A Justifiable Madness

by AB Morgan

  Mark realised that he was going to be in for a rough ride, but could not fight the tidal wave of fatigue, and an hour or so after he had swallowed his first ever dose of an antipsychotic medication, he gradually nodded off in a chair, not caring if he stayed awake.

  Welsh Phil had been present in the dayroom when Mark had announced that he had just swallowed ten milligrams of Droperidol liquid. Phil watched as the effects caught hold of Mark.

  As Mark slept Phil took the pad and pen from Mark’s lap without him even stirring, but when Phil looked at the notepad, he couldn’t read anything that Mark had written. To him, the shorthand looked like scrawl. ‘Oh God, the meds have scrambled his brain!’ Phil announced to his fellow patients. For this reason alone, he went to find one of the staff nurses to raise the alert.

  He returned with Charlotte about ten minutes later, who gently roused Mark out of his drug-fuelled slumber.

  As Mark came to, he appeared to have considerable trouble speaking, and his tongue had started to protrude out of his mouth as if he were rudely sticking it out in defiance.

  The expression on Mark’s face however, was not one of defiance but that of abject fear. He stood up out of the chair, leaning forward, trying to speak.

  Getting to the stage of panic breathing, he held his hands up to his throat. Christ, what’s happening? I can’t breathe … I can’t talk. Mark was freaking.

  This made for an alarming sight.

  Charlotte called urgently to Vance, the most composed, calm and collected of all the healthcare assistants on Pargiter Ward, who made his way into the dayroom. He talked Mark through the fear and anguish, giving him constant assurances that this would be dealt with in a matter of minutes. Mark was crying in fear of his life. His tongue had swollen to three times its normal size, his jaw had stiffened painfully, but with help from Vance, Mark realised that he could still breathe through his nose. He had to concentrate hard not to lose self-control. ‘Breathe gentle and slow, man, like a Caribbean breeze …’

  Vance was a stockily built West Indian man with a voice like a warming hot chocolate drink on a cold winter’s day, and it had magical qualities that you couldn’t buy. He never panicked and he never broke into a sweat. Ever.

  Charlotte meanwhile, had hightailed it to the office and bleeped the on-call psychiatrist urgently. She took instructions over the phone. This was a psychiatric emergency because Mark’s airways were at risk of being compromised altogether. Charlotte shakily prepared an injection of Procyclidine ten milligrams, as instructed; to counteract the side effects that Mark was enduring. Mark didn’t even wince when Charlotte administered the injection. His dread of needles had been trumped by the fear of death.

  The on-call doctor ran straight to the ward to see Mark, who required another injection before the terrifying swelling and stiffness abated. As the effects of the first one wore off, the second one took twenty minutes to have any sort of lasting impact on his desperate situation. Without the remarkable soothing voice of Vance, Mark knew he would have been in all sorts of trouble. After what seemed an eternity, his tongue, jaw and throat torture subsided, but the damage was done. Mark had been psychologically shaken to the core by this experience.

  So that Mark could have a side room, Vance organised a reshuffle of the men’s dormitory, and sat with him throughout the night.

  Surprisingly the Procyclidine injections had not only relaxed Mark’s muscles, allowing his tongue to return to normal, but it had also made him much less sedated. It was a brief respite.

  ‘Phil, I thought I was a goner …’ Mark mumbled.

  ‘I thought you were too!’

  Phil had been sitting outside Mark’s side room door throughout the night, listening to Vance’s calming words and to Mark’s questions and gentle snoring. During this time he made notes in Mark’s notepad. Mark managed to get some rest, but by the time the morning shift were arriving, he had begun to identify a new unfamiliar restlessness from within. He was uncertain as to whether it was a type of anxiety caused by the injection. Mark had then wondered if this unsettled feeling might simply be a response to the hours of tongue torture, but he recognised that he also felt tearful, physically weak and psychologically vulnerable.

  Once Mark was up and about in the morning, in a drowsy state, Phil handed him back his writing pad and said honestly, ‘I don’t mind being your secretary a bit longer, if it helps.’

  Mark gave him a weak smile, and thanked him for his concern and for ‘being there.’

  ‘Ah, that’s no problem. It’s a scary, lonely place. Mind you, Vance was amazing, wasn’t he? Lovely man, heart of gold.’

  29

  Watching

  Emma and I emerged from the early morning handover meeting on Wednesday, and agreed that there should be a special request to review the plan to give Mark regular Droperidol. It was far too risky for him to have another dose. We both knew that young men were more prone to physically distressing side effects of antipsychotics, and that side effects were almost inevitable in patients where a mental illness was not at the heart of their problems. Mark fell into both of those categories.

  I phoned immediately through to Lucy, Dr Sharman’s secretary, to make an urgent request for our consultant to review Mark without delay. What that bastard had done was unforgivable. I was dreading having to speak to Charming in person, but that day I was determined not to be swayed or bullied.

  Unexpectedly, it was Dr Siddiqui who returned my call later in the morning. Emma spoke to him, and he agreed to come to the ward immediately.

  ‘Weird. He sounded truly concerned,’ Emma said, ‘which may have something to do with the news that Charming is away preparing for his “I’m an immensely important psycho-pharmacologist” conference on Friday, and he has given the Pargiter Ward deputising role to Dr Sticky. Did you know about that?’

  ‘Don’t be silly, they don’t tell us mere mortals about such things, that would constitute good manners.’

  Dr Sharman was in fact staying in a well-appointed hotel, being wined and dined at the expense of at least three pharmaceutical companies who were funding the National Psychopharmacology Conference. There were eminent professors and doctors who would be speaking to a room full of other academics and doctors for hours on end, congratulating themselves on their achievements.

  I was immensely relieved to hear that Dr Sharman was away for the whole weekend. Dr Siddiqui, taking his new role seriously, met me in the goldfish bowl ward office, and we went through the events of the previous night as they had been recorded in Mark’s patient notes. I thought that Dr Siddiqui was in an odd mood. Was that sadness? Guilt? I wasn’t sure. We sat looking through the finer details of the impact of Droperidol on Mark, which included the fact that he had become dizzy and had fallen, banging his head against the arm of a chair in the dayroom. There were no indications that he had been knocked unconscious or sustained any injury, but it was not a good advert for patient safety.

  Dr Siddiqui sighed loudly and turned to me speaking in earnest, and at length. I struggled with his accent at times, but his message was clear enough.

  ‘Monica, I want to say that I have been thinking about what you did and what you said the other day, and you made me realise that I can’t work here anymore.’

  ‘Oh God, did I?’ I asked, worried that whatever I had done had made this man so miserable that he was leaving. Had I turned into a bully?

  ‘Yes. I have been belittled,’ he went on, ‘and I have had my confidence taken away by that man. So I am leaving. I will be gone in four weeks’ time, and I wanted to thank you. You stand up for the patients and I am a coward. That man has a narcissistic personality, in my professional opinion, and he’s dangerous, Monica. Be careful, or you could end up like me. But you are not me. I suspect that he has other plans for you, because you challenge him and he hates that.’

  It was no surprise to me that Dr Sharman could have a personality disorder. What threw me was that another doctor had recognised it and viewed him a
s a bully.

  ‘I don’t know much about Narcissistic Personality Disorder,’ I confessed, to which Dr Siddiqui instantly responded by fetching a book down from the shelf and handing it to me saying, ‘Look it up. Know what you are dealing with. I think you will find it enlightening and of use to you all. I am sorry for being so weak. But now we shall see Mr El Amin and change his prescription. I will face the consequences on Monday.’

  Dr Siddiqui did exactly that. He met with Mark in the side room, apologised, and reviewed how the poor exhausted man was feeling. He crossed out nearly all the medication on the drug chart. ‘No more medication of any kind, other than the Procyclidine, is to be given to this man. Nothing, until such time as the side effects completely subside.’

  Emma and I were even more delighted when we persuaded Dr Siddiqui to be braver and to allow Section 17 leave for Mark. Dr Siddiqui made it abundantly clear that this was ‘solely for the purpose’ of ensuring that Mark had his CT scan, which was arranged for Friday that week. Dr Siddiqui gave permission for two hours of escorted leave and asked me to ensure, without fail, that I was the escort. ‘No one else,’ he instructed.

  I raised my eyebrows, smiled, and happily agreed. We had hoped to get more leave for Mark than that single two-hour window, even so Emma and I felt the stirrings of a rebellion and it excited us both.

  Mark, on the other hand, was not feeling any excitement. He felt dreadful. It was as if an invisible hand had pulled the plug on his positive emotions, and left him at the “crest of a slump”, if there was such a thing. The most miserable of thoughts invaded his every moment, and his previous negative life experiences were replayed in a gloomy monochrome, accompanied by the appalling feelings they invoked at the time. In addition, out came emotions of intense sadness and pain. These were the ones he usually kept safe in a psychological box at the back of his mind. They came darkly flooding back and he began to weep.

  Mark was unable to assemble his thoughts in a useful order to write his feelings down, no matter how painful, and he had resigned himself to the fact that he was incapable of being any kind of journalist. He also decided that he was an unworthy soul, who would never find love.

  Phil spent hours sitting with Mark, being comforting and gently positive. Emma put herself on watch, and carefully, from a distance, Mark knew she was observing for warning signs that could indicate if he was slipping into a dangerously low mood and headlong into suicide territory. He was.

  By lunchtime on Wednesday, Mark’s agitation was noticeable as it reared its ugly head. Mark began to pace. He paced up and down the green lino corridors for the rest of the day. He could not sit still even when Phil was reading to him from the newspaper or trying to engage Mark in completing a crossword that he was usually so good at solving. Mark was exhausted with the endless compulsion to move, and was talking to himself. ‘This is hellish torture. Make it stop, someone.’ The nursing staff had nothing to offer other than reassurance and Procyclidine.

  It was a tense waiting game, which continued for a further two days, but by the Friday the worst of the effects were easing and Mark gradually poked his more positive self out from beneath a dreadful hangover feeling, sad emotions and negativity. This was much to the relief of patients and staff alike, including Dr Siddiqui who made sure he attended the ward everyday to see Mark and any other patients who needed their medication reviewing. Dr Siddiqui wore a smile as if he had at last gained a sense of pride in his work.

  30

  The Right Thing is Wrong

  ‘Listen up, everyone! We have two new arrivals who came in yesterday evening. One disturbed and disruptive young lady, determined to cut herself using any suitable item she can lay her hands on. She is Tania White. Some of you may remember her. We may have to organise additional staff for one-to-one specialing if she’s true to previous form. So far we have not been directed to put her on close obs, but stand by.

  ‘The other new guest, Wayne Parker, is an undernourished tracksuit-wearing and hostile gentleman, who is supposed to be voluntarily entering into an alcohol detox programme on the ward before he progresses to a highly sought after bed in a residential rehab unit in the depths of North Wales. Your guess is as good as mine as to whether he makes it that far.’ Bob had a way of ensuring that we knew what to expect. His handovers were descriptive, but not necessarily subtle or polite.

  I missed the rest of the information, as I was required to take a call from Richard Huntley. He apologised profusely for contacting me, but assured me that he had no other choice.

  ‘Not a problem, Richard. How can I help?’ I asked innocently assuming this was to do with a tribunal report or arrangements to access Mark’s notes again.

  ‘I’m sorry, I know that I asked you not to help me with Mark El Amin’s case, but I’m at a real loss as to where else to go.’ Richard went on to explain that he had searched through Mark’s patient notes again, double checked the ward Section paper copies file, and even asked Harriet Morris in the Mental Health Act office for information, however, there was no sign of the original Section 3 recommendation made by Dr Giles Sharman, that he, Richard, knew existed because he had seen it. ‘I saw it myself, with my own eyes,’ he confirmed.

  He had indeed seen it the previous Friday when he first met with Mark. I knew that, because it had been in the notes that I had provided for him, and in fact I had gone to a lot of trouble to ensure that the Section papers, copies of, were placed on the top of the patient notes. Richard had picked up rapidly that day that I had suspected a number of things were wrong with those Section papers.

  ‘Yes, I remember it vividly,’ he said. ‘I even read it out to Mark at the time, to clear up the issue of whether he was already known to mental health services or not,’ he recalled. ‘And now I cannot find a single copy of that original Section paper.’ Exasperation was getting to Richard. ‘This is a cover up of astounding overconfidence,’ he announced. ‘That Section paper has been smoothly replaced by a Section 2 recommendation, as it should have appeared in the first place, and you have been blamed for misinforming the patient as to which Section he was under.’ He then took a steady deep breath and asked, ‘Monica, do you have any idea where I can find a copy of that original Section paper?’

  ‘Yes I do, but I could be in the biggest possible trouble if anyone finds out where you got it from.’ Still, in for a penny, I thought. I had already disclosed to Richard far more than would be acceptable from my employer’s point of view.

  ‘I took an additional copy at the time that I made the ward copies,’ I told Richard frankly, ‘and I put it in my pocket to read carefully later because what Harriet said at the time didn’t make any sense.’ I went on in an attempt to defend my actions. ‘She said that the Section 3 paper which I had given to her, indicated that the patient, Mr Trainman, was known to Dr Sharman, which was not possible because we didn’t even know his name then. I hadn’t had time to read it before I took the paperwork to her office that day, so I took the copy out of curiosity … I say curiosity, but there was another reason. I don’t know which word describes it, but Dr Sharman made my life hell that day and I wanted to find anything that might give me ammunition for revenge.’ I was gabbling nervously. ‘Oh God, that sounds so ridiculous now I’ve said it out loud … sorry Richard. In short, I still have that copy at home, in my flat. I can drop it in at your offices when I finish work if it helps.’

  ‘I don’t care why you have it, or how you got it, Monica, but you are a star, as far as I’m concerned. The ends will justify the means, so let’s say no more about it. Put it in a plain envelope, address it “private and confidential” for my attention and write “by hand” in the left hand corner, then I will know it’s from you. Monica, this information and your description of what happened in ward round on the day it was written, is enough to ensure that revenge will indeed be served up fairly soon. Please do not breathe a word to anyone. I have a couple more matters to put in place and hope my darling wife does not have the baby early.’
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br />   ‘Oh, Richard, I’m sorry. I forgot to ask when it’s due!’ I exclaimed, genuinely upset that I hadn’t remembered the pending birth when we’d met again.

  ‘Not for another week,’ he replied ‘but knowing my luck, junior will make an unscheduled appearance, just when I need him or her to arrive a little late if possible. Never mind, we will do what we need to, to get Mark released from his Section. It’s illegal, or it was. I’m seeking expert advice from the Mental Health Commission regarding the legal points. Still, that’s not your concern. You have done more than enough. Keep your head down and thanks again.’

  The Mental Health Act Commission contacted Richard Huntley later the same day and he was put in touch with an expert barrister by the name of Lewis James.

  Richard didn’t make the connection at first, until he actually spoke with Lewis on the phone and recognised the voice and accent of the man he knew as James Lewis. Lewis had to confess to the whole truth about his involvement with Mark ‘El Amin’ and about the research project.

  Richard could not have been more delighted with this revelation. Justice, at last was going to be seen to be done, and by more than professionals and members of a tribunal. This was a national story in the making.

  Once I had finished speaking with Richard on the Wednesday morning, I phoned James Lewis, Mark’s visitor and family lawyer. I hadn’t spoken to him before, and I quite liked the sound of him. He was a bit of a character. He was one of those people who gave his surname first when he answered the phone. Or so I thought. ‘Lewis James,’ he said, when I rang the mobile number contained in the patient notes. I introduced myself as Mark’s named nurse, which he appeared to find funny for some reason, and he made a flippant remark about the fact that in his view, ‘everyone should have one of those.’