morning question

"Will I be good to my neuronal terminals today?"

Suppose you ask yourself that question, and the answer is "no." Do not bother with the rest of that day. It will not be worth the effort.

One of the really lovely things about methamphetamine is the way it damages the terminals of neurons involved with dopamine and serotonin. It chainsaws them. Not a good thing, really, because dopamine is that most excellent neurotransmitter which gives you a feeling of reward when something you do goes well. It's the brain's way of giving itself a nice box of Godivas.

He was asleep when I got report from the nurse on the previous shift. Four-point leather restraints held each limb to the bedrails.

Smoking crystal meth causes the brain to flood with massive amounts of dopamine, initiating a brief intense rush.

It took several staff members and a host of security people to get him there. Somehow he had persuaded the night crew that he would be okay if taken out to smoke a cigarette. He ditched the staff member assigned to watch him and went to look for his soulmate among the bushes near the parking area, so I was told, and police were notified.

The dopamine peak soon subsides, the pleasant feelings ebb away gradually, and the user feels empty and cranky. Tweaking.

A previous incident with the police initiated his little stay with us to begin with. After a crystal binge he swore he saw his most honored loved one doing it in a car with someone else. (Hallucinations? Poor romantic choice? Both?) As she's the mother of his child, (so presumed,) this upset him greatly, and he got weird with a knife or something. The cops tasered him to no great effect, and he took a couple bean-bag-bullets to the chest, too, before he was subdued.

To dispel the emptiness, the user does more methamphetamine. And each time the drug is used, it further impairs the ability of the brain to produce and deploy dopamine in ways that make one feel pleasure naturally. Eventually the habitual user becomes completely devoid of the ability to experience pleasure, except in those meth-induced fitful respites.

He slept most of the morning. Then the calming effects of the medicines began to wear off. He yelled obscenities, struggled with the leathers, and alarmed the watcher at his bedside, who felt that the wrist leathers needed to be re-secured. When we did that he got an arm loose and everything went to hell for a bit.

So goes the downward spiral of methamphetamine addiction, taking with it the twisted and broken ends of the neuronal terminals that allow a person to feel good. Period.

We managed to hold down his arm while calls went out to other staff people and Security. After a couple hours of struggle, and the administration of some sedatives and anti-psychotics, he went to sleep again.

Almost all meth addicts relapse, since there is no other way for them to experience anything positively, really. Love, beauty, a fine meal, a happy ending... nope, nothing there. Banished. Gone like two Beatles.

Then the love of his life came to visit. We did not want her there, afraid that he would wake up, see her, and go off again. There she sat. There he did lay, tied to the bed with leather belts, medicated into submission.

"He really doesn't do drugs that much," she said.

How Can You Tell?

When I got him, he was still pretty messed up. Chest tubes, paraplegic, tracheotomy, and a decubitus ulcer on his butt that was covered by a dressing as big as Tom Delay's face, of which it seemed to remind me. But he was a really nice guy, soft-spoken and polite, and the family members I met were good citizens all. So, the initial story I heard about him didn't ring true to me.

At first I was handed some tale about a home-invasion robbery in which he took a bullet in the back. "Serves him right," some staffers said, going along with the notion that the frightened homeowner was of course justified in blasting this guy into a wheelchair for life.

Then another person, a staff supervisor who I trust implicitly, said that was not the case. Instead, the patient was outside the scene when struck by the bullet. Like an innocent bystander, tragically and randomly cut down by urban violence.

That story fit better with the patient's personality, from what I saw in him.

I never asked him. I did not feel that it was helpful, at that stage of his recovery, to discuss it. He's got the rest of his life to sort it out. I only had the few minutes that my work allows me to spend with each patient, so in that small amount of time, I did what I always do. I cared. We got him looking good for a visit from his children. He had not seen them in a month, due to his intense hospitalization.

Later when he left the hospital, I went to say good-bye and he remembered me by name, though I only worked with him for a few hours. I discussed these two stories with the discharging nurse, and she turned it back around again.

She spent a lot more time on him than I did, so I do not distrust her version, which placed him in the home as something of an accomplice to someone else who instigated the robbery. That still makes him an alleged felon, in a Roshomon kind of way.

It is even presumed that eventually he will be charged. Perhaps when he gets out of rehabilitation.

I would not want that. Paraplegia has a way of reforming even the most violent among us, and he didn't seem to be one of them, anyway.

really doing it

My precocious young one wants us to go to a sushi restaurant and insist that the waitperson bring us "chapsticks" instead of "chopsticks," just to get a funny reaction.

When the young one was 4 she already had "a favorite opera," Salome, so we have several recordings and a couple DVD versions of Strauss's notorious score. She loves it when Salome kisses the head. The head of John the Baptist, that is.

When Macy's had a cutlery sale, this not-yet-seven-year-old insisted that I get a cleaver. I just couldn't talk her out of it. Personally, I prefer a santoku. The salesperson wisely counselled the young one to "be careful with it."

I'll say.

While driving to Winslow one day a couple years ago, the radio was broadcasting a recording of the infamous final scene, which culminates in the head-kissing and then the crushing death of Salome herself. The young one said "Leonie Rysanek." I really couldn't tell, and I have a little bit of an ear for this stuff. On a car radio it sounded like maybe Leontyne Price to me, but the young one nailed it.

Commence walking now

We filled up last night for about $2.27 for the low-grade stuff. Personally, I have made a bet with many people that gas will hit $5 per gallon before Bush leaves office, but it was not the price which caused me alarm.

It was what the attendant said.

"We only have 87 octane," he told my spouse, who went to inspect the W.C. "That's what I'm getting anyways," I said. Then I realized that meant they had no higher octane fuel to sell.

Blagojevich

Under his emergency filing , this northern-state governor has decreed that pharmacies must dispense birth contol prescriptions despite the personal feelings or objections of the pharmacist. If he or she refuses to fill the scrip, then another pharmacist must be made available to do so, or arrangements must be made to have another pharmacy provide service.

This, in response to the recent spasm of fascist legislative attempts to allow pharmacists to apply their "moral" objections to their customers, and the blogosphere (or at least the part of it that is reality-based and of sensible humor,) is resounding with "what ifs." I have a few of my own.

For example: what if I have a Republican patient who suddenly requires defibrillation? Can I refuse to do so on moral grounds? For what, exactly, would be the point of jump-starting the so-called "heart" of a Republican?! It just doesn't make any sense to do so. Not just immoral, but stupid, really.

Isn't pulseless ventricular tachycardia a divine manifestation of God's will?

Other "what ifs" include possible refusals of service to men with Viagra prescriptions, refusals based on racial bigotry, refusals based on just plain laziness, etc.

Why would a pharmacist of firm moral standing dispense hemorrhoid-shrinking steroidal cream to a Republican, for wouldn't that be assisting suicide?!

Or vaginal lubricants? Isn't vaginal comfort just another fiendish Satanic ploy? Would you ask a pharmacist to do the devil's work?! No, I say. Good women hardly need such things. (Smirk here.)

If John Ashcroft were a PetSmart register jockey, would the shareholders support his moral "right" to refuse to sell kitty kibble to owners of calico cats?! In God's kingdom, hell yes!

I'm sick of it already.