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Twisting all the bad things into good

Feb 4, 2012

CHAPTER 6: THE PATRON SAINT OF . . . WHATEVER. Side Effects & Adverse Reactions

More than a drug is what I need
Need a change of scenery
Need a new life
James, Say Something  

THURSDAY. 9/9/10

            Dual diagnosis?
            I understood the doctor, but I don't understand this nurse.
            Dual diagnosis? What the hell does that mean? 
            I ask again, but this time, out loud.
            "Dual diagnosis? What the heck does that mean?"  
            The girl sitting across the desk next to the nurse does not seem offended by my use of the word "heck". That's swell, but I have no idea who the "heck" she is or why the "fuck' she has to know about my dual diagnosis. Maybe it's "Bring Your Friend or Daughter to Work Day." That concept makes sense because what could be more kick ass than taking an unpaid day off from your own shitty job to spend it at someone else's shitty job? Actually, that doesn't make sense. I'm still going to mark the day on my 2011 calendar, and then set a reminder for myself to send a reminder to my Gynecologist friend, because that shouldn't be too uncomfortable. Well, unless you're the one in the stirrups. Me being allowed to attend a cervical screening is about as likely as a mental ward allowing any kind of "Bring Your Whoever to Wherever Day".
            It doesn't matter who the girl is. All I'm trying to do is act not insane. The only way to pull that off is by keeping my big hypomanic mouth shut. Besides, I'm probably just overthinking this girl's presence. She's obviously not having fun, so she's probably training. She is definitely judging. Maybe paranoia is half of my "dual diagnosis". Maybe the other half  is being delusional, like thinking I have a friend who is an OB/GYN.

            The nurse looks up from the doctor's notes scribbled on my evaluation. She explains that a dual diagnosis is for patients who are lucky enough to have both substance abuse and mental problems. They call this "co-occurring disorders". I call it being "fucked up". She tells me that I am going to be taking up residence in the Crisis Stabilization Unit for the head cases whose preferred substance to abuse is drugs. There's also a separate unit for the alkies who have been dually diagnosed.

            The nurse is showing the trainee my chart. She is explaining something about how to properly fill out Axis I to Axis V. Then she starts talking about quadrants.
            "You need to mark one of the categories under the quadrants of care," she tells her. "James is a category 3."
            Unless there's a hurricane named after me approaching South Florida, it sounds like I'm a "category 3".
            "What's that mean?'' I ask. "What's category 3?"
            The nurse looks at me and then looks at the trainee as if she asked my question.
            "That's when a patient's substance disorder is more severe than their mental disorder."
            "Oh. Yeah, that's definitely me then," I proudly reassure them.

            Although I am relatively coherent, it still seems surreal to hear terms like "crisis", "substance abuse", and "mental disorder". I guess it's not the actual terms that bother me as much as the fact that they are being used in reference to me.There's no point in trying to explain that any of my mental problems were just results of my drug problem.             

            The nurse begins to tell me what medications that I will be given.
            I'm guessing that Oxycodone and Xanax are not on the list.
            "We're going to start you on twenty milligrams of Lexapro."
            "What's that for?"
            "It's an antidepressant. It also helps anxiety. You'll start on that as soon as you are admitted, then you'll be taking it in the mornings."
            I guess I'm not as close to being a pharmacist as I thought, unless it's a pharmacy that only sells painkillers and benzos. Everything else is everything else. If it never got me high, I probably never heard of it. I ask her when I should start to feel it. She says it will take time to build up in my system, but I should notice a difference in about ten to fourteen days. That seems like a long time when you're used to taking pills that anti your depression in about twenty to thirty minutes. But, by now, I think we all know how that worked out. Whatever. On to the next pill I've never heard of.
            She tells me that the Risperidone and Trazodone will  be taken before bedtime to help me sleep and to stabilize my mood.
            "Okay. Do any of these have any side effects?" I ask her.
            "It depends on the person's physiology and the medication. Everyone is different so some people may have different reactions to the same thing. The most common side effect of  the Lexapro and the Risperidone is usually some weight gain. The trazodone can sometimes cause prolong direction."
            "What's prolong direction mean?"
            "Prolong direction," she repeats, as if I would understand the second time that she said the same exact thing in the same exact way.
            "Okay, I'm sure it's me, I still don't know what that is."
            She assumes I understand her medical jargon. She repeats it a third time.
            "Prolong. Direction." That time she said it a little slower with a little emphasis. She may as well have said, "You mean you've never heard of prolong direction before? Hey silent trainee, James doesn't know what prolong direction is. Now's the time to break your silence so that you can join me and together we can  laugh in his crazy Category III face. Ready? 1,2,3, laugh. Hee hee hee hee! Awww, look at him. He's so vulnerable. I love it. We should get drinks after work and talk to some hot guys who don't have a mental illness that is only slightly less severe than their drug addiction like James has."

            Even though everything that they didn't say is pretty much true, this nurse is not the only one who is losing her patience. No matter how slow she says it, I still don't get if she's talking about my balance or sleepwalking or what. If she writes it down, I'm gonna freak.
            "Yeah, prolong direction, I get that part. But what direction?"
            Now the trainee is not the only one who is speechless. She gives the trainee a look of disbelief and embarrassment. Maybe she's embarrassed that she lacks the vocabulary necessary to properly explain herself.  I look at the trainee. Even though she quickly puts her head down to avoid eye contact, it's clear that she is familiar with the possible side effect in question.
            The nurse's mouth moves before any sound comes out as if she is going to speak in slow motion. She obviously thinks this mad genius across her desk is a moron.
            "Not "direction". Prolonged. Erection."
            Now I get it. Why didn't she just say that the first three times?
            "Ohhh, "prolonged erection". I thought you were saying "prolong direction"."
            I'm pretty sure she already knew that. I laugh it off, if only in an attempt to make the trainee a little less uncomfortable than I am. I tend to talk too much when I'm uncomfortable.
            I say, "I guess that direction would be "up" in that case."
            I laugh. Alone.
            "I'll just make sure to keep my shirt untucked."
            Silence. The uncomfortable kind.
            Thank you, ladies, you've been an awkward audience. I'll be here all weekend. You can catch my last show on Monday. I hope.
            "No, that's fine. I can handle a prolonged erection," I tell them.
            What did I just say?
            They can think I'm mentally ill, but I can't let them think I'm gay.
            "I mean, I can handle my own prolonged erection, not somebody else's."
            If I were a psychologist instead of a psycho, manic would be my diagnosis.
            "I'm just saying, when I think of side effects, I think of anal leakage or something."

            I'm the one in the stirrups.

            "You know, like on tv?" Their dumbfounded faces indicate that they don't. "Those commercials that list side effects that are even worse than whatever the drug's supposed to cure?"

            I'm the one who needs to be cured.

            "Like when they say how an antidepressant might make you suicidal, as if you don't have enough problems already."

            I'm the one with enough problems already.

            That suicide side effect doesn't seem so bad right now.
            Suicide I can live with.
            Better than "anal leakage".

            Alright, I think it's time to go.
            Can someone please bring me my strait jacket and then kindly point me in the prolonged direction of my padded cell?

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