by AB Morgan
Mark sat up in the single bed, and put his head in his hands to ground himself and become re-familiarised with his surroundings. Crap. Did I wake everyone else up? He wondered. He didn’t appear to have done so. The five other men in Mark’s dormitory had disappeared to bed after having their nighttime medication and had been asleep within the hour. A cacophony of snoring had commenced shortly afterwards. Despite Mark’s nocturnal disturbances, it continued unabated.
Lying awake, churning over endless irrelevancies in his head for the rest of the night, he listened to the snoring and mumblings in the dormitory. Most of the patients hadn’t been too scary or as threatening as he had feared and many had stayed in their rooms, actively avoiding the company of others.
Mark was thankful that he had achieved the first part of his task. He had been admitted to the ward, as planned, and could look forward to his first ever psychiatric ward round. It would be the first step towards getting himself out again. A week at the most would be all the time he would need. The challenge was on.
8
Holding Court
‘Morning, Monica. Morning, Charlotte.’
‘Morning, Bob. Good nightshift?’ I asked, keen to hear how Jesus had settled in. Bob, as the nurse in charge, was always a solid and dependable man. In the handover meeting, the nightshift team supplied the early morning staff with the latest update on all the Pargiter Ward patients, large and small. I was sharing the staff nurse duties with Charlotte that morning.
‘Generally it was a quiet night. No significant disturbances. In fact I’m led to believe that the whole ward was relatively settled in the afternoon and evening too.’
‘That’s unusual. I can’t think of the last time we had a settled ward at night.’
‘I think credit should go to the healthcare assistants for talking themselves hoarse reading to Greg. It’s definitely working. That and the medication probably,’ confirmed Bob, who, along with Charlotte and myself, was waiting for latecomers. In the meantime, the general chatter amongst the nurses who had arrived for duty so far indicated that the staff teams were intrigued by our new mystery guest.
The night staff had noticed that Mr Trainman’s sleep was exceptionally poor. ‘Even by the usual standards of a person’s first night on a psychiatric ward, he had a rough time,’ Bob said. There was a consensus of opinion that night terrors were being demonstrated.
‘No wonder the poor man looks so tired,’ I said.
The nightshift staff had also been keen to report that Mr Trainman had willingly assisted one of the younger patients with a jigsaw puzzle that she was trying to finish, and they noticed how taken aback he had seemed when he spied the self-harming scars crisscrossing her forearms. One or two of those wounds had been relatively fresh, and deep.
The young girl in question, had not yet come to terms with the death of Nirvana lead singer Kurt Cobain a few months previously, and her pattern of self-harming had become increasingly dangerous. Before this, she had never imagined finding herself in a psychiatric hospital. I don’t suppose she ever dreamed of completing a jigsaw puzzle with help from Jesus either.
‘I don’t reckon that our Mr Trainman has ever been in a place like this before. But I also think he’s a bit of a cool customer. He’s too relaxed and there’s a confidence about the way he walks and moves, the way he watches everything. It could be paranoia … I’m not convinced. Weird. And he looks just like Jesus,’ Bob said. Those present agreed with this observation: It was impossible not to. It seemed that the whole team were puzzling over Jesus as much as Emma and I had done the day before.
In a desperate effort to be well prepared for the morning, I checked the ward round list while breakfast was being handled by the rest of the staff, and swiftly organised the pile of patient files that had to be available in the large soulless office where the ward rounds took place.
‘Do we know who’s coming in for ward round today?’ I asked Charlotte who had her head in the ward diary. ‘Apart from the doctors, I mean.’
‘Barbara from the community team. That looks like it … no psychologist again. He doesn’t want them on the ward, does he?’ A rhetorical question from Charlotte, who was referring to Dr Sharman’s open dislike and disapproval of our psychology colleagues. He viewed them as an unnecessary hindrance. As a professional group, they had been pretty much excluded since his arrival at Hollberry Hospital.
‘Good, I like Barbara. At least I’ll have one ally. Any of the CPNs coming along?’ The community psychiatric nurses were also our allies. They were assertive and dynamic. I aspired to be a CPN one day.
New admissions were always seen first, which bought me only a matter of minutes to try to squeeze a titbit of useful information from Jesus Trainman before his appearance in front of Dr Sharman. Luckily, Jesus was up, fully dressed, and in different trousers that fitted decidedly better than the ones we had found the previous day. I met with him in a small office to let him know what the plan was for that morning. Not letting his alarming good looks interfere with my professional role, I outlined slowly and carefully what ward rounds consisted of.
‘We would like to know what to call you, and I’m sorry if we are causing offence, but at the moment you are being referred to as Mr Trainman.’ I hesitated and then added, ‘Perhaps you could write your name down for me on this paper …?’
But Jesus only smiled politely and shook his head.
I resorted to closed questioning. ‘Are you Spanish?’ He did look Spanish, I thought, harking back to what one of the policemen had said the day before.
Jesus shook his head. This was tremendous progress, because previously this approach had failed miserably.
‘English?’
Nod.
‘Do you know where you are?’
Nod.
‘Did you understand what I explained to you just now, about the ward round?’
Nod.
‘Excellent. Tell me, do you believe you have a mental health problem?’
Shrug.
‘Do you hear voices when there is no one there?’
Shrug.
This was getting me somewhere, but not fast enough. Just as I had started to crack the uncrackable, I had to leave my golden opportunity for assessment, because Dr Charming Sharman had arrived with his entourage, and he was demanding cups of tea or coffee for all. He was unerringly specific about his refreshment requirements, which were provided on a tray with a plate of biscuits: plain mugs, a jug of milk, bowl of sugar, pot of tea, and a cafetière of decent quality ground coffee. Dr Sharman took black coffee, one sugar, and on each occasion, without fail, in his fine bone china cup and saucer. God forbid this should be forgotten. He expected drinks to be poured by the staff nurse in charge of each ward round.
A tall slim man, immaculately dressed, everyday Dr Sharman wore a pristine, pinstriped tailored suit. His finely manicured hands confirmed that the heaviest things he ever lifted were his cup and saucer, and his pen. Dr Sharman had the sallow complexion of a man who rarely ventured into the daylight, and piggy eyes that were too close together for my liking. Over his wrinkled brow, hung a mop of dark unruly hair. The grey at his temples gave a distinguished look.
‘Right then, shall we get on?’ he announced in a wonderfully exaggerated public school accent. He then took a sip of strong coffee from his china cup, before the proceedings commenced. ‘New admission, Nurse Morris?’
‘Yes, Dr Sharman. Admitted yesterday afternoon to the ward. Dr Siddiqui saw this man in A&E, and he’s on Section 4, which commenced at 13.30hrs yesterday. The approved social worker, Anna Brown, from the assessment can’t be here I’m afraid.’
‘Never mind, we don’t need her. Siddiqui, please present your case,’ pronounced The Charming One.
Dr Siddiqui opened a thin set of hospital notes, and shaking visibly, attempted to give a summary of the facts about Mr Trainman (real name unknown). He stumbled over his words and reached the point where he had to explain why he had made use of Section 4.
Dr Siddiqui bravely explained the dilemma he’d had the day before. Apparently the police officers were not local, and also were not familiar with whether they could keep the patient in a place of safety under Section 136 of the Mental Health Act in an A&E department. According to the trembling Dr Siddiqui, they had sought advice but to no avail, and therefore as there was purely by chance an approved social worker in the department at the time, she and Dr Siddiqui had used Section 4 to detain the patient as an emergency. They felt the patient was ‘at serious risk of hurting himself or others.’
‘Right. Understood,’ said Charming unexpectedly.
Certainly it was unexpectedly as far as I was concerned, because I didn’t understand what it was that Jesus had done. What was it that had indicated to the doctors that he was such a big risk to himself or others? Had I missed vital information? It was the same old comedy routine. Apart from the odd moment of belittling from the consultant, doctors usually stuck together like glue, and backed each other up regardless of the facts. I should have learnt not to be so surprised when this happened, because it did, on a frequent basis. Something to do with old school ties, I believe. A brotherhood, a herd of doctors, a dose of doctors or could it be a consensus of doctors? Whatever the collective noun was, they were a law unto themselves at times.
When Dr Siddiqui announced that the patient had stripped off on a station platform, and performed religious rituals and prayers during the morning commute, Charming was even more impressed, despite the details of Dr Siddiqui’s account not being exactly the same as the ones we had been led to believe the day before. He gave the distinct impression that Jesus had been aggressively intimidating and threatening violence towards members of the pubic.
‘So, he was handcuffed when he arrived on the ward. Risky chap then. Well done, Dr Siddiqui. Good risk assessment, and I’m pleased to see that you used your common sense in this case. There we have it gentlemen, we have a man who declines to inform us of his name, with no known relatives, we are not sure from whence he hails, but we do know that he’s presenting with a severe mental health problem.’
Do we? I thought. That was a hell of a leap in assumptions on Dr Sharman’s part, in my view. So it was that I was compelled to interject, to ensure the facts, as few as there were, were accurately reported. ‘Umm, I’m sorry to interrupt Dr Sharman, but would you like the nursing report, as we have a few details to add that may be helpful?’ I received the usual irritated look, the one that said, ‘If you really must, Nurse.’
Given the go-ahead by a condescending nod, I provided a succinct account of the admission, including the real reason for the use of handcuffs and trolley by the police. Confirming that our patient understood English, I added that there had been ‘no observations which indicated a disturbed mental state.’ That was my first big mistake, and it acted as the flame to blue touch paper, a catalyst to a series of unpredictable events.
‘Yes, I’m sure that’s what you do think,’ came the reply, with a sarcastic emphasis on the word ‘do’. ‘Shall we meet Mr Trainman? Please bring him in, Nurse Morris.’
Charming was on the offensive.
As Jesus entered the room, I could see that he was understandably nervous. Anyone would be in that situation. But despite that fact, as he strolled towards a chair to my right, he still looked like someone who had recently returned from a beach holiday, including the weary look of the jet-lagged traveller.
Charming pompously introduced himself and his team. He excluded the senior social worker Barbara from the community services, and he excluded me. We happily introduced ourselves for the record.
‘I’m Nurse Monica Morris,’ I said. ‘We have met, but just to clarify for those present, I’m your named nurse while you are with us.’
Jesus nodded but with no smile apparent this time.
Mark had enjoyed his one-way chat with Monica before the ward round, when she had cleverly used direct questions to try to extract a tiny fact or two. He had played with her by giving nods of confirmation. In return, he was amused to discover that his paperwork identified him as Mr Trainman. He had secretly suspected that the staff teams were referring to him as Jesus, as the two policemen had done the day before. He would too if he were them.
Mark had entered the ward round feeling relatively confident, but as he walked in front of the men in suits, nervous butterflies bubbled up in his stomach briefly. Maybe, he thought, it was because he was aware that he had woken in the night shouting, and was considering the chances of this having been reported by the night staff. Was that a bad thing? He wasn’t sure.
His nose was pleasantly tantalised by the fabulous aroma of good ground coffee wafting in his direction as he walked into that large room full of people. Mark deeply regretted not being able to access a cup of equal quality right then. He could do with a stimulant effect to help his concentration after his night of poor sleep.
It was not hard to identify the man in charge. The pompous parody of a buffoon, who had introduced himself as ‘Consultant Psychiatrist Dr Giles Sharman,’ began. He asked Mark a series of leading and rhetorical questions, most of which he then answered. At least he’s worked out that I won’t be replying, thought Mark.
‘So you don’t recall your own name then? No. And you divested yourself of all clothing in front of a large crowd at the station. Yes? I understand that at this time you were somewhat elated, and believed you had special religious powers to heal others by praying for them, that’s right isn’t it?’
Mark tried to remain impassive.
Barbara and I glanced at each other. She raised her eyebrows confirming that she had not heard this in Dr Siddiqui’s presentation, and was wondering where this new information had come from. I was watching the scene carefully; Jesus did not respond other than to shrug intermittently.
Charming then spoke to his group of fresh-faced, eager, trainee doctors in a booming tone. ‘The patient is guarded and suspicious. He appears to be responding to unseen stimuli, and I strongly suspect that he may have an underlying psychosis. In which case, we need to continue to assess, and treatment with antipsychotics will undoubtedly help to address these symptoms. Then he will speak to us when he’s not so paranoid.’
I could contain myself no longer.
‘Sorry. Dr Sharman … I’m confused by this assessment. This man has been calm and settled, and apart from not speaking, we haven’t seen anything indicating psychosis. I wonder, well … Dr Siddiqui thought it may be a drug-induced episode?’ I proposed.
My intention was that Dr Sharman might consider this as the reason behind the apparent rapid recovery made by Mr Trainman since his arrival on the ward the previous day. Unfortunately my helpful suggestion only served to aggravate the situation.
‘Well, Nurse Morris, that’s why I’m a consultant and you’re not.’
Withering look.
‘I’m qualified to diagnose, Nurse Morris, and you’re not. I’m also in a position to make a decision about care and treatment which you will ensure is applied.’ He then took a deep breath, and staring at Jesus, with his audience of junior doctors waiting for the exciting conclusion, he announced the following, ‘Section 3! I will complete the second recommendation to add to that of the Section 4 assessment yesterday. We will commence on …’ He paused for effect. ‘Haloperidol and Lorazepam.’
I reacted instinctively and without hesitation.
‘Haloperidol?’ I questioned. ‘Could we perhaps use medication that is less sedating to start with?’ I put forward this idea while accepting that the chances of success would be slim. I was trying to avert a potential nasty experience for Mr Jesus Trainman, assuming he was a first-timer in psychiatric care.
Charming was furious at my challenge and seethed for everyone to see. ‘No, we will not.�
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A cold sensation which originated in the pit of my stomach, spread up my spine, and I felt a little sick. I was mortified. What had I done? Had I made this happen? Had I made Charming take his revenge on Jesus for my insubordination?
There I was, a nurse doing her job, and trying to advocate for her patient, but by doing this, I might have changed his future prospects. Bloody effing Nora! Haloperidol and Section 3. There were countries that could refuse an entry visa if you had a Section 3 on your medical record. Oh God. What about his future employment? Shit. What if Jesus was a teacher or a law student?
As Mark had left the large meeting room having been seen in an acute psychiatric ward round for the first time in his life, he had felt more than a little confused and disconcerted at the series of events that had played out in front of him. He had been immensely proud of his acting skills and performance, which had led with such ease to his admission the day before. It had been relatively straightforward and had played out exactly as planned.
Then he had met Dr Sharman. Mark had immediately taken a strong dislike to the man as soon as the consultant had pretentiously introduced himself and his silent fawning team of doctors. What is that man’s problem? Mark wondered as he walked out of the ward round and down the main ward corridor.
He had no doubt that he was placed under a Section 3 of the Mental Health Act, and that the consultant believed he had psychosis, although there was no diagnosis mentioned. He was puzzled, however, as to how that had happened solely on the say-so of one man. What did I do to deserve that? He had pitched his admission perfectly. Not too exaggerated, no risk to the public but enough to be convincing. He hadn’t even spoken a single word, so how in damnation had he managed to end up on a Section? Christ, I’m in the shit now, he thought, I’ll never get out in time. A speck of uncertainty was growing ever bigger in the pit of his stomach. Mark was shivering slightly as the cold sweat of anxiety was intensifying. His control over events had been spectacularly eradicated.
