Sugar

You could smell Mr Tossel when you opened the waiting room door. He had that slightly plastic wet paint smell, and if that wasn't enough for you there were the freckles of paint in his hair, paint punctuating his overalls and spattered on his boots. He lumbered into the room like an ox.
"Can we make this quick?" he said. "I've left the dick-brained apprentice in charge."

I'd scanned the file on the way up to the waiting room. "Should be okay," I said. "No big changes?"

"Same old, same old," he said. Mr Tossel had been with the programme for fifteen years. Fifteen years of picking up his dose from the chemist three times a week, three monthly doctor appointments, no heroin since the late nineties.

"Still on one hundred and fifty?" I said. That's a big dose. The pharmacist doles it out into a paper cup as a sticky red syrup, dilutes it with water. Still, methadone rots your teeth (it's not the sugar, it's the decreased salivation, happens with all opiates), and Hep C does too (an autoimmune effect on the same salivary glands), and he was lucky to have the teeth he had.

He nodded.

"No heroin?"

"Not since last time."

"Speed?"

His face curled. "Nope. I can't stand the way it makes you smell. That metallic sweaty smell." He thought. "Plus it turns you into a fucking psycho."

"True enough. How's things otherwise?"

"All the same. All the same as it always has been."

I stopped writing for a moment, looked up at him. "You must get bloody sick of coming in to see us."

He grinned. "You must get sick of seeing me."

"Nope, you're paying my mortgage, mate."

"Things are going good. I've even started to cut down on the sugar."

There's no real place on the methadone assessment form for a dietary history, even though a fair proportion of our clients are clinically malnourished (if you know someone who is taking speed or ice, get them to take multivitamins - mainly B and C). "The sugar?"

"Two kilo bag lasts me... " he paused as if calculating. "Seven days, now."

I nodded. "That's a lot."

"I reckon it is," he said. "Thing is, I can't stop it. I just love the sugary drinks. Even at night. Every night I make myself a milkshake, put it near my bed. I get three litres of milk - meant to be good for the teeth, they say - three litres of milk, twenty five spoons of sugar, fourteen spoons of vanilla essence and two eggs. I mix it all up and drink it at night when I get up."

"You get up often?"

"I'm always up," he said. "Ten times a night I'm up. Pissing and pissing. Like there's no tomorrow."

"You get thirsty?"

"Christ yeah. During the day - five, six litres of that Sunnyup stuff."

Sunnyup is a particularly lurid local brand of soft drink, produced in nine different fluorescent colours and radioactive flavours, currently available without prescription but hopefully soon to become Schedule Nine drugs alongside pharmaceutical heroin and magic mushrooms.

"You tired?"

"Last few years, pretty much all the time," he admitted.

I stared at him. I could almost imagine the sugar in his blood - damaging eyes, kidneys, veins. "Have you ever been tested for diabetes?"

"Came back clear," he said.

"How many years ago?"

"Ten - maybe twelve."

I looked around the room. We don't have a glucometer, or an ophthalmoscope, or much of anything in the rooms. Like a lot of doctors who lack confidence, I try to always get some independent verification, some number I can point to and say, "Look, that proves it" - even though I know the story in this case is more than sufficient. A story without blood test results, for example, is a useful starting point, something that can help people. A list of numbers without a story attached are only useful as academic exercises.

"I think you have diabetes," I said. "I'm not certain. But I'm pretty sure. Go from here to your local doctor's. Actually, I'll ring, make you an appointment. First thing in the morning - without one of those drinks, if you can - go get this blood test."

I hate GP kind of work, sending sick people whose diagnosis you don't know and whose treatment you haven't even started out into the wild world. Part of me thinks "But who will look after them?"

Anyhow, we had a talk about diabetes - he knew a bit about it, his mum and his brother had it - about how it could be controlled, and how if he didn't control it he'd be leaving the dick-brained apprentice in charge of more and more stuff.

"If you want to keep working," I said to him, "go to the doctor Friday."

He nodded.

After he left I turned the air conditioner on - I love the smell of paint and grease and chemicals, anything that suggests hard work and industry, but I know some of my clients are sensitive souls. And all that day and a lot of tonight - despite what that "Keeping Doctors Alive" booklet says - I have been worrying about Mr Tossel, and thinking about what the future holds, and how it may not be that good. And thinking about our role in this, about methadone's role in stuffing up every single endocrine system your body sends out, stacking on the fat, maybe predisposing him to what he has now. Wondering if anyone told him fifteen years ago, wondering why no-one saw this before now.

And also, part of me wondering at it all, turning the paradoxes over in my head. Someone like him, big, strong, calloused hands, skin like armour - his blood sweet like rosewater syrup. Strong enough to work twelve hour days in cramped rooms in the Australian summer - but not liking speed because of the way it made him smell. Someone with shoulders and skills like his having to lie in bed of a morning, leaving things to a skinny, dick-brained apprentice.

Anyhow. Work tomorrow. Shall post replies to comments soon.

Thanks for listening,
John