Saturday, June 17, 2006

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,



Anonymous Camilla said...

What a horrible shock.

I can't think of anything else to say, really.

3:46 PM  

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