Mad Worlds

by Bill Douglas

  Kenney smiled. “Yes. My promotion to Deputy in July got a strong protest from one of my peers, who’s been a consultant here for decades. Poor man’s been off sick most of the time since, and, to rub it in, wasn’t shortlisted for the top job.”

  “Really.” He wanted to know of any undercurrents. “Who is this?”

  “Theo Godsell – whom they call ‘the god’. Our paths haven’t crossed much.”

  “Aye, tricky.” He drained his mug. “How goes the ‘Acting’?”

  “Early days. My spell at the helm is of course a holding operation and I’ll retire soon after.” Kenney’s expression lightened. “Enough of me. What of you?”

  He liked this man. Maybe he’d stay on as Deputy? But now wasn’t the time to broach this. He talked about himself – his motivation, experiences and hopes.

  They discussed the morrow. Kenney would introduce him to key folk in the hierarchy, then act as guide on a tour round the male wards.

  Macdonald sat at breakfast, savouring his mug’s aroma of coffee beans. “Anything I should look out for on my tour?”

  “I’ll tell you one or two things – a bit delicate to mention on the wards.”

  Kenney had sensitivity. “Go on.”

  “We’ve always had our share of violence, but you should know about a couple of recent incidents. Last month, some male patients tried to escape and two got out. One’s still away – and entitled to stay outside.”

  “What’s happened to the patients who didn’t get out?”

  “Put into padded cells on Refractory, then onto that ward. I’ve never been consultant there and I don’t know how these men are now. Oh, there’s one exception – a patient who’s a peer of the realm. He was returned to Admissions.”

  “A nobleman – in here? Delusions of grandeur?”

  “No, he’s a bona fide peer. A story I’ll tell you another time.”

  “And Refractory is for –?”

  “Patients with a record of violence. We’ve a few from Broadmoor. The staffing level’s higher than other wards.”

  Probably needed to be. “There’s no equivalent at Dingleton.”

  “Two nurses sustained injuries, and have got COHSE involved.”

  He knew of COHSE – Confederation of Health Service Employees – a large trade union, important to most in the NHS except medics. “Sounds grim.”

  “And last Saturday one of the escapers, a paranoid schizophrenic, wounded the charge nurse on Refractory. The patient had walked into a police station after a day or two, got sedated and brought back here. Somehow he smuggled in a blade and slashed Charge Parker in the neck. Just missed the carotid. Parker’ll be off weeks.”

  He nodded. “On the way round, Liam, can you discreetly indicate the patients involved in all this? I won’t mention the incidents. I want to keep a low profile.”

  “Yes. I’ll whisper in your ear. I’ll tell you now about the escapers.”

  “Please.” He listened carefully, noting mentally the names.

  “Let’s go. Brace yourself. Everywhere’s locked.”

  Walking along the corridors, Macdonald said, “This is gloomy, depressing.”

  “Yes. Needs lightening. I can try to get work started, if that’s okay with you. Corridors, Main Hall, wards and toilets. I’ll speak with our Hospital Secretary, who heads up admin/clerical, and our Hospital Management Committee Chairman.”

  “Fine. That all sounds useful.”

  “I’ll take you to the admin block first and you’ll meet Ronald Cope, the Hospital Secretary.” Kenney stopped in the empty corridor and whispered. “A prosaic fellow, Cope, who thinks he, not the Medical Superintendent, should be in overall charge. His empire includes the Records Officer and the Chief Engineer. Then you should see Bernard Hallman, Chief Male Nurse retiring end of January, and Caroline Dee, the new Matron. It’s Caroline’s first month in the job. In the boss’s absence, I was in on her appointment; she’s a breath of fresh air. Oh, there’s one absentee – my dedicated secretary Miss Bewlay, who’s on leave until next week.”

  *

  Cope, a tall willowy bespectacled man who eyed him cautiously, impressed with his knowledge of Springwell’s administrative workings, but wholly lacked in vision and was opposed to making changes. When Jamie took up office, one priority would be talking with the Secretary, to listen to concerns and try to win the confidence of a man who must be a key figure at Springwell.

  Hallman was Neanderthal. Patients must be “Kept well away from the sane folks outside, so need to be locked up in their wards. Except when they’re taken to the Shocker or for their leucotomies. We let two wards onto the airing courts twice daily.” This man’s successor must have a radically different vision.

  In contrast, Matron Caroline (forty-ish, highly personable) impressed. He’d expect any Matron to be efficient, but this one exuded passion for reform and clarity of vision. With her as an aide, change would be a less Herculean task.

  *

  Entering Male Admissions, Macdonald saw it was empty of patients. “They’re all on the airing court, Sir,” Charge Nurse Mullen said.

  All on the airing court? “Where do they go at other times?”

  “They’re out on the court mornings and afternoons, for exercise, except when they’re having treatment or in for meals. Evenings they’re inside, in the day-room.” After hearing about Mullen – ex-army, newly-promoted – and getting an overview of routines, staffing and the patient population, he asked about lengths of stay. As he’d suspected from Mullen’s patter, some patients had been on Admissions a long time (and one ‘trusty’ for decades).

  Admissions should be about shorter stays – not keeping patients to suit staff.

  “I’ll take Dr Macdonald to the airing court,” said Kenney.

  When the door was unlocked, he followed Kenney into a large drab courtyard with high walls. Great-coated men with peaked caps stood at the corners watching patients slouch round. A scene he associated with the old asylums and prisons.

  “Grim. Up north we got rid of these long ago.”

  Kenney shrugged. “The boss liked them.”

  Later, he stood in a corner while patients came in for lunch. He noted the ill-fitting institutional clothing and patients suffering the indignity of clinging to their trousers at the waist. “So’s they can’t escape, Sir,” was Mullen’s explanation.

  They left Admissions. “Let’s have lunch,” said Kenney, and led him to a small, pleasantly furnished room with a waitress and choice of menu. “For psychiatrists and other senior staff. But ears are too long for talking business.”

  *

  Macdonald’s afternoon tour started with Male Infirmary, where he saw rows of beds, some unoccupied. Charge Nurse Macnamara, a youngish man with an Irish brogue, sat with him in the office and spoke about patients and approaches to their treatments.

  He noted Macnamara’s comment about the patient with the bandaged head. “Kong Mackay, one of the would-be escapers. They gave the poor man a leucotomy in town, and I do wonder why. He’d been in a violent incident once before, but sure he was known as a gentle fellow.”

  “Leucotomy’s a last resort, indicated only to relieve unbearable tension.”

  “Yes. Sadly, it’s being used here to suppress troublesome patients.”

  More confirmation of abuse. This charge nurse sounded caring, frank, knowledgeable.

  “I thought there might be buckets of urine around, Mr Macnamara,” he said jovially. “But I can’t spy any.”

  “Months back when I came here, they were our number one feature. We’ve worked on hygiene.” Macnamara smiled. “Sure we smell real fragrant now.”

  *

  On Male Annex, where Kenney was consultant, Macdonald listened to Charge Nurse Williams. “I came up from Devon, started on Refractory, but found my true home here this past twenty years. I knows every patient on here and all their stories.”

  “How long do patients stay?”

  “Some have been in Springwell thir
ty, forty years, Sir, and some longer. Soldiers from the Great War, some. Most aren’t loony, though they might’ve been when they came in. Forever, mostly, they’ll stay. Though not all – they’re sometimes sent back to the ward they came from.”

  “Any violence?”

  “Not as I’d call violence. One patient kicked off the other day. He has senile dementia, wanted to go play football. We had to restrain and sedate him and step up his medication. Any violent ones have had leucotomies, and, lost souls, they just sits there looking vacant and sad.”

  “What about activities for the patients?”

  “One patient was a stand-up comic, and we sometimes gets him, with more baccy, to put on an act. Mind you, it’s mostly us nurses that laugh. We take some to the dance Fridays in the Main Hall, with patients from Female Annex, and us and the female staff supervise. And one of our nurses brings records in to play.”

  This charge nurse sounded caring, but lacking any notion of discharge into the world outside. Understandable in the man’s work context. Another area to tackle.

  *

  On Male Refractory, Deputy Charge Jackson looked elderly and harassed. “I’m acting up while Mr Parker’s off, Sir.”

  From the overview, Macdonald noted a high ratio of nurses to patients was “Needed to keep the patients in their place,” and “we expect violence.”

  The incidents Kenney mentioned. “Any violence recently?”

  “There’s two attacks on nurses just happened. An ex-Broadmoor patient floored one of our nursing assistants. Another patient weighed in and got hurt. Our man was injured bad and he’s still in hospital. And last Saturday, the charge nurse got stabbed by a paranoid. Won’t be back for weeks.”

  “What’s happened to these patients?”

  “We put them straight into padded cells, Sir. Except Chisholm, from the first attack, that was sent to our Infirmary and is now back on this ward. And Paranoid Moloney, that near killed the charge nurse, got released onto the ward again.”

  “I see.”

  “And Sir, Charge Parker, before he went off, wrote in the notes advising they both have a leucotomy. I drew Dr Singh’s attention to this, but he wouldn’t hear of it.”

  Good for Singh. Using the leucotomy to subdue folk was criminal. “Uh-huh.”

  “But Dr Godsell, the consultant, is coming back. He’ll think different.”

  Godsell – ‘the god’, the long-server overlooked for promotion. “Really?”

  “Oh yes, Sir. Dr Godsell keeps troublemakers in check.”

  He’d discuss with Kenney, though maybe it was too late to help the patients. This was delicate, and traditionally ‘no go’, to question a consultant’s clinical judgment. “One other thing. Why are there so many cells?”

  “We have to put some patients in there over staff lunchtimes. There wouldn’t be enough of us to cope.”

  This institution was mainly about using power to control and detain. The cells could be refurbished as single rooms.

  He and Kenney walked back down the ward. Patients had come in from the airing court. He felt a nudge, then heard a whisper, “Chisholm, blond hair.” Yes, the teacher – gaunt, athletic, face alert but strained. He saw Chisholm stare back at them, and looked away. He nudged Kenney and they left the ward.

  *

  In the evening, Macdonald met fellow psychiatrists at a buffet in the boardroom. After, Kenney asked, “What did you make of it?”

  “A useful meeting. All the consultants are men.”

  “Yes. It’s hard to attract women suitably qualified. The odds are stacked heavily against them being accepted for medicine.”

  Exactly. It was ironic that, while Springwell’s female population exceeded the male, their fates were in the hands of male consultants. Pretty well mirrored UK psychiatry. “Ingrained attitudes of the old guard prevail, sadly.”

  “Yes, Jamie. Your wife must be outstanding to have got into medicine.”

  “She’s much brighter than I am. I did meet two women this evening.”

  “One’s Lizzie McVeigh. A registrar, she works with me on both Annex Wards. She’s capable, good with patients – men and women. She’d make a fine consultant.”

  “We’ll need two more consultants, Liam. Encourage her to apply.”

  *

  Over supper, Macdonald talked with Kenney about his tour and the issues of concern.

  “You’ve a mountain to climb here.” Kenney smiled.

  They’d much common ground. “Liam, I hope you’ll stay on as Deputy.”

  Kenney looked thoughtful. “I was going soon, Jamie. But I like your thinking. I’ll stop on a year or two. It’s a great time to work in mental health.”

  The mountain had shrunk. He’d begin the ascent with Kenney and Matron.

  “I’d like Cope on board, but he struck me as pretty insecure, even hostile.”

  “That’s how I find him. I hope you can work the miracle needed. Our Secretary has clout with Committee, and he’s a close buddy of the Chairman.”

  “I’ll try, Liam. Another thing, much more pressing – leucotomy’s being used by at least one consultant to control rather than treat. That’s not acceptable.”

  “Yes, I see the devastating effect on some patients in the Annex. Barbaric. Shall I declare a moratorium on sending patients for the op, with immediate effect? I could type a memo, and, quoting you as well, get it round tomorrow – even though it’s the Sabbath – to my consultant colleagues, with a copy to all charge nurses.”

  “Please do. It’s that urgent. Won’t help your popularity – or mine.”

  Kenney smiled. “I’ve nothing to lose. And your shoulders are broad enough.”

  *

  On Sunday morning, he sat in chapel with Kenney in a pew reserved for senior staff. Patients from the Annex Wards sat in rows – women on one side of the aisle, men on the other. Nurses were interspersed. Even in worship, there was gender segregation.

  He had time for only a whirlwind tour of female wards. Matron Caroline agreed to list the changes she’d want and go on a tour with him when he took up post.

  He had a final coffee in Kenney’s office. “Any reform Caroline suggests on the female side, I’m happy if you can take it forward. The male side won’t change till Hallman goes. And I’ll want to be involved in appointing key staff.”

  “Fine, Jamie. I’ll keep you in touch.”

  On the homeward journey, Macdonald shut his eyes, reflecting on his experiences. For some staff, the changes he intended would come like a bomb blast. At least he’d have powerful allies in Liam and Caroline.

  Working on Cope would be important to goodwill. Tension between them was inbuilt structurally. As Medical Superintendent, he was formally, and legally, the overall boss. But some resentment from Cope, and blurring of who was in charge of what, was understandable, as the man effectively controlled everything non-medical.

  Jamie wanted to shape a caring community, not a cluster of mini-empires.

  Surely high drama and battles lay ahead. He thirsted for the fight.

  45

  Friday 21st December 1956 – in Springwell.

  John lay in a mist. Hell of a lot of Shocker. Struggling to think gave him a headache. Everything was jumbled.

  Sometimes he couldn’t remember his own name, never mind those of others. He’d witnessed a few scraps, and stayed clear.

  “You’ll see the god on Monday,” the boss white-coat told him.

  He’d a bad feeling about this.

  Monday 24th December 1956 – in Springwell.

  The man looked familiar. Not the god. The turban, the beard – the Asian psychiatrist!

  “I am standing in for Dr Godsell, who is off sick.”

  Dr who? He stood in the office with white-coated escorts. “Uh.”

  “Mr Chisholm, do you remember me?”

  “Yes and no. You look familiar and I know your voice –”

  “I am Dr Singh. I have seen you before, several times. Tell me, Mr Chisholm – wh
at are the names of your wife and child?”

  Wife and child. Yes. The images were hazy. Names? “Can’t remember.” His head was solid with concrete.

  “What year were you born?”

  Stupid questions, that his weary brain wouldn’t stand for. “You figure it out.”

  “Mr Chisholm, you have just finished another course of ECT. It may have benefited you in your mood; but your memory may for now be affected.”

  “Yes.”

  “How do you feel, Mr Chisholm?”

  “Hellish.”

  The doctor was gazing at him. “How clear is your thinking now?”

  “My head’s clogged.”

  The doctor turned to the boss white-coat. “Mr Chisholm should be transferred. To the Annex. ECT will end now. I will not restart other medication, as he appeared to manage without chlorpromazine. I will approach the consultant on the Annex.”

  46

  Tuesday 25th December 1956 – in Aversham.

  On her knees, cooing to Becky, Heather encouraged the tottering steps towards her across the living room carpet. So much for the idea that her child might be backward in development. It was great to see Becky walking without support and uttering recognisable words. Graduating from babe to toddler.

  Her eyes misted. John wasn’t here, and probably never would be, to see Becky growing up. What sort of miserable Christmas would he be having?

  It was wretched enough here. No decorations – what was there to celebrate? Likewise, no stocking from Father Christmas, and no toys, except Teddy the bear and Jane the doll. She gathered Becky up and swayed from side to side, humming.

  She’d been invited to Christmas lunch by Elsie and Moira. Elsie asked first and she’d said yes. She was glad. Moira was having folk to stay, while Elsie had no family. Also, Mattie’d been diagnosed with emphysema (bad news, though not as bad as the ‘big C’ Elsie feared) and might not be around for many more Christmases.