I’ve been thinking for the last few days about how to write this entry, and I still haven’t worked it out. I don’t – believe it or not - like melodrama, and I don’t like causing problems or embarrassment for people.
And I haven’t been sure lately about all this self-disclosure. I’ve felt sometimes in writing this blog like I did in anatomy class as a junior doctor – carving down through the layers of skin and fat and flesh, exposing layer after layer of tissue, in the vague hope of finding some central truth.
I think at some level what I am trying to find out in this blog is the same thing that I was trying to find when I did my anatomy dissection in first year (elderly man, advanced prostate cancer, bony metastases): some answer to “how does all this work?”, “how come this is alive?”
You can ask those questions about the mind as much as the body, and you can dissect away at things, anatomizing them, applying mental as much as physical scalpels, cutting deeper towards some anticipated centre, something that will explain everything.
But it's a fool's errand, in anatomy, and in writing. There isn't an answer, a centre, a core. There's just ... stuff. Stuff that helps you understand in increments, but no single key insight or organ. No "aha".
The thing I remember most about anatomy is how as we dug deeper things became more and more strange, grew more and more alien, less and less like a human being. Faces and hands look like parts of a person, lungs and adrenals look alien. Strange organs, essential and vital but (in the first few months of medical school) yet not understood.
Anyhow. There comes a time when you’re going to learn no more through anatomizing, dissecting and digging deeper, when you have to pan back, take a wide angle view, or maybe even think about something else for a while.
So: in the last fortnight or so I have become unwell. Suffice it to say at the moment I am at
I say “have become unwell”, although it is debatable how much of what happened has been intrinsic illness and how much a response to events around me. My psychiatrist – Doctor Tesla again, the vaguely mantis-like Netherlander with the crisp enunciation and the unerring clinical eye – detailed the events of the last year with me:
The death of Burian, the writer, and of Dr Greene, the consultant – both senior, almost father figures, both at the end of paths I wanted to travel.
Cancer in a close friend that I failed to diagnose, the subsequent messy and poorly managed surgery in the hospital to which I took him, at Florey.
Psychotic depression in another, whom I detained in hospital against her will,
My own hospitalization earlier this year, for the first time in years.
There’s more. I stopped work in emergency, and for some reason that feels and felt like a retreat, a cop out, a retreat to safer and less turbulent waters. I started work in an area that I don’t believe in as much, one that doesn’t give you that rush, one that rarely gives you even the semblance of success.
Add to that the fact that I failed (at some level) to look after my niece – she returned briefly to her mother over the summer holidays, and she will be staying this year with a family friend. And along with failing her there is the simple fact that I will miss her.
And all of these events - and several more that I have doubtless forgotten - these caused stresses, strains, hairline fractures in my important relationships. I ended up seeing less of my colleagues and friends, even less of Sarah, hardly anything of my sons, seeing more of people at work. That meant mixing with a different set of colleagues and also getting to know more and more about my patients, hearing more and more about the day to day, eternal, horror of their lives.
Failing to do what a doctor should do, or a father, or an uncle, or a husband should do.
And there’s certainly more than that, some embarrassingly stupid stuff (and yet not the most embarrassing stuff in this entry). There’s the fact that in a few weeks I will be forty, that I have a friend coming over in a few weeks who is lissom and single and debonair and I am on drugs that make me sexless and globose. There is the fact that the close friend’s cancer that I failed to diagnose was testicular cancer, the fact that both of the father figures who died were - there is no sensible way of putting this - sexually alive people, men with a masculine vitality. Some of the crisis was stuff about sex and love as much as death.
And there is more to the story than I am going to speak, more that I could say but am not saying here and will not say here. Those who are inclined to do so can guess the specifics of what other things happened, what precise form the other element of this crisis took - please do me the courtesy of not informing me of your opinions, the whole “Ms Scarlett in the library with the candlesticks” thing.
But anyway – a few months of deepening depression, sloping like a continental shelf, then the drop into the abyss.
And I said I didn't like melodrama. Anyhow – some endpoint was reached a few Saturday afternoons ago, NewYear's Eve eve. I was leaving home, allegedly to stay at my brother’s house for a while to sort some stuff out. Coming on to midsummer, but the sky patchy and unseasonably cold, cold like this Christmas was cold, cold and dry like this year has been cold and dry. Three or four phone calls on the way to and from people close to me that underscored how badly I’d fucked up everything I’d cared about, that seemed to say to me at the time that the roads were closed, no way out, no way back.
And a last meal, a very pleasant meal, at a friend’s place, him and his beautiful wife, new house, satisfying career, two lovely children. And driving home that night thinking “fuck it, if you don’t do it now, you never will”.
Anyway. The next bit happens offstage. When next we see our subject it is in the ICU, after sedation and paralysis, intubation for thirty six hours. Certainly not the only person to spend New Year’s in a coma. Waking up enraged after a couple of days with a sore throat and weird bruises everywhere and tubes in virtually every orifice. And a fairly spectacular forty eight hours of what they call ICU psychosis – hallucinations of imps and sprites, crawling insects everywhere, and hundreds of thousands of budgerigars, overhearing malevolent conversations about me that almost certainly weren’t happening.
A few days later getting wheeled through the ED at the Royal to the waiting ambulance that took me to
Having said that, there was apparently a hell of a clinical effect, hence the day and a half intubation, and the prognosis was at times fairly poor. Sarah sat at my bedside for days at a time, those friends who knew wept, family members who don’t believe in God apparently prayed and made strange bargains.
But the Royal, to my everlasting embarrassment, are good at what they do. And I awoke and found me here on the cold hill side. Barely able to talk or walk, still occasionally confused, enraged and embarrassed and stupidly and inconveniently alive. With no real plan on what to do next, where to go, how to get there.
No direction home, as the man said, like a rolling stone.
And here I will be staying “for weeks” Dr Tesla has said.
Well. There is a third act to this, and although it is way past lights out I have to write it. It’s hard to write, especially since some of it is stuff I know but do not yet feel. But here goes:
From what I understand, lots of people attempt suicide every day. Many, many try (many even with considerable knowledge of what to take, how much, etc.). Many attempt, with varying degrees of conviction, some “succeed”. But the weird thing I have seen, even at this early stage, is that by failing where I thought to succeed I have in fact succeeded rather than failed*.
I can see intermittently – and you’re going to have to take my word for it - that suicide would have been a failure, not a success. That there was not “no way out”, there were several. That I was not a disappointment to everyone I loved, but I was instead loved most by those I had most recently disappointed but who loved me anyway.
Other times, of course, I plan how next time I won’t be so fucking inept. Hence the prognosis of “weeks” in
Anyway. According to a friend of mine, suicide is an option, but it is the last option, and you don’t get to the last option until you’ve gone through the fifty billion trillion other options. Life sucks? Try moving to
I sometimes believe now, even if I do not yet feel, that the feelings will return.
And lastly never, seriously never, trust any decision you make in the grips of a mood disorder. The last week or so have shown me just how fucked up my thinking got – the malicious nurses, the imps that danced across my bed, the things that crawled across the floor towards me but never quite got there.
If you have a mood disorder and you think that life sucks, Occam’s Razor suggests it may just be that instead of life sucking it is an episode of your mood disorder that is distorting your thinking. And don’t rely on yourself to diagnose a mood disorder in yourself, because you’ll suck at it when you do it because you’ll be having an episode of your mood disorder and it will be distorting your thinking.
One thing I feel is important to get out of this is that depressed people don’t see things as they really are. I thought I would not be missed, for example, and that has been shown not to be the case. Depression distorts your ability to collect data, to deal with it, to make a prognosis and a diagnosis. I suspect that Dr Greene, the best emergency doctor I knew, maybe didn’t know that. I know I lost track of it for a while.
Anyway. I can’t say what I am trying to say here in the right way, but that is partly because my frontal lobes are still simmering in the eleven secret herbs and spices that the Royal and
Thanks for listening,
*These are great drugs.