Saturday, September 02, 2006

Paradoxical Reaction

In the stricter sense of the word, I have seen one or two paradoxical reactions.

A paradoxical reaction, in medicine, is a reaction that is exactly the opposite of what you expect. Rather than the therapeutic effect, you get the antithesis of what you anticipated when you prescribed the medication.

You give the antibiotic and the tuberculosis gets worse.

The patient takes the prescribed sedative and half an hour later she has to be held down by security guards - "Nembutal Rage".

The patients develops wheezing and rash when you give him the antihistamines.

In a paradoxical reaction you cause exactly what you tried to prevent. It's embarrassing, because it's one of those things that should always be in the back of your mind, but when it happens you often work it out a little bit later than you wanted it to.

There are paradoxical reactions in other fields, too - the people who are only interesting when they are unattainable, the money saving measure that costs you, the exercise routine that leaves you laid up in bed for three weeks with housemaid's knee and lapdancer's back... and so on. You elect someone who says he stands for freedom and he ends up wire-tapping you, that kind of thing.

Anyway. I heard about two paradoxical reactions the other day.

The first was a large-framed, almost chubby man whom I booked into the Alcohol Unit. He had that round-headed, slightly baffled 'Charlie Brown' look that some men in their early forties get, that look they get when they when they first encounter mortality, when they feel the rising arc begin to descend. He had, after several years of abstinence, began drinking again, and I was gently trying to work out what had caused this, and what we could do about it.

(You see, some things you ask, some you don't. The man who had left the room before him, tall, multiply pierced, worm-thin, a drummer in a punk band, had begun lacerating himself at the age of thirty two, only a few years ago. Multiple shallow cuts on the inner arms. I had asked a few questions around that, trying my best to listen to something he was not openly saying, drawing back before I got close, and after a minute or so I had the outline of something, like those carnival tricks where the marksman outlines the girl in bullets, and he asked if we could stop. And we did, and I drew back, and you could see the outline of what it was, what he said he had yet to tell his psychiatrist, and it was something horrible that he did not want to know I knew).

But anyhow, our baffled man. I scanned the nurse's history.

"It says you're separated."

He nodded.

"For better or worse?"

He shrugged. "It's better now. I still see my kids, she's got someone else... it's all pretty amicable."

"Do you reckon" I said "that alcohol had something to do with that?"

"With what?"

"With the marriage breakup"

"Shit, yeah" he said. "We'd still be together if I hadn't changed."

"How'd that work?"

"Well, it was okay while I was on drugs. But I went to the doc's and he told me I was killing myself, so I gave up the goey. Cold turkey. I was getting to the stage where you don't enjoy speed anymore anyway. And it brought a lot of tension to the relationship."

"Made it worse?"

"Lot worse. We had these fights. And then the doc told me to give up drinking, said it was was stuffing up my liver, so I stopped. Didn't drink for eight years, started back at the footy, joined the army reserve. Best years of my life, that way. But things got worse."

"The marriage?"

"Really bad. We had these big fights. I don't know if it was loss of control, or what. I remember one time she said "You're such an arsehole. I liked you better when you were pissed all the time", and I said "Well, I liked you better when I was pissed all the time, too'."

I winced.

"Yeah, well, it sounded smart at the time. Then I went back to the doctor and he told me to give up smoking, and I did, really fixed up my asthma, and that was pretty much the last straw."

I had this momentary image of the local general practitioner, an avuncular family doctor of the portly, white-haired type, smiling contentedly as this man left the surgery, thinking of another human being helped.

And the second one was the ongoing battle with Meredith Furlong, one of my ten "most likely" patients at Southern. That's "most likely to have to explain to the coroner" - a woman whose prodigious consumption of benzos, barbiturates and injectables keeps me staring at the ceiling long into the night. She's the "bottle of fifty sleeping pills in thirty seconds" woman. Plus a hundred mg of methadone a day, lungs like a paper bag, kidneys like sultanas and a more steel in her body than a Cyberman.

Anyway, very bad things have happened to Meredith. In the last three or four years she has experienced more tragedy than I hope anyone reading this experiences in their lifetime. She has been arrested, assaulted and abandoned, her body is a patchwork of scars, three of her former partners are in prison, both of her children are in some sort of protective custody.

She has responded to these crises by consuming any and all drugs she comes across. She recently was taken to hosptial because she went to a friend's place, and while browsing in the bathroom cabinet (as we all do) found a bottle of pills and took them all. This was done with recreational rather than any overt suicidal intent. The drugs in question turned out to be some fairly formidable old-school antipsychotics, and she went into what is called an oculogyric crisis - all the muscles in her back and neck stiffened up and they wheeled her in to the ED balanced on the balls of her feet and the crown of her head.

Anyway, lately things had been calming down for Meredith. It had been six months since she had been admitted to the psych ward or locked up by the police. I had managed to start to get a handle on the amount of benzos she was taking (or at least the amount she was prescribed) and she hadn't injected for months.

But just when things seemed to be going well...

"Four hundred thousand" said her partner. He had come in to see me alone, and now he sat in the surgery with his head in his hands.

"Four hundred thousand dollars?"

"Near as" he said. "From the motorbike accident, five years ago."

"Bloody hell" I said. There was a pause, then I said it again, slower and with more
foreboding. "Bloody hell."

He nodded again. "She's out of control."

And he described what had been going on. Six hundred dollars the first day, no sleep for five days. Then her on the phone, calling dealers she'd been unable to afford to see for months. Then the benzo crash - three days of sleep. Waking up and tripping over the carton of beer in the hallway, and the syringes in the bath.

And this guy was no choirboy himself, but there were shifts of proportion involved here that were alarming him. There is a limit to how quickly and how badly you can fuck yourself up on the disability support pension, and Meredith had been doing, by her count, remarkably well.

Until now.

"Now," he said, "it's all going to go to shit."

I told him there was nothing I could do. She wasn't detainable - being mindrootingly stupid isn't a mental illness. The police, he said, were out of the question. Once she took enough speed to develop a psychosis, he could ring the psych crisis team, but until then... did she have any friends who would be interested in stopping her using drugs, some kind of intervention - never mind.

Well, we thought failure and misfortune had been damaging to Meridith, wait until we say what success and good fortune could do.

Anyway. There's apparently an old Jewish curse that says may you inherit a shipful of gold, and it not be enough to pay for your medical bills. It's deliciously nasty when you look at it, which is what curses are meant to be, I suppose. But I don't know of any curses that say may you inherit a shipful of gold and that be the cause of most of your medical problems.

Thanks for listening,
John

4 Comments:

Blogger lauritajuanitasanchez said...

I've always feared winning the lottery for that reason. Good post. Still play it, though. Go figure.

10:48 AM  
Blogger Foilwoman said...

And some of the blessings now sound like curses:

"Land without rent to you
Health and good cheer to you
A child every year to you*
And may you die in Ireland"

Then you've got the moderately acceptable ones:

"Here's to beefsteak when you're hungry,
Whiskey when you're dry
All the men** you ever want
And heaven when you die"

Still, not the right toast for a vegan or a Mormon or a cloistered nun or Carrie Nation.

*Clearly, it's a guy saying this to a guy. Or one hopes.
**Change or retain gender depending on reader's gender and sexual preference.

1:59 PM  
Anonymous Danny said...

On a totally different note...your team is going down on the weekend mo'fo!

11:19 PM  
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6:48 PM  

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