Of Needles and Things

Julie is dependent on the medicines she takes. She’s taken them for so long – all through her adolescence and early adult-hood – that we can’t always tell what is Julie, and what a side-effect of her medicines.  A few days without them rapidly leads to disaster.  This doesn’t necessarily mean that she can’t function without them at all – but it does mean that if she comes off them suddenly, the powerful withdrawal symptoms are overwhelming.

The last two admissions to hospital were triggered by inadvertently coming off her medicines, so Julie opted to have monthly injections.  This is working reasonably well, though it may need some fine tuning.   Just after the injection, Julie feels great.  She’s cheerful and funny, and her old self.  As the month wears on, she slowly winds down.  The old worries start to surface, and she becomes more withdrawn, harder to motivate, and increasingly odd.   We suspect she would benefit from a little more of one of her drugs, but she hasn’t seen the community psychiatrist in six months.  

There is one unexpected problem with logistics: GP surgeries only allow you to book 3 weeks in advance.  This means that if you have treatment at 4 week intervals, like an injection, you can't book the next appointment before you leave the surgery - you have to remember to phone back a week later.  Given that the huge benefits to everyone of keeping Julie out of hospital by giving her these injections, this rigid bureaucracy seems a false economy.  A patient who has recognised problems with memory, and who struggles to take medication regularly, is expected to remember to make an extra phone call every month.  It seems odd that we are the only people checking that she makes and keeps her appointment, and nobody following up to make sure that the treatment is effective.