Second opinion

IT has long been known that, along with an inability to learn from experience, the desire to take medicine is what distinguishes man from the animals. This desire, indeed, is what kept the enterprise of medicine as a profession afloat during the many long centuries when there were plenty of drugs but no cures. The placebo effect pleased the doctor at least as much as the patient.

For many centuries, therefore, it was perfectly rational for man to be irrational, at least with regard to illness and its treatment, for the raw, unvarnished truth was insupportable. Unfortunately, irrationality cannot be switched on and off like a tap; so now that man has more control over nature than ever before, he seems to have no more control over himself than at the dawn of history. He is just as badly behaved as ever, but with a wider range of choices.

Last week, I was consulted by a female patient in a semi-Taleban outfit. Round here, most young women are dressed either as a nun or as a slut, the nuns being by far the more attractive, of course; for young white flesh raised on an exclusive diet of takeaway food and exposed to the open air is distinctly off-putting. Oddly enough, quite a few of the young women in their Muslim headgear smoke cigarettes, which I suppose could give rise one day to a charge of attempted arson with recklessness as to endangering life. So far, though, they've always got away with it.

My patient in the full costume had been admitted to hospital unconscious after having swallowed an unspecified amount of methadone, the heroin substitute that is prescribed by doctors for heroin addicts, in order that they might reduce their compulsion to steal `to feed their habit', as the cant phrase has it — by giving them a saleable commodity free of charge. Needless to say, my patient had never been prescribed methadone by any doctor.

'What happened?' I asked.

'Well,' she said, 'I don't smoke in public, so I went behind this bus shelter and then two lads came up to me. They said they didn't have no money for fags, so they asked me whether I didn't have none to spare. I said I didn't, I was down to my last fag, so they asked me for two quid. I gave them the money, and then they said they'd just done over a chemist's and got two big bottles of methadone. They asked me whether I wanted a swig.'

'And what did you say?'

'I said no.'

`So what happened then?'

'They said, "Go on, a little methadone won't hurt you, you'll like it."' `So you took some?'

'Well, I'd never tried it before so I thought I may as well.'

Shortly afterwards, she was found deeply unconscious and scarcely breathing near the bus stop.

That afternoon in the prison, a young man came to me complaining that he couldn't sleep.

'I think it's because I've been taking crack, doctor,' he said.

'Why do you take it?' I asked.

'Because I'm not taking weed or brown no more.'

'What about taking nothing at all?' I asked.

'Oh, I couldn't do that, doctor. My nan's just died, my girlfriend's lost a baby and my head's not thinking straight.'

Theodore Dalrymple