Insulted

Hail,
Graphic medical, language and sexual stuff ahead warning.

A rather vexing session at the Drug and Alcohol Service today. I was SMO (senior medical officer) on, which is an administrative term for an enforcer. Basically on these days it is my job to help people negotiate the vast distance between what the patient wants and what we are going to give to him or her.

This is often difficult for all concerned, because on the one hand our clients are in need, in terrible need. I have seen acute opiate withdrawal, mostly in the prisons, and it is a truly horrible condition.

(Heroin withdrawal, by the way, is very unlikely to kill you. You might be one of those truly unlucky people who vomits and inhales your own vomit, which may well kill you, but aside from that it is a period - hours and hours - of aches and shivers and cramps and diarrhoea and misery and wishing you were going to die, but very little chance of death.

Alcohol withdrawal, on the other hand, can kill you. I believe withdrawal from the benzodiazepines (common sleeping tablets) has killed some people, but I'm not sure. Other forms of withdrawal, on the other hand, may actually help save lives).

So, our clients are in need, but we can't and don't give them what they need. Why is this? Well, methadone prescribing in this state is very tightly controlled. You have to turn up physically to get your dose and swallow it in front of the pharmacist. If you manage to get "take-away" doses they are limited. If, God forbid, you lose one of the take away doses - the dog eats it, say - you have to bring in a death certificate from the vet to even get a look in.

Anyhow. Client number one was a woman who presented wanting immediate admission to the ward for a five to ten day detox then an admission to one of the longer term facilities for a minimum of three months. Like everywhere else, there is a waiting list. I explained this to her and there was a lot of sobbing about how I was literally driving her to prostitution and we went through the various options (emergency accomodation, medications to help get her through some of the withdrawal, that kind of thing) and none of this was any help at all and that was that.

Number two was a man who had been caught diverting his dose. Diverting the dose means you don't swallow it, you take it outside and spit it out so you can inject it later on. We don't let people do this because they are more likely to die if they do it than if they don't. He had been caught on video, which was a first because for the last week or so when they went outside his girlfriend had been obscuring the video with her hand, and had had to have a restraining order issued against her by the pharmacist - it was all very complicated.

Anyhow, we told him we would not be prescribing him that particular medication any more, we would instead be prescribing him one that can't* be injected, and we discussed that. There was much shrieking and railing and threats - apparently the entire service is going to be closed down Monday, we will all lose our jobs, that kind of thing - and then he arced up.

We tried to explain things, but to no avail, and as a final paragraph, he explained how he was going to get us shut down. Rather than cause offence, I will translate some of the terms he used into more neutral phrases.

"I'll fucking have this place closed down" he shrieked. "You'll all be out on the street come Monday."

"You are free to appeal against the decision - " began our social worker.

"You don't reckon I can?" he screamed. "Listen boy, I've [engaged in more acts of oral intercourse with prominent political figures] than you ever will. I've [performed acts of the previously described nature] like you wouldn't believe. You'll all be out on the fucking street."

There was the briefest of silences, and I spoke again.

"Look, I can see you're angry. At the moment - "

"Don't fucking talk to me. I've [engaged in more acts of anal sexual intercourse] than you ever will. I've [been the recipient of said acts] from judges and politicians. This place'll be closed down. You'll be [performing acts of receptive intercourse for monetary payment]."

At this point neither the social worker nor myself knew what to say.

"Look -" began James. "All we -"

"I've [performed a truly remarkable act upon a political figure not usually known for that kind of thing]. How much [of this particular act] have you done? You better get to it because I'm going now to [perform said act upon a number of people] and get you all struck off."

He stalked towards the doorway, wheeeled and paused, one hand on the door. "You'll be sorry you tried to [perform yet another sexual act] upon me."

And that was that. I don't honestly know what was going on there, if underneath all that there was some kind of delusional something, if he was disinhibited, something to do with the frontal lobe... or if this was just how he expressed himself.

I'll leave clients three and four for another day. But no wonder voter disenfranchisement is so high. I've felt so disengaged from the political process this last decade or so because I've obviously not been going about it the right way.

Anyway. Will post soon.
John

*well, yes it can, but it's not as good