Two strange things

Hail,
And as the title suggests....

Strange Event the first:

I was going through the patient notes for one of our patieints and I found an old urine drug screen result from the prisons medical service. I reproduce it below in its entirety:

11/10/04
Forensic Urine Drug Screen Analysis:
Methadone.
Buprenorphine
Benzodiazepine.
Methamphetamine.
Cocaine.

Comment: Mr Smith denied any extraneous drug use, claimed "only taking some medications to help with drug withdrawal that Doctor Bronze gave me".

No wonder there's a drug problem up here, it's all down to me and the medications I dole out - "Yeah, coming down off amphetamines can be hard - here, take the edge off it with some coke."

The thing is, I went to a friend's birthday party the other day and he only got some videos. Where are my priorities?

Strange Event the Second:

I’ve been asking the nurses to ring patients on the morning of their appointments to remind them to come in, and this morning Briony (nurse) rang Steve (methadone client). Steve sounded intoxicated.

"Steve – don’t forget about your appointment today" she said.

"My what?"

"Your appointment"

"Why? With who?"

"Drug and Alcohol Services. You know, you’ve been coming here for years?"

"The fuck? Where’s that?"

"Mordor. Like always."

"Jesus. What's the address again?"

Anyway, she manages to get the information across and at ten thirty Steve turns up. Only it’s not Old Steve (Steve the Old-School Smackfiend, hairy and belligerent) who’s been causing us hassle for thirteen years, it’s another guy. New Steve. Bald and confused. Big methamphetamine problem.

Yes, two people, selected from the area almost at random, are both called Steve, and both have out-of-control injecting drug habits. It seems we’d called the wrong number - transposed a few digits - and thus called the wrong Steve. New Steve said he reckoned his family had dobbed him in to it. No wonder he didn’t know anything about us. Old Steve, who had been described by our nurse as "evidently severely intoxicated" that morning, has yet to appear.

Thanks for listening,
John

Shiny, shiny

Well, good times have come to me now*.

Seriously. Ten days to go to the exam and I feel pretty damn good. Remarkably relaxed, in fact. Remarkably, remarkably relaxed.
Why is this so?

Not entirely sure. It's not the less sleep, boundless optimism, "my wings are like a shield of steel" kind of stuff. It's more something intellectual. It's almost like I have constructed a win-win situation out of this exam.

See, whatever I do, in a fortnight the exam will be over. I will either have passed or failed. If I pass, well and good.

If I fail, I can quit shift-work.

I can earn more.

If I quit I can get a normal job and see Sarah every evening. I can work less.

I can write. All that stuff I promised myself.

I can read. I can finally go into "the room with the books" and pick one of the one or two thousand books - seriously, two deep in the four big bookcases, another massive bookcase in the hall, an unstable ziggurat of novels and anthologies stacked by the bed, and that many again in cartons in the shed - I can read.

I can travel. I am going to go to Asia, I can wander through Europe, I can see New York. I am going to pick people out from these remarkable spots on the map and visit them.

And the career - which if I don't pass the exam will probably end up being Drugs and Alcohol or GP - it won't be that bad. The patients who terrify most GPs - the unexpected emergency, the "psych" and the "druggie" - those are actually my favourite patients.

And I can go back to the gym. Learn a hobby, fencing or hawking or bee-wrestling or something.

If I pass, of course, that'll be okay, too. And even if I don't, it's not certain. I could always try again in six months, although at the moment the thought of that makes me sick.

Anyway. I don't know. The last few years have been rather event-filled, things are calmer now. Behind every time I decided to study or do shift-work or whatever there was an element of delayed gratification and an element of self-loathing if not self-doubt and an element of fear - I'm not explaining this right - and a lot of those feelings are less strong now.

By the way - have a look at Doonesbury for today (27/8/07). There's a phrase in there and a moment of clarity that will just stop you dead. Greatest living American short story writer.

Thanks for listening,
John

*I went to a friend's part and there was a big screen up playing stuff like this, and now it's stuck in my head. Not my fault.

Paradise

...but I had to post this.

This was in Harpers this month. It's a poem by a woman called Ina Rousseau, first published in 1954, translated recently by Coetzee, whose copyright I am doubtless infringing.

Somewhere in Eden, after all this time,
does there still stand, abandoned, like
a ruined city, gates sealed with grisly nails,
the luckless garden?

Is sultry day still followed there
by sultry dusk, sultry night,
where on the branches sallow and purple
the fruit hangs rotting?

Is there still, underground,
spreading like lace among the rocks
a network of unexploited lodes,
onyx and gold?

Through the lush greenery
their wash echoing afar
do there still flow the four glassy streams
of which no mortal drinks?

Somewhere in Eden, after all this time,
does there still stand, like a city in ruins,
forsaken, doomed to slow decay,
the failed garden?


Good Lord. Does anyone know why I can't find anything else in English by this woman on the net? Even a fleeting reference to a book printed fifty years ago? Does anyone know of a translation of any of her stuff?

See, times like this I really regret being monolingual.


John

Hiatus

Hail,
I might have to put this blog on hold until the exam, which is 3rd - 5th of September. Slightly over two weeks. That sound you can hear in the background is my adrenal glands spasming.

Thanks, and see you in a fortnight,
John

And I'll try to put one of those RSS things on it, too. Hope everyone else's three weeks goes well.

Seventeen things I'm going to do after this bloody exam

1. Watch Black Sheep, a horror movie about killer sheep from New Zealand. Tagline "The Violence of the Lambs".

2. Watch the DVD I have bought of my football team's most recent win, while sitting nude in a bathtub of red, green, purple and white... jewels and things and laughing as I trickle them over my head. Maybe pausing occasionally to read aloud from the article published in the newspaper where one of their quislings trash-talked us and told us to expect a brutal physical assault, and then watching the DVD again, which shows how right he was - except for the whole "who assaults, who is the assaultee" thing.

3. Go back to the gym. I dropped an apple the other day and rather than falling to the ground, it slowly revolved around me.

4. Watch some of those Shakespeare Retold things I've got.

5. Go to Thailand and Vietnam. I don't care if I have to paddle there on an inflatable rubber seahorse, I'm going. As an aside - from what I read, the Vietnamese have defeated (at various times) the Chinese, the French and the Americans. That means three out of the five members of the security council. Plus great martial arts, brilliant food, and a few thousand years of history each. And other great stuff.

6. Go down to Innsmouth and lie in the water until I am as pale and wrinkly as one of those brain-people from a fifties sf magazine cover. Hopefully don't get shot by Terran space-captains as I emerge.

7. Plan next year's trip to maybe the US and Europe and everywhere.

8. Feed the goats - pictures to appear on Sarah's blog soon. Sarah has bought them special goat food - it is labelled "High Performance". Which is good, because up till now they have been really underperforming. All they do is gambol and frisk and eat. I expect big changes.

9. Eat squid on the beach.

10. See friends I love.

11. Re-read the early Superman stories, the ones where he was a lefty who tried to rehabilitate juvenile offenders and tore down slums so that decent housing could be built.

12. Hit the punching bag again.

13. Write. I have three novels and twenty short stories somewhere up in my head to finish and get down on paper.

14. Sit and talk to my father. Reread Night.

15. Publish some stuff. I don't care if it's in a cookbook or a superhero comic. Something.

16. Give most of my books to the prisons. I have well over three thousand books in my house, most unread. If I read a book every week I will have to live to some bizarre age in order to read them all. What I am going to do instead is get rid of most of them and buy and read some new ones. Suggestions welcome.

17. Go back to the town I grew up in, the Goldfields, Kalgoorlie, Coolgardie, Boulder. I have this idea of travelling by a combination of bus and hired car to where I was born, on the Greenstone belt, the oldest rock in the world. When you stretch your hand up the sky is dense and hard and clear, and you can feel the earth as porous as a lung beneath your feet. Old mining towns and deserted farms, standing on the old earth, all honeycombed with empty mineshafts and dry wells.

See, if I went there now, the air would be too hot to breathe and the light too bright to see with. I've been inside, been pale too long. I'd have to travel slowly, to adjust.

Seriously, I don't know about this study thing. From one point of view I can't really lose. If I attempt the exam and fail - as I well might - it will be easier next time, and I have learnt stuff. If I attempt it and pass, no complaints there. Either way...

The thing is, I don't know that anyone is really expecting me to pass - there has been no real training programme at Florey this year, and I have been doing this pretty much alone, with no-one to bounce ideas off, practice vivas with, etc. That sounds like whining, but it isn't anyone's fault, just a statistical fluke - there are nine other registrars and all of them are studying the other half of the exam. Plus, I am studying while working in another relatively brain-draining field, plus there's the events of December and the fact it took me a few months to get over that.

Plus I know all of this "it's okay if I fail" stuff could be seen as saying something about my own lack of emotional investment in the training programme, or my own self-image, etc. but really, I'm just so sick of study I want the entire thing to be over, one way or another.

I got another job offer the other day. They come from all parts of Australia - this one was from Alice Springs. It had the usual shots of rugged gorges and beautiful rivers, but also a few shots of venomous snakes and gigantic crocodilians, interspersed with spectacular xrays. The text deviates somewhat from the standard "Come to the Alice" tourist guide, too - it dwells enticingly on the high incidence of stabbings and spear-wounds, and the chance to encounter rare and difficult-to-find diseases such as leprosy, Norwegian scabies and donovanosis.

Anyway. Not yet. I had a brief drunken discussion with my eldest son the other day and the topic of Intelligent Design came up, and I pointed out that not only are some of the most important tissues in the body the worst at healing (how come your hair grows back but your heart doesn't?) but also that there was an appaling lack of forethought around the whole reproductive area. Pain normally serves to tell you that something is wrong - how does that explain period pain, or childbirth pain? And why haven't I got little ribs around my testicles?

Then I reiterated my belief that the absence of a trunk was a major design flaw. Nothing elephantine, just something slim and nimble that you could use to feed yourself, brush your teeth or hair, that kind of thing.

Shortly after that he left.

Anyway.

Thanks for listening,
John

Coda

Hail,
A brief post here, in between reading about the barbiturates and coming up with new excuses not to read about the barbiturates. And herein an update on the ICU.

When first we spoke of this there were five patients in the ICU who were horribly unwell. Then there were four, now there are two.

Mr Ayre, as stated, left us. He made a brief return one night when I was not there, but we did the same as we did last time (mask on face, antibiotics) and the same thing happened (he became well enough to return to the ward). Mr Ayre's situtation is that he is now in end-stage airways disease, and in the end stages of respiratory disease the intervals between hospitalisations become increasingly short. He moves from the ICU to the general ward to the ICU, home becoming more and more remote. He may not get home again.

Mrs Burns is almost well enough to go to the ward. She is the large, inoffensive woman who had the colonoscopy. The repirator kept her breathing, the chemicals prevented most of the kidney damage, she had four days without surgery recently. Her husband has not left her side.

Mr Wood died. You could almost feel the anger leave the room. It was three in the morning, Dr Fang was downstairs helping with a resus, he died quietly and quickly. His son had apparently been holding out for a miracle, without wishing to sound horribly twee I feel he got one.

Erica Stone has left "AMA", against medical advice, having stayed in hospital for eight days. She was prevented from leaving with the IV line in situ, and arrangements have been made for her to continue the antibiotics for her heart infection, but she is gone.

And Mr Mettle died. He was - and this may not be politic - the one whom we had tried hardest to save. Every ICU consultant, the infectious diseases people, Professor Veoli from the respiratory unit had been there, seen him, clustered around the bed or held hushed conferences in the corridor. Turning up or down the oxygen, adjusting the pressures of air going in and out, thinking of another antibiotic we hadn't tried yet... everything.

But still, there are laws of hysiology, not as clearcut as the laws of physics but in this case as irrevocable. His lung compliance - a measure of how easily your lung inflates, the more easily the better - was the lowest Dr White has ever seen. His white cell count - the white cells are the cells your body releases to fight infection - was so high* people asked about leukaemia. He'd spent a fortnight on adrenaline and noradrenaline, he was starting to get the profound muscle weakness that people who don't move in the ICU get.

I don't know. It seems stupid. You look around you and you see what we've got - magnetic resonance imaging and monoclonal antibodies and artificial kidneys - and you think how come pneumonia still beats us.

Sorry, I don't know how to put that. But it's not cancer, or some horrible AIDS associated phenomenon. It was pneumonia in a vigorously strong young man, who probably didn't go to the doctor from one decade to the next. And we couldn't stop it, and we couldn't slow it, and we never even found out what it was - blood cultures, lung cultures, everything came up clean.

Anyway. Back to the brainstem.
Thanks for listening,
John

*Seventy two. Our lab says normal is four to eleven point five.