A Seaside Practise

by Tom Smith

  The atmosphere in that house – it was more of a community of old men living together than a hospital – is hard to believe now, looking back from the viewpoint of the liberated twenty-first century. The only doctor they ever saw was an eccentric Scot, Dr Haig, whom I judged to be near retiring age. Twice a week he would arrive at eleven o’clock, have a cup of tea, then do ‘his round’. The old men were frightened of him: they sat up to attention when he spoke to them. All he ever asked them about was the state of their bowels. He never listened to their answers, but he ordered enemas for them, regardless. We dreaded his round, because we had to follow his orders. That meant taking the men to the sluice room, asking them to lie on a table there, and administering the soap and water mixture. As the junior, I was delegated to help the staff nurse with the task. The patients hated it, the nurses hated it, and I hated it. I couldn’t imagine why we had to do it, because none of the men needed the treatment, as far as I could see. While I was performing this unnecessary, demeaning and brutalising function for them, I could see Dr Haig through the window, walking around the perimeter of the cricket ground, hands clasped behind his back, muttering to himself. He must have walked for an hour in this way after each visit to us.

  As for the nurses, many of the older staff had come into the profession not because they wanted to nurse, but because it had been the only secure job open to them in the depression years of the Thirties. They had little sense of vocation: they looked on what they did as a job, and if they could relieve its boredom by finding some amusement in it, so much the better. Unfortunately, the amusement was always at the expense of their unhappy patients.

  So every patient had a nickname. Mr Spencer, who believed he was the King of Mars (he really did) was called Donkey because at times he spoke in Martian, largely a very loud language that sounded like braying. Some nurses amused themselves by calling him ‘Your Majesty’. That upset him, because he was on Earth incognito, and didn’t want his real identity to reach the penny press. If it did, the Venusian king would send his hordes to ‘see him off’. I remember thinking how cruel it was that professionals should joke at his expense, knowing the distress they caused.

  Mr Harper, who predicted every day that the end of the world was coming tomorrow, was called The Doomster. On the famous day of the house’s outing to Skegness, Mr Harper managed to wander away unseen from the rest of us, sitting docilely on the sands. We found him half an hour later haranguing the Butlin’s holiday campers about their waste of their last few hours on earth in tomfoolery and frippery. What happened then still makes me ashamed to this day.

  The two nurses in charge ran up to him, grabbed him by the arms, twisted them behind his back and frog-marched him along the Prom towards our little forlorn group sitting on the sands. They shouted at him that this was the last time he would be allowed on a trip, but his mind was on other things. All the time he was being manhandled, he was shouting to the crowds walking by that the world was about to end and that they should save themselves. They stood still, taking in this scene of a poor deluded man being shoved around by two burly nurses, and making no move to help. They tittered or laughed out loud at the spectacle that would make for light conversation later around the bars or in the chalets, but none complained that our behaviour was unacceptable. I write ‘our’ because I was complicit in the scene. As a boy of eighteen I was very much the junior, and had no say in how Mr Harper was to be treated. I still feel that I should have spoken up.

  My favourite patient was Mr Evans. The staff called him Penguin, because he had inherited a mixture of handicaps. Today these would have been lumped together in a ‘syndrome’ and his genetic problem would have been identified. Then he was just labelled with the main title of ‘mentally handicapped’, and the subtitle of ‘near-imbecile’. Mr Evans had been in the hospital since he was thirteen years old – committed there because, walking in Lincoln High Street, he had stroked the hair of a young girl passing by.

  For this heinous offence, he was detained at His Majesty’s pleasure - His Majesty at the time being Edward the Seventh. Since then George the Fifth, Edward the Eighth (briefly), George the Sixth and Elizabeth the Second all seemed to have gained pleasure from Mr Evans, because they kept him in the hospital for the next fifty years. He had not been beyond its doors, except for that annual outing to Skegness, in all that time.

  Why was he called Penguin? Mr Evans was four feet six inches tall, and his build was not in proportion. His legs were much shorter than normal for the length of his torso, and he was unable to move them apart from his hips. He had to walk with a strange waddling shuffle, his knees clamped together, his feet turned outwards, so that they were set at more than a right angle. He bobbed from side to side as he walked, so that the description of Penguin fitted him exactly. His face, too, was bird-like, with a sharp beak-like narrow nose, virtually no chin and large protruding eyes. He was bald - I hesitate to add like a coot - another similarity that added emphasis to his nickname.

  Why was he my favourite? Because despite his diagnosis of near-imbecile, made so many years ago, Mr Evans had become well-read. In his early years he had been assigned to clean the hospital library, a room frequented by staff and doctors, but rarely by the patients, for whom it had been meant. Forty years on, having taught himself to read, he would speak quietly to people he could trust about all the wonders that he had read about in his days in the library. He was a gentle and kindly person, and would never have harmed anyone.

  On some days I would be on the evening shift, arriving at two in the afternoon and leaving at ten. My job then was to make sure my charges were fed properly, toileted, showered and helped to bed. The evening medicine round sticks in my memory. To make sure everyone slept well and in their own beds (men shut away from women for years had an understandable urge to share a bed – a habit that was illegal at the time), they were given a disgusting liquid medicine called paraldehyde.

  At nine o’clock, the men formed a queue in the downstairs sitting room to receive it. The charge nurse, that is the head nurse, a male equivalent of a ward sister in a general hospital, stood beside a large table on which there was a huge brown glass bottle, and two trays of small medicine glasses. Each man in turn would walk up to the nurse, be handed a glass that had been filled from the bottle, and would bolt down the contents. The glass would be replaced on the tray and the next man would be served with the next dose. There was a sink nearby, and it was my job to rinse out the glasses and replace them on the trays. Some of the glasses had red paint on them. These were to be used by the patients who had tuberculosis, and had to be rinsed in a different sink. The ‘TB patients’, as they were called by everyone, (thereby violating their right to secrecy of diagnosis), were segregated at mealtimes, too, eating in a small separate dining room, with red-painted crockery and cutlery. They slept on a verandah, since the hospital still had not understood that fresh air was no real cure for their illness. Even in the summer they were cold at night. I often wondered how they survived the winters.

  In the bottle was an awful-smelling and even worse-tasting fast-acting sedative called paraldehyde, so that fifteen minutes after their doses, they were all asleep, snoring and grunting their way through the night. They called it their paralyser, and that’s truly what it was. Years later I realised that it was virtually an anaesthetic, and that their sleep was closer to coma than to normal sleep. The one person to be excused a paralyser was Mr Evans. Years before he had developed a severe reaction to the mixture and had almost died. It was decided that he was harmless and that it wouldn’t be a problem if he didn’t take it. He was probably the only man in the whole place whose brain was still receptive to the normal rhythms of sleep and wakefulness.

  Which was why I often sat beside him for the last quarter of an hour of my evening shift, when my routine work was done and I was waiting to cycle home. He was often better company than the other nurses, whose main topics of conversation were women, foo
tball or the latest joke about some poor patient’s aberrant behaviour. I asked him one evening if he didn’t resent being kept in this place for so many years, when he obviously was normal mentally.

  ‘Look at me, Nurse,’ he replied. He always called me nurse because, he said, I was the only one of the staff who called him by his proper name. If I was good enough to call him Mr Evans, he would give me my proper title, too.

  ‘How would I have done out in the world looking like this?’ he continued. ‘I’d be in a freak show. The hospital has fed and clothed me and given me a bed. I’ve long since given up wanting respect and if they want to make fun of me, I can’t complain. I’ve got my books, and now I’m old, that’s all I need.’ I marvelled at his acceptance of his unfair lot in life.

  Around a week after this short conversation with him, we had a new arrival in the house. Richard Brown was eighty years old. At the age of nineteen he had been sent to Broadmoor for the murder of a man in a pub who hadn’t agreed with his political opinions. He had escaped the noose because at his trial it became clear that he was ‘dangerously insane’. I know this now because I’ve researched the newspaper clippings of the time but we, the staff on the ward, were kept in the dark about his past. As far as we knew, Mr Brown had been transferred to us from another hospital because we had the room to take him, and he was now so old that he was no longer a problem. All he needed was routine nursing care.

  Mr Brown arrived seated in an ambulance car with his small brown case in the company of two male nurses, which on reflection afterwards was unusual. Most of our ‘transfers’ came by public transport, usually a train, with a single attendant. He looked very fit for his age, clean-shaven, neat, well-muscled, despite his advancing years. His light blue eyes had a piercing quality, as if they looked right through you. My immediate thought was that it might be difficult to persuade him to swallow his paralyser, and my second was that if he did, it might not work.

  As I showed him his bed in the upstairs dormitory, I tried to make light conversation with him, but he kept quiet, holding his head down, as if staring at some detail of the polished wooden floor. He clearly didn’t wish to talk to me, and that was his affair. He put his few things in his locker, and followed me downstairs to meet the other men in the day room. I remember thinking that he had so little to show for his long life.

  The charge nurse allocated every able-bodied man to a small job. Today it would be called occupational therapy: then, it was just an easy way for the nurses to avoid having to do the dirty jobs. On the second day there, Mr Brown was asked to help Mr Evans brush the dormitory floors. Mr Evans was happy to have him: at least this man hadn’t yet heard of his nickname, and wouldn’t laugh at him. I watched them go up the stairs together, and returned to my task, with the staff nurse, of making the beds in the sick room on the ground floor immediately underneath them.

  We heard the bump about ten minutes later. It was as if something heavy had fallen over in the room above. Then silence. The staff nurse and I looked at each other, then dropped what we were doing and ran upstairs. Brown was standing looking out of the window, as if nothing had happened. Mr Evans was lying on the floor, a large brush beside him, the working end of it covered in red. It had obviously been swung with some force directly at his left temple, from where the red had stopped oozing. The fact that it had stopped wasn’t good. Staff nurse bent over him, looked at me, and shook his head. For a second or two I wanted to rage and shout at Brown, but the feeling passed. He was in many ways as much a victim as my friend. He needed treatment, not punishment, and there was no treatment for him.

  Naturally, the hospital held an internal inquiry. Oddly, my staff nurse colleague was called to it, but I wasn’t. The superintendent ruled that as I was only temporary staff, and ‘only a boy’, I couldn’t add anything authoritative to its conclusions. However, he warned me not to speak about it outside the hospital, a subtle hint that if I did, I might not keep my job. Nor would it bode well for my medical school career. I wasn’t well off. I really needed the extra cash – five whole pounds a week – to keep me going at medical school. So I didn’t speak about it. In fact, this is the first time I have done so, fifty years later. I’m the only one left who knows about it.

  Neither Mr Brown nor Mr Evans had any living relatives, or at least any who knew or cared about them. So the affair was dealt with quietly and efficiently. Mr Brown went back to Broadmoor, and Mr Evans was buried in the small plot near the hospital next to all the other forgotten human debris. He was seen into the ground by a vicar who had never met him, the men from the funeral company, the two gravediggers and myself. As far as I know, there was no inquest. Certainly there was no publicity about the case.

  Even at eighteen years old, and still really a schoolboy, I knew that the way these men had been treated was wrong.

  The next summer, after passing my anatomy and physiology courses, I had to make the decision on where I would work for my last long break before I started my time on the wards. After that there would be no summer vacations – we would be up at medical school all year round. I hesitated about going back to the ‘house’ but decided to give it another chance, partly because I knew the routine, and partly because, despite Mr Evans’ death, I still enjoyed the work. And I sorely needed the money.

  I was astonished at the change. In the main building, the rooms were brighter, and the patients happier. There were far fewer locked doors, and the walls of the corridors and wards were no longer painted in ‘mental hospital’ brown and cream. The wards and corridors were newly painted in bright colours and pictures, most painted by the patients themselves, hung on every wall. The exercise yard was now a vegetable garden, with gangs of patients happily tending plants in the earth that had the previous year been a featureless expanse of unbroken clay. The padded cells had disappeared: the rubber had been stripped from them, and they were now used as study rooms or art studios.

  What had made the difference? One big change was the introduction, earlier that year, of a single drug – Largactil, or chlorpromazine. It was the first drug to make a real difference to the quality of life of people with severe psychiatric illnesses, such as schizophrenia and personality disorder. The other was a change in staff. The old superintendent had retired, a younger man had been appointed, and he had brought a whole new breed of nurses into the hospital. He had shaken up the nurse training school. I was hugely impressed how a new broom could truly sweep clean.

  There was another change. Dr Haig was no longer there. A younger doctor, a woman, now did the rounds. There were no more enemas. She was kind and compassionate, and she seemed to care about their physical well-being.

  But it wasn’t the last I had seen of Dr Haig. One of the perks of the job was that the hospital had a cricket team. I was hopeless at cricket. My long sight meant that when I could see the ball it was too far away from me to hit it, and when it was within reach I had no idea where it was. In my seven years trying to play the game at secondary school I had never been able to hit a ball with a bat, except by accident. However, I was young and fit and could chase after a ball in the field, so I was asked to make up the numbers for matches. As they involved coach runs into the countryside to visit the other hospitals in the East Midlands, it was a welcome relief from the job. The team was a mixture of patients and staff, and we got on well on the journeys. The trips were classified as work, so I was even paid to go.

  On one of these trips, to a hospital in Nottinghamshire, I was fielding in my allotted place near the boundary (my poor eyesight didn’t let me field anywhere close to the bat) when I saw a familiar figure walking briskly towards me, around the perimeter line. It was Dr Haig. He was muttering to himself in his usual stance, bent forward, hands behind his back. As he passed close to me, for the first time I heard what he had been muttering.

  ‘He needs an enema, he needs an enema,’ he was repeating, over and over.

  At the tea break,
I mentioned to one of the team that I had seen Dr Haig. I asked why he had been transferred to the Nottinghamshire hospital.

  ‘He’s not a doctor here, he’s a patient,’ was the reply. The new medical staff in our hospital, in their review of the pharmacy stock, had wondered how it was that the hospital was top of the national league by far for orders for enema soap. Only then did they query Dr Haig’s mental state, and found that he was well into the middle stages of Alzheimer’s disease. The transfer was very discreet, and Dr Haig was given his own room, and would wander round the wards ordering enemas, apparently under the delusion that he was a member of staff there. A short time later I was told that he died, never realising that he was, in fact, a patient.

  That story heartened me: the hospital service was human after all. The nicknames had gone, too. Patients were called by their proper titles. Mr Spencer and Mr Harper had both been given Largactil. It was hugely successful for the King of Mars. Mr Spencer still thought he was the ruler of the red planet, but he had lost his delusion of persecution by the King of Venus. He didn’t mind any more that his secret was out. He confided in me that he realised now that Venus was an inhospitable planet that could never have supported life, and that all that stuff about its king must have just been in his imagination. He was much calmer, and the braying voice was down to normal volume. He was at peace with his self-imposed exile to Earth, and was regally and kindly disposed to all around him, including those who had made such a fool of him in the past.

  Mr Harper’s experience was less successful. He had responded exceptionally well to the drug, losing his sense of impending doom and becoming quite rational. He was so well, apparently, that, under the relaxed laws of the new hospital regime, he was allowed out with a few fellow patients to walk to the local hostelry, a hundred yards from the hospital gates. Apparently, on the way back he had crossed the road into the path of a fast-approaching car. Doom had in the end overtaken the unlucky Mr Harper, just as he had begun to think, for the first time in thirty years, that he might escape it.