A Ketamine of a Year

One of the first patients I ever gave ketamine to was a forty-year-old man with a nasty open dislocation of his ankle. After having the distorted joint snapped back into place, he burst into tears and told me Jesus had visited him and turned him Irish.  Another patient, an elderly lady with a displaced leg fracture, was entertained by a troupe of dancing cauliflowers while her displaced tibial fracture was being set.  Most patients however report later they recall nothing much after ketamine, and are surprised the unpleasantness is all over so quickly. Some though, have a profound but brief moment of clarity on the way out of the “k-hole” in which they get a glimpse of existential terror.

 

I’ve never had ketamine myself, but after 2020 so far, I feel like I have. A trip to New Zealand in March to see heart-achingly distant adult children morphed into a dissociated weirdness of only seeing them through the glass of an AirBnB isolation house, plus occasional dream-like episodes of jogging through sunny empty city streets.  

In April, folk clapping the NHS in the UK, and fire trucks sounding their bells outside Emergency Departments in New York induced a teary intoxicated pride in being a key NHS worker. It was hypnotic recruiting-band music for selfless public service and the ideals of universal health care. Back in work itself however, clinical care with multiple new PPE rituals to remember, and a nightmarish new disease felt like a flashback to the first anxious imposter shifts as a newly qualified house surgeon dealing with sick patients with the Oxford Handbook open.

 

The summer months carried on into a sort of timeless partially sedated unreality. FFP3 masks, sticky hand gel, and yellow & black chevron tape on the floor. Endless Zoom calls into colleagues’ front rooms with their ensemble cast of young children and pets. All formed the blurry backdrop to a drama increasingly devoid of ongoing serious action. Painful stimulation to a higher Glasgow Coma Score mostly only came from new intolerances of other people’s behaviour: a mask under the nose in the supermarket or anti-vaccine posts on social media the equivalent of a brisk sternal rub.

 

Now the 2020 emergence phenomena are starting to break through with flashes of panicky alarm. Second waves, economic collapse, mental health crises, racism, climate change and anarchy all smashing through the bathroom door with Jack Nicholson grins announcing a serious intent to mess you up. If this were happening to a patient, we would do two things. Reassure them they are safe and that this will quickly pass. Then reach for the Midazolam to smooth their passage back to sentience and rationality. 

 

As 2020 moves to the autumn of its unpleasant and bizarre k-hole, there is unfortunately no sign yet of the confident clinician with the calm voice and a big syringe of normal.  Perhaps eventually, after the cauliflowers stop dancing, and we no longer feel compelled to speak with a Dublin Brogue, it will all seem to have passed in an instant. We will wake up groggy, but with all our essential parts back where they should be.