In Two Minds

by Gordon Parker

  Sarah entered the locked mental health unit with trepidation. It was relatively modern but had a disconcerting ambience. The receptionist who buzzed her in sat behind a thick glass security screen and simply gestured for Sarah to take a seat. Sarah noted the relative sterility of the waiting room and the corridors, the heavy security and an atmosphere of lost souls. She waited impatiently for half an hour before Dr Bennett walked into the room and introduced herself.

  ‘Can I see my husband now?’

  ‘You can, of course, but I’d prefer if we could chat first.’

  They moved to a small interview room, Dr Bennett moving her chair from behind the desk to near Sarah’s. ‘Your husband is very unwell, Mrs Homer.’

  ‘I agree.’

  ‘What have you observed in recent weeks?’

  ‘Well I’ve been overseas. For just over a week. And Martin was due to pick me up at the airport. He’s always on time. For him not to be there was most peculiar.’

  ‘What about his behaviour before you left?’

  ‘His mood was quite down. His mother had died some weeks before and he grieved her very deeply. It was extreme grief for a period. He felt guilty about not diagnosing her cancer. It seemed to explain his depression.’

  ‘What did you notice?’

  ‘At his worst he was just a shell of himself. He completely lost his vitality. Everything was doom and gloom, he couldn’t be cheered up and I know that he was getting little sleep.’

  ‘Was there any evidence of psychosis?’

  ‘What do you mean by that?’

  ‘Either delusions – perhaps feeling he was being persecuted – or hallucinations – such as seeing or hearing things that didn’t exist. Perhaps from the TV.’

  ‘No, not that I was aware. I’m sure I would have noticed if there was anything like that.’

  ‘Any suggestion that he was in a suicidal mood?’

  ‘I worried about that possibility but he never gave any suggestion. And, of course, he was working nearly all the time during this period. He said that work helped him. If he’d been really depressed he wouldn’t have been able to work. And his colleagues would have picked up on it. They would have suggested he take time off.’

  ‘What about his alcohol intake?’

  ‘Minimal. Two drinks a night at the most. And that’s not even every night.’

  ‘Any drug taking?’

  ‘No.’

  ‘No stimulants? You know, amphetamines, ecstasy, cocaine?’

  ‘Martin would be the last person to take any illicit drug. He’s even reluctant to take any medication for a physical problem.’

  ‘Did he seek any treatment?’

  ‘No. And he was possibly right in his judgment because his mood lifted in the week before I went away.’

  ‘Lifted?’

  ‘Yes, he became positive again, all of his energy came back and he was so enthusiastic about being out of the depression. He was my Martin again.’

  ‘Just back to himself or more of an overshoot?’

  Sarah hesitated. She remembered the night before she flew out and Martin’s excessive sexual demands. But she felt uncomfortable about providing such details to this young doctor. Especially when Martin had had no libido during his depression and presumably simply had had his libido return. As for his gestures of generosity? Just Martin appreciating being out of his depression.

  ‘No, just Martin back to his wonderful happy and generous self.’

  ‘And while you’ve been away? Are you aware of any problems?’

  ‘He wrote me in more detail than I might have expected but then he clearly missed me. And he loves to write.’

  Sarah hesitated. She should say something about Martin’s affair but, as she was quite unaware of what had occurred, she remained concerned about Martin’s probity lapse becoming common knowledge, and so she proceeded cautiously. ‘And it would appear that he’d been fraternising with a woman to some degree in the week I was away.’

  ‘Fraternising?’

  ‘I don’t know who she is. But they were apparently together quite a bit. She can apparently be a bit disinhibited.’

  ‘So there might have been drugs involved?’

  ‘Not Martin. I can be sure about that.’

  Dr Bennett detected the tension in Sarah, and decided to move ahead. ‘Is there a family history of any psychiatric problems?’

  ‘His father had depression but it was not talked about in his family. Apart from him, no one.’

  ‘Has he had any major medical problems?’

  ‘None.’

  ‘Not on any medication? Not allergic to any medication?’

  ‘No to both.’

  Dr Bennett leant forward. ‘Thanks for that. You’ve been very helpful indeed. He’s currently quite psychotic. As you may have heard he was picked up by the police for excessive speeding. He told them that his dead mother was talking to him. He has to be hospitalised.’

  ‘My God!’ Sarah exclaimed, wiping tears away with her hand as the doctor reached for some tissues. ‘Hospitalised? Is that really necessary?’

  ‘Absolutely, I’m afraid.’

  ‘Could he go to a private hospital?’

  ‘They only take voluntary patients. He’d sign himself out claiming he was fine. We’ll admit him involuntarily on a schedule.’

  ‘Schedule?’

  ‘A Schedule One. It’s part of the Mental Health Act and where I’ll document the evidence of him having symptoms of a mental illness and detail how he meets criteria. It allows us to admit him as an involuntary patient and treat him until he’s better. To hold him we’ll require another certificate from a second doctor in the next few days. There is another advantage to him being with us. The police are unlikely to proceed with any charges.’

  ‘You stated he was psychotic. What type of psychosis?’

  ‘Not sure at this stage. I’ll discuss it with the duty consultant. And we’ll need to run some tests.’

  ‘For what?’

  ‘Mostly routine. A full blood count, liver and thyroid function tests and some tests to exclude an encephalopathy or a delirium. I don’t think there’s anything organic but he’s not cooperating with cognitive tests. And we haven’t done a full physical exam as yet. He’s just a bit too prickly at the moment. But it will be done in the next day or so.’

  Sarah noted that they had not mentioned an HIV test. Was this out of delicacy?

  ‘And we’ll do a drug screen.’

  ‘For what?’

  ‘Mainly for amphetamine, cocaine, benzodiazepines and any opiates. And we’ll need to do a brain scan – CT or MRI – again just to rule out anything organic, but we won’t do that till next week.’

  ‘And you’ll be able to get him better?’

  ‘I’ve no doubt about that.’

  ‘What with?’

  ‘Almost certainly we’ll start with an antipsychotic drug but I’ll check with the consultant.’

  ‘And how long will he be in hospital?’

  ‘Really impossible to know. Could be a few days to a few weeks.’

  ‘As long as that! My God. He’ll go crazy.’ Recognising the irony, Sarah changed direction. ‘Can I see him?’

  ‘Of course. Probably best if you don’t mention we are admitting him and if you could keep your time with him brief.’

  Dr Bennett escorted Sarah to the interview room and left her there with Martin and the two nurses. Martin had his head in his hands but when he heard Sarah’s voice he sprang up immediately. There was no smile. He appeared dishevelled and desperate.

  ‘Sar. Oh Sar. Please forgive me for not getting to the airport.’ He hugged her closely.

  Sarah allowed the hug to continue. ‘Of course. But you look so stressed.’

  Martin arched back, let go of Sarah and started to walk around the room. ‘Can you believe it, Sar? Simply on my way to pick you up and I end up in a psych unit. It just doesn’t make sense.’ He became more imperious, if not high-handed, and spoke without his
usual warmth. ‘There’s nothing the matter with me. The doctors have it all wrong.’

  ‘Ask for a lawyer, Sunny.’

  ‘And I want you to get me a barrister – the best – and get me out of here.’

  Sarah drew back. She felt the hair on the back of her neck rising. An eerie sensation she had never experienced before. Martin, always positive, generous of spirit and tolerant, the man that she had loved for years, was no longer Martin. Here was an angry, self-entitled and overbearing man.

  Dr Bennett entered the room and nodded to the nurses who moved towards Martin. Sarah quickly gave Martin a hug, feeling the tension in his body but not feeling any warmth from him, and he twisted away from her as the nurses slowly approached him, seeking to move him to the observation unit, a high security ward for the most disturbed patients.

  Dr Bennett asked Sarah to wait and not follow Martin. At the door Martin propped and said he was not going to go into the unit. The nurses quickly linked their arms with his and walked forward, offering encouraging comments. They passed the secluded cell, its door half open as another patient had just been taken in there. The patient was prone on the floor, one nurse holding his head to prevent spitting or biting and four nurses holding a limb each, so avoiding any torso pressure as they prepared him for an intramuscular injection. Martin shivered spontaneously. There but for the grace of God…

  The nurses took him straight to his new bedroom. A third nurse entered the room and explained admission procedures. She was carrying a policeman’s truncheon.

  ‘Martin, I presume you would like to stay in your clothes.’

  Alarmed by the truncheon, Martin spoke quietly. ‘Is there any alternative?’

  ‘We can give you a hospital gown if you’d prefer.’

  ‘My clothes then.’

  ‘We do need to undertake an inventory…and check through your clothes.’

  ‘I’m not a prisoner.’

  ‘And this is not a prison. We just need an inventory of all your personal goods. Some might best go into the ward safe. But you can give some things, such as your wallet, to your wife. We also need to check that you don’t have a cigarette lighter or anything like that.’

  Martin viewed her as being too delicate, not wanting to state that they were checking him for a concealed weapon or drugs. They asked him to open his pockets and, as Martin handed over his wallet and some coins, one nurse recorded each item, while the third nurse passed the truncheon – which he explained was a metal detector – over him. Martin felt humiliated and dehumanised, and he protested at their every action despite the nurses explaining each interventional procedure in quiet and reassuring voices.

  ‘We’ll keep these in the safe and we’ll give you a copy of the cashier’s receipt. Judy will –’

  ‘Judy who?’

  ‘I’m Judy,’ said the female nurse brightly.

  ‘She’ll give you a full orientation to the ward. Show you where the bathrooms, showers and TVs are. Tell you about food times. And visiting times of course. I just need to give you a Schedule Three – it’s a statement of rights. Your rights.’

  Martin laughed. ‘My rights?’ He threw the A4 sheet on his bed, stared at it for a minute, picked it up and ripped it into four pieces, before dropping it into a bin. ‘Truth in action, eh? What Justinian referred to as the ligament which holds civilised beings and civilised nations together. How shallow you operationalise my rights.’

  ‘Would you like something to eat?’ said Judy.

  Martin glowered. ‘I haven’t got time to eat.’ He raised his voice. ‘Why don’t you all get out of here. You’re no help to me.’

  Judy smiled brightly. ‘We need a urine sample from you, Martin. Tell us when you are ready and we’ll come and get it.’

  The nurses backed out, leaving Martin pacing up and down his room. One nurse went to tell Dr Bennett they had been able to get him into the ward without trouble. Dr Bennett had finished briefing Sarah about likely procedures and was escorting her back through the locked entrance. She smiled her appreciation and rang the consultant duty psychiatrist.

  ‘Doctor Fielding, Jayne Bennett here. Sorry to trouble you but I do need to run an admission by you.’ She could hear the background noise of a sporting event. Perhaps he was watching his son playing soccer.

  ‘Go ahead, Jayne.’

  ‘A 42-year-old general practitioner, brought in by the police who pulled him up for speeding. He’d told them he was in communication with his dead mother. A collateral from his wife indicates that his current state was preceded by a severe grief reaction following the death of his mother. But he was able to keep working. A family history of depression in his father. No known medical or illicit drug problems. May have been some recent infidelity. His mental state when I assessed him initially was extraordinary. Striking pressure of speech, flight of ideas, over-inclusive, tangential and quite incoherent. Quite entitled through the interview, irritable, querulous and angry at times.’

  ‘And his insight?’

  ‘Absent or minimal. Can’t be drawn about his mother.’

  ‘So he’s definitely psychotic?’

  ‘Absolutely.’

  ‘And the key precipitant again?’

  ‘The death of his mother. And guilt that he didn’t diagnose it early enough.’

  ‘Could be a psychogenic psychosis then. They tend to recover pretty quickly with an antipsychotic. Could be schizophrenia but seems unlikely. Mania is a good possibility, I guess. Or simply a manic defence to the death of his mother. What about an organic psychosis?’

  ‘He’s not cooperating with formal cognitive tests but I don’t think there is any delirium. I’m planning to get a scan tomorrow.’

  ‘I agree he needs to come in. Shame for him as we’ll have to inform the Medical Board. Tell the staff to call him by his Christian name and try to ensure that the other patients don’t learn he’s a doctor. As he’s clearly psychotic I’d suggest some olanzapine. Do you think he’ll take it?’

  ‘We’ll try.’

  ‘If not, I’d suggest no IM, at least for the first twenty-four hours, unless he can’t be managed.’

  ‘Should we add some lithium?’

  ‘Possibly. How about a four hundred and fifty milligram tablet tonight? Anything else brewing in the ward?’

  ‘All fine, Doctor Fielding.’

  ‘I’ll see you – and him – tomorrow then.’

  Dr Bennett went to the nursing station, charted the medications and headed off to the emergency department, where two patients were waiting for her assessment.

  After the nurses left his bedroom Martin put a chair against the door, to guard against being assaulted. One patient – presumably the one he had seen in the Seclusion Room – was screeching, screaming and swearing. Another was yelling as he ran up and down the corridor, banging on all the doors.

  Martin sat on his bed and inspected his room. It was barren. A bed, a locker and a chair. No pictures on the walls. Cold linoleum. The single window to the outside barred. A window on his door so that he could be inspected. Paintwork chipped, some presumably by patients who had scratched at the walls.

  The situation was intolerable. He was an excellent doctor, due to be at work the next day by eight at the latest, and now he was imprisoned. Even Sarah, who he had thought would be able to explain things satisfactorily to the doctor, had failed. And now she had left him. Perhaps because she was angry at him for not being at the airport. Presumably she had joined forces with them. To punish him for his failure.

  He had to get out of this hospital.

  He realigned the torn sections of the Statement of Rights and read it rapidly. The third paragraph detailed how he could be kept in the hospital against his will if he was certified by the facility doctor as a mentally ill person.

  The word certified initially unsettled him and then made him angry. And it noted that a mentally ill person is someone…who needs to be kept in a mental health facility for his or her protection or to protect other peop
le. That sentence, even apart from its tautological logic, exasperated and enraged him by its implications. He spent his life caring for people.

  Martin continued reading. As a mentally ill person he could be kept in the hospital until an inquiry had been held by the Mental Health Review Tribunal. The inquiry must be held as soon as practicable. At first, Martin felt a glimmer of hope. This was a finite statement of now. He would demand they hold the inquiry that afternoon. But, as he read on, his hopes diminished. It seemed that if the Tribunal decided he was a mentally ill person, he could be kept in hospital as an involuntary patient for up to three months, and could even be judged incapable of managing his own affairs and subjected to a financial order under the New South Wales Trustee and Guardian Act 2009. However, he could be represented by a lawyer.

  His spirits lifted. Sarah would get the barrister. But would the barrister be able to come on a weekend? He read on and was relieved to find that he could appeal to the medical superintendent for a discharge. Excellent! He would begin immediately to write the appeal. But he then read that the superintendent might not respond for up to three days. What an infuriating document. It raised hopes then dashed them. And worse, he could be treated against his will. There, in the Schedule, it stated he could be given appropriate medical treatment, even if he did not want it.

  Appropriate? Martin riled at that statement. And who would judge what was appropriate? Who judged the judges?

  After placing the torn Schedule sheets in his bedside locker, he ruminated. Sarah had left him in the hospital and it might take her days to get a barrister. The hospital staff were jailors and he had seen what they had done to the other patient being admitted. The ward was violent and dangerous, and he was at risk of being assaulted. The staff could force medication on him.

  He would be a drooling idiot in no time. No one was going to help him. He could not waste any more time. He was on his own.

  ‘No, you’re not, Sunny. I’m with you. If you can get over the wall, I’ll have a hire car waiting for you.’

  Martin smiled. He could always trust Edina. Everyone else had conspired to lock him up. But Edina was going to set him free. And assist him with his mission.

  ‘I’ll organise a first-class ticket to New York. I’ll have a car at the airport to take you to Bethesda. And you can then meet with the director to discuss your brilliant diagnostic dog idea.’