Saturday, July 29, 2006

We have a new champion....

Something of substance later on, but...

July 27, 2006
Study suggests TV-watching lowers physical activity
Using pedometers, researchers find that more TV means fewer daily steps

BOSTON—A study of low-income housing residents has documented that the more television people say they watched, the less active they were, researchers from Dana-Farber Cancer Institute and colleagues report.

Remember, you heard it here first.

Thanks, and thanks for wellwishings and comments.

Wednesday, July 26, 2006


Glissade, by the way, is a sweetened carbonated drink made from crushed glisses.

Well, today I spent at home. I got three or four hours sleep last night, the increased dose of reboxetine is kicking my diurnal rhythms about like Jacky Chan at the soccer. I finally got up at five and wrote apologetic emails to everyone I know, which luckily were so long and grovelling and involved they (mostly) remained unsent.

And I've been stripping the house of carbohydrates like a fanatic during a purge. If it's got sugar or starch in it I eat it - tomorrow I either start on cellulose (eating old newspapers) or begin licking the coating off all the cat medication in the house (mmmm, lactose - plus I'll be safe from ringworm).

There seems to be a close correlation between glycaemic index of my food, my score on that Beck Depression Inventory, and how many furlongs my waistband is. There's a research paper here waiting to be written.

Mmmm, paper.

Besides the Beck Depression Inventory, by the way, there exists a Geriatric Hopelessness Index, a Buss-Durkee Hostility Inventory, the Rust Inventory of Schizoid Cognitions, and the MRS (or Mania Rating Scale, where extra points are obtained by folding the single sheet of paper upon which the questions are written into a beautiful pair of wings that will enable mankind to flee the tyranny of gravity and build a million shining cities on the Moon).

Anyway, I stayed home because, to be honest, the whole thing was starting to get to me. Is there a recommended daily maximum of murderers and rape victims you want to see in a day? Or a RDI, a Recommended Deviant Intake?

And I also had a day (and maybe more) off because the staff at Southern have been concernedly commenting about the number of times they come in to my office to see me sitting at my desk, head in hands, or staring teary-eyed at the wall.

And today was some kind of meeting, anyway, and I didn't fancy sitting there in front of the various clinical teams from every point of the compass and looking like I cared about irrelevant stuff - so I stayed home and stared at Chapter Four of Ganong, entitled Synaptic and Junctional Transmission, the Untold Story.

A problem shared is a problem halved, or doubled, or something, so let me transcribe a little bit from this " bestseller acclaimed for [its] readability...":

"Brain-derived neurotrophic factor (BDNF), neurotrophin 3, NT - 4/5 and NGF each maintain a different pattern of neurons, preventing apoptosis, although there is some overlap. Disruption of NT - 3 gene knockout causes a marked loss of cutaneous mechanoreceptors, even in heterozygotes. BDNF acts rapidly and can actually depolarise neurons..."

What alarms me the most about all this is the rising tone of excitement in this man's voice (and he is a man). You can almost hear the incredulous squeak as he breathlessly announces what BDNF can actually DO!!! I have nothing but sympathy for Mrs Ganong, if such exists. And all this after marrying a man with a name like a bloody sound effect, as Sarah points out.

I should point out I aim to get out of this mood thing before the whole constellation of symptoms descends on me and those around me like a meteor shower. I am a long way from any "ideas that kept coming into your head" or "unusual beliefs" or "things you believed very strongly at the time that later on turned out to be wrong", or "hearing something, like a voice, or something moving about, but there was no-one there?", all of those phrases I use with speed clients. No owl-headed people, no temptation to vote conservative, none of the other stuff I am too embarrassed to mention here.

And no suicidal ideation, which is good, because I'm the only guy who is allowed to ferry the methadone from central to southern. I'm the doctor, (or one of the two, and everyone knows Dr Grizzle is crazy), so I've got one hundred and fifty mgs on the kitchen bench, next to the bottle of cleanskin red. I stress that 150 mg isn't nearly enough to kill a full grown adult with no other co-morbidities, but there is a touch of irony in this.

Sigh. I have also been trying to do all that mood-lifty stuff I tell other people to do. In my case one of the things that works well is looking over my fiction writing, seeing what I've sold (very little) finishing up and sending off some stories. Normally this cheers me up.

And I'm sure it will. But not quite yet. Look at this poem I can't sell:

Eric had an iPod and he used it on the bus
He turned the volume way up high when people made a fuss
The tinny driving rhythm made him slump upon his seat
And twitch and chew his bubblegum and trample with his feet

He had a great big duffle bag, he slung it on his back
And as he passed by pensioners he gave them all a whack
While veterans of Gallipoli were forced to stand and watch
He sprawled across a row of seats and rearranged his crotch.

But late one winter afternoon (the sky was cold and dark)
As Eric waited for the bus outside the football park
Instead of the old rattletrap that usually appeared
Came one different. Black as midnight. Sleek and shiny. Really weird.

The driver was big man with a tattoo on his face
He chewed on his tobacco and sat staring into space
Behind him sat a woman with a helmet on her head
Her teeth were long and sharp and white but both her eyes were red

"What a backward bunch of losers" Eric muttered with a sneer
"The Government should get these freaks and move them out of here
They make the place look ugly. They take room up on the bus
I don't know why they drive around like they're as good as us

Get out my way, ya senile git! Move it, ya brainless dork!
Come on, ya mangy cripple! Wassamatta, can't ya walk?
Well, next time move y' bloody foot! D'ya think I've got all day?
Oi you! Porky! Baldy! Stupid! Move your fat guts out me way"

The bus turned off the highway down beside the railway track
(The sign "St. Martin's home for psycho killers" on the back)
As Eric turned the iPod on and sprawled across the seat
He did not see the massive man get slowly to his feet

He did not note the barn-door back, the walnut-crushing fist
Did not observe the badge that said "Officially round the twist"
He did not feel the chassis shake beneath the man's slow tread
Didn't even see the crowbar till it hit him on the head

And down there by the railway half a dozen scattered graves
Stand in mute and morbid testimony, and the visitor who behaves
Can be shown around the spots where Eric's body was interred
But of the large and violent man, no more was ever heard.

No bugger wants this kind of stuff. They want vampire porn or serial killer stories or meandering, frustrating vignettes where people stare emptily, make futile gestures and then bang on about how meaningless life is and other stuff that makes no sense.

Anyhow. That's my crie de couer - or at least my crie de dysfunction within subcortical (striatal-thalamic)-prefrontal networks and the associated limbic modulating regions (amygdala and midline cerebellum).

Can't argue with that. Anyway, I'd better go... one of the choir outside has just coughed up a pellet of mouse bones. Thanks for listening,

By the way - have I mentioned my idea for a mood bank? Prudent bipolar patients - and face it, we're a dime a dozen - could store up some of their mania for a cloudy day, and draw on it when stocks were low. The problem would arise when you tried to factor in interest - you could bank a feeling of smug satisfaction and when you withdrew it it would be clinical monomania. Alternatively, you could have a small overdraft, but then if you lost your job and interest rates changed, you'd end up with unhandleable psychotic depression. And what about when someone stole your credit card and ran around town giggling and cackling while you got more and more miserable at home?

Tuesday, July 25, 2006

The Gods themselves

By the way - not sleeping, thinking stupid things, writing lots of bright shiny stuff to distract myself, moods fairly shit. I have rung the appropriate specialists, moved the dose of medications up a notch, and aim to run this without making everyone around me suffer.

And I think I have seen something remarkable today.

For some months I have wondered about meeting one of the Gods in the offices of the Drug and Alcohol Clinic. A Hermes or a Maia, a Cybele or the Great God Pan.

I don't know where this idea comes from. It may have something to do with childhood stories of Morpheus and Hypnos, the gods of poppies and sleep, or some image of the island of the lotus eaters receding in the south, while Odysseus's sailors shuddered and sweated and spewed. And some part of it is an admiration for these people, the patients, the way some of them seem... timeless, untouched by things that would crush me and thus eternal.

But anyway. Without wishing to cause alarm, and making it clear that I am speaking metaphorically, you can draw correlations between the ancient gods and my patients.

Athena - a silent, grey eyed woman, early forties, smarter than I am, a tattoo of an owl on her left scapula, pupils like pinpoints, looking inward.

Poseidon - a bearded crayfisherman, big hands red as lobster claws, bringing in speed on the boats.

Ares - a tatoo'd, broad-shouldered man, in and out of Mauro, given space in the waiting room, feared, but not loved.

That's a danger, of course, to treat a person as an incarnation or an idea, to mistake the image for the thing. That's the intellectual jab-jab-cross that leads to someone joining the Klan, or believing advertisements for soap, or getting the crush on the unsuitable coworker - none of which are associated with smart decisions.

And I know that that the radiant blonde couple holding hands out there are not Apollo and Aphrodite, and more than the fellow sitting next to them with the long nose and the pot belly is Ganesha. But sometimes you do glimpse Hermes in a slim young man, garrulous on amphetamines, or Hades in the grim-faced older man, black goatee, wealthy with a younger wife. Not literally, I stress.

But then again, I met Jesus in the mall about three months ago, and I mean that much less metaphorically, I mean that as a sacred truth.

So - the ancient gods, having finally grown out of all that worshipping and sacrifices and adulation stuff, no longer that desperate needing to be needed, dwindling down to earth, retiring by the sea, in a similar climate, heroin instead of nectar, dreaming away the dusk of an eternal life.

I saw Mrs Smith today. For reasons that shall become obvious, every single possible identifying feature of Mrs Smith has been removed.

Mrs Smith is small, almost dumpy, large-bosomed, a diminutive woman of Willendorf proportions. Her eyes are cornflower blue, the fringe of her hair is dyed carrot orange, she has cheeks like Jonathon apples. She lumbers into the room, shopping bags clenched in each hand, manouvres herself into the seat, freely perspiring (it's the methadone - you sweat and your teeth rot) and says "I've got a bit of a problem, doctor."

I look back at the notes. A few scratchings about her isolation - she's out near Fang Rock, where nothing grows and the buses won't grow, acres of prime saltmarsh someone zoned up as suitable for housing during the Great Local Government Methamphetamine Binge of the late nineties. A note about her interest in a course for survivors of sexual assault. A brief precis of her life story, the need for anonymity (silent phone number, post office box address, notes filed under a different name) a few concerns about her eldest sons, and her assertion that the younger one was going wonderful, the apple of her eye.

"We're here to help" I say.

And she describes the last three months. Her ex, the man who owns the house she lives in, he's her only transport. He drives her to the methodone clinic three days a week, without him she'd be in withdrawal. He's been pressuring"" her for sex, she says, and he'll kick her out if she doesn't give in. She doesn't really want to, what with the methadone and all. No drives in that area at all. And him, he's got very strong drives, powerful urges - even after the quadruple bypass and then the heart attack (part of me notes that this problem may solve itself in the very near future). He also demands sex in exchange for taking her - and even a Pollyanna would detect an element of irony in this - to her course on sexual assault.

Anyway, I call the social worker in and we talk about how sex obtained via threats is actually rape. And we say that this problem is going to keep on happening while she lives in someone else's house, and if she wants to exchange sex for accomodation and transport then no problem, but if she doesn't, she is going to have to change the situation, rather than wait for his powerful urges to settle down. We look at alternatives - all the way from moving to a women's refuge to getting a bicycle.

She trundles out with the social worker, and I am left with the uneasy feeling that this is somewhere in that penumbra between sexual assault and sex work, that there is something in the way Mrs Smith thinks that leaves her vulnerable to this.

Anyway. After she's gone I flick through her notes. Like a kaleidoscope, one small shift and it's a completely new picture. THe pieces fall together. It's that Mrs Smith.

Forty five years old.

Has given birth to twelve children.

Of the twelve, eight are dead. Two died in infancy, the other six by violence, a car crash, a stabbing, "fell in with bad crowds".

Of the four who are still alive, three are in prison. One for a further eight years, another almost finished twelve, the milksop of the family for only three.

And the one surviving non-incarcerated child, the thirteen year old, the one who's stopped going to school, spends his time smoking pot, quiet, very withdrawn, never bothers a soul... he's no trouble at all. And to think she was worried about how he'd do without a strong father figure in his life.

Because, of course, he can never meet his real father.

And who's his real father? I remember saying.

He's one of the Saltwater rapists. The Saltwater rapists - and I am attempting to disguise this as much as I can - were pretty much this regions most loathed criminals during the nineties. Five young women are dead, ten are stil missing, and the Saltwater rapists are serving extremely long but doubtless inadequate sentences behind bars in the various prisons dotted around the state.

A client once told me he'd been cell block D with one of them, and the thing is, one of the group by himself wasn't anything special, just a weedy little bloke, a bit stupid, never said much. But if two or more of them was ever gathered together, it was cold. They'd bunch together, tight as fingers in a fist, and one would talk and the other one or two would laugh and laugh.

Cold, the big man had said, with a troubled look on his face, and frightening.

Anyway. Before Mrs Smith left my office she had smiled - she'd smiled shyly throughout most of the discussion with me and the social worker - and said how she wasn't that keen on going back to live in Mordor (once we applied for higher priority housing, Danny Boy), but she supposed that "Life was what you made it".

I read this, and I tried to come up with some kind of lesson from it, tried to let my brain do what it has evolved to do, and I failed. You know that thing where you try to learn something, try to make sense of it, the thing where you take disparate events, chunks of data, thread them into a story. Something our ancestors could memorise and retell and learn from.

I sat there for a while, but nothing came.

I don't know. She's an example of how complex we all are, how we defy classification, simplification, reification. How when you make someone a god or an idol or an incarnation of something you lose whatever made them intersting in the first place. She defied that. You couldn't sum her up as weak, or strong, or wise, or foolish... you couldn't say if her endurance was something to be envied or pitied?

How could someone endure all that and smile, and shrug, and say "Life's what you make it, I suppose"? You get the image of the Furies shrieking and whipping, and frustrated by her endurance, beating her more and more.

I don't know. I don't know how anything we can do can make any difference at all.

Maybe I've got the wrong idea. Maybe I wasn't dealing with a god after all.

Prometheus, who stole fire from Heaven, was punished eternally by a vulture tearing at his liver. He was a titan, one of the people whom the gods supplanted, and towards whom they showed such eternal hatred. Every day the vulture tore Prometheus' liver, but every night the liver regrew - a miraculous thing. But Hephaistos, who was an Olympian and a child of Hera, when he fell to earth and broke his hip, he never healed, walked with a limp thereafter.

Perhaps, thought the gods and the fates and the furies, you harmed the titans and they healed, so you had to harm them again and again and again. Perhaps that what was happening to our Mrs Smith.

I don't know. Gods and furies in the waiting room, a titan in the methadone clinic. Be assured that this is a long long way from any owl-headed people, and well before that there are the appropriate specialists, and the demonstrably effective medications, and so forth.

Anyway, thanks for listening,

Sunday, July 23, 2006

What I learned in Clearwater psych ward - part the first

Been thinking about pain, and wealth, and trees that fall in the canopy, oddly enough, amongst a lot of other things.

Anyway. Me and the Clearwater psych reg.

I was in final year Med School at the time, and almost constantly frightened. Dimly aware that in a few short months I would be sent out as a real doctor, and understanding that my knowledge was deeply inadequate to the monstrous task ahead of me, I had constructed for myself the most demanding final year I could.

While other people lounged away their time in ear nose and throat clinic (three days a week), or hepatology outpatients (four out of every five people you saw had either hepatitis C or cirrhosis and the fifth had both, so that you only had to read ten pages of Harrison's, and you had two months to do it), or colorectal (watching endless footage on a tv screen with innards onnit while the specialist shoved tubing up some sedated person's bum), I did four terms of General Med, one General Surg and one psych.

I did this because I wanted my inadequacies exposed during the few short months left of being a medical student, not after January when I was an actual doctor who could kill people.

General Med means a bit of everything. General Med means the guy in this bed has renal failure, the next one had end stage diabetes, the third has some thyroid problem, the fourth is NYHF class IV heart failure, and so on. It means you have to know stuff. It means you get ritually humiliated in front of your peers and your patients until you can, at the very least, make a half-arsed attempt to keep most people alive until someone competent comes along. General Surg is the same, but with innards.

And that's what saved me in first year doctoring.

Although, to be honest, it didn't save Mrs Butterwoman, the woman who died on the first night Benedict and I were on duty, and actually expired beneath our hands. Dead set, I'd been a doctor less than twelve hours, and my record stood at one night, one death. Apparently Benedict told the tale of Mrs Butterwoman to a group of interns a few years later, and her blundering, futile, gruesome and ultimately unsuccessful resuscitation, and everyone in the room paled and grew still.

Anyway. In first year the only time I wasn't frightened (and more on that fear later, too) - the only time I wasn't frightened was doing psych. I remember strolling across Clearwater's open lawns, chatting to the snub-nosed registrar and listening to the magpies carolling in the trees*, and daydreaming about the time, a year and a bit in the future, when I would be a trainee psychiatrist, and would never have to see another broken bone or heart attack in my life.


She (the psych reg) was freckled, and blonde, and blue eyed, and more than a little bit stressed, and I was determined that this rotation was going to be painless. So I did everything I could to make her life easier. I answered phone calls, I checked medication charts, I wrote up clinical notes for her to sign and I got a review article for her on the phenothazide antipsychotics so she could scan it the morning before clinical rounds and impress Dr Melleril.

And all the time I tried to gently extract from her any survival tips for life beyond graduation, some whisper of what it was like, some hint on how to survive.

At that time I looked on becoming a doctor as one of those "Schwarzchild radius" things, one of those event horizons that information cannot cross. Like having a child, or being in love, you can hypothesise but you can't understand what it's like until you've crossed over - and once you've crossed over, you can't cross back. I knew that by the end of summer someone would sign some bit of paper and offer me a job and I would become something that killed or cured.

So - I tried to extract handy hints. Survival tactics. Social mores and exotic customs for our destination.

Gods, I've rambled on, and that entry was meant to be about something else. Right - next entry is pain, freckled blondes, and trees and stuff.

Thanks for listening,

*You know how Doctor Doolittle and Solomon and various other people could understand the speech of animals? I've often wondered about that. To you and I, birdsong is melodic chirping. But were Solomon or Doolittle to stroll beneath the eucalypts, they would hear bird after bird shrieking "You mate, fuck off - this tree's mine", or "Hey, girls, get a load of this!"

Shock, and treatment.

Well, the end of the third week of my study programme, and I'm more than half a week behind. Today I have fed the chooks, done the clothes washing, cleaned the kitchen, and burnt the excess rubbish - anything other than work. I have, not thirty centimeters from my hand, a copy of "Pharmacokinetics made easy", but until they give me "Pharmacokinetics made interesting" or "pharmacokinetics made sexually enticing" or whatever, it's going to have to wait.

So, I have not been studying, and I have developed the guilty habit of avoiding looking at my textbooks, of averting my eyes when I see them marshaled accusingly on the table, or accidentally glance at them slouching angrily on the passenger seat of the car.

Because I know I've let them down. I know I haven't done what I've promised. And I know, when I go back, that they're going to make me pay.

So - what have I been doing?

Well, there's a lot been going on. The friend of ours who had been in and out of hospital all year looks to have turned some corner and is now on open release - can enter and leave the hospital virtually as he chooses. He is still unwell, although it's difficult to tell which of his symptoms are due to his bipolar and which are due to his treatment (two anti-psychotics, two antidepressants and a mood stabilizer, plus the electro-convulsive therapy (ECT)).

But he now sleeps more than three hours a night, can get those recurring ideas out of his head and the persistent, fleeting images out of the corner of his eye, and for the first time a few days ago mentioned his plans for what he would be doing next year.

ECT, by the way, is a treatment about which opinions are polarized. I saw it done one morning at Clearwater, years ago. The patient comes in, an anaesthetist puts a line in his or her arm or hand (my friend has terrible veins, he bruises easily and often, even now, a fortnight later, the back of his hand is tender and dark), sensors are placed on the chest, the head, the arm.

A small amount of a clear liquid is infused, he or she becomes unresponsive. Another infusion - muscles relax, the oxygen mask hisses. A few quiet words, a tap on a keyboard.

The literature assures us that the amount of electricity is not large, and the procedure does not take long - although it seems longer - and that although there are miniscule twitches of the stimulated muscles, the opening and closing of a fist or the blowing out of the cheeks, there is no true convulsion and no pain is felt.

We'll get back to the pain in a moment. But the thing I remember most about ECT was the psych registrar (a freckled, blue-eyed blonde, the same one whose first discharged patient died) assuring me that ECT was "not a violent procedure".

I dispute this. I am a supporter of ECT - if opinions are polarized, I am a conservative on this, a supporter of more and better machines - but I don't know that anyone can honestly look at what goes on in ECT, the effects and side effects, the pathophysiology, and say it is anything other than an act of violence.

It is an act of violence, as high-functioning psychopaths everywhere know.

But then, so is surgery. Surgery is cutting people up. Chemotherapy is poisoning them, xraying is giving people cancer, and sticking needles in people hurts them.

And like all these things, you have to weigh up how much it'll hurt to have the procedure versus how much it'll hurt to miss out. ECT is horrible, and two antipsychotics, two antidepressants and a mood stabilizer are horrible, but untreated psychotic depression is horribler.

Anyway. Tonight I want to write this post that's been kicking around in my head for a while about pain, and what the Clearwater psych reg said is a damn good place to start.

Thanks for listening,

Wednesday, July 19, 2006

The Sole of Wit

Yesterday was at DAC, either the Driver Assessment Clinic or the Desperate Alcoholics Clinic, depending on who you ask. It's the part of my job where I sit in judgement of people who've had their licences revoked for drink driving. Currently one day a week, and much hated.

By the way - in the ED, if someone comes in after a fall or having being in a fire, or after a fight, there is a greater than normal chance that alcohol is involved. But apparently - and I find this surprising - if they come in after a motor vehicle accident, there is actually a LESS than normal chance that alcohol has been involved, or so recent study suggests. There are a number of things that could explain this, from alcohol-dependent people not driving because we've takne their licences (or because they buy alcohol instead of petrol) to people who are drunk and involved in car crashes choosing not to come to the ED to avoid scrutiny - but it surprised me.

Anyway. Apparently we've got a nuisance caller in DAC at the moment, someone who rings up multiple times a day and makes threats against staff, etc. This is a common thing at DAC - in fact, I thought about doing it myself once, ringing in anonymously and threatening to "blow that Bronze bastard's head off" in the hope that I would be removed from duties at DAC for my own protection, but I haven't done it yet.

But this guy is serious. After being found driving his car while intoxicated he was assessed at DAC by Dr Kahlua and Dr Khat, and found to be alcohol dependent, and his licence was not returned to him. Now he rings in ten or twenty times a day with abuse. He started out using his own name (!) but now uses a number of cunning aliases ("tell them it's John Smith") and harangues anyone who will listen - telling us his opinion about Indian doctors, Afghanistani doctors, young doctors, female doctors, government doctors and anyone else remotely associated with the drug and alcohol service.

And he - the complainer - is a prominent local doctor. Well, was until being struck off earlier this year.

The weird thing is, I have some degree of sympathy for him, because you can see this is a man with only one solution to a problem and that solution is not working.

Anyway, "brevity is the sole of wit" as a girl once wrote to me. I still imagine some kind of fishy comedian, a fantastically amusing herring or a kipper with a keen sense of the ridiculous. The bluebird of happiness, the salmon of doubt, the sole of wit.

Thanks for listening,

Monday, July 17, 2006

The Cat of the Curse-people

More on mad cat owners later. And the following contains blood, madness and hints of sex.

Well, went to see the psychologist the other day.

See, for the past six years or so I have been telling people that people with mental illnesses respond better when tackled holistically - they get less sick when treated with medications plus "cognitive stuff" plus "lifestyle stuff" than they do when treated just with medications. After long years of parroting this to all and sundry I have finally come to beleive that it is true, and since my psychiatrist, while good, is mainly a neurotransmitter kind of guy, I have sought out my own psychologist.

And I went Saturday. He seems almost spookily normal. A largish man with a passion for the football (the World Cup kind) and good Greek cooking, and who has one of those sudden, explosive laughs that bursts balloons, rattles crockery, frightens small children and makes elderly aunts clutch at their chests. He's somehow much less respectable than my psych, which does make it easier to confess my failings. And he's about my age, and I suspect has been through some similar experiences, and he's remarkably easy to talk to.

And as you talk you get things that you didn't know were true until you said them, or that you didn't know were in you until they came out of you.

See, men don't talk about a lot of this stuff. Football, maybe politics, how things work - on average, the amount of things a man can talk about and feel entirely safe talking about is relatively small. I feel incredibly grateful that in my later years I have a group of male friends - the comic book geeks, Benedict, my brother - with whom I can discuss almost anything.

But aside from that, when men meet for the first time, there is an almost infinitely narrow range of acceptable emotions to display, appropriate questions to ask, safe answers to give. My wife once asked me why I was so interested in the football. I said I don't drink beer and I can't fix cars, and that didn't leave a lot of options to prove I was a man. I am only half joking in this.

Imagine a light-house on the rocks of some cold bay, a tall tower with a signal-fire atop it. You put flint to kindling and the light blazes all around, the centre of a circle.

Then instead of a fire, make it a searchlight. The light is brighter, and less wasteful, but it leaves large areas in darkness. The light sees far but not wide.

Narrow things down some more. Instead of a searchlight, use a laser, like the common or garden laser pointer. A thin, coherent beam of light, a light perfectly in step with itself. Monochromatic, perfectly collimated so that it does not diverge - a thin, thin beam of light of a single colour.

That's your brain on too much testosterone.

Anyway, this is what I mean.
One summer when I was sick, and actually rather unwell, there was a group - ten, maybe twelve - men and women with the heads of owls, who stood outside my bedroom window late at night. It was dark, and the melaleucas whispered in the wind, and their thin leaves slithered across each other, and the summer air would sigh through them.

The owl-folk were naked, or clad in some flowing thing like a Greek chiton, and they kept watch, although I was not sure if it was to guard over me or with a more hostile or scientific intent. They would watch throughout the night, and just as I would drift off to sleep, usually around dawn, they would keen or chorus, sing some lament. I could hear the voices but I could not understand the words. The thins they said to me were always on the edge of hearing, in the same way that you cannot quite read something in the gathering dark.

You can't tell anyone that. It's not on the list.

But what could we talk about? There is some kind of permission given when you talk to a psychologist. I imagine this is the feeling, the idea that people have had talking to me in the ED or in the Drug and Alcohol job, when they hunch forward in their chair, hands clasped together, and confess. There is this idea that you are safe, that the two of you exist within a closed circle, that things otherwise unacceptable can be spoken.

So, what did we talk about? The second visit was the more confronting, I'll post on that later - a hell of a lot later. In the first one we talked about fathers.

This is a difficult issue here - not to get all whiny, but there is a lot buried there, from my own father walking out and leaving his two kids when I was four years old to my own almost identical actions a generation later - but we talked about this.

And as we talked one of those 'things you don't know you believe' came out of me - the idea that my father and brother are men in a way that I am not, because they work with their hands. My father built roads with black tar and blue metal, my brother fashions steel. I do what at some level seems a weaker person's task - working with my mouth, my quick brain and my soft hands.

See? Once you get it out there, the idea's daft. And my brother and my father would be stunned to hear that at some level I count my work in the Emergency Department as less of a task, less real, less "hard" than what my dad and brother do.

That was a bit of a revelation. To be honest, we just sat around being revelated for a while, at one hundred and seventy dollars an hour.

The weird thing is ED work is physical. I've had my hands in someone's chest. It's a chest tube, and it's exactly what it sounds like. You give the patient an inadequate amount of anaesthetic, and also something so they forget who to sue, and you make a cut in their skin, in between the ribs. You get a pair of what look like pliers, and you grunch your way though the ribcage (parallel to the ribs) until you can fit a hand inside, and you hear the hiss of air, and the wet breathing, and you can feel the inside of the chest, feel the rib and the muscle, the movement of the lung rising and falling under your fingertips.

If you're lucky, I have read, (or if you're very unlucky, and you've put the tube in the wrong place) you can feel the beating heart.

In my emergency medicine handbook (how big are these people's hands, anyway?) it lists the indications for insertion of a chest tube: blood, or air, or pus, or anything else in the space between the lung and the inside of the chest. It also lists the contra-indications - among them are bleeding disorders (i.e.: people whose blood won't clot, for obvious reasons), and "the unco-operative patient".

No shit, Sherlock.

Presumably that warning is there because there are people (doctors) who thought that there were other people out there (also doctors), who needed to be told that. Don't try and stick a bit of polypipe into the chest of someone who is fighting you off, it won't go well.

Anyway, enough meandering. My niece is away at my father's house, and it's Sarah and me in a blissful night alone. Thanks for listening,


PS - Chiton refers to the tunic. Not the mollusc.

Sunday, July 16, 2006

Tom Coathanger and the Bad Crowd

Been thinking about alternatives lately. And strong language, some violence, and a remarkably beautiful picture follows.

Years ago my cousin - a member of our family - Fell In With A Bad Crowd. In accordance with the usual order of things, her grandparents demanded more respect, her father bellowed, her mother boo hoo hoo'd in her mother's grief, and I, her elder, barely noticed, wrapped up in my head with Plastic Man, prayer and Philip K Dick.

Meanwhile, my cousin fled from counsellor to friend's home, friend's home to foster home, foster home to shelter. That year my mum divorced again, and I had moved up to Uni - still don't know how that all fitted together, us kids leaving and my mum and dad breaking up, don't know what caused what and what fed upon what and who made what happen for what purpose -

- this picture is what families are like -

and I was speaking in tongues and being a young socialist and getting two girls pregnant in one month and generally being the kind of person whose existence proves that time travel into the past will not be possible during my lifetime.

Because if time travel into the past is ever discovered, I swear by God I'll go back and kick that pretentious, pompous, self-obsessed little bastard half to death. And when I was nineteen I wasn't assaulted by a frenzied geriatric in late-twenty first century clothes, so that means I'll never be able to do it, and the only possible explanation is a disappointing lack of progress and possibly a poor work ethic amongst time travel machine makers.

So don't invest in time travel companies until I'm dead.

Anyway. My cousin. Two years younger. Ash blonde hair and the same dark brown eyes we all had, the same facility with words and people and truth, the same - I don't know what, whatever it is that makes people like you more than they like other people, the people they should like, the people who would be better for them.

I remember bailing her out of the police station one time, receiving stolen goods, five hundred dollars I didn't have, and I remember going up to her house one time in Geraldton, thousands of dollars lying around in plastic bags, syringes and electrical goods still in the cartons and suspecting that maybe possibly something was up...but aside from gestures like that I was precious little good to her. Anyway, she moved around a bit, Sydney, Geraldton, Melbourne, and I remember one time I bumped into her coming out of a bookshop, and there was her standing in Hay Street Mall, the central mall in Perth, with her new boyfriend.

She introduced him, and he said hello, sort of squinting into the sunlight, and I probably said something stiff and formal, and that was that. I remember he had long hair, and had something wrong with his teeth, like a picture of a teen sasquatch, and was barefooted. And his toes were all splayed out, like an animal.

Of course, we see things, and that includes people, not as they are, but as we are. I am prepared to admit there was in his appearence something of my rage, my contempt, my frustration at the situation, my slow realising that she (and therefore me) had fallen in with no bad crowd, that we were our own bad crowd. By that time I had left my first wife (herein Ruth) for the first time, and I knew I was the Bad Crowd with whom Ruth and a number of others had fallen in.

Anyway, looking back that was, if not the point of aphelion, something close. It was a cold season for all of us. That winter my eldest son was born almost three thousand miles away, across the desert. My mother married again (and later again). My cousin went off with Tom Coathanger and lived as one of the Bad Corwd - methamphetamines in the Melbourne cold, heroin for the warm Sydney summers. Another one stood in the basement of his house and stared up at the noose he'd tied to the rafter. My uncle drove off the road somewhere in Queensland, rolled the car, no seatbelt, died on the way to his fortieth birthday party.

Anyway, many of my friends could tell sadder stories, and don't. The thing is, the other day, I looked down the list of patients I was to see at the drug and alcohol clinic and I read a name.

"You are joking me" I said.


"Tom Coathanger, four o'clock" I said. Not his real name, obviously, but his real name was something similarly unusual, even folkloric, and it was a name that you could easily remember twenty yers later.

"Do you know him?" said Mel.

"I doubt it" I said. "I knew a guy with the same name, but that was years ago. What are the odds?"

And four oclock came around, and Tom Coathanger, medical assessment prison transfer from Furlong Prison, did not appear, and I relaxed and worked on my powerpoint presentation (Assessing Alcohol Dependence in the Elderly Patient). And ten to five, eighty minutes late for a ninety minute medical assessment, Mr Coathanger appears in the foyer. I went out to see him.

"Can't be done" I said. "We're closing in five minutes."

"This is fucked" he said. "Youse said turn up at quarter to five"

The secretary shook her head, but Mr Coathanger would not be turned from his course.

"Look, I've just got out for armed robbery. Seven and a half fucken years, four years before that. Y're forcing me to go out and commit a fucken crime - I'm going down to Innsmouth to stick up the BP Servo and it's all your fault."

"Innsmouth... BP Service... Station" wrote the social worker.

"You're gonnna get the blame" continued the man. "I'm going out to - "

"If you don't mind me asking" I said, "Did you ever spend any time in Western Australia?"

"Ten, fifteen years, back in the nineties" he said.

"West Coast Eagles or Freo?"

He curled his lip. "Eagles, what do you reckon? Anyway, I'm warning all of you here that the next thing I'm doing is going down to Innsmouth -"

"Look, we can book you in here or the Eastern Clinic at the next available booking, and tomorrow you ring Furlong Prison, tell them what's happened, and they extend your script."

There was a pause. "This is fucked" he said. "I'm gonna go out an commit a violent crime. Youse are gonna get be responsible -" - but by now, his tone was grudging acceptance.

"Thrusday week, two o'clock" said the secretary. "We'll ring the northern clinic -"

" - Innsmouth BP Service Station - "

And all the time I was looking at him. Face a bit thicker, as if time, or heroin, or ten and a half years of imprisonment for armed robbery (or for being caught, which was not surprising considering how closely he was playing his cards to his chest at the moment)... but same long hair, same something sasquatchian wrong with his (fewer) teeth. And although he was not barefooted, I could imagine under the counter his toes splayed out, like an animal.

"There'll be an appointment at Eastern" I said. "Before that. I'm sure of it."

The secretary looked up at me and I nodded to him. "Ring Eastern tomorrow and they'll tell you the next available appointment."

I gave him a card with a number on it.

"That'd be the best option for you to take." And I looked at him, and I tried to look like I was being as helpful as I could to a countryman, and I imagined tearing down the glass partition that separated us and kicking him to the ground and breaking the bones in his neck.

After we got him out the door I got on the phone to Sarah. "You will not believe this" I said, and I explained why I was willing to deal with three murderers (including at least one double murderer), countless dealers and pimps, numerous rapists, and a woman who beat her child so it was taken away, but I was not going to examine, diagnose or prescribe for Tom Coathanger. You have to blame somebody, and blood is blood. And the next available appointment at the Eastern service was offered to him, and I checked the Sackbutt the other day and no-one had robbed the Innsmouth BP, so I suppose that was the offer he took up.

Later on my brother came around and we had a yarn, both of us standing in the shed, throwing the cricket ball around.

"Do you reckon it was him?" I said.

My brother has this gift of seeing easily things that are opaque to me. "Name like Tom Coathanger? Right place, right time, only interests in his whole life were heroin and violent crime? What do you reckon?"

Anyway. Alternatives. Most of us got off the track we were on. My cousin is a farmer's wife in the southwest, happy and healthy, in a town where nobody knows what went on in her past (- and vice versa. Maybe the woman who coaches the netball team is an ex-assassin, and the piano teacher a retired stripper).

The cousin who was going to hang himself at seventeen is married now, and happy. My mother is blissfully happily married and playing the grandmother, and me - well, you've had hundreds of thousands of words about that.

But somewhere, in some alternative, Tom Coathanger is family. He's my cousin-in-law, or a cousin many removed (by the police), or something, the black teen sasquatch of our family tree, the "unseen guest at every meal". A reminder of how things could have been. The stuff you're thankful for.

Anyway, enough of this. I will try to reply to comments now.

Thanks for listening,

Brevity, not levity

A crappy weekend
Little more to say of it
Thanks for listening

Well, I know that's not a true haiku, but it's the best I can do at the moment. Drama and tears throughout the family, everyone sick or distressed or sitting around feeling the cold, and me on Saturday listening to a psychologist who told me unpalatable truths.

I will try and write something non-time-wasting later today.


Monday, July 10, 2006

Instead of learning pharmacokinetics...

... I've been reading the dictionary. And a damn fine read it is too.

(This is going to make me sound like an utter geek, of my two clearest memories from my pre-teen years is lying in bed at night playing a game I had invented with the dictionary, where you would pick a word at random, and read the definition, then read the salient words in that definition and so on, until you had "tricked" the dictionary into a circular definition. I did this while other kids talked to their friends.

And the other clear memory is my grandmother burning it, along with all my superhero comics, when I was nine, because I spent too much time reading. I still remember the concrete trough kind of thing the fire was in, and the old Federal comics issues, the one where the Human Torch fights Plant Man, the clear strong lines of artwork curling in the flames...

But I'm over it now. Completely banished from my mind. No, at least they can't say I'm bitter...).

And Sarah's family have this wonderful old two volume set, either the Shorter Oxford or the Less Massive Cambridge, books that will rupture your biceps if you try to hold them with one hand, cornucopias where every page has a word you'd never seen before.

Two of my favourites are

Kern - a lightly armed Irish footsoldier, noted for his ferocity. Alternatively, a yokel.


Postulant - a candidate for admission into a religious order.

Thus, I am an emergency medicine postulant who spends his days treating amphetamine withdrawal in kerns.

But - the dictionary. This is no ordinary dictionary, this is Stedman's Medical Dictionary, 26th edition. While allegedly revising the mechanism of muscular contraction, I glimpsed the word myophone, and for a few moments everything else stopped.

Myophone: An instrument to enable one to hear the murmur of muscular contractions.
From the Greek "myo" for muscle, and "phone" for sound.

One word, ten thousand questions. What does a contracting muscle sound like? Who invented the myophone? What constellation of signs and symptoms would cause a doctor pull out a myophone ("Now, just contract your muscle, Mr Smith...")? What did the device actually look like - was it some elegant combination of brass bell and rubber tubing, something native to the nineteenth century, and now relegated to the same dusty rooms as the phrenology head and the clyster? Or was it a nineteen fifties device - bulky white boxes on a laboratory bench, a screen with oscillating green lines, reel-to-reel magnetic tape?

And further on - the word root "osmo-"

Osmo-: to do with smell, or with osmosis.

Ignoring osmosis for the moment, the "osmo means smell" prefix gives us

osmodysphoria: an abnormal dislike of certain odours.

osmogram : This is not a strong-smelling singing telegram, but comes from the Greek osme, meaning smell, and gramma, meaning a drawing].

Another mind-boggling idea. A drawing of a smell. If that doesn't stimulate your mind, you are clinically dead.

It is, in fact, an "electronegative wave of potential occurring on the surface of the olfactory epithelium in response to stimulation by an odour" - a map of the way a smell changes the voltage on the skin of certain cells on the inside of the nose.

Someone who apparently spent a lot of time studying this was Ottoson, and it is in his or her honour that the osmogram is sometimes called the Ottoson potential.

An osmogram is also known as an electro-olfacto-gram , abbreviated as an EOG: if you are ever wheeled in with central crushing chest pain, and the junior doctor treating you insists on one of these, rather than the more common ECG, stagger to your feet and run.

An osmophore - now this is a remarkable idea. An osmophore is the group of atoms in the molecule of a compound that is responsible for the compound's characteristic odor. If you had cinnamon osmophores on your finger, and stuck your finger up your nose, your finger would smell of cinnamon. Osmoreceptors in your nose are like locks, osmophores on molecules of smelly things are like keys, when the key fits in the lock, voltages change, ions flow, a nerve fires, and your brain smells the smell of a madeleine soaked in tea - and you know the rest.

Osmology is the study of odors, their production, and their effects, a term somehow less impressive than the synonym osphresiology.

And an osmometer is an apparatus for measuring the acuteness of the sense of smell... in what?

What the hell, you are asking, are the units of smell? I read in the BMJ (British Medical Journal) a few years back that this is the Olf, which is defined as the smell emission derived from a standard non-smoking person having 0.7 baths per day.

Anyway. My academic career will be measured in the kiloolfs if I don't get on with pharmacokinetics.

Thanks for listening. Tomorrow I am replying to comments, for which many thanks.

Monday, July 03, 2006

Early morning nymphomania

Grovelling apologies first of all - lots of stuff going on and not enough time to blog. Having said that, not as much going on for me as for some.

Firstly, Sarah is a bit low at the moment, hopefully not from early stage SLIMI (Spouse /Lover Induced Mental Illness*) and I have had to reassure her over the last weekend that I am not going to leave her for a teenage gymnast with early morning nymphomania. We've been doing a fair bit of talking and I have tried to tell her that for me, the ability to put your heels in your ears while achieving the Congress of the Crab is much less important than the ability to look convincingly interested while I bang on interminably about myself.

Anyway, as they say in writing classes - show, don't tell. So, flowers, clean house, romantic gifts (as far as I understand the term) and off to traditional Tibetan/Nepalese Restaurants (where they serve prawns? Do they have prawns in the Himalayas?). Stuff like that. All will be well with this. Without wishing to sound ubermanly, that's not some glib reassurance, that's what's going to happen.

Meanwhile, I have started studying again, for some reason. This time, I have reassured everyone, will be easier, and I will be less curmudgeonly to live with, and so far it seems to be true. And I might even pass. A lot of the stuff is interesting - I am studying physiology and pharmacology, which is basically how the body works and how medications work, which means I leaven conversation with fascinating little tid-bits like "the freezing point of human blood is half a degree below zero" and the fact that warfarin, the popular blood thinner and rat poison, was invented when vets noticed that cows eating mouldy sweet clover would die from uncontrolled bleeding from miniscule cuts and grazes.

This technique gets me unlimited time by myself to study, and can clear a room faster than some of my nieces music.

I also managed to get a science fiction short story published in a magazine "into which I have been trying to get" for years, and which will be coming out soon - and I've started writing again.

One of the stories may be unpublishable because in it Bobby Fischer (the previous world chess champion) goes mad and starts raving about the world-wide Jewish conspiracy and mind control. The only reason I think this is not actual libel is because as far as anyone can tell, Bobby Fischer (the previous world chess champion) has gone mad and does spend a lot of time raving about the world-wide Jewish conspiracy and mind control.

Plus I have been going to the gym and doing judo and so on.

Plus the last week has been rather busy with a friend of mine being in and out of hospital (i.e.: in unless accompanied by a fairly responsible adult, which usually means Sarah or me).

And before anyone asks, the possible implications of all this increasing energy, increasing goal-directed activity and feelings of remarkable self-confidence are apparent to me. But this is the longest period of uninterrupted psychotropic compliance I have ever had. All, as previously stated, will be well.

Thanks for listening,

*Couldn't choose between this one and SLIMED (Spouse or Lover Induced Mental or Emotional Disorder). Feedback welcome.