Saturday, 28 June 2008

I came across this story on Liz Spikol's page. At first I thought it was a joke but a quick search confirmed the story at the New York Times.

Timothy Pinkston is a homeless guy with bipolar disorder who manages his symptoms with drugs and alcohol. He sought treatment at St. Joseph's Hospital psychiatric unit in August where he was subsequently detained. While in an intoxicated state within the unit, he said he wanted to kill the president. Now, how would you expect staff in a psychiatric unit to respond to this type of behaviour... discuss the issue?... distract the guy?... create a calm environment and encourage him to sleep it off?... maybe even sedate him? Err, well no, over at St Joseph's they came up with a different response, they called in the secret service.

The next day Pinkston said he had been intoxicated and didn't know what he had been saying but he did admit to the secret service that he did not like the president's foreign policy or his handling of the Iraq war (wow... what a bizzarre point of view).

The court was very understanding and supportive regarding his mental health problems. U.S. District Judge Susan C. Bucklew sentenced Pinkston to 57 months in prison, just three months short of the statutory maximum for the crime. "Mr. Pinkston, there's no good answer here," Bucklew said. "I don't think I would be doing you any favor in giving you a shorter sentence."

I wonder if I should risk trying out an unpatriotic statement when I see the new shrink and say something like... "I think Gordon Brown has lost his moral compass and is implementing policies that punish the most vulnerable people in our society, I hope he gets the cold". Will they rush to call MI5? Will I end up in HMP Barlinnie for 28 days?

Thursday, 26 June 2008

So I went to see Portillo on Monday about my raised valproate levels. He wasn't particularly concerned about it and said he wanted to leave it to "the experts"... I presume by "the experts" he means the new magnificent all powerful psychiatrist "Dr X".

I now have a name for Dr X but will postpone deciding on a pseudonym until I have seen her. Yes, it's a she. She has a name that just cries out for clang associations, God I can hardly contain myself. But the clangs would risk revealing her identity so I will wait and see if any of her characteristics jump out at me and prompt a nickname. Oh, I forgot to mention that Dr Portillo has a massive spot of acne on his face at the moment. I had to apologise as I couldn't stop looking at it. Like some drooling perv faced with a large breasted woman, my eyes kept darting downwards, unable to maintain eye contact with him. Fortunately he took it well with only a brief blush when I rudely pointed it out.

Much as I like Portillo, as a good bloke and an excellent medical doctor, he is a bit of a bar-room psychologist and once he gets an idea in his head he is like a dog with a bone. Unfortunately he is often barking up the wrong tree but that does nothing to shake him. He once felt (wrongly) that my sister might have had an eating disorder and he has never let it go. Anyway, he started on about how I had once wrote him a letter when I was psychotic, saying I thought I had paranoid schizophrenia. He interrogated me at length about any psychotic symptoms I currently have. It was a bit weird as I described how my certainty about being persecuted by the health service was constantly varying. Genuine events with clinicians and ex-colleagues have taken place which are irrefutable but whether there is a concerted effort to undermine me by the NHS Trust, I'm often at variance with. I explained that I feel my level of insight invalidates any delusions I may have as they are therefore not unshakable beliefs. I also described how my brain still feels physically altered and I no longer have a personality. Portillo then went on at length about this brilliant professor he knew of up in an ivory tower in Edinburgh who feels that bipolar disorder and schizophrenia are one and the same thing. He seemed very impressed with this theory and not too pleased when I replied "No wonder they keep him locked up in a tower".

Portillo then spoke of how all my medications had either not worked or affected me adversely. He was repeatedly subtly pushing the idea that I should prepare myself for a diagnosis of paranoid schizophrenia. Personally, I think he is havering but either way it doesn't matter what label is hung on me, as long as it's not malingerer.

Mrs Mo's ankle is improving and she is hobbling about without crutches now but is still unable to drive. We have had a quiet week as I have also had man-flu... or as she says, a touch of the sniffles.

We had to take the car to the garage this afternoon. When we returned there was a message on the answering machine from Portillo. I couldn't believe it. He said the pirate wanted to see me. He wanted a joint meeting with him, me and Dr X to discuss the handover of my care. Jesus H Christ!

In order to proceed I have to meet with him despite the fact that I have repeatedly said I do not want to see him again. I am once again being railroaded into his web. Mrs Mo will phone tomorrow and I will reluctantly agree in the hope that it is a one-off session and not a meeting to discuss rules of long term engagement.

Sunday, 22 June 2008

On Thursday night Mrs Mo was was more down than usual. After some vodka lubricated discussion we spontaneously decided to get away for a couple of days. I hate being away from home but to my wife it is like a breath of fresh air, so we logged onto Late Rooms and found a cheap offer on a hotel in Perth. The hotel had a pool so that would keep the wife happy regardless of the weather and her limited mobility. We left on Friday morning and headed up to Dunkeld and the visitor centre at the Loch of the Lowes. We were lucky with the weather it was a lovely day over the loch...

Through the binoculars we managed to get good views of the Ospreys which nest at the loch. I even managed to capture a picture...

Inside the visitor centre the webcam allowed us to see the chick in the nest. There was also a large wall of glass out into the woodland where feeders were situated. We sat and watched all manner of birds come to feed including a Greater Spotted Woodpecker. A red squirrel also came and fed at the nuts.

We also visited The Hermitage. Mrs Mo managed to walk some of the way along the path under the huge pines with one crutch but soon became tired and sore and had to sit down.

I went on a bit and took an arty farty picture of the gorge in the River Braan before we left...

Otherwise we spent most of our time in the pool.

On our return home we found that messages had been left on Friday and Saturday from the duty doctor regarding my bloods. Could I phone NHS24 when I got home and ask them to get the on call doctor to phone me. I immediately phoned NHS24 and navigated my way through the "If you have diarrhoea press 2" scenarios. Once connected to a real person I explained that I had been asked to get the duty doctor to call me back. The operator was confused, this was not on her list of options. I explained the situation but she said she would have to contact her supervisor.

There then commenced a very lengthy 3 way conversation during which she asked me numerous questions which were then communicated to the mysterious and silent supervisor but they were still perplexed by the situation, they weren't sure what to do. What a fucking circus. They asked if they could access my medical records, which I said was fine, they checked my address, when did I have the bloods done, why was I at the doctors on Thursday, what did my doctor say... and so it goes on... eventually they have a great idea and decide the best thing to do is to get the duty doctor to ring me back. Brilliant, that's just what I had asked for at the start. Is it just me? I mean, I know I am officially mad but is that carry on not just fucking insane. Was it a wind-up? Were they complete buffoons or just trying to be obstructive?

I sit by the phone. A couple of hours later it rings and a man asks if he can speak to Mmmjvfgrtt brrrkhttr... he tries but is unable to pronounce my name. He is the duty doctor and tells me he is phoning about my Wulprat. My Wulprat? Yes yr wulprat sodium... oh my sodium valproate... yes yr wulprat. Now before you start accusing me of xenophobia, I couldn't give a toss about his race, creed or colour but I do believe it is essential that a doctor is able to communicate clearly with patients. This is even more essential on the phone where speech is the only form of communication available, there are no visual or tactile clues, words are everything.

Despite having access to my records, he asks why I am taking my valproate. I explain it's for bipolar disorder (I didn't think semi sodium valproate was used for epilepsy in the UK?). He tells me my levels are too high, I ask how high, he says "hang on I need to check what the normal dose is" (dose wtf?). He then tells me my levels are "sky high". I ask what "sky high" is? He says he doesn't know as he doesn't have the results to hand. He asks what my previous levels were, "last month they were about 70 I think" I say... "Well they are 135 now". Eh, how does he suddenly know? What the fuck, this is a bizarre conversation. "How much Walprut are you taking?", "two and a half grams a day", "that is no good to me, how many pills?"... is this for real?... I explain I take 5 in the morning and 5 at night. He tells me to cut this to 4 in the morning and 4 at night and to see my doctor on Monday.

As he offered no other advice or assurance, I searched the web for information about valproate toxicity. The therapeutic range is 50-100mg/L and apparently serious intoxication occurs at levels above 450mg/L. It would seem then for a fat guy like me that 135mg/L is no big deal and there is no need for me to write a will and call the priest just yet.

NHS24.... Your life in their hands, fucking champion.

Thursday, 19 June 2008

I was back at the doctors today with my urine sample. He'd asked me to return in a month with it to make sure my obesity wasn't making me diabetic. I'm pretty sure it was just a ploy to get me to return. Anyway, he asked how I'd been since the increase in my valproate and I explained I had been less animated and certainly no better. He decided to check my valproate levels again to make sure I wasn't toxic (afterwards I remembered he didn't ask when I last took my meds, previously the lab has refused to analyse them without time of last dose, oh well). A lengthy course of acupuncture took place as he attempted to access a vein. Fortunately he did eventually managed to get a couple of mls before we ran out of sites on my arms. I don't know if it's illness or old age but I don't mind phlebotomy at all now and no longer feel any pain from the needle. When I was younger I used to get so anxious and tense I'd be almost fainting, it was probably the tension that made it hurt so much.

Anyway after taking the piss out of me and bleeding me dry, he decided to give me a brief lesson in humiliation and again weighed me. The way things are going he's going to need industrial scales soon or a public weigh bridge.

He then asked how I wanted things to progress and what I would like in the way of treatment. I said I would like medication. He asked what antidepressants I had tried, I reminded him I had been on Fluoxetine, Imipramine, Venlafaxine, Mirtazapine and L-Tryptophan. I forgot to mention Citalopram which is weird as it was the one I was on the longest. I explained none of them were of any benefit to me and about the only thing I hadn't tried was an MAOI as life without red wine and cheese would be unbearable... "have you been feeling suicidal?" he asked. I could just envisage the headlines...

How weird. Anyway, we moved on from the suicidal ideation after I explained that mostly just have feelings of dissociation and depersonalization rather than despair. He said it was a pity Mirtazepine had failed on me as it was the wonder drug he was pinning his hopes on. I mentioned that the last time I had seen the pirate he was considering Quetiapine. Portillo wasn't keen on this as he felt it was pharmacologically close to Olanzapine which affected me much the same way as 4kg of lard daily. He said he would have to discuss it with the pirate, he had meant to phone him after my last visit but would definitely phone him this time... yeah sure. I'm getting a bit dubious about Portillo.

I then amazed myself by suddenly blurting out that I was thinking about agreeing to see a psychiatrist again if I could see someone other than the pirate. I then had to explain why I didn't want to see old redbeard, I could have given 100 reasons but two or three were sufficient. I also reminded him that the pirate apparently did not want to see me. he had not turned up at my last appointment and I seemed to have fallen off the CMHT radar. I've worked in a community team before and if one of your regulars suddenly stops getting appointments, you don't just forget them, you ask the secretary if they died, moved, went into hospital, whatever. And when a patient phones up adamant that they are being seen, you don't simply shrug them off saying they don't appear to exist on your records, you look into it. I can't believe that the complete neglect of the CMHT has been an ongoing series of blunders and coincidences.

Portillo then said he would try and arrange for me to see another shrink, Dr X. He built her up, telling me she was the lead consultant of the team and went on about how capable she was, I didn't care if she was an SHO or a cleaner as long as it wasn't the pirate. Now I've come home and googled her and found she is the Staff Grade psychiatrist in the team. Why has he lied to me? The pirate is the only consultant in the team. What is Portillo up to? I'm not even at the shrink yet and already the mind games have started...

Anyway, I've to go back to see him in a month just to check that I am safely under the wing of Dr X in the CMHT and that I haven't been lost among the ether again.

Saturday, 14 June 2008

Just when I was merrily wallowing in my own self pity, tragedy struck. My wife fell at work, lost consciousness and tore the ligaments on her ankle. I had to get off my lazy fat arse and actually do something. She saw a nurse then a doctor at the local health centre who gave her a cold pack and decided she needed an X-Ray. I had to drive her 20 miles to the dreaded hospital where I used to work. Fortunately my former colleagues did not recognize me as, like Dr Who, I have regenerated into a new lifeform. I am now an immense fat freak with a shaved head (forgot to put the guard on the clippers during a recent hair tidy and so had to shave my entire head) and a beard who waddles slowly and looks gormless and vacant. On arrival, the nurse took off the bandage I had applied, gave my wife some analgesia and then vanished. My wife was left on a trolley for a couple of hours with no further observation or assessment nor any information telling us what was happening. Nurses frequently walked by the open door, never once looking in or saying "are you OK?" or telling us what was happening. Despite the pain, my wife was calm but I was very wound up and of no help or comfort to her whatsoever. Instead, she spent the time reassuring me and discouraging me from exploding and kicking off about why we were left ignored, sitting in a cubicle listening to the nurses "busily" chatting and laughing along the corridor. It made me wonder if all the violence experienced in A&E departments is purely down to drunken yobs or if poor standards of nursing care are also a big factor. A mute porter eventually arrived and dumped us in X-Ray, my wife was X-Rayed, then the robo-porter wheeled her back to the cubicle. We spent the time examining the dirt and counting the blood stains on the floor, thankful that my wife did not have an open wound. Over an hour later, a nurse practitioner arrived and to be fair she was really helpful and supportive.

She reviewed the X-Rays and was surprised there was no fracture as my wife's ankle was grossly swollen, with some deformity. She then applied a bandage and helped her onto crutches and advised her how to use them before giving her analgesia to take home. In summary, my wife fell at 3:30 and we were back home by 8:30 with a different bandage. Fuckin' marvellous.

I hadn't really appreciated how completely dependent I had become upon my wife until this happened. With her unable to walk I suddenly realised that I am usually waited on hand and foot and all I give back in return is snarls of anger and impatience. I am not taking to this at all. I have become such a creature of habit that any disruption in my little world makes me anxious and uptight. As you can see, I am still talking about me, me, me. This is typical, my wife is injured and all I can think about is how it affects me. What a great man I am.

Friday, 13 June 2008

My wife has torn the ligaments on her ankle and is unable to weight bear on the injured leg. She is only able to manage a few paces with crutches.
My wife has torn the ligaments on her ankle and is unable to weight bear on the injured leg. She is only able to manage a few paces with crutches.
My wife has torn the ligaments on her ankle and is unable to weight bear on the injured leg. She is only able to manage a few paces with crutches.

Monday, 9 June 2008

Strange. One minute I'm taking photographs, writing a novel and recording an album. Next day I have no sense of purpose and no sense of self. Unwashed and unshaved but still eating. Food is the one constant in my life, hunger never leaves me, my greed is insatiable.

Friday, 6 June 2008

Been in bed for a week, kinda lethargic, dazed and confused.