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Santa Monica/Culver City; father a quart-a-day gin drinker; mother deeply codependent; father later sober ~35 years but “dry/angry.”

Teen: ska/mod (Specials, Selecter, Untouchables, Madness), Vespa rides, alcohol/weed/amphetamines.

Berkeley & Free Clinic

Chose Berkeley (also accepted to MIT); Berkeley Free Clinic mentorship; lineage to Haight-Ashbury Free Clinic (David Smith; bands funded care).

Purpose & “hero’s journey” framing; service as “primary purpose.”

Anesthesia / pain medicine

Charmed by physiology-in-real-time and the human connection (esp. parents in pediatric cases).

Basics: take away pain & anxiety/memory (e.g., fentanyl, Versed); use relaxants; manage airway/complications.

Favorite contrast: from tiny trigger-finger release to replacing the aortic arch.

Fentanyl descent (1999)

Diverted via paper logs; carried 2 mL for a month before first sterile IV use; loved the warm/relief/confidence.

Waited ~6 weeks, used again; escalated to “after work only,” leading to daytime withdrawal and concealment (long gown to hide arms/weight/sweat).

Experimented separately with other drawer drugs (e.g., propofol, pentothal; hates ketamine → “crumpled cellophane” feel).

Sufentanil even more potent but dangerously narrow window.

Intervention & recovery

Chairman’s page about missing fentanyl; offered help, not punishment; referenced prior resident death.

Bathtub cold-turkey detox; called a sober doctor; went to an AA meeting of doctors; felt less alone; kept going; “ultimate challenge is handling success.”

Treatment feedback groups taught honest feeling-language and service; newfound congruence.

Finished residency (board made it 2 years), married, child, then shift to treatment medicine in Malibu; “fish met water.”

Substances & side topics

Adrenaline/epinephrine: synthetic now; shooting it feels “weird/anxious.”

Hitler: amphetamines + opiates (references Blitzed); late-stage junkie logic/psychosis frame.

Halsted: cocaine mapping nerves → heroin maintenance, long IM use with periodic retreats; even “stable” heroin isn’t smooth.

Crowley: “infinite supply” idea discussed; brain adapts—no stable bliss.

Benzos vs. opiates

Opiate withdrawal: nausea/diarrhea/sweats/chills/aches/runny nose/goosebumps unique to opiates.

Benzo withdrawal: anxiety/fear, same feeling benzos treat → especially hard; seizures risk (Dave shares lived seizures).

Memory / benzos / awareness

Benzos disrupt hippocampal consolidation, but recall can still occur (e.g., intraoperative awareness with strong stimuli).

Kratom

Opiate-like activity; ~1/3 minimal withdrawal, ~1/3 rough as fentanyl, rest in-between (his experience).

Often uses Suboxone to transition; prefers to wait/see which group before MOUD.

Suboxone vs. abstinence

MOUD prevents death/harms; some should stay indefinitely; for most: “cast/training wheels” until life is rebuilt + real recovery connections in place.

Fentanyl now

Overall OD deaths have ticked down recently from the peak, but fentanyl involvement is sky-high; he says he’s seen fentanyl in other drugs, counterfeit Percocet common; heroin is rare now.

Economics: opium supply changes; fentanyl is cheap; heroin cachet remains among some.