Sunday, February 24, 2008

Special needs

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,


Anonymous Milo said...

Dear BJ, your post brought me down to tears... It so much reminded me of myself nearly 10 years ago, second year physiotherapy and just diagnosed with paranoid schizophrenia. Of course, I am not there anymore as the "cognitive impairment" started to set in... I did let the supervisors know but... I think you can figure out the rest. yeah... sorry it is way too emotional to talk about. Good luck for tomorrow, or today rather. shit i better get some sleep... got a lecture at 10 o'clock this morning.

3:40 AM  
Anonymous Milo said...

Sorry it's me again John. I really think i should add this too.. after i got kicked out, I think now days that particular department has employed a really good retard/spastic detection and elimination system! Just to make sure people like me are never sieved through ever again.

4:11 AM  
Blogger Ladyk73 said...

It is nice to see your posting again! I love your stories.

As one who has just been diagnosed with bipolar, I struggle with this stigma as well. To tell or not to tell. I told one of my profs, and it was a big mistake. He implied that I needed a scarlet letter and openly discussed his obligation to report these "findings."

I did tell my field educator. I felt like I had to, as one of out new intakes was someone who knows me as a "peer." It has been good that I have told my field educator in many ways, but sometimes not.

In my training, I am often asked "how I felt" about things. I always struggled with those inquires, before I was "out."

I do think it is important to reveal my disease to supervisors, if I am going to work in a clinical manner. But it is an awful situation.

The irony is the ob-gyn appears more impaired to me. Oh...but being a thoughtless &%$#& is okay!

6:25 AM  
Blogger Benedict 16th said...

Nice to see you post again, I have missed you.
Now lets see, filter out all the doctors with bipolar disorder, hmmmm that should cut down on the raging excess number of medical graduates out there....

I can think of 7 doctors I KNOW are bipolar, and about 100 others I have very strong suspicions of. I suspect those medicos that protest the loudest, are like the closet homosexuals who deny their sexuality and manifest their ambiguities by going out for a bit of poofter-bashing and the like.


10:21 PM  
Anonymous foilwoman said...

Hey, bipolar and depression don't concern me too much, as long as you (and I) have our psychopharmacologist on speed-dial. It's the raving psychotics abd the narcissistic personal disorder types who've made my life a living hell. Also, as the former girlfriend of a bipolar guy (back in the 80s), I can say: we had a better time, bar none, than anyone else on the planet when he was turning manic. Got a bit scary after that, but some of my memories from that fleeting romance have probably skewed the orientation of my brain and emotions regarding romance and excitement. No one else ever even came close. He's an architect now. He's gotten awards for some of his truly manic inspirations.

If I ever travel to Oz, can His Eminence, Benny, point out Dr. Broil to me, and I can set DestrutoGirl and TigerGrrl on her in a dark alley with bad tummy bugs, and see whether she survives? Please?

3:01 AM  
Blogger Bronze John said...

Hail Milo,
SOrry to take so long to reply to comments, and sorry to hear that similar things happened to you. The weird thing is when I started writing about the events of - bloody hell, more than five years ago now - it took me a while to realise that I was still angry about it. Not the throw things around the room angry, but the delayed, coals-under-the-ash angry that means that five years later it still hurts. And like I said - no-one has died, and doctors whom Dr Broil would have said were less spastic or autistic or dwarvish than me have made mistakes that I have not made. Not that I'm good, but like the old joke says, if you can't be good, be careful.

Thanks, anyway.


11:00 PM  
Blogger Bronze John said...

Hail Ladyk73,
Thanks for the kind words, and commiseration on the diagnosis. I hope you've got someone good looking after you. And it's a pity to hear about the reactions you've received.

I did have one case where a young man died in the ICU and the consultant asked the other registrars what they thought should have been done differently and then turned to me and asked about how I felt emotionally about what had happened, and I said I felt emotionally that we should have tried ECMO earlier when his pCO2 was still handleable. ECMO stands for extracorporeal membrane oxygen thingy, and it was basically what almost saved the guy, but I think the point I was trying to make was that I wasn't at work to deal with my feelings, I was there to get the job done.

Anyway, good luck.

11:10 PM  
Blogger Bronze John said...

Haqil Foil!
Thanks for that, and for all your comments. And you've reminded me of something very pleasureable from my past.

It seems, oddly enough, that revenge on Dr Broil is no longer necessary. In fourth year I was revising for paeds and I found an old made-by-the-hospital DVD on how to do some paediatric physical examination thing or other. It said it starred Dr Broil, and she was marking the exam, so I thought "This'll do" and took it home.

It was filmed in the late seventies and it featured twenty increasingly distressed minutes of Dr Broil, wearing the most ludicrous outfit I have ever seen on a paediatrician, (some kind of pill-box hat with a little veil thing in leopard spots and a wrap-around skirt-dress-toga thing with matching elbow gloves (also in leopard spots)), and examining a squalling, spitting child with growing dismay.

From what I later found out, Dr Broil had come dressed up because she was going to be on video and then had been asked to examine a child for the benefit of future generations of medical students, while someone filmed it.

I remember starting the DVD, staring, hitting the pause button, and going out to get Sarah in hushed tones and begging her to look at this. I will swear on a stack of seventies Siver Surfer comics that I am not making any of this up. A deeply cathartic experience.

But thanks for the offer.


11:21 PM  
Anonymous said...

Holy hell. THat's why I never, ever disclose. But I'm glad I found your blog.

11:37 PM  

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