We Have Met the Enemy and He Is Us: The Opiate Education of a Vermont Doctor, Beach Conger, 2020

This is a terrific book—-laugh-out-loud funny in parts, cry-out-loud sad in others, perceptive, entertaining, engaging, and important.  Conger is a few years older than I am and initially traveled a very similar path—Amherst, Harvard Medical School, residency at Boston City Hospital, CDC—before he left academia and became a small town internist in Windsor, Vermont, only six miles from our home here.  In the interest of full disclosure, I will acknowledge having had dinner with Beach and his wife some years ago, and he was the doctor who diagnosed, prescribed, and cured my first encounter with Lyme Disease.  That being said, I believe I brought an objective and open mind to this book, and  loved it. Conger is the kind of ‘Marcus Welby’ doctor that all of us in the 1960’s and ’70’s initially planned to be until we discovered that we loved radiology, dermatology or in my case, neonatology.  Not Conger, he spent 40 years in Windsor as a “general internist who tended to older and sicker people with too many medical problems.  The kinds of people for whom someone with my training and skills was ideally suited, ensuring, as best as possible, that the treatment of one medical problem would not exacerbate the others.  I was the kind of doctor who once was highly valued, but has all but disappeared.” While doing this, he accumulated a lifetime’s worth of anecdotes and amusing stories.  This book is filled with clever banter and colorful characters and is a memoir of sorts, but Conger’s main goal  is to take dead aim on his medical professional colleagues whom, along with big pharma,  he blames for the current opiate epidemic.  He points out that, moving at whip lash speed, physicians changed from ‘pain is bad, opiate pain killers (e.g. oxycontin, fentanyl, percoset, etc) are good’ to ‘no pain, no gain, and no narcotics’.  Unfortunately, caught in the middle of this ‘reset’ are the thousands of individuals addicted to opiates, many through the prescriptions originally written in good faith by their doctors but now left to find their fix on the street.  Conger, a bit bored after 40 years of general practice, decides to do something about the opiate crisis and becomes a certified addiction doctor, approved to prescribe buprenorphine, a partial opiate agonist which prevents withdrawal while eliminating the craving for heroin, fentanyl, and other dangerous substances.  Conger’s the real thing—-a real doctor, a real person, and appropriate to this season of the Jewish High Holidays, a real tzadik, someone committed to healing the world.

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