Imaging

Back from night shift, and wondering if my being awake at noon really qualifies me as an insomniac.

Read someone's blog the other day, and she had this quote saying "Sleeplessness is a desert without vegetation or inhabitants." Originally by one Jessamyn West. I don't know who Jessamyn West is, but s/he got that thing damn right. Have a look at the blog, too:

http://g_pi_exile.blogspot.com/

Damn fine writing. Has inspired me to maybe actually review these occasionally before posting so I can write coherently.

But not tonight. Tonight is pure brain to keyboard. Times like these I am too tired for any kind of extended thought, so I might just restrict myself to a few short, malign anecdotes.

Friend of mine just came back from a stint in one of the EDs in Queensland. Part time he worked in a family doctor kind of practice, seeing the wealthy healthy, measuring cholesterol and so forth, the rest of the time in the ED. He told the story of a madwoman who came to his practice a few months back.

She said she had a brain tumour, she said. She could feel it, something pressing and thrumming behind her left eye, worst after exercise, changed throughout the day, that kind of thing. She described the classic symptoms of a tumour headache. And a woman in her late forties, not impossible. She asked for a CT scan, to rule it out. Seemed reasonable.

Here is where any doctors would have left off thinking. She needs the CT, do the full neurological examination (fifteen minutes of Simon tapping her with a hammer and engaging in awkward small talk), get her the CT, go on from there.

But not Simon. He keeps chatting, asking about sleep, appetite, tension, where she came from, which doctor she normally sees, that kind of thing. Pretty soon he's convinced she has more going on, something going on in her mind as much as her brain. In fact, she has symptoms of a fairly severe delusional state.

A delusion, by the way, is a fixed, false belief. There is some room to manouvre in this - false is not the same as unverifiable, and there are culturally apppropriate false beliefs, that kind of thing. But generally delusions are demonstrably false beliefs that are inaccessible to argument.

However, mindful of the First Law of Psychiatry (Mental illness does not prevent physical illness) , he arranges the scan and does some research.

By the time she has had the scan he has discovered that woman 'fitting her description' has had twenty eight CTs of her head in the last year - all of which are normal. SHe still knows she has cancer. Fixed false belief - not susceptible to argument, whether that argument comes in carefully chosen words, or the tapping of a hammer below the knee, or the pattern of light and dark on a computer screen.

Anyway, she comes in for the result of the latest CT, and as gently as possible Simon raises the issues of the vast number of normal scans, the lacunae in what she told him, the various identities. He mentions delusional beliefs, the causes, the consequences, the treatments.

No joy there. She stormed out of the room. Out of this story, he thought.

Until four months later, and he's in Emergency, and he's scrolling through the CTs on the screen, looking to see if Smacked in Head by Mate is actually bleeding into the brain, and sees her name. "Jesus Christ" he thinks. "Not again." Another bloody CT head.

And looks up the scan, and she's got cancer.

He rings Dr Sock, the neurologist. Doctor Sock is small, Indian, distant, brilliant and depressed a typical neurologists. It's not a big cancer, she says, but not a nice one, either. Luckily, they caught it early. Something may still be able to be done.

Does Doctor Sock know that this woman is cut snake crazy asks Simon, for a moment deviating from the appropriate mediacl terminology.

Pretty much, says Dr Sock. She's had thirty CT scans in a year. That's a lot of radiation, and it's almost certainly a radiation induced cancer. The likely thing is the scans gave her the cancer.

See? Mental illness kills people.

Anyway, enough malign little snippets. Read an interesting word the other day - femininism. Celebrates frilly feminine things. And I have decided to refer to the current influence of the Christian Right over the teaching of evolution andstem cell research as the Endarkenment.

There should be a word for that thrill of recognition you get when someone defines/explains/makes clear something you have known about for years but have been unable to articulate - something that means "That's what I've been trying to say all these years".

Anyhow, next post may be about crises - ways people do and don't get off drugs.

John