الجمعة، مارس 28، 2008

لا تقتل، لا تسرق، لا تمرض


عزيزي المواطن: لا تكن بين السادسة عشرة والرابعة والعشرين وتسقط من مكان عال وتأتي لتصلح كسورك، خاصة لو كنت واعيا!

حتى تسمع صراخ انسان يتم جذب كتفه وجسمه في اتجاهين عكسيين لرد خلع الكتف بدون تخدير فأنت لا تعرف بعد معنى الرعب.

كنت أقول للأصدقاء إن الذكور المصريين لا يفعلون شيئا سوى أن يقعوا من أماكن عالية صباحا أو يُسقِطوا عليهم أشياء من أماكن عالية كنوع من التغيير، ومساءا يتعاركون سويا ويتسببون لبعضهم بجروح نافذة بآلات حادة. يأتون للمستشفيات فيصرخ الأطباء والممرضون ورجال الأمن فيهم ويزعقون ويتأففون من صراخهم المحموم. يُتركون في الممرات لأن لا بطاقات شخصية معهم – وهو خطأهم أن لم يحملوها معهم بينما يحملون "القصعة" ويصعدون السقالات رديئة الشد التي يسقطون من عليها. قد يأتي الضباط من القسم ويسبون أمهاتهم لو كانت هناك شبهة جنائية.

يشيع التمريض في الطوارئ إن الحالات تزيد حين أكون موجودة. أقول لهم إنه على الأقل في هذه الحالة لا يكون لديهم وقت للتعارك بالأيدي مع المسعفين – وهوما حدث قبلها بيوم حين تجمعوا ونائب الطوارئ وضربوا المسعف في معركة شوارع أمام باب الطوارئ الخلفي.

تأتي الأمهات برضع مرضى. مع حلول الساعة الرابعة مساءا لا يعود هناك أي مكان في قسم الأطفال، ولا مكان للرضع. كلهم مرضى بصدورهم. إحداهن تأخذها الطبيبة بدون أن تسدد الرسوم رغما عن التعليمات الإدارية لخشيتها إن الفتاة لن ترى الصباح لو خرجت، خاصة مع أمها محدودة الذكاء. الطفل المريض مسكين جدا، يكف عن البكاء والرضاعة والاستجابة ولا ينتفض حتى من الألم.

ينقلب التوك توك ويصطدم بسيارات وحوائط وبشر وغيرها. يقود التوك توك عادة ذكر تحت العشرين. في إحدى الحوادث يصاب الفتى و يسحبه زميل ويأتي به إلى الطوارئ ليدخل الصديق في سين وجيم وخناق مع الأمن والتمريض الذي يتلذذ باصطياد اثنين من الفتيان المساكين جدا، يهددونهم – بينما الفتى المصاب مازال تحت العلاج – بإنهم سيبلغون الشرطة التي ستأتي لتأخذ كلاهما. يبكي الفتى المسكين – المصاب - ويهرب بجلده خارجا دون أن يستكمل الاسعاف. "في ستين خرارة": يقول الملازم الذي حضر لاستلام محاضر اليوم. أنظر له وأقول إن الفتى لم يتهم أحد أصلا ولم يطلب الشرطة. يقول الملازم – الكبير في سن، يبدو إنه ضابط "مخلة" – آه، الموضوع لا يخصنا إذن.

ركبة الرجل معوجة تماما. شكلها غريب جدا. أسأل نائب الطوارئ: "تفتكر فيه كسر كمان ولا خلع في المفصل بس؟" يرد إنه من الصعب أن يكون مثل هذا الشكل الغريب مجرد خلع. ينزل نائب العظام. وجهه دائما مكفهر وخلقه ضيق. يصرخ الرجل فور أن يمس ركبته.

"لا يا دكتور، عايز بنج"

"مافيش بنج" – ويطرد زملاءه.

أطرد نفسي أنا أيضا. تعودت أن أطرد نفسي في أوقات معينة، حين أرى ما لا أرغب في تعلمه ولو من باب العلم بالشيء. لا أريد أن أتعلم كيفية رد العظام بدون مخدر ولا كيفية تقييد الأطفال ولا الخياطة بمخدر موضعي غير فعال ولا فحص ضحايا الحوادث بدون مسكنات.

أقابل المراهقين الصغيرين أصحاب حادثة التوك توك. يدفع الفتى زميله المصاب على كرسي ذو عجلات خارج المستشفى. أسأله عن اسمه. يبكي قائلا: "عبدالله". أقول له "سلامتك" فيبكي أكثر وتنزل دموع كثيرة. وأفعل ما وعدت نفسي ألا أفعله منذ بدأت ارتياد المستشفيات. أعطي لنفسي بعض الفرصة في البكاء بعد أن أخلع المعطف الأبيض الخانق في الحمام.

أرجوك يا أخي المواطن، لا تمرض ولا تصاب في حادثة ولا تقع ولا توقع عليك شيئا. أرجوك!

الثلاثاء، مارس 18، 2008

Regarding the Provigilled Me



Dedicated to Mostafa, my friend who thinks I’ll give him an idea about the abuse of modafinil ,who hates benzodiazepines and writing his name with a “u”

I’ve read almost all the literature I could get my hand on. Actually, I have known about it for years after I first read on the research on the hypothalamus biological clock that earned its guy the noble prize who knows when. I just kept asking pharmacists about it, till I did find it. Having read a lot about the dream drug, I didn’t know what to expect, maybe because I almost never experienced what they were talking about. There was no “old me” I was craving to be again. I remember talking to Elset Naama a couple of years ago, when she said she doesn’t like getting older and wishes she was a teenager again. I said I didn’t care. Regardless of the philosophical views of experiences and such, I was neither more active nor more energetic when I was younger. In fact, my energy level is getting better year after year – physically speaking, and NO, it’s not a good thing.

I have struggled for energy since I was a kid. I was not sick, I suffered no chronic ailments or disabilities, but I seemed to always be lacking energy physically. Of course I was better when it was things I was motivated to do, but sometimes it was ridiculous. I mean, I had nothing against school, I was making perfect grades, I was sleeping by eight, and waking up feeling so tired at seven the next morning. I was six. There was just no reason that could come to mind. I was tired in mornings to the point of tears, and it took hours for me to get into the day. It got a little better in late childhood, to head back to square one in early teenage years, and get worse from there on. True, they say some people are just not morning persons, but that was beyond. No amount of sleep gave me a fresh wake up. I was spending more and more time in bed and being in the company of books didn’t help in making me realize I might be missing on something. In secondary school I was skipping days for the sole reason of being too tired, without a physical ailment and no, I wasn’t saying that so my parents would let me stay home. It seldom mattered anymore if the thing I was supposed to do is motivating to me or not.

Through college it was like a nagging pain that one can’t really locate. It didn’t help that I took a job as a flight attendant; the hectic sleep-wake schedule was too much for the already fragile energy chemicals. I remember vividly after finishing the service on flights that I sometimes just stared at the carpeting of the full plane and recruited all my self control to stop myself from just laying my fatigued body on the ground and lay my head to sleep and breathe. In fact, this feeling is one of the most vivid memories my memory of feelings has registered.

I never seemed to be on the same energy levels as my peers. I began faking excuses early, because teenagers don’t get “too tired”, and it seemed lame. Sometimes I went through the day by picturing my bed at the end of it. Somehow breathing was easier in the recumbent position. In college, when everyone was on their feet, I was looking for a chair. I once had to leave a camp to be able to get some rest and return. Not really flattering when you’re twenty two.

It was hidden well. I was an over achiever, so subtracting the lack of energy factor, I became an “achiever” and no one took notice. It really took decades, when I made a closer group of friends that they began to notice that I do seem to spend all my life in bed and fall off suddenly. I envied people my age who were always on the run and never seemed to fatigue. I employed yoga, meditation, tai chi, prayer, multivitamins, supplements, doctors appointments, therapy, diet changing, caffeine, detaching from life, antidepressants - nothing of which seemed to really work, nothing of which put me on the same level as those my age and my health status. And of course there were the headaches, terrible ones that started on my fifth year in school. They hit me just like that one day and I had my first aspirin ever (other than baby aspirin when I was a toddler), my mother never medicated us. I remember that I marveled when the pain was gone, I thought it was there to stay, because it was so bad. I thought something serious was wrong with me. I hadn’t known any pain like it before and I hadn’t known the marvel of pharmaceuticals before, either.

So, my enthusiasm when I heard about modafinil is understood. I got excited about Arcallion, that doesn’t even have the starch in the placebo. I never dared or even wanted to try amphetamines, I always wondered about them, but I really didn’t care much about the anxiety and the craziness, my cup was full and flooding already.

Two weeks ago, I had a deadline and I popped a 200 mgm pill of the oblong provigil tablet. Well, actually half of it first, and when I waited for a couple of hours for my world to rock and it seemed I was just sitting there staring at the laptop screen, I popped the other half, for a couple more hours I felt like my usual half-sleepy-on-the-couch self, and then I noticed something. It was almost 4 o’clock in the afternoon already, and I’ve been working for 6 hours straight, I even forgot to move my poor back. I finished, had still enough energy to prepare lunch, wasn’t tired at all, did three loads of laundry , called the movers to take my old bedroom furniture and was sitting up straight for an evening of work on the laptop. It might sound like a regular day to most thirty year olds, but it is never the everyday thing at my ville. Of course I noticed my back hurt at night because I was so into what I was doing that I forgot about it. I forgot to eat too and was a bit too active to sleep (probably because of that second half of the pill, but hey, patience was never my thing).

Last week, my second half a pill this time, was even more impressive (never underestimate placebo). On four hours of sleep, I was in college by time for 4 lectures and ten hours straight in the emergency room. I assisted in 15 trauma cases. I couldn’t believe it. This was definitely not me. At midnight I was so mentally alert it was frightening.

Today, I took my third pill. A whole one this time because I was really tired. It has been several days since I felt well. So, spring cleaning was done, my deadline was met, I spent the evening with a friend, carpets were scrubbed and cleaned and inventories taken. And here I am, writing this, so vividly alert, it’s almost divine. Maria, who spent the evening with me comments: “something is different about you, you’re active, it has been a long time since I’ve seen you like that”. Well, it takes Maria to notice that within an hour. And on that note, abundant energy is not all. I’m alert, mentally active, couldn’t be tired, craving mental activity, dying for a mentally challenging book like some sort of an itch! And, amazingly, unlike other chemical agents that elevate alertness, anxiety seems to flyaway, probably because one has no mental space to give for anxiety in a frenzied search for mentally challenging activities

Of course it’s not that simple. It’s hard to handle a 24 hour steady energetic state. One better choose the days of “provigilling” carefully. It is tiring in its own way. There is also the ignorance factor. It’s a new drug, we still don’t know. No one should take it on a daily basis, or even every other day except if it’s really worth it – I understand that in narcoleptics and people working with lives. I hate that school kids are using it to achieve more – the good ones, what kind of place have we put them in? I hate the fact the doctors are prescribing it way too much off label to be taken daily. I hate that it will give devils more mental power and let not the evil sleep. I love that it gave me days like those of thirty year olds. I love that it alleviated my anxiety on a tough hospital day without wearing me down.

Is it worth the price? 70 Egyptian pounds per a 200 mgm pill is a lot, but hey, one only needs half a pill and only once a week or twice at most, that tough start that gets the week going, or that terrible Thursday one just can’t take, or that last night before surgery’s final exam.

That’s not the scary part though. The real horror is this: “If it’s antidepressants that give people a positive outlook on life and a forgiving lovable self, and it's anxiolytics that make them take decisions more rationally and it's stimulants and "performance enhancing drugs" that makes them alert and memory sharp, what’s left of the real person? Without the positive outlook of SSRIs and the motivation of NSRIs and the rationale of short half-life benzodiazepines and the jitters of caffeine and the energy of modafinil… , who the hell are you? Who the hell is anybody? It’s a new world for sure, but I doubt it’s brave, or else, it wouldn’t have took it all these chemical equations just to look the morning in the eye.

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