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.

Anyway.

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.

John