Welcome back, Tiger - now piss off.

Hail,

The following contains sexual references.

And here is a link to one of the better medical essays I have read this year - something called "The Itch" by Atul Gawande. He's a damn fine writer, and this is an intrinsically fascinating subject. If you remain silent after reading the sentence that concludes the tenth paragraph, you're dead.

And by the way - it's about itching. A fair proportion of people get itchy reading about itchiness. I just had to stop typing this - and again - to scratch an itch: I get itchy writing about itching. Itching may be one of the few conditions that can be transmitted over the internet, that you can actually contract from someone electronically. Your ISP is a fomite.

What else has been going on? I broke up a marriage the other day.

Now, this will obviously come as no surprise to those of you who know me personally. Chubby, balding, middle-aged man with history of mental illness and interest in superhero comics - doesn't it just scream "marriage-wrecker"? You can tell by the way I use my walk, that kind of thing. But this actually happened. And the following is transcribed as accurately as I can remember it while preserving patient confidentiality - I have not altered it a whit, not a jot.

Maybe a tittle, a little tittle, but that's all*.

Anyhow, back to the marriage stuff. My last patient yesterday was one of my most likeable - a smiling, pink-faced, soft-featured Italian man who had adapted cheerfully to every impediment life had thrown at him. I smiled when I saw his name on the patient list and went out into the waiting room.

"Mr Barbapapa?"

He leapt up and rolled towards me, and extended a pink hand like a pseudopod. We sat down.

"So, how's things?"

"Brilliant. Abso-freaking-lutely brilliant.**"

"That's good..."

"Never better"

"Good to hear it. Now - "

"Yep, moved out, getting a divorce."

"What??" I yelped.

"Yep, all organised."

I was surprised because all through Mr Barbapapa's notes were references to his domestic situation, and in particular the stress that methadone had placed on his sex life. Methadone supresses testosterone secretion, which causes osteoporosis, loss of muscle mass, occasionally depression - as well as depressed libido and erectile disfunction. Mr Barbapapa had not lost his libido, he desperately missed what methadone had taken from him, but he had been unable to have an erection for three years***. To a man in his late twenties, this was a very significant thing.

I had done what I could. We had tried dropping the dose, but it was a difficult thing. Methadone withdrawal knocks you about, and he had a responsible job, a lot of physical labour. We had done the appropriate blood tests, and I had arranged the endocrinologist referral so we could prescribe him supplementary testosterone. And the last visit I had given him a few samples of sildenafil, which is Viagra.

"Try this" I said. And I'd told him that what was going on was a medication thing, tried to do what I could for his confidence, and sent him away.

And here he was. "Yep, it was that viagra stuff you gave me, really sorted stuff out."

I stared. "How?""

"Well, it was a long time coming. I told you - we'd been pretty much just living in the same house for the last three years. So I came home with the tablets and I showed her."

"What'd she say?"

"She laughed." For a moment his face fell. "Said it was a waste of time. She said 'It's not the tablets, you freakin'clown, it's you - you're an arsehole. I've been rooting the guy from the Seafood Shop'."

I stared. "Jesus."

"Yeah, that place on Main South Road, down near the Cashies."

"God."

"Yeah. Did you see what those thieving bastards charge for hake? There's no way -" He seemed to refocus. "Anyway - really got things out in the open, it did. Cleared the air. I don't think we'd really been communicating before that."

"And now you are."I managed.

"You can say that again. Anyway, moved out. And she doesn't want custody, so I've got Adam, which is pretty much the only thing that matters. He's four this week. And I got a new job - like close on double the pay, week on week off, flying out to the mines. And I met this woman - she's a librarian, bloody gorgeous, smart, really nice blonde piece. And we've been going at it hammer and tongs."

He reached into his wallet to show me a photo - I declined.

"Anyway, I want to start coming down off the 'done. Reckon it's time. It's the best thing that's ever happened to me. And it's all down to you and that blood y viagra. Wonder drug, it is."

"Right" I said.

We finished the interview, and he stood up to go. Before he did he reached out and shook my hand. "Gotta thank you again, doc."

"No worries" I said.

"Yep, this Viagra - really helped me out."

Anyhow, off to heal the sick.
Thanks for listening,
John

*At the moment I am talking to people like this, too - frequent digressions, lots of rapid-fire witticisms which only I find amusing, leaping from idea to idea. And I am finding it difficult to sleep, and I have a fair amount of energy, and, most damningly, I feel Fremantle has a chance this week against Geelong in the football. I am compliant with medications and seeing Dr Tesla soon.

** The technical name for this is tmesis, from the Greek temno, meaning "I cut". Actually, it's more accurately an expletive infixation. Now we can all sleep at night.

*** In his defence, not many people can have an erection for three years.