Darkness

Hail,

Disturbing day today.

Tell you what, though: it's weird sitting down to write this. I get this weird feeling when I finally collapes at the computer to write. Today was get up, drive lodger to train-station, punch and kick and elbow punching bag for half an hour, hurl last night's food at chickens, scarf breakfast, shower, drive other relatives to train station, meet new RMO, see wall-to-wall-patients, in lunch break ring sexually transmissible diseases folk and talk to RMO about early signs of schizophrenia and the legalities of detention under the mental health act, have feedback session with manager, see more patients, scribble madly in notes and fax letters, run out door, drive home, lock up chooks and help feed swirling tribe of cats then collapse in front of computer.

It's weird - is there such a feeling as psychic decelleration?

Lot's to unpack today.

For the prurient amongst us, today I had to tell some horrified girl that
a) she had chlamydia
and
b) it's a notifiable disease, so someone would have to make sure her partners knew.

The chlamydia news was as well received as could be expected, since by no-one gets out of the room* without being told that sexually transmitted diseases do not only affect skanks and lowlifes, that they are largely curable and/or treatable, that it's not "fair" that they got caught, etc. I don't know that many people overtly think these things, but it would be unusual if they did not at least recognise the ideas at a basal level.

On a tangent here, but Casanova's memoirs are, as you'd expect, pumped up with sex, but also intrinsically interesting, not only because of when and where he lived, but because of the kind of person he was. But from a twenty-first century point of view, it's horrifying to hear of his recurring symptoms of what they used to call venereal disease, intersperse with is frantic coupling. He relates with glee how the doctor of one particular town thanked him for brinign the pox to the local area, thereby ensuring that they would be kept employed.

THe medical attitude towards spreading disease seems to have hardened somewhat. Nowadays what happens is before you get any kind of test for STIs we tell the clients about "notifiable diseases" - diseases that, if you get tehm, we have to inform the government. Chlamydia is one, so I had to go through th ething with the girl and ask if she wanted to contact her sexual partners within the last twelve months and or if she wanted us to. If you ask us to, it's anonymous: the health comission sends you some kind of letter saying "We have reason to believe you may have been exposed to nobrot fungus" and things go on from there.

She elected to get us to inform one of her sexual partners, although I don't know how much success the clinic will have at tracing "Alan or Andrew Green, late twenties or thirties, had a tattoo of a shield or something on his chest, I think he was once in the Army".

Dulce et decorum est, I imagine, to bang a drunken fourteen year old without a condom, but if you're reading this, defender of our hearth, get a checkup.

Anyway. Darkness.

It's weird what affects you as a doctor. People can tell you hideous stuff and you still go on. It's not getting inured to horror, it's being able to hear without being paralysed. If I mourned for every cancer, every stroke, every miscarriage and suicide, I'd fall apart. And there'd be no doctor at Hogarth, and maybe someone I'd otherwise help would fall away.

So you have to keep listening and analysing and commenting, even as you listen and hurt and mourn. And usually you just ride it out.

But today some kid said something and I was still thinking about it a few hours later, and I'm thinking about it now, so I guess you can say it got to me.

Briefly, and anonymisedly:

seventeen year old man (?boy? whatever) presents with his "depression". Doctors haven't been able to fix it. "Depression" keeps him awake at night. Depression means he's pretty much pulled out of school, can't keep a job, can't concentrate. Depression was too much for his girlfriend to deal with, she dumped him.

Depression takes the form of constant, low-level auditory hallucinations, ceaseless voices, about the volume of a firm voice, intrusive, abusive, denigrating him and telling him to die. Every conversation, every moment, every single thing. Dieyouuselesscuntyoufuckenmakemesickno-
onefuckencaresifyouliveordieyoucan'tdoshitrightyourfuckenmotherhatesyouyougavehercancer...
every day.

No-one has actually dealt with this before. No-one has asked. Twelve five minute general practice consults pay more than one one hour consult. And he's a withdrawn, mumbling, teary kid with a confronting message on his shirt and he smokes a lot of marijuana.

But there's one thing that seems to bring the volume of the voices down, one thing besides the fifty or so (I kid you not) cones a day he smokes, which he believes treats his illness and I believe causes or at least unmasks it.

He goes into his "quiet place", which is an old buried rainwater tank, part of some storage thing years back, seven metres underground, in the dark. No TV, no radio, turns the light off . Sits in the dark for hours, four, five, six hours. Just staring.

It seems to help.

For some reason, this got me. It's one of those ideas that sticks in your head. That horrible mental image, that poor kid, having something so horrible grinding and thumping and scratching and chattering in his head, something so grim and ghastly that sitting for six hours in the dark and silence seven metres underground is better.

Anyhow, tomorrow is meetings and Saturday I'm going into town, and tonight I'm going to have my two standard drinks of Merlot to wash away the idea of people using drugs to wash away their ideas.

Less grim tomorrow.

John

*Not even the cleaner