Tuesday, October 30, 2007

Queens, God, and Hell's Angels

If my calling had been psychiatry I would be in poor shape. Not that I don't enjoy the interactions with patients, its purely because I don't understand it. I just don't get it. When I see patients on a daily basis, what's the actual goal of my conversations with them? You can't just ask concrete things like, how's your pain, are you peeing, and how's breast feeding going. Instead you explore their delusions of grandeur or paranoia, you dive into the depths of their feelings of worthlessness depression and terrifying anxiety to see how the neurotransmitters in their brain are being affected by the cocktail of blockers or stimulators that you have them taking. You go up gradually on the anti-psychotics, play around with their sleep medication until they come back in touch with reality as we know it. Of course, those with more training in psychotherapy give cognitive behaviour homework to those with depressive and anxiety disorders, and together we work through coping strategies. But if you're frankly psychotic, if you think you're the queen of England, there is no logical reasoning that can make you believe otherwise. So we tinker with the neurons in their brain.

There are times when I'm intrigued by perceptions of reality and get caught up in the stories. I want to probe into their theories of spirituality and understand their relationships with God. But then I realize they are God and we're not actually talking about the same thing. As a medical student I remember walking through the unit and there was a patient lying on the ping pong table proclaiming that they were the Messiah. Another patient came up to her and said, "are you really God?" To which God responded indignantly, "yes, of course I am!" The reply came with a snort, "well do I ever have a bone to pick with you!"

Last week it was 'Welfare Wednesday' which meant being on call Sunday was incredibly busy. As it was explained to me, you get your check Wednesday, go buy your drug of choice, alcohol, crystal meth, crack, whatever, have your binge which can last two or three days and by the weekend you're in withdrawal and come to hospital with you heart about to stop or thinking Hell's Angels are hunting you down. Now some crazy people can be hilarious, bursting into song and quite comfortable in their role as the queen and its fun to joke about, but when Hell's Angels want you dead the fear is palpable. You see terror in their eyes and you can nearly smell their angst. Then its not funny at all, its terrifying, and all you want to do is convince then that they're safe . . . which you can't do, so you play with their neurons again.

So I am left fascinated by the mind and unable to understand its complexities. Entertained at times and heartbroken the next minute. It seems a lot of time is spent convincing people to take medications that they desperately need with the rest spent convincing people NOT to take drugs that alter their mental state. My mind is hopelessly concrete, and although I am intrigued by the minds of others, my skills lay in more surgical things . . . and catching babies on the happiness ward of course.

Wednesday, October 24, 2007

Psychosis NOS*

Well, I've had a hard life. I'm not gonna lie to you. Why would I lie? Would you lie? Sorry, I don't mean to accuse you or anything, its just that you don't know who you can trust. Everyone has their own motives you know. But yes, my life is hard. Its hard being this sought after. They watch me all the time you know. I see them drive by me in cars when I ride my bike to work, or sometimes they just follow me, not overtaking just so they can watch me. Do I think someone's going to harm me? Oh no! Of course not, well, maybe kidnap me for a ransom, but only because I'm so well connected. My dad was a cocaine trafficker in his younger years--this is off the record, right? Anyway, so he's pretty wealthy and then there's the 'celebrity by association' that I get from my job. What job? I'm surprised you don't know! I guess you don't read the news much. Angelina, I'm her agent. Its busy, well, and complicated. Its a long story, but the problem is she's actually got quite the crush on me, hard to handle, you know, professionalism is vital these days with media coverage being what it is. But Brad's a bit jealous, as he gets, of course I'm not interested in the slightest, all she's got is skin, bones, tatoos, and lips. They send me these messages that get me all rilled up though. No, not voicemail, they usually talk through the TV and tell me to do things. I don't like it. What do they ask me to do? Oh, things like making sure no bad press gets out about them. Sometimes I just get so MAD! Today I had to take all 'The Enquirer' magazines off the shelves in Safeway and burn them. Security and the fire department are such idiots, they just don't understand the brilliance behind my actions. Yeah, I think that's who drove me here. Why am I even talking to you?

Anyway, so I might move to Peru, people know me there as well, but at least I'd get away from Angelina and her crazy boyfriend. Geez. What would I do in Peru? You must only watch sitcoms. I'm next in line to the throne. You'd have to pay some good money to get this kind of interview with me there. No royal family in Peru? Did you even finish high school? Hello . . . the Inca royal family! Basically I'm a direct descendant of Inti Raimi. Yeah, so my job possibilities there are basically endless. I could work on my classical guitar career, yeah, I'm pretty good, I've played with some of the greats. Led Zepellin and I actually did a duet together on his last album.

Do I hear things that other people don't? How should I know, I don't know what other people hear, its not like I'm inside their head or anything! Would I ever hurt myself? Are you nuts?!? I have endless possibility, money, AND I'm famous, my life is great! Why else would all these people be monitoring my movements if I wasn't something special? I'm actually most likely going to be the next prime minister of Canada, yeah, Stevie Harper is on the way out, did you hear that throne speech? He's nuts. But God has really given me a lot of gifts, I think I'm up for the task, I'd feed those poor people and set up all sorts of social programs to end inequality in the world.

Pills? You want me to take pills? You think I'll fall for that one? I only eat organic things, and those are NOT organic, I don't want to put chemicals into my body! Besides how do I know I can trust you? You keep on asking these weird questions, maybe you should see a psychiatrist. I get one phone call, right? I'm calling Angelina, and boy, is she ever gonna be pissed at you!


* not otherwise specified

Saturday, October 20, 2007

Morilla, Meatloaf, and 10,000 cows

We crawl through the fence and into the barnyard. Chickens, sheep, pygmy goats, regular goats, and a variety of cows, oh yeah, and a couple dogs. My aunt has names for all of them, well, maybe not the chickens. I follow her out to the pasture where the Jersey cows and calves are congregated, my new sneakers with the pink flowers on them encounter the slipperiness of a cow-paddy despite my best efforts. We throw bails over the fence for the cows. Scratchy, itchy hay on my arms, the warmth of the cows reassuring, manure on my jeans, the bright blue sky, farm house in the distance, the pasture scattered with farm machinery my grandparents used in the first part of the last century. Its all so familiar to me. I remember dusty summers exploring the woods, mud fights in the dug-out, riding horses (and getting bucked off), chasing cows, hot sleepless nights with mosquitoes biting and coyotes howling. Summers at the farm.

I visit a friend who has known me since I first came to Canada. I swear she's the reason I got through university . . . private tutoring and she didn't even start charging! Now she's married with a bun in the oven (notice the official obstetrician terminology), they live on a farmstead, have started a market garden and are building a new house. In my wildest dreams I never imagined her raising chickens and goats but now it seems like the most natural thing in the world. It somehow felt right to be eating things that were grown only a few hundred meters away. Maybe I'm idealizing it but the connection to seasons and the land is a different concept than in the city where our peas come from China year-round and apples are shipped from Washington instead of the Okanagan.

From the idyllic farmstead where I see all that is good about life in rural Alberta I went to the feedlot that my cousin manages. 10,000 head of cattle. To be honest I was expecting to be horrified with vagrant abuse of animals. To be even honester I was horrified at how naturally I accepted it as imperative to our lifestyle by the end of the day. To provide the all-powerful consumer with the beef we want at the right price this is how the system must work. 9lbs of grain for 1lb of meat. The healthiest, fattest cows I've ever seen. Vaccinations and growth hormone when they get shipped in, then they eat all day everyday, continuously monitored to make sure they stay healthy. Meat is big business in Alberta. I'm ashamed that I can't quite bring myself to tell my extended family that I'm mostly a vegetarian, it seems like the most intimate of betrayals that I am rejecting their very livelihood. Of course, I still love my cousin. "Different strokes for different folks," I tell him when he asks what I think of it all.

I loved every minute spent not thinking about anything remotely related to work. Of course, it can't be avoided when your cousin rips off his shirt and asks for his rash to be diagnosed or your aunt wants to know your opinion on cancer causation. I tried to spend lots of time kicking through crisp dry leaves and watching sunrises and sunsets. Life is good.

A large pumpkin, a mammoth zucchini, gourds, and garlic accompanied me on the Greyhound back to Calgary.

As far as my post-holiday resolutions:

Live more. Love more. Volunteer. Eat beets. Play guitar. Laugh more.

P.S. Morilla is a Jersey cow and Meatloaf is a pygmy goat.

Saturday, October 6, 2007

Alberta Bound

Friday brought with it an epic journey. First squeezing through the narrow pass of Phimosis, only to be met on the other side by the sticky pit of chronic Balanitis with crusting around the edges. Then, after wading through the mushy swamp of Prostatitis I ended my foul run of luck along the meandering stream of Epidydimitis with tender hard boiled eggs (without the shell).

Sticky foreskins and sensitive testicles aside, in all seriousness I have found a new appreciation for men's health over the past few days. Turns out sexual issues are important for the health of men as well as women . . . who knew?

Fortunately, after seeing four patients complaining of problems with 'the boys' my day brought a bit of variety. There was a lovely three year-old whose mom brought him in with a cold. He played doctor with my stethoscope and obediently opened his mouth wide for me to take a look. To me he was a little miracle, so smart and inquisitive, crawling up and down from the examining table with endless questions. Both his mom and dad are HIV +. He is negative and as healthy as any kid his age (snotty nose included!) Seeing him filled me with endless hope and optimism, that this can happen, and not just in Canada.

The afternoon was a bit more disturbing. A young guy of the exact same age as me and currently at university. He had a sore throat and had noticed a lump on his neck. I examined him and reassured him that he had a cold and most of the time you do get some swollen lymph nodes. He didn't buy it. "But why have I never had it before with a cold? This isn't normal." When the questions kept coming I realized there was something else going on. So I asked if he was worried about anything specific. The can of worms opened. Throat cancer and HIV. Lots of high risk sexual activity. However, he was skeptical about HIV. Wasn't it possible that its all just a money making scheme for doctors and drug companies. People are killing themselves with the drugs they take, you can treat it with diet.

I could nearly hear the creaking of my jaw dropping as he spoke. Speechless. Where do I even start? We had a long discussion, and I hope I opened some doors for dialogue. He went to get the blood work done and we'll see what happens. When I talked to my preceptor about him he said without hesitation, "he needs to wake up, or he's going to die."

In the span of a few hours I went from an explanation of a foreskin re-growing contraption, to a deep feeling of hope in the eyes of a child, to shock at a population that has somehow fallen through the cracks in understanding the gravity of what HIV means. The absurd, the wonderful, and the disturbing . . . its nuts! My work day came to a close on a high note with my evaluation. Stronger than your peers at this level. (What?!? Don't they know I went to U of C and am clearly deficient in pharmacology and anatomy?) Fantastic with patients, great people skills, open-minded and sensitive to patient issues. (Okay, I guess they do know I went to U of C).

And then . . . freedom. Frantic packing. Airport. Plane. Cowboy on plane. Calgary. Hugs, family. Bright sun, blue sky, golden leaves and of course, turkey.