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