Posts tagged: drugs

A Big Decision

By , June 29, 2010 11:13 am

The woman looks at her son.  Then she looks at me, then across to her own mother, and then back at me.

“Oh,” she says finally, wringing her hands like she’s on a quiz show, “I really don’t know.  It’s such a big decision.”  I take a breath, quietly.  “I mean – you’re the doctor.  You tell me what to do.”

“Okay,” I say, “let’s go through it again.”  She nods in agreement.  “Jonah has enlarged lymph nodes in his neck, yes?”  I point across at Jonah, his neck as wide as a bullfrog.  He waves at me comically.

“Yes.”

“And he’s been treated with antibiotics for over a week, with no change.”

“There has been a change,” corrects Grandma.

“Okay, there’s been a little change,” I concede, “but not a lot?”

“Not a lot,” she agrees.

“Your GP sent you to the paediatrician for a second opinion.  He did some blood tests, a screen for glandular fever, and a blood count that came back looking perfect.

“Perfect?” Mums asks.

“The white cells were normal.  We look at these for signs of infection, and…for other nasty things.”

“Nasty things?”

“Like leukaemia,” I say, not wanting to get bogged again.

“Leukaemia?” Grandma pipes.

“Yes, one of the things we look for with this is leukaemia.  And there was no sign of leukaemia.”

“So it’s not cancer?” Mum asks.

“No,” I hear myself saying as a reflex.

“And it’s not an infection?”

“No, it probably is.”

“But you said that the blood test showed no infection?”

“The white cells were all normal…”

“…Which you said meant no infection.”

I pause for a moment, counting sheep.

“This blood test was done two weeks ago.  At that stage, his neutrophils were in the normal range.  I don’t know about today without a repeat test…”

“…If we agree to that test,” Grandma says, shaking her head.

“That’s right.”

“But you said that he looked fine, and that he wouldn’t need antibiotics?” Mum says.

“I said that if this a viral thing, then antibiotics wouldn’t make any difference.”

“And you think this is a viral thing?”  They say it together.

Looking at them, they’re like twins, except that one of them has been kept in a time capsule for twenty years.  Wrinkles aside, they are the same person –  same disposition, same head tilt, same cross-examination technique.

“It probably is.”

“Why?”  Again together.

“Because…”  I pause to gather my thoughts.  “Because he looks so well.  Because he’s never had a fever.  Because he has green snot coming out of his nostrils, and a slightly reddened throat.  And because if this was a bacterial lymphadenitis, he wouldn’t be able to turn his head, his glands would be hot and tender, and he’d be as sick as a dog.”

“But glandular fever is a virus?” says Grandma.

“Yes.”

“And it’s not that?” Mums chimes.

“Well, it may be.”

“But the test was negative.”  Grandma’s turn.  “I thought this was the one thing we did know.”

“The screen was negative, but it’s an imperfect test.  We’d need to do serology for a more accurate test.”

“Why can’t you people give a straight answer for anything?”

“Because unfortunately, medicine isn’t straight.”

They look at me like I’m mad.  Maybe I am.

Through all of this, Jonah has been watching, slightly amused.  I look directly at him and he grins widely, like he’s watching a spectator sport.  I get the feeling that I’m not the only male to get this kind of grilling.

“Oh, oh, I really don’t know about this,” Mum says, “I think I need to talk to Greg.”

“Sure, go for it,” I say.

“You know Greg?”  I look at her, confused.

“So he doesn’t have to be admitted?” Grandma asks, hijacking the conversation.

“You don’t have to do anything,” I say, slightly exasperated.  “It’s a free country.”

“It’s just that Greg is a naturopath, and I think he’d want to know if we were going to pump him full of antibiotics.”

There is a halt in proceedings.

“But he’s already getting antibiotics,” I say finally, confused.

“Yeah, he’s swallowing them,” Mums says, adjusting her woollen headscarf, “he’s not being pumped full of them!”

“Right,” I say, pretending to understand.  “I’ll let you guys talk to Greg, and then have a think.”

* * * * *

I head back in, fifteen minutes later.

“We’ve decided we want the blood test, but not the drip,” says Grandma.

“We want to go home after, and we want the paediatrician to follow us up if it’s not getting better.”

“And at that point, if it’s no better, he’ll come back for further investigation?” I ask, trying to clarify.

“We’re just trying to avoid the trauma.”

I find these people genuinely confusing.

“Which trauma?”

“Of staying in hospital.”

“Oh, that trauma,” I say, a little too candidly.

“It’s no laughing matter,” Grandma says shortly.

“No, fair enough,” I say.  “I guess…most people are worried about needles.  That’s the trauma people are usually scared of…”

“…Oh, we’re fine with that,” Mum says.  I look at Jonah, who does in fact, seem fine with that.  With everything, really.

“If we’re getting the blood tests, we often leave the drip in, in case anything else needs doing, so we don’t have to use another needle…”

“…We don’t want the drip.  We don’t want it to stay in…”

“Okay,” I say conceding.  “Let’s do the bloods, and a chest X-ray, and then we’ll see what they show.”

“And then we can go home?”

“And then you can go home.”  These people have a knack for getting me to say what they want to hear.  “But if things still aren’t improving in five days, you’ll come back in for the drip then?”

“Yep,” they say together.  “And Greg agrees, too,” says Mum.

“Great to have Greg on board,” I say.  “We’ll do the glandular fever test…”

“…I thought we did that one?” Grandma asks.

“Shut up Mum.”

“…And we’ll do one for CMV, and Cat scratch disease and a couple of other infections.”

“Sure.”

“And we’ll just get that chest X-ray as the last thing before you go, hey?”

“No problem.”

* * * * *

Jonah is a delight throughout the blood test.  He’s a special kind of kid.  A bubble of mucus plays at the edge of his nostril as he happily chats about his holidays, not even noticing as the needle goes in.  He then heads off to radiology, excited by a new adventure.  Even Grandma manages a smile, basking in the rays of this joyful child.

I’ve already printed their discharge letter by the time they return from Radiology.  I’m keen to get them out, happy for the paediatrician to sort this out another day, my own head throbbing from diplomacy.

“I’m back from getting my X-ray, Dr Mark!” Jonah yells on return.  I salute him, which he returns with a giggle of innocence that only goes with being eight years old.  His mother smiles, rubbing at his hair, knowing it won’t last forever.

I log into the computer to check the bloods.  The FBE is pristine.  The other tests sit there pending, not due to return till another day.

I minimise that screen, logging into the radiology program.  I punch in numbers, checking them against the name that pops up.  I click on it, and immediately pops up a black and white image.  A Rorschach ink blot.

My heart falls through the floor.   I feel sick.

I drop my head in my hands.

* * * * *

“Hey,” I say.

“Hey,” they all say together.

“Jinx!” Jonah shoots back, clapping his hands in delight.

“What is that?” I ask, pointing at the half-eaten chocolate bun, sitting on a plate beside Jonah.

“Dessert,” Grandma sighs.

“Leah and Trina,” I say, keeping my voice light, “can I just have a chat to you for a second?”

“Sure.”  They both rise and follow me.  “We’ll be back in a jiffy,” Mums says.  Jonah smiles, biting down on his treat.

They follow me into another room, another cubicle;  this one with a door.  There are three mismatched chairs laid out for interview: one covered in red vinyl, strings of cotton coming from it’s edges, one an anaemic green in hard plastic, and a third made of wood, designed for a toddler.  I’ve pre-arranged them so the two adult chairs face the baby one.

“You two take those ones,” I say, “I’ll take this one.”

“Are you sure?” they both ask.

“Quite sure,” I say.

We sit, the silence of the room suddenly very loud.  Those two seconds of deathly stillness sit in the pit of my stomach for a very long time.  Still now.

I take a breath, about to start.

“This doesn’t seem good,” Leah says, laughing nervously, looking across at her mother.

“It’s not,” I say.  Leah looks at me;  her head tilting and her brow knitting.  Trina looks up, mid-ruffling through her handbag.  I take another breath.  “When we did the X-ray, we saw a mass in Jonah’s chest.  Something that will be related to the lumps in his neck.”  They look at me, their eyes yet to register.  “We’ve seen a growth, sitting above his heart.”  I find myself touching my own chest, like I’m playing a piano chord on my chestbone.  “Right here.”

Leah lets out a little sigh, like a cough, like she’s just been winded.

“A growth?”  I see her eyes dancing, searching.  I say nothing, waiting for her to comprehend.  “What do you mean?”

I pause for a moment.  “We don’t know exactly, but I’ve been talking to the oncology team…”

“…Oh, Jesus,” Trina says.

“And we want to admit Jonah, so that we can investigate further.”  There is another silence.

“Is this cancer?” Leah asks.

I feel the acid in my mouth.  I can see my sadness reflected in her eyes.

“It could be.  We’re worried that this is lymphoma.”

Leah stands bolt upright, putting her hand to her forehead.

“No!  No!  No!” she barks, each word getting louder.  She walks around in a tight circle.  “Oh, Jesus.  Oh, Jesus, oh, Jesus,” she breathes.  She sits again, and then looks up.  “But it could be okay?  This might be nothing?”

“We really just need to bring him in to do some more tests,” I say.  “Maybe to get a bone marrow and a needle sample from the node.”

“This is not happening,” Trina says, as she dissolves into tears.  We all listen to her sobs for a while.

“How big is it?” Leah asks finally.

“About eight centimetres,” I say, measuring between my thumb and forefinger.  Trina continues to sob.  Leah is quiet and still.

“Who ordered the X-ray?” she asks.

“I did.”

“Thank you.”  I feel my own lip wavering, tears at the edge of my eyes.

“I’m sorry about before.  I really am.”

Leah moves forward, and takes me into a hug.  It leaves me totally thrown.

“It doesn’t matter,” she says, her voice now monotone.  “Nothing matters now.  All that worry about doing the right thing?  Thinking everything else is such a big decision?  It all just fades to bullshit, when this happens, doesn’t it?”

I frown, nodding.

“So he’ll need to come in now,” I say, eventually, quietly.

“Of course.  Of course,” she whispers.

She stands again, her hand returning to her head.  “I’m in a nightmare.  I’m in a fucking nightmare.  Somebody wake me up.  Please, somebody wake me up,” she groans.  “My poor boy.  My poor boy.  It couldn’t have happened to a better kid.”

I hear those words.  I think of Jonah, of his laughter, and his innocence, and I really hear those words.

I look back at Leah, a study in grief reaction.  In less than two minutes, I’ve seen her go through denial, anger, bargaining, and now depression.  She finally lifts her head and looks straight at me, her eyebrows folding at their edges.

“Why, Mark, why?”

I feel myself frown, trying to remain calm and professional.  But I can’t.

“I don’t know, Leah,” I say, finally, my voice cracking.  “I…I don’t know.”

Valium

By , May 11, 2010 3:57 pm

“Give her some Valium,” I say.

“Really?”

“Sure.”  I look up from my page, and across at the nurse.  She looks at me blankly, shifting awkwardly from side to side.

“What for?”

“It’s a really good muscle relaxant.  Great for muscle spasms.”  Her eyes widen.  “It’s okay in a fifteen year old.”

Eric nods his head beside me in consensus.  With this, the nurse walks away to complete the order.

“Thank you, Sir Eric,” I say.

“As you wish,” he replies, without looking up.

* * * * *

Fifteen minutes later, I walk into the cubicle.  The first thing I see is the red markings on the teenage girl’s face.  There are layers of skin peeling from her forehead, down her cheeks, and off her chin.  My heart leaps, as I compute, attempting to understand why triage had neglected to let me know that this child’s face had been through a cheese grater.

A mother stands at the girl’s side, holding her hand loosely.  The girl is otherwise dressed in sporting gear, her singlet top and limbs free.  There is blood down her arms too.  The only thing left unstained is the white blanket;  a temporary bandage over gaping war wounds.

“Lauren?”

The girl smiles broadly, her glazed eyes trying to open.  The kid is stoned.  If I’d been given Valium at fifteen, I probably wouldn’t have minded my face being torn off either.  “How are you?”

“Pretty relaxed now, I think,” says her smiling mother.  She pats at her hand as only a parent can.  She turns back and looks at me, as proud as a soccer mum.

I stare back down at the record, checking that I’m in the right cubicle.  Right hospital.  Right planet.  In my world, Mum’s don’t smile when their daughter’s faces have been torn off.

I take another step closer, and Lauren grins widely.  Another bit of her face falls free.

“Is that?”  I can’t help but touch the bit that fell.

“Don’t,” warns her Mum, slapping at my wrist.  I recoil like I’m four.  “It’ll stain, and then you’ll never get it off,” she coos, her best impression of a Stepford wife.

“Right, right,” I say, rubbing absently at the back of my hand, “I get it.  What’s the name of your school house?”

“Red House.”  Lauren rubs at her face, some more war paint falling.  Literally.  It isn’t blood all over her, it’s coloured zinc cream.  “Have I still got some on me?”

“Just a little bit.  You look like you’ve been through a mincer.”

“You silly sausage!” her Mum says.  With that, she lets out a little yelp, puling her hand to her mouth, like she’s broken a self-imposed bad-joke ban.

“Is the diazepam helping?” I ask.

“I think so,” Lauren says, her falling closed, “I can’t feel the spasm anymore.”

“Can’t feel anything anymore,” whispers her Mum.  The hand returns to its rightful spot.

“So what happened?”

“Well, I was finishing the race, the fifteen hundred metres.”  Lauren stops to take a breath.  And I was coming up the straight,” she continues, her arms starting to pump, “and I felt pain down my side, all down here…”  She touches her right loin, the only part not covered in red.  “The pain just kept building, and building and building.  Until I collapsed.”

“DNF,” says her Mum.

“Right,” I say.  They both stare at me.  “Which is code for?”

“Did not finish,” says Lauren, yawning slightly.

“Bummer.”

“Yeah, bummer.  But it’s all good now.”

“I’ll bet.”  She looks at me and giggles.  “Let’s have a look at your side.”

* * * * *

I lean Lauren forward.   “Tell me where it’s sore.”

“Yeah, right there,” she says.  I notice her singlet, a synthetic thing – probably made of recycled plastic bags.

“Fancy looking singlets they get you guys in these days, aren’t they?”

“Nah, that’s not from school, that’s indoor-cricket.”

“Right.”  I look across at Mum, still smiling proudly.

“So what time did this happen?”

“About one-thirty.  Just after high jump.”

“Right.  Was that your only other event?”  Both of them laugh.  I stand back, waiting.  For the gold.

“Ummm,” says Lauren, scratching her head and grinning.  More red flakes fall.  “No, there were others.”

“Go on.”  Lauren looks at her Mum, who smiles politely.  Like it’s shrink wrapped on.

“The one hundred, the two hundred, the four hundred.”  She stops and thinks for a moment.  “The high jump, the long jump, the eight hundred.”  She looks across at her Mum.

“The discus,” she continues.  They both think for a moment more.  I expect Mum to pull out a list.

“Shot put,” Lauren says.

“And then the fifteen hundred.”

They look at me, like it’s my turn.

“Is that it?”

“Well, then this happened, she couldn’t go on.”

“No, I guess not.”  They frown with disappointment.  “I’m joking.”   Their eyes light back up.  Even Lauren’s.  “I think we know how you got the muscle strain.”

“How?” says Lauren.  I look at her, and after a couple of seconds, she laughs.

“Have you been hydrating today?”

“Yeah.  I had an apple and some chips.”

“You had an apple and chips?”  I hear the disbelief in my voice, but I can’t help myself.  “Deep fried chips or crisps.  Chips?”  She nods.  “When did you have time for chips?

“Just before high jump.”

“And then you did the fifteen hundred metres.”

“Yep.”

“Doesn’t anyone else at your school do sports?

“Yeah.”

“Are you the only one in your house, then?”

“No,” she says, laughing, “I just like sports.”

“You like sports?  Really?”  She breaks into a full Valium-giggle.  “What else do you do?”

“Cricket, and footy umpiring.”

“She wants to play football with Melbourne Uni,” says her Mum, suddenly officious, “but we’ve said she’s got to leave it to umpiring at the moment.”  I look at this slight girl, swimming around in an oversized tank top, her wiry frame falling against the bed, flakes of red peeling off.

“You want to play footy against fully grown women at university?”  She nods.  “I mean, these aren’t just fully grown women.  These are the ones who like to play football.”

“You should see the size of some of them,” says her Mum.

“I really don’t want to.  I see the size of you.  You’re fifteen.  Why would you want to play against them?”

“I like sports,” she says plainly.

All I can do is nod.


* * * * *

I walk into the office, where Eric looks up.

“This girl had a muscle strain after running the one hundred, the two hundred, the four hundred, the eight hundred, the high jump, long jump, discus and shot put.  She did it during the fifteen hundred.”

“She strained a muscle?”

“Yep.”

“Geez, that’s bad luck.  Some people are just unlucky, aren’t they?”

“It was just after she had a steak and chips.”

He stands up, looking through the window and into her cubicle.

“How big is she?”

“Fifty kilos.”

“Shot put?”

“Yeah, she was born to do it.  And she wants to play footy against Melbourne Unis women’s side.”

“Jesus!” he says, “they’ll kill her!”  He sits back down.  “I played touch-footy against a mixed team that included some of those women.”   He shakes his head with sorrow.  “They didn’t understand the concept of touch.”

I look around the office, and see the nurse heading our way.

“How’s she doing with the diazepam?” he asks.

“She’s flying,” I reply.  “I think it’s the only thing that will stop her from training tonight.

We both stand and look through the window, this mother helping her daughter with her stretches.

“Did you tell her to do that?” he asks.

“Absolutely,” I reply.  “If she ever expects to win, she’s got to get back out there and throw herself into it.  Kid’s these days, I don’t know.”

“Did she win any of the events?”

“Nup.  Best she did was a third in the shot put.”  He looks at me and frowns.  “I know, the girl who came fourth is also in the waiting room.”  He looks at me, daring that its true.  “The worst thing, though, is that this girl was winning the fifteen hundred.”

“Oh no!” he cries, “gutted!”  We sit back down, and the nurse walks past, watching Eric as we do.  I catch her, and she blushes.

Eric returns to his notes, oblivious to this interchange.  I do too.  We both write for a couple of minutes.

“How many instruments does she play?”

“Sorry?”

“How many musical instruments does she play?”

I smile.  “I haven’t asked yet,” I say, getting up, “I’ll go and find out.”

I walk out through the door.  “I’ll be back in an hour,” I yell, as it closes behind, leaving Eric and the nurse in the office alone.

* * * * *

Pumpkin Time

By , April 27, 2010 3:05 pm

I check my watch.  It is 2.23pm.  Just as I am getting up from my desk, I hear the sound of thumping steps down the passage.  Through unconfidential walls, I can hear Glynnis, one of the General Practitioners, bustling past my door, talking urgently as she goes.

“Do you want to call a Code Blue?” a voice asks with urgency.

“Ah, no, not yet, we should be right,” she replies, her tone stating otherwise.

I stop for a moment, my hand reaching for the doorknob.  I pause.  And then the announcement comes:

“Code Blue, front foyer.  Code Blue, front foyer.”

I pull at the door and turn left, walking the hall, following the scent of blood.  As I open the door to the waiting room there is an unusual sight – not a single head facing my way.  Instead, everyone is craning towards the exit.  I follow their eyes through the sliding doors, walking as I do.  And there I see Glynnis and another doctor crouched over a prostrate body.  There are four others standing around in a ring.  As I approach, I see Glynnis stab a barrel through a pair of jeans and into a left quadricep.

Overdose.

Working in Medical Rooms at the base of inner city Commission Flats has been an education.  Based in Paediatrics, I have not been direct witness to the effects of drugs;  more so the indirect emotional and behavioural butterfly effect they can have on kids and their families in the area.

That is, until now.

“Mark, wake up, Mark.”

As if the scene isn’t surreal enough, Glynnis is trying to bring me round.

“Yes, Glynnis?”

“That’s his name,” they chorus together, like they’ve been practising all afternoon.

“Right.”

I reach down for a pair of blue gloves.  As I move around, I see Mark’s face is a darker hue than the plastic on my hands, his eyes ajar, his pupils pinpoint, his mouth slack.  There he lies, in Jesus Christ pose.

Mark’s having a great time.  But he’s stopped breathing.  Party time is over.

Like I said, working near the Commission Flats has been an eye-opener.  The vicious circle of underprivilege hangs like a pall over the area.  Living in government housing, the near-association with gambling and crime, the tap-on effect of alcohol and drugs, and from there, to mental illness.  I’ve the seen the kids of these parents, and the results of this dangerous cocktail.

I’ve written letters to the Department of Housing about cockroach infestations, I’ve spoken to school teachers of kids that don’t get lunch in the second week of the dole, and I’ve liaised closely with the Department of Human Services after seeing forms of abuse that are better not written about.

It’s heartwrenching, and it’s definitely not pretty, but it’s a totally different type of not-pretty to this.  Had Mark not shot up in the toilets of a Medical Centre, in six minutes time, he’d be dead.

“Hey, Mark,” Glynnis yells.  I try not to startle.  She positions his flaccid neck, applying the oxygen mask to his face.  The other GP moves his legs around, stimulating him, trying to check for any signs of life.

A short and measured debate ensues about whether he needs bagging and masking, or whether the Narcan is starting to have effect.  The jab in the thigh will save his life, but cut well-short Mark’s high.  The reality of this situation is that when Mark comes round, he’ll be more pissed about losing his high than he is grateful for being alive.

Ah, beautiful medicine.

“What the fuck is going on?” Mark asks, stirring intermittently, swiping at the facemask, before settling back into his coma.

“You were using in the toilets, mate.”

I feel for a pulse.  Strong and regular.  In about ten minutes, he’ll be tearing strips of the ambos.

“Nah, I wasn’t,” he dribbles about 30 seconds later.  He falls back down the rabbit hole.

Mark is well known to clinic, and through months of trust that had developed, he was granted two minutes alone in the toilet.  This was just long enough for him to grab a spoon from the kitchen, and cook up his next meal.

When, three minutes later, Mark was discovered on the floor with his gear and his spoon, he was dragged to this current plot of concrete.  The spoon was left in the loo, waiting to be retrieved by cleaning staff and returned to it’s rightful home.

Just in time for someone’s pasta lunch.

Glynnis performs a quick neurological examination of Mark, in response to a story about a limp and difficulties standing – the reason for the toilet in the first place.  A bad case of leg-paralysing-constipation.

Surprisingly, he’s perfect now.

Within moments, on this beautiful, warm summer’s afternoon, we see the flashing lights of the ambulance.  It’s Mark’s approaching coach, just waiting to turn into a pumpkin.  Seven minutes and counting.

We stand and chat, the moment passed for medical intervention, as Mark continues to bat weakly at his plastic oxygen mask, in the final throes of his high.  Inside his veins, a powerful drug blocks receptors by the million, closing in like a relentless crusador.  It’ll be over in no time.  Last chance to play the astronaut, Mark.  Fly, buddy, fly.

Two doors open, and from them emerge a pubescent girl and a silverhaired gent.  They walk slowly towards us, all blue uniforms and tilted gaits, their lean balanced by heavy bags and heavy moods.

“Hey guys,” we say.  They look at Mark.

“We got here early.”

“Just in time,” Glynnis says, an unspoken truth understood by all.  We all look at Mark, like something worth pondering.  “We’ll leave it to you guys, then?”

They know that just as they make it to their dispatch hospital in five minutes time, Mark will wake in rage, asking for his money back.

I call it pumpkin time.

Panorama Theme by Themocracy