Tuesday, May 27, 2008

A Day in an Iraqi Psychiatrist Life (part 2)

Yesterday was the last day of my break from work. I went to bed soon after the electric power was lost. That was at 12:45 midnight. It was hot. I woke up first at 6:00 am. I take a look at the clock. I felt how much my throat was dry. I tried to swallow but there was no saliva. I searched for the water bottle. It was hot water but it helped a lot. I decided that I sleep a little. I woke up at 6:45 am. I have some headache. Some neck pain too. Oooh I said to my self and walked drowsily to the refrigerator were I found a cold bottle of water. I felt better. Washing my face, taking on my clothes, putting the flash ram, a pencil, and money in my pocket I’m now in the street feeling that the sun’s light is so intense, so I contracted the muscles around my eyes. I took my first bus at 7:00 am trying to relax my forehead muscles which are already frowned, a thing that will cause me tension headache in an hour or two.
At 7:15am I bought a weekly magazine and took the second bus. At first it was so fast. The streets were not that crowded. I enjoyed reading about the history of Baghdad in the magazine. We reached that area. The road was blocked. Cars were stick one to another. We entered that irreversible crowd. Our driver tried to go back but he could not because of the cars behind us. We stayed that way for some minutes. Then cars started going back on the other part of the road. Our driver told us that there is no way he can made it to the place we were going to and that he will go back. I asked the driver whether I could walk for some distance and find another bus. He showed me the way. I went and it was so easy to find another bus, but it took me so long to reach another blocked road. But this time all the people left the bus silently and the driver started looking at me and told me: “this is it brother, it is blocked since one month!” I asked him how to reach my place of work; he took a pause and then told me to ask those men standing near that bus. I went to that bus, I asked them, they proposed that I take a bus that goes away from my working place then find a bus that goes to my working place. It was the only way. I made it. I took a bus, then a jeep. A jeep made in the 1930s or 1940s, with one sitting next to the driver, 8 in the back, and 2 or 3 stand on the back door. You know what? I was among those who stand on the back door.
So it took me 5 buses (4 buses and one jeep) to reach my job at 10:10am. I walked fast to my room to wash my face again. I took my white coat and went to where the committee must be now. It is Tuesday, and the forensic psychiatric committee is held to see the new cases and review the old cases. I was supposed to be there at 8:30, or at least 9:00 to see the new cases and write my notes before the committee is held at 10:00am. Anyway, nobody asked why I was late. They started there interviews. I listened and asked few questions. One of the new cases was a case of substance use disorder. He said he want Parkizol (=artane= trihexiphenidil). He repeated that. Then he started crying. The senior told him that it is ok. But he wanted it at the moment. Then all of a sudden he pulled a razor and put it in his mouth. He said: I will swallow it if you don’t bring me Parkizol NOW!!!!
We were all silent; only one senior was dealing with him. The police tried to help but all they did is just to make him more agitated. The senior asked them to be silent. They could not. The senior asked them to go. They did. The senior talked a little with the man who started crying profoundly. The senior asked one of the police men to come in, then the senior asked the man to give the razor out of his mouth to the police man. The man obeyed him. It was a lisson for me how to deal with theatrical patients and how to stay calm.
After that the senior next to me (there were 5 seniors today in the committee) asked me: Sami, what is the difference between school phobia, and truancy from school. It was an easy question. That senior loves me and loves to see whether I know things or not. He loves to ask easy important questions. I answered him. He said: Sami, you are good. At that moment I thought that my senior is just trying to raise my moral. To make me feel more confident. Especially after what that man with his razor did. My senior may had felt that I was tense. But why school phobia came into his mind? Well we can say that I’m a student in a school, and I may have some phobia especially after seeing such a man with multiple scars of self mutilation who threatened to suicide. Was that senior telling me that it is better to have a “school phobia”, like in my case, than to have “truancy from school”, like in that man with substance abuse disorder case? You may see those last lines silly but that was running in my mind when I was walking back to my room at 12:30 pm after the committee finished its work
I took my lunch at my work and it was: rice, a wing of chicken, yoghurt, and a half of an onion. At 1:30 pm I took the first bus back to my home. I reached my home at 3 pm exactly after another 3 buses that run so fast cause the streets were open this time. I took a bath. Oooh dear, I told my self, how beautiful life is! I put my head on the pillow for some minutes. Then took a thesis entitled “prevalence of depression in the physically disabled patients”. I thought about my coming thesis which will be entitled “prevalence of depression in psoriasis patients”, and wondered of the methodology I may use. It took me for about 30 minutes examining the tools of the methodology of the thesis in my hands. It uses the general health questionnaire-30 (GHQ-30), then used the ICD-10 structured interview on the positive cases of GHQ-30, then finally used the Beck Depression Inventory 13 to assess the severity. I wondered if that was necessary.
At about 5:00 pm, I took Michel Foucault book “history of madness” and started reading about the ship of fools. And I wondered wether the ship of fool is still existing in Baghdad symbolically.
At 5:30 pm water came back to my home. I started washing my clothes and dishes.
At 6:30 pm I took one of the psychopharmacology books to see whether there are long term side effects to the tricyclic antidepressants like a patient had asked me today. I told him that there is no need to worry but told him that I will look for the rare ones for him. I can remember I have read someday somewhere that there are reported cases of tardive dyskinesia due to long term treatment with tricyclic antidepressants. But I failed to find this note again today. I will look for it again before midnight in Companion to psychiatric studies because I think it was there were I read that thing. It must be that I read it somewhere but I want to make sure about it. After midnight I will go to the my sleep land to find some dreams waiting for me.


Jeff said...

It's funny how our minds are limited.

I try to read and think about Iraq a lot since my people have so much responsibility for what has happened there. And I try to be respectful when Iraqis talk and listen instead of telling them my own stupid outsider ideas.

But you know the thing that made me raise my eyebrows in surprise was that you were writing about psoriasis! Iraqis have psoriasis????

Of course they do! But it's easy to forget when big things like wars are going on that people get psoriasis too and it makes them miserable. War doesn't change that.

All the time that extraordinary things are going on, ordinary things are going on too. That's what I like about your blog. It gives a window into the "ordinary" life going on in Iraq.

But of course, with human beings, the ordinary is often not really so ordinary after all!

tracy said...

Wow....what a day...5 buses, a patient with a razor blade in his mouth (ouch, that one hurts to even think about), self-mutilation, school phobia...i thought my days were, ah, rough lately.
i hope you had some very sweet dreams,

Jeffrey said...


I thought of you last week when I read this article from the BBC:

A Shoulder to Cry On in Baghdad.


tracy said...

wow, excellent, heartbreaking article, Jeffery, thank you so much.

Hi Sami

Abbas Hawazin said...


have u read this?