Monday, October 02, 2006

The truth of the matter

First off, thanks for the many undeservedly kind and helpful comments.

Today, I suspect, I may have alerted my co-workers to the fact that all is not well as far as moods go. We had our doctor's meeting and we were talking about drug companies giving gifts to doctors, and whether we should let them drop off pens/notepads/other bits of subliminal advertising to us.

Some said it was harmless and some said it was a bit dubious, and the boss asked me what I reckoned. I said that my considered clinical opinion was that pharmaceutical companies were, and these were the exact words I used, "the incarnate spawn of Satan, and Glaxo Smith Kline is Satan walking to and fro upon the earth."

There was a fairly sizeable pause, and someone said "Mmm", and the other guy said "well, where would we be without pharmaceuticals?" and I said I had nothing against the individual molecules themselves, it was the ideological hegemony of the bloated* pharmacrats and their capitalist construction of illnesses. Phrases I haven't used in public in near on twenty years.

And there was another silence and the other guy said, "Quite, quite", and we moved on to the difficulties we've been having getting good dental care for our patients.

It's not as bad as it sounds. They advertised my job (well, the equivalent one) the other week and no-one applied. There seems to be a perception that nobody in their right mind would work for Drugs and Alcohol, which dovetails nicely with my observation that no-one in their right mind does. There are only about ten of us doctors in the organisation, and once you rule out the daft, the disinterested, the disinclined to work and the detainably unwell, demand far exceeds supply. And believe me, the heroin problem in the south isn't going to go away anytime this Age, and Emergency Departments in the south are looking at three times the patients being treated by half of the emergency doctors in twenty years time.

I am essentially unsackable.

Having said that, I found out the other day how much money I could make just writing prescriptions for oral morphine tablets. The going rate for 100 mg MS Contin (oral morphine, you crush it up and inject it into your vein, or snort it if you can't do that) is apparently something like $60. Temazepam and the various "sleepers" are a lot cheaper, but still, it adds up.

There are apparently entire communities, particularly in the Northern Territory, funded by morphine tablets - the elderly who cannot survive on their savings or pension go to the doctor and say they have back pain, the doctor prescribes them oral morphine tablets, the pensioners sell it to the able-bodied youth who clean their gutters, etc.,... it all goes around.

It's weird looking out across this imagined landscape, where beaming matrons push gurgling babes in prams down well-kept streets, and think it all depends on drug money. And all voting to get tough on drugs.

I don't know this is true, by the way, but the patient who told me this looked very sincere (and tanned) and was on one hundred and fifty milligrams of methadone.

As an aside, have a look at this. It appears to be a hand-held game that kids (6 - 10) year olds play that rewards them in chocolate and candy - without the hassles of them trying to sneak into the pokies. It's made by Nestle. Nestle are the only company trying to do something about our epidemic of "kids who don't sit around and stuff themselves with junk food enough". From what I can work out they have adopted a rather sophisticated "triple pronged" approach to the problem - the Wonkazoid simultaneously prevents dangerous outdoor exercise, ensures that we don't run low on national stocks of kids with attention deficit disorders and helps our kids learn that "sugar", "fun", "popularity" and "artificial colouring" are actually synonyms.

With industry support like this, paediatric cardiology is going to be one of the hottest growth areas of medicine in about ten years time. In thirty years time, we doctors who can remember when one hundred kilogram eight year olds were unusual will be considered quaint.

Anyway, enough about other people, what about me? Not sterling. I usually manage to get five of the required nine symptoms of deppression for two weeks with little difficulty. I've got nine before, when unwell. I have a friend who regularly gets nine for weeks on end, but she's always been driven to excel. Currently I sleep like a baby (waking every two hours screaming and not knowing where I am... not really), and I am eating all the pizza in the house to avoid the temptation of there being pizza in the house for me to eat. But I am going down the gym and checking out how many days of holidays I have accrued and doing all that stuff.

Speaking seriously for a moment, there is a lot I could say here. There is a lot on my mind, stuff that goes around and around, churns and thuds repetitively like malfunctioning machinery. The usual thoughts, the usual threats, the usual things. But I don't know that there's any benefit to me saying it, or anyone hearing it. Writing things down only bores me when I am sick and embarrasses me when I am better.

Once I am worse, of course, I will "realise" that these thoughts are not the symptom of a disease, but are insights into the true nature of things, profound glimpses into what is actually wrong with me, the skull beneath the skin. And I will doubtless look to share this with anyone who will listen, write for hours and hours, filled with the need to apologise to anyone who listens, or to stand at some upper window and lash myself for the public amusement. Prove something, in some futile and deeply screwed up manner.

But before then there is the cognitive stuff, and the maximum dose of the reboxetine, and the higher dose of the valproate. And the body and the brain and libido to match.

Lucky I have accrued twenty one days off. And I'm not rostered on for holidays for a while, and we're short staffed, but believe me, nothing gets you to the head of the sick leave queue like a history of bipolar depression with psychotic features. If they mention how it's not a good time to take sick leave, I can always say "Funny, that's not what the owl people said". Go directly to your car, do not pass go, do not collect two hundred dollars.

Anyway. Thanks for everything, and any and all remedies will be employed (while I still think I am sick - that's a joke, and not a particularly funny one), and apologise in advance.

Thanks for listening,

*I didn't say bloated, but it was definitely implied. Aside from that it was word for word. The wide eyed medical student is starting to look like a manga frog.


Anonymous Danny said... it just me or does that drug not work? I usually have to take about 4 to 5 a pop just to get sleepy. But then drugs don't work on me at the best of times...makes ya wonder eh?

7:25 AM  
Blogger Niamh Sage said...

Is it a bad thing that even when you're writing about...well, bad things, you still make me laugh? I loved your bloated pharmacrats speech.

Hope you feel better soon.


"wtnoks" - sounds like a word a maiden aunt would use instead of a proper swear word.

3:15 PM  
Blogger Juanita J. Sanchez said...

I'm sorry, I was laughing too. But I was feeling for you at the same time. It must take a special talent to be able to make others laugh when you're not feeling so hot. I wish, wish, wish I had been at that meeting. I would have thoroughly enjoyed your little diatribe. Too bad I can't tell you a bit about my screwed up life, you'd feel so much better. I'm sure of it.

9:08 AM  
Blogger Niamh Sage said...

The wide eyed medical student is starting to look like a manga frog.

For some reason, this reminds me of the "dessert hoping mouse" you told me about years ago :D

*nhkwdn* - licence-plate abbreviation of a Western Australian country town name? Somewhere in the Wheatbelt, by my reckoning.

9:45 PM  
Blogger Benedict 16th said...

Hey BJ
Did you see what I wrote about you in Foilests Blog?
Also I have found a new CIV game for you to play...

It's set in the near future when suddenly millions of people just disappear....

Clearly fantasy

9:59 PM  
Blogger Shiny Happy Person said...


I've just been told about your blog, and though I have not had time to read it all, I will be returning.

Nice to know I am not the only bipolar doctor with a blog.

12:01 AM  
Blogger Benedict 16th said...

Hello SHP,
You realise BJ is going to kill me?

9:10 PM  
Blogger Shiny Happy Person said...

Ah, but I didn't say WHO told me.

You did that all by yourself.

9:39 PM  
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8:04 PM  

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