Tuesday, September 26, 2006

Baby Love

Right - I want anyone reading this entry to read through the following list and tell me which one sounds convincing.

Acute Reiter's Syndrome*
Jumping Frenchman Disorder*
Itchy Red Bump Disease*
Persistent Sexual Arousal Syndrome*
Chronic Ergophobia...

Any joy so far?

Because tomorrow I have to ring in with something very very feasible, because otherwise people will suspect, rightly, that I am lying to get out of work.

Why would I do that?

Well, I got a phone call today. It was from the nurse at the Princess, the Royal's subsidiary hospital, which deals with women and babies and women having babies (and quite frequently, babies having babies).

It turned out that a twenty four year old first time mother had been brought to the Princess in the small hours of the morning to have her child. It was one of those much anticipated but poorly timed events, but the mother had been to all the antenatal classes and had apparently built up quite a rapport with the midwives and staff.

And delivery was apparently quite uncomplicated, albeit painful (mother requiring quite a lot of pethidine), and baby was born healthy and well, and not even that sedated from the narcotics. All was well, all manner of things were well.

Until baby began to show signs of opiate withdrawal – an unconsolable high-pitched cry, yawning and sniffing, increased muscle tone and exaggerated reflexes. And the urinalysis showed methadone metabolites in the urine. And mum, confronted with this, broke down and confessed that for the last two years she had been using a some of her partner’s methadone. A tiny dose, five milligrams a night , just to get through some of the stuff she’d been going through. Well, five milligrams a night to the nurse, and fifteen to the midwife, and forty or so to the doctor.

Anyway. Baby has been put on a miniaturized version of our opiate withdrawal programme, "all other things being equal" will be sent home on Thursday on zero point two five milligrams of morphine syrup a day, which is virtually a homeopathic dose for an adult but who knows how much for a newly born liver and brain. "All other things" are by no means assured of being equal – social work are involved, and they are all the more fervent because they didn’t pick this up themselves.

Anyway. There are a number of interpretations of these events which do not require mum being taken out and killed. She is, apparently, virtually hysterical with remorse. She may be unwell herself, she may have tried to give up and failed, she may have concealed what was going on initially out of ignorance or shame and then from mounting panic. A selection of stones in various weights is available at the counter for all those who have never sinned. Time will tell – I will almost certainly never find out.

But I will find out something tomorrow, because tomorrow I have to get her partner’s notes, and bring him in, and ask him how we could best reconcile his frequently repeated assertions (four to six times a year) that he was taking his medication as prescribed, with his wife’s (and the laboratory’s) descriptions of how he was sharing it with her.

And if she’s been lying for two years, he’s been lying to us. That means back to square one for him, swallowing all his doses before the watchful eye of the pharmacist, and an urgent (as in the next day no matter what) appointment for her at one of our offices to work out what help she needs. Because she may or may not have had an opiate problem before, but she’s certainly got one now. It's something that the whole family shares.

Anyway. With a bit of luck, he won’t be our client – he may be Sarah’s, or even the northern clinic’s. And maybe he’ll be forewarned, come in, make a clean breast of it. Hoping that his co-operation with the court will be taken into account come sentencing. Sigh.

Because God I love telling people we know they've been lying to us, and I know I do such good medicine when I'm angry, and I'm deeply pissed off at my own clinical inadequacies and our regulations and whatever cogs in the machine played a part in that kid getting born with parts of his brain all faulked up**.

So that's why I was thinking about feasible diseases. I know I'm angry, I can feel it, and even though I know it's not all his fault (I feel a considerable amount of it is mine), I know that I don't make good clinical decisions when I am angry. And I am a doctor, and by definition these people are sick, and I don't know that sick people benefit from the doctor suggesting that they take their bullshit stories and rx pr ad libitem***.

So. These itchy red bumps are getting bigger, and there’s that pain, deep and unfeasible... I mean unpleasant, gnawing at the fifth ventricle of my spleen. Could be something contagious. Don’t want to go in and risk infecting the rest of the staff, that wouldn’t be professional behaviour. Not at all.

Only thing to do is scratch something impressive sounding on this script of sick notes I have at my desk and send my apologies to work.

Sigh. If only. Anyway, will write more soon (health permitting).

Thanks for listening,
John

*Genuine medical conditions. Accept no substitutes.
** A private joke, concerning one of the two or three worst doctors I have ever met, which can only be revealed once I am dead or he is dead or he is struck off the register - probably next week.
***rx is "take thou", or "take". "Ad libitum" is as often as you like. PR refers to how the medicine is taken. It stands for "per rectum", and it means just what it sounds like.

4 Comments:

Blogger Niamh Sage said...

Yikes. What about Jumping Aroused Red Frenchman's Itchy Sexual Spots Disease? That should cover all the bases.

2:24 AM  
Blogger Benedict 16th said...

1) I was going to post this story* when I started reading todays tidings but I got the wrong end of the stick
2) It reminded me of one client I tried to get to see Dr Sarah, cos Dr Erection ruled that
she was pregnant and couldn't have the "brown methadone" and had to have "biodone".
This client had FITH** syndrome and really wanted the old brown stuff and had even
organised a pharmacy who still had some.
Dr Erection wouldn't allow it because the brown stuff was about 10% alcohol*** and therefore was not allowed to have it because she was pregnant... #
3) If she is going up north... send her to me...
We private prescribers are so much slacker that you guys and your rules....
4) Dr "Rose for Emily" at the Shipman - was his dad really an Archbishop?

We need to catch up,
I have more Breanna## for Sarah and some incriminating photos of your family....

Cheers
Benedict


* 12-year-old Russian girl gives birth to second baby
“Well, it happened by accident, so I had to give birth to my child,” says Bashtam Gorbunenko as she shrugs her shoulders. Bashtam lives in the village of Komsomolsky, in the Volgograd region. She turned 12 in February.

Bashtam gave birth to a baby boy several days ago. It is her second child, she gave birth to her first-born son Mitya a year ago. Bashtam was 11 at the time.

Bashtam and her partner, Mikhail, 21, cannot go to a registry office and have their relationship officially registered because she is far too underage. Mikhail is the father of both offspring. Nevertheless, they live together. Bashtam and Mikhail happen to share the surname despite being members of the only two Gypsy families in the village. The Gypsies are known for their common family names.

Mikhail took the news about Bashtam’s second pregnancy for granted. Disregarding the Gypsy tradition which forbids the father to partake in care of a baby, he promised support and help to Bashtam.

** If you don't know I ain't gunna explain it
*** max methadone dose is 150mg, at 5mg/ml maximum ethanol 30ml, about 2-3 standard drinks, I think she was on about 50mg (10ml ethanol)
# maybe the biodone (red stuff) doesn't feel as nice IV'd, or she likes the mild burning sensation in the veins of the
<1% alcohol of the diluted brown stuff (cos take aways of methadone are diluted by a factor of 10 or more)
## Breanna or Jasmin, or Sheila, or Wanda, or Wendy or whatever the OCP is called these days

11:13 PM  
Blogger Juanita J. Sanchez said...

John, that's a tough one, but I'm not sure why you could possibly deserve any of the blame. I think it's a positive sign that you are able to feel anger or guilt due to the situation, instead of the hardened indifference that infects so many doctors and nurses.

1:26 AM  
Anonymous Danny said...

Doc, pure and simple, junkies always lie. There's very few of them who actually break out of the pattern and tell the truth and clean up.

It's like this...that first hit you touch God. Then you spend the rest of your days trying to recreate that first hit. It never happens. Seen people very near and dear to me go that way. Once saw a guy with a gun to his head lie about his addictions, even when it was laid out in front of him. Sad, but true...

7:20 AM  

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