Second opinion

IT's a rum world: everything is upsidedown or inside-out, a mixture of Kafka and Through the Looking-Glass, of the sinister and the hilarious. Horace Walpole said that the world is a tragedy to him who feels and a comedy to him who thinks, but to him who both feels and thinks it is a tragicomedy. One wants to do away with oneself and fall about laughing at the same time.

Such, indeed, is my daily fate. Last week, for example (and I take it only as an example), there was a man in my ward who had taken an overdose of methadone. A foolish doctor had given him a week's supply rather than a day's, and my patient, not believing his luck, had celebrated by scoffing the lot. Then he stopped breathing. After we revived him, I asked him why he took methadone.

'I've taken meffs for five years,' he said.

It is amazing how many people consider such an answer to be perfectly satisfactory. I tried again.

'Yes, but why did you take it in the first place?'

'Well, if I didn't take it, I'd have to take heroin.'

'Why would you?'

'Well, I have to take something, don't I?' I suppose that is true of us all, and since the line of questioning was — as the prisoners would put it — doing my head in, I changed tack. I noticed that his arms were covered in injection sites, suggesting that he took methadone in addition to heroin rather than instead of it.

'When did you last inject yourself?' I asked.

'I haven't pinned up for three weeks,' he replied, 'thanks to the meffs.'

'So you've been taking methadone for five years to give up heroin for three weeks. It doesn't make a lot of sense, does it?'

He had also taken large doses of tranquillisers, known round here as diazzies, nitrazzies and temazzies.

'Where did you get them?' I asked.

'I was passing this drug clinic and a woman what I know came out. It's like a big circle.'

'I thought you were going to say it's like a big circus.'

He laughed. 'Well, it's that as well. Anyway, she shook my hand and put these pills into it, so I took them.'

You don't look a gift pill in the pharmacopoeia. Not that it would have made any difference if he had: he knew they were dangerous in conjunction with methadone, he didn't want to die, but he took them all the same. It isn't information people need, it's something to live for.

I went that afternoon to prison. My first patient was a man with a bad case of gold-front-tooth syndrome, gold-front dentistry being the display plumage of the slums. I asked him in the course of our conversation about his schooling.

'I was expelled from every school I ever went to.'

'Why?'

'Fighting.'

'How's your arithmetic?'

'What's that?'

About half of the people under 25 round here have never heard of arithmetic. Their three Rs are Rock, Reggae and Rap. My patient explained that he had always truanted. 'That's where all the crime came in,' he said.

'Came in?' I repeated. Unbidden visitors are always unpleasant.

'Yes. I mean, I've had 139 convictions in the last five years. It's all madness.'

'What is?' I asked. 'The crimes or the convictions?'

'My head,' he said. 'It's cabbaged.'

Theodore Dalrymple