A Justifiable Madness

by AB Morgan

  9

  The Court of Dr Sharman

  One way or another, I made it through the rest of the ward round, which took all morning and half of lunchtime, and I tried hard not to contradict Dr Sharman, but it is not in my nature to let the bully win. Underneath my expressionless exterior, I was furious. I don’t get bullied. I hate bullies, I thought, as I was reminded of my endless battles at school, which explained my consequent incendiary reactions to any sort of injustice, either perceived or real.

  Remain calm and do the right thing, I advised myself. As soon as I’d had that thought, it immediately occurred to me that I had tried to do the right thing once already, resulting in Jesus being placed on a Section 3 of the Mental Health Act. That fact alone meant he could end up in hospital for up to six months of his innocent life.

  I was confusing our patient with the unlikely possibility that he was as saintly as the real Jesus. Nevertheless, it was not imaginable for me to collude with Dr Sharman’s approach to care. The Charming One continued in a vindictive vein throughout the ward round that day. I noticed that he seemed hell-bent on increasing each and every patient’s medication, and as a result, drug charts were being re-written left right and centre. It was becoming obvious that we nurses would be dishing out medication like Smarties, but ’twas ever thus.

  Several of my colleagues were either intimidated by the doctors, or sadly chose a submissive approach, identifying themselves with the old-fashioned idea of the ‘doctor’s handmaiden’. Despite this, there were enough of us on Pargiter Ward who bucked the trend, and were not afraid to do the right thing. I confess, that on occasion, we even had to resort to professional subterfuge.

  A number of the patients on the ward had recently been struggling with nasty side effects, mostly because, in my opinion, Dr Sharman had been heavy handed with the doses of medication he chose to make use of. One poor man was so restless that we became increasingly concerned for his wellbeing. It made him profoundly miserable.

  Through deliberate deceitful means, we were able to avoid administering his most recent increase in dose, because Emma claimed not to be able to read the prescription on the drug chart, and Dr Siddiqui had, as an oversight, forgotten to re-write it. This gave a reprieve of several days, allowing me to raise the problem in ward round on that Tuesday.

  I approached this in a cautious manner with Dr Sharman. He appeared to listen to the complaint, and I was optimistic that he would at the least reduce the dose or change the medication for another. However, he had me in his sights, and my efforts backfired, yet again.

  ‘You appear to believe you are the expert today, Nurse Morris. Let me remind you that there has been a remarkable improvement in this man’s symptoms, entirely because of the medication, and we will be sending him on home leave at the weekend. So tell his wife to collect him on Friday evening, and we will discharge him on Monday, assuming all goes well. I’ll remove his Section when he returns after the weekend.’

  That was power play. Nothing else.

  The patient appeared bewildered, not least because he didn’t actually have a wife. He lived alone. Nevertheless, he was pleased with the result and later told me before he left for his weekend leave, that if he hadn’t had the glimmer of hope in the shape of discharge on the horizon, that suicide was beginning to look like an option worth consideration. He was in any event, planning to stop taking the medication as soon as possible after his discharge. In the meantime he would play along with whatever Dr Sharman wanted, in order to be released from his Section.

  ‘This medication, it’s unbearable,’ he stated categorically, and I didn’t disagree with him. I even documented the remarks in his case file in the confident knowledge that no doctor would bother reading my notes. They rarely did.

  Before long it was Greg’s turn to be seen in ward round. Dr Sharman could not be persuaded to leave his throne to assess Greg in a smaller room. For a brief while we held on to the vain hope that Dr Sharman would consider this as an act of kindness. No, instead, the nursing staff had to carefully escort Greg to the large office, crammed with intimidating professionals, and do our best to manage the resultant distress. As he entered the room, Greg was muttering and searching around with wild eyes. Fortunately he had Margaret specialing him again, who talked gently and consistently to keep him as calm as she could. Charming had no such professional subtlety in his repertoire, and he went straight for the psychiatric jugular.

  ‘He doesn’t seem to be taking his medication properly. Spitting it out, aren’t you, young man? Yes. Let’s sort out injections, please, Dr Siddiqui. Clopixol. Don’t bother with a test dose. No need to bother with that. Straight in with 400mgs weekly, as of today.’

  I was dismayed that none of his entourage tried to guide their consultant towards acceptable clinical practice. Not one of them mentioned the fact that Greg had already been prescribed liquid medication to improve his level of concordance with treatment. Neither did any of the passive gutless group of doctors propose an increase in the dose that Greg was currently taking, to see if that would improve the situation.

  ‘Sorry, Dr Sharman, you did say after a test dose he would be starting on 400mgs Clopixol weekly injections?’

  ‘No, Nurse Morris. There you go again. I’m the prescribing doctor, and I have a PhD in Psychopharmacology on my CV, and I made it abundantly clear that there is no requirement for a test dose because the patient has already been trialled on antipsychotics orally, young lady.’ He informed me of this in a fine patronising manner. Short of patting me on the head, he couldn’t have done a better job.

  ‘Yes, I understand that, but what if he has a reaction to this different drug?’

  ‘Nurse Morris, pay attention, if you will, to your nursing duties, and desist from challenging my treatment plans. It is not your place to do so.’ He snarled at me. ‘And frankly if there is one more interruption from you today, I will ensure that you are transferred forthwith to another ward, or preferably another hospital, and furthermore, I shall be speaking to your senior manager about your dreadful attitude.’

  That told me.

  Bully.

  Bastard.

  Poor Greg, I thought. I knew from experience that he would have to be physically restrained for an injection to be administered, which was bad enough, but there was also no way of telling how significant the side effects would be from the whacking great dose he had been prescribed. I felt tears stinging my eyes, but I managed to keep it together, determined that Charming was not given the satisfaction of seeing the results of his bullying.

  10

  Making Sense

  That first ward round seemed to take up hours of everyone’s time. After his turn, and to make the most of the experience, Mark joined the group of patients and relatives who were waiting to face their nerve-wracking ward round appointment. He witnessed the fall-out as each of them emerged afterwards.

  He watched in fascination as each patient returned, listening carefully in order to glean what he could about the decisions made in the inner sanctum of that large room. Mark saw the young man who had been in the side room, being escorted by the nice lady called Margaret, who often spent time reading to her patient to relax him. She appeared to be crying when they exited the ward round room only minutes later. Mark was desperate to know why. What the hell happened there?

  One man had real trouble sitting and waiting his turn. He was restless, and when he did sit for any length of time, his legs wiggled up and down endlessly. His pelvis appeared to be gyrating like that of Elvis in his prime, but quite involuntarily and without the music. He was describing to anyone who would listen, that this went on ‘day and night. It never stops and I can’t go on much longer. I’d rather be dead than this.’ Mark could not fail to notice the amount of desperation in the man’s voice. Is that what I’m supposed to take? Tablets that make you want to prefer death? Mark shivered at the thought.

  In an unexpected turn of events, when the same man returned to give the outcome of his ward
round appointment, he was remarkably cheerful.

  ‘The news is good,’ he said, rubbing his hands together with joyful expectation. ‘I can go on weekend leave, and then I’m for a discharge meeting on Monday, and after that I’m out of here. The good news is that I now have a wife! I didn’t have one before I went in to see Dr Sharman, but he decided that I should have one, and that the nurses need to phone her up, whoever she is, and get her to collect me on Friday. I hope she’s a looker, with really big boobs! What a great weekend this could be, if only that were true.’

  Raucous laughter resounded around the dayroom, and everyone joined in the humorous chatter resulting from this happy announcement. Mark had no idea if the man was still mentally unwell, or whether what he had said was reflective of the true facts. Either way, it was entertaining, and to everyone’s relief the man’s despair had been temporarily alleviated.

  Throughout that day, as well as watching the goings on in the ward, Mark spent time around the other patients whenever he had the chance. A tall fresh-faced young lady, who turned out to be an occupational therapist, had approached him in the afternoon. She advised him that there were activities and groups that took place on the ground floor in the OT department each day ‘apart from the weekends.’ However, because he was not speaking, they would suggest that he joined the art sessions, which would commence again in the morning. ‘I’ll collect you and introduce you to the rest of the group personally,’ she offered. ‘What’s your name again?’

  Nice try! Mark remained silent, appreciating her attempt and nodding politely, but not disclosing anything verbally. He was actually cheered by the news that there were ways in which he could fill his days. Being mute was extremely restrictive for his mind, which was yearning for him to ask lots of questions. Maybe he could hold out one more day, but until then he had to resort to helping out with jigsaw puzzles, crosswords, and being a listening ear.

  He was pleasantly surprised by what he had learnt by the end of the day, not only about the patients, but also about the staff team. It was obvious that the regular patients on the ward were distrustful and wary of Dr Sharman. Most disliked him intensely and inevitably compared him to the last consultant, Dr B.

  ‘Dr B was a real gent,’ said an elderly gentleman named Rodney. ‘He had a heart. Not like this new one. He’s an out-and-out bastard. I stopped the tablets because they’re shit, the ones he gave me, what … four months or so ago. I wouldn’t give them to my worst enemy. What did he do? Put me on them again, only a bigger dose. I know which ones work for me, but I forget to take the ruddy things sometimes,’ Rodney explained, ‘but that bastard doesn’t listen. Doesn’t care. He’s a shit.’

  Mark pondered the ‘Catch 22’ situation that Rodney was in. If he didn’t take the tablets he would become ill again, whatever that entailed, and end up in hospital. However, if Rodney took the tablets prescribed for him, he had a miserable existence. Mark wondered how many people were failing to get back on with their ordinary lives and who were resigned to relapse for the same reason. This could mean not coping, ending up on the streets, or returning to hospital on a regular basis for more of the same.

  Contemplating those depressing possibilities, Mark experienced yet more stirrings of uncertainty about the situation that he had placed himself in.

  11

  Stuck on a Section

  After ward round, I had to break the news to Jesus Trainman about the implications for Section 3. The final recommendation on the paperwork had been completed by Dr Bastard Sharman, and I had a responsibility to inform Mr Trainman what this meant, because even though his real name did not appear on the pink recommendation form, it was still legal to detain someone under the Mental Health Act without knowing his or her true identity. It happened quite often. In the previous three years, we had two ladies both convinced they were the Queen of England, and a male middle-aged Princess Diana. Not all at the same time, fortunately.

  Jesus Trainman could be ‘detained for treatment for a period of up to six months,’ so I carefully explained the ‘Right to Appeal’ information, and left Mr Trainman with a copy of the required leaflet to peruse. He seemed to have a wry smile on his face, which I could not fathom. Then I slunk off for a good cry in the staff toilets. It had been an awful day so far.

  ‘He’s done what?’ Emma exclaimed, as she came onto the ward for the late shift. I was then on my way to the medical secretaries’ offices on the ground floor to deliver the Section papers, and to make a copy for the ward records. I didn’t have much time in hand to chat.

  ‘You heard me. Honestly that man is a complete bastard!’ I shouted over my right shoulder as I departed.

  The lady in the Mental Health Act office, Harriet Morris, no relation, always seemed kind and helpful. She scrutinised the Section information on the forms, and cast her eye over the recommendations written the previous day. She ensured that she had the second recommendation from another approved doctor, in this case Dr Sharman.

  ‘Oh, that’s helpful. Dr Sharman seems to think Mr Trainman is a known patient. What a shame that he can’t remember this chap’s name. Still, perhaps he knew him from his last hospital. He’ll remember sooner or later. We can request the old hospital’s records then, can’t we, dear?’ She smiled in my direction, before going about the business of filing and recording the information.

  For whatever reason, I did not question a word she had said, even though I was bewildered by her comments. Something was awry with the paperwork, so when I asked to take a copy of the Section papers, all of them, I deliberately took two copies of Dr Sharman’s Section 3 recommendation. I put one of those in my pocket, with a plan to take my time and have enough privacy to read what was written, away from the busy ward environment. Once I had completed the simple task of photocopying paperwork, I returned to the ward and filed the rest of the papers as I was supposed to.

  ‘Jesus no more has psychosis than I have,’ I said to Emma. ‘How can we justify administering Haloperidol, for goodness sake? It’s wrong. Anyway the drug chart has been written, leaving us to consider morally and ethically what to do about it.’

  ‘You have got to be kidding. We can’t withhold treatment, Monica Moronica! And …’ added Emma, ‘what if Charming is right?’ She wagged her finger in my direction. Duly reprimanded, I simply grinned back at my good friend and colleague. She was right of course.

  Although it was actually nearer to teatime, I made it home for a well-deserved, late lunch. I chatted to my big fat cat, Boris, so named because he bore a striking resemblance to the Russian President Boris Yeltsin, and I told him about my ‘amazing, supersize crap day.’ I ruminated endlessly about the events of the ward round and Dr Sharman’s fine display of bullying tactics. I remember thinking that a man had not upset me this much since my most recent and long-term boyfriend, Ben, had decided to leave me for another woman.

  He had found himself a young blonde airhead from the office. In all probability he wouldn’t have noticed that there was a space in her head where a brain should have been. Although a good six months had passed, he would have been unable to look beyond her enormous tits, to discover a personality inside, if there was one.

  According to Ben, he was proud of me for the great job that I did in the NHS for ‘those sorts of patients’, but he couldn’t cope with the fact that I always had to be right about everything. I didn’t think that was fair, and I threw his belongings into the street in an act of childish revenge. Not that I was bitter. Even if I wasn’t wholly content and fulfilled in my life, I was at least free from the incessant wittering about football, which I hated anyway.

  Emma was beginning to despair of me. After Ben had unceremoniously moved out, I had settled into a routine of social avoidance. After work, I liked nothing more than to vegetate in front of the telly. I hadn’t taken up any new activities or joined a club as Emma had suggested. In fact I was licking my emotional wounds, having been distraught when Ben left, because I had honestly thought we were heading for marria
ge and children. When I eventually gave myself enough time to review my doomed relationship, I had concluded that Ben had lacked an understanding of how important my career was to me. If I had been honest with myself at the time, I should have declined additional shifts and spent time with Ben. Weekend and late shifts were bad enough in themselves for playing havoc with any routine, but they had all but destroyed a joint social life. What remained, was my focus on being a good nurse, in the hope that it would fill the gaping hole that Ben had left me to contend with.

  These days it was me and Boris the cat, in our new compact and bijou flat, and that evening I was planning to crack open a lovely bottle of wine as I was on a late shift the next day. I consoled myself with the fact that I deserved wine. It was a necessity, not a luxury, as was the bar of chocolate waiting for me in the fridge. I also anticipated being able to flick on the TV and catch up with an episode of Cheers or Roseanne. Something mind-numbingly uncomplicated but uplifting was in order. However, before dulling my senses with wine, I decided to use what little brainpower I had left, to examine the words on the Section 3 recommendation paper written by Dr Sharman earlier. The copy I had in my pocket was crumpled, but the words were clear to read.

  The first part had pre-printed options where the person completing the form confirmed their qualification as a Section 12 approved doctor. The form also required opinion and evidence as to why they were making the recommendation for detention under a particular Section.

  Dr Sharman had completed the required parts of the form, and indicated that he already knew the patient. That was strange. He went on to state the following, ‘… and has a diagnosis of schizophrenia. He is currently exhibiting clear signs of relapse in the form of grandiose delusions of a religious nature, paranoid delusions, and is responding to unseen stimuli. His presentation is of a nature and degree which warrants recommencement of treatment via detention in hospital, which cannot be achieved by any other means as he presents a risk to himself, his own health, and as a risk to the public. He has declined an informal hospital admission.’