Affettuoso

Traces of ick in the subsequent post, read at own peril. And I am writing this against a time limit,straight from brain to screen here, forgive the errors.

Early this afternoon found me listening to the first movement of Tartini's
"Abandoned Dido" Sonata, arranged for violin and played affettuoso, and examining a young man's scrotum.

I think that affetuoso, by the way, means "with great tenderess", which would seem to be appropriate to the situation.

(And for this I gave up Emergency Medicine. The spectacle, the excitement. You don't see this on ER - unless there's a cable version).

(and by the by, they call it the ED, not the ER, over here. I used to think that our acronym made more sense (it's a department, not just a room), but I have just noticed that ED is the approved acronym for the heartbreaking problem of erectile dysfunction).

Improbably, I do know an amusing story about erectile dysfunction which I will document another time. Presumably a time when I am clinically disnihibited.

Anyhow, this morning was spent in the central clinic, looking after people who've come in to detox off various substances, and one of tehm was a young man who was coming in to get off amphetamines, heroin, buprenorphine (that medicine we give to get people off heroin), two kinds of opiates, three kinds of benzos and pretty much anything else.

He also had four different and mutually incompatible psychiatric diagnoses (the more often you turn up to the public health system the more psych diagnoses you get. They accrue over time, like barnacles on a bottle buried on the seabed, so someone who is poor and has been in and out of psych wards for ten years gets at least eight different diagoses.

If you are a junior doctor and are faced with patients like this, the safest thing to write under diagnosis is "schizoaffective disorder with component of personality disorder" - that covers pretty much anything and can be used to explain any possible symptom a human being can show. If the patient you saw at nine o'clock and said was doing well escapes by lunchtime and is arrested breaking into Parliament with a sack full of carrots, that can all be explained as "schizoaffective disorder with component of personality disorder".

Anyway, back to the young man in question and his genitals.

He was concerned he had contracted lice. He knew that whereof which he spoke,he had had them before, and it looked possible that he had them again. I had a good look and decided that I couldn't see anything, but I'd send him off to Prof Scanq at the sexually transmitted infections clinic and let him not see them.

And also to see if the scratches and sores on this young man's legs were actually due to scabies, as the young man said, or due to him injecting a gram a week of ice since early January, and thus a sign of ongoing low-grade tactile hallucinations and the peculiar delusional state known as "formication" - the delusion that insects are crawling under your skin. As I said, not having seen either before but knowing my psychoses better than my little arthropod things.

Anyway, off to the clinic with him. It is an interesting fact I have never met a doctor who can examine someone who has claimed or even suggested, to have lice or scabies without themselves getting itchy. Even now, writing about it, I have to stop to scratch my head and beard.

This means the idea that one has scabies is probably the most contagious folie a deux (delusion shared by two people) in existence. Someone who falsely beleives that s/he has little insect things living in their skin can convince you that you have little insect things in your skin just by talking to you.

Enough of this, I need to go get some antihistamines.

Anyone who is feeling itchy just from reading this post, email me back. I'm going to write this up in a paper for the Lancet - "Internet Transmission of Folie a Deux - a case study and review of the literature."

This guy, by the way, had had sex with 2000 men in the last fifteen years. I remember sitting in on a talk in the sexually transmitted infections clinic when Prof Scanq mentioned that one of the questions he asked patients was how many sexual partners he'd had. I considered how I'd answer that - trying to think of a number somewhere between "slut!" and "can't get a root!", and Prof Scanq says "Approximately! Ten? Twenty? Five hundred?"

This last figure was treated with snorts of mingled derision and envy by our group until Dr Scanq put up the first slide, a case of a young man who, we calculated, ahd claimed to have had a new heterosexual sexual partner every two or three days for the last ten years. No misses, no repeats. Close on fifteen hundred.

Again, people different to us.

Anyhow, my next client awaits. Thanks for listening,
John

Love will find a way

Love, they say, hurts. I, and all of us reading this, know this to be true. But I don't know that many of us know it as definitely as Mr Pearce does.

(By the way, you know those Renaissance paintings where Cupid is blindfolded and carrying a bow and arrows? To us it's some simpering fat kid, saccharinised and sentimentalised so it is no longer any kind of threat. But I reckon the people who painted it were using the best visual analogy they could. Love, they knew, is a blind and childish figure, and it's airborne and carries the most effective long-range killing weapon available at the time.

Nowadays, love would have stealth technology and be armed with a streetsweeper*. And it would wear some kind of leather jacket with a romantic couplet in gothic letters, scattered with umlauts).

Anyway: Mr Pearce, my "patient least likely to..." from a few days back. Mr Pearce had recently, and I suspect temporarily, been released from prison. I say this because throughout his interview he slumped in his seat, desperately trying to keep his eyes open, falling asleep mid-sentence, pupils the size of pinpricks, while denying to the three of us that he had had heroin.

And all this with a forensic urine test pending the next day, and the absolute certainty of return to prison if his urine contained even a smidgin of anything recreational.

But in the interim he was here with me, long, pale hair, gaunt featured, hatchet-faced, dressed in coarse, well-worn black, a lower socio-economic status Elric of Melnibone. I asked about amphetamines.

"Hate the shit" he said. "Never touched them."

I sighed inwardly. "This is different to the drug court stuff" I said. "We want to know what you're on so we know how much medication you need. No-one can get these notes without a subpoena. We're not interested in punishing people."

Untrue after my last post, but still.

"Speed's for fucking junkies" he said, in between micronaps. "Filth".

"I only mention this, sir, because your last.... fourteen urine tests have had amphetamine metabolites in them, and because a year ago you told the prison doctor that you'd been using a gram of speed a day, every single day you weren't in prison, since you were nineteen, and you're forty one now. See, it's all in this letter here with your signature and photo on it."

There was a long pause, which I think he may have found a bit discomfiting if he'd been awake through it.

Anyway, after we worked out that side of things I asked about his general health.

"No probs" he said. "Never been sick a day in my life."

"Those scars..." I said. He had about thirty scars over his forearms, with a few on his forehead and one on his neck. "What happened there?"

The prison notes had said "sustained in ATM robbery", but I doubted this.

"Ah, that was my missus" he said. "Went mental at me in the pharmacy back in Christmas 2004. Reckoned I was seeing another woman."

"With a knife?" I said. The mark in his neck was two centimetres lateral to his trachea, had missed the common carotid artery by what looked like... no distance at all. I only knew it had missed it because Mr Pearce was still here talking to me.

"Mate, you're bloody lucky to be alive. That was someone who was trying to kill you"

He shrugged. I went on.

"And supports in the community? Any family here?"

He shook his head. "Nah, but there's me and my missus and my kid."

I nodded, then gazed at him as an idea struck me, so crazy it just might be true. I paused, and tried to think of it in a way that would not give offence.

"If you don't mind me asking, sir, is this the same woman who tried to stab you to death in the pharmacist in Christmas 2004?"

He waved his hand dismissively. "Oh, she's over all that now. She says she's always been short tempered. Reckons she doesn't know what went through her head when she did that."

Amongst his other scars this guy had a deepish one over his right eyebrow, where only the supraorbital process of his frontal bone had stopped a non-Medicare funded frontal lobotomy. I was thinking it was more a question of what almost went through his head that was the worry.

I said absolutely nothing. He leaned forward, looking as troubled as a man can who's just had two hundred dollars worth of smack up his arm, and confessed his guilty secret. "But you know something, Doc? Sometimes I reckon it's affected the relationship.... There just... I don't know.... There just doesn't seem to be as much trust as there was."

I nodded. For a moment we understood each other. "Not that it's any of my business" I said, "but I reckon that's not always a bad thing."

Love and other bruises.. and incisions, and stab wounds, and blood pressure of ninety on nothing...

See, perhaps that man was one of the Lamed Wufnicks, the thirty six truly righteous people upon whom the fate of the universe rests. I think he was a man capable of acts of forgiveness and charity of which people like me can only dream. He was definitely a much more forgiving man than me.

I'd know I'd be the kind of petty, legalistic person who'd take being stabbed almost to death badly.

I wouldn't move on.

I wouldn't let bygones be bygones.

I'm serious. The least little flurry of lacerations to the arms, knife-blow to the skull and deep stab wound to the throat and I'd be be holding a grudge (and possibly any item of clothing I could find, pressed against the arterial blood spurting five feet across the room) for the rest of my life.

All thirty or so seconds of it.

Anyway.

Today was much less remarkable, although I did have one "couple" who explained that although they came in to see me together and although she, who did not use heroin, answered several of the questions for him, who used, that they were not "together".

"No worries" I said. I glanced at Paul, my client, who nodded.

"Have you changed your address out the front desk?"

"Oh, he still lives with me, in my house. Always has. And we sleep in the same bed, because there's only one. But we're not together."

"Okay" I said.

"I've got a new boyfriend and everything" she said.

"Right"

"But he's not allowed to come over" she said. I looked at Paul, who shook his head with the air of a man who knew when liberties were being taken.

"And why - ?"

"Paul won't let him" she said.

People different to us.

Thanks for listening
John

*And why do I know about this ghastly thing (an automatic shotgun, by the way - for those times when normal shotgun just won't kill masses of people fast enough)? Because a fellow medical student of mine, a Republican from Arizona, used to own one.

When Steve (pretty much the only guy I know who would insist on onymity** in a blog like this) mentioned his "gun collection" to Sarah and me, we both imagined a collection of elegant eighteenth century fowling pieces, breech-loading muskets, perhaps a flintlock pistol. It turned out that Steve's collection instead featured what looked like cannons on tripods, handguns the size of Volkswagon engines and devices designed to flense sizeable crowds of your enemies while you wait.

Despite this frankly terrifying admission, Steve turned out to be a relatively gentle and tolerant soul. As far as I know he never showed any hard signs of understanding primum non nocere in a different way to the rest of us. And anyway, most of the charges were later withdrawn, and none of the witnesses could be persuaded to testify.

Steve is now an ED doctor in a large American city, and in many ways a better one than me.

** Opposite to anonymity. Send onymous love letters, it's less romantic but saves needless confusion.

Crossing Over

One funeral and two phone calls from the police "just clearing up loose ends" about patients of mine who have died, and I am feeling a bit "in the midst of life, we are in death"-like.

Consequently, today I did something I wouldn't have thought I'd do a year ago. And today I am finishing the bottle a bottle of cab sav that is impressively packaged, highly recommended but leaves a sour taste in my mouth and probably isn't very good. This is, believe me, the appropriate wine for the occasion.

So, prelude.

I saw Mrs Weber the first time two months ago, one of those cold clear days at the end of spring, where the sky is that empty pale blue and the sun gives bright light but no heat. She had previously been Dr Grizzle's patient, and I wasn't really familiar with her case. She was the ten thirty appointment, but ten o'clock hadn't turned up (he had, it turns out, been detained and admitted to Jack Napier House, the high security forensic psychiatry place in Innsmouth, where the three admission criteria are you must be bad, you must be mad, and you must be dangerous to know).

So it was Mrs Weber sitting on her chair, a woman with eyes the colour of the overcast sky and hair a dirty straw colour, wearing some old kind of woolen coat over a pair of stovepipe jeans and a pair of thin-soled sneakers. I called out her name. She looked up, and I could see she was crying.

I closed the door and went out to the waiting room. Occupational health and safety regulations have since made this an offence, in part because the head of psychiatry in South Australia was shot and killed by a patient a few years back, and partly because we need some kind of industry into which we can put all those people who used to work making ships and so on, so now they make laws to stop other people doing stuff.

Anyway, I came out and sortof crouched down in front of her and asked if she was okay, if she wanted to come back and talk some other time or if she wanted we could talk now, but she gathered up her shopping bags full of stuff and came inside, weeping silently.

I think at one stage I must have asked what was wrong, because what I wrote down for that half hour was an almost biblical catalogue of woes. She was homeless. Her children had been taken from her, as had her grandchildren. She had been raped - again, it was so many times now she'd lost count. The one friend she'd trusted had stolen all her stuff. Hassles from her ex, child protection, her children....

And so on and so on. The notes suggest I asked only minimal questions, partly because she was crying so much she couldn't speak, and I wrote "needs social work consult urgently" and then I went into the room down the hallway and got our beautiful, impeccably groomed, so-good-looking-you-don't-want-to-talk-to-her social worker to see her then and there. And as she was lead from my room I noticed that she was crying if anything more than when she came in.

Anyway. I glimpsed her a few times after that, usually in the morning when the practice was at its busiest. She was more a nursing patient than mine, and I had asked a few times about her and received a roll of the eyes in response.

It emerged that although she was on methadone, the big drug issue was her drinking, and she had to come in every morning to be breathalysed to see if she was sober enough to be given her methadone. Most mornings she wasn't, and would have to come back in the afternoon, or miss a dose.

Two months passed, and Sam the nurse bumped into me in the corridor.

"You've got Sarah Weber tomorrow" he said. "I'm really worried about her."

"What's wrong?" I said.

Well, a hell of a lot, it turned out. She'd been admitted to Florey a few months ago - I rang up and got the discharge summary and sat and read it while my coffee went cold.

"Good God in Heaven" I said. "Good God. She's going to die."

And she was. She had been admitted with seizures - potentially fatal seizures caused by trying to give up alcohol "cold turkey". She'd had blood tests done - I thought guiltily of what I hadn't done the morning she sobbed uncontrollably at me - and the blood tests were horrible. Kidneys that were several decades older than she was, a alcoholic heart that was big and thickly muscled and horribly, horribly weak. Liver function tests that showed her liver corroding inside her belly. A CT of the liver that showed it swollen, lumpy, deformed. Blood that wouldn't clot, because her liver had basically given up making the proteins that stop you bleeding to death when you cut yourself.

I did the maths. Ignore the heart for the time being, because clinically she'd never been in heart failure, same with the kidneys. They were going to go, but they weren't the things that would go first. The big risk, the thing that kills practically everyone on methadone with a crap liver who is still drinking alcohol and also taking unknowable amounts of valium - I scanned through our notes, read the name of her GP, covered my eyes - the thing that killed them was one day they just stopped breathing.

Whether it would be her (very infrequent) heroin, or the cask of wine a day, or the handful of diazepam, or her liver just not coping with the load... it wouldn't matter. You drink your cask along with your methadone, the alcohol stops your liver breaking down the methadone - you basically die of a methadone overdose. But after you've finished drinking, your liver, which is used to dealing with all that alcohol, rips through the methadone, so you get underdosed - maybe you treat that with heroin. Or more alcohol, or diazepam. Again, you die. And that's with a functioning liver - Christ.

And Florey had seen her before. She hadn't told Dr Grizzle this - a year back she'd had hepatic encephalopathy, which means her brain was getting poisoned because her liver wasn't working, not clearing the crap out of her blood. Hepatatic encephalopathy was what my pathology text called "an end stage manifestation of liver disease, often immediately preceding a precipitous decline".

Gods. I sat down with Sam.

"What can be done?" I said.

"What hasn't already been done?" he said. "There's a small army of people trying to look after her, and she won't have any of it. Tells them all to fuck off. And she's drinking more now than five years back."

"She won't see another five years" I said. "She might not see this one out."

"Can anything be done, you know, psychiatry wise?"

I shook my head, tio my shame I had already thought of this. "Not crazy enough to detain. Not brain damaged enough to get a guardianship board ruling. Free to make her own decision."

"Are there any medications?"

"None that work when you don't take them." Depressed, homeless alcoholics have notoriously poor compliance with medication regimes. And she'd been tried on altrexone (three days), acamprosate (one)...

Nice military-sounding word, that, regimes.

Anyway. The conversation went around and around, and I read the notes some more, and I looked at the CT report and shook my head, and I went back and had another cup of coffee (if you have alcoholic cirrhosis, by the way, whip into the coffee - preliminary evidence suggests it may actually help), and I couldn't see a way out.

So, got on the phone to my boss, and then we called her in. We sat her down and we explained our reasons and the rules under which we operate, and her choices, and we let her think about the offer of an admission to hospital for alcohol and valium detox, and maybe a changeover to a medication that was safer in people in her situation.

And we explained our concerns about us prescribing a drug that would quite possibly play a part in killing her in the next few years.

And we reminded her how she'd been able to blow zero on the breathalyzer three years ago, and that was a really positive sign.

And then I told her that unless she was able to come in here and blow zero every single morning we were going to have to reduce her off her methadone - removed the medication that stopped her using heroin.

There was silence for a few moments. She knew that what I was threatening would make her suffer for months, long drawn out weeks of cold turkey, never comfortable, never warm, always sick and shaking and afraid. And the only things she would have to take away the pain - alcohol. Valium. Hammer.

What we were threatening would probably kill her sooner. Maybe we could just ignore the stuff from Florey, keep her on the methadone...

Could you repeat that for the benefit of the members of the jury, Dr Bronze?

Anyway. She said she'd think about it, ask one of her non-existent friends. This time she didn't go on her way crying, it was more a pale face, set and shocked, with something of the uncomprehending about it.

I suspect I know what will happe.

She won't take up our offer of detox. You have to want to stop drinking, and she doesn’t.

She won't be able to blow zero for more than a day or two at a time. Again, what else in her life could be stronger than the urge to forget it?

And she won't be any better off without the methadone. She may have less chance of that just stopping breathing, the "sounds more peaceful than it is" death that she was heading towards before I interfered, the death that could claim her any day now.

But I'd choose that over the slow and unutterably horrible death of liver failure, the skin the bright, soft yellow of a child's raincoat, the confusion, the belly swelling and taut, the speckled bruising wherever you have been touched. The end of many alcoholics. Jack may live here, but he dies in hospital.

Anyway. I reckon she'll be off our books in two or three months. The drugs and alcohol version of the transfer TDT - transfer "to die there". The important thing, it appears, is that when she dies, soon (later than if we'd kept with the methadone, I'll admit that), the coroner can look at what happened and check up the list of agencies who were involved in this death and see Drugs and Alcohol's name not there. He or she can see we did the sensible thing.

And the thing is, I may have done the wrong thing by my patient, the one I am sworn to protect, but I did the right thing by my medical career, and by the organization, and by our risk management people. And if you look at things from a utilitarianist point of view, greatest good for the greatest number, there's a shitload of them and only one of her. That's a lot of good I've done... for our organization.

Our organization. May they be beaten with an empty bottle to within an inch of their life, and if not, may the shades of cowardly doctors and callous lawyers squat upon their chests anight like nightmares.

I can, if required, repeat that for the benefit of the members of the jury. And I know there's nothing better that could have been done, that it's a choice between the lesser of two evils, and here I am blubbering like a boy about it, but, whatever. Luther said Credu ut intelligam - I understand because I believe. Drunk and late at night, I can only do one of them at a time. I can understand I did the right thing, but there's not a lot of beleiving.

Anyway. Off to bed. Sorry about the self-pity overdose. As I said, I would feel less bad about this if I had not had the police ring me twice in two days about different patients who died - none of which I actually killed, but still, it is not cheering.

Thanks for listening,

John

Big Brother

Horrible shock yesterday. I walked in on my niece in the loungeroom, and she was doing something that utterly revolted me.

Yes, lying on the lounge watching a show called Big Brother. She says many will be familiar with the basic sadomasochistic premise of this show, apparently there are versions everywhere.

So I sat down and tried to share her interests/spoil it for her. Lasted exactly twelve minutes. Twelve frickin miutes of watching someone you don't know gossip about someone you don't know, interspersed with grainy action shots of a group fo people lying in bed. I kid you not.

Good God, now I know how those fundamentalists preachers feel when they thump the Bible and rail against teh rising tide of immorality that threatens to engulf us all. I am going to look and see if this programme is actually mentioned in Revelations as a sign of teh End Times.

Our text for today is Revelations 17, verses 3 and 4 and verse 18, from the Revised Revised Standard Version.

Rev 17:3 He carried me away in the Spirit into a wilderness. I saw a woman sitting on a scarlet-colored beanbag, full of blasphemous tatts, having seven piercings and a skanky swimsuit top.

Rev 17:4 The woman was dressed in purple and scarlet, and decked with six carat gold and dangly earrings, having in her hand a golden cup full of something the cat would't drink and the impurities of her upcoming prime-time subtle-as-a-bus-crash fornication.

17:18 The woman whom you saw is the number one winter ratings programme, which reigns over all of the earth, but mostly teh growing tide of stupid ones.

Words fail me (not yet, more's the pity). What is the masculine of skank? What is the collective noun for airhead? If you opened the door and threw in a live idea, would the poor little bugger slowly die of exposure before finding a brain to crawl into?

This is series six. Well, stupid is when you don't learn from your mistakes. I honestly believe that each series, each episode of this show lowers the collective IQ. I am not joking. You are what you eat, you can only write good stuff if you read good stuff... this stuff is some kind of negative learning, teh neurological equivalen of those meals that allegedly take more energy to digest than you get out of them.

We as a species are doomed. We've already had five series - anyone notice how well the space race has been going lately? Da Vinci code on the top of the bestsellers list? Vote counting machines that can't... well, count votes?

Three more series of this show and the bloody koalas will be able to take over. A plane will land at Sydney airport (from some blessed place with no TV) and there'll be an eerie silence, broken only by the sighing of the wind, and gum trees from horizon to horizon.

I warned you....


Thanks,
John

A day of marked crapness

Well,
Dropped in on Florey today. Florey, for those who can remember, is the ED where I am allegedly doing my Emergency training. Hadn't really set foot in there for months, but I stopped in there on the way home, went in there, had a wonder around. No real reason.

Or none that I could have explained without embarrassment.

See, the work at SMACHEAD (I did come up with a better acronym, and you reckon I can remember it?) was never going to be full time. It was a stopgap, a way to get some decent nine to five hours, learn some skills, some better (almost twice as good) money, that kind of stuff.

But I don't know that it was something I could see myself doing long term.

The reasons for this were several.

Firstly, I am too lazy and stupid not to be in a training programme. I forget the old stuff and I can't be arsed learning the new stuff. I don't keep up with new developments in medicine anything like as much as I should - although today I started screening my male methadone clients for testosterone deficiency, because methadone, along with making you fat, miserable, weak, toothless and apathetic, makes you sexless. Methadone is a truly crap drug - unfortunately it's the least crap one we have that we are allowed to prescribe that does what it does.

Seriously, I'm forgetting stuff at an alarming rate (is it one kidney, two livers, or the other way around?). The half-life of un-used knowledge in my head seems to be about three days. Sarah can remember all of her one hundred and forty client's names, most of their doses and a fair few of their addresses - she says that if you write something down three times it basically sticks in your memory.

I suspect sometimes that the reason she and I had no children is because we have different numbers of chromosomes. There is something like a species gap between us, in some of the stuff she can do with her brain.

Second, I am a bit frustrated with the drugs and alcohol job. It sounds juvenile, but with the D&A job a lot of the time you are not looking for success, you are checking for failure. You ask how long since the patient slipped up and used heroin, you check the urines to check who's lying to you, you do the physical exam to see if the drinking has screwed up the nerves in their legs so they maybe shouldn't drive. Success - and the vast majority of patients are successes - success seems to be defined by an absence of failure.

Maybe what doctors find so unsatisfying is that it's not that nobody is healed, maybe it's that they heal themselves over time rather than you healing them, and that's much less satisfying to the medical ego than sticking a tube in someone's chest and getting them to breathe again. In the D&A job we don't save anybody - and maybe you do't become a doctor unless you've got that messiah requirement.

Anyhow. Some of this off-pissedness is doubtless temporary - I am still oddly shaken up by that Mr Gouger, whose funeral is today. He seems to have just vanished from our care, no-one speaks of him. The whole thing seems - I don't know. Unfinished, undone. Like there was still something we could do, but we are not.

Plus he was the closest I have come to missing a diagnosis of suicidality - I saw him, a number of months later (about two, I believe) he was dead. All of my other psych patients who have died (see below) there has usually been a period of months intervening, and I have always referred them, either voluntarily or involuntarily, to a psychiatrist. And psych is meant to be what I'm good at.

Although I did speak once to a psych RMO, a young blonde Englishwoman who was woking her way around Australia and showed me her photos of skindiving on the Great Barrier Reef and clambering through rainforests - she had had a worse time. The very first patient, the first patient she sent home froma psych ward killed himself three hours later. Never worked in psych again.

Christ this is morbid. But wait, there's more...

Yesterday I got the most humiliating phone call of the last several years. The police rang me up asking me about a psychiatric patient of mine who had died in 2002. They geve a name and all I could remember was that the guy hadn't used his real name (which was a collection of eastern european consonants), but had called himself "Tim" or something. The date of birth suggested a man in his early forties - which didn't narrow it down.

Anyway, this patient had been seen by me in 2002, detained, sent home or somewhere else, and died soon afterwards.

"Was this the guy who threw himself off the sixth floor of the remand centre the next day?" I said.

"No""said the constable.

"Sorry, sorry. The one who hanged himself in Mauro?"

"No" said the police officer. A tone of wonderment had crept into his voice.

"Terribly sorry. The one who got sent home and then jumped off the Slythering Bridge?"

There was a pause while the constable noted down my name and resolved never ever to see me.

"No doctor, this is the one who died at Shipman because he lay down to sleep- "

"Without his mask, asphyxiated in his sleep. Right, right, sorry. How can I help you?"

Well, howabout I fax you a list of my family and friends and you agree never to see them?

Plus yesterday one of our more troublesome (i.e.: brains of a spoon) clients had to take her three year old child into Florey because he had gotten into her stash of diazepam and oxazepam and eaten some, and was so drowsy he was not breathing. And he's a good kid, and she's a decent woman, but seriously too stupid to have her own children.

Apparently the contempt - from doctors, nurses, ambos - was radiating around the place when they brought her in. The junky mum who'd poisoned her kid. But Child Protection are already involved, so this should pretty much finalise things. So that's the only thing keeping her on the straightish and narrowish gone - but hopefully he's safer.

And I had to tell this other guy yesterday if he didn't stop doctor-shopping for valium I was going to have to cut his methadone, because people on methadone who take handfuls of valium and have Hep C and cirrhosis and drink die at a remarkable rate, and in the words of my boss, "if he was going to kill himself, we didn't want it on our CV".

And I hate, hate, hate cutting down on people's methadone as a punsihment. Thank Christ they're not diabetics - "Well, mate, you knew the rules and you broke them - no insulin for you for a few day"."

So - yesterday I drifted in to Florey. It was a busyish afternoon, it's winter, and Dr Van was on, one of the two or three best doctors I've worked with, used to tutor us in the exam prep, the exam where I missed out by under five percent on passing. And I asked him how Florey was going, and how the exam prep for the other registrars was going, and if is was a bad winter (looking that way), and everyone - doctors, nurses, admin staff - said hello, and I asked about doing one shift a fortnight, just getting back into practice. Looking forward to next January, when I can go back to the hospital at least half time.

Anyway, someone waiting outside to lie to me, and hear me lie to him. Better get to it.

Thanks for listening,
John

Mysteries and problems

Well, grim tidings herein. The following contains - I don't know. Some violence? Adult themes?

You be the judge.

It was a few months ago that I first saw Mr Gouger. He struck me at the time as a tall, pock-mark featured man, with a permanent groove between his eyebrows and a way of speaking through a clenched jaw. He arrived suspicious and departed enraged, because what he wanted (an order to the pharmacist to have his buprenorphine uncrushed) was not what I was allowed to give him, and there was little throughout the half hour appointment that we could offer each other.

Aside from that, his opiate substitution was going well - one of those opiate users who hate speed and pills and alcohol ("never catch me trying any of that shit" he said), his main issues were getting his elderly father out of the nursing home and looking after his two kids. The father, it emerged, was in the home recovering from a sizeable stroke, and had terminal bladder cancer as well, and Mr Gouger wanted him to be able to spend as much of his last few months at home as possible.

Then the next visit, three months later, about a month ago. Therapeutic rapport was still not strong, and although he seemed resigned that there could be no alterations in how his medication was given, he was still unhappy about it. It was clear that he wanted the interview over quickly.

"ANd how about things in the rest of your life" I asked, and scanned through my mental list. Finances? Relationships? Stuff like that?"

"No change, is there?" he rasped, and stared at me.

I nodded. Last time I had written that his finances were stable, that he had lived in the same house for fourteen years, that even in the injecting drug scene he had had no real friends or aquaintances.

"Okay" I said, bending my head to write the script and feeling his rage a few feet away, like sunlight prickles on your scalp. He took the script and departed.

Afterwards I sighed with relief. He was not the most aggressive client I had seen in the South, but to be the most aggressive of our clients you would have to fight your way past a lot of big men with a lot of jail time, and he was certainly not happy with our service... or a lot of other things. I had been able to offer him one thing - he was required to turn up to the pharmacist three times a week to get his medication, and with him being sole carer of two pre-teen boys and a dying man I was able to make a strong case to the Dependent Drugs Council for his take-away medication allowance to be increased.

I filled out the paperwork and sent it off.

And I came in this morning and our nurse, Phil, was holding the letter from the Dependent Drugs Council and shaking his head.

"What've I done?" I asked. There was one woman at the DDC who could be almost legendarily pedantic, and if I'd jotted where I should have tittled, things would be set back a fortnight.

"This letter about Conrad Gouger" he said. "Extra takeaways".

"What'd they say?"

"Well, they say yes. But I just spoke to the pharmacist over at Amals. He's dead. Cut his wrists and throat in the bath, Tuesday."

"Jesus Christ." I sat down. I had that whole shaking, breathing fast thing. "Jesus. What happened?"

And I have been thinking about that question for three days now, and I do not believe there is an answer to it.

From what I understand, Noam Chomsky divided our ignorance into problems and mysteries. Problems are questions our brains can eventually answer, engineering problems where we've got the right mental tools. Mysteries are problems we will never be able to solve, things for which we don't have the basic, cognitive raw materials.

I don't know about this stuff. "Never" is a long time.

AFAIK this is sortof what Kant meant about the phenomenal (stuff that's to do with things we can observe) and the noumenal (unknowable, ineffable, untranslatable stuff).

Human history, Chomsky says, is the story of the movement of questions from the "mysteries" column to the "problems" column. Flight used to be a mystery, now it's an engineering problem, and so on.

Anyway. What happened to Mr Gouger? What happened in his head?

Opiate users in the South are by necessity rather than choice a small and close-knit community, and news travels fast. Apparently Mr Gouger had succeeded in his attempts to bring his father home. He had made the necessary sturctural adjustments - handrails, alterations in the bathroom, steps converted to ramps. He and his children were all prepared for the big day when they brought Grandfather home.

And the big day arrived, but Mr Gouger did not. They waited at the nursing home, and then Mr Gouger's brother drove across to Mr Gouger's house (the kids were at the ex-wife's place), and let himself in, and found him.

And after that, the line of enquiry ends. The questions you want so much to ask - why? what was there that could have been done? - the door has closed. Nothing left of the man who was a father and brother and son but tissue types - skin and bone and brain. A mystery.

I don't know. I have been over the notes five or six times. Looking back, he had some of what we call "risk factors" - he was caucasian, solitary, increasing age... but fully half the people I see every day are like that. But they don't run a bath and run a razor across their throat - and he did.

I don't know. He denied depression - but isn't anger a common symptom of depression in men? But isn't anger common in people who don't get their medication in teh way they want it, too?

And it's a myth that depression undrlies all suicide. Psychosis accounts for a share, pain, fear... and I think sometimes the realisation that you have painted yourself into a corner, that you cannot do or feel or think or beleive in the way you want to, and have said you will. The realisation that you have trapped yourself, and maybe even before that, the slow bricking yourself into somewhere uninhabitable.

I don't know. Suicide is sometimes a slow process. Maybe it had already begun, maybe it was well advanced by the time he sat in my office and grated about his medication and talked about his dose, like a heart attack is the result of a thousand days of rushing blood gnawing at an arterial plaque.

I don't know. You just want to say to him that there is always a way out.

Anyway. I saw him a month ago, so that means at the very least a phonecall from the coroner, and at worst some kind of enquiry. We shall see.

Thanks for listening,

John.

Of interest possibly only to Doctor Who fans....

Unusual departure point for a blog entry, but...

Went over Benedict's place the other day and saw an episode of the new Doctor Who. It's mighty fine, almost hold-your-breath good in parts, and I drove home afterwards (replete with fine food, fine conversation and what he assures me was a fine red wine) thinking about the whole women in science fiction thing.

My first memories of women in SF were those who wrote or starred in my favourite reading material (second hand SF books or superhero comics) or who appeared on my favourite TV show (Dr Who). And I have to say, ladies, that you disappointed me. My first experiences with women in SF were not entirely positive.

For a start, why couldn’t women write decent SF? What were the options? Anne McCaffrey writing about dragons – obviously brainless fantasy stuff, unlike credible male stories of time travel and faster than light ships. Ursula Le Guin – wizards and such-like, or long novels about feelings where nothing ever happened. Marion Zimmer Bradley – never looked that interesting, to be honest.

But on the male side we had luminaries like Clarke, Priest, Cooper. Why couldn’t a woman write a short story like Harlan Ellison could? Why couldn’t she give you that “blow your brains away weirdness” like Phillip K Dick, give you that “courage in the face of despair” feeling like Wyndham could? Why couldn’t a woman write about the horrible loneliness of people surrounded by friends and family like James Tiptree Junior?

And why didn’t anyone tell me until five or so years later that the horribly talented James Tiptree Jr., whose collection of short stories I had read and reread until the cover fell off, was in fact a woman? Would have saved me a lot of painful re-thinking.

And for the record, the best living horror writer in the world at the moment is Lisa Tuttle. Not horror that makes you go “bleargh”, or horror that makes you run off screaming, but horror that makes you lie in bed at night for a few days afterwards thinking – I don’t know, something you can’t put in words. Some cross between unease and sorrow and yearning, all on the surface of a definite undercurrent of fear.

Anyway. Women in the comics were different. They were, as previously confessed, my original and most loyal crushes. Sue Storm. The Black Widow. Later Emma Frost. But when you go back to the original comics I read – the late sixties/early seventies stuff – and you look at the women in them, it’s startling to think what stuff you took in unthinking.

Plot of early FF comic, (imperfectly remembered):
Nefarious villain (whose name escapes me at the moment) has trapped the Fantastic Four and has somehow goaded them to fight each other by causing them to see illusions of whatever they most fear.

The Thing (rocky, supernaturally strong looking guy) sees… something he doesn’t like.

Reed Richards, the modestly entitled Mr Fantastic (infinitely fluid body, smartest man in the world) sees his greatest fear, (can't actually remember it).

And Sue Storm, the Invisible Woman, able to bend light and punch holes in brick with her mind, certainly the most physically powerful "don't even think about it, boy" member of the group, sees – her beloved Reed embracing another woman.

Chaos ensues, but things are eventually set right. Reed outsmarts the other guy, and afterwards Sue weeps in Reed’s arms.

Invisible Woman: “Oh Reed, I feel like such a fool!”

Smartest man in the world: “Not a fool, Sue, only… a woman.”

And this is the hero and the smartest man in the world talking, and what he says is all treated as completely normal speech, and she weirdly doesn’t use a forcefield, or a shotgun, to blow a hole in that big fantastic brain of his.

The past. Another country.

But the main reason I was thinking about this stuff as I drove home was the latest Doctor Who that I’d seen at Bene’s place.

It’s weird, looking at something twice at two widely separated times in your life.

It shows you something about yourself.

It’s almost as if you can use these things, these books or televisions shows or whatever, to look at yourself, and if you use the same object, the same book, the same idea, the same character or situation, you can see how you’ve changed over time.

Like when you return after a long absence to a room in which you lived as a child, or to your old primary school, and you see how small and close-packed everything is that once was huge and open. Or when you measure yourself against something inanimate – the table in our old house comes up to my hip, my mother remembers me running underneath it without ducking my head.

See, in the original Doctor Who, the Doctor traveled with a series of companions. The Doctor was immeasurably old (at least six hundred), vastly intelligent, a moral paragon, infinitely alone – exiled from his race and planet to wander amongst the stars. His companions were generally young, attractive, female, human beings who existed to have things explained to them, to require rescuing… but also to be the comforting terrestrial response to the situations in which the Doctor and his companion found themselves. The Robin to the Batman, the Watson to the Doctor’s Holmes. The companions would last a few series and then be replaced by another – so you had the ever-changing progression of beautiful young women who needed rescuing and who could never be as smart or as powerful as you.

Overall a very satisfying show for young people – and particularly for geeky young males.

Anyway, in this latest series, the Doctor (and new, young, attractive female companion**) are investigating the archetypal strange events at a local school. Simultaneously, these events are being investigated by a reporter for a newspaper – one Sarah Jane Smith – the Doctor’s companion during the mid seventies.

And the whole show from then on is emotion. There’s the compulsory extraterrestrial menace subplot for the kids, but for us it was all about the interaction between the Doctor, the new companion and the old, and the asking of questions that wouldn’t have made any sense to any of us when we were eight years old, but made a hell of a lot of sense now.

What kind of man does what the Doctor did? Intense, serial relationships that begin (and occasionally end) at his choosing**? Is that what a moral paragon does? What else is going on in his head? If he’s so perfect, why does he need a companion at all – which he obviously does? How honest is he being about what's going on – with himself and with her? What about hubris, what about the confusion of power with strength, of knowledge with wisdom?

And what kind of effect would that have on someone – to be picked up, taken to the end of time and the far reaches of space and then be dropped back in the suburb and time you grew up in? How do you get over that? What if you don’t? What about being hurt by someone like that, how do you get that anger out?

Anyway. Big questions – questions that make you grateful to be asked. Questions without answers, things that maybe wouldn’t occur in the world of a moral paragon or a hyper-intelligent being. But now the show's about a vulnerable man and a woman who won't be spoken down to, who sometimes knows more about what's going on than he does - something impossible to have imagined back when I sat watching Sarah Jane scream through "The Pyramids of Mars."

Anyway, thanks for listening,
John

*It's a Dalek sucker, okay? And it's not doing anything untoward. Just... looking t her, or something.

This is a show for kids, for God's sake!

**This line is the subject of some dissent in the Bronze household. Did the companions leave of their own volition or were they “left behind” by the Doctor? Email your recollections in and save our marriage.

Crying

Housework day today, and the various electrical implements around the house are purring along. I have descended upon the chickens like a deity from on high, bearing fresh hay, chook food and leftover pizza, and the kittens are gamboling in the sunlight.

And hopefully a few very brief blog entries today - some sombre, some not. This is sortof a slightly sombre one.

Yesterday at work I had four people cry on me - including one waiting for me in my office when I got there and one in my lunch break - and I also had a sex worker tear off her trousers to show me (and the wordless "first day on" social worker) the scar where they took her spleen out.

Yes, the spleen normally does reside in the upper abdomen, but the spleen scar was just the first course of what turned out to be a quick tour of scars, spots and funny looking bones that took in her entire body below the heart - including a pelvis with a notch in it that she could slide a cigarette lighter into, and did. Remarkable.

But the three crying women, and one man, in one day.

First up was the pharmacist, a young, Asian female who has been hired to replace our recently fired old, Caucasian male pharmacist. She has been having a difficult time of it, partly because she has walked straight from pharmaceutical school into a morass of irritable heroin users who are used to getting their own way... and partly because of who she is and who she is not.

She is not Alan, the previous pharmacist. Alan is no longer with us because he had a habit of handing out medications as he saw fit, rather than as the script I wrote and as the legislation controlling the dispensing of schedule eight drugs suggested they should be dispensed, and when you are handing out vast doses of take-home medications to people who then inject themselves with them and die, something's gotta give. Last month it was him.

But more damaging than not being Alan, she is not an elderly man, she is a young woman, and she looks, in certain lights, almost ... Asian. Methadone clients are largely a conservative clietele - and it's always seemed odd to me that those who have been most punished by the old order of things, those who spend their lives in prison or twenty years unemployed or have spent their lifetimes working in a steel works for minimum wage and the real possibility of industry mediated death or disfigurement - these people are amongst the most politically conservative people you will meet.

And to this conservative clientele, a young person does not give orders to their elders, a woman does not issue instructions to a man, and an Asian doesn't come to this country and tell us how to live.

So, ongoing racist abuse for her, a few sggestions as to how a young woman might better meet the needs of her clientele, and a difficult time for Ms Cheok. Tears all around, and not a lot I could do but listen.

The next who cried was a friend of mine who comes up to visit me in my lunchbreaks whenever he can. He is having ECT for his bipolar disorder. He has recently been discharged from hospital (but must have frequent contact with his doctor and book in every Thursday for more electroshock treatment) and has had something like sixteen sessions of bilateral ECT in the last month and a half. They lay him on a table, sedate him, and pass a voltage of 150 volts through his brain. It is working, but the suide effects are more disabling than I had previously realised. He has profound, deeply distressing short term memory loss - he can't recognise my office, where he has visited me almost twenty times, he gets lost driving to his house (and this is not normal for him), and he feels certain he commits ten thousand little social faux pas every day.

Again, a lot of reassurance, stressing that he is better than he was, and urgings for him to tell his psychiatrist about his symptoms.

And two other crying people - one of whom was trying to get her kids bck and another who was still on methadone five years after she'd sworn she'd give it up by Christmas.

Caffeine I

Brief entry here, and not the one I vaguely recall promising I'd write. But...

Been thinking about free speech and caffeine.

First off - went to the ex's house a week or so back, to visit my youngest on the occasion of his confirmation, and stayed overnight in a house with seventeen other people. It's a three hour drive, and you arrive in the sleepy part of the afternoon, and the first thing you want is a coffee.

But the cupboard was bare. Not bare bare - there was an antique tin of some kind of do-it-yourself-latte mixture, something the Ancient Mariner might have sipped from as he stoppeth one in three, and there was some fruity herbal tea (I haven't scanned the appopriate legislature, but tea now apparently means "some twigs and bark in a bag", rather than anything that actually does something for you), and three - all suspiciously unfinished - jars of decaffeinated coffee, uncaffeinated coffee, un-infra-sub-ex-hypocaffeinated coffee and even some molecules of anticaffeinated coffee that she kept hovering in a small magnetic field inside a very hard vaccuum - but no caffeine.

So, back in the car, drive forty kays to the corner shop, slap my money down and ask the good man for a foaming tankard.

Anyway - this got me thinking. Why is caffeine not sold as a condiment? Why can't you buy the stuff along with sea salt and cayenne pepper? Don't have time for coffee with your breakfast? Sprinkle a bit of caffeine on your cornflakes. Want to spice up that tired pork stew kind of thing? Chilli con caffeine.

It wouldn't work, of course. Someone would start mainlining it, as has been done with almost every other substance, and like "they" apparently did with Vegemite* when I was a kid, resulting in a prolonged absence of the stuff from the shelves. Although - IV drugs that are cheap, analytical grade purity, safe, from a supplier we can sue and therefore trust - who knows where that could lead?

Possibly a thought I haven't given enough... thought, if you follow me.

Anyway, off to admit people to detox - apparently there are no people presenting to give up alcohol today or tomorrow and precious few in the foreseeable - the nurses blame the World Cup.

Free speech soon, I promise.

Thanks for listening,
John

*Theologians and philosophers refer to some experiences as ineffable, often numinous. The experience of the numinous or ineffable cannot be translated into mere words, it must be experienced in order to be understood.

Vegemite, I think, is like that. And IV vegemite would almost certainly be.

Video Stores Want Your Soul!!!

Proof of how naked capitalism really operates! See for yourself!

Really spastic, totally gay.

The following, for those who can't read the title, contains pejorative terms that may offend some viewers.

Been reading in the Guardian about some controversy that arose because a radio announcer in the UK used the word "gay" - in the sense of "lame, crap, rubbish". This is someone on a Government radio station, so people are writing in to complain, rather than just tuning in or out as their preferences dictate.

From what I can tell, the DJ is one of those unintentionally creepy thirty something year olds like Marilyn Manson and Hi Five who market themselves as hip and in and so on, and cultivate an audience half their age by using the language and imitating the interests of children.

Anyhow, I started thinking about the rights and wrongs of this and in fifteen minutes I managed to get myself utterly entangled up in "shoulds" and "buts" and "on the other hands". So I thought I'd share it with you. Anyone who can disentangle this for me, please write in.

First off, when I was ten, growing up in the wilds of Western Australia, we used to play sports every lunch and recess and every Friday afternoon. We played on the Nyabing sports ground. It was a roughly shaped oval of baked clay, hard and unforgiving, and in winter we played football in the slippery mud and summer we sunstroked our way through cricket in the sun. If someone took a spectacular mark, or scored fifty with the bat, they were "heroes", or "stars", or "legends". If they didn't, they were a lot of things: weak, girl, poofter... but most commonly they were "spastics".

"Spastic" was the most common insult. Children are by nature more expressive than adults, so we didn't just call our inept fellows "spastics", we flapped our hands in incoordinate motions, grimaced hideously and made moaning noises while shrieking "You spazz!". Drop an easy catch (that'd be me, by the way), bowl three no-balls in succession, or (I only did this once) grab the football, run twenty metres and kick a goal - having run the wrong way - and you get to hear that term a lot. But I used it a hell of a lot too.

Now, what did we mean by that?

I don't know. We meant it as a term of abuse, of course.

But were we saying anything about "real spastics" at all? Did we mean that "real spastics" - and at that time our contact with what would then have been called "real spastics" was limited to a five second shot of a lurching big eyed child on the telly, asking us to give them some spare change once a year - did we mean "real" spastics were ugly, useless, bad? Did we mean we wouldn't want one as a friend? Did we mean that real spastics were intrinsically bad people? Did we mean that they shouldn't be allowed to mix with us, or breed, or that they shouldn't be allowed to live?

I sat in the car at the lights today and I thought about this, and I couldn't aswer. I reckon maybe it's a non-question. For a start, what do I mean by "we"? None of us were all of us. We had a variety of views. Some of us were big hearted, automatically befriending the new kids in town, the ugly, the friendless - certainly would have befriended anyone in a wheelchair. Some of us wouldn't know what we thought. Some of us were protofascists, usually of the "for their own good" variety. Thrity five year old DJs aside, there is no voice of youth.

And second - is that the important question? Is "what we meant" the even important at all?

What about what people thought we meant?

Our friends, our peers, our school teachers?

What about the "spastics" themselves - if we'd ever seen any, of course, which we didn't, because they were insulated away in special homes and school and hospitals?

What about the boy who eight years later rode a motorcycle into the salmon gum on Collins Road and ended up in a wheelchair?

What about the girls who listened to us and later went off and had a child with a spastic paralysis?

I don't know.

The first person I even met who had some kind of spastic paralysis was my first wife's younger sister, Angela. Angela was smarter than me - I remember over one weekend getting systematically whipped in trivial pursuit, boggle, scrabble and some other weird word game I can't remember. She dragged her left foot when she walked, and her left hand she kept curled and close to her chest, something slim and soft like a flipper. And she was pretty funny, and like me she came back from Uni no longer a creationist - the only two non believers in a household of ten or fifteen - and just to further ensure my position in the Second Circle of Hell, she was quite the hottie, too. I walked in on her while she was getting changed after a shower once, topless and beaded with water, and the embarrassment and guilt and weirdly compressed desire have etched that picture more clearly in my head than almost anything else from that year.

I don't know. I don't use the term "spastic" now - except in the medical sense, a "spastic bowel" and so on - and I don't think I've used the term "gay" as a pejorative for ten years or more.

I think the cure for this kind of thing, if there is anything wrong with it, is changing the situation as much as trying to change the language. If you know homosexuals and people with spastic paralysis and Aboriginals personally, work with them, maybe - horrors - work under them, then that's what's going to change things.

So is changing the language "top down", applying penalties to the use of the words any part of the solution? I feel it is, but I don't know. The same people we, and the powers that be, used to call spastics are now called "physically challenged" - the term carried irresistably along by what is known as the "euphemism treadmill" - but "physically challenged" is by the powers that be and by the schoolchildren. If you drop an easy mark now you're not "a spazz", you're "challenged".

Me, if I lose part of a leg, I'm going to call myself a cripple. It's got a fine historical pedigree, at's got that beauty that old words mysteriously accrue, like barnacles on a bottle beneath the sea, and it says absolutely nothing at all about what I can and cannot do.

Next post, in fact, may detail how in medical school one of my lecturers placed me among the spastics, the autistics and the dwarves. Be there for that one, it's a killer.

I don't know. Years after all of this I heard a commercial radio announcer, broadcasting from some place on the coast, telling fish jokes (no idea why). And he asked what kind of fish won't lend you any money, and told us it was a jewfish* - geddit? I still remember the calm, cold rage I felt, the hours of it.

So, I'm confused. I'm starting to feel that maybe trying to change language is part of, but not the whole solution.

And I don't even know that I have a right to speak on this - I'm not gay, or spastic, or whatever. I grew up essentially insulated.

And any attempt to change the language is going to have to face up to the fact that language is not a solid that can be cut and arranged into orderly or pleasing patterns, it is a fluid thing with tides and currents of its own. Maybe "gay" means "rubbish" to fifteen year olds for the same reason that "wicked" means "good", and "cool" means almost the same as "hot" - irony, exclusion of outsiders, novelty, whatever.

Gods it's complicated.

Anyway. I know as far as gay (in the pejorative sense) goes, I have an irremovable disquiet about the term. I don't like it, I doubt I will ever feel comfortable with it, no matter the intentions or avowed intentions of the speaker, no matter what those who hear it say they understand by it. I suspect a lot of the kids who use the term would violently disavow homophobia, and would say when they dismiss some tv show or unfashionable item of clothing or thirty five year old DJ as "gay" that they are not saying anything about sexuality.

And yet. I keep thinking of the constantly petrified kid in the back row, the kid who may be good at football, or may be crap, who is wondering how long he can hide things and what if his mates knew and how do you tell your mates you're gay - I keep thinking of him, and how he is going to react to the word.

Whatever. Fifteen minutes of a car trip and no further forward.

And what is my conclusion? What is unarguable about all this? Only a few things.

Language is complicated.

The fifteen year old demographic is important to a lot of radio stations, they spend a lot on stuff.

And most of them, like most of us, aren't gay, or spastic, or whatever.

And thirty five year old men, for a lot of reasons, are going to want to keep appealing to fifteen year olds.

And for the next couple of years the gay kid hiding in the back row is just going to have to deal with it.

Like I said. Explain this to me if you can. Because I can't.

Thanks for listening,
John

*The dhufish (the dhu pronounced as in Jew) is a popular table fish over here. Caught one myself off the coast of Albany, twenty years ago.

Train up a child

And today, a video game review.

This may perplex any who know me, because I never got the hang of Space Invaders and the whole point and shoot little pixillated people thing doesn't do a lot for me. But this one speaks for itself.

It's called "Left Behind: Eternal Forces", and it's on sale now, and I swear before God I am not making this up.

In "Left Behind: Eternal Forces" the scenario is that the Rapture has occured and all of God's Chosen have been lifted up into Heaven, leaving the rest of us to suffer the torments of the damned in something called the Tribulation*.

Anyway, you get to play as a foot soldier in a Christian paramilitary group, fighting to establish the dominion of Christ over post-Rapture America. From what I can see - and I haven't played the game - you get the usual high-tech weaponry which you can use to kill those who resist becoming Born Again.

"Train up a child in the way he should go: and when he is old, he will not depart from it (Prov. 22:6)." And he'll be able to afford some real guns. Good to know.

I don't know who the people who are shot are meant to be, but what I was taught - and there is a lot of overlap between the group I was with in my teens and the ideas in this game - the enemy was the Jews, the Catholics, the Muslims, the homosexuals, the evolutionists and apostates. I used to stand on a street corner and bellow about all this.

Here are actual examples of the kind of stuff I used to hand out, while scurrying commuters avoided me and occasionally shot me glances of what I thought was the torment of a soul unsaved but I now recognise to have been sympathy. So now you can read the stuff I handed out and be saved at in the comfort of your own home or workplace: the Gospel truth about whether all Catholics are going to hell, whether Muslims are going to Hell (hint - it's the same answer) and whether evolutionists are going to Hell (Hell is apparently fairly capacious).

Anyway. I have to go off and repent now. I think, from memory, that the apostates occupy a circle of Hell* relatively close to the atheists, sodomites and blasphemers, so I reckon I might be able to wave to a couple of you through the sulphurous fumes.

Actually, I just looked this up in Wikipedia, and it's more confusing than you might think - give it a look, it pays to think ahead, see what you should pack and so on. Depending on the rating scale the various demons use, I could end up in the Second, Sixth or Eighth Circles. A lot of what I thought of as the classical sins - like apostasy - don't correlate with any specific Satanic suburb or piece of Infernal real (or unreal) estate.

Maybe that's teh secret - commit sins that weren't really invented back then. If the infernal administration is anything like as slow as SMACHEADs, you might slip between the legislative cracks.

Anyway, apparently we get to see corrupt politicians immersed in a lake of boiling pitch. I have started compiling a list, but I'd better get back to healing the sick.

Thanks for listening,
John

* Attack by tribbles.

Actually, this kind of thing has always struck me as the worst of what theology can offer. It's the imposition not only of human qualities onto the divine, but of the nastier and grubbier of those human qualities. What you get in these cases is a fairly transparent and sadistic revenge fantasy projected up onto the Big Screen and thereby absolved of any moral responsibility. Like religious homophobia and racism, the believers can claim that it's God's will, not theirs that is being done, and thus the actions are unchallengeable.

Calm down boy.

The Resurrection and the Night Life

Howdy,
And first off, a suggestion - nay, a demand - that anyone reading this check out Foilwoman's blog. Do it if only to read the backstory and thus be able to testify in her defence when she does finally snap and chain her ex to her ex's lawyer and hurl them both into the caldera of Mt St Helens.

FW, I have a sheaf of sick notes here, and if you want we can detain you to Bene's house - it's got alcohol and hot and cold running children. Just say the word.

So, how go things here?

They go aggressvely well. The older I get and the more medicine/psych I do the less patience I have with the purely pharmaceutical treatment of mental illness. I know no doctor advocates treating mental illness solely with a packet of pills, but I also know a lot of people to whom it seems to have happened, so something's happening somewhere.

Anyway, I am doing all the prophylactic things I tell my patients to do.

Judo (last night).

The gym (tomorrow morning).

Taking the medication (a while now).

Alcohol and Doctor Who (this weekend).

Going to my writer's group (Thursday) and writing stories (as we speak - a story which features, amongst others, some telepathic crows! Soon to be a major film with remarkable special effects).

Reading good stuff - currently a book on the history of electricity, complete short stories by Truman Capote, and a book of obscure words (did you know that "jaculate" is a word still occasionally used for the throwing of an object, particularly a spear or dart - but potentially a suggestion or idea? If struck by a particularly insightful idea during your next lunchtime meeting, attract the attention of your superiors by urgently and loudly announcing your intention to jaculate.

Jaculation also refers to the verb transitive, to jaculate is "to dart", the action of darting. A word certain to enliven any sporting commentary - "Judd attempts a tackle, but Pavlich jaculates towards the goal-square...").

(And did you know that there is such a word as pogonophobia? It refers to a morbid dread of people with beards. This means that somewhere there is someone who has a morbid fear of me. I would like to correspond with this person, s/he could be reassured and I suspect I might find the process personally empowering).

Also social intercourse - several times this Friday and Saturday.

And so on. Looking forward to it. Seriously, cognitive/behavioural interventions, that kind of thing. And I have signed myself up for some CBT sessions - although apparently the first few meetings often make people feel worse rather than better, stir up stuff and so on. Something to look forward to.

Thanks for listening,
John

Recognition

Hail,

Sorry for intermittent nature of posts, much going on. In unrelated news I am back on what is for me the max dose of the mood stabiliser and the miserybegone tablets, the first real trial of this radical "take the tablets before you get sick" approach I have been recommending to everyone else for the last five or six years and am now forced to employ myself.

If this does not work and things worsen, the next step is the antipsychotics again. It will be interesting to see which of my friends disappear once I start taking the tablets. My money's on Chad.

Anyway, this will be quick as I have to get to bed because I work tomorrow. I went and saw the kids, and since today was my youngest's confirmation I went to a church service, which was, I kid you not, forty five minutes of why my religious faith is shit, why lukewarm hypocrites such as myself will be spat out of Christ's mouth in the coming End Times, and why I, me specifically and personally*, am going to Hell.

And the foyer (rather than the fire, as it should have been), filled with pamphlets showing cavemen riding dinosaurs and reports of evolutionists recanting on their deathbeds.

Give me that old time religion... and a truck full of fertiliser and fuel oil.

Tomorrow I would dearly love to have what they call a "doona day", but no such luck - I have no sick days left, plus every time I take time off the clinic seems to fall to shit, and there's no point taking time off if you're the one who has to catch up the next day.

Anyway, been thinking about deja vu and jamais vu, and two weird psychiatric syndromes, and wondering if there could be a connection.

Tell me if this makes any sense.

First off, some definitions. Deja vu ('already seen') is an inappropriate feeling of familiarity, a sense of recognition for something never seen before and thus unknown, literally a re-cognition where there should by rights have been no initial cognition. It's a common enough thing, and in a particular kind of epilepsy (right temporal lobe, I think) it can be a sign of a seizure - or even the seizure itself.

Jamais vu (I think it means 'never seen') is the mirror condition. It is an inappropriate lack of familiarity, a failure to recognise something one has seen many times before. It is distinct from things like the 'face blindness' people with prosopagnosia get, where the ability to read and recognise faces is impaired (and therefore secondarily the ability to recognise faces is also impaired), I think it presents as a feeling of being lost in places where you should be at home, a feeling that one has not been here before even though one has.

These are fairly well known. Maybe less well known are two of the weirder delusional states, called Capgras Syndrome and Fregolis Syndrome. Capgras syndrome is the belief that people familiar to you have been replaced by impostors - that your loved ones are not the people they look and sound and act like, but are actors, or aliens, or androids. I actually met a woman with this at one time (her children had been replaced by robots), and remember leading her out of her completely normal three bedroom brick suburban house to the waiting ambulance. Capgras is, by the way, a potentially lethal delusion - mothers have killed their sons, believing them to be other than what they were.

And Fregoli Syndrome - which I have not seen - is almost an opposite of this. In Fregoli Syndrome the sufferer (and this is an appropriate term) believes that the many people he or she meets who seem to be different - different sex, different size, different mode of speech or colour of hair - these seeming several people are actually one person. One human chameleon, who is both willing and able to change his appearence many times a day so as to fool all but the most careful observer - the sufferer of the disease**.

Weirdly enough, there is a report of someone suffering from both Capgras and Fregoli at the same time. Women and blacks seem to get diagnosed with Capgras' more frequently than would otherwise be expected, and there is also a variant of Capgras involving inanimate objects - the sufferer believes that his/her possessions have been replaced by inferior copies by someone who is in some way out to get them***.

Anyway - what's the similarity?

In each case these delusions have something to do with recognition. You either recognise something that you shouldn't (deja vu, where you "recognise" strange places, or Fregoli Syndrome, where you "recognise" separate people as one), or you fail to recognise something you should (jamais vu, where you don't recognise a place you've been a hundred times before, or Capgras, where you don't "recognise" those familiar to you). The failure of recognition means something subtly different in, say, jamais vu and Capgras, but in ieach case you are not getting that "Ah, this is such and such" feeling, that identification/recognition/knowing that you would normally get.

What does this mean? I have no idea. Despite my interest in the subject I suck at neurology, it took me weeks to grasp the basics. But say there is "a" part of the brain (it may well be several, like in vision, so we can call it a recognition network. Important parts may well be in the right temporal lobe) that fires in recognition, that lights up when you have that "Ah, this is so and so" moment.

In deja vu and Fregoli's it fires up when it shouldn't. Inappropriate feelings of recognition, the idea that you know someone or something even when you don't. Maybe the difference between the two has to do with the subset of the recognition network that deals with people, as opposed to places.

In jamais vu and Capgras, it fails to fire when it should. Inappropriate lack of recognition, the idea that you don't know someone or something even when you do.

Anyway. There is an article in this month's Fortean Times that got me thinking about this - it started out with a description of some of the difficulties faced by someone who was experiencing what sounds like constant deja vu. There was great difficulty convincing the man of the usefulness of coming to see the doctor, for example, because he was convinced beyond reasonable doubt that he had done so many many times already.

Fascinating stuff. The problem with speculating on this kind of stuff is you come up with an idea that you think of as original, like snarfling, and it turns out that the 30th International Conference on the Recent History of Snarfling is being held that year in your city. Ask me one time about my "cure" for hepatitis C.

Thanks for listening,
John

*I have read that paranoia is not commonly a symptom of the downward arc of bipolar. Perhaps that's just what THEY want me to think....

**In some way, obviously, you could tie some of these syndromes together with paranoia and mania. At the core of each of them is the belief that you are in some way important enough to justify what must be an incredible amount of effort.

***Then again, perhaps my car was shit before I took it to the mechanic's.