. Joe developed the habit of dropping by -- usually he just sat on her porch swing, muttering over and over the words by which he was best known: Pray for me. Pray for me. Please pray for me. (He drove otherwise even-tempered people insane with this incessant request. One minister of my acquaintance actually interrupted his sermon to yell: "I will NOT pray for you right now. Shush!")

But there came a summer night when Joe was hungry. He didn't want shelter food, so he decided to check out the staff meal over at Marilyn's house. Knocking on the door, he made his request known.

He was ushered in, and Marilyn set herself the task of making him a plate.

"We have egg salad, veggie lasagne, rice noodles with peanut sauce, meatballs, squash casserole, and crusty bread. What would you like?"

"A cheeseburger," said Joe.

"No, we don't have any burgers tonight. How about some meatballs and squash casserole. Nancy-Kate made the casserole, so you know it's good!" continued Marilyn.

"A cheeseburger," reiterated Joe, who seemed to know what he wanted.

She was losing patience. Finally, after a few more rounds of obstinance, Marilyn put a little of this and that on the paper plate, grabbed some napkins and a spoon, and thrust it all at Joe.
He looked a little frightened at that point, and held out his hands as if to push it away.

"That's okay, no, no, no. Pray for me?"

And with that, Joe went off into the warm fragrant night, unfed.

Marilyn told it better -- she laced it with funny details and had a timing that rivaled the best of raconteurs. But the punchline, the lesson, does not need any decoration:
Beggars can be choosers.

Walking home after the service, I remember trying to reconcile Ed and Marilyn's messages, trying to marry them together.

Were we to override Joe's wishes and force pharmaceutical normalcy on him, place him in adult day care for the sake of sanity? Were we to offer him a smorgasbord of choices, and delight in his choices, even when we did not understand them, even when he went away hungry?

And why, oh why, had we not had these conversations while he was still with us?

"when I came first to know that there were flowers also in hell"

Vahan Bego's [Saint] Sebastian:

Hoo boy. Shooting pains, followed by a little intimate throb::throb in the left shoulder. shivering from fever. is the night really over? I sent Fred off to worship with the militant existential feminist lesbians just a moment ago;  For the first time in years, we failed to wish each other a good morning -- we failed at every nicety of habit.

"See you," he said.
"Bye," said I.

He knows that I am teetering on the edge and he just doesn't need it right now -- no one does.

So, how sad is this? My insurance coverage does not kick in until (we think) 15 september... 24 days away. I have managed to stay out of the hospital since last October... which has been a real struggle plus a work of genius by my doctors -- true grit! -- only to fail at the attempt in the last few weeks before being covered again. No-o-o!

Just ignore me. [Have you ever gone to the top of a Blogger blog and clicked on Next Blog?  It takes me back to my days as a kid, traveling via National Geographic, a budding wheelchair anthropologist...]

I am emotionally needy when afraid, when I reach this point -- {what point?} -- When my attempt to control everything looks to be failing. I cannot even get my temp down to normal these days. Doc said to alternate ibuprofen with the acetaminophen in Percocet... I can get it down to about 100 but it just hovers there and i am worn thin (Oh, now, that would be nice; I had to raise the steroid doses and am hungry, always).

Okay, change the subject.  At least, for a few paragraphs.  There is a need -- not to be ignored -- to write about Hell, but it can be deferred a while.  Maybe I can even bury it in a big pile o' persnickety verbiage.

One of the ways I exercise and exorcise my various moral complacencies is by following the joys and resonant sadnesses inherent in the living work done at The Open Door

(Hmm.  At the words "living work," through the brain shot "Asphodel, that greeny flower"!  And so I went to renew that poetic friendship, one of my first.  Who does not grow up, at least in America, at the precise moment that red wheelbarrow depends?  As I reread most of Asphodel -- and is it any wonder that I don't get much done? -- I came to respect my memory, and the need to tell you about my Hell evaporated.  It's been done, as is said.  And so much better:

Of asphodel, that greeny flower,
like a buttercup
upon its branching stem-
save that it's green and wooden-
I come, my sweet,
to sing to you.
We lived long together
a life filled,
if you will,
with flowers. So that
I was cheered
when I came first to know
that there were flowers also
in hell.

I remember, once, an grad student in American Lit having a cocktail party moment, saying that WCW was so pedestrian. I wish! I wish!

So anyway, yes, I think of greens shooting in the spring from thin, bare branches when I think of The Open Door Community. Their needs are always, and never, met. Hey, I have an idea! If you have money to spare, send it to them:

Online donations can be made through Donate Now, a service of Network for Good.
They also need walking shoes, sizes 11-15, especially, and sandwiches, meat & cheese on whole wheat bread.  (I cannot remember if I have blogged on how beggers can be choosers?  It would have been a piece on Joe Coppage... and Ha! Ha!  I found it.  It's called:  beggars *can* be choosers!  I will repost it, as it is part and parcel of an offshoot to The Open Door.  Also?  Everyone knows a Joe, we just don't want to think about it.  That's why I am here, perhaps.  Sometimes?) 

I look forward to reading their monthly newspaper, Hospitality, as much to follow the health and well-being of founders Murphy Davis and Ed Loring as to keep an eye out for my own stuck-in-the-mud-ed-ness. Stucked-in-the-muddity? Fred and I are no longer part of the struggle, and yet are, of course. (We all are.)  It's just that we are out of practice, our hospitality is not crisp, is stale.  There are no homeless people in Tête de Hergé (très décédé, d'ailleurs).  Those who flirt with that sad state quickly find succor, usually with The Cistercians, sometimes here at The Manor, in Marlinspike Hall, where we can always use a hand -- but where we also can lend one, to the tired, to the sick, the worn out, to those teetering out-of-balance.  We aren't terribly different from The Cistercians, when push comes to shove.  They just operate with more of a theme.  Every room has a twin bed, a dresser, a bedside table -- all made of fiberboard -- with a Book of Psalms and a New Testament.  (The Old Testament causes the monks both dyspepsia and nightmares) In the Manor bedrooms, we have everything from rickety day beds to king-sized waterbeds, tables from consoles to converted one-of-a-kind medieval reliquaries, not to mention a mind-boggling assortment of religious reading material (often first editions, autographed) as well as every underground issue of Keep on Truckin'.

Anyway, the last pages of Hospitality are for Grace and Peaces of Mail, wherein I sometimes see the names of old friends and death row inmates.

In the latest issue of Hospitality, my eyes bugged out to see a letter from Father Tom Francis of the Monastery of the Holy Spirit. I mean, it is not unusual to see Father Tom's words out in the world, as I think the brothers are all wonderfully worldly, in spite of, or because of, being cloistered.  It's what he wrote that took my breath away... simple, to the point, and right. He probably doesn't consider himself brave, but I do.

Dear Gospel-friends, Ed and Murphy,
Even though I winced at the article Dear Pope: Call Me in the May-June Hospitality, it is all so very true, completely accurate, and needs to be read by most Catholics, who tend to blindly side "with our Holy Father." The multiplicity of [sexual abuse] cases and the extent of the cover-up by the bishops are ghastly evidence that even church institutions "protect" their reputations and money bags, ignoring grievous injustice to children and parents and the betrayal of the trust given to clergypersons. I hope this rightful exposure will bring our Catholic Church to complete transparency on these matters, now and in the future.
Father Tom Francis
Monastery of the Holy Spirit

Cistercians, those wacky Trappists! They keep you guessing.  Fred theorized that were we to drop in unexpectedly, we might well find Father Tom scrubbing the flagstones with a toothbrush.

Ah, it's now late in the afternoon, and my Hell begins to descend again.  I will do all I can to fight it off, starting with poetry.  Funny, but I am unfamiliar with Kora in Hell, Improvisations.  Dare I say that those poems are too young to help me, written before hell was properly understood? 

Yes, I do dare.

All these images in my hot head: Father Tom scrubbing floors for denouncing the Holy Father;  Ed and Murphy blessing people with big pots of grits and available toilets;  Joe Coppage, still crazy and still dead; Bottles of bitter white tablets, methadone;  Flaming arrows thudding against my body, stuck deep inside my pus-filled joints, female counterpoint to Saint Sebastian.

Take a few moments and enjoy this excerpt from Asphodel -- so lovely, so basic to our poetics, a protection against chaos.

Asphodel, That Greeny Flower
by William Carlos Williams

Of asphodel, that greeny flower,
like a buttercup
upon its branching stem-
save that it's green and wooden-
I come, my sweet,
to sing to you.
We lived long together
a life filled,
if you will,
with flowers. So that
I was cheered
when I came first to know
that there were flowers also
in hell.
I'm filled with the fading memory of those flowers
that we both loved,
even to this poor
colorless thing-
I saw it
when I was a child-
little prized among the living
but the dead see,
asking among themselves:
What do I remember
that was shaped
as this thing is shaped?
while our eyes fill
with tears.
Of love, abiding love
it will be telling
though too weak a wash of crimson
colors it
to make it wholly credible.
There is something
something urgent
I have to say to you
and you alone
but it must wait
while I drink in
the joy of your approach,
perhaps for the last time.
And so
with fear in my heart
I drag it out
and keep on talking
for I dare not stop.
Listen while I talk on
against time.
It will not be
for long.
I have forgot
and yet I see clearly enough
central to the sky
which ranges round it.
An odor
springs from it!
A sweetest odor!
Honeysuckle! And now
there comes the buzzing of a bee!
and a whole flood
of sister memories!
Only give me time,
time to recall them
before I shall speak out.
Give me time,
When I was a boy
I kept a book
to which, from time
to time,
I added pressed flowers
until, after a time,
I had a good collection.
The asphodel,
among them.
I bring you,
a memory of those flowers.
They were sweet
when I pressed them
and retained
something of their sweetness
a long time.
It is a curious odor,
a moral odor,
that brings me
near to you.
The color
was the first to go.
There had come to me
a challenge,
your dear self,
mortal as I was,
the lily's throat
to the hummingbird!
Endless wealth,
I thought,
held out its arms to me.
A thousand tropics
in an apple blossom.
The generous earth itself
gave us lief.
The whole world
became my garden!
But the sea
which no one tends
is also a garden
when the sun strikes it
and the waves
are wakened.
I have seen it
and so have you
when it puts all flowers
to shame.
Too, there are the starfish
stiffened by the sun
and other sea wrack
and weeds. We knew that
along with the rest of it
for we were born by the sea,
knew its rose hedges
to the very water's brink.
There the pink mallow grows
and in their season
and there, later,
we went to gather
the wild plum.
I cannot say
that I have gone to hell
for your love
but often
found myself there
in your pursuit.
I do not like it
and wanted to be
in heaven. Hear me out.
Do not turn away.
I have learned much in my life
from books
and out of them
about love.
is not the end of it.
There is a hierarchy
which can be attained,
I think,
in its service.
Its guerdon
is a fairy flower;
a cat of twenty lives.
If no one came to try it
the world
would be the loser.
It has been
for you and me
as one who watches a storm
come in over the water.
We have stood
from year to year
before the spectacle of our lives
with joined hands.
The storm unfolds.
plays about the edges of the clouds.
The sky to the north
is placid,
blue in the afterglow
as the storm piles up.
It is a flower
that will soon reach
the apex of its bloom.
We danced,
in our minds,
and read a book together.
You remember?
It was a serious book.
And so books
entered our lives.
The sea! The sea!
when I think of the sea
there comes to mind
the Iliad
and Helen's public fault
that bred it.
Were it not for that
there would have been
no poem but the world
if we had remembered,
those crimson petals
spilled among the stones,
would have called it simply
The sexual orchid that bloomed then
sending so many
men to their graves
has left its memory
to a race of fools
or heroes
if silence is a virtue.
The sea alone
with its multiplicity
holds any hope.
The storm
has proven abortive
but we remain
after the thoughts it roused
re-cement our lives.
It is the mind
the mind
that must be cured
short of death's
and the will becomes again
a garden. The poem
is complex and the place made
in our lives
for the poem.
Silence can be complex too,
but you do not get far
with silence.
Begin again.
It is like Homer's
catalogue of ships:
it fills up the time.
I speak in figures,
well enough, the dresses
you wear are figures also,
we could not meet
otherwise. When I speak
of flowers
it is to recall
that at one time
we were young.
All women are not Helen,
I know that,
but have Helen in their hearts.
My sweet,
you have it also, therefore
I love you
and could not love you otherwise.
Imagine you saw
a field made up of women
all silver-white.
What should you do
but love them?
The storm bursts
or fades! it is not
the end of the world.
Love is something else,
or so I thought it,
a garden which expands,
though I knew you as a woman
and never thought otherwise,
until the whole sea
has been taken up
and all its gardens.
It was the love of love,
the love that swallows up all else,
a grateful love,
a love of nature, of people,
of animals,
a love engendering
gentleness and goodness
that moved me
and that I saw in you.
I should have known,
though I did not,
that the lily-of-the-valley
is a flower makes many ill
who whiff it.
We had our children,
rivals in the general onslaught.
I put them aside
though I cared for them.
as well as any man
could care for his children
according to my lights.
You understand
I had to meet you
after the event
and have still to meet you.
to which you too shall bow
along with me-
a flower
a weakest flower
shall be our trust
and not because
we are too feeble
to do otherwise
but because
at the height of my power
I risked what I had to do,
therefore to prove
that we love each other
while my very bones sweated
that I could not cry to you
in the act.
Of asphodel, that greeny flower,
I come, my sweet,
to sing to you!
My heart rouses
thinking to bring you news
of something
that concerns you
and concerns many men. Look at
what passes for the new.
You will not find it there but in
despised poems.
It is difficult
to get the news from poems
yet men die miserably every day
for lack
of what is found there.
Hear me out
for I too am concerned
and every man
who wants to die at peace in his bed

[excerpt from -- I apologize for not reproducing the versification accurately.]