Drug of Choice

Well, I haven't been thinking most of today, I can tell you. Why is this so?

Well, it's because of promethazine. I've only been up a few hours, and it's mid afternoon already.

From what I can work out, a fair proportion of doctors on shifts take something, some drug. Promethazine is pretty harmless, it's one of the old-style antihistamines that works on every chemical receptor in your body. Twenty five milligrams for the day between the nights and the same for the first night after the days and I'm pretty much back into the normal day-night rhythm. And the big thing is it has minimal abuse potential - as far as I can find out. If I take it for more than a few days it doesn't seem to work, and that's something that worries me a bit - decreasing effect for the same dose may mean you have to take more to get the same effect, and that's part of addiction. And I watch for the effects - I beleive I have a kind of benevolent boneless lassitude for a few hours after I wake up, a kind of blurry smiley feeling.

Some doctors and nurses take benzos. Apparently ten or twenty of temazepam works well, gets you off to sleep and is out of your system pretty much by the time you wake up. From what I can work out, that's part of what they would have had me on when I was unwell, years ago, and I will probably be uncomfortable with any of those medications for the rest of my life.

But a lot of doctors and nurses take them. Apparently it's a very pleasant feeling, a calming, relaxing thing, something like being mildly drunk.

Pretty much that's it. Coffee, of course, is the lifeblood of the ED. I remember one night getting that tremor, the same kind of tremor that people get when they are put on salbutamol nebs for their asthma, a fine, continuous shaking of the hands. I noticed that night that the doctor having trembling hands does nothing to reassure the patients. But then, with that preternatural vigilance common to caffeine and amphetamine freaks and paranoiacs, I noticed a lot. Like my heart pounding like a wind-up monkey's drum, and my hands around the stethoscope like I was ready to lassoo someone.

And that's pretty much it, in terms of drugs people use at work. Other drugs is different. With little effort I can call to mind the major recreational drugs and reel off lists of people I know who have taken them - several of them successful, a number of them doctors. Heroin, amphetamines, LSD, the obligatory marijuana, opium, etcetera. Most taken before the persons concerned went on to become doctors, scientists, engineers, one of whom went on to become seriously mentally ill.

Now, pretty much all I know about is one doctor who drinks too much and a few nurses who sound like they do, and several who've still got the pack-a-day habit, the one drug that even in almost homeopathic doses will still kill most of its users early.

But five or so years ago Sarah and I had a party at our house, up in the hills, and afterwards, cleaning up the next morning, we found an empty syringe. Just like in the ads. And I remember sitting there with her afterwards, trying to work out which of our utterly innocuous friends, the people who are now GPs and psych registrars and emergency trainees, all upper midle class men and women who sat through the talks on Hep C and amphetamine psychosis and so on, would be doing such a thing.

Thanks for listening,
John