Outpatients appointment in the spinal injuries unit. Seeing Dr Derry. He is standing in for Mr Nuseibeh. Derry will soon be a consultant himself. Ann Mackenzie it is at the desk. She welcomes me with a smile. We exchange greetings. I wheel onto the platform of the electronic weighing machine. 56.2 kg after deducting the weight of my chair. She takes my blood pressure. 85/50. “You are in consultant room number three,” she informs me.
Derry opens the door and beckons me in. I enter and settle at the far end of his desk. He sits in front of it, swivels his chair and faces me. He is thin, clean-shaven and is dressed in a white clinical coat. He is a respectful and thoughtful doctor. I like him. I have always liked him.
“Hello Michael. How are you?”
“I’m not doing very well, Dr Derry.”
“What’s the problem?”
“I’m spasming badly. The spasms are vicious and cause my blood pressure to rocket. It gives me terrible headaches, brain splitting headaches.”
“What medication are you on?”
“I’m taking 200 mg of morphine?”
Derry’s jaw drops. He nearly falls off his chair. “What? 200 mg of morphine? Who on earth prescribed that?”
“I told my GP I was experiencing agonising spasms and pain, and really high blood pressure — the spasms were causing my blood pressure to shoot up. My head felt as though it was splitting apart. I asked for the most powerful medication he had. I’d been through all the usual painkillers: paracetamol through to codeine and tramadol. They were useless, so he prescribed morphine.”
“He gave you morphine for spasms?”
“These are no ordinary spasms, Dr Derry. Sometimes they’re so violent they toss me out of bed or my wheelchair.” — I sense I am babbling, desperate to get my point across. “I ended up wedged down the side of the bed, pressed up against the radiator the other week. The most terrifying thing about them is the blood pressure. The slightest twitch causes it to rocket. The systolic goes well above two hundred.” — Now I really am babbling. “I get an intense pain right in the centre of my brain. It’s excruciating. My GP originally prescribed 20 mg of morphine, but I ended up taking 200 mg to get the same effect. Now I can’t stop taking the stuff. As the drug wears off my spasms increase. I’m in a vicious circle. I have to keep taking more and more morphine. If I don’t the spasms and blood-pressure will kill me. It’s as simple as that.”
“Didn’t your doctor warn you about building up a tolerance?” Derry sounds alarmed, angry.
“Yes, he told me this was very addictive. But I was desperate. I am still desperate. Can’t live like this.”
“Okay. I’ll take your blood pressure now. He winds a cuff round my arm and pumps on the bulb. I watch the mercury rise up the gauge. “Hum … it’s not too bad. 140/80.”
I’m surprised. It was much lower when I first came in.
Then he slides a pen tip across the top of my thigh. I feel a thud in my chest, then a tightening around my throat. He takes my blood pressure again. His eyebrows rise. 210/95. Scribbling notes, he says, “Your skin is incredibly sensitive. I need to discuss this with Mr Nuseibeh and Dr Jamous.”
“It all started after Jamous cut the nerves to my spinal cord. I never had any of this before then.”
“Interesting …” Derry clasps his hands, touches his lips with the tips of his index fingers.
“Do you remember treating me when I came back onto the ward after the operation?”
“You may recall, then, how tight my stomach muscles were. They wouldn’t stop wobbling. My blood-pressure was elevated, too. Those spasms never died down. Then my feet started, and then my legs. My back muscles are also as tight as a drum.”
“I’d have to refer back to your notes. As I say, I will mention all of this to Mr Nuseibeh and Dr Jamous. You will eventually have to come off morphine. It’s doing you no good. We are most probably going to have to wean you off. Meanwhile, I want you to start reducing the morphine and take oral baclofen. Reduce as much as you can. You’ll hear from us soon.”
“How much baclofen will I be able to take?”
“Hundred milligrams a day.”
“Thank you for seeing me.”
Derry gets up and opens the door. I push my way out of consultation room. We say goodbye to each other. Wheeling past Ann who is still sitting at the desk, I smile. “Bye, bye Ann,” I say.
“Bye Michael. See you next time.”
I don’t know whether I’m a anxious or glad to get out of the place. I hate hospital. They have cured me and fucked me up in equal measure.