Maddest man in the whole damn town...

Well.

Well.

Well.

Yes, I am struck speechless. I have just had a meeting with what I firmly believe is the maddest man in Mordor. Mr Jarusnich (last seen here and here), the Latvian bodybuilding loon, a madman of the first water. He of the twenty inch arms

- below, for comparison, is a man with either twenty six inch arms, or something like a baby's head inserted into his upper arm,



the twelve out of ten women, the narcissistic personality disorder, the body dysmorphic disorder and so on.

Anyway, Wednesday was our team meeting. The meeting was originally called our "Pharmacotherapy Meeting", after two weeks we started calling it the "Difficult Clients" meeting, and now it is the "People Who Shit Me" meeting. Each of us (doctor, various nurses, social workers, etc.) bring the bulging files of our most difficult clients and slam them on the desk, and we all try to work out what we can do about them.

And as a result of Mr Jarusnich's file notes, and the reports from his pharmacist, and our copies of the various letters to his local doctor/s from the Comission for Drugs of Dependence, and his recent four star urine drug screen (everything except cocaine in it - cocaine's pretty hard to get over here) we had rang his house and asked if he could come in and see us.

So he did. I can tell you now, our clinical intervention did not meet with success. He limped into the room,wearing his four hundred dollar tracksuit pants and his eight hundred dollar shoes, leaning on his walking stick, courtesy of a minor motor vehicle accident three months ago, and we began our futile dialogue.

How was his pain since he lowered his methadone?

Worse

How was his injecting since he lowered his methadone?

Way up.

Did he want to increase his methadone?

No, he wanted to decrease it.

What did he want?

Oxycontin.

As we had explained, we could not prescribe it. This was because the Government would only allow us to prescribe it for people with cancer -

Wasn't that unfair, the way the government discriminated between people. Did the government know how much pain he was in? Did we? Did the doctors and the lawyers who made these rules? Did the cancer patients?

- and because people, such as Mr Jarusnich, injected it into themselves.

And how else was he expected to cope with his pain?

Well, there was the methadone, a very potent pain relief but with little recreational effect when taken as prescribed ...

And so on and so on around in a circle. There are interesting philosophical dilemmas here, about governmental control over access to pleasure, the apparently quite alienable right of someone to inject whatever they like into their own body, the ideas behind heroin trials and so on, but neither Mr Jarusnich nor I were after a philosophical victory. He was after oxycontin and I was after keeping him alive, me employed and my name off the front pages of the Sackbutt.

After fifteen minutes we'd all had enough. "Okay," I said. "You're injecting yourself with heroin again. Do you see that as a problem?"

"No," he said.

"No worries," I said. "When you do, give us a call. Now, the methadone - it may be that if we give you more methadone, you may feel less desire to inject heroin. Would you be interested in that?"

"No way," he said. "I want to get off the methadone. It's for junkies."

"Right," I said. That is a word that is starting to shit me, possibly because I hear it so often from people who are injecting opiates themselves. "Junkie" seems to be one of those terms like the horizon - everyone knows one but very few people admit to being one, if you follow me. The junkie is always someone that little bit worse off than you are.

"Okay," I said, "One last thing. Amphetamine. Methamphetamine. Heroin, codeine, morphine, oxycodone, buprenorphine. Diazepam, alprazolam, temazepam and oxazepam. Ecstasy, fantasy*... this has got to be costing you..."

He nodded, pleased that we were about to discuss his problems. "Shit, mate. You've got no idea how hard it is."

"Where's the money going to be coming from? Long term?"

He dismissed this. "My father, my uncle, my mum, my grandfather. We've got a farm we can sell."

There was a brief pause.

"It says here," I said "that your father is in hospital today getting his second knee replacement. And your mum's got cancer, and your uncle is in a wheelchair with, you said, some 'fucked up muscle disease'. And your grandfather - hasn't he got Alzheimer's? Are they going to be keen to pay for your heroin?"

The question seemed to irritate him with its thoughtlessness. "Well, they won't want to see me in pain, will they?"

There was another pause while I tried, and failed, to think of any common ground here. Anyway, we went back and forth - actually, that's not true, because back and forth would imply some kind of movement, and this was the ceaseless banging of an irresistible force (my refusal to prescribe him oxycontin to inject himself with) against an immovable object (his desire for anything else). Eventually he got up to leave.

At the door he turned around.

"I've been under a lot of stress," he said. "Serious. My uncle's in a wheelchair, he shits himself all the time. My grand-dad's got Alzheimers, he doesn't know anyone in the family any more, just wanders around the farm. And my mum's in hospital getting chemotherapy every day. It's bloody hard."

The poor bastard, I thought. I've got him wrong. He's doing it hard.

"Yeah, chemotherapy every day, and all her hair is falling out. It's terrible to see." He paused. "Do you have any idea how embarrassing all that is for someone like me, something like that? I can't bring anyone around or anything. My sex life is fucked."

He glared at me. Something in my wide-eyed, voiceless, unbelieving stare must have failed to satisfy him, because he turned aside with a grunt of exasperation and left.

I stared at his broad, twisted back until he shuffled out the door, and then I went inside and sat down and closed the door.

Thanks for listening,
John

*But not a lot of reality