A Justifiable Madness

by AB Morgan

  ‘Monica, I have written a prescription for the Mr Trainman for PRN Lorazepam and Haloperidol, in case he becomes disturbed later on. You can give it if necessary. He needs to be seen first on the list in the morning at ward round, by Dr Sharman.’ I didn’t need reminding of this fact, as I was not looking forward to the event.

  Dr Charming Sharman, the consultant psychiatrist for the unit, was so called, by the staff, because he was not. He was far from charming. His ward rounds were tense affairs for patients, for their relatives, and for staff, and it was no place for the weak, ill-prepared, or incompetent. No one seemed to challenge him about his dreadful behaviour, and only the sycophantic or well-endowed attractive female had the ability to shift any decision, once he had made up his mind. I was neither of these.

  He had only joined our ward team six months previously to replace lovely old Dr B, who had retired after decades of sterling service to the NHS. Dr B had an impossibly long Sri Lankan name, which resulted in nobody ever bothering to pronounce it. Fortunately the man himself was perfectly happy being called Dr B. When Dr Sharman had arrived as his replacement at the unit, it was rather like experiencing an earthquake with numerous aftershocks. It was devastating.

  The staff nurses of Pargiter Ward, as a group, raised concerns with our managers about Dr Sharman’s harsh treatment decisions, and bullying approach. Our delegation to the senior management was dismissed as evidence of troublemaking.

  ‘Whether you like the man’s attitude or not is irrelevant,’ said Gordon Bygraves, the unit manager. ‘You will have to make the necessary adjustments to accommodate our new consultant. He has an exceptional reputation and is highly thought of in the world of psychiatry. Surely you are all aware that he has written numerous research articles and he’s been published in national and international psychiatric journals. Impressive don’t you think?’

  The nursing team was not impressed.

  ‘You cannot accuse him of bullying, so I suggest that if you’re not happy working here then you start looking elsewhere for a job. We’ve had no other complaints.’ I knew that last remark was quite untrue. There had been a number of complaints by relatives. These must have been swept under the carpet, which would explain the lumps in the flooring of Gordon Bygraves’ office.

  Given the challenges that our consultant presented us with, the best plan of action for the rest of the staff was to be well informed and thoroughly prepared. So I made it my business to organise the standard baseline physical health checks for Mr Trainman, in anticipation. The usual: blood pressure, pulse, temperature, urine sample, height, and weight.

  Often this was impossible to achieve for new admissions, as our patients were, in the main, significantly disturbed when they first arrived, or simply unable to cooperate fully. Not in the case of our very own Jesus. He appeared to understand English perfectly well and was not at all distracted or distraught. In fact, he followed me around, watching, and almost scrutinising everything I did. A couple of times I made him smile, but he never uttered a word. Not once.

  5

  Mark has Doubts

  Mark instantly took a liking to Nurse Monica Morris who had taken the trouble of introducing herself properly as his named nurse, and had shown him around the ward. He had managed to hide his disapproval at being shown a single bed in a dormitory. He would have to make the best of it, and he couldn’t complain to Monica, he wasn’t speaking. Mark thought her to be unconventionally attractive. Tall and slim, Monica carried herself with an air of efficiency, without appearing too bossy. He liked that. She smiled easily and was engaging and welcoming. Mark noticed how the other staff responded positively to her, especially the almost incomprehensible Italian cleaning lady, and the other staff nurse, Emma Foster. She who had showered him with biscuit crumbs on his arrival.

  He did find it strange at first that none of the staff wore a uniform of any description, and that most were casually dressed in trousers or skirts and short-sleeved shirts or blouses. The only things that distinguished them from the patients were their name badges, he realised. He supposed that this casual dress code was designed to put patients at ease and avoid the look of authority or the expectation that the classic white coat would be the order of the day for all psychiatric staff. No one had come to take him away … He had manufactured his own admission to a psychiatric ward. Very successfully.

  Mark wasn’t nearly so confident about how he would be received by his fellow patients. He was aware that anxiety was creeping in and that he was becoming more nervous as time passed by. When he had planned his dramatic performance he hadn’t thought about the consequences fully. Concentrating more on his efforts to convince professionals that he was mad, he had not really considered how the other patients would relate to him. His arrival had attracted attention from the resident patients, some of whom spoke to him briefly just to say hello. Others made a beeline for him, and chatted away, seemingly unaware that he was not joining in the conversation. It’s a damn good job I’m mute, mused Mark. At least I don’t have to worry about saying the wrong thing.

  There was one particular lady who spoke at him for a considerable amount of time, barely pausing for breath. She was animated and emotionally overexcited, but Mark allowed her to carry on ranting while he nodded politely. He couldn’t think what else to do, as he didn’t want to upset her. What was she rambling on about? Plainly the subject matter was significant from her perspective. The brightly dressed lady in question was wittering on about how ‘only the mad have an understanding of the mad’ in a takes-one-to-know-one way, and she had obliged him with a theatrical wink as she said it. Mark wondered if he had been revealed as an imposter already. He could argue the case, as he was certainly mad for putting himself through this whole charade.

  Hell! There’s a relief, thought Mark, as the lady in the bright clothing finally buggered off. He had coped well until that point. His levels of anxiety had even eased. What had started as amusing, was now striking Mark as being a test of his resolve. Reality struck home: I’ve only been here for a matter of hours. God knows how I’m going to last long enough.

  Although never entirely peaceful, overall the ward was a lot less chaotic and intimidating than Mark had expected. He had assumed, in anticipation of his stay, that there would be people wailing and talking to themselves throughout the day, and he was almost ashamed that he’d had that thought.

  Mark soon concluded that the vast majority of the patients were elsewhere in the hospital. He would meet them all at around teatime, as Monica had pointed out when she explained as much as she could to him, keeping the language simple. Mark appreciated that she had no idea if she was addressing a person who understood, or spoke English, and he admired her patience. He was slightly dreading having to meet his fellow dormitory mates, and for this reason he tried to keep within sight of the main office and the staff. He was not sure how the other patients would continue to react to him not replying to questions, and not joining in conversations. For Mark, isolation and fear of intimidation were shadows that lurked nearby.

  He was not nearly so worried about being seen by the consultant the next day. He had planned for that scenario, and had pre-empted the likelihood of being prescribed tablets. That was going to be the tricky bit. Knowing this, he had practised at home with headache tablets, and had managed to develop a technique whereby he used his tongue to poke the tablet into his cheek, appearing to swallow it with water. The only weakness to his carefully rehearsed madness was whether his efforts would not only be believable enough, but be so for long enough to achieve the required results. I can but try, Mark assured himself as he settled back on his bed to read a scruffy old Reader’s Digest magazine. He wondered what was going on in the outside world.

  6

  No Clearer

  By the time the next shift had arrived, Emma and I were none the wiser about the identity of our new arrival. We were no clearer either as to what mental health problem he was actually experiencing, if any. We had watched him orientat
e himself to the ward, find the toilets, and we noticed that he passed by the smelly smoking room, where most of the patients spent too much of their free time.

  ‘Blimey, that’s unusual,’ remarked Emma, ‘a patient that doesn’t smoke. I wonder how long it will be before he starts chain-smoking like the rest of them.’

  I didn’t expect Jesus to smoke. He hadn’t smelt of cigarettes or anything else on his arrival. ‘Emma, you know how other people notice when someone has B.O.? Do you think we’ve become desensitised? Jesus smelt clean. Did I only notice that because everyone else who gets admitted smells as if they haven’t washed for weeks?’

  ‘Yeah, good point. Do you think I can rely on you to tell me if I smell?’ Emma had her own way of looking at the world. She and I watched as Jesus spent time flicking through the pages of an old Reader’s Digest magazine. He looked at the patient information leaflets strategically placed around the corridors and on noticeboards. When he spotted a leaflet about the Mental Health Act, he seemed to find what he was looking for.

  So, on that basis, I assumed he could understand and read English.

  Eventually, Jesus Trainman settled down to listen to Janet, the healthcare assistant who had taken over from Margaret. I could hear her relating to Greg, an interesting travelogue from a National Geographic magazine that the late shift had arrived with minutes previously. Once or twice, other patients would try to speak with Mr Trainman. In return, he looked at them and smiled politely, but he never once engaged in conversation. Interestingly, he made good eye contact with the other patients when he met them, and remained unruffled.

  Throughout the rest of the afternoon, Emma and I tried many times to encourage Jesus to write something down, but he only shook his head, indicating his decline of this offer. Emma made one last attempt before we had to go home for the day. ‘Look, just keep them with you. You never know. You may decide that doodling will help you pass the time.’ At last, he was persuaded to keep hold of the paper and the pen, which we both took as a hopeful sign.

  After a long busy shift, we were glad that the end of our working day had finally arrived. When Emma had finished the handover to the next set of staff, we both trooped slowly towards the lockers to grab our personal belongings before we gratefully headed home. We didn’t refer to Mr Trainman as Jesus when we discussed him with any of the other staff. We kept his nickname to ourselves.

  On the way to catch our respective buses, we chatted as was usual but this time more animatedly than was normal after a tiring day. The topic soon turned to the next day’s ward round and how well Jesus would be received as a new patient by Dr Charming Sharman.

  ‘Oh great,’ remarked Emma, ‘old Charming is going to give us, well you, a rare grilling tomorrow. We know nothing about this man and we have no evidence for any obvious mental health problems.’

  ‘Actually, there is a fair bit that we do know, so I’m going to impress The Charming One by sticking firmly to the facts. Our new patient may well not have a mental health problem, but he doesn’t seem to have a physical health problem either. The baseline physical checks are done, with nothing abnormal to report. Blood tests are ordered for tomorrow morning, and the CT scan has been requested, and what’s more, we have an update from the police to say they haven’t any further information … yet. I don’t think being mute, on its own, is an indicator for any drastic mental illness, do you?’

  ‘Nah … So …’ Emma said as the truth of the matter seemed to hit home, ‘It’s actually Dr Sticky that is going to get his arse chewed, because he admitted a man who shouldn’t be here. Poor Sticky.’ She then indulged in wild imaginings. ‘What if he is the real Jesus?’

  ‘Right …’

  ‘Or what if he’s here to escape from the police and he has actually committed a terrible crime, and losing his clothes, etc. and pretending to be mad helps him evade capture by Interpol?’

  ‘I doubt that very much,’ I replied. ‘However, you have a point. Why would anyone who wasn’t unwell or who wasn’t intent on avoiding the criminal justice system, want to be admitted into a psychiatric unit? Maybe he has lost his memory and can’t say anything because he can’t remember who he is. Either way he is lovely to look at and it is free to look, isn’t it?’

  Emma reviewed these latest offerings. ‘I think he would look a lot more bewildered if he had lost his memory though, and he doesn’t even look distressed, in fact, mildly anxious at best which is peculiar in itself … so maybe he is Jesus.’

  ‘Bloody hell, Emma. He’s in trouble. If he decides to talk tomorrow and tells Charming that he’s Jesus, he’ll never get out of the ward. The Charming One will slap him on a Section 2 as fast as you can say bonkers.’

  We had reached my bus stop where Emma and I usually said cheerio.

  ‘Have you marked up your calendar for next weekend?’ Emma enquired. ‘I know you don’t want to, but it’s high time you were back on the market again, and there’s no better place for finding a real man than at the rugby club. Jake’s mate Max still fancies you.’

  Emma was teasing me, but I knew that any attempt at resistance was futile. ‘Yes I’ll come along to shut you up, as long as you promise that we’ll still go to the cinema as well.’ She nodded. We would see each other at the lunchtime handover the following day. Emma was due on the late shift, and I was to be on an early one managing the ward round, for my sins.

  7

  First-night Nerves

  Following a staff shift change later in the afternoon, four o’clock heralded the return of more patients to the ward from their groups and activities. As a result, the overall volume of noise increased on the ward, as did the people traffic along the corridors, in the dayrooms and dormitories. Mark picked up from the snippets of conversations around him, that the general topic amongst the patients was about medication, and getting off the ward. Several of the patients had permission to leave Pargiter Ward to go into the hospital grounds, or even to the local shops.

  Much to Mark’s surprise, the ward doors were not locked, but instead the staff monitored the comings and goings of patients and visitors. He watched, fascinated as the vast majority of the patients had to be formally signed in and out, because they were detained under the legal provisions of a Section. This seemed to keep the two staff nurses on duty permanently occupied. He watched them intently through the generous windows of the ward office.

  On each occasion, a patient would approach the big glass office, knock, and wait to be given permission to leave the ward. Mark quickly picked up on the fact that each patient had a set of papers in a file, which detailed the exact permission that they had been granted. He could overhear most of the conversations.

  ‘Yes, Rodney, you still have six hours’ unescorted leave left today, so we’re happy for you to go to your sister’s for tea. Have a lovely time and don’t forget to smuggle a slice of cake back in. Oh, hang on. What meds are you on? No, it’s okay, as long as you’re back for nighttime meds by ten o’clock.’

  Mark had observed how carefully the nurse had checked the papers and what he assumed to be a prescription chart, before giving the nod to allow Rodney out of the main ward doors.

  The beige square social worker, Anna Brown, who Mark had met briefly in A&E, had inferred that he too was under some sort of Section of the Mental Health Act. However, she had been disappointingly lax in providing him with any written information, which would have clarified his position. He didn’t even know whether he had any permission to leave the ward.

  After searching along the corridors and on various walls, he found the leaflet that he was looking for, but it was pinned to a noticeboard, which was glazed: no it was Perspex … He could only see the leaflet’s front cover. This frustrated Mark’s efforts to clarify what Section he was on, and what that might mean. Am I on a proper Section or not? Mark asked himself. He could only wait to be told. He had done a lot of waiting that day.

  Feeling brave, Mark decided to test the possibility that he could at least go outside for
fresh air as a welcome release from the smelly smoky atmosphere of the ward. He approached the office with determination, and once he had caught the attention of a male nurse, he pointed towards the ward doors.

  ‘Sorry, young man, according to the paperwork I have here, there’s no going out for you I’m afraid. You’ll have to wait until the consultant in the ward round has seen you tomorrow. He’s the only one who can grant you any leave.’ Mark nodded and shrugged. That answered his question. He was on a Section.

  With the ward events such as medication and meal times creating a regular routine, Mark found to his surprise that the rest of the day went by fairly rapidly. Despite being an intense day, he eventually went to bed after eleven, where he endured a restless fitful sleep, interrupted by his usual nightmares. He woke up sweating profusely in the early hours more than once. He was certain that he had shouted himself awake.

  Earlier that evening, he had seen a girl with deep self-inflicted wounds, which had thrown him a bit, but he couldn’t put his finger on why. After all, he was used to seeing wounds, but not ones self-inflicted by such a young person. This had been playing on his mind, and must have led to his predictable set of terrifying flashbacks. The flashbacks, which played like internal live-action films, were of incidents that he had been exposed to in the last few years. These indelible memories resurfaced most often when he was sleeping. On occasion, he had waking replay of these events, during which he could smell the metallic sulphur of gunfire, the blood, and the dust. When this happened, he experienced full-blown terror as if it were in the present.