The Nightmares Come Like Seasons

The nightmares come like seasons. Waking in the night soaking in sweat, the terror and faces of the dead. The accusations, “you did not do enough”.  “You failed me like all those before you,” the suicides shout circling, disembodied faces and shrieking voices.  Life was not enough. Why didn’t you convince me. It was your job to save me. You failed me. You failed me.  The wraiths are there in black whispery gossamer chanting angry anxious spectres invading the depths of my sleep, tearing me from peace and making me a morning zombie.  I review the cases over and over and over again.  Ask what I could do different.  Know that the wise avoid such end stage lives.  The cherry pickers never go near those dying of a thousand pains and repeated rejections on rejections with bodies and brains not up to the task of survival.  And yet I tried.  Trying wasn’t enough. The thousands saved in forgotten wars don’t count for the dozen or more are there to accuse.  You did not do enough. I had no resources. I was alone I said.  The hospital discharged you. You hung yourself. I didn’t even know you were free. I was on holiday. I say to another. You didn’t wait for my return.  Borderlines on borderlines on borderlines. And now the angry say I should kill them and beg euthanasia and marijuana and opiates and say I don’t care. You don’t care. You have never known despair. You don’t know my pain. You don’t know my truth. You’re like everyone else. Your medications and your words don’t help. There is no reason for living. Life is a lie. The judges and politicians and bearocrats and institutions are all bought. There is no life without money. You don’t know poverty. You’re a rich doctor. You don’t care. You’re only in it for the money. You don’t care. You don’t listen. You don’t understand. You don’t help me. You don’t know your pain. Take the needle out of your arm, I say.  Take your lips from the bottle.  I need this, you say. It’s killing you.  If you knew my life you’d want to die too.  Let me die. The teen agers are begging me for euthanasia too and they were given marijuana and ritalin and opitates before.  But there’s no solution in running away. But what do I know. I get up and go in the ring and box each day with death and there’s no money in it. There’s no crowds. There are no sponsors, no contracts. Just me and someone saying I want to die and whatever audience there is says give them euthanasia. Who are you to judge life is better. Let them die.  Be kind and let the girl whose boyfriend left her kill herself on you tube.  Why do you interfere.  Let them die. Kill me she cries. Kill me he begs me. And the media is missing the point over and over and over again. Death by cop. Death by suicide. Drama and 20 minutes of Andy Warhol. I stood in the carnage of epidemic reservation suicides and stopped the teens from offing themselves in sensationalism.  Cutting down the hanging boy.  Looking at the face lifeless now in the morgue. Overdoses and overdoes and overdoes with an occasion jump from a bridge or stepping in front of the bus. In the nightmares the throats of those who hung are red and scarred while those that dove off high rise buildings have faces crushed like they did at impact.  And I was there in the front lines.  The aids patients who killed themselves in shame and misery. The children who failed their parents. The godless. The homeless. The sad and angry but mostly angry.  Occasionally there’s a gun and the exit wounds remain a memory like funerals that are subdued for a life so young.  Now more are suicidal and there are no beds. Their is no profit in the already marginalized.  My colleagues avoid them or reject them.  I’m there in the end but what is there to offer and what I offer they refuse. More and more they can’t afford the solutions that might change the course of history in this small important way but there’s rationing and so many people were unprepared for the party to end. Old age. Disease. Lovers leaving. No work because they thought there would always be jobs and the cost of housing rose and their pay didn’t and they waited too long to move back east. It’s lovely here in the summer. People kill themselves in the rain.  The faces accuse me.  I failed them.  I failed myself.  Even better I’m told I was wrong to care. I cared too much. I should have worked with healthier people, done more ‘prevention’, seen far fewer people, refused to see the very very very sick.  There’s only so much one doctor can do.  Each of us talks like this. I tried to share my nightmares but he was as frightened as I.  I saw that my horror triggered his horror and it wasn’t like soldiers. Ours is a dirty war. It’s like Vietnam. There’s no honour in stopping suicides and suicides want to distance themselves from you and their near escape with the abyss. Eventually death gets all of us. Why rush headlong. But the depression and the pain is like the rain. It’s sometimes 40 days and 40 nights. The long dark nights of the soul. The winter the men and women killed themselves with cabin fever. And my sleep is broken. My sleep is disturbed.  I have nothing more to offer her or him. There are no asylums any more. They closed the doors. The patients don’t even have homes.  There are no shelters.  The psychopaths and sociopaths steal the shelters and the homes and the money and the resources.  The corruption in the system is putrid but in the end they’re all so far away from the cries and accusations of the dying and the dead.  We’re going back to ECT and neurosurgery. All the pills and talk have been used and there are no further restraints.  Euthanasia is the only ‘medicine’ the single health care for profit government service will pay for says the truly cynical. I hold out hope. Offer yet another trial. I’m like an oncologist suggesting different treatments for the cancer of the soul.  Suicide.  Addiction. Depression. Schizophrenia.  I’m crying in the night again.  This too will pass. It always does. It lasted longer then but not now.  I know that tears are punished. There is no use in crying.  One shouldn’t care.  One shouldn’t advocate for the lonely and those in despair.  It’s all punishable. They punish those who feed the starving in America.  Do not feed the poor. Do not feed the animals. Do not stop the death. CO2 is the enemy. Stop the breathing. Save the planet. The rocks are more important than the life.  There’s billions for the spotted owl but not for the young man or woman not wanting to live in pain but worse not for the old.  The drug addicted psychotic with the false promises don’t even know which way to turn in their smoke filled haze.  They choose death like they would an ice cream bar or a toilet. Drugs and alcohol blur perception till death is like a bowel movement. Who cares.  Why are you stopping me.  Shut the fuck up. Don’t tell me death isn’t sublime. I’m going to kill myself and there’s nothing you or anyone can do about it. And there isn’t.  It used to be I could lock him up till the rage and insanity went away but there are no beds.  The hospital beds went to the jails.  The mentally ill are criminalized.  Marginalized. Stigmatised. And now I wake in the night with nightmares again. Dammit! Dammit! There’s nothing more we can do. There are no more resources.  There never were that many to begin with.  I’m old too.  I know more than I ever ever knew. I’m at the top of my game.  I’m a master and yet the challenges just get greater. I scaled the foothills as a kid but now each case is an everest of pain and disease and mental illness and lack of resources and addiction and suicide and crime and infectious disease and fear and anger.  I’m done in in the morning, worrying about details.  Did the shepherd count all the sheep. Did all the children come in from the playground .Are all the swimmers out of the lake.  Is there something new in medications I didn’t read about. Have I tried everything.  Should I have done a urine screen. How could I know the patient was smoking that much marijuana and drinking that much booze.  How come I didn’t do a home visit to check their medicine cabinet.  They were buying the benzos on the street. They got the opiates from several different sources. Why didn’t I see it coming. You did see it coming but you couldn’t stop it. They’re like bullets now but the speed of fire is machine gun.  You used to have only one person referred to you suicidal in a month but now it’s weekly. Everyone is suicidal and they’re all older and all the medications have been used by the gps and everyone has provided a consult but no one has time to sit with the patient and hundreds are clawing at your arms and legs and begging you for more time and I ask myself am I giving the time to those who need it most. It’s all triage now.  The ones that scream and scream and have seen everyone but won’t do anything for themselves may never get better but the one who needs just a little help might be missed but with just that hour or that day of care might get up and walk another year or more.  But this one can only have an offer of a detox but they’re refused the hospital and I know they might die. I’ve seen death. I’ve smelt death and I’ve known too much death.  But fresh out of school the boys and girls flock to the administration jobs. No one wants to work the front lines. No one wants to do more tours than the least possible with the chronics and the dying.  The rich are so much cleaner. The poor are so dirty. I scratch myself for days after some patients.  The scabies, lice and fleas and bed bugs get to me as much as the threats of suicides.  The threats of homicide are there as well. The bullying and the guns.  Sometimes they even point a syringe.  And it doesn’t bother me for weeks or months and then someone gets through the armour and I wake crying in the night remembering the judge condemning her for loving her child and her death in the morning papers.  And i couldn’t do anything about it so they condemned me as well.  And funny as it seems I’m sometimes visited by the old man that died because the hospital didn’t fill the oxygen tank and I was pumping dead air into dying lungs and he was looking at me forgivingly because well, ‘pneumonia is the old man’s friend’ .  So maybe the bureaucrats and for profit insurance folk in the space station offices are right euthanasia and give them a toke is all they need. The psychotic 20 year old Chinese genius smoking dope and never again to complete another brilliant year of university but convinced for ever that people are out to get him off in some schizophrenia ward when the drug dealer promised him nirvana.  MArijuana is good for you. It’s a herb.  I can’t forget the teen age boy hanging in his room, his clammy skin.  I didn’t even know him except to cut him down. Another doctors nightmare. Now a shared nightmare.  Silly now. I’ll go back to bed. It’s all so overwhelming but it’s just the rain.  And once again hearing ‘we have no beds’ .  Vancouver is not a place for old men, the mentally ill or the poor.  It’s a fast and tough city for the very best.  The old, and mentally ill and poor should move.  Die already.  Losers.  Here take some change. Move along.  And the money goes to the drug dealers and for booze.  There’s always money  for critics too.  And reports.  And special reports.  And committees.  I’m alone for an hour listening or talking or selling life and I’m the last one who will see the person.  “I phoned 37 psychiatrists and you’re the only one that would take them.” I’ve heard that dozens of times.  “I’ve no where else to go.”  And it’s not that I want to see them but I’m a people pleaser and I have trouble saying no. I have trouble collecting unpaid bills from patients or their rich lawyers or their rich families.  I have trouble saying no and trouble with accounting and thinking what’s in it for me and where’s the most money and how can I best use my time for my betterment not the betterment of others. I’m missing some special gene of self interest that would allow me to focus on the healthy and wealthy treating the worried well like health food stores and appearing compassionate with the broken fingernail. I’ve been bleeding out my butt for weeks he told me. His fistula smelt in the office but I didn’t say just taking out the aerosol after he’d left. The bandages must have slipped. The surgery went well. I’m so glad. He’s such a fastidious fellow. He was so ashamed of the smell.  I do hope the cancer doesn’t return. i’m praying ever day for my patients. I’m praying for them to be well.  I’m dying too. We’re all dying.  Life is finite. There’s not eternity here in this little compartment of infinite reality.  Why be so attached. Wear life like a loose robe.  Listen to the whining and the crying and the rage and leave it all at the office.  It’s easy. You do it most days. But then the nightmares come again.  I hate the nights of sleeplessness. I hate going to work bagged again knowing there will not be enough time and no more assistants and never any resources.  The boxes of kleenex and soap are an exorbitant cost.  The chairs have been worn out by sitting and waiting.  I’ve just ordered a new desk. The desks have come and gone as have the chairs and I’m still there.  It’s not all that much longer.  A decade, two at most.  It’s not like the beginning facing the 50 years before the gold watch, I’ve done 30 years.  Tens of thousands of strangers have become known and close and gone and they’re the sad, angry, sick and unhappy ones. So many are thankless. So many are just always ornery. Were born that way. Lifelong histories of difficulties, failures, crimes, divorces, lost jobs, illness.  So many people have let them down, used them, abused them and then there’s me and I’m just another one of them. The paranoids have given up differentiating friends and foes. Everyone is foe. It’s easier that way. Sometimes they take the medication. “It takes the edge off”. Other times they slash their wrists and bleed till they’re sutured in emergency.  She called me today and said she was suicidal and she’d told another helpless worker that she was suicidal and another hospital emergency had said they had no beds and I’m awake in the night wondering how I’ve failed, how I could have somehow stopped her jumping off the roof. They blur.  The boy with the gun.  All the ones on the suicide wards. The ones in the asylum. The soldiers here and overseas.  I’m depressed, doctor. I’m thinking suicide.  In the courts they get us to criticize each other dividing the doctors into the good and the bad so they can get ugly. The media loves the ugly. There’s sensationalism everywhere but in my office itsl just despair. It’s making love to same unloving woman or man day after day week after week. Everyone is good at the sprint. It’s the marathon that takes it’s toll.  I’m tired now.I’ll go back to bed.  The nightmares forgotten. The faces are gone.  I’ll go to graveyards. I ‘ll talk to trees. I’ll pray and meditate. I’ll sit alone in churches. I read and study some more . I’ll learn more and more about the latest drug and wait till some hotshot academic tells me I don’t know anything or some doctor police condemns me for not doing enough. There’s a shitload of critics and all manner of back benchers doing the light lifting but there’s way too few of us at the front lines.  There’s no resources.  It takes a village to raise a child.  They’re children. They’re humans.  They’re mentally ill.  I beg each day for my patients to get them food, shelters, medications, beds and it’s all unpaid. The begging the authorities and badgering the authorities. There’s no money in that. All I should be doing is writing a prescriptions and saying good day.  That’s where the money is. That’s what the smart doctors do. Those are the doctors who get ahead. They’re the ones that go on to police the doctors. They’re the smart ones who stay as far from the patients as possible.  8, 10, 12 hours of direct patient contact most days and for 30 years.  You should have stayed in that government job where everyone just met and talked about the patients in committees after committees but no one actually saw the patients. it was such a good job with all manner of perks and pension and health benefits.  you’re an asshole to have left the good things in life, the easy times. It’s your own fault you insist on seeing the really sick and accepting these end stage losers in your practice. you should be ‘selective’ like I am.  I ‘ve heard it all.  Dinner with the other old warrior doctor was good for the soul. We laughed when he told me he ‘d got scabies twice when I told him about getting TB .  Scars.  Silly silly scars. Memories.  I saw another TB today.  I didn’t know what that rash was and was so thankful that a colleague was there to look and recognize it.  Little mercies.  It’s so late. I’ve got to get some rest.  It’s a long day and the week has just begun.  They’re always dying around Christmas and then it’s a deluge till March or April. When the crocuses and tulips come, the suicidals lessen.  Until then it’s depression .  I’m just adjusting to the winter rains.  It rains tears in Vancouver this time of the year. I’m so thankful for all the other front line workers and doctors and colleagues.  My friend copes by riding his bicycle a hundred miles after work.  Now that’s one way of shedding demons. My other colleagues goes for day long drives. I’ve been out in the woods and really should be sailing.  But it’s just another day and another week.  it’s so much better than other years.  There’s the hope of death one day as release for sure.  Aging makes everyone seem less important in a different way.  It’s not so intense. And I can share it.  I don’t have to hide from those so superior they don’t ever cry and suck the life out of rooms when they swagger through the doors.  There’s so many working It’s worth it to remember that. So many things to be thankful for. So many nights of fitful sleep. So many good things and good friends. All the other patients weren’t suicidal this week. It’s just the one that’s triggered the deluge. The one that was phoning every night in the wee hours desperate has survived their storms this month and are smooth sailing, another job, a place to stay no longer crying in the phone and coming to the office desperate. The angry still hide behind the tears of self pity. The blamers and shakers still claim they’re innocent. There’s karma and retribution and no doubt you’ll come back as a butterfly. Someone has to be a caterpillar. These are the best of days.  So what if you wake in the night screaming soaked in sweat. It’s been an adventure. It’s a good year. Life is grand. God is good. Thank you for whole and everything and all. Thy will be done not mine.  God help me be the best I can be each day.  Be with me now as I go back to bed and help me through this night.  Thank you.