The Shell

Hail,

And a quick warning – the following contains frank discussions of medical and other problems.

Well, this is all rather humiliating. I am writing this from home. Not from hospital, which is good, but not from work, either. And work is where I said I was going to be, but this morning I got Sarah to ring me in sick. Third day back after close on a month away and I’m already back on sick leave.

From what a couple of people near me are saying I went back to work too early. It wasn’t planned that way. It was planned to be a gradual thing, a phased entry. Sortof like those military phased withdrawals you hear so much about. Go in there, have a non-clinical day, follow that up with a fairly mild semi-clinical day at Central, then gradually ease in to seeing patients, be back at work full time by this time next week.

And how well did that work out?

Not that good. Monday, the alleged patient-free day, I saw six. Admittedly, one was only for a breath alcohol, and another was because we’d stuffed up his appointment, and another was a decent bloke, and then someone I saw as a favour to the nurse, and the second last was a prison transfer who we had to see. And the last, as I was leaving, was the guy fixing the gutters. He saw me leaving the building with my steth around my neck and ran across the car-park to ask me about his rectal bleeding.

“I’ve been really worried” he said. “Litre, litre and a half every morning.”

“You should get that checked out” I said.

“Serious, every morning I have to get up and run to the toilet. And my dad – he had the same thing. There’s this family history of diverticulitis. That’s probably what it is, hey?”

“Maybe, maybe not” I said. “But you’ve got to get it checked out.”

“Can’t be cancer, can it?” he said, and pulled up his shirt to show me how loose his pants were. “I’ve been losing weight. I’m only twenty three.”

“Probably isn’t. But you can’t say it isn’t unless you get it checked out. You don’t want to be one of the one in a thousand”

“What if it is cancer? Is it fatal?”

This time I paused, waited long enough so that what I said would sink in. “Only if you don’t get it checked out. I reckon you should get it checked out.”

He paused. “So, go get it checked out, you reckon?”

I nodded. “Definitely. Write yourself a reminder on your phone. Get it checked out.”

And off he went, hopefully to get it checked out. Which might sound harsh, but the alternative was a thorough physical examination of his lower gastrointestinal system, which he (and I) wouldn’t have wanted in the car-park.

So, Monday I was a bit stressed. And I didn’t sleep, and Tuesday I was worse, and Wednesday I was almost useless again. The whole agitation, disturbed sleep, intrusive thoughts, the thoughts of hopelessness and despair.

Those particularly unpleasant thoughts, the thoughts that got me into Clearwater in the first place, the rationalizations and the plans and the preparations… they seem to come a lot more easily now. As if a wall has been breached and not built back up, or some weed has been torn up but the roots remain.

Gods, this is tedious to talk about. I went to a conference in Sydney a while back and learnt some stuff about ‘management of the difficult bipolar patient’ – which I am not, by the way. There was considerable talk about the “bipolar spectrum” (some people divide bipolar not only into types I to V but also types one and a half, two and a half and so on), the bipolar mixed state (which seems similar to the agitated depression with which I am familiar), and the “something to look forward to” fact that as the bipolar patient ages episodes of mania become less common and episodes of depression more common.

This plus a lifetime suicide rate in the twenties (I don’t know what to make of that, it seems remarkably high), and the extremely poor outcome of people with two or more illnesses at a time: SUD (substance use disorder), anxiety disorders, chronic pain, personality disorders plus BPAD – bad news.

Anyway, I treated the agitation by taking lots of coffee – maybe hoping it’d have the same effect as dexamphetamine does in ADD – and by the time Sarah came home I was not that good. I went out and sat by the chook-house and stared.

The baby silkies are still small enough to run in and out of the wire, flowing through like water, while the mother clucks in alarm, herself too round and plump. And the turkeys are trying to swell out of that feathered skittle shape, but most are still gangly teens. I stared at them for a while, trying to ease the pressure in my chest and the ugly thoughts in my head and get my mind somewhere where I could do something with it, but tonight it wasn’t working. It wasn’t good.

I waited out there until sunset, trying to keep hold of the idea that I was sick.

The other problem I was facing is who do I tell about these thoughts? I can write some of this in the blog but too many people I know read this. That’s good and I'm grateful and everything, but it means that this is not a forum for confession. What I needed, I felt, was someone or something that maybe only found in mythology – something out of a Greek myth, a shell found on the shore into which you whisper all your unspeakable thoughts.

In the end I rang one of my friends and spoke to him. He was surprisingly helpful. I say surprisingly because he’s a doctor, and it can be hard for both parties to separate out the “friend ringing friend” from “layperson ringing doctor” and “doctor ringing doctor” phone-calls. We ended up talking about suicide.

The thing that he was saying – from what I can work out – is that suicide is an option, but it’s an option that you have to compare to every other option. Now, if you are five hundred kilos and you are on forty mgs a day of olanzapine, and it still doesn’t work, or you have intractable, progressive pancreatic cancer, or if your every single waking hour is filled with thoughts of how your maths’ teacher sodomised you, then maybe suicide is the most sensible choice.

But for someone like me, and this is what I got out of it, for someone born into such a position of privilege, someone healthy and male and white and English speaking with all his limbs intact, “every other option” includes a hell of a lot. It includes, or if I choose, excludes, emergency medicine. It includes working on Palm Island, or Darwin, amongst the crocodiles. It includes taking five hundred dollars out the bank, getting on a bus, going out to the Nullarbor, just staying a week in a hotel there, standing outside every night, bathed in starlight. It includes giving medicine up to become a circus clown, it includes – it includes a galaxy of things.

Every other choice.

That doesn’t mean I am going to abandon those who depend on me and ride through Paris in a sports car with the warm wind in my (scant and stubbly) hair – unless I realise, pathologically or not, that that is the only non-suicidal option. But it means that if I keep the thought in my head that there are other choices I can get rid of the other thoughts, the dangerous ones.

For me I think that explains the reason that hopelessness is such a dangerous symptom in the risk assessment for suicide. Hopelessness means the disease (schizophrenia, unipolar depression, bipolar three and a half, whatever) that is driving the person towards suicide has progressed to narrowing down the thinking, making a tunnel out of the field of vision, making everything like a telescopic sight, until for that person there is only one way out. It is no longer purely a mood disorder, the disease has become a thought disorder. The person is moving further away from reality, like a boat drifting out into the river.

So, what to do?

Well, for the next three nights take the quetiapine. I pissed and moaned until I got changed to it, may as well take it. Hopefully that will reboot my sleep patterns without giving me flukes and a horizontal tail.

Ring my psych to see if I can get switched over to Dr Tesla. Not that there’s anything wrong with my guy, but I have worked with him, and he’s not someone to whom I can tell this kind of stuff.

Get a counsellr kind of person, a good one, one insulated from anyone else involved in this. Failing that, find that shell on that deserted beach and start whispering.

I should thank the good God that I have not committed myself to starting in the ED soon. I should have a Law like in the Island of Dr Moreau:

Not to take up too much too soon, that is the Law. Are we not men?

Not to draw a line which I myself then stumble over, that is the Law. Are we not men?

Not to forget there are alternatives, and that I have friends, that is the Law. Are we not men?

Not to work-up patients for rectal bleeding in the car-park, that is the Law. Are we not men?

Might have less trouble with that one than the others.

Thanks for listening.

John

Crocodiles

Hail,
First day back after almost a month of absence. This last episode has used up all my sick leave and fair amount of my holidays, and cost myself and my family two and a half thousand dollars... plus untold emotional damage. But I am back at work and doing stuff. We are still in the mire but at now at least we are digging upwards.

Everything was going okay... well, as far as could be expected.

I don't know. Things aren't back to normal. Things tire me out that shouldn't tire me out, I am still a little more labile than I would like to have been, patient's stories affect me. I don't sleep without low-dose antipsychotics on top of everything else - or I sleep until three or four in the morning, then I wake up. Unless I stop myself I gorge myself. I am still susceptible to panic. When I am alone, or stressed, I still get those dull, churning thoughts, the steady mechanical thud and clunk of self-loathing and suicidal ideation, fainter but still there.

But I don't have the hopelessness, the helplessness, that cold agitated desperate emptiness that marked the last few weeks before my admission. I am nothing like that sick now. And I am a long way from decisions and plans and preparations.

Anyway. I saw a patient today, a busy, energetic man, looking much younger than his thirty years, working as a carpenter up near Darwin. He was tall and thin with blond stubble-cut hair, too busy to get his Hep C checked out but also too busy to get on the smack, and he spent half the time telling me the new projects he was working on - a new extension to the Royal, some hotels out in Uluru, work for the Royal Flying Doctor Service.

"We get all the medical jobs" he said.

"Might see you at Florey" I said.

"You probably will" I said.

And he told me about the events of the last three months, which included his wife's brother's suicide, and then those of the last year, which included two other suicides (both of his cousins).

Two hangings and a shotgun, a family hit three times in a year, bodies found and funerals attended.

"And the thing is, the brother in law, I saw him the day before. Told him I could get him some tickets for the Ashes."

I nodded.

"Didn't seem any different. Couldn't have told" he said.

"No-one can" I said. "Doctors, family, friends. No-one can see it coming."

And I was able to listen to this as well as I normally do, asking all the right questions, his moods, his sleeping, any unpleasant thoughts (no to all the above, never been depressed, could't understand suicide) and I marked him down as one of those people at considerable risk in the long term, a stoic man whose any requests for an urgent appointment should be met, but maybe not someone at risk now. And we discussed warning signs and who to call.

"Anyway," he said, "better get on with it. Meant to be on the flight at two."

"It'd be getting hot in Darwin" I said. "Thirty degrees easy"

"Thirty four today*" he said, (not pronouncing the asterisk). "Only thing wrong with the work is the heat. I love the cold, Iused to live up in the hills, close to freezing all winter. Mist every morning, owls and possums in the trees, ice on the ground or dew on the grass until lunchtime. That was back when I was on the smack."

I nodded. He spoke more quietly, reminiscing.

"Crazy days. I was staying up there with four hookers, stayed about a year. Two sisters and two others. One of the sisters was a pretty good friend of mine. The landlord, he had a forest, like a real forest on the property, twelve acres, he was breeding deer. There used to be one male, a buck, and about eight, ten females."

He paused for a moment. "I just used to - you know, you get up late in the morning, they'd all get up late, and we'd have bacon and eggs and then we'd hit up and me and the girl would just sit out on the verandah, watch the deer. That one guy, that one stag, going at it like thirty times a day, every single opportunity, in the forest, out by the dam, up near the fences. Wearing himself out, and we'd be watching him. So damn cold his breath was like mist and still be going at it. Back in the day"

"Back in the day," he said again. He stopped, and for a moment I imagined I could see his pupils change, diminish, that "looking-at-a-bright-light" look of the heroin fix. Back in the day.

"Anyhow" he said, picking up his script from the desk. "Thanks for that. Hope to see you next time. Three months?"

"Three months" I said. "See you earlier if you need it."

So there it was, my first patient back. I don't know how to put it into words, but all that life and death crammed into half an hour. And I have gone back over what I did, and there were no mistakes that I can see, no jots or tittles, no wrong doses.

Anyhow. In half an hour we have the first of today's pregnant buprenorphine clients. In the interim I will leave you with an email I found among the literally hundreds ("Urgent: the small blue stapler has gone missing from the Port Innsmouth Office...") in my inbox that have accrued in my one month of sick leave. It was marked Highest Priority. I reproduce it in full below:

TO ALL MORDOR STAFF
Please be advised that a step-ladder has been left against the sliding door and wall in the staff dining room. One staff member has been injured from walking into the room and colliding with the ladder. I have now put up orange cones and a notice in the dinning room. I have been advised by Property Manager Ian Dolent that the ladder is property of Kray security who are putting up a security camera in Inpatients. As the CNC of Inpatients is not onsite today I have requested via inpatient staff that the Coordinator requests the security person when they come back to store the ladder is a safer place. I will advise Ian Dolent later today if the ladder is still onsite.
In the interim I can only suggest that all staff walk slowly into the dining room.
bye for now,
Pedro Antic
Occupational Health and Safety Officer

I defy anyone to read this and tell me why the writer (dead set, more than six foot tall and shoulders like an ox)
a) couldn't move the bloody ladder himself, or ask someone to, and
b) what we are supposed to do about people so stupid they walk into a ladder standing in front of them and then bitch to occ health and safety about it.

This is why it's the twenty first century and we still haven't reached the stars.

Thanks for listening,
John

* That's ninety three in America, and humidity above fifty percent. Plus crocodiles. Every month I get people writing to me asking me to come work there. I'd love to.

Event horizons

First off, thanks to everyone who has left comments on here while I have been unwell. The support has been almost palpable at times, and to have the demonstrated support of so many kind, decent, caring people has been therapeutic in the best sense of the word.

Danny, by the way, is a deeply decent, compassionate, emotional person, and someone who goes to considerable lengths to conceal the fact. Don't believe him. He said some stuff that made a lot of sense when I came out, and thanks to Sean, and SHP and Seamonkey... Thanks to everyone, in fact.

So. Random thoughts here. And in case anyone gets the idea that it’s roses, roses all the way, I may as well include some soundings from the bad days as well as the good.

Because there are bad days. Definitely. You don’t have to ask me about this. You could ask anyone else with a mood disorder about this, or my psychiatrist, or you can ask my niece or my wife or my friends and co-workers.

Bad days are to be expected, or course. If I’d broken a leg a few weeks ago I’d still expect pain, if I tried to run on it I’d still expect to stumble. It’d still hold me back.

And it does. Monday, for example. What went wrong Monday really went wrong Sunday night, when I didn’t sleep and I didn’t take the olanzapine I had been prescribed for this very eventuality. So Monday morning I was shrieking at my niece and Monday evening huddled on the phone with my heart pounding, and Monday evening raging and gibbering incoherently at my wife.

One of the things I have realized is you can almost measure the degree of my unwellness by how unwell I reckon I am. When I am well I believe I have bipolar disorder. When I am unwell I realize that the problem is not one of sickness or health, it is one of good and evil. Ludicrous as it sounds, that is what I was telling Sarah Monday evening.

Times like that I can understand why people don't take the tablets. It's not only the usual things that stop people taking the tablets (psych meds have all the qualities needed for non-compliance: they have side effects, they have to be taken for long periods, they often have to be taken more than once a day and if you don't take them, often nothing all that bad happens in the short term. In fact, if you don't take them, in the short term, things can become utterly fantastic).

But it's also the fact that people don't want to take stuff for conditions which they do not believe they have.

The weird thing is me - and a number of other people I know who have this - believe we have an illness only when we are not having an episode of it.

This is strange but true. When I am well I know i have bipolar disorder. But when I am acutely unwell, either what is wrong with me is too fundamental for medication to affect (the low) or there's nothing wrong with me at all (the high).

I suspect that “insight”, which to doctors means roughly the patient's understanding that he or she is ill, is a much rarer thing than we doctors take it for. It is unpleasant to believe that you are unwell, and unpleasant thoughts are ... well, unpleasant. That's why breaking bad news is so hard, so important a skill, and why on the wards and in the clinics you can hear people (mostly concerned relatives) saying things like "He says it's only a few cancer cells - that can't be serious, can it?".

In the mood and cognition disorders there is an additional difficulty. I think most people are cognitively set up to believe they are well, to believe that what they believe is true, if you follow me, and that their feelings are "to be expected" responses to outside events. Admitting and keeping admitting and understanding that that is not the case, coming to believe that, although you believe and feel a certain way so strongly, that it is not true.... - it's more than hard, it's un-natural.

It's hard to come up with an example, but - you know when you’re in a train and there's another train next to you and the other train moves and for a moment you get the feeling that it is your train moving? Until inertia and time and the smiles of your fellow passengers tell you it's not the case?

Well, I can tell that the moving train is an illusion, but I can’t as easily dismiss the alterations in the appearance of things when I am down or up. I can't convince myself that the people who show me every outward sign of affection do not secretly despise me. I cannot believe I have not disappointed everyone I have ever met. I cannot believe that the wrongness, the twistedness, the sour, heavy, dark cold inside of me is not detectable by everyone with whom I come into contact.

I don't know. Not a particularly good day today, either, although that CBT starts tomorrow, and that may at least partially explain it. Monday Sarah was able to sit with me and calm me, which I suspect is another strain on a relationship that I have recently put under a fair amount of pressure, but I would rather talk to her than take anti-psychotics. The weird thing is I was almost able to pin-point the moment when I went from believing "I am a venomous creature and any contrary thoughts are meaningless" to "I am someone who is depressed and these contrary thoughts are a symptom of that depression." And somewhere in there would have been this quantum state, partial awareness, a phase exactly balanced between insightlessness and insight.

You know something, I was thinking the other day about some people I know who have some sort of mood disorder and who are in some way high achievers. All of us in different ways: one is an academic who regularly receives university prizes, another dresses impeccably, another probably by now some kind of craniofacial surgeon, a fourth someone who works with people on the fringe of society. Not high achievers in the narrow sense of the word, but people who go above and beyond.

And I was thinking about black holes, the places, if they are places, where stars consume themselves, tear themselves apart, those black pits into which limitless amounts of matter, stars and planets and everything the collapsed star can grasp pours.

The thing is, we can see where black holes are. If your eyes could see the right kind of light, light in the far ultraviolet and Xrays (and I have heard that if you stand in the dark for long enough you can see X-rays) - then you could see where a black hole was by the blazing, the burning up of objects as they fell into it and were consumed. Paradoxically what looks from the outside like a very bright star can can in truth be a black hole.

Anyway - and I don't know if this is an analogy that can be sustained - there is a reason that those people I mentioned are achieving in the way they do. There is a reason they spend hours at the laboratory or in the operating theatre or in front of the mirror.

The reason is that horror, that absence, that lack, that black hole that lies (in both senses of the word) at the heart. If they didn't have that absence, that cold darkness inside themselves, then they wouldn't be burning up everything to make themselves shine.

The thing you cover up, drown out, distract with fire and noise.

Anyway. I am going to go off and take the prescribed (and non-stupidifying) medications. Will post soon.

Tuesday, by the way was better, and so have most days been. This is a normal progression back to health, and I am better today than yesterday, and so on.

By the way, anyone know how to update the links here? I've asked Chad a number of times and he keeps telling me and I keep forgetting. And get a map and some other stuff?

Thanks for listening,

John

I'll protect you from the hooded claw/Keep the vampires from your door

Hail,
And an overdue post, in at least two senses of the word. But instead of posting I have been kickboxing in the shed, cleaning out the study and staring at the chickens. I have not been down to the beach yet, but for that you can blame the heat.

And the chickens are mighty fine. I went out and gazed at them yesterday, late morning, with the sun already stinging my white marshmallowy body. Days like yesterday I try to check their water twice a day. And they were there, a mixture of pure-bred and mongrel silkies, a pompadoured male, his live-in lover and one ferocious mother hen with chicks. The chicks are small enough to run through the fence, like water through a sieve, and when they do their mother clucks in alarm.

We also have three or four turkeys, the precise size and shape of feathered skittles. Silkies, by the by, have five toes, much like most of my readers. Unlike, I suspect, many of my readers, they are covered in down, and their bones are black.

Anyway, I stood in the shade of the eucalypt tree and gazed at the chooks, and I pottered around the shed, and I found my old copy of Lieh Tzu, and yesterday, after a good few hours of doing other stuff, I managed to become relaxed

I say this as if it was a big thing, and it is. I don't relax easily. And by relax in this sense I mean that deep relaxation, where you can just stand there, unravelling, untangling, feeling things unknit.

Always been a problem for me. But it's doable.

Anyway: today's post, tentatively entitled "I have the best wife in the world".

There may be some of you who have already met Sarah and are already convinced of this, and if so, feel free to stop reading now - go stare at some chooks. But there may be some of you who have met her, or who have yet to meet her, who are yet to be convinced of the truth - for truth it is. Well, read on.

While I was in Clearwater, she visited every day. While I lounged, trying to learn how to think again, she worked.

The unpleasant fact is the things that got me into Clearwater were not just biochemical abnormalities. What I was taught about episodes of mental illness (particularly the mood disorders) was that when someone has an episode of illness you have to look at their personality structure (cognitive habits, ways of dealing with stuff, that kind of thing), and the things going on in your life (which I needn't go into here), and the neurochemistry.

In this, I am no different to anyone else, and I am booked into the first "looking at ways you deal with stuff" session Monday. Somewhere along the line I expect to discuss traits of selfishness and cruelty and stupidity and ego, wrongs I have done and left unrighted. Terrifying.

But anyway, that is the subject of another entry. The thing is, even though a large part of what ended up with me borderline psychotic and unmanningly depressed was my own head, Sarah visited every day she was allowed. And while I lay in bed she got up early to drive my blood relatives to school, and brought me in food (particularly a small plastic tub of dried chilli, bless her)- she scoured the internet for special gifts for me (a DVD of Much Ado about Nothing, another of Cemetery Man, a U2 t-shirt, a hard-to-get - come to think about, most of them were hard to get - documentary on Canadian schoolgirls*). etc.

And she is trustable, and loyal, and loving, and giving, and can navigate her way home drunk and in the dark using only a nineteen seventy six street directory with half the pages missing, while I sing Pogues songs beside her. And she is much more physically beautiful than she thinks she is, still one of the most beautiful people I know, eyes the colour of dark polished wood, skin that feels like silk - that kind of beauty where you get more beautiful as you get older.

I know I don't deserve her. One of my friends (and I don't deserve them, either), said something to the effect that she was someone "most of us would strangle a baby to have", or something. I am the luckiest man in the Galaxy.

Anyway. In the latest stuff U2 stuff (went to the concert the other night, post pending) whoever writes their lyrics seems to be talking about the limitations of romantic versus what he/they sometimes call real love:

I could never take a chance/of losing love to find romance

and so on. I don't know what he meant, obviously, but the reason that lyric works for me is that to me it's about the difference between that short term crush that you get versus "the real thing".

Foilwoman wrote some time back - can't find the post or I'd link to it- on the realisation that those crush feelings, or even those "my God s/he's hot" feelings are not a good guide to how good any relationship between you and Mr/Ms Hotness-Personified would be, how happy you and someone else could be together.

As we all (please God) sooner or later realise, the real thing is different. And the thing is, with Srah, I feel I have emerged into some place, realising that I love and am loved both in the real and the romantic sense.

Anyway, that's my yearly quota of talking about other people - next post will be all about me again.

Thanks for listening,
John

*Do not be alarmed. It is actually a documentary where someone follows these five girls for a year and sees the different ways their lives work out. It's called "talk 16". I am trying to write a superhero comic based on my vague recollections of it.

Thalassa!

Home today, after two weeks in, with strict instructions for a further two weeks off.

I have been struggling against this reflexive accreting of tasks and responsibilities, and I have managed to keep the tasks down to three.

I am going to write and read only what brings me pleasure, nothing that is the fullfilment of a duty.

I am going to feed and water the chooks, and sit in spring sunlight and gaze at them.

I am going down to the sea, a few kilometers away, like I have been saying I will do for the last seven years. Seven years in a coastal city without going down to the sea.

And I am going to be a good husband.

Pretty much all I have to say.

Thanks for listening. Will be able to read, and respond, shortly.
John

I hope I shall arrive soon

Hail,
Strong language, although not strong thinking or strong writing alert.

I can’t think.

I can’t write.

I can’t do any fucking thing.

"Drugs", or "depression", or "depression plus drugs", or "the unbearable fuckedness of being" seem to have done something seriously stupidising to my mind, damped down the amplitude till all you get is a fuzz of background noise, an intellectual and creative flat-line. Nothing is emerging from the water.

I am going home soon, and I really don’t know how or if I am going to cope with what seem like the gargantuan tasks before me. The tasks are of this order - packing up my stuff from here. Driving my car home. Picking up cat food on the way home. It is as if I am a child again, in the sea-green water, and the salt backwash is drawing me in and the waves tower over my head.

I used to run resuscitations.

I’ve been noticing a few things, particularly when stressed. I notice the tendency to want to apologise to everyone (nurses, orderlies, reception staff), but to simultaneously hide from them. One of the things that makes depression a killer is the way that the depressed person, as s/he descends, cuts him/herself off from everyone who could help. Almost as a pre-emptive strike, the way the killer in the movie cuts the phone lines before closing the lights and bringing out the carving knife.

There are times now when my own thoughts repulse me.

And I notice the way things are rorschached – and I don’t know a better word for it – into images that correspond with my emotional state. There is a small patch of chipped paint on one of the railings that looks like a screaming face. The patch of oil outside in the car-park looks like a tumour. A bird outside cries, it sounds like a razor scraped over a whetstone.

We see what we believe. And I don’t believe in the screaming face, or the tumour, or the razor, but you can see how these things could happen. There is, by the way, some self-censorship going on here. I write and delete, or write and rewrite, so that the nett result is that I seem better than I am. The worst times are the ones I don’t write about.

That reminds me of something I read once, years ago. “A ghost is an outward manifestation of an inward fear”. That’s what makes a good ghost story. You create someone the reader cares about and you make them afraid. Read M.R. James for unalloyed perfection in this area.

I think the things I have going for me are many. I don’t have a comorbid substance use problem (i.e.: am not smoking or injecting my olanzapine*). I continue to have a bafflingly strong support group – a faithful and tireless wife, glorious friends, supportive if overly emotionally charged family. I am normally capable of doing stuff – running an ED overnight, studying, writing. I can remember a time when things were better. I understand the objective side of my illness and my treatment better than most people, I know what to expect from the drugs and the disease.

One thing, weirdly, that helps is writing. So I’m going off to write something easy, something bright, something therapeutic, fresh, satisfying and brainless.

Sounds like someone I knew in high school.

Thanks for listening,
John

*When I heard this I thought "God only knows why people would do this. The stuff is an emotional and creative and intellectual anaesthetic". And of course, there's your answer.

Mosquito

Late afternoon here, after a day of highs and lows. You can look out over the balcony (through the safety glass) and see the parklands and the tops of trees and maybe a glint of river. Beneath me, in the smokers' gazebo, you can see the tips of lit cigarettes, glowing and burning, the colour of cats' eyes.

A few years ago Clearwater (and much of Mordor) suffered the ignominy of a mosquito problem. I smiled when I heard it. I like the thought of mosquitoes descending and alighting on our patients, then flying off feeling… somehow different, filled with psycho-active chemicals from the patients' blood.

Clouds of mosquitoes on lithium and valproate, fat, calm, celibate and benevolent mosquitoes. And the mood stabilizers gradually seeping through the ecosystem until we have relaxed magpies, chubby mice, hawks who don’t feel any more that the government is keeping an eye on them.

Nature, fluffy and pink in tooth and claw.

The low came earlier today, when I was told that I would not be going home today as hoped. I had been home over the weekend for overnight leave, and advised to have a “low stimulus” night at home, which I interpreted to mean sharing a bottle of wine over a romantic Doctor Who video and later on watching an episode of ER.

That was good, that part of the night went very well, but not everything else was good. I did go backward a bit, as if by returning to the place where I got sick I took the sickness back.

I got the whole emotional lability (going from fist-clenching frustration to to sentimental tearyness in minutes, each time in response to things I would normally have taken in my stride), indecisiveness (being literally unable to decide whether I should or should not have a cup of coffee), and late at night the return of that churning, repetitive, dull kind of thinking, like a cement mixer, over and over and over again, until I surrendered at one AM and took the prescribed “something to help me sleep”.

Anyway. Ups and downs. The main thing at the moment is Dr Tesla feels I am not yet well enough (“And did you think you would be? Are you Speedy Gonzales? If your leg you had broken would you be running only two weeks afterwards?”) to go home, and so we will see. Maybe Wednesday, maybe Friday. Two weeks off from work after that, if we can afford it.

I know I have some way to go. I know beyond a shadow of a doubt I cannot work as a doctor like this. I would not put myself in charge of the onion rings at the football.

The thing is, I feel – I don’t know. It takes time. It takes time not only because I have to heal but because I have to change, change the way I do things.

Without wishing to be tedious, this is how I see things. The following may contain traces of amateur psychology.

When I get sick I feel that there is some absence, some structural deficiency in me, something essential missing, some loss or something lost. I suspect this may be the case for everyone.

In my daily life I spend a lot of time and energy trying to cover up for the loss, pouring a lot of stuff into the void, filling up the emptiness with noise and light. Working, helping, saving, as if there is some equation that says “If I do this, if I work hard enough, if I am interesting enough, if I be good enough, If I save enough people… I will be loved.”

Again, I suspect this may be the case for a lot of people I know as well.

The problem is that there is no amount of this kind of stuff that will fill that hole. There is no amount of external validation that can fill up that internal lack. There is not enough sacrifice and noise and spectacle in all the world for that, no way to solve this algebra of the heart.

So how do you stop causing it? How do you change what you’ve been doing for years, stop all the fuss

...the least experienced drug and alcohol doctor in the busiest clinic in the part of the city with the grimmest part of the city … doing lots of “extras” – giving talks to the interns, med students, nurses, being involved in the ECG program (me and three others), the immunization program (me and one other very part time guy) and the methadone/endocrine program (me and no-one else)… trying to keep in touch with my chosen field, through infrequent shifts and even less frequent study, as the exam draws ever closer and my chosen field moves further and further ahead of me…being a husband to Sarah, a son to my elderly father, an uncle/father to my niece and a father to my two sons*, trying to write and keep fit and keep the house looking decent and feeling more and more guilty and panicky as these things trickle out from between my fingers… and covering up the guilt and panic by scrabbling for more things to take up –

... stop all the fussing and start to learn to do without it?

How do I learn to listen in the quiet when that's just not something I've been particularly good at for the last ten or so years?

With things as they were, something had to give. There is a reason they called these places asylums.

Anyway, that’s what I have to learn to do. I am wary of “shoulds” and “have tos” at the moment, wary of drawing that line which I then trip over. But I think it would be a good thing to learn, and I’ve been told to take this two weeks off, not do or plan or work at anything other than getting better (and some manual labour – apparently building a new chookhouse is okay), and in this I will, against all previous inclinations, be guided by my doctor.

Thanks for listening,

John

*It was in this last cause, by the way, that I went with my eldest son the other day to see Jackass II. The best thing about it was you didn’t have to see Jackass I beforehand, you could sortof pick up on the plot and the character development that had happened before fairly quickly.

Tractor

Less therapy today. One of the therapists is off sick, and the other has yet to arrive. This can be good – I don’t know if I mentioned before the fact that sitting in an armchair talking about yourself is oddly exhausting.

There is a Greek word for that thing that boxers do, I think the word is skiamachia - shadow boxing. That's what the therapy is. And I've been keeping my hands up and my chin low and trying to be light on my feet, but me and the shadow, we're both heavy hitters.

Anyway, so far today it’s been me and the medications.

There is a sign, by the way, on one of the big rooms here most mornings, saying “Do not enter – therapeutic session in progress”. The sign suggests Bach flower remedies and a woman in a sarong gently massaging your temples, but what is on the other side is actually ECT. That’s electro-convulsive therapy, the old school shock treatment, kick-starting your brain.

By the way, if I am ever in a position where the three choices are stay really sick for a long time, go on massive doses of psych medications for a long time, or have ECT, it’s the ECT every time. As far as I know it’s the least horrible solution to a horrible problem.

Anyway. I was reading that Anatomy of Melancholy – and it’s a remarkable book, a truly unique book written by a bipolar man of almost supernatural erudition in the sixteenth century – one thing that he says is dies dolorem minuit: “the day diminishes sorrow”.

Time goes on, you forget. Oblivion, he says, is a common medicine for all losses, injuries, griefs and detriments.

I have seen this myself, both in myself and in others. We forget even when we try to remember. We overwrite what was written in our own hand, we learn, over time, to endure losses that at first seem unbearably painful, things too heavy to bear become bearable.

When I was fourteen my best friend fell from a moving truck and was killed, driven by his frantic father to a hospital but dead on arrival. Three hours after midnight.

In the first few months after he died I thought and spoke and even dreamed about him, what he had said, what he would have done. I remember sitting in science class and being asked to pick partners for an experiment and turning to where he would have sat, and him not being there.

Now weeks go past without me thinking of him. The truth (and I think it’s both horrible and merciful) is we heal, we rebuild, we are built to go on.

There are exceptions, of course. What I reckon happens is we take the event, the loss, and like everything else we experience, we turn it into part of a story that we tell ourselves. Like an oyster forming a pearl from a wound – the initial irritation is transformed.

I think that as far as our minds are concerned, a fact in isolation is useless, worse than useless, like a free radical or a loose cannon on a ship. A story, on the other hand, is powerful, can explain or justify, or teach.

Nocumentum documentum, Burton tells us. Hurting is teaching.

Having said that, sometimes the story we come up with is powerful, but harmful. Sometimes the story heals us and sometimes it seals up the hurt so it is still there, and sometimes it makes the hurt worse.

I don’t know the vocabulary here, I don’t know if I’m getting across what I want to get across. I think the olanzapine is effecting my ability to find the right words.

I remember seeing a woman when I was in the community psych team, a hundred kays from the city, up near the river. She was a farmer’s wife, twenty three or twenty four. She was one of those agrarian looking women, square-built and strong, dusting of freckles, blonde hair and blue eyes, looked like Proserpine. She had married her childhood sweetheart three years ago, and three months later his tractor had rolled over and he had been killed.

Three years. Her friends and family had become concerned and called us out, and I sat in the small atrium of the hospital and spoke with her. She had all the signs – poor sleep, poor appetite, ongoing morbid thoughts – and by my “first year out of med school” standards she was grieving.

But the thing that had caused her relatives to call me out, and the thing I was powerless against, the thing that made me recommend an admission and a senior consultant referral was that she was not getting better. If anything she was worse now than a year ago. Whatever some part of her mind was doing with the fact that he was gone was not making her better. It had more the appearance of something that was making her worse, pushing her closer to death, so that the tractor rollover in the wheat-field, December three years ago, was going to kill someone who had been five kilometers away when it happened.

Anyway. Close to midnight. The olanzapine is doubtless wearing off, I have to go off and get my top-up. Have I mentioned lately how I hate the stuff? My brain feels like it is running on a mix of herbicide and seven dollar rum, I have to stop in the middle of sentences because I have forgotten what I was trying to say or what words I was going to use to say it, and my body shape is going from spherical to superellipsoid.

The guy who invented the super-ellipsoid, by the way, wrote an excellent essay on the subject that begins with the line

"Man is the animal that draws lines which he himself then stumbles over."

Can't beat that.

Hear me moan, as they say. But when I get out of here I’m going to write to the people who sell the competitors to olanzapine and offer them free advertising space on my page. “Olanzapine – rated crappiest anti-psychotic by one out of one mental patients”.

Anyway, thanks for listening,

John

Serum misery level

First off - I should point out that I can't actually read this, or any comments. I write these on a memory stick and Sarah takes them in for me.

Well, I had lots of therapy yesterday. No wonder I’m feeling like shit.

First off was the psychiatrist. My psychiatrist while I am here is one Dr Tesla, an extremely tall man, an ectomorphic patrician with sea-green eyes, hooked nose and closely cropped hair. He speaks in a precise, European accent, and for some reason the thought of disobeying him, or of concealing things from him, does not enter my head. He sits, long legs crossed above the knee while I explain things to him – first the vegetative signs (the sleep, the appetite, the concentration, etc.) and then what I think of as the personal things: the thoughts, the feelings, the memories.

Conveniently, I suppose, I arrange it a little like presenting a case, all I would have to add would be the introduction: “Mr Bronze is a thirty nine year old man who came in as a voluntary admission with a diagnosis of bipolar depression…”

He generally attacks at dawn, like a Masai, seeing his first patient at seven AM. I think this is why psychiatrists think mental illness is so widespread. Many people who present as suicidal, homicidal or floridly psychotic at seven AM would be perfectly reasonable two hours later with a cup of coffee and a decent breakfast inside them.

So, I sit in a room with him and talk about myself. One thing I am struggling to come to terms with is what we call lability, the fact that my mood is so changeable. Some hours of the day I feel okay. These are the hours I write, or go to the gym, or read. Autobiography of a Geisha. Anatomy of Melancholy. A Maze of Death. Some book on scurvy that would have made a damn fine two thousand word essay rather than a thirty thousand word book. Ganong’s Review of Medical Physiology – this last one I brought in because when I can read it I will be well enough to go home.

Actually, the therapy started earlier, if you want to count chemical therapy. That starts just after breakfast, with the valproate and reboxetine. And the pantoprazole to cover the side effects of the valproate. And the citrus-flavoured, quick dissolving wafer of anti-psychotic I can take if I want to (I try to keep that to a minimum. Both my parents have type two diabetes. I might be crazy, but I’m not that crazy).

One day, by the by, someone will explain to me why the side effects of the psychotropic drugs seem to come on within hours while the beneficial ones take weeks. Are there side-effect receptors in the body, and entire separate (and very fast) side-effect physiology? Is there a way we can take advantage of this, develop a drug for some mild condition that as a side effect cures schizophrenia?

Anyway. Those are the good hours, and when I came in they were essentially absent and now they are the majority of most days. So I am getting better.

But there are other hours, other days. The bad days, or bad half-days, like I’m having tonight. Nightmares. Waking early. Eating and still being hungry, sleeping but still being tired. The still watches of the night where all the stupid feelings that got me here come back.

And the thing is, at the moment I am so pathetically fragile. One slip-up, one minor thing goes askance, and immediately some part of my brain throws up its hands and says “Right, everybody, into the car, we’re all going to go jump off the Narrows”.

Last night I had a dream. I (in the dream I was thin, red-haired, rather androgynous looking) was a counsellor or teacher of some kind, teaching disadvantaged children. I was going to see this kid about his truancy. I sat on a low brick wall talking to him, went through his pockets and took the knife he had made – a fine handle but a weak, rusted blade. I tried to lead him somewhere to get help, but we got lost. I remember writing directions in the sand and the wind blowing them away.

We ended up at the beach, and it was a beach where sand-dunes sloped precipitously into the sea, and the wind whipped the skeleton grass. Everything was eroding. He ran into the water so I followed him, he was near the rocks and I was in the deeper water. There was a lizard underneath the water, some kind of iguana-creature, who had been there a couple of weeks. I tried to reach him, to save him or be saved by him but he was too deep, the water was too cold, and I felt myself being drawn out to sea, away from everything.

I woke up physically frightened and sweaty, five AM, so tired my eyes stung.

These kind of dreams need no interpretation. Loss, erosion, failure, weakness, cold, the ground moving under you, the knife with the weak and useless blade.

On the bad half-days, the bad days, the bad couple of days, I realize something essential is missing from me.

Anyway. I don’t want the rest of today to be crap, so I have to commence the protocol.

Grab my morning medications.

Peruse the newspaper, which appears to have a picture on the back page of a goat, dyed in Australian colours, with the name of one of our cricketers batsmen painted on it. The goat looks suitably repentant and is surrounded by angry Indian men. From this I deduce we won the Champion’s Trophy, and have been celebrating it with our trademark courtesy and restraint.

Psyche myself up for the gym.

Maybe read a book rather than just buying another one.

Try and convince Dr Tesla not to increase my dose of olanzapine.

Anyhow, thanks for listening (and sorry for the bleak and unhelpful posting),
John

When The Sleeper Wakes

And today's title from an old H G Wells novel, by the way.

Years ago I had an idea for a superhero comic. I wanted to look at some of the ideas in the superhero genre, some of the assumptions and the things that were bothering me at the time. Ideas about violence, ideas about identity, about constraints.

Probably wouldn’t have worked. But as a start-point I had a sextet of classical music playing schoolgirls, aged fourteen or fifteen, high achievers, who travel to Palomar Observatory… and five years later wake up with superpowers.

The “discovering that you have superpowers” scene was relatively easy – there are things you can do in your daily life that alert you to the presence or absence of superpowers. Getting the lid off that jam jar is easy, say, if you’ve suddenly got Hulk-level strength – although it was interesting to look at how useful and how useless super-strength is for someone who probably hasn’t formed a fist in ten years. And how superstrength could almost be an impediment for a certain kind of girl in a certain social environment.

Boys have it simpler. Superboy, you see, would be stronger and faster and less vulnerable than all the other boys. He could dominate, could beat the other boys up and no-one could beat him up, that’d be what made him super.

But what would a Supergirl be like, a girl who dominates and excels? A supergirl could make everyone hate you and make you think that it’s your own fault, and make every other girl and boy love her.

Now, I know that things aren’t so simple, but that was the basis of one of the issues – what would happen to a girl who found herself with super-strength and super-speed and worst of all, invulnerability. Like most of my stories, it ended badly for many concerned.

Anyway – why this boring prelude?

Because another of the characters (superperson name Quartet) gains the ability to quadruplicate herself, to be in up to four places at once, doing four different things (relevant to anyone’s life? Anyone?) at one time. The way she discovered this was gradual. She felt hungrier. She woke tired. She began to feel as if there was something in the house, would wake and find things moved about. One night she spent in terror, lying in bed listening to what turned out to be one of her selves, nefariously making a peanut butter sandwich in the kitchen and singing a U2 song.

Eventually she works out what is going on, meets up with her friends: the super-strong one, the one with the new voice, the one who looks like an angel from the Book of Revelations… hijinks ensue.

Why is this even peripherally relevant? Because I had a Stilnox tablet (zolpidem, 10mg)* last night, and this morning I woke up and all of my food was eaten.

Sarah has been wonderful with me being in here, more wonderful than I deserve, and last night when she visited she brought me some bocconcini. It’s one of my favourite foods and I was looking forward to eating it, and this morning I discovered the empty container on the bedside table.

Apparently I’ve already had my treat. I’d eaten it. Either that or someone came in at night and stood by my bed when I slept, sinisterly eating cheese.

And that’s not all. I have the not-to-be underestimated luxury of reading before sleep here, and apparently while I was somnambulistically scoffing bocconcini I was reading too: “The Autobiography of a Geisha” by Sayo Masuda. When I went to bed the book was open about a third of the way through, the setting was nineteen forty, and Little Crane was a senior novice. Now it’s more than half way, it is two years later and the chapter title suggests Little Crane has “awakened to love”.

So the least bizarre explanation is that while I slept I read and ate. Bizarre.

It’s a really weird feeling, seeing evidence that you’ve done something about which you have no memory. Occam’s razor suggests that I sleep-walked, sleep-ate and sleep-read, even though I have no memory of it at all. I can’t prove it, of course, that would require Occam’s razor and lather, maybe even Occam’s shaving set, but someone scarfed my food and read my book while I slept, and I suspect the guilty party is me.

The good thing is I get to read that part of the book again, and I’m quite enjoying it. The frustrating thing is “I” missed out on the sensual pleasure of eating bocconcini, whereas calories eaten while asleep do count.

Maybe I could set up a punching bag by my bed, or a treadmill, do a bit of aerobic work, sleep kick-boxing…

Anyhow, thanks for listening
John

*apparently this is quite common with zolpidem. I am being changed over to zopiclone.

Re-entry

I am trying to come up with a theory about night times here. Night-times here are weird.

“What, in the psychiatric ward?” you say.

But it’s true.

In the small hours of the morning a man strides along the corridors, purposive, possibly fixated, an empty watering can in hand, as he has done almost every hour of the last three days. A slump-shouldered girl and a red-head young man play pool, him almost unbelievably poorly: he is, he says apologetically, normally quite good, but the lithium makes him miss-hit. An elderly woman moves nervously along the corridor, smiles apologetically at me, but flinches if I smile back.

Last night there was someone sobbing, or someone singing – you know those sounds at the periphery of your hearing, like when you can see something but you can’t quite work out what it is – singing or sobbing just before dawn.

Like they said in Spinal Tap – Well, I'm sure I'd be more upset right now if I wasn't so heavily sedated.

There seem to be two separate populations of people, or two aspects of the same person, a nocturnal and a diurnal, like the crescent and the gibbous moon. In the daytime people here are relatively gregarious, but solitude is a nocturnal creature. The grey-headed woman with the walking frame who shuffles along so slowly at three in the morning, I am sure she is not the same woman as the one who sat chatting over her Earl Grey tea with her relatives this afternoon.

Anyway, the theory. It’s not coming that easily, and only part of that can be blamed on the olanzapine (wouldn’t have been my first choice, but, hey, I’m not getting paid to make the decisions). Last night, just meandering, I wondered if the theory would have something to do with phobons. That’s phobons, like photons and phonons, but different.

Photons, as you know, are the smallest possible lumps of light. Light doesn’t come in any smaller sizes than a photon – you break up a photon and what you’ve got left isn’t light anymore. Phonons, from what I understand, are analogous quanta of sound – when sound travels in a crystal lattice, phonons are the smallest possible chunks of sound.

(As an aside, light is made of photons. Pretty much everything else can be divided into tachyons and tardyons. Tachyons – and I cannot remember if they have actually made the leap from science fiction to science fact – travel faster than the speed of light in a vacuum, they have mindbending properties like negative mass and getting younger as time passes. Tardyons is everything else – we are made of tardyons).

Phobons – and I’m making this up as I go along – phobons, like photons and phonons, would be fundamental particles… but of fear. I’ve got this vague idea of the walls of psychiatric hospitals being saturated with phobons, all those anxious, depressed, miserable people giving off phobons year after year. And then, at night time, the lights go off and you get a phobovoltaic effect, so that stored phobons are emitted… and that’s what makes night in psych hospitals so weird.

Okay, it’s a crap theory. But that doesn’t mean it can’t be used in medicine. Crap theories have a long and distinguished pedigree in medicine. There is a strong tendency in medicine to substitute “what we understand” for “what works”, to do things that accord with what our theory says should be the case rather than things that accord with our (or, Heaven forbid, our patient’s) experience.

The problem with this is the patient’s experience is often a bloody great chunk of what makes the patient believe s/he is sick. You end up with those dialogues where the patient says “I’m still sick” and the doctor says “Well, you shouldn’t be.”

The patient gets frustrated and the doctor gets angry because the patients aren’t getting better like the theory says they should – and if the fault does not rest with the theory (which may be literally unthinkable), then it must rest with either the doctor (very unpalatable), or the patient (unfortunate, but seemingly unavoidable).

This kind of theory based thinking is what kept us bloodletting, prescribing purgatives and carminatives that made sick people vomit and poo until they were transparent, doling out medicinal arsenic and mercury… and today keeps us “curing” homosexuality and “preventing” AIDS without using condoms.

What I am trying (for some reason) to say is fundamentally medicine shouldn’t be a science, it should be a technology. How does lithium work in bipolar disorder? God knows, but if you wait for a perfect theoretical understanding before taking the tablets, you’ll be no better off than those inhabitants of asylums in the eighteenth century who were taken out on boats and exposed to the moonlight – because the theory said it should make them better.

Hence the name "lunatics", by the by.

Anyway. Off to tell the night staff my new phobon theory. I’m a bit nervous, so I’ll keep the phobons out by just putting on this tin-foil hat – there, fits perfectly.

That should get the night time dose of olanzapine back into double figures. I’ll be looking like a sperm whale come Christmas.

Thanks for listening,
John

Odd John*

You know that Thoreau quote? I went to the woods because..?

Here it is.

I went to the woods because I wished to live deliberately,
to front only the essential facts of life,
and see if I could not learn what it had to teach,
and not,
when I came to die,
discover that I had not lived.

Well, I went to Clearwater for a number of reasons, maybe none of them as good as that.

I went to Clearwater because the clinical signs suggested it. I think if I had been my patient I would have sent myself to hospital. I would have done as my doctor did, which is reassuring, in a weird way. I think I would have asked the same questions, elicited a list of symptoms, assessed the details of any plans, judged them in terms of feasibility and lethality, and acted accordingly.

I went to Clearwater because it is better to jump than to be pushed, and better to be a coddled resident of Clearwater among the worried wealthy well than to be a shackled bedlamite in what passes for the public psychiatric system.

And I went to Clearwater for self-preservation. Because for a few days there, things got very bad.

There is a lot more detail that I could put in here, but won’t. What happened is difficult to write about (partly because of the subject, partly because of the symptoms, partly, doubtless, because of the medications I am now on). But even if I could write about it with comfort, I could not imagine everyone reading about it with comfort. There is a tendency to self-disclosure here that I am wary of, a primitive, childish reflex: a pattern of thought that says “If I show how much I have been hurt then I will be loved.” I enrage myself when I hear myself doing it.

Anyway. In summary: I am unwell. A week ago I was very unwell, sort of a five or six year record low. Looking back now – and I’m not better yet – I can see what was going on. The disturbed sleep, the gorging on carbohydrates, the constant churning thoughts of death and disease, the poor concentration – I reckon I got nine out of nine symptoms for close on a week.

In retrospect, the most frightening thing is that in the few days before the admission – and there’s a word with a number of meanings: admission of guilt, admission to hospital, opening the fortress door and admitting the enemy – in the few days before the admission I had begun feeling… better. My symptoms appeared to have improved. The sleep, the mood, the concentration – things seemed quieter, less anxious.

Looking back now I can see that was a false dawn. Like Mrs Cesious with the silent chest, this kind of silence is often – and I should have known this, for Christ’s sake – deceptively reassuring. It takes a few seconds to realize that this silence of the emotions, this calm, is actually premorbid, a danger sign. It suggests an end to an interior struggle not because some kind of harmony or resolution has been reached, but because one side has been defeated and the other has claimed victory.

That’s around about the time that Sarah drove me to the psychiatrist’s office and I described what part of my brain was planning to do, carefully calculated milligrams per kilogram and the other stuff that had started to happen – the mishearing things, misreading things, the things at the edge of sight, and the preparations I had already made. And I told my psychiatrist all that stuff and then Sarah packed me some clothes and I packed some books and she drove me to Clearwater –

and now I am here.

In a private psychiatric hospital, in an attractive building, set back from the river and the road, discreetly veiled with eucalypts and casuarinas in blossom. If there is some kind of Michelin guide for psychiatric institutions, this would get at least two stars (or straightjackets, or whatever).

And I’m a voluntary patient rather than a detained one, which is good.

And I’m in the private system, which means my notes are anonymised and kept in the psychiatrist’s office, and my blood test results are accessible only via a code (which I don’t even know), whereas in the public system any of the many, many doctors and nurses whom I know can look up my history, my drug doses, my clinical reports, everything, giggle at my diminutive renal function and make disparaging comments about the shape of my ECG.

So, here among the wealthy healthy. I am reassured that I am not the first doctor to come through here (apparently this is the place for general practitioners withdrawing from alcohol and surgeons on morphine), and I’m not even the first lefty doctor in Mordor to go private when the wheels fell off.

Anyway. What am I doing now? I am typing on Sarah’s laptop – no internet access, I am six days behind on the cricket. Outside the sky is dull and heavy, the colour of beaten lead, and no birds sing. I spend a lot of time in my room – I am trying to unlearn stuff, to learn not to fuss, not to worry, not to take things on.

There is, my psychiatrist says, a frightened, lonely child inside all of us. That takes some getting used to.

Occasionally, when the rest of the bedlamites** are sequestered basket-painting or finger-weaving, I go downstairs and make myself some coffee. It’s coffee the way I like it, hot and black and bitter and cheap. Times like this the ward is almost silent. There is nothing I must do because I must do nothing. By preventing me doing anything my psychiatrist hopes to force me to do nothing, for the first time in years and years. That takes some getting used to, too.

You get the coffee out of one of those hissing dispensers, press a button and it burbles and foams out of the plastic tap. It warms your hands when you carry it upstairs and set it beside the computer. When you look at the surface there are miniscule island galaxies slowly rotating on the surface. They coalesce and separate over the space of a few minutes, as if I am watching billions of years of stellar evolution in minutes.

And I am alive, and inexpressibly grateful. Tomorrow will be sunlight and a clear sky. In a few weeks I will be able to go outside and look up at the sky and it will be a beautiful night. A week ago I held Sarah’s hand and cried in my psychiatrist’s office because I could not imagine being alive in three days time, and already that state of misery seems ancient, distant, almost unrecognizable to me.

I am alive today and I will be alive tomorrow. All will be well, all manner of things will be well.

And I’m going to get better.

More news as it comes to hand.

Thanks for listening,

*The title, as those fluent in geeklish will know, is that of a novel by Olaf Stapledon, a man whose imagination was too damn big for any media but the printed page. Read it in junior high school and it’s stayed with me ever since.

** Too damn good a word not to use twice

John.