Special needs

Hail,
Long time no write again, and a lot to write about. I’ve been wanting to write, but tied up by a combination of other stuff going on, embarrassment at returning after so long (work that out) and weirdly, too much going on to blog about.

So, insert the usual groveling (and sincere) apology here and read on.

I have formally given up emergency medicine and started psychiatry training. It’s an unusual move, sortof like switching from amateur shot-put to competitive needle-point, but it has surprised very few people, and already I get the feeling that after a few months of psych I will be more comfortable and competent than I was after a four years of fairly hard-core emergency medicine training.

Having said that, the first few months anywhere are a bit tumultuous, and since the mood is actually quite a bit down – no need to panic, I am a long way from the events of a New Year’s, almost a year and a season ago – I am finding things a bit trying. Partly, this is due to the usual process I go through every time I start at a new workplace, where I inform my immediate clinical supervisor about the bipolar.

There’s a few reasons for this, and I suspect it’s the most responsible thing to do, but it’s not pleasant. However, I’ve done it a number of times and by now I have arrived at a fairly practiced two minute performance piece which gets the necessary information across but and keeps the self-disclosure down to a minimum.

Usually my monologue takes the form of ten seconds of what I have, ninety seconds about how well controlled it is, how I see my psychiatrist regularly, how I am compliant with my medications, how I have never in my or anyone else’s opinion made a poor clinical decision due to my illness and how I do not see my job as part of some therapeutic process for myself, and how I am not going to be charging down the corridor shrieking about the Freemasons.

Choruses of owl-headed people, maybe, Freemasons, no.

Anyhow – three paragraphs of reassurance and then I whip out a folder and say “And while we’re here, Mr Smith’s psychosis is worsening/potassium is eight point eight /arterial blood is coating the floor of cubicle three” (for psych/ICU/ED rotations respectively). This brings the conversation to a close.

The reason I seek to exercise so much control over this conversation is it has gone badly in the past.

One of my consultants in the ICU reassured me that I was not the first bipolar doctor they had worked with - “Not at all” he said. “In fact, I graduated with someone, class of eighty eight, Sydney, very smart chap. Everybody liked him. His wife and kids were devastated, you know, afterwards. Of course, looking back, there were signs…”.

Others tell me the about those they worked with who stole the cancer patient’s morphine, or who missed cancer after cancer as the cognitive impairment set in, or ended up shackled to the bed after a particularly difficult night shift, or had a complete nervous breakdown, ran off with a girl thirty years his junior, never worked again.

The depressing thing is I believe that these people were honestly trying to reassure me.

The same cannot be said, however, of Dr Broil, my obstetrics/gynae supervisor in third year. I don’t know if I’ve told you this before, if so, feel free to compare this version critically with the last one and see what a liar I am. But the way I remember it now, Dr Broil was my supervisor for a good part of third year. Third year was pretty much the year I was diagnosed with bipolar, but long before I got the right dose of medications, and a year I was sick for some time.

Afterwards, although I hadn’t been sick during Dr Broil’s rotation, I was advised to go see her and disclose “the whole illness thing”. I did so, and she stared at me for a moment.

“Well, that’s terrible” she said.

I nodded. There didn’t seem to be any arguing against that – and anyway, she was the consultant and the year supervisor, I was the medical student.

“But wasn’t there any screening process?” she said.

“Sceening?” I said.

“Yes, you know. When you got into medical school. To keep people out. Unsuitable people.”

I stared at her. There had been a screening process – there had been a full-day exam, and an hour-long interview, and an investigation of my academic performance over the last ten or so years. It had been a relatively rigorous process, excluding fifteen people for every one it let through, and I had passed.

“Not to be discriminatory or anything” she said. “But to identify people with special needs, needs the school couldn't be expected to supply”.

Needs for what? I had this sudden, clear image of some kind of "brain repolariser" set in the wall of the school, a socket into which I could plug my head to fix things. Well, that'd be nice...

“I sit on the board of St Crowley’s, my daughter’s private school – and we have to screen for people with special needs, like you. " She gazed at me with her bright blue eyes. "Spastics. And autistics, and dwarves.”

Another crystal clear mental image – I don’t know if this is a useful survival skill or what, the generation of detailed mental images under conditions of emotional stress, it’s not really up there with the fight or flight response, is it? - but this image was of four people, society’s flotsam and jetsam, those who had been rightfully ejected from a society that could not afford to coddle them and their "needs". The first was me. Next to me was a young man with rigid limbs – Dr Broil’s spastic. Beside him was a thin man staring into space – the autistic. At the end of the line was a dwarf.

For some reason we were all wearing jester’s motley. We were sitting on a park bench and drinking out of paper bags.

Anyhow, things went on. I passed third year (just) and fourth year, and I blundered on, keeping just under the radar, twisting and turning this way and that to avoid the screening process, and it’s been seven years and I haven’t killed anyone yet. People have died, but they’ve been people who were going to die when they came in, people who had something wrong with them, or people to whom some unforseeable and unpreventable event has happened.

And I have still not, in my or anyone else’s, opinion made a poor clinical decision due to my illness.

That screening process has some pretty big holes in it, apparently.

Anyway, bedtime. Tomorrow I observe electro-convulsive therapy, which should be… I don’t know.

Thanks for listening,
John