A Justifiable Madness

by AB Morgan

  Don’t get me wrong, I didn’t object to their use entirely, indeed they worked well for the most disturbed patients, but in my view, they were not the drugs of choice as a long-term treatment. Goodness me, I wouldn’t want to experience those side effects, I thought.

  I sat in the goldfish bowl office to write up the relevant patient notes, and it was only at that point in the shift that Emma and I were reunited. She scooted into the office, full of beans.

  ‘I hear Jesus is talking,’ she said brightly.

  ‘Yes,’ I replied, somewhat astounded. ‘Where did you hear that?’

  ‘The patients, silly. Welsh Phil and the dodgy duo are sitting in the small dayroom, chatting away with him like they are good buddies.’

  ‘The dodgy duo?’

  ‘Yes, you know, Tweedle Dumb and Tweedle Dee.’

  ‘Emma!’ I chastised her for being so disrespectful to two rather round gentlemen who happened to look similar, and who had become inseparable on the ward. They were both on the road to recovery from depression, and this had much to do with their newfound friendship.

  ‘You okay?’ she asked me.

  I didn’t bore her with the full details of how my day had gone since I had seen her last, but she was intuitive and canny.

  ‘I guess that Dr Sharman and his lies have hit a raw nerve with you,’ she said. She was correct in her assumption. My sense of injustice was jumping up and down inside my head screaming for action.

  ‘I have been doing a bit of sleuthing on your behalf today,’ Emma announced as she busied herself putting files away. ‘Janet and I had a bit of a shave-a-thon. One or two of the men were looking decidedly scruffy so we opened the Pargiter Ward bath and barbers emporium. We had been sorting out the leftover toiletries in the clinic room, and it seemed a waste not to do something with what was there. We gave the majority to the patients who don’t have any family to bring stuff in for them, and we lined the men up for showers and baths. Then Janet, who it turns out is a wizard with a safety razor, gave them a shave. Only the ones that needed it the most. I tell you, Greg was as chuffed as chuffed could be. He hasn’t had the motivation to wash properly since Charming put him on that injection. It’s cruel at that dose. Oh, and Jesus came along too, right at last knockings. He had been on the telephone. Where did he get the change for the phone, did you give it to him?’

  I shook my head.

  ‘Anyway he sounds lovely when he talks, and he looks even better now he’s had a shave. Still looks like Jesus though. He doesn’t look like a Mark. I’m going to struggle to call him by his real name.’

  ‘What has that to do with sleuthing?’ I asked eventually, when Emma drew breath.

  ‘Oh yes. Janet was shaving Welsh Phil, which was a task and a half because as you know he can’t stop talking at the best of times.’

  Pot, kettle, black, I thought.

  ‘Anyway, he was saying that he thinks he knows Dr Sharman from Farley Hill Hospital back in 1980 blah-di-blah. He was sure there was some sort of scandal. Phil has told this same story to a number of the patients and there are rumblings about exactly what this scandal may be. This could become a bigger problem, because, let’s face it, Mon, most of the patients are jumpy about ward round as it is, but especially Phil because of the Chocolate Wars.’

  ‘Oh, that’s not Phil’s fault. Dan is splendidly paranoid, and thinks someone is poisoning Phil’s chocolate stash, so he keeps trying to protect Phil by taking the bloody chocolate. God, you couldn’t make it up! Anyway, as mad as it sounds, you will be pleased to hear that it is being sorted as we speak. He wasn’t on any meds you know. Dan. Bloody hell, Em, I had even begun to wonder if Charming is a real doctor, but if Phil knows him from previously, then he must be. I feel a bit of a prat right now.’

  Actually, it was more than that, I experienced a horrible sinking feeling when recalling what I had said to Richard Huntley about my belief that Dr Sharman might not even be qualified.

  ‘Don’t beat yourself up. I haven’t finished my sleuthing yet,’ Emma said. ‘My sister Laura used to work at Farley Hill in the eighties before she had kids. I’ll give her a ring and see if she remembers him. I hope the scandal is juicy. A sex scandal. Bound to be!’

  We had to stop talking and concentrate, as we needed to get ourselves back on track with the requirements of the ward, and its endless routines. Emma had drawn the short straw for ward round on Tuesday instead of me, and she was not looking forward to it. We agreed to help each other with the preparations on Monday, but before that, Emma and I had the weekend to plan for. Unusually we both had time off together, which meant that we could chat away to our hearts’ content for hours. Emma had also badgered me until I agreed to go with her to the rugby club in town, after work on Saturday. The match would be almost over by the time we arrived, but I had promised I would go along for a drink, and to address my social avoidance by actually talking to the opposite sex.

  Emma was trying her level best to set me up with Max Davis. He was nice enough, but too sure of himself and bit of a caveman. I was more excited by the prospect of a trip to the cinema on Sunday afternoon to see Forrest Gump. After which I would slurp wine in front of the telly on Sunday night. Lovely.

  22

  True Colours

  My new social life awaited me, with only Saturday morning to get through. That was no great hardship, as weekends tended to be genteel affairs on the ward. The majority of the patients were on home leave, and there were no activities downstairs in the OT department. Moreover, no doctors would be appearing on the ward unless requested. Visitors came and went in a steady stream, often bringing long-awaited items of fresh clothing and food. Patients, if they were permitted to do so, could have leave to walk in the hospital grounds or go out to lunch with their loved ones and friends. For others, it was unfortunately a long boring drag through to Monday when the chaos of the ward rounds started again.

  I would usually buy newspapers on the way in to work when I was on shift at the weekends, and that week I had badgered and cajoled the local newsagents into donating unsold magazines, and out-of-date local and national newspapers to us at the hospital. These contributions went down splendidly with staff and patients alike, and especially with Mark, I noticed. He practically devoured every morsel of information in the papers and the magazines as if he were ravenously hungry.

  ‘You alright, Mark?’ I enquired gently.

  ‘Yes, good thanks. I was feeling excommunicated from the outside world,’ he explained. ‘I never knew I would miss the news so much.’

  He seemed genuinely engrossed, and went straight back to reading everything I had delivered that morning. He had a valid point about feeling disengaged from the world outside the hospital, and I made a note to request daily papers for the ward from the management. I had a sneaking suspicion that the staff would end up buying these, but it would be worth asking anyway.

  A short while after lunch on that Saturday, I asked Mark if I could speak to him. I think he knew what was coming. I wanted him to give me the ins and outs of how he ended up in hospital, his family history, his background, his medical history, the whole lot. I asked him standard questions about sleep, appetite, mood, memory, concentration, thoughts, beliefs, and I delved into whether he had ever had any unusual experiences. A usual bill of fare, for psychiatric assessment purposes.

  It was a fascinating assessment process as it turned out. Mark, as far as I could determine, had no psychosis, past or present, but he did seem to have other problems. His sleep was very poor indeed and he had more than night terrors. He had flashbacks but could not, or would not, detail these in relation to specific traumatic events. He had low-level anxiety, and his mood was not as good as it could have been at times. Despite his willingness to divulge information, I still felt that parts of what he said did not represent the full truth.

  I was wholly unconvinced by the story that he had banged his head in the train toilet compartment before leaping naked onto the platform, but it did serve t
o remind me that I had requested a CT scan for Dr Siddiqui several days previously, and an appointment had not been forthcoming. It was a bit late, as the request had been as a result of Mark being mute on admission. Not that I could work out why it was still required. I’m not a doctor.

  I am a thorough nurse, however, and therefore I wrote up the comprehensive assessment report and filed it in the notes to help the team to fill in the blanks about Mark. It would aid Emma with her ward round feedback to Dr Sharman. Come Tuesday, I was not confident as to how well Charming would react, as undoubtedly he was going to feel embarrassed about getting this case so wrong, and I was going to prove my point.

  ‘Bloody hell.’ I recalled my ex-boyfriend’s detailed character assassination. ‘Ben was spot on.’ I did like to be right all the time. I hated being criticised, and I was most uncomfortable with being wrong. But if I’m wrong I will say so, as much as it hurt. I hoped vehemently that the whispers about Dr Sharman being involved in a scandal were wrong, because otherwise we would have a disruptive set of patients primed to fire off in the direction of the staff, if the rumours turned out to be true … whatever they were.

  Monday had come around too quickly, and I was not in the mood for work. I had enjoyed my time off far more than was good for me and my liver was making an aching complaint that day. Emma and I had both raved on almost endlessly about Forrest Gump – what a brilliant film! I was pondering the fabulous phrase ‘Life is like a box of chocolates, you never know what you’re going to get’ as I walked from the lockers and on to the ward in good time for handover. As it turned out, that phrase was prophetic.

  The ward seemed its usual shambolic ward-round-day self, and I was gearing up for sorting out the vast number of pharmacy orders and leave arrangements for the majority of the day, and after that I would be preparing for the next day’s ward round with Emma, as I had promised. We were both waiting in eager anticipation for her sister Laura to get in contact. Frustratingly, we had to console ourselves with leaving a message on her answerphone machine because she was away for the weekend with her husband and children. Emma’s parents had informed Emma of this fact only after we had established that no one was at Laura’s home to answer our calls. We had no choice other than to wait for Laura to call back. Meantime the rumours about Dr Sharman’s past continued amongst the patients. Most staff seemed oblivious, thank goodness, or chose to assume it was fantasy on the part of one of the patients.

  I did a whirlwind tour of the ward and checked the allocations board, which outlined who was in what bed where, and by virtue of coloured magnetic labels, the board denoted what Section of the Mental Health Act, that person was on, if any. Simple, but effective.

  Charlotte had drawn the short straw for managing the ward round that Monday morning, and she appeared to be deflated in her mood when she walked into handover. She used the word ‘crushed’ to describe how she felt. Nevertheless she bravely gave us the lowdown, not only on the general issues for each patient on the ward, but the outcomes from the ward round itself. She did not succeed in completing this before succumbing to tears. She explained that Dr Sharman had been in a thunderous mood, complained about his coffee, and had only agreed to keep to the discharge plan for Rodney Wells if he accepted that he had to take his medication in injectable form. Apparently, Sue, his CPN, who he had worked with for the last four years, had been present and even she had said that this was an unnecessary action. She had already purchased a pill dispenser box with the days of the week on it for him, to help Rodney remember to take his tablets.

  Secretly, a lot of my ward colleagues aspired to become CPNs when they sought to move on in their nursing careers. Working as a community psychiatric nurse was stressful but it had its compensations. The CPNs always appeared smartly dressed and confident as they carried their big diaries and leather briefcases.

  ‘Sue was assertive,’ said Charlotte, ‘and well organised for the discharge. She and Rodney had plans. Sue had arranged reminders for Rodney on his fridge and bathroom mirrors and she even promised that his medication could be reviewed if it didn’t suit him. She’d already made a follow-up appointment for him to be seen by a community psychiatrist in six weeks’ time. Rodney was pleased with this plan, although I suspect he was also simply relieved to be getting off the ward. He was desperate to go home.’

  At this, Charlotte had begun to cry. She described through her tears and the odd nose-wipe, how Dr Sharman had become more than furious with Sue the CPN. He had ranted and raged, even accusing her of undermining his authority and professional decision-making. Sue the CPN, according to Charlotte, had been dumbfounded, but had then retaliated by informing Dr Sharman that she was not expecting to be spoken to in such a manner.

  ‘He said, “In that case I suggest you wait outside” and demanded that she leave the room,’ said Charlotte. She then cried and sniffled for a while longer before controlling herself again. ‘Rodney begged and pleaded with Dr Sharman, he was distraught,’ Charlotte sobbed. ‘Dr Sharman wouldn’t rescind his Section unless Rodney had an injection. He was crying when we gave it to him. We were all crying. It was terrible.’

  Those in the room listening to Charlotte were silent, and only occasionally did we look at each other for confirmation of how we were responding to this news. Once Charlotte had finished her feedback, we talked all at once.

  ‘Poor Rodney; such a nice man. He wasn’t even that bad at remembering his meds,’ one of us said quietly.

  ‘I think we have to raise this again with Gordon,’ someone said, referring to the senior unit manager Gordon Bygraves.

  I reminded everyone that we had tried to raise objections several times in the last six months, and the result was always a curt denial of any problem, and a deaf ear or blind eye being turned to any facts we presented. ‘It was not well received.’

  ‘What about the Medical Director?’

  ‘Who’s the current Medical Director?’

  ‘We have to do something. How about we put our concerns in writing?’

  ‘What about a Union Rep? Could they do anything?’

  The suggestions came in thick and fast, but in the end no one took up the challenge of putting pen to paper. Vance, one of the healthcare assistants suggested that he could speak to a Union Rep for advice, and to test the water. His offer was accepted, and we agreed that, in the meantime, we had to be brave and raise concerns with Dr Sharman directly, documenting any disagreement in the nursing notes for evidence.

  At that moment, Gordon Bygraves’ secretary put her head around the door, and announced that she was looking for me.

  ‘I’m sorry to interrupt. Monica, could you come with me please.’

  There was no hint at what was about to happen. Life is like a box of chocolates.

  I followed Gordon Bygraves’ neat secretary to his spacious office on the ground floor, which held not only Gordon himself within, but also Dr Giles Sharman and the lovely lady from the Mental Health Act department, Harriet Morris, no relation.

  ‘Please come in, Nurse Morris,’ requested a serious looking Gordon. I took his stern expression as a forewarning that something ominous was about to come my way. The three senior NHS staff figures of Gordon, Harriet and Dr Sharman sat in stylish office chairs, which they had placed strategically in a rough semicircle, while I stood inside the door in front of them, rather like a naughty schoolgirl summoned to the headmaster’s office.

  ‘We have an unprecedented situation on our hands, Nurse Morris, but fortunately we have Dr Sharman to thank for arriving at a swift resolution.’

  I still didn’t know what was coming.

  There was then a lengthy discussion about a discrepancy on Mark El Amin’s Section papers, and an attempt at explaining in a convoluted way, that the hospital had found it necessary to seek advice from the Mental Health Act Commission itself on the best way forward. I was perplexed as I stood in front of them trying to follow the conversation.

  Harriet sighed and tried to simplify the main points for
me, as obviously, judging from my confused expression, she realised that I was at a loss as to why this had anything to do with me.

  ‘The thing is, Monica, Dr Sharman has been most magnanimous in his support for you. He appreciates that you did not intentionally supply him with the incorrect application form in ward round last Tuesday. He completed the Form 11, and we are aware that it should have been a Form 4 for a Section 2. This is not as dire as it seems as the signatures and information, and importantly the times, are correct.’

  Quite frankly, standing there with my mouth gaping I must have looked like a frog trying to catch a fly. I was incredulous. What were they talking about?

  Dr Giles Sharman, appearing self-assured and more than a little arrogant, gave a wide smirk and leant forward. He then took up the narrative. ‘Yes, please don’t let this worry you. We know, that you think what you did, was correct at the time. We have taken steps to rectify the situation because we have to resubmit the recommendations anyway in the light of the information which you kindly sent through to Harriet on Friday: that we now have a name for our mysterious patient.’ He then sighed. ‘However, the hospital managers may take an extremely dim view of your actions in regard to Mark El Amin’s appeal request.’

  ‘I don’t understand,’ I said, managing at last to make a connection between my brain and my mouth.

  ‘No, we do appreciate that, which is why we have asked to see you, Monica,’ smiled an imperious Dr Sharman as he tilted his head and raised one eyebrow at me.