Three

Well,
Mrs Quintain did not do well. I came in and there was another patient in her bed, a white-haired man who kept cracking jokes, and when I checked on the computer there were no bloods, no Xrays from about three days ago. In the end, Dr White said, it was probably the pneumonia. She is gone and there is no record of her passing.

That is what death in the hospital is like - less and event than the absence of an event, less something that is noted and marked than something that ceases. For a brief half-hour there is a space and then another face, another sick person, another respirator patient.

. That is what happened with Burian, my friend who died in the Royal, earlier last year. I woke and there were messages on my phone, I rang and got put through to admissions and they said that the patient was unknown, there was no-one of that name in the hospital.

A hospital now is a machine, like everything is a machine, and like all machines a hospital has structures and practices designed and constantly modified to maximise efficiency. The walls are white and each room is identical and there are no pictures and when someone dies the most efficient thing to do is to move them out and move the next one in.

I don't know. As you can probably tell from the tone of this, I am a bit low at the moment.

Part of this is no doubt situational. A number of things have been going on lately. My patients keep dying, of course. The death rate in the ICU is one in five. I don't know what the death rate is in the Drug and Alcohol field, but it is high in a different way. Three of my drug and alcohol patients have died in the last three months - none from my medical care, and one not even in my medical care, but still, it's something that affects you.

And the last one in particular, a young Asian man, twenty six, whom we'd seen for a few days before Christmas when he tried to get off heroin. It didn't work, buprenorphine gives nothing like that slow opiate buzz, and he only turned up twice, in the dry months before Christmas. He went away, we rang a few times, then we closed the book and we never saw him again until the government pathology service asked us if we knew about the death a week ago.

I didn't, and I found his file, and there was his photo in the front sleeve - strong-jawed, pugnacious, dark eyed, looking straight into the camera and through me. As if he saw something in the distance, something real, something more substantial than mere flesh and blood.

Twenty six. That age it's either violence of some kind - stabbing, suicide, car crash - or it's heroin, and this was heroin.

It's rare, I think, at that age. I'm not sure, but I think most heroin deaths are thirties and forties. Anyhow, the coroner is not sure if she is going to look at this, and I have asked to be informed either way.

So, that hasn't been helping. That plus the deaths in ICU - not so much the matter of the deaths but the manner of them - and the study, and a few other things. We have a new boss at the ICU - a Dr Black, who will be sharing Dr White's load - and that means I had to sit him down and give him my practiced "I have bipolar" speech. I'm getting quite good at it now, have it down to a minute and a half, a carefully constructed monologue on how well supported and managed I am and how dangerous and incompetent I am not, and a carefully prepared clinical question to use to terminate the conversation:

Me: " - as a March hair. Stark, staring bonkers. Now, could you have a look at this blood gas for me?"

And on top of that - and this will seem trivial and whiney - but I am studying the psychoactive drugs this fortnight and the last few days I have been revising the antidepressants, including the tricyclics - the drugs I took when I overdosed - and reading about the management of overdose - and by extension, what would have happened to me.

Plus we had a tricyclic overdose in the ICU a few days ago, a pallid, obese, gelatinous woman, mouth distorted from the endotracheal tube, and all around her the rustlings of contempt, Dr Fang in his two hundred dollar shirt, the slim nurses moving briskly past the room.

It's odd, because I look back on some of that and there is no memeory. I remember sitting in the ED and I remember waking up and nothing in between. Dendritic protuberances were not formed, soemthing didn't happen in the medial temporal lobe, and you get another space, another absence where something should be.

Anyway. This means dragging myself to the gym - seriously, if an antidepressant did what exercise can do, in terms of efficacy and drug interactions and side effects, it'd slaughter every SSRI on the market - and keepng on taking the valproate and stuff and seeing Dr Tesla on Monday.

We shall see.

Anyway. Apologies for this morbid post, and count yourself lucky you weren't here for the much longer one I wrote and deleted, working title "The hopeless hopelessitude of life". Off to Dr Tesla.

Thaks for listening,
John