Tag: health

To Love again

That’s what I want…I think

I’m beginning to think that I am going to be alone for a long time, maybe forever. I’m conflicted at times, oddly at peace with it others. It comes down to reality vs. want and I will come down on the side of reality more often than not. The reality of it is that I have a very unremarkable and disappointing history of relationships and I’m not interested in adding to the heap.

But part of me still wants to be with someone.

The negative guy in me could say that my lack of success in relationships is my own fault. After all, it makes sense that the immaturity and character flaws that negatively affected every other aspect of my life would certainly affect my relationships. I was, and perhaps still am, a very mixed-up person. But it was not all bad. I had some amazing relationship moments that I will always cherish. Also, it isn’t fair to myself to assume that my relationships didn’t work only because of me.
It’s not always me.
But unfortunately, in the absence of answers, my nature is to blame myself.

Now that I am in a forgiving phase of my life, I am able to take a hard look at the possible reasons that I am single and without prospects. I am capable of taking an honest look at myself and dealing with what I come up with. So I ask myself…why am I single?

Physically, I have some challenges. Should a woman actually take a look at me I look old. I shave my head because if I don’t my hair grows in like the infield of a little league baseball league in August. I have a goatee that is not even gray anymore, it’s white. I wear glasses and hearing aids. I am a bit overweight. That is what the world sees.
Should a woman look past those things and want to learn about me they will then find that I am not financially independent and do not have my own place. These things, along with hair, matter. How do I know? I have been openly rejected on dating sites for those very reasons.

That hurt a bit.

It’s a shame that character doesn’t matter in the transactional dating world of today. If it did, then someone could see that I am loving, affectionate, caring and loyal. I have no problem with monogamy. I like it. Because I’m honest. When I find something I like, I don’t look for something else. It’s too bad that doesn’t matter anymore. If it did, someone would also learn that I have a very youthful attitude and the sex drive, and prowess, of a much younger man. I know how to work the equipment. I’m in the Union.

All that aside, as 60 approaches, it appears that I may be alone. I can make peace with that. I’m just sad that I have to. I’m a romantic at heart. I feel a tug when I see happy couples in real life. I want to live the moments portrayed before me on TV and movies. I want to hold someone’s hand, yet all I have to hold is the remote. I want another chance at being in love. At living my life with someone else. To have my heart skip a beat when I think about someone.

Maybe it isn’t in the cards for me to have another shot. Maybe I’ve had all the second chances In life. Maybe I don’t hold the appeal that I think I do. I can, and likely will make peace with that. I may have to. After all, who says that I deserve anything? I may have already been given my one and only and screwed it up.

I think the best course of action is to let the universe do my bidding for me. I’ll see if Love finds me when I’m not looking. After all, that is how the many blessings I have been given have occurred. Why not another?

Stoic and didn’t know it

I’ve always desired to live my life by a Philosophy, a theory or attitude as a guiding principle for my behavior. It’s a source of great curiosity to me because, before I really explored my need for this, it felt like I was a protégé without the luxury of a mentor. It was as if I wasn’t leading my own way, but instead I was looking for someone or something to guide me.
Which made me a follower. Which I hate. When it comes to who you are, nobody wants to be a lump of wet clay.
That realization saddened me and served as a revelation as well. I looked hard at things and realized the many ways in which I tried to be someone or something that I was not. It took far too long, but eventually, I developed the ability to be myself. Of course, that presented a whole different set of challenges. “Myself” was not a guy that I wanted to spend time with. I am working on that and it is a challenge that I am not taking lightly. In fact, it is almost entirely what I think, dream, read and write about. I am taking a particularly hard look at where the “follower” in me ends and where the unique individual in me begins. After much investigation, the inevitable conclusion was that I was not living a life and presenting a persona that was consistent with my core beliefs and desires.
In short, I didn’t know who or what the hell I was!

Thus began the most difficult thing I have ever done, taking a searching and fearless look into what really mattered to me. To do so required me to identify every way in which my life was ruled by convention and to challenge it. The good news is I think I have a better idea now. But I wish I knew how I was able to deny myself the liberation of living by my core values and beliefs, my very nature, for so many years of my life. Was I afraid of challenging the status quo?
I didn’t require a great “philosophy of life”. No school of thought or set of principles is going to serve every situation. I believe that what I needed was consistency and I was in search of a means to maintain it.

I’ve learned a lot about myself of late. But learning is not enough. I must embrace what I have learned, live it not shy away from it, and create real growth. As a good start, I am definitely defying convention, the very thing that made me a follower.

For the sake of brevity, I will not list all of the many ways that I have changed my thinking, I just want to touch on one. I always thought that I was complex. Yes, I know, all men say that. But as it turns out I’m very simple. Not Carl from Sling Blade simple, simple in that I don’t need or want much. I like things to be manageable, regardless of how difficult situations become. Simple to understand and consistent in what I stand for. Simple as defined by the familiar colloquialism “you get what you see.” If only there were a school of philosophy that embraced simple existence, harmonious and non-intrusive. One for those who want to live with the earth, not just on it.

Imagine my joy when I (re)discovered Stoicism! There IS a Philosophy that I CAN use and adhere to as I work towards the life I crave. Stoicism is actually quite simple.

“It’s not what happens to you, but how you react to it that matters.”

― Epictetus

I have been a Stoic and didn’t know it!

Inventory

Having gone on a retreat/hiatus of sorts, I have had some much-needed down time to decompress and do some thinking. The deep thinking predictably led me to assess my life and do a proper inventory. Inventories are difficult and can be painful. If a business owner were to become complacent in the inventory of his goods, he may find that he is in worse off than he thought financially. It works the same way when you inventory your own life. You may not like what you come up with and at that point you are faced with a choice; to accept it as it is or to seek a solution. To seek a solution requires asking questions, and that is where I am at in the process. I began questioning everything.

The first thing major question I addressed was whether I left my job for the right reasons. I had put in 6 months as a Recovery Case Manager working with those struggling with addiction. I loved it and by all accounts I was great at it. Entering a field such as Recovery without a background (educationally or by virtue of being an addict oneself) is difficult and requires a specific skill set and a proven ability to display empathy, understanding, and listening skills. Despite not using my Psych degree since I graduated in the early 90’s, it was a roll of the dice. But the complicated series of events that I call my life qualified me just fine. I became a thorough, relatable, competent and effective Case Manager and I was making a difference.
 But it kicked my physical and emotional ass. Health reasons, physical more than mental, drove my decision. I am immunocompromised due to my Kidney Transplant and I was working in a fucking Petrie Dish. After contracting COVID twice, a stomach flu and a cold that I couldn’t shake for over a month I made the decision. But the job satisfaction aspect nagged at me. If you need to know just ONE thing about me to understand the possible loftiness and intense nature of my statements, know that I am ALL about purpose. I have received the gift of life and have escaped the Bastard known as DEATH more times than any one many should be allowed. I therefore have the attitude of gratitude. If I stopped doing a job that satisfies my mentality of giving back and paying it forward, what am I going to do in its place? 
It didn’t take me long to realize that I am not going to lose that side of me, as I have lost so many other things that gave me joy. Therefore, I resolved that I would continue to volunteer my time and resources to causes that matter to me. That gave me comfort about my decision to leave a job that satisfied my soul. I vowed to research local charities that I could volunteer for; Make-A-Wish, Animal Shelters, Veteran’s causes and Motorcycle groups that focus on charitable rides. Therein would lie my answer.

I was then troubled to realize, after a few weeks of semi-retirement that another question had risen up and begged answering. Why was I not full of that desire to go do all of those things that would adequately fill the void created by leaving my job? Where was that motivated guy? That guy was laying on the sofa, eating junk food, watching TV and not doing anything productive at all. I will cut myself a small break, I wasn’t feeling good. I was still recovering from the virus that made me leave my job. And it was Winter. The cold weather, constant snow storms and lack of sunlight are not my friends. Not excuses but worthy of mention. Still, I was concerned that I was going to fall into a regrettable cycle; lazy, unmotivated, unaccomplished, and lacking purpose.

That is when I decided to head to see Mom in West Palm. I vowed to get moving physically and mentally. To walk, workout, read and write at a pace that I have never before. I have checked all the boxes so far. But to write everything I have come up with is going to take some time, due to the number of questions that I have raised and, thankfully, I have the desire to put to paper.

Fortunately, time is something I now have a lot of.

Question Everything

Question everything. That is where I am now. I do not know how it happened, but the way I look at everything seems to have changed lately. Two things come immediately to mind; it happened quite quickly, and I love what I am seeing. In short, everything is upside down and on its side. As Dr. Venkman so eloquently stated in Ghostbusters…

Things happen that way with me. I have epiphanies, moments in which my eyes suddenly open, my mind shifts, my vision becomes clear, and things suddenly make sense. Not always forever in some cases, but enough to enable insight and encourage change. My most recent epiphany is here to stay. It is not a fleeting thought or a passing fancy that serves to temporarily inspire or provoke thought. Instead, as a result, the world around me presents if I were a young child. A world in which everything is a new and exciting experience.
Somewhere, at some point in the last 6 or 8 months my understanding of countless aspects of life, my own and those of the wonderful world around me, shifted (morphed?) in such a way that I am questioning, with the intent to be and do better, my understanding and perception of everything. To name a few,
Relationships.
Friendships.
Politics.
People.
Family.
Conversations and events old and new.
The world around me and,
My role and purpose in it.

I find myself very motivated by what I am feeling. I feel like I am on the right track. In many ways, I feel like a different person. Where there once stood a man that, while mostly positive, was prone at times to see things in a very cynical and unproductive light, now stands a man that looks at every interaction, recalls every conversation, and replays every situation to assess if there is anything that could be learned from it and what could have been done better? It’s truly a liberating and exciting feeling to experience such an injection of emotional vitality and intellectual stimulation at a time in my life in which I was dreading stagnation and lack of interest in learning or applying anything new.

This, in conjunction with my current deep dive into the Stoic Lifestyle, is giving me the exact boost I desperately craved.
That’s enough for this post, but expect more (I do hope you read it and share it with me) as I share that which is in question, my old take vs the new, and the effect it will have on me as I continue to work towards “better”.

Stoic

Somebody once offered up in conversation that I was “Stoic”. As a guy who considers himself well-versed in language, context, and vocabulary I took it to mean that I have a rather stone-faced demeanor. That is to say that the initial interpretation of the face I presented to the world was indifferent and void of emotion. As it turns out, I wasn’t far off in my understanding of “stoic”. After some research I was then happy to learn that “Stoic” has more than one meaning,
1) A member of the ancient philosophical school of Stoicism.
2) A person who can endure pain or hardship without showing their feelings or complaining. To possess toughness and quiet endurance.
Interesting…I may have been onto something there.

A member of the ancient philosophical school of Stoicism.
I took an interest in Stoicism. I did some more reading and, like everything else in my life pre the great collapse of 2016, I moved on. It didn’t fit my lifestyle at the time. I recently revisited it after reading a fellow blogger. It is now apparent that it aligns perfectly with my current approach to existence. By aligned I mean it was a sledgehammer to the forehead.

A person who can endure pain or hardship without showing their feelings or complaining. To possess toughness and quiet endurance.
If you know me at all, pain and hardship have been omnipresent in my life. I have done my best to roll with it all and to try to convert it into self-improvement and motivation to inspire and help others. I have never complained, I have references. It doesn’t help anything, and nobody gives a shit. But it definitely shows on my face. I can’t count how many times it’s been said to me some variation of,
“when I first saw you I thought you were a jerk. But then I got to know you and you’re actually a good guy.”
I’ve also been told by employers and well-meaning coworkers that my facial expression, gone unchecked, was the male equivalent of Resting Bitch Face. I took it under advisement and made a conscious effort to be aware of it. But the nuts and bolts of it were that my face was saying, Don’t fuck with me, I have had enough and I am not going to give you a chance to hurt or reject me.
That was who and what I had become.
But the result, the fortunate side effect is, and I need to take a temporary break from my adherence to humility is;  yes, I am tough, I have endured a lot of shit and I am stronger for it and ready for more. Bring it the fuck on. So it logically follows that my face, as the window to my wounded soul, will reflect. To reluctantly but necessarily put a smile on it is to embrace the Shakespearian notion of Masks. Everyone, not just thespians, wears a mask to conceal who they really are and try to be someone else.

Stoicism is the approach from which I am existing. It is validating and empowering, more so with every page that I read. It is in synch with my new attitude of minimalism, simplicity, positivity, and adherence to values. It confirms my desire to no longer be the person I once was. At one time I was full of hubris. I wanted to run with the beautiful people. I wanted wealth and influence. I was not ruthless, but I wasn’t a man of true character. I cared less about virtue, empathy, compassion, and benevolence, opting instead for callousness and relative morality. I needed to make a change in order to sleep at night. If you believe that it is never too late to make a change, then change is not only possible but also achievable.

It is not possible if I am to keep your interest, to list all of the tenets and principles that appeal to me about Stoicism but I’ll offer 10 key principles.
Live in agreement with nature.
Live by virtue.
Focus on what you can control.
Distinguish between good, bad, and indifferent.
Take action.
Practice misfortune.
Add a reserve clause to your plan.
Love everything that happens.
Perception is key.
Be mindful.

As an aside, I find it significant and amusing that Stoicism is sometimes referred to as “Supermanism”, considering I have written over 300 posts under the moniker of Superman.

The Art Collector

There is a museum in the vicinity of Harvard Yard that houses pieces of Art from the Eastern and Western worlds pre-1200 AD. The museum is named for its collector, a known Philanthropist who made 14 Billion dollars off of one product. He is famous for a quote,
“I’ve often said I approached collecting as a Biologist. I want enough data to be able to draw valid conclusions. Art is a passion pursued with discipline. Science is a discipline pursued with passion. You have to really pursue the object, you don’t just sit there and have the objects come to you. You want to be a great collector, you better think of the fact that you’re gonna commit yourself to a real passionate treasure hunt.”
Recognize it? Ok let’s try this one,
“The drug isn’t the problem the user is the problem.”
Still drawing a blank? The museum is named after Arthur Sackler, owner of Purdue Fredericks, later Purdue Pharma, the company that introduced the world to OxyContin.

To be fair, Sackler wasn’t alive when Oxycontin was released in 1994. But he would have been proud to know that his background in Medical Advertising, in which he created “new and innovative ways to ways to make ill people into regular customers”, was passed on to his younger Brother Richard after his death. As the owner of MS Contin, a slow release Opiod (slow delivery due to its shell, Contin =Continuous) used largely for end-of-life care and in Cancer Patients, Richard Sackler of Purdue was painfully aware that the patent was soon running out and they would need a “Blockbuster” drug (take a second to absorb that concept) to recover their revenue stream. They came up with taking the much stronger opioid Oxcodone and blending it with the slow release Contin to create a more powerful and long lasting pain killer. Herein lay the dilemma; the market for End of Life and Cancer Care didn’t provide a large enough customer base for a long enough period of time. So they improvised.
Purdue shamelessly hired a Doctor within the FDA, spent 3 days in a rented room and wrote a blatantly deceptive application for approval that they were assured by their FDA indider would easily pass. The application included false research and outright lies about the lack of danger of long term dependency and addiction.
It passed. Thus began the crime of the Century. After their marketing campaing, perhaps more appropriately dubbed “push”, in which slick Pharmaceutical reps with uncapped bonus plans incentivised reluctant Dr.’s through any means, legal or otherwise to get the new drug to be described to a wider demographic for ailments as innocuous as knee pain. There is not enough room on this page to list the unfunny comedy of errors that occurred as Purdue relentlessly pushed this product through any means, misinformation campaigns or greasing the palms of all-too-willing Congressman (who looked away as their own districts were collapsing under the weight of the epidemic) happy to lie to their constituents and peers about the extent of the problem. It is a truly disgusting story of Corporate Greed, Political power through dirty money donations, manipulation of Government regulations and the frightening power of the media as evidenced by “America’s mayor”, Rudy Giuliani taking Purdue’s filthy money to make commercials praising Purdue’s commitment to assist those Americans who suffer from chronic pain.

It worked. Tragically well. At its high point 125 million Americans had a prescription for Oxycontin. That is half of the estimated population of this country. If you weren’t in pain, there were plenty of Doctors in Ferrari’s that could set you up in their “pill mills”. Even CVS got in on the game.
20 years later 500,000 Americans had died of overdoses. For reference, as many Americans die EACH YEAR of Opiod overdoses as perished in the entire Vietnam Conflict.

So let’s look at a segment of Richard Sackler’s quote again,
“You have to really pursue the object, you don’t just sit there and have the objects come to you. You want to be a great collector, you better think of the fact that you’re gonna commit yourself to a real passionate treasure hunt.“

Purdue didn’t wait for them to come to him, they went on a real passionate treasure hunt. 14 Billion dollars worth of treasure.

Good tired

It’s a bitter cold Sunday morning here in NH and I am sitting here, coffee in hand enjoying Day one of my weekend. I am comforted by how tired I am because it is a good tired, a culmination of a whirlwind week of doing good work for good people. I feel like I made a difference this week. For me that is the best of all possible feelings.

I can honestly say that I have been on top of my game lately. I have grown into the role I’m supposed to play. I’ve overcome most of the challenges that have kept me feeling less competent than my peers; the administrative tasks (which are formidable), the organizational pieces that make my job harder such as scheduling and overall time management, and I have learned to rise to the level of my biggest foe, myself, to a point where I at last long feel like I belong.
Let me drill down on that for a moment. I work in a high-pressure, high-turnover position. I have spent most of my career in such situations. One of the unfortunate realities is that people don’t accept you right away because the possibility of liking someone and investing in them and then have that person not work out is very real. In addition, I’m additionally challenging to accept because I’m awkward. Let’s call it what it is. I’m intense, hard to read at first, a little overbearing and somewhat neurotic. In short, I’m a lot. Now, the people that once cautiously said hello to me in the cafeteria are calling me to join them. People who left me out of the conversation now involve me and enlist my thoughts. My peers in my department and everyone else I interact with as we all work towards the same goal have recognized what I want to be my most visible and dominant traits: a good heart and a genuine desire to do a good job.
And I think I am. I’ve built the foundation and now I’m interjecting my own style, the culmination of years of dealing with people, my own experiences, and personal battles. Pepper in what I feel is a relatable manner and some small acts or kindness and I’ve found my niche.

Last night, on the way out the door I received a call from the tearful wife of one of my clients. She was missing her husband terribly and wanted to know how he was doing. He wasn’t due for a sanctioned call to speak with her but I told her I would get a message to him. I drove to Detox, found my client, pulled him downstairs to a private room, dialed the number and gave him my phone. Ten minutes later he gave it back to me and tearfully thanked me. He didn’t have to, it’s what I try to bring to the job. Small acts of kindness are, or at least should be, part of the job description.

Inevitable

I always knew it. I’ve known it for years, but I didn’t want to admit it. But after diving into the model of addiction as a profession, I’ve realized that I am no different than the people I work with.
I am an alcoholic.

All the signs are there. As we say, the circumstances vary but the progression is the same. There is no exact template; you don’t have to drink every day, you don’t have to have hit “rock bottom”(I believe absolute Rock Bottom is death), you don’t have to lose everything, you don’t have to have experience “blackouts” nor do you need to have crushing consequences of alcohol use. You merely have to admit that alcohol has affected your life irreparably and that is a problem that you have no control over.
That’s me.
I have been drinking at an unhealthy level for 40-plus years. I haven’t always consumed alcohol every day and I haven’t always gotten drunk. But it has been a destructive force in my life. I have drunk at the expense of my health. I have lost my temper with my family and other loved ones. I’ve driven intoxicated more times than I can count (the words “incredibly lucky” come to mind) and I know that I have set a terrible example for my children. I have made an ass out of myself in front of friends and co-workers more than I want to admit and I have wallowed in shame and regret more often than I care to consider. Even now that I’ve been able to achieve long periods of sobriety, I think about it every day. Not a day goes by when I do not think about going to buy a bottle. When I do buy one, I may not get plowed that day but I will drink out of it every day until it is gone. That means that working out, blogging, preparing meals and any other worthwhile pursuit will be left by the wayside as I feed an old, tiring habit. And I get zero value or reward from it.
It’s time for a change. I feel good about it. I don’t enjoy it anymore, I rarely get intoxicated, and when I do I beat the hell out of myself emotionally during and after.

Alcoholism is about control. I no longer have control over it. Being able to avoid it is a mild accomplishment but I need to change my mindset and work towards a healthy and fulfilling life. Yes, I already crave this, anyone who knows me can confirm it. But I can do better.

I always tell my Clients that the key to embracing recovery is to not look at it as a continuation of the Old Life, but instead to look at it as a new beginning. It has occurred to me that I may be full of shit when I offer advice but I know I’m not. I am knowledgeable of the model of addiction and can speak with some conviction. But I need to go one step further and join them in doing the work. I can live the life that I want for them by joining them in the battle.

Today I am beginning the 1st of the 12 steps of Alcoholics Anonymous. I am admitting that I am powerless over the lure of alcohol, and that I currently live a life that is unmanageable. This is an important step in my overall goal of being an honest, accountable person of substance. It makes sense finally.

Current Situation

I thought that while Mom is in Florida I would revel in having the house to myself for almost 6 months but it’s actually quite the opposite. I’m sad and bored. In addition, I’m embarrassed to admit it. I miss my Mom. We have been getting on each other’s nerves lately, her fastidious nature about keeping her admittedly beautiful house spotless and clutter-free has led to some bickering. It was never a serious problem. We have an amazing relationship and I love her dearly. It’s my problem. I know it comes down to my persistent (and somewhat silly) sense of shame at living with my Mom at my age because my poor decision-making and illness have led me to this position of being poor and unable to have my own place. It leads to pushback because when she gets on me, despite her right to do so, it only serves as a reminder that I am a 57-year-old man living with his mother. In my book that equals LOSER. When you factor in my guilt over feeling that way when it is painfully clear that she saved me from homelessness by taking me in when I knocked on her door 7 years ago with a Honda Civic full of everything I owned, it is entirely unacceptable to me that I could hold any negative thoughts towards the wonderful woman who has never been anything but great to me. If that isn’t enough, I’m dealing with a lot of internal strife right now. My work with severely damaged individuals in exchange for a paycheck has sent me down a road to self-discovery. These broken people have actually inspired me to make changes in myself. If you have ever read me, you know that I am not afraid to make changes if it leads to growth, but I’m dealing with some powerful shit right now and it sucks that I’m alone as it is occurring. I suppose it doesn’t help that I have very few friends within 100 miles, I am without female companionship (by choice I’m afraid) while still craving the intimacy of an adult relationship, and it is colder than a Canadian Lumberjack’s nut sack outside. I can’t believe that I’d rather be at work than alone at home.

Angels and Demons

I was warned when I started my job as a Case Manager in addiction, that there will be times when my entire client list would catch fire.

The addiction patient comes in several forms, ranging from first-time in recovery, young or older (sometimes in their 70’s) to the “readmit” who has been in multiple times (I have one young man in his 30’s who has been in rehab 41 times). Some are very motivated and others are counting the days. They come to us for many reasons. Some are court-ordered and others made the brave choice to change their lives and are willing to make bold moves to do so. One thing I have learned is that there is no room for assumptions about outcomes (that is obviously way beyond our scope) and there is no connection between willingness, enthusiasm and cooperation and stability during treatment.
There is no such thing as a stable patient.
Any patient can turn on a dime in one day, often defying every expectation. The addiction patient is dealing with a plethora of internal forces that pull and tug at them. One day there are doing fine; motivated, encouraged, and on course. The next day they may decide that it’s too hard, that they are needed at home, that they can deal with their addiction on their own, that getting back to work is the key, and my personal favorite…they think they are ready. Even when they are not. It is the mental push/pull that comes with making major change against a force that is larger than them. I attribute it to the dichotomy of human nature. Think of it as the scene in the Flintstones when Fred has a little devil Fred on one side and a little angel Fred on the other.

When this occurs, the adrenalin kicks in and the push to keep them from leaving begins. I know it sounds awful, but we know what is good for them even when they don’t. We have at our disposal the research to support it, compiled over millions of patients worldwide. We are trained, and we have the additional resource of many co-workers who have been through recovery themselves. We are armed with every tool, backed by sheer good intentions to help them recover. When we tackle this obstacle, it is exhausting. At least to the new guy, which I am, and my more experienced colleagues are more able to cope with it than I. While these waves of change occur in nearly all patients, it happened with too many of mine this week.

I approach my position as I do my own matters. aggressively and with passion. I challenge, poke and prod, tell the truth, and insist on reciprocation. While I am not a clinician, I get the information we need and I learn the ins and outs of the person in front of me. I invest, and I am here acknowledging that I do so at the sake of my well-being, of myself into my clients. I know it sounds corny as hell, but I care about people and despite my best efforts to dial it down, I can’t. Sue me, I give a shit. I need to know at the end of each day/week/month that I did the absolute fucking best that I could for those in my charge.

And it is taking its pound of flesh.