Saturday, April 3, 2010

PSYCHOPOMP - CHAPTER SIX (Twitter Novel / Keitai Shousetsu)

To start at Chapter One, click here

So it’s a 20 minute trip into town, 45 minutes in the waiting room, and now 35 minutes so far in the little examination room KG was led to through the maze of prefab hallways and computers and med carts behind the Checkpoint Charlie of the front desk. And then, Doctor William Hennig sweeps into the room, deftly checking the chart as he pirouettes to close the door. He beams at KG as he takes a seat and clicks open his pen.

“Hello, Mister...Granta! Would you rather I call you Kevin, or..?”

Shrugs amiably. “I usually go by KG.”

Makes a quick note on the file. “KG? You got it. You can call me Doctor Bill.”

KG gives him a weak smile. “Okay, Doctor Bill.”

Eyes dart back to the chart. “So you-are-in-for...a med change.” The doctor turns slightly, pulls his most sympathetic face, touches KG lightly on the arm. “The Paxil’s not working for you anymore, huh?”

“No, like I told the nurse, it’s been working less and less all the time.”

“Yeah, it’s been...what...” Again Doctor Bill looks at the chart. “5, 6 years about?”

“About that.”

“It’s pretty typical for that medication to run its course in just about that time period.” Doctor Bill rips the Velcro on a blood pressure sleeve, gestures to KG’s right arm. KG pulls up his shirt sleeve and offers his arm to the doctor who wraps it in one quick motion. “The question now...” The doctor pumps, holds, releases. “Good! The question now is: what next?”

KG shrugs. “You tell me.”

“You’re looking to continue on medication.” More a statement than a question.

“Yeah. Yes, absolutely.”

“Well, then you’ve got two choices. On the one hand, we’ve got Lexapro. Same family as Paxil, same basic results, fewer side effects.”

“No vivid dreams?”

Doctor Bill grins. “No. None of that on Lexapro.”

KG grimaces. “No, you misunderstand. I want that. I’ve really missed that since the Paxil started becoming ineffective.”

Doctor Bill raises his eyebrows, tilts his head in a very parental manner. “KG, I’m in the business of prescribing medications, not side effects.”

KG, embarrassed: “I...used a lot of the stuff from my dreams in my work, that’s all.”

“That’s right, you’re a...musician?” Looks at the chart.


Chipper. “Well, sir, you’re just going to have to find your inspiration elsewhere.” The glib way he just dismisses what was, to KG, incredibly important. “Your other option, which, unfortunately for you, also does not result in vivid dreams, is Effexor. With Effexor you get a combination effect because it consists of an SSRI and an SNRI.”

“Another type of reuptake inhibitor?”

“That’s right. Norepinephrine.” Impressed that KG knows the terminology. “Again, far fewer side effects compared to Paxil, but it’s a gradual slide in compared to the Lexapro, which should kick in pretty quickly.”

“Which is...which is going to help more with the Paxil withdrawal?”

“Hmph. Well, I mean...”

“Because from what I’ve read, it’s a real bitch.”

“Ha ha. Well, yes, it’s...there is going to be a certain level of...discomfort...with the change. That-is-not...something you’re going to be able to avoid.”

KG sighs. “Right. So it really doesn’t matter.”

“Not for that part, no. But you should see a quicker turnaround on Lexapro, or a more gradual, gentler intro with the Effexor.”

“Hmm.” KG is just afraid of the Paxil withdrawal, and is having difficulty making any choices. Doctor Bill mistakes his silence for something else.

“We-e-ell, there is something else we could try, but although the test results were all very effective, the jury’s still out on the long-term effects. But the side effects should line up nicely with what you’re looking for.” Smiles. “All kinds of dream-stuff going on with this one. Of course, most people don’t want that, but in your case – hey, to each his own.”

“What’s it called?”

“Comaxyn. I’ve got some literature on it, and we got a bunch of samples when it was approved earlier this week, so if you want to give it a try it’s very possible for us to make that happen.”

“I’ve never heard of it except for an item I saw online just this morning.”

“As I said, it’s real new, just approved, so I don’t have the kind of long-term studies available that I have for the other two. But again, vivid dreams are the only noted side effect so far, so it may be just what you’re looking for.”

KG thinks for a moment. The doctor gets up.

“So, is Comaxyn what we’re going with?” He looks at KG expectantly. KG never fails to be amazed by the speed with which medical personnel expect patients to make decisions about incredibly powerful drugs which can literally change your mind. He sighs.

“Sure, Comaxyn. That’s fine.”

Doctor Bill smiles. “Okay then. Now, I say this to all my patients taking psychiatric medications, and you are no exception: a combination of medication and therapy has consistently proved to be...”

KG waves him off. “Yeah, no, I’m good. I mean, I’ve tried it a bunch of times. I’m kind of...therapied out. You know?”

“Okay, then.” That obvious requirement out of the way, the doctor moves to the door. “The nurse will be right in with the samples and the brochures, and I’ll want to see you back in...three weeks?” He looks back at KG, who nods. “Just drop the Paxil by 100mg everyday for the next three days, then open with the Comaxyn starter pack on Thursday.” He puts out his hand to shake; KG takes it. “Just make your appointment at the desk on your way out.” Doctor Bill smiles. “Stay well.”


The doctor spins out the door and into the claustrophobic maze of the receiving rooms.

Go to Chapter Seven