So before I went down to Norfolk, I went to the Inova Alexandria ER to see the urgent care doc. These are the people that treated me for Meningitis a few years ago when I worked at AOL (there was an outbreak in Reston which I contracted from a coworker, ostensibly in the cafeteria, although who can know...?). So they have ample history on me. I went to urgent care because I was leaving town and I had been in a kind of vicious insomnia trend. I haven't been able to sleep in months. Literally, months. I've been taking, typically, anywhere from 250 to 400mg of diphenydramine (Benadryl, Unisom, Tylenol PM, etc), and either adding Seroquel or Zyprexa (incidentally, also dating back to the AOL days), and throwing them back wth NyQuil or the Teraflu "warming syrup" (both are pretty high in alcohol content: 15-20%).
The MD on duty told me that she couldn't give me anything because she "didn't know my history" and that she didn't know whether I'd "do well on" them. She recommended I "call my psychiatrist" and "get something phoned in by the oncall nurse." I explained that I was leaving town for a week or more and that this was simply not possible.
What, exactly, did she think would happen? That she'd give me Ambien, Lunesta, Sonata, or any of the new pseudo-benzos and I'd kill myself with it or something? Exactly how is this different from a psychiatrist giving them to me? I happened to have an Rx bottle on me showing that I had a prescription and was just out.
So I drove from Arlington to Norfolk (this is 3.5-4h, give or take) on no sleep. I also taught a class for DISA on no sleep. I revised the lesson plan, tested the labs, got my clothes to dry cleaning, etc. By the time I was done with the class, I'd lectured for six hours, driven 425 miles, eaten nothing but a chicken sandwich (Wendy's) and an Odwalla bar (banana nut for whatever thats worth), and had been awake for 27 hours.
Of course, immediately afterwards, I had to revise the lectures and labs again, and struggled to get 4 hours of sleep.
You know you're an insomniac when you keep the NyQuil in the fridge (it's easier to yack down). That's how serious this is. I take the benadryl because I can wake up more easily when I take that. If I go with the Seroquel or Zyprexa, I get sleep, but it's usually eight to twelve hours, and it's a complete nightmare to get me out of bed in the morning. Unfortunately, if I don't get sleep, it's as or more dangerous than getting sleep but being groggy in the morning. This is the stuff ruined careers and families are made of.
I wanted to tell that doctor she was a complete waste of oxygen, but it wouldn't have helped. She was determined that it was not safe or reasonable to give me drugs. I've used the word pharmocracy in the past. This is surely what's going on here. There is a drug-prescribing oligarchy that is self-selecting and unwilling to cede any power to the consumer for fear of losing their relevance.
I have no problem whatsoever finding the right drug for myself. I've been in some form of physician care my entire adult life (either because of external stressors or internal medical issues, such as all of last year), and I know what does and does not work. It seems reasonable to me that I'd have the option to decide my own path of treatment, and enlist the MDs as advisors, much in the way the DOD prefers to secure its own systems, but asks me to consult.
In this case, what's wrong with a 30-day supply of Halcyon or Xanax? It would be trivial to argue the exact opposite is true: to not give me the means to get a good night's sleep is to virtually guarantee that my performance will be lacking on the road, in class, etc.
People seem to believe it's okay that we have laws criminalizing illicit drug use (the definition of the term 'illicit' itself being open to broad interpretation). But nobody seems to want to discuss the simple fact that educated consumers are capable of making their own decisions with respect to medicine. If HMOs wanted to prevent people from self-diagnosing and charging up an enormous ta on expensive drugs (Seroquel being among them, also Ambien and Maxalt), why not only cover for drugs which are prescribed by a doctor? I'd be happy to pay out of pocket for migraine drugs, somnolents/soporifics, and various psychotropic drugs (SSRI's, etc) if it meant I got the damn drugs.