Mr B.D.

Name: B D Disease status: Bipolar Disorder
Year of Diagnosis: 1978
Sex: Male
Ethnicity: Black-Caribbean
Medication Prescribed: Lithium (Priadel) Extended release: 450 mg in the morning and nighttime, Olanzapine 20mg  tablets in the night.

Hello Mr BD, My name is Ezzy and I am your pharmacist for today, I was just wondering if you could spare five minutes to talk about your medication. Not that I give a fuck about it, I just need to reach 200 medication reviews and get shitloads of money for pretending to care about Healthcare in this country.
Here is my colleague and because I am too lazy and bored with all those doses and your symptoms and talking about it gives me a migraine, I will pass your disease and your conscience to her. She is a lot younger and has more patience than me. What do you think mate, can you spare five or ten minutes?  Just fill in this form for me and follow my colleague into the consultation room for the review.

BD could spare ten, thirty minutes or his entire lifetime. He could not work, did not have any friends and his family could not stand his weird looks, his constant blared expression and his manic outbreaks; so they had rented a one bedroom flat for him next to the psychiatric hospital where he was admitted every 2 months or so. Easy busy, his life anyway was wasted, he would never be able to have a partner as he was always changing personalities, who would want a crazy, bipolar psycho to take care of every day and withstand his alternating depressive and manic episodes?

On the sight of the young girl he felt the panic starting from his legs and going in one millisecond all the way up through his stomach, chest and into his head.
‘Erm no I don’t think so, I am very busy today indeed, and I have gone through this review with my doctor and my psychiatric nurse already. She is a lovely lady and she always knows how to calm me down, and I have no time today indeed. As a matter of fact, I’d rather be going; this room is getting tighter and tighter and I feel like it is going to choke me sooner or later. I am sorry I really need to go.’

No problem at all Mr BD, if you ever feel like you need any support I am always here for you. The young pharmacist decided she could not hold him against his will, although the boss would not be happy about this. No, he would not be happy at all.

Damn these five minutes could be worth around 20 pounds for him, if he gathered around 10 patients a day for the next year he could finally buy this new Audi that he always wanted and take his wife to this hotel at the Maldives where all her friends had already been. Now, he knows his wife doesn’t swim and she avoids the sun because it will give her wrinkles and make her look older, but she still had to go so that the others would shut their mouth and continue talking about their makeup kits and their botox.
So she went back inside, a bit sad for losing this patient, not because she wanted to contribute to her boss’s golden dreams, but mostly because she knew this guy and she liked him, and she liked the feeling of helping people in need. She had so much love to give and having none to give it to in her own life, she could well spend it all in her lovely patient victims.

After one minute there was a frantic knock on the door. Not a usual one, it was a bit of a mad knocking, intense and loud, no rhythm at all.
‘Oh hello, sorry to disturb you, I decided I will finally do the form and the discussion for you.’

Smile all over her face, her eyes got bright and lively again. ‘He came back. He came back to talk to me, to spend ten minutes with me and tell me about his life, his illness, his concerns. Let’s do it well now’, she thought, but it has to be soft and cause as little trauma as possible.
So she sat him down at first, then she realized this position was not appropriate for this. Penetrating into someone’s soul requires a lied down position, with the shirt of the big black patient open. How would she dig into his heart if not like that? She needed to have access into his inside, his concerns, his crazy daydreams and his dark nightmares. No, he had to lie down so that her arm could reach his chest and insert her needles with more comfort.
Yes, that was a better position for both of them, she could now start cutting the skin, carving his chest with her sharp knife-tongue and her metallic words.

So, MR BD, I see you were diagnosed around ehmmm 40 years ago?
First attempt to access chest. Heart rhythm goes up. Patient-victim starts shaking –he knows what is going to follow from now on but he stays, he feels paralysed.  Comforting mile follows her slow but steady movements on his chest , this would help reduce his heart pumping and relax the pectoralis major muscles.

‘Yes, indeed, I was 18 years old back then. My parents just moved here from Jamaica, you know, everyone in this area was sharing the pot and it felt good at the beginning. Then it started getting down to me, I started smoking it everywhere and all the time, even in my dreams you know! I had paranoid, grandiose thoughts, crazy loops of subtle rivers of them, which ended up being waterfalls and then storms in my mind. My mind is so strong you know. So strong but so weak at the same time. It can make stories, it can create people, money, sex, emotions. But these are the ones that dig through it and make it weak and then make it like a paste and that’s it. That year was the year I broke up with my girlfriend back then, I still remember her so well.
She was so dark and pretty, she had this amazing afro hair which would complement her tall thin neck like a black diamond and which would make me crazy. Crazy about her and crazy about life and wanting to crazily kiss this neck and her arms and so crazy which would give me a fire and a burn for my everyday walks in the park, and yes the pot would feel and taste even better. But she is long gone now, long gone.

First attempt to access heart successful. Patient has started bleeding. Muscles are all relaxed, in an apathetic position: he started opening up. The myocardium is reached, soft and tender. Blood keeps coming out; the procedure hurts him.
He is hurt a lot, he feels the pain starting from his inside, moving around his body and doing warm circles. Bloods vessels are blossoming like flowers everywhere, this is the perfect state to dig more into this. But she knew she had to be careful not to cause too much damage and laceration. Time for coldness, frozen words had to be recruited at this point.

I see BD, could you talk to me a bit more about your medication? How do you take them and do you ever experience any side effects?

Second act, attempt to reach the heart continues. Now the river of blood thickens up, goes into his eyes and blinds him. The young pharmacist’s hands are full of a mixture of mucous, red liquids, veins, arteries, muscles and various nerves which are tangled through her fingers and under her nails. But she has to keep carving the body. Her knives are sharp enough to go under the muscles and the bones and all the soft tissues and the various organs on the way. She had been trained oh so well and had many splendid certificates which gave her the permission and the skills to do this.

‘Oh the Lithium you see, the Lithium is a nasty one. It helps me a lot yes, it does help, I mean it is a mineral after all innit? It is supposed to be from the Nature, to the people. But it makes me so hungry; in the nights when I take it I feel like I want to eat everything, I want to eat even my sofa sometimes and the dirty carpet and sometimes even myself. I bet it is all due to the Lithium. But my sister is helping me now, you see she is all about this vegetarian organic healthy eating, so now I eat more fruits and vegetables and raisins, peanuts, all these healthy things.
Yes, even raisins. Me! A handful at night, after the lithium tablets.
And the Olanzapine gives me these weird nightmares and lively dreams, and my movement changed. My face sometimes turns into a mask, I cannot move my expressions, I have to stare at the ceiling for hours. This I would do from very young anyway, but now I am more, you know, immobile.
I cannot move, I cannot think, I cannot act. But then suddenly, my arm might want to move independently or my back wants to bend or stretch and then I get confused. I do not want these parts of my body to move without me.’

I understand Mr BD, these are the so called extrapyramidal reactions and mask like face, they are common long term side effects of your medication.

Another wound made, now she feels the blood splashing all over her face and her white clothes. She didn’t mind that, the only concern she had was the bovine smell of the blood which she could feel it deep into her nose and on her tongue –her sense of smell was extremely sensitive and picky.

‘They are what? My meds you see, they are nasty, but I need them.  I used to think that when I feel better, when I leave the manic phase and get away from my depressive, suicidal one, then I go in the Middle, in the right, the good, the normal phase. Then I used to think I do not need them and I would stop taking them, I was fed up with it, 5 tablets every night, and day and if I want to sleep at my brother’s house and see my niece how would I cope without the tablets? It’s a hassle to be dependent on them.
But one needs to chose, to depend on the psychiatric hospital or to depend on the meds, so I chose the meds. There must always be an addiction in one’s life, at least I feel so.
No, I’m used to them, we live together happily now. Me, and them, them and me. And I do not need to be back in this hospital, I haven’t been there for months.’

Mission accomplished. She realized she could not dig further down, then the unconscious would start hitting and it would be such a weird mixture with all this blood and the mucous that she would not be able to handle it. She did not have the right training for this anyway, not the divine unconscious, the passages there are too dangerous.

She fixed his shirt, brushed his few hairs, gave him a bag of medicines and explained what they do once again and how he should take them. With her pair of sterilized pliers she picked the remains of the big, tender heart and threw it into the bin along with hundreds of others of various sizes and conditions. She then washed her hands, collected as much blood as she could in a tiny bottle with the label BD outside and escorted him out with her previously white coat still dripping from the sides.

‘Thank you very much for talking to me today, Mr BD’.

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