Dual Diagnosis

Dual Diagnosis
Dual Diagnosis

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

Five Trees

Five Trees Five Trees

Five Trees

Five trees with dying leaves. The center tree and the one to its left ablaze with the dying rays of the sun. A beach house stands at the end of the row. Abandoned. The marshy tufts of grass swept by a wind from off the beach, which slopes gently away from the grassy turf where the trees stand, erect against the sea breeze.

The dark outline of the beach house is captured stark against the evening sky with wisps of clouds blurring the outline of the golden sun.

It’s 3 PM and there’s a chill in the air as I walk toward the beach house, almost a silhouette at the end of the plateau close to where erosion has claimed and continues its claim on the plot of land where the arbor stands. Eventually they’ll either need to control the erosion or let the sea take the beach house. Even the trees flirt with the edge. I’m coming up the berm and climbing up the edge that spills into the flat space where the lonely trees wave gently against the sea breeze that drives the waves I can hear to my back. When I finally get to the flat grass where the beach house sits, I need to make a sharp right to walk along the edge of the plot of land to move toward the cabin.

I enter the cabin. I’m not alone. The tinkling sound of another man standing at the trough that serves as a urinal. I step up to the line on the floor delineating where one needs to pee over to hit the intended mark. The warm organics flow toward a central drain where we both hear our work flowing into the sewer.


Five trees. Two golden in the sunset. A sea breeze.

Stark against the evening sky.

A chill in the air. The eroding of the shoreline.

I walk to the cabin.

I am not alone. A dimly lit figure beside me works in the same way as I.

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

Medical Geology

Medical Geology
Medical Geology


Medical Geology

So, we have this task, see
To create a piece based on words
Selected by another
Based on their expertise.
Their work.

This is tough for me.
I’m a one-trick pony.
It’s a pretty slick trick…
I can cut a person open
and then put them all back together again with ease.

That’s about it.
So, I picked these geological terms.
A subject I know nothing about.
Medical geology?

Medial moraine
…any glacially formed accumulation of unconsolidated glacial debris that occurs in both currently and formerly glaciated regions on Earth
I’m thinking about how, embryologically,
The human spine is formed…
Backbone a synonym for moraine.

Granitic intrusion
…like Devil’s Tower
In that Spielberg movie
I went to nightly while ill
During training.

…a glacial island
I’m reminded of this woman,
Her cancerous flesh
Jutting out from her pale breast skin.

…a mountain lake or pool, formed in a cirque excavated by a glacier.
Like Crater Lake
Where I and my son’s mother abused one another
For the sake of Shakespeare.

…(from the German for mountain cleft)
German, like mittleschmerz,
The “middle pain”…
Free blood in the peritoneal cavity after ovulation.

Then things got easier…

…what I am –
Or at least had been –
On the day before the anniversary
of Kristallnacht.

There it is!
…an ice hockey player whose primary function is to check opponents,
Like Coburn, or Sustr.
I knew one!!
Hockey, being another skill I’d forgotten about.

All this for the craft of poetry,
Which I’m hoping will be
A way for me to say
Things unsay-able.
About grief, and loss, and dis-ease.

Unsay-able because
IF I said them
I’d cry.
And Boys Don’t Cry
And I’m a boy.


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

We Went On The Boat (a sonnet for David)

We Went On The Boat

We Went On The Boat (a Sonnet for David)

It was our pride and joy, that boat…our prize.
We’d go to Key West every year in fall,
After summer downpours left the noon.
We made our pact there as we both had suffered
from the plague ungluing all our lives.
Now I’m here next to David’s pallid body –
pale blue masque on, jaw a slack, grotesque.
He made the leap; he had escaped, was gone
Upon a journey I could not attend.
He left me all alone to sail solo,
Yet, He was captain and I his lowly mate.
Who would pull the spinnaker to catch the breeze?
Or talk with me as a person, unaffected?
Now, I was all alone just cast upon the water…

I sold that boat…

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

The Morning Liturgy

The Morning Liturgy
The Morning Liturgy


The Morning Liturgy

It’s 9 AM
And my phone,
Which has been monitoring my slumber
All night,
Chimes its tune.

Now, that fucking song will be stuck in my head
As the day progresses.
I check to see
How well my sleep app
Says I’ve slept,

Completely ignoring
The fact that I feel
Rested and ready
With only a bit
Of residual from sleep clinging to my eyelids.

The next part of the ritual
Is to expectantly
See who has been in contact
As that cloud of awakening dissipates.

I empty my mail trash
(I get a buttload of that
Despite trying to keep my inbox
Lingering on my favorites.

After doing what I can
On my handheld,
I roll out of bed
To the adjacent chair
At my computer,

The central piece
Of my organizational life,
And attend to my reminders
And any work
I couldn’t do remotely.

I preen the computer
Carefully, like a vine keeper
Minds his orchard
Keeping my machine
Lean, fit and trim.

After this
(And it may take some time)
I’m ready for the Coffee Rite…
10 cups of cold, filtered water
Over burr-ground Sumatra, a guilty indulgence.

The next formula
Is the March of the Medications.
They were carefully laid out
The evening before
And all ready for the ceremony.

This one with food,
That on an empty stomach.
Each one
Taken like Communion
Due to their large size.

The necessities done,
I turn to hair and wardrobe.
All just so
As the ceremony comes
Toward its end.

Finally, the dog’s pills,
(You see, at our house,
We keep Big Pharma going strong)
The bundling up…
The harness on the patiently waiting pup,

Out the door, across the parking lot,
A glance at the headlines
Blaring from the machine in our path,
Across to his favorite bush to water
And that delightful first sip of java.

The “Mass” is ended…and we go in peace into the world
For another piece of the miracle of a shiny new day.

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

Can You Fix Anything. Anything At All.

Can You Fix Anything. Anything At All.
Can You Fix Anything. Anything At All.

Can You Fix Anything. Anything At All.

Can you fix anything?
That would assume
You had some ability to change the past
And as we know
That is not possible.

Or is it?
Can we create a meaning for the meaningless?
Can we work to conform a given story
Into something
We find more palatable?

What about finding meaning
In the meaningless?
Is there such a thing as “meaning”?
I think I know that answer
But, life, sometimes, in my experience,

Is a cacophony of noise and furor
Signifying nothing
It is true, though
That I still try
To wrestle a story into a frame,

Like a painting…


Can you fix anything?
That would suggest
That we can alter
Immutable facts and happenings
Which we cannot.

Or is there a way?
Perhaps our lives are about
Creating a meaning
Out of the meaningless
In order to present it in a frame


Can You Fix Anything? Anything At All?

The short answer
No, but you can fix
A thing’s

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

Our Sunday at the Locks

Our Sunday at the Locks
Our Sunday at the Locks

Our Sunday at the Locks

It was my first time
At the Locks.
About time after living here
After 20 years here.

They were fascinating
Watching the water rush in
To carry the big boats up about six or seven feet,
The discrepancy between the Sound and the lakes.

Lots of traffic
From less expensive mooring
On the bay
As opposed to Lake Union.

Yet, Lake Union was where everyone wanted to go
There…or Lake Washington.
Through the Cut
Close to Portage Bay where the houseboats sat quietly.

We walked through the arbor
And chatted about things…
Our collective and individual pasts
And our present and future.

Someone brought up
My husband’s and my “date night”.
I mentioned that, after almost a dozen failed attempts at love
How important I’d found it to keep things fresh between my hubby and I.

And it had worked well
For the last decade and plus.
After our meandering
We ended up on Capitol Hill for cider and small bites.

What a wonderful evening
Capped off by hugs all ‘round.
Only the dog was unhappy at our late arrival,
Scolding us about our absence.

© Richard A. Martin, Jr. MD CPC 2016





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




I was on my way
To a place I grew up in.
I knew I was on the right road-
The big mountain was right where it was supposed to be…
The Brothers had lost most of their snow-pack
In the waning throes of that summer day.

But…the spidery cranes and laborers
Carrying sheet rock to and fro,
The skeletal web of girders and concrete
Everywhere I looked…
Not a familiar sight at all.
The bookstore now a high rise…very disorienting.

Gone was the PETCO
Where Ms. Kiddy had her nails done.
Gone was the old tavern
Where we’d drink and sing karaoke
And brunch together on Sundays.
Was this actually the right place?

It was so
All over the city…
Growing taller,
Places I’d visited many times…Gone.

Yet, in the midst of all that change,
There it was…Easy Street.
The familiar breakfast,
The records now replaced with CDs.
But Paul was there, and Alice, and Scott;
Teresa even made a cameo.

The same but different.
In the midst of change,
We ate, we talked…
Even went by the old house, still there.

A comfort among the disquieting

© Richard A. Martin, Jr. MD, CPC 2016




Just like clockwork…
The winter has begun.
Bumbershoot is over, winter’s upon us.
Oh, we may have a few more decent days
Of Indian summer
But winter’s coming.

So, there’s a real strong marine push today.
And here we were, Felon, my dog, and I
Walking down to the alley
And coming towards us
A guy I knew from my brief stint in the 76 store
Last Fall.

This guy used to visit frequently
During a shift – say 12 hours and 2 or 3 visits –
And always make the same buy,
The fortified beer…one can…in a bag
Perhaps he needed that to be healthy
Which he always appeared to be.

I knew him from the church,
Ozanam House for the Chronically Homeless.
He had a nice warm bed and three wholesome meals a day.
I wondered if he didn’t actually need that frequent drink
To keep the ship aright
But that would be another story.

So…me, Felon one way, this man the other in the alley…
And it was the first time I ever saw his feet.
(The counter obscured view from the waist up when we’d interact at the mart)
And as we came slower towards each other,
He and Fel lock eyes…you see, they were buddies.
Fel loped his happy dance toward him and both sets of eyes brightened.

He had to re-ask Fel’s name, and each time he chuckles when I say “Felon”
“Like a criminal”, just to translate
He always says, “Oh, he’s not a criminal!”, with a great big smile.
And, not sure how he comes ready with pepperoni stick in pocket,
But he does, every…well almost every…time
Today, tho, I saw his feet…first time…

He had a Reebok on his right foot
And a Rockport on the left..
And while he and Felon were exchanging hugs and kisses,
I longed to get the “story” of that mismatch.
“Business on the left, party on the right” came to mind
An old comedy routine

At it’s inception a sociological statement about a type of haircut,
But topical here, it seemed.
And, of course, me, the storyteller reached inside to my things…
How I became “branded”.
And here’s the one I made up here…
Once upon a time…

And the story was about this man,
Living on $756.00 a month plus food stamps.
He has shelter but this costs him dearly
Fifty-six bucks left,
At about $7 a can,
He needs that extra cash from his pension
To stave off those infernal shakes.

And, so, shoes take a different place in his life. Amen
Whew! He’ll just make it! On the beers.


© Richard A. Martin, Jr. MD CPC, 2016