Monday, January 30, 2006


Early morning at the drugs and alcohol job, and I've just had a date with Destiny.

Destiny is a small, blonde girl, two and a half or so years old. Her mother is on the methadone program, seems to be doing if not well, then better than this time last year. Put on a bit of weight, better dressed, looks healthier. Destiny, too, looks to be in the best of health.

Anyway, mother and child came in this morning for a script review. So me, Destiny, Mrs Tribble and a student nurse from Hong Kong all crowded into my superhero-poster adorned waiting room.

"Ireckonoverallitsbeengoingprettywellactually" says Destiny's mother. She speaks at easily twice the normal human speed, punctuating her sentences with laughs or sighs as appropriate. While I speak she grins and stares wide-eyed at me and twists around in her chair. Behind me Destiny leaps full-bodied onto the box of toys, seeming to suffer no harm.

"Good" I say. "So, no feelings of withdrawal on the dose?"

"Nahgoinggreat!Ilikehowyou'vedoneyourhairdear" (this to the student nurse) "IwishIcouldgetthatshine-"
- intake of breath -

Behind me Destiny stops fossicking in the toybox, shrieks "Ball!".

I force myself into the conversation.

"And no sweating, you're not drows-" A tennis ball hits me in the back of the head. I turned around. Destiny grins and waves a plastic sword.


"It's okay" I say. "Do you want to hold her?"

"She'sveryhealthy" says mum, making a shortlived and half-hearted attempt to grapple with Destiny.

I wrote something about pupil size in the notes. The tennis ball bounces off the wall in front of me, I grab it with one hand, shove it in my pocket. Destiny bursts into tears and hurled herself under the examination bed.

"So how long since you've used heroin?"


I cut her off.

"First class. Any speed?"

For a moment she looks downcast, distracts herself by handing Destiny a pad of post-it notes and my pen.

"Goey" is speed or amphetamines, the most common recreational drug in the Mordor-Slytherin area.

"Injected or eaten?" I ask, then lurch forward, in considerable pain. "Jesus!!" I look down. Destiny has slapped a post-it note onto my groin.

Mum is distraught.

Somewhere in my mind the realisation is forming that this - the sticking of post it notes on the doctor - is an ongoing disciplinary issue in the Tribble household.

"It's okay" I lie through clenched teeth. I wipe the tears from my eyes and look at the notes. "Are you on any other medications - oh no you don't"

The tennis ball (presumably retrieved from my pocket during my microsecond lapse into unconsciousness a moment ago) sails across the room, towards Ultimate Iron Man. I extend one hand and snatch it from the air.

Destiny stares wide-eyed at me. There is a brief battle of wills. Without taking my eyes from her I poise my pen over the notes. "Any other medications?"


There is a pause, and then Destiny breaks free and leaps on the toybox again. There is a sizeable plastic battle-ax near the bottom of the box, of a style usually found only in old Conan the barbarian comics. She begins to burrow towards it. I take a very truncated drug history, "Speed? Ecstasy? Magic mushrooms?", thrust a urine sample jar in mum's hand and hustle them out of the room.

And close the door, and lean against it.

Things are a lot better for Destiny Tribble. She's fed, clothed, attends some kind of daycare. Mum is off the heroin and is probably using less amphetamines than before - not "a taste on the edge of the knife, first time in ages", but not two hundred and fifty dollars IV a day, taking all the electrival goods down to Cash Converters. Things are better. And the welfare and the mental health team and the outpatient paediatrics people are well aware of the situation. Shafeera Wati, the paediatric registrar up at Florey, remembers the time she saw Destiny in outpatients and wasn't wearing closed shoes - Destiny lunged at her and tried to bite her foot.

A lot of the girls I saw in Mauro, the youth prisons, they were like this. Healthy, excitable, free-spirited.

Anyway. That's community medicine. Very different to the ED, but a lot of overlap, too. From what I can work out, the ED is for acute crises, the community teams (Drugs and Alcohol, Psych, etc.) seem to be for chronic crises... and for people like Mrs Tribble and Destiny, it's all crisis all the time. Always has been, may always be. We succeed if we can help them ride out the bumps.

Anyway, back to work.

The novel, by the way, is a damn sight harder than I thought. But four thousand words looms closer. We shall see who wins - me or a bloody keyboard and a blank screen.

Thanks for listening,


Blogger Chade said...

I have no doubt that the novel will occur with great frequency after the first 5000 words. Getting started is the hardest part after all.
Keep up the good work doc and I'll see you on friday. Can't wait to hear what you say about DD.

10:15 PM  
Blogger Benedict 16th said...

Gosh, it reminds me of a child a few years ago, remember (you know the South African medical student Cassiope's daughter Prudentia), except I suspect the endorphines/sympathomimetic amines were all endogenous in that case.

11:02 PM  
Blogger Foilwoman said...

Poor BJ, mauled by a two-year old.

Your eminence: How does he handle a full-body tackle by the Benniette or the Bennydude? The FoilKid does a great flying leap from the coffee table into maternal arms. Sometimes she even warns me first. Innana has managed to forbid such behavior, but no such luck for me.

Anyway. Smart doctor v. hyperactive toddler round 2: Toddler 1, doctor 0. Maybe BJ should stick to cricket? One rarely gets injured whilst bowling, and it's my understanding that BJ did well without serious gonad-impairing injury doing that.

3:18 AM  
Blogger Bronze John said...

Did I say two? She was at least two and a half. Maybe she's from one of those secretive schools of ninjutsu where they start training their pupils at birth. That means... lets see, two years...she could be a black belt if she was really dedicated.

That's it. I was beaten up by a ninja master. Sounds much more gratifying.


9:16 AM  
Blogger Foilwoman said...

The Foilkid is six, and has just passed from the girly colored belts in to the more ominous and macho dark colored belts. Should you ever travel to the U.S., she will freely volunteer her bodyguarding services to keep you safe from all nasty two-year olds and other dangers.

1:53 PM  

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