THE PSYCHIATRIST, THE HEMATOLOGIST AND THE PATIENT

So far so good it has been easy on the haematologist  I hope by the time the patient is in dire need of the haematologists help, the psychiatrist would have done a very good job. Being a sickle cell anaemia patient means encountering agonizing pains that could last from a few minutes to weeks which makes it the haematologists duty to find an analgesic that will keep the patient sane enough for a long time. Most of these drugs are either NSAIDs or opioid  These drugs may be used together sometimes or staggered (mixing them up instead of using one the entire period eg; morning dose could be diclofenac, afternoon tramadol and night ibuprofen).

Recently my thirst for want of pentazocine, an opioid, began again! I would rather not go into details of how it started. When I noticed I was getting back to the old habit, I knew I needed help but with that feeling of non-stop crisis, I just wasn't fully ready to face the beat. I went to my haematologist and complained of the pains I had been experiencing and only partially told him of my past dependence/addiction to pentazocine and how I was scared it could be happening again. He prescribed a couple of investigations requiring blood and urine samples and dihydro-codeine (DF118). To be honest the drug worked just as effectively as any other analgesic but in my mind there's this extra efficiency of pentazocine/promethazine when taken! I couldn't help myself I had to find a way of getting a shot of penta/prometh. I did! In fact, I managed to get 2 ampoules! Happy me! That was on a Monday. On Tuesday when I went to give my blood sample, I finally decided to go and see a psychiatrist.

It's a very rare case for a "sane" person to go and report to a psychiatrist in Africa and in cases of drug addiction/dependence it was a miracle if the person went of his/her own free will. It is a very hard habit to break. Lakin... when I found the psychiatry department and went in I met with Dr. A who had patients with him and after the introductions and all, he told me they had clinics on Wednesday afternoons and he would see me there. That was great news I had haematology clinic that same Wednesday morning, so it was perfect!

I had such a long day, leaving home really early so I can get an early spot with the haematologist  Normally, the doctors attend to in-patients before getting to out-patients wherever we are located; speciality or general. So clinic starts roughly between 10:00hrs - 11:00hrs. Blessed are those who forfeit sleep for they shall be called in first! Amen! I was called in first and I met Dr. A (apparently the hospital's filled with Dr's A). We had a lively, friendly chat on genotype, blood group and sickle cell awareness then I told him about my little miracle, Aisha (of course). I was cleared with the normal prescriptions; folic acid, proguanil and some analgesics; tramadol, celebrex (expensive drug) and an appointment in 4 weeks time (11th Sept, 2013). I didn't get any of the analgesics *embarrassed smile*. I was done pretty early which left me with so much time till the psych sessions. I was really tired and just wanted to sleep...no! Wait! Eat, drink then sleep.

It was finally time and psych Dr. A came in and casually checked the waiting room; I guess it was for me, probably to see if I was just another one of them say-no-do persons! I was there! My name was called! Our conversation went thus;

Me: Good afternoon

Dr: How are you?

Me: I'm fine thank you.

Dr: So why did you come in yesterday, it is very rare for patients to come into psychiatry on their own?!

Me: It's actually a long story but lemme start from the end I'm addicted to pentazocine/promethazine...see, I was addicted to it about 4 years ago..." Then I went into details of my last encounter and how the present one started. He asked questions, I answered. Some of the questions I can recall were on the triggering factors, personal life, family life, financial and educational, and finally the reason why I came seeking for help and if I came on  my own free-will.

I did come on my own free-will and I had two main reasons "First; for my daughter. If I live long enough till she gets older, I know she will be needing my help and I want to be fit/sane for her. Second, I am a sickle cell patient and I don't want there to be a time when I will be in dire need of an opioid but it doesn't work for me." Dr. A went on to give me more reasons Religious reasons, it intoxicates the system and makes us unaware of the real life and it is forbidden to pray or even be in that state with no legitimate reason. It harms the organs, gradually. During job interviews, a doctors general assessment of the applicant will be needed and he can't...no, won't give a pass to an addict. It could also affect my work and interaction with people.

Dr: I am glad you are determined. It is going to be a long process divided into two..." Then he went into detailed explanation of  how there's physical drug dependence withdrawal symptoms which we could treat with available medications and the psychological drug dependence withdrawal symptoms which would take a lot of work especially on my part. He told me about a drug test that would have to be done regularly but he didn't want to put more financial stress on me.
Dr: I want you to promise that you won't let me down. Don't take the drugs no matter how much you may feel you need it. I will be counting on your honesty to let me know if you took it.
Me: In Shaa Allah I won't let you down. In Shaa Allah.

He prescribed diclofenac (PRN) for any pain that I may experience, loperamide (PRN) for diarrhoea (these two are part of the physical drug dependence withdrawal symptoms which he said I may experience), carbamazepine (ON) at night only and an appointment for the following week.

I thoroughly enjoyed my first session with him and was looking forward to the following week!