Monday, March 27, 2006

The wrath of [Insert Name Here]

It's pretty clear what has happened recently. In fact, I could say it has All Become Very Clear.

I have, in something I have done or something I have not done, perhaps in some inadvertent and seemingly trivial transgression, some word or deed or thought ... I have a short time ago angered a god.

Let me be clear about this. Not G-D, or God, no SkyFather or Thunderer or anything, but a god nonetheless. Maybe a minor deity from a forgotten age - a Hittite or a Babylonian semidemihemiurge, a god of keyholes or spilt milk or spiderwebs. One of those gods with a beak or who is part serpent.

Pazuzu, I have been thinking, or maybe Zamama, last heard of as the Tutelary God of the city of Kish in the third millenium BCE. He can't have been busy lately.

Then again, I reckon some of those Meso-american deities were pretty vengeful.... better look into that. In the interim, and in accordance with Talmudic tradition, S/he will have to be referred to as [Insert Name Here].

And why have I, only recently having ceased (under doctor's orders) my antipsychotic, formed this admittedly heterodoxical opinion?

Because it's the only one that makes any fucking sense, that's why. Listen to this roll-call from last week.

Tues: Close friend near death in Royal, overnight vigil, delirious due to sepsis and pulmonary embolus. Does not die. Get two and half hours sleep.

Wed: Work at drugs and alcohol, then visit close friend in Royal until midnight. Stumble home. Nine hours sleep. Find out in morning that close friend died unattended in Royal, nurse having tried to contact me but me having slept through alarm. Friend died having had fewer days and more pain than he would have had if the orthopaedic surgeons had not got their claws into him.

That night, discover that shed has been broken into, tools borrowed from someone else stolen (i.e.: thousand dollar welder), plus saddles and stuff.

Thurs: Wife coming down "with something". Other friend (red hair, blue eyes, vast brain) deteriorates. Second overnight vigil, resulting in five AM trip to Royal with close friend: said close friend taken to emergency department by me in the clear knowledge that they will detain him under mental health act. Friend detained under mental health act. Security guard placed outside room, ED full of aggro drunks and shrieking babies. Friend transferred later to public psych ward, same subsequently found to be "completely full of loonies" (not my words). Drove home late afternoon, having had actually no sleep at all previous night. Slept ten hours that night.

Fri: Red headed friend worse, grappling with feelings of betrayal and abandonment by friends (oddly enough). Other friend (this one dark-haired) reveals she has been sent letters by madman (previously subject of restraining order due to his stalking of her two years back) currently in Arkham Forensic Hospital, where he awaits trial (again) for criminal assault (again). Letters from madman explain how madman has bought all the CDs she has made and has been watching her all the time on telly, and detail their future life together.

He loves her, he says, more than life itself. I say this means that from his point of view, death, say by police gunfire, is preferable to a life without her. Explain that madman seems to be displaying symptoms and signs of being batshit crazy. Careful explanation given as to why this is a potentially life-threatening development and must be treated as such.

Detained friend (red-haired) now displaying clinically evident psychosis, has been seen by two doctors for total of eighteen minutes, seems worse.

Psychiatrist (mine) suggests now not best time to stop quetiapine.

Sat mane: Beloved cat found dead, possible lymphosarcoma. Wife distraught, unwell.

Visit friend in Royal, definitely worse.

Sun mane (about six thirty): Informed by phone that sixteen year old niece (allegedly staying overnight at friend's house in suburbs), has managed to 'miss last bus from city' at eleven thirty at night(!), stay all night in city, found by close family friend at six o'clock in morning in pub ("getting drink of water").

Sun mane (few hours later): Niece picked up by me from family friend's house. Family friend (child-free wastrel pot-head who has never held a job in his life) attempts to give me advice on how to handle this delicate situation. Violence averted by narrowest of margins (i.e.: presence of several witnesses, no bleach to clean up bloodstains). Niece told of new game plan. Histrionics, rending of garments, gnashing of teeth (including multi-thousand dollar braces).

Mon mane: Niece announces intention to leave home rather than groan under iron heel of my fascist dictatorship. Told cannot be detained against will, but advised to wait until after tonight, as fascist dictatorship will be taking her to guitar lessons at six. Actually deeply wounded by niece's declared intention to leave home, but (probably) concealed it.
Mon afternoon: Niece complains of abdominal pain, etc, several of cardinal signs of appendicitis. Taken to Princess by fascist dictatorship. Third overnight vigil (admittedly, in fold-out chair, but better than Royal). Dispute between surg (wrong) and emerge (right) about diagnosis (appendicitis).

Tues: Appendectomy (niece's, not fascist dictatorship's). Entire family (scattered across three states) in hysterics for one reason or another. Wife comes down with hideous gastro from either Royal, Princess or private psych ward.

Wed: Worked today, having run out of sick days. and having realised in small hours of morning that all close to me have been struck down by wrath of minor but malevolent god, who seems to be able to lash at all around me but is prevented from actually harming me himself. Stopping in at Woolworths on way home to purchase spotless bullock and unblemished virgin goat. Making sacrifice at sunset, if allowed to get home.

Plan to lure the bugger down from "On High" and tai-otoshi him into the Underworld.

Anyway, the good thing about all this is that it forces someone out of depression - it's impossible to sit around whining about your own concerns when they are manifestly so much less than anyone else's.

So, will speak soon - possibly.

If anyone wants to know what they could do to help, perhaps it would be beneficial if you could all accompany me....(clashes cymbals, blows on goats-horn trumpet): All Praise [Insert Name Here], praise him in a loud voice, for he is great, descend unto us, oh [Insert Name Here] that we may more closely worship thee...(repeat until fadeout).

Thanks for listening,

Saturday, March 25, 2006



Things progress. Off the quetiapine (still on the other stuff), which means no more "accidentally slept in to lunchtime" for me. And it also means I am able to think again, which means a return to spontaneous social intercourse and, less importantly, work.

I will post hopefully non-gushing thanks/replies to posts in the next few days. And I should be able to read other people's blogs, now that I am chemically capable of being interested in somebody other than myself. Hope all goes, if not well, at least non-catastrophically for you.

So, what's been going on? A fair amount. In the last week, one friend has died, and now another is gravely unwell in hospital. I do not think I am able to put either of these things into words now, so I won't try.

The moods - which until recently were relatively stable, seem to be returning to an equilibrium. There was the up, then the down, then the getting better, then the recent events, which convinced my psych to suggest that perhaps I should stay on everything a little longer than we had originally planned, and now things coming back to normal.

By normal, by the way, I mean fewer of those embarrassing descents into morbid panic. But anyway, I am bored witless talking about myself and my feelings (surely a sign of returning health), so I thought I'd talk about something else.

Specifically, men and their feelings.

So, the last few days I've been thinking. Some of this stuff is going to be hard to put into words, but here goes: Here are three brief stories. I don't know if I can tell them so that the common theme is evident, but here goes.

I spoke to a friend of mine from medical school a few weeks back. He is, by all accounts, a successful man, and by most measures we are friends. Our respective partners, Sarah and Melissa are good friends, they talk cats together, and thus Mark and I have often found ourselves in the same place at the same time - sitting around his place in the Hills, drinking very good red wine and eating food made from vegetables he'd grown in his garden, while the chickens probed amongst the cabbages and the whippets poked at our knees.

This has gone on for five or so years. We see each other, usually via our wives' arrangements, most months, which is more often than I see most of my friends. And he's good at cricket, and can tell some interesting stories about the old bikie days, and he's always interested to hear about my patients, and wonder if he really did the right thing going into administration.

Anyway, I was speaking to him a fortnight or so back, when the depression was at its worst, and he could tell something was wrong. I have not told him previously about the bipolar, but these things osmose out. I mentioned - very briefly - the few weeks of increased energy, the projects started, the ideas that seemed so much better than they turned out to be, the new friendships and plans - and then the subsequent period of deflirting, jobsloughing, unvolunteering. I stated that this was a fairly uncomfortable process, and one that was more than a little embarrassing.

And then I mentioned, in a kind of a "listen to this ridiculous shit" way, the few-hour long descents into panic, the fact that at times I fear that patients I discharged three years ago will become the subject of a coronial enquiry, or that my brother will crash his car and die, that my friends will see reason and abandon me in droves, or that my wife will discover The Horrible Truth and leave me.

Mark said the appropriate things. This is something he's always been very good at, he should have done psychiatry. He said a lot of people have these fears at one time or another. He asserted that a person is known by the quality of his friends, and that if I have this sterling wife, this remarkably good brother, this circle of good and loyal and deeply decent friends then that says something fairly irrefutable about me. And he said a lot of men do insanely stupid things, things that seem like a good idea at the time, things that can't be said to strengthen the marriage, and a lot of men come closer to screwing things up than anyone on the outside ever knows.

I nodded, in a kind of recently medicated way, and said that him and Melissa had always seemed to have something right about their marriage. Him, the classic "tall, dark and handsome", and touchingly devoted, her slim and blonde and vivacious.

And here he looked at me with his dark, quick, expressive eyes, and sort of nodded. And then he said that sometimes he wished, when they were watching the television together, and it was some comedy or something, that she'd find the same things funny as he did. Get the same jokes, that kind of thing. And there was in that short sentence a whole unspoken conversation about someone who'd married someone who was kind and loving and all that stuff but with whom he couldn't share some things.

We quickly moved on to something else after that. I suspect that we will never touch on anything like that again, and in fact I got the strong feeling that I was the first person he had told this, and that he regretted it almost immediately afterwards, some form of disloyalty. But it got me thinking.

And yesterday I heard from a friend of mine, a trainee radiologist who had worked in France for a while before med school. I hadn't heard from him for a while, and the other day he rang up, and we met down the pub. Over a few ciders he told me what had happened.

His cousin had been unwell, he said, between drinks. Cancer, in fact, a non-seminomatous testicular tumour. CT showed no regional spread and surgery - which we both knew was removal of the affected testicle and surrounding tissue - looked like it had cleared things up. There was little chance he'd need the chemo.

He had another drink, and explained how this had brought back to the surface of his mind something that had happened to him ten years ago in the south of France - a girl he'd met, one wet summer, a few months of sex in a beach house. Things already going wrong between them when she first became unwell, something he'd dismissed as some form of emotional blackmail, some histrionics. The separation - eventually agreed upon as the only sensible course - and him climbing the stairs to the plane, and her saying "don't keep in touch". He remembered how sick she'd looked when he left, how pale and thin.

And a letter from a sister a year and a half later, saying she'd died. Cancer - that horribly aggressive subset of chronic myelogenous leukemia that younger people sometimes get.

And then ten years had passed - medical school, marriage, training. And then this diagnosis, the second time cancer had stuck at someone close to him - and how this had all detonated under him in the last few months - couldn't work, couldn't think, took time off from the training programme, stayed at home and stared. Only now starting to get over what had happened, what he'd done. Thought he was losing his mind. Nobody knew but me, and I was to swear not to tell anyone.

And then from another friend I heard of a psychiatrist - no-one known to me, but my friend's supervisor when she did her psych attachment in Melbourne. A tall, handsome, eloquent man, surgical-steel smart, who had been in charge of the largest open psych ward south of the Yarra, and lectured at Melbourne's best medical schools, where he presumably covered ethics and similar stuff. And whose beautiful Asian wife came home one week a day early from a conference, and found that he had stocked the house with prostitutes (three at a time, apparently), and then it all came out, the gambling, the prostitutes, the sex with patients and pupils - and now he was done for, struck off the register of licensed practitioners (and he had also been struck off by the psych registrar, whom he was also screwing).

Anyway - to me there is something that ties all these together, something about men and feelings. I don't know how to put it, except it's got something to do with the difficulty of being alone.

See, the first two examples - my friend Mark, my friend the radiologist, both deeply anonymised - the things they told me they had told no-one else. And I had known both of them for years, and at least one of them immediately regretted the discussion. And the last guy, the uberpsychiatrist - at some stage, he must have thought "this is all getting out of hand, maybe I should ask advice".

How did things come to this? Didn’t he have a friend?

It's a cliché that men don't talk about their feelings as much as women do. I have a number of fairly close male friends, I wouldn't have two to whom I could confess, say, a difficulty in my marriage, or an ethical or diagnostic mistake I had made. The most humiliating thing about the bipolar is that the extreme mood states that occur are often fairly public events, and I do and say and reveal things I find myself cringing over later on.

Last time, I am given to understand, apparently involved kung fu. I didn't have many bruises when I got home, evidently things worked out fine.

I wonder - my wife says she's noticed that cats conceal their illnesses, and that she has heard that this is a common thing about predators, maybe a common thing about animals surrounded by dangerous opponents. I wonder if there is some element of this in that, if all men at some deep, silent level see each other as potential threats, and do not dare confess a weakness for fear it will be exploited. The leader of the pack thing.

I think that there is no secret men's business.

This may be why, by the by, men live longer when married (although I doubt it's that simple), whereas I understand the reverse is true for women. And it may be why men commit suicide more, and may even be the victims of more violence - from other men, of course.

However, I think sometimes men, when they can't confess their feelings to other men, are able to confess them to women.

The problems that arise out of this are several. It is hard for a man (and I am speaking predominantly of my own experience here - I am certain that there are many men, decent men, who feel that everything I've written today is baffling) - to meet up with a woman, get to know her, talk about his feelings and then stop it there. It's hard not to make what seems like the natural, pre-programmed step, the natural progression. I don't know if it's a subconscious thing, or if it's hard not to fall in love with someone you can talk to, or if it's a deliberate strategy, the "talking about your feelings to get her into bed" thing.

I think, by the way, this is what's behind that phenomenon of overlapping, that infidelity that arises in some relationships, where you have some troubles with your partner, you don’t know who you can tell, you find some sympathetic female ear to talk to about it, and six months later it's a monstrous cock-up that everyone but you saw coming, and you see your kids every second Saturday. More about this over-lapping later on.

This is why I suspect it would not be a good idea for me to become good friends with the mordant black-garbed secretary at Central who likes Star Wars, or the wide-eyed-and-possibly-crazy social worker at the southern office, or the shy blonde ICU nurse with the ponytail. Because next time I'm even a little bit disinhibited, bang. Embarrassment all round.

I don’t know. Men (again, by which I mean myself) find it hard to be alone. The psych term for that is dependent. I don't know, I don't need a lot of people I can depend on, but I do know I need one. I suspect that if I hadn’t met Sarah I would have married around that time, anyway, married someone. It would have been stupid and it would have been for the wrong reasons and it would have been a disaster - but that wouldn't have stopped me. I happened to get incredibly lucky - so lucky I still shake my head about it - and find her, the only person who could have kept me going all this time.

Anyway, random thoughts. Womenfolk, don't trust your man's new good female friend - from what I can work out female friends he's had for a few years are generally okay. Men, don't trust yourself. People with medical conditions, take your tablets. Talk to each other, because you never know if the other one's going to die on you, and you'll be left with something still unsaid.

Enough of this. I have a plethora of possible topics for next post - it's been an interesting month - and should be able to get back to it soon.

Thanks for listening, and everything else.


Sunday, March 19, 2006

Days of whine and neuroses

Can't remember if I've used that title before.

Okay, more of this writing rather than panicking thing. I find this a decent way of dealing with stuff.

So far, so okay. The medications have helped the sleep, and I'm not unmanageably dopey at the moment. I did put sugar in Sarah's tea this morning, which is understandable given that she's had the same "milk and none" recipe for only ten or so years. I've started looking at the bills I had forgotten to open. And yesterday I scrubbed the kitchen clean, which was partially necessary because I had come home the day before, found some flies had found their way into the kitchen and sprayed the room liberally with what turned out to be non-stick canola oil.

Plus with the autonomic side effects of the reboxetine I can now strike matches on my tongue.

Anyway: I got some sleep, some decent sleep, and that's going to help things. And many side effects diminish over time. And apparently tentacles are in this year, anyway.

Valproate, by the way, is a damn fine drug for the more egotistical bipolar patient - three months of valproate induced weight gain and the world really will revolve around you.

Seriously, from what I can work out (which isn't much) the principal method of valproate-induced weight gain is alteration of insulin secretion, which means I have to get back down the gym before I am mistaken for a Goodyear blimp. The quetiapine (anti-psychotic) induced weight gain is apparently treatable with the reboxetine (anti-depressant), which is good. Now all I have to worry about is the hair loss and the admittedly small risk of lactation.

I kid you not. A fair proportion of men on antipsychotics (large doses for long times) lactate.

Well, saves me having to bring a bottle of water to the gym, I suppose. Bleargh.

Anyway. What I always tell my patients is that medications are only part of the solution, and the rest of it is the cognitive "what goes on in your mind" stuff, and the lifestyle stuff. The lifestyle stuff is workable - I am going to go out with my friends this weekend even if I have to be wheeled out, frothing and gibbering in a steel cage. I am going to the gym and judo, unless my mental state deteriorates too badly (and as long as I can bring my lord and master, the duck). I am going to fight my way down to the comic shop, the one place in town where my extreme social withdrawal and low-level affective blunting will not be immediately apparent.

The cognitive stuff, the looking at how you think, that is more difficult. For a start, I am thinking more slowly. It has taken me longer to write this than usual - normally it's just sit down and hammer it out, this is day two or three.

I think the main thing is and will be recognizing the emotions – the deeper swings of depression that last a day or so - as that, as neurochemically induced pathological states and not as reflecting how things truly are.

It is not true that my medical career has been littered with the dying and the dead. Well, sometimes it has, but they were dying when they came in.

It is not true, for example, that my wife is going to leave me when she finds out the horrible truth about me. Even if I feel it.

It is also not true, I feel, that my funeral would be attended only by a whiskey priest, a passing tinker and a few disgruntled foes who had turned out to make sure I was dead. And a man wearing a red dress, who had sworn that as soon as I was buried he would dance on my grave in a red dress.

It is unlikely that even now, my erstwhile fellow workers have gathered in secret caverns underneath the hospital, each one robed and masked, and silently shuffle past a hanged effigy on which a crude likeness of my face has been painted, and as each approaches she or he stabs at the effigy and vows “John must die!!!!”

Even drug-free I could see that that last one is quite unlikely. You can’t get the buggers to meet down the pub, let alone elsewhere. And I reckon the nearest caverns are a thousand kays from here.

And so on. Every feeling of despair, every realization of of failure, every cold conviction that the world would be a better place without me. Every tree, every truck, every train track. Check everything.

Weirdly enough, that was my confirmation verse: First Thessalonians, chapter five verse twenty one: “Test all things, hold fast to that which is true.” Not how I originally envisioned using it.

Anyway, enough levity – back to the whining. But seriously, the drugs (which I won’t be taking forever) and the cognitive stuff and the lifestyle stuff will work. If I was my patient I would assure myself that I was prescribing myself the right medications for me, and and I’m sure my ringing confident tones and screeds of scientific evidence would convince me of how right I was, and how foolish I was to doubt me.

Seriously for a moment, I loathe this feeling and I loathe the selfishness and childishness and self-indulgence that goes with it. I hate hearing myself whine and I hate lying at home achieving fuck all and I hate not being able to think straight or fulfill my responsibilities.

I will do anything to get my brain back. If I am prescribed a diet of broken glass and nutella and was convinced it’d make me better, I’d eat it. And I really hate nutella.

Sorry about all this. Normal serotonin/dopamine/noradrenaline levels will resume soon.


Friday, March 17, 2006

The Nail Fright Mountain Models

On the way back here (picking up friend from hospital, seeing psychiatrist, trying to track down unpaid bills and pay them, that kind of stuff) I passed eight roadside memorials. Eight of the things. Everywhere here there are signs somebody has died.

I should try and explain the things I mean – although I doubt they are an exclusively Australian phenomenon. You see a streetlamp, or a salmon gum, or a road sign, and tied to it or nailed to it are some faded flowers, or a broken sign, and a name. By the intersection of Cooper and Laing streets, there is half a tilted cross strapped to a lightpost. It says "Daniel P..." but the rest of the name is worn away.

These are not distributed randomly, but the mathematics behind the pattern is obscured. There is a mathematical model that should be able to be used to predict when and where these memorials will occur - I refer the interested reader to the Nagel-Schreckenberg model of car accidents, a mathematical model of how traffic flows or does not flow, and when and where to expect collisions.

As an aside, I hadn't heard of this mathematical model before and I looked it up. The most comprehensible nuts-and-bolts article was from wikipedia... but in German. I tried translating the page with Google's translato-thingy, and I got a relatively normal looking article... but then I noted that among other things, the translated page spoke not of the deterministic and non-deterministic Nagel Schrekenberg models of traffic flow, but of the Nail Fright Mountain Models.

Now there's a mental image. The Nail Fright Mountain Models. Coming soon to your fashion show, to lurch psychotically along the catwalk in tattered rags at midnight, and stare at passers by through the broken glass of empty shop-front windows.
Sound like one of those bands my niece listens to - that stuff they call black metal, although it's only ever done by white guys.

Anyway. From what I see of where these memorials are, long straight roads seem to be over-represented - the five or six kilometer stretch of the single-lane street from the railway tracks to the sheet-metal place, the straight stretch of Kraepelin Highway as it comes down from the north. This suggests the usual suspects - fatigue, inattention, complacency.

I wonder, at the moment, if there was anything else involved.

Those voices in the silence, that kind of thing.

But some of the patterns are surprising. A few years back there was a horrible accident close to here. A big semi trailer came down the hill, end of the Freeway, came through the lights. On the other side of the intersection the cars were lined up - a small Civic, a Barina, a beaten up station wagon, a VW. Eight or ten people died. I was doing final year at the time, closer to the centre of the city, one of my friends was doing emergency, another surgery, another orthopaedics - several of us saw these patients, or had spoken with those who had. We descended on the patient files like flies, the way you anxiously grasp at news of a strange country towards which you are being taken.

Anyway, eight dead, tens injured, the close-knit communities of the south reverberating with the shock. Psychiatrists and social workers spoke gravely on the television about the effects of things like this.

And yet today I drove past the entrance to the freeway, and there was nothing. No flowers, no cross, no small sign hammered into the stony ground. As if, perhaps, that death was too obvious to require a memento, or too vast to be claimed as one person's death.

And anyway. These things do answer some questions. Are we forgotten after we die?

I suspect we are.

Before I cause offence, I am not suggesting that those who mourn their dead only make show. And I know - I have seen - people crippled by their losses - husbands who survive their wives by less than a month, fathers who've buried part of themselves with their sons. My own best friend, when I was fourteen, fell from the back of a flat-bed truck onto the road, cracked his head open, died on arrival. I cried like I had never cried before. It changed my life.

So - do I remember him?

One answer is of course. His father grew trees (it was a windy night, the young trees they were transporting were being blown about, he stood on the back of the truck to hold them on), and even now each time I see a nursery I am reminded of him. And I did what theology I did and aimed to be a pastor like I did at least partially because of him, imagining in some daft way that he would be honoured by me taking up what he had always said he would do, my picking up the torch that he had dropped.

But there is more to this than that.

The first few days I heard about this I cried, cried constantly for a few hours.

The next few weeks there was less crying. There were times spent talking, gathered knots of us, or sitting outside classes while teachers sat with us, being comforted.

Then the next few months. We did stuff - wrote about it, organized some English prize in his name or something, once or twice we prayed together. But we also played a bit of basket-ball, fell in and out with each other, discovered dungeons and dragons. I think that was the summer my new best friend Alastair hooked up with that red headed girl and I hardly saw him.

And now. Now it's once or twice a year I see a nursery, or I hear that 'four Yorkshiremen' sketch, or see someone who runs a bit like him (that nodding-headed, enthusiastic way), or some weather patterns (it sounds really mawkish, but when the sun comes out from behind a cloud - that's what he was like)... that's what reminds me.

Something has changed. I have recovered. I think on those events and I do not feel quite the same pain. In one sense, it has been forgotten.

Neurologically, I suspect we can find out what has happened. The brain is plastic, meaning that it flows and deforms in response to pressures: emotional pressures, cognitive pressures. Not so much on the macroscopic stage, but at the molecular level - neurons and synaptic knobs and patterns of neurochemicals. It adapts, it flows around, ineluctable as water round a rock.

Over time the brain recovers from what neurologists call 'insult'. Horribly, callously, unpalatably, most people pretty much get over it. They continue on their way - an altered trajectory, subtly or less so, but still continuing. They keep on moving.

I suppose if we are talking neurology, the 'reason' for all this is unclear. But perhaps some griefs are intolerable. Scar tissue forms around the wound.

(However, this is not always true. I remember seeing a woman when I was with the Mental Health* team, working in the far south of the city. I had been asked to see someone after her GP became concerned about her ongoing depression. I drove miles and miles over dry, sun-baked land, past tiny shopping centres and service stations with two petrol pumps, to find her, in a tiny regional hospital on the banks of a slow-flowing river. We sat in the courtyard while she told me of her husband's death - eighteen months earlier, some agricultural accident, a few days in intensive care in the Royal, and then an end.

She - no sleep, no energy, not going out, fewer and fewer friends, voice slowed and whispering - I don't know that she would get better. It had been a year and a half, and she was no better at all. I recall reading at the time that women widowed at a relatively young age have a very poor prognosis).

So mostly we forget. That's it. No thesis here, no particular argument, no pushing a certain point of view. If we die, then (eventually and to a certain extent), people get over us.

This, I suspect, is why the flowers are faded on the signs that say "Always in our hearts", and why Daniel P's surname is obscured, and why I wager nobody in the surrounding shops (KFC, an aquarium shop, Alf's tyres, Carpet World) could tell me who he was.

Anyway. Enough of the morbid thoughts. And enough of the internetting. I have to get in the car and pick up my niece from the bus stop. Basic social contract stuff.

I was right about the drugs, too - three out of three. Mood-stabiliser, anti-depressant, low-dose anti-psychotic. I spent the night looking up the pharmacology of these medications, and the day imagining I have every documented adverse effect possible. I doubt it. But next post will probably be an installment of Fear and Loathing in the Frontal and Temporal Lobes.

Thanks for listening,


*Not in the mood for amusing-to-me nicknames. And anyway, I've forgotten what I called this organization. It's the community mental health team, the people (nurses, social workers, doctors) who go out and visit the mentally unwell in the community. Did this for six months almost three years ago. Very much an "into the underbelly" job.

Thursday, March 16, 2006

Background radiation

They call these the small hours of the morning, but they loom large when you are in the midst of them. Between two and three in the morning as I write. There are occasional whispers of rain outside: a few seconds' sussuration, a smell of cold air, and then a silence. The first real rains of Autumn are still some weeks away.

I can't sleep. Outside I think there is a half-moon.

If I go outside now, and stare up between the clouds, I can see that blackness between the stars. I suppose I would say I am looking at space, or looking into space. But 'space' is an elision, something omitted rather than stated, a common, short, handleable word for something that is really too strange, too alien, to really fit into our heads.

Think of it this way. You look think you're looking up and out, you gaze out maybe with vague thoughts of the future... but you aren't. You are looking back and behind you, looking into the past. You're seeing things how they were, tens, hundreds, thousands of centuries ago.

The way your mind works - and it's perfectly adequate for most times, most places, seems to get us by - the way the mind works is you see a point of light in the sky, and you think, because that's how it always is, that that burning point of light means something. That there is something there, some glowing thing, some star, that there is out there some fire in the dark.

But that's not true. What you see is not there. It's really a trick - a trick within a trick, a trick of the continuum and another trick of the mind. All you really see, all you ever really see, is afterimages. You look up in the sky and see things, stars and galaxies, but some of the stars you see now will have died - flickered out or flared into unwatchable light - died before you were born.

All we ever get is afterimages. You can go out there now and gaze into the workings of a time machine, face up into the dark, while the cold, old light, ten thousand years aged, sinters down on you, light from things that were dead before you were born.

Back in the sixties, from what my currently seemingly quite drug-fucked brain can remember, they (you know 'them', the ones who find out stuff, prove things, the whole amorphous gaggle of of them, white lab coats pressing against each other, thick glasses glinting) - they discovered something about the night sky.

They found that the sky is not utterly black and cold. They found the sky glows, too faint and cool for us to see, seems dark and yet it glows. It glows with microwave radiation almost three degrees above absolute zero. Something only detectable by sensitive instruments, a cold, dim murmuring drowned out by sun and star, but always there.

This thought is leading me somewhere, I'm not sure where. I will try and be patient and tease it out. But outside to the west there is the sound of thunder, soft and low. Something moving in.

This three degree, microwave radiation, this faint afterglow you see wherever you look when you look at the night sky, this is the cosmic background radiation. Mathematics that I cannot understand assures me that this is of significance when determining the age of the universe and other imponderables.

Right - all spaced out for a moment. A brief diversion.

What's going on in my life? Besides the low, the not-going-into-work, not-sleeping, not-seeing-or-writing-to-people low, the humiliate-myself-in-front-of-my-workmates-because-I-can't-remember-shit low?

I'm dragging myself out today to see my psychiatrist, which should be a hoot. He is meeting me at Clearwater, the state's sole secure psychiatric hospital. It is a pleasant, Edwardian building set amongst manicured lawns, and surrounded by a sixty centimetre (yes, that's right) tall decorative brick wall. The locked wards are hidden deep within - all security guards and electronic locks. Whenever I drive in there I imagine seeing uniformed guards pursuing a shaven-headed man in a straightjacket across the lawn, in the sunlight, beneath the oaks.

I was there in fourth year for a day as part of my psych rotation. I'm sure it'll feel good to be back.

And I'm taking the tablets. My psych will probably suggest the good old triple whammy - anti-depressant, mood stabiliser, anti-psychotic. I suspect that may mean no work for a while. Looking back, I reckon starting the valproate was the right move, good clinical decision. I reckon wimping out on the antidepressant was less so. If I'd done that before no-one would be talking about quetiapine now - a drug I have only ever prescribed to psychopaths and criminals.

And I'm checking the thoughts, not letting the bad ones build up any of that horrible emotional momentum that they can.

And I'm doing all the things I know I should, (the things involving tablets and exercise and a non-negotiable "getting out of bed and fulfilling basic responsibilities" plan) and I'm doing none of the things I want to. Because a lot of those things are stupid ideas.

I think the thing about the background radiation - the reason the phrase came into my head about four am the other night, the reason I am trying without success to get these words down, explain some thing before it is lost - the reason all of this came up is the thoughts of death. My thoughts, specifically. My death.

Now, my experience is that phrase generates more alarm than perhaps it should. I stress there is a difference between this and much more worrying suicidal ideation.

I think thoughts of death are common thoughts. I feel that thoughts of death, of dying, thoughts of just not being here any more, of stepping into oblivion - I have believed for many years that these are under-reported, that they may be extremely widespread, almost ubiquitous, maybe experienced by almost everybody at some, possibly fleeting, times in thier lives. They are the rule, not the exception, and thus it is difficult to really consider them a symptom of a disease.

To put it another way, thoughts of death, thoughts of your own death, even fantasies about your own death and dying, may not necessarily be pathological. Or if they are, then we are all very sick indeed.

Specifics: I think that everyone - child to adult, father or son, mother or daughter - I feel that everyone at some stage imagines these things:

what would it be like if I died?
would it hurt? even if it did hurt, it wouldn't hurt for long, would it?
how would anyone get on? would they get over me? would they mourn forever... or would I be forgotten?
what's it like - if there's a like? is there a like?

See, there is a seduction, a guilty childish pleasure in these thoughts. I suspect there is some deep ego-stroking in it. I suspect, in fact, that if a benevolent extraterrestrial starship descended upon us tomorrow, and gave each and every human being a necklace with a fragile bauble on it, and said "this is our gift to each of you: whenever you want, reach up and crush that bauble and you will fall dead, instant, soft and painless"... then a fair percentage of the population would be gone within the month. Impulsive, unplanned events. Stepping out into oblivion.

Those thoughts of death are common. They are, if the analogy makes any sense, they are the background radiation. We don't notice these thoughts when brighter stars are in the sky, but in the still small hours they are there. Murmuring away, beneath the threshold of our hearing, but audible to the heart when it is alone.

But those thoughts of death are not suicidal intentions. Again, if we locked up everyone who had ever thought of killing themselves, it'd be pretty damn lonely out here. There'd only be those people from breakfast cereal ads and the occasional cheerleader.

Having said that, at the moment the other thoughts are there too. It wouldn't be depression without them - I think they're the ninth out of the nine criteria - and I've got a fair few of the other eight. But I don't know that they're that uncommon either. It's all fairly low-grade stuff.

Who has not driven along a lonely road and thought - that tree. That salmon gum, that she-oak, that tingle tree. Or seen a rafter and thought - that looks strong enough. These pills. Or the gas oven - easy enough.

My understanding, by the by, is that modern technological advances - in this area, as they have in many other areas - have made achieving this kind of peace a much more difficult process. It's something about the gas.

And with the new catalytic converters - not sure of the details here, might be the petrol, told you I know nothing about cars - it's fairly difficult to asphyxiate yourself. People who have 'success' in this area tend to own the older cars. Otherwise it tends to require a fair amount of fuel. Every year we see a few people in the ED who have been brought in by police, who attempted to end it all but instead ran out of petrol and have had to call the RAA.

And don't talk to me about the pills. Overdose is bloody difficult. If you can't get hold of some decent cardiac or oncological drugs, you'd better hope that your GP is incompetent enough to put you on the old-school tricyclic antidepressants. Otherwise, these things have a depressingly high failure rate, or an embarrassing wait after the event while the damage done kills you - paracetamol is the classic example here - one dramatic orgy of pill-swallowing, then a week or so of mild abdo pain, the seven to ten increasingly unpleasant days on the transplant ward at the Royal. Fucked if that's where I'm spending my last days.

I have morphine, diazepam, a few vials of atropine (not enough), a very little insulin - even I've brought people back from more than that. The atropine might need a bit of work, but there's nothing there that's really useful.

And the chances of fucking up some major organ that you really don't want to do without - liver, brain, whatever - and still having to live, always sick, never as good as you could have been, only now with every bugger watching you like you're crazy... those chances are relatively high.

Nope, as things stand, couldn't recommend the pills. To be honest, suicide, except in my patients, is not something that I look into that much. I have kids.

So, that's what's going on now. I don't think it's the background radiation, it's something else. It's pathology. Maybe it's because everything else has gone quiet, the way you notice silence sometimes, so loud it rings your ears. But that's pretty much the tenor of my thoughts this last few days.

There - spoken.

See, there's only so much you can cover up with speculations about the seven dwarves and woodworking.

This is what, lately, I think about a lot. My death, the arranging of it. That tree. That lamp-post, a good site for a noose. That eighteen-wheeler barrelling along the highway - that'd crush a skull, surely. I could sling a rope over that rafter.

I stress this is not a plan for suicide. Even if I could do these things - and I can barely tie a knot at the best of times, and I am a terrible physical coward, more scared of injury and disability and weakness than of anything else - I would not be able to.

I have a beautiful and long-suffering wife (at least until she wises up) and two glorious sons, and a niece who looks up to me. From what I have seen of survivors of suicide (and by that I mean the people who are left behind, the ones who have to deal with what the others fled), suicide cripples those whom the suicide least wishes to harm, those who were closest to that unimaginable ground zero. The fathers, mothers, sons... a wound that does not heal for years. Nobody should be able to harm their children so much, plant that cancer in their souls.

And I know, too, that people with depression are much less likely to see how things really are than they are to see things as they are not, to show the symptoms of their disease - inappropriate guilt, poor concentration, disturbed sleep, loss of pleasure in things that normally give pleasure.

And I know that this is a good life, that I do useful work when I am well, and that I have friends who love me and people who depend on me.

I just can't feel it at the moment.

This is the bitch about the moods. The ups have to have a down.

So dawn goes down to day / Nothing gold can stay.

And that's another thing I have to do. Read something good. Doctors should prescribe poets as well as potions. This time, straight for the top-shelf stuff, the schedule eight literature - Much Ado About Nothing. Taming of the Shrew, the Tempest, that kind of thing. And some of those cheery little ditties from Ted Hughes. Maybe not.

Seriously, if you hammer beautiful thoughts into your skull you feel better. I have experienced this to be true.

Any day now the valproate will kick in, that soft purple blanket effect. And then the others will. And I won't have to be on them for ever - the valproate for nine or so months, the reboxetine for less, the (still experienced as deeply humiliating) quetiapine maybe only a few days. Then this will pass, and I will get better, and I will be judged worthy to go back to work.

Anyway. Enough of this staring into the dark. I wonder if it helps - after you've looked at the night sky long enough, even the half moon seems bright. After writing about this kind of stuff, I feel better.

However this goes, if you're reading this and you feel low, it gets better. You just have to wait it out.

And however this all ends out - and I know it will end well - everyone here has been wonderful.

And while I will pre-emptively appreciate everyone's concern, this is not so much a plea for reassurance or help or company or anything. I won't be fun to be with for a few days yet. But should be compos mentis soon.

Thanks, and look after yourselves. Will join you later.


Wednesday, March 15, 2006

Nothing to say here....

Just in to work on this allegedly therapeutic dose of hell-proate (which is playing hackey-sack with my intestines as we speak), and already feeling sleepy and grumpy. At this rate I will have progressed through all seven dwarves by the end of the week.

It is possible, of course, that Disney's Snow White is not a bowdlerised and saccharine German folktale, but actually a multilayered allegory on the experience of mental illness. Snow White lives free and happy, living with sideshow freaks and talking to animals in the wilderness, until betrayed by the wicked queen, who tricks her into taking a poison apple and being cast into a deep slumber - sounds like your psychiatrist detaining you under the mental health act followed by ten mls of zuclopenthixol in the right buttock.

Presumably Snow White's subsequent three months of electro convulsive therapy was cut from the 1938 version.

Of course, in this analogy the dwarves "Bashful", "Doc", "Dopey", "Grumpy", "Happy",
"Sleepy" and "Sneezy" only refer to unmedicated bipolar. The dwarvish pantheon for medicated BPAD would have to be expanded to include Fatty, Floppy, Baldy and Drooly, plus a dwarf named after that weird reaction you get when your neck gets stiff and your eyes roll back in your head. Oculogyric Crisis-y? Extra-Pyramidal Side Effects-y? Well, the latter are commonly abbreviated to EPSE, so Epsey the dwarf it is. Epsey, meet John, John, Epsey.

Grumpy in French, by the way, is Grincheux. Sneezy in Spanish is Alergico. Swedish had Butter for Grumpy and Trotter for Sleepy, while German gives us the evocative Pimpel (the understandably Bashful dwarf) and Schlafmütz (Sleepy).

So, butter and schlafmutz today, and only getting schlafmutzer and more buttery as the day goes on.

Anyway, actually sick person at the door. Will reply to emails, etc. ... soonish. Feel very averse to talking to anyone, even those who have been excessively courteous about this whole thing. I am more in the "things to do: curl up and die" stage at the moment.

However, if I do wig out and murder Benedict, I note that I am in the unusual position of being able to write myself a valid sick note and presumably fully exculpate myself. I may need legal advice on this. I wonder if I can sign my own detention form...

Thanks for listening,


Monday, March 13, 2006

Instruments of doom

Tell you what, all this disturbed sleep and emotional neediness is having one fortuitous effect - I have been writing like all get out.

And today, for no particular reason, I shall share with you my feelings about surgery, in a post that could have been titled "Why I am not a surgeon".

When I was in junior high school, we had things different. Boys did metalwork and woodwork, and if they were lucky, learnt how to strip down a diesel engine. Girls learnt cooking and sewing, and if seen as worthy, typing. I should point out that since then I have sewed on buttons and darned the very occasional tear in clothes, and I have cooked and eaten a considerable number of meals. And I have typed hundreds of thousands of words.

But I rarely have had to construct dove-tail joints, I have had little use for spot-welding, and with car engines - I barely know my expensatron from my povertiser.

Anyway. I was an exceptional student at woodworking. I was, apparently, the most exceptional student the teacher had seen in his twenty one years at my high school. I was so truly exceptional that the mark Mr Dour wished to give me was actually forbidden by the school, and he was forced give me a mark that did not truly reflect my aptitude, diligence and promise in this field.

"But the bastards won't let me fail you," he snarled at me one memorable summer afternoon, "so I'm pushing for a D double minus, you dopey bastard. You reckon you're up to that?"

Truer words were never spoken. The woodwork curriculum began at a doorstop (two bits of wood nailed together) and progressed to a wooden pencil case (six bits of wood nailed together). After that came inlaid tables, lathed lampstands, folding chessboards and finally a decorative jarrah cabinet with panels of deep red sheoak and honey-coloured blackbutt. Each boy's craftmanship was exhibited behind the desk, and each week Mr Dour would select a particularly fine journeyman's piece and discuss it before the class, noting precise joins, smooth finishes, beauty and functionality.

But he didn't pick my pencilcase. He could have picked my doorstop, but it wasn't a good doorstop, because the little bit fell out of the big bit after a while, and it ended up being a doorstop that would not actually, you know, stop a door. I had coated the thing in varnish until it glistened like a slug in the first dew of morn, but beauty wasn't enough. It had to have functionality, and so I was passed over.

Enraged, I set about the pencil case. As I said, six bits of wood. Soft, malleable, any-fool-can-do-it pine, the ligneous equivalent of play-dough. Already cut into approximately the right size, requiring only grooving, sanding, some other arcane practice I've forgotten, and hammering together.

Couldn't do it.

Seriously. I could groove, I remember grooving with the best of them. Sanding was bad, I tried sanding, and the sander made deep grooves. Lining things up was next to impossible - simple "shapes that should fit together" no longer fit, my right angles became wrong, my rectangular sides of the pencilcase assumed the dimensions of a Moebius strip. I remember at one point holding something in my hand that seemed to be a square but had four corners and five sides.

I hurled it all away and began again. This time the sander bit right through the side of the lump of wood, making a loud snapping sound and hurling a fragment of a hundred year old tree skittering the room, like the work of a vengeful dryad. The next time something went wrong with the staining - I tried to conceal what I had done, but Mr Dour lifted the six slices of wood that had assumed the colour and stickiness of freshly spilt blood and asked the class for feedback.

And the last time - twenty one weeks later, two hours a week, and not a thing to show except a door stop that didn't stop doors - the last time I got as far as joining the thing together and hammering the nails in, only to turn it over and find that every single nail I had hammered now protruded into the interior space of the pencil case, and it was less a case for pencils than a device for returning them to the True Faith - a pocket Iron Maiden, for the travelling Teen Inquisitor (TM TduCN!).

Anyway. Worst student in twenty one years. And metalwork was no better, I remember being sent off to the metalwork shop for a "long weight" and actually standing there waiting a very long time before "getting it" and slumping back to class. Basically, not good with hands and machines.

(Weirdly, my sutures are pretty neat, and my chest drains seem to work, and the time I was going to stab that kid in the chest with a bloody big needle I was looking at the right place. But I still have to practise every three months, rather than six, with the defibrillator).

Anyway, second year medicine we did a surgery, and I hated it and it hated me. You can't talk to patients during surgery. And cutting people up always seemed violent to me. And my first attendence at a surgical operation involved me holding a retractor (a kind of bladed hook thing) for a Whipple's procedure (a horrible kind of surgery for an only marginally more horrible disease - less than ten percent of people who have the operation are alive after five years, and it's not always a pleasant five years. But it's probably better than pancreatic cancer. Probably.).

The Whipple's lasted four and a half hours (removing gallbladder, common bile duct, part of the duodenum, and the head of the pancreas takes time) and for me that was four hours of hunching over, unmoving, applying not too much and not too little tension to a metal handle and trying to keep out of the increasingly irascible surgeon's way. This, by the way, is why Frankenstein's assistants are always hunched, grimacing, subservient and have dubious social skills. Their formative years are spent hauling on a retractor, cringing beneath the iron hand of the surgeon and breathing in ether - no wonder they don't impress.

So - thank God we're not living in the old days where it was deliver a baby at three o'clock, set a bone at four, whip out an appendix at five. Emergency medicine is the possibly the least specialised of the specialties, but there is nothing more reassuring than seeing a good surgeon arrive to assess and treat the "probably appendicitis, but could be ovarian" patient whom you have stabilised and worked up. If you're not a surgeon, under the skin of the abdomen is a black box. Kudos to the good ones, and Christ in His mercy help the patients of the rest.

One last thing - surgical instruments. I love the names. If you want to look up some elderly man's hooked and patrician nose, you use a special pair of forceps called a thudicum. Thudicum. Is there a more beautiful, euphonious word? Possibly, somewhere, but is there anywhere a more beautiful, euphonious word for something that goes up your nose? Not really.

And the others. Strange names - gall stone scoops. Lens spoons. Rongeurs and proctoscopes, the Breuning otoscope and the Quire Mechanical Finger, mastoid chisels and Gerzog mallets.

Terrifying or wondrous names - vein strippers. Muscle clamps. Brain sectioning knives. Iris Suturing Forceps and the Wells Enucleation Spoon (don't ever ever ask, especially if you want to eat anything, anything, with a spoon ever again. Ever).

Rich names full of history - The Metzenbaum scissors. The Olsen Hegar needle holders. Lister bandage scissors, and even, oddly, Kevorkian forceps. The McGivney Hemorrhoid Grasping Forceps and the McGivney Hemorrhoidal Ligator.*

By the by, don't click on that link unless you really want to. They put it right where the name suggests. And bran: eat lots and lots of bran.

Anyway. To each their own. I suppose every time I hear of one of my patients kept overnight in the surgery ward with inadequate pain relief because they are, quite clearly, junkies, or hear about someone whose was sent home with (insert terrible tale of surgical arrogance here) I should think about me, standing over some comatose man, trying to tease out pathology from normal variation without nicking anything vital, in someone who will die by my hand if I don't get this right. Like I said, Thank God for the good ones, and thank God twice that none of them are me.

Thanks for listening,

*Product Description: Improved model with offset handle for better vision and comfort. 7" (17.8 cm) working length. Can be disassembled entirely for cleaning. Supplied with drum loading cone and 100 Latex O-Rings.
Grade: German Stainless Steel
Price: $420.39).

Sunday, March 12, 2006

Not actually about me

Bit of an issue awaiting me next time I go to work. Hear this out. And the following is - shock, horror - not about my feelings or me.

There are two doctors at SMACHEAD. There's me, usually Monday, Wednesday, Thursday, and some other days. And every second Friday there's Dr Grizzle, a saintly looking woman in her late fifties, every second Friday.

Why only every second Friday? More on this later.

Well, the other day the nurse, a tall, slim, good-looking blond with blue eyes, a vigorous sexual appetite and an impish sense of humour came and spoke to me. It was about Dr Grizzle.

"She rang me up yesterday" said Phil. "Three times in an hour."

"What about?"

"Well, the first time was to ask if I'd 'told on her', to Dr Bear," he said. Dr Bear is the senior doctor for Drugs and Alcohol in the state, our "Great Sage, Equal of Heaven" kind of person. A tall, bearded man, gentle, but frightening looking, and justifiably feared.

"Told on her? What for?"

"Don't know. I told her I had no idea what she was talking about. Then half an hour later she rings me up and apologises for being so rude."

"Was she rude?"

"Hardly. Never says a sentence without 'please' or 'thankyou'."

I nodded. "And the third time?"

"Asked if I'd been talking to Dr Bear about her. Again."

There was a long pause while we both digested this. It came on the heels of some nursing concerns about Dr Grizzle's attitude towards benzodiazepines - a class of drugs about which medical opinion is divided. A lot of doctors around here think they are first line pharmacological treatment for depression. I reckon they are Satan's jellybabies. We have to be careful here with prescribing benzos because benzos plus methadone plus all that other shit our clients have going on in their lives equals overdose. I have managed to avoid the coroner's office so far.

Dr Grizzle has, to her credit, been quite open about her problems. I don't know quite what they are, but I suspect some kind of schizoaffective disorder. She has that more-than-a-split-second delay when answering questions, that slight alteration in posture that comes with the phenothiazine antipsychotics - thioridazine and so on. I was put on this back in the nineties - the sensation resembles having your head sawn off and replaced with a balloon.

She talks about seeing her psychiatrist (I don't talk about seeing mine, by the way. The bipolar is a closely guarded secret between me, my psychiatrist, my immediate senior doctor and a few of my closest friends. And anyone in the world who has internet access). She admits something is quite wrong.

And something is wrong. She's prescribing benzos like M&Ms and writing wrong doses. She's seeing patients for the sixth time and not recognising them - patients tell me this. She's writing scripts that finish three years before they were written, and so on.

It seems pretty clear what has to be done. And the central organisation has been doing it. Dr Grizzle has been slowly removed from all of the high-stress, full-contact areas of drugs and alcohol. She never seens patients for the first time. She rarely deals with 'comorbid' patients - those who have two or more "types" of problems - drug dependence plus mental illness, for example. My gay Aboriginal guy with heroin and amphetamine addiction, homelessness, brain damage from violence, low-grade psychosis and a history of spontaneous violence, seven different kinds of sexually transmitted diseases, plus I reckon something wrong with his chromosomes - she's not able to prescribe him anything useful.

Neither am I, by the way, but that's another problem.

But Dr Grizzle is still here, out in the south, and it seems that in the last few months her condition has worsened. Impaired memory is dangerous, poor concentration is dangerous, but for sheer "Oh my God, what do we do now?" the prize has to go to psychosis, and these recent phone calls sound like low level psychosis.

This came up at Florey once, doctors and mental illness, and I said you can practise with mild, mild depression in some jobs, you can sometimes practise with a mild anxiety disorder and that's about it. Someone else has to know about it and you have to run things by them, and you have to listen to what they say, but mild depression and mild anxiety are doable - if we sent home every anxious, depressed doctor the whole ED would have to close down, and I reckon the psych service would vanish.

You can't practice in the ED with even mild mania. Depression is actually a lot safer than mania (in my case, anyway), you tend to overcheck rather than leap confidently into a diagnosis.

But no-one can ever practice with psychosis. The thing is before the actual clinical psychosis (depending on the cause), you get abnormalities of cognition.

You get concrete thinking - the inability to think in the abstract, a difficulty in generalising, a tendency to think in terms of objects rather than relations between things. One doctor I heard of ordered skull Xrays (an almost useless investigation, but the way, it's CT head or nothing) for everyone who came in with a headache.

You get paranoia.

You get confusion.

You get feelings of inappropriate guilt.

You get the things that I think it's likely that Dr Grizzle has got.


This is not going to be easy. Dr Grizzle is terrified of being "pushed out". She only works one day a week now (alternating one day with us, the other doing busywork at central office). She fears, probably rightly, that the work is one of the few things holding her head above water. And she is a close friend of Burian, and a few times I have gone in there and seen her holding his hand. And she is a dear woman (no other word for it): courteous, hardworking, compassionate, intelligent.

Anyway. At the moment I am just trying to collect information - find out what is actually going on. I heard about this late Friday, managed to speak with a few people, and everyone I've met - the giggling chainsmoking receptionist at SMACHEAD, the dark-haired mordant secretary at central, the other nurses. Almost everyone has expressed concerns.

There are a lot of big questions here - about how the medical profession reacts to people who can't practice any more, about the closed shop, that whole priest-hood thing... but some other time.

So, we shall see. Next time I'm non-crazy enough to work I have to tell someone else she's not. Joy.

Anyway, thanks for listening.



I had hoped that this post would be something interesting, something other than more of my empty whinnying about me and my emotional state, but apparently this is not to be the case. So, roll on up...

Today's title, by the by, is a memory that floated to the top a few nights ago, three AM. It refers to the high Calvinist position on the doctrine of predestination - the thesis that before Creation, God had already decided which of the people He had yet to create would falter, fall, and be cast into everlasting damnation.

Calvin's position, clearly stated in a number of texts, was that God knew (because He had decided) that some of His creation were created for damnation. Babies who died before the preacher hurried to the house, men and women who had prayed and forgave others and believed themselves born again. Death, a brief moment of confusion and then seasons in the abyss.

Some of us, therefore, are born to fall. A doctrine that is simultaneously deeply repellent and yet in accord with much modern thought. One of the many, many reasons I am not a Calvinist.

That and the hats.

By the way, does anyone else think that the history of the twentieth century would have been very different if the Vikings instead of the Puritans had set up the first successful American colonies? I'd imagine Republican appeals to the ideas and practices upon which the USA was built, all that "the faith of our forefathers" stuff, would have to be radically altered.

And Thanksgiving would involve mead and wenching (and whatever the gender apposite term is, hunking or whatever) and wassailing and so on. Hats with horns instead of funereal black. Every Thanksgiving people could all drive big long cars with dragon-heads on them.

Anyway, enough about other people, on to me and my feelings.

Not that there's nothing else going on in my life, by the by. In fact, Burian is still in the Royal, my friend Elizabeth is very unwell, and there are a number of other issues of similar import going on that I am not permitted to discuss here.

Maybe that's part of it. I went and saw Burian the other day, but didn't go in. I didn't go in because he was having physiotherapy - the cancer in his kidneys that has spread to his hip has been treated by surgery - what sounds like a total hip replacement. Post-operatively - and to a certain extent, pre-operatively - he has been confused. This confusion - called alternatively post-surgical delirium, post surgical psychosis, whatever - is a common thing. Healthy men after cardiac surgery throw themselves from windows, middle-aged women who have had their gall bladders removed become suspicious of their loved ones.

Anyway, last time I saw Burian he was fairly seriously unwell. I spoke a while - stories, the affairs of friends, the political scene - and he nodded, more from hearing the sound of my voice than from any of the vague platitudes that I had said. Then, as I fed him his raspberry jelly - almost the only food he will eat, that whole second childhood thing - he grasped me with one thin grey hand and opened his bright blue eyes.

"The nurses," he hissed. "I am beginning to feel that they mean me harm."

I nodded, and sat a bit longer, and reassured him, and afterwards I went to see the ICU registrar. I went on about post-operative psychosis, and Burian's childhood - he had been in some group called the Deutsches Jungvolk, a sort of Hitler Youth for tweenagers - until about eleven years old. And I mentioned the heart-rate of ninety eight in a post-surgical man in his late sixties, and asked if they had him on clexane, because he had that possible blood clot about a week back, but then again it depended on exactly which surgery he'd had, which nobody including Burian seemed to know a lot about - and I went on about a great many things until the ICU registrar had to leave, and doubtless as he left he gave instructions for me to be stopped by security next time and not allowed back into the building.

And I went back and reassured Burian that the nurses and doctors were bending all their skill and care towards making sure he was safe and that he recovered well, and that they were very practiced at dealing with cancer and depression and post-surgical psychosis and hip surgery. And he seemed a little reassured by this.

And the next day I went in and apparently later that day he'd clambered out of bed, trying to escape from something, and fallen a metre onto his side, onto the other hip, which was now quite badly bruised and painful.

I'm not one of these "telling the overworked nurses off" people, and I'm not saying it was their fault, I feel it was the doctor's, but thank Christ I wasn't in charge of the orthopaedics ward when that happened. There wouldn't have been any spare beds in ortho, I would have filled them all with staff.

Anyway - we shall see what happens. I have told Burian that there is every chance that he will be able to go home after the surgery. I did this speaking clearly, in a low and calm tone, and with a reassuring manner.

Top of my class for lying, seriously. Can do it better than anyone I've met. If it'd been one of our assessable clinical skills, I would have burnt the class.

So there's that.

Anyway. What else?

I am low, moodwise. This is quite possibly convenient - I feel I have still got some clearing up to do, post hypomania. I am busy buying fire-engines for two-year-olds and leaving timorous messages on my friends' answering machines.

I remain convinced, until it is demonstrated otherwise, that part of this depression is exogenous. It is a result of a number of things, of what is happening to Burian, of what is happening to Elizabeth, of those other things I mentioned.

Well, the taking of the valproate goes well - I remember most times. Is it working? Can't tell. If by working you mean "Is there some kind of one-on-one association between taking the tablets and a complete and total cessation of all symptoms", then it's not working. The wave moves on. After the high comes the low, things burn up then they burn out. But medicated crashes aren't as bad as unmedicated ones. We shal see.

And the state of play now: the sleep still isn't back to normal. The energy is stll there, more of an agitation, really. The concentration, not one hundred percent. The mood, fluctuates between so-so and those black hunched up moods that make me less than fun to be around.

Anyway. Don't have to go back to work until Tuesday, and that's at the half-a-brain job. I am going to ring Florey and tell them I'm off for the foreseeable. I shall check the mail to see if there are any bills from divorce lawyers Sarah may have seen.

And I'm taking the appropriate medication, and I'm seeing the appropriate specialist, and so forth.

So none of my friends have to call the mad-catchers on me, as I have done to many others.

Plus I'm doing all the other stuff - the gym, judo, that kind of stuff. Yesterday I went out with my son and we kicked the football around and talked - mostly me listening, just stuff about this new computer game he's got, how bad his math class is. At the end of the night he hugged me - and I reckon that's close on a first for a long time. And I had friends around and some marinated chicken thing and it's football season again. And I have comic book friends and medicine friends and even weirdo judo friends, and sooner or later I will be able to go back to Florey.

Things like this make it hard to be depressed for long.

Anyhow, thanks for listening. And for listening before.


Monday, March 06, 2006

And now for something completely different...


The following is best read in a gruff, masculine and embarrassed voice:

Right, thanks for that everyone, everything's all cleared up now. Should be okay from here on, thanks again for your help, very much appreciated...


I am going to take some of the excellent advice I recieved, which can be boiled down into three simple phrases ("get a sense of proportion", "take your own medical advice" and "for God's sake, John, grow a pair") and move on. Moving on in a low alcohol, low risk, appropriately medicated way, and carefully checking out if there is any repair work to do (post mania* behaviour requires an entire new set of verbs: Deflirting. Counterpromising. Aggressolysis. De-Don'tworrymateI'lldoiting): moving on slowly but presumably in a direction that makes sense.

Having said that, this has shaken me up a bit - not a call for reassurance, just an observation - in that that was the first serious upswing for a long time. I don't know if it was related to the medications I should have been taking more of earlier, or the fact I'm not doing shiftwork anymore, or if this is the new shape of things (I doubt it, but I'm not a psychiatrist, even if a week ago I reckoned I knew as much as some of them) - but whatever caused it, it's perturbing. Needs looking into.

Anyhow, on to stuff that isn't just about me (having said that, thanks one last time, everyone).

Anyway, today was allegedly work but is in reality a two day seminar on "dealing with the violent patient". It was actually quite good - a lot of the "self defence" courses I've been to have been about how to smack the other guy out insterspersed with somewhat unfeasible wristlocks and so forth, whereas this one was more on the applied psychology - how to verbally and physically manouvre things so that what could have been an assault remains a conversation, and so on.

The presenter was actaully quite normal for a martial arts bloke. He was full of ghastly tales about people who ignored his helpful advice and were then punched, bitten, stabbed or run over with semi-trailers, and then came back to him and said how right he had been... but otherwise normal.

Anyway, off to bed. Thanks again.


* Please God

Saturday, March 04, 2006


Well, well, well.

As a prelude I am posting something I wrote a few days ago but never quite had the concentration to post. Read that now and it might explain some of what this post is about...

So: what happened next?

More of the same, actually, more of the same faster. I continued with the lack of sleep, which was irritating and frustrating not because it made me tired (it didn't), but because I would have to lie in bed staring up at the dark before sneaking out to play Civilisation or surf the net for stuff.

And because a lot of the time I was easily frustrated and irritated.

Then get up six fortyish up to drive the niece to school, go to the gym, heal the sick (more on whom later), go to the gym again on the way back from work (unless it was judo night), then clean the house.

I should point out that a lot of what could get done with this glorious excess of energy I get does not get done. I get a bit distractible when high, and if I am working (I took a bit of time off, may be back this coming Wednesday, depending on professional advice, may not be) I tend to spend a lot of my energy rechecking things, or wasting time. I've put Florey on hold for the time being. The SMACHEAD job I could do with half a brain, but I spoke to my boss on Wednesday about taking time off and had a very light workload Thursday, and will hopefully be back there by next Wednesday, depending on advice received.

Anyway. About a week of increasing elation, culminating in last night's master-stroke: calling in "sick for the foreseeable" to Florey, suddenly ramping up the dose of valproate to full-strength (and for my next trick - buckling up my seatbelt as I drive through the red light...) and going out to meet my comic book geek friends for our usual few drinks down at the pub. Yepo, drinking and a dose adjustment in the same day - seemed like a good idea to me at the time.

Of course, lots of things seemed like a good idea at the time.

Anyway - the pub. The pub has the name of an imaginary equine creature, so in keeping with this theme I will call it the Completely Reasonable and Sensible Horse. I have yet to meet one of these, and many authorities beleive them to be mythical.

The comic book geek friends, by the by, are remarkably socially adept and pleasant company - a fact for which I was grateful later on.

Well, the pub didn't go well. Well, the pub went fine but the cumulative effect of inadequately medicated hypomania, five days of four-hours-a-night sleep, an indeterminate amount of wine and a potent psychotropic medication (they should put warnings on this stuff about mixing it with alcohol... hold on...) meant that the night, after a while, didn't go that well.

I think it started off okay, we read Ultimates and talked about feelings or something. Then I started to feel really weird, feelings that were not quashed by my usual one or two glasses of wine. Even when I started drinking the bottle of wine I had on me (I was intending to walk to a friend's house afterwards, and so I had the wine and I'd decanted it into a plastic ... oh, never mind, it made sense at the time) - that didn't seem to stop me feeling weird. In fact, I felt weirderer.

I will point out at this time it would easily be a year since I got more than slightly tipsy, and it would probably be five years since I got really drunk.

Tejhn it started. I started off with surprising and possible unwelcome confessions about my amatory past, intersposed with looking around for someone to fight. Then I think there was a brief, hopefully forgettable and ghastly to recall meandering monologue that touched upon the Incredible Hulk, my erotic ambitions, the sympathetic and honest way in which Mark Millar had written previously unlikeable characters such as Iron Man and Captain America, whether that dark-skinned girl over there was hot or not, the idea of the Godhead in Buddhism (Algernon's idea), smart brunettes and redheads, Nicky Winmar and racism in Australian football, girls with glasses and sexy hands, and whether following Fremantle Football Club amounted to an abusive relationship.

And there was talking fast and waving my hands and stuff, and remarkable insights, and all of my jokes were funny.

The night went on. For some reason I was lead out into the street by Chad and the increasingly alarmed Algernon. There had been some talk about kava, but even then I knew that that was a bad idea. I dissolved any remaining self-restraint in copious amounts of cabernet, drinking in the street, staring at street acrobats cavorting on the riverbank, and leering at frightened women. I started to feel a little bit like Fear and Loathing in Mordor. I told a wide-eyed girl in the dark that I liked her teeshirt.

Things deteriorated. Eventually I was led, almost incoherently drunk by my two comic book friends to another friends house, only stopping on the way to hug some other wandering, inebriated emergency doctor, who was also blundering around the streets.

What are the odds of that, by the way? is this how Ed doctors spend their time, or is it just the ones I know?

I will mercifully draw a curtain over the remaining events of the night. Suffice it to say that there is a question in the "Are you a pathetic piss-head" questionnaire, the one we have to use to determine if someone should be get their licence back, that asks about causing embarrassment to yourself or others while drunk. I'm going to be fairly unambiguous in my answer to that in future. Luckily, the friend whose house I went to is a pharmaceutical rep who has the anti-emetic (i.e.: anti-nausea) contract for half the Eastern seaboard. So I got a sample of a medication they usually only use to treat cancer patients (twenty two dollars a tablet, I ask you) and went to bed.

And here I am, sick and sore and with a head like a child's toy, typing this.

Anyway, I've noticed a tendency of mine to put morals at the end of some of these entries - this one's pretty obvious. Read the fucking label. Take your own advice. Remember you get sick too.

But I don't know. I don't know if any of it was cathartic or not - there's been a lot going on, but whatever was going on is still going on post getting drunk. I reckon that hypomania - and that's the first serious bit of it I've had for years - doesn't respond too well to medications you don't take, and I reckon valproate and promethazine (an anti-histamine I took to help me get some goddamn sleep) and shiraz cabernet is not going to become a standard treatment protocol for anything any time soon.

Having said that, no-one died. And given a few months I am sure one or two of my friends will start talking to me again. Perhaps.

Anyhow, work to do.

Thanks for listening.