Saturday, July 09, 2005

ED jeebies

Another apology for another hiatus in this blog thing. We have had a cat-associated loss of computer function for close on a week. I kept trying to dial up and got this arcane little message about some remote computer. I eventually told my wife, mentioning that there was nothing we could do because it was the fault of whoever was meant to be looking after the remote computer, whereever that was, and we just had to wait for them to get their shit together.

She gazed at me with the look she normally reserves for her most hopeless patients, walked into the study and fixed the problem with a few keystrokes. Then she explained, or tried to explain, how the internet worked. She said that there is no "remote computer", no vast Deep Blue kind of thing in a warehouse somewhere, that somehow contains the internet, that it's all just connections between computers and so on. After a few minutes, though, she gave up trying.

Anyway, what's been going on? A fly has appeared in the ointment about next year's rotations. It appears that reports of Lazarus' resurrection may be premature, and it may not be able to teach me stuff I need, such as the all-important anaesthetics term. I am looking around for other options as we speak.

I have joined a writer's group. More on this later.

And I went over to this friend's house, a nurse, to clamber up on her roof and fix the air conditioner, and had a chat, and she seemed quite upset, and she cried for about half an hour, and she said she wasn't sleeping, and she wasn't eating, didn't even have an appetite, food tasted like crap, and how since the kids left she lay in bed all day or watched daytime tv, and she was drinking what for her was remarkable amounts of white wine, and she didn't want to go outside to do the shopping because she didn't want the neghbours to see because she was ashamed, and how she was letting the bills pile up and she kept forgetting to pay stuff or even if she had paid it or not and ....

and eventually I said "Do you think it's possible that you're depressed?"

She laughed bitterly and said something unprintable and anatomically inadvisable. ED nurses, possibly even more than ED doctors, are unshakeable in their belief that any form of mental illness is for losers. Most of them retain this belief right up to the time they suffer from depression. If pressed, they say that their distain for mental illness stems from their day-to-day dealing with people who are classed as "psych" on the casualty sheet.

As I have said before, the problem with this is this is not a representative sample - "psych" includes not only the mad, but also the bad and the the dangerous to know. So when ED nurses and doctors think psych, the mental picture is more likely to be of some tattooed goon just out of prison smashing up the ED and spitting blood at the triage sister, or a hundred and fifty kilogram man exposing his genitals in the corridor. Not that those people haven't got mental health problems, but there's more to mental illness than that.

Anyway, my friend the nurse didn't believe in depression, even though she had some pretty damn classic signs, plus a family tree with a fine crop of mixed nuts, and after a half-hour discussion, we got onto "what now?".

"Well, I reckon you should find a doctor you can trust" I said.

"You're a doctor" she said, showing that her clinical acumen remained undimmed.

"Can't be me" I said. "I'm your friend."

"Why does that matter?" she said.

Anyway, I was going to launch into a discussion of the medico-legal implications of all of this but instead I sortof came up with a list.

1. You should be able to tell a good doctor anything. You should be able to tell a good friend anything. But sometimes it's not the same anything. I would not want to tell my friend about any retrograde ejaculation I suffered as a result of a medication, for example, or the spectacular vomiting/diarrhoea/increased urinary frequency trifecta that some people on lithium get. And I can almost guarantee that my friends would not want to hear.

2. Doctors have to detain people. Friends don't lock other friends up under the mental health act. Nor do they scan each other's brains, or strap each other to the bed perform, detailed physical examinations on each other, and stab at each other with syringes full of psycho-active substances.

Well, maybe some friends do. Your Saturday nights may be more full than mine.

3. You may sometimes have to bitch to your doctor about your friends, and you can certainly bitch to your friends about your doctor. But problems arise when you are bitching to your friend about your doctor (the self-righteous prick) and your friend is bitching to you about his patient ( a self-indulgent histrionic egomaniac) and you realise you are both talking about the other.

4. It's almost impossible for the doctor to be objective about you. Objective doesn't mean unsympathetic, or disinterested. It means you have to be able to treat patients you like no better than patients who frankly give you the shits. I'd end up treating her a little better, and then maybe I'd end up getting her cheap medicaions, or bumping her up the queue for a hospital bed, which would be cheating the person who is sicker or who has ben waiting longer but doesn't have the advantage of having a personal friend who's the doctor.

5. Although it makes no sense, I could not stand the worry. Say I prescribe gigglopram to some perfect stranger, after a discussion of possible side effects, etc. That person develops one of the extremely rare side-effects the manufacturers mention . I could possibly live with the idea that I had been responsible for giving some anonymous patient glow-in-the-dark nipples, or lymph nodes in the groin that sing in a pleasing tenor voice. But I'd feel inexplicably really really bad if it were a friend.

Anyway, we came up with a compromise with which I am not entirely comfortable, but she's doing something about it. We shall see how it works. I shall keep you all in touch.



Blogger Benedict 16th said...

She could try Scientology - it works for Tom Cruise.

1:37 PM  
Blogger Foilwoman said...

Yeah, Benedict, it works so well he needs to place a minder on his fiancee.

I'm hoping she's at least trying some medicine? Some serotonin reuptake inhibitors? Or is seeing a doctor other than you? Or, heck, a nurse practitioner?

10:37 PM  
Anonymous Camilla said...

I loved the way you described the difference between friends and doctors - so true! Hope your friend feels better soon.

3:42 PM  

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