A Window on Madness (part two)

The Unit

“Caring for psychiatric patients in the community is a fine and noble idea; unless the community itself is a pathological phenomenon.”
Anon.

“Get up” somebody said in my ear.
One eye opened, but my sticky body glued itself tight to the damp mattress and my mind hung in limbo.
“Get up and go” insisted the unpleasant rasping voice.
Reluctantly, I turned over and looked at the alarm clock which seemed strangely large in the half light, and showed luminous green hands at 20 minutes past late. I yawned until my jaw cracked, then pushed my leaden form onto the edge of the bed, where the whole room whirled reassuringly around me.
“Bloody Hell, I’ll never make it to work like this.”
But the room slowly stabilised, and I started to look for my slippers amongst the debris which seemed to have accumulated in the bedroom overnight. There were magazines and newspapers, cuddly toys with impish faces, lots of pillows, and plates of food with greasy egg patterns strewn around the floor. The whole mess instantly disappeared when I switched on the light, and I cursed the garish carpet and the flickering shadows for playing cruel tricks on me. Yet the room still held an eerie glow under its energy-saver bulb and the pigments swam around like Salvador Dali’s paint palette as I limped towards the bathroom and douched my face with an icy jet from the tap marked ‘hot’. Carol hadn’t stirred, and I showered quickly under a scalding hail of liquid bullets, wondering if I’d eaten something I shouldn’t, or whether I was just drunk from a forgotten night before. The stairs were spongy as I half fell down them, and the moonlight projected jagged silhouettes through the thin gingham curtains, adding to my unease.
There was already an overpowering smell of cooking fat and cabbage in the kitchen, so I decided against the usual burnt toast, and made do with an Argos mug of full strength coffee instead. It was curiously textured as it trickled down my throat and I wasn’t sure if I’d enjoyed it or not, as my nerves twitched under the caffeine flick. Opening the curtains, I gasped at the sight of deep snow covering the roofs and gardens, and a huge full moon suspended above the escarpment like an alien sun, almost blinding me as its rays bounced off the white fairytale landscape and flashed into my blood-shot eyes. I sensed that my reactions were unusually disproportionate, but the scene sent shivers up my spine and riveted me to the window with an overwhelming, transcendental force. Winter was hardly a unique event, yet it assaulted my senses with unbridled power, and I was momentarily transfixed.
There was still just enough time to walk to work, so I pulled myself away from the window, donned my once-a-year Wellingtons and put on the old student great coat. I snapped open the warped door, staggered under a blast of freezing air, pulled on my tea cosy hat and headed up the street, now almost enjoying the bagatelle forces which seemed to be gripping me. There was certainly a weird unreality in the world, as the icy wind warmed my cheeks, the frost crackled loudly underfoot, and the snow blew lazily upwards in concentric circles. I was spellbound, rather like a child walking into a fairground from the pitch black street, and I became aware that my senses were almost penetrating the objects about me, enhancing colours and forms, shadows and perspectives, sounds and smells. Bringing everything alive with magical ease.
But there was a price to be paid for this sensory acuity, and I began to experience an uncomfortable vagueness about my whereabouts and intentions, walking forward automatically, but with little in the way of anticipation. The frozen wastes seemed to float by and I found myself giggling at the sight of smoke coming out of three chimneys on nearby roofs; the whole terrace looking rather like a White Star liner breaking through the ice pack. In fact, I was just expecting to see the infamous iceberg, when I turned the next corner and saw a half-hearted snowman listing badly in somebody’s front garden. There was no joke, but for some reason I found myself howling hysterically at the prospect of the terraced houses crashing into the little snowman and sinking out of sight; until an irritable looking goblin face peered out of the nearest window and silenced me.
With lightening speed, my euphoria gave way to irrational terror and I found myself running down the slippery path and across the grey spooky park as though the hounds of hell were after me. I ran for half a mile through deserted streets, past the vast, silent, empty office blocks and on towards the three-tier bulk of the hospital, where I finally stumbled to a halt, heart thundering, chest heaving and a staccato pulse beating loudly in my ears. My powers of reflection were clearly dying, and I could only hold on tight as my footsteps now advanced towards the Gothic horror of the hospital with little volition; yet Frankenstein intensity.
Like an image trapped in a can of film, I was being projected.

“Buzzzzzzzzzzzzz!”

“Christ, another bloody nightmare.”

The alarm had shattered my dream world and I gradually adjusted to the twilight, the cold beyond the bedclothes, and the prospect of another early shift on Devil’s Island.

“Stop exaggerating” I croaked.

But I wasn’t exaggerating that much, and for a few precious moments I shrank back into my warm little cocoon and waited for the nagging pains of conscience to grow stronger, while memories of yesterday’s late shift slowly percolated through my brain, and there was another click of the rack’s ratchet.

Cecilia, a rather difficult patient, had arrived back from her father’s house, apparently in quite a good mood, laughing and joking, conversational and basically too good to be true. Inside twenty minutes, she was punching doors, kicking over chairs and telling anybody who came near her to “fuck off”. Another ten to fifteen minutes and she was pounding her bleeding knuckles on the brickwork, depositing a cup through the smoke room window and ripping two toilet seats off their hinges. She refused to talk about it, wouldn’t take any medication, alluded to “voices” and seemed to take a devilish delight in her behaviour, as she continued her systematic demolition of the unit. Being on duty with only one other member of staff – a dear old lady auxiliary nurse who sat petrified in a corner – I decided against any heroics under the common law and instead took the consultant’s advice to ring the police. Two hours later they reluctantly appeared, only to observe the patient enjoying a mug of coffee in the T.V. lounge as she amiably apologised for her loss of control. The bill would be around £250 I suppose, but the cost of such damages was never borne by anyone on the unit so we would never know.

Still, Cecilia very rarely misbehaved in the morning, because she was usually too busy making her way through a labyrinth of getting-up routines to worry about violence. I knew she used these obsessive-compulsive rituals to stabilise her troubled mind, and I momentarily reflected on how my own life of ritual work, ritual holidays, ritual meals, and ritual conversation probably served a similar function. It was an irony which rankled, but I completed my ablutions, mouthed a silent farewell to the deeply sleeping forms of my children, ventured downstairs to the kitchen, and flicked on the radio:

“The government is concerned at the number of people killed by ex-mental patients. It is estimated that there have been 100 murders by care in the community patients in the past five years, and that 1,000 have killed themselves over the same period.”

This was just what I wanted to hear (not), so I switched the radio off, parted the gingham curtains and looked out on a row of dead stick trees bending under a heavy frost. There was a solitary sparrow attempting to pierce the rock hard lawn with its beak, a fat black cat lurking under the bramble hedge, and an endless sweep of red bricks and stained picket fences - as our toy town estate rolled on and out. Not even the greatest romantic poet could infuse this view with any transcendental meaning, yet I knew that by the end of my shift I would be yearning for these same sights with nothing short of rapture.

An amplified trump reverberated around the toilet bowl upstairs, and an invisible hand pushed me to my feet.

It was time to go.

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Mutually Assured Destruction (M.A.D.)
In the 1970’s the cold war was still pretty hot, and there were endless news items and documentaries about the proliferation of nuclear weapons. The impotent masses tended to see this practice as dangerous, but a series of governments assured us that the frightful threat of atomic warfare was effectively keeping the peace. This was the policy of Mutually Assured Destruction (MAD).
It was the first official recognition that madness could be a normal state of affairs.
But as community mental health care has proved, not the last.
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I opened the side door and was almost blown off my feet by a cannon-like blast of Arctic wind, and saw that a boiling black bank of cloud was rolling across the horizon, with my name on it. Some lights were on in the neighbouring houses, and I was momentarily consoled by the fact that other people were preparing for a working day that they also roundly despised. Even more cursed, I imagined, were those who wore their chains willingly and were actually looking forward to their office gossip, hierarchical positions and new sales targets. They were unlikely to ever look up at the open door, and escape.

Setting off, I assumed the obligatory 45-degree angle walk to counteract the funnelled gale and eventually passed a row of Edwardian houses which seemed to have caught quite a bit of snow in their interesting angles. I reflected on how much I missed our old 1930’s house, even though the tiles were always falling off and the sub-tropical garden had begun to undermine its foundations. I remembered also the G.P. who lived behind us, cutting the edges of his lawn with tailors’ scissors, and weeding the flowerbeds under house floodlights, as half an hour before midnight he fought off the stress of his inner-city surgery.

But working in health care had impacted on me too.

Passing houses and gardens which were once uniquely interesting, but now merged into one amorphous mile of brick and plant because of the two thousand times I’d walked past them on the way to work, I reached the bus shelter. Full of broken cider bottles, covered in artless graffiti and smelling of idiot’s urine, the dilapidated 1970’s structure was hardly sylvan, yet something arrested my attention and this proved to be a black dog huddled in the corner. Conscious that I had not so far talked to another living creature, I said “hello” to the dog in a worldly-wise manner, and the poor thing began to follow me. All the way through the park, with its winding paths and coiled rings of crusty poo, down the narrow terraced streets of Victorian forecourts and high bay windows, past the 1960’s concrete building blocks, and on to the crumbling gates of the old, tired hospital. Here, the black dog looked up, turned around and headed back towards its council estate, showing me a wiry tail trailing in the cutter and a baleful look of psychic certainty. I also looked up at the Gothic masterpiece, with its disused turrets and castellated chimneypots; knowing only too well its inner Dickensian ugliness, and its indestructible black soul.

My eyes drifted across the road to a comforting news board:

“Papergirl stabbed for 50p”

The Sunday Bugle, 9th. May 2003.

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Bed Blocking in Psychiatric Units

Crisis looms in mental health units and wards around the country, as community care patients are often unable to move through the system as intended. Beds are blocked for long periods, because patients are not responding to therapy or they cannot get funding to move from one part of the service to another. This is creating a backlog of referrals from the community teams to acute wards, from acute wards to rehabilitation units, and from ‘rehab’ units back to the community. There are also long delays transferring people from the mental health sector to social care and private facilities because of financial difficulties and ‘territorial’ disputes.

At the same time, there are growing numbers of people with drug and alcohol related problems being referred to acute psychiatric wards.

Dick C------
Medical Correspondent

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The hospital had been a workhouse in the nineteenth century, but now it was very much the reverse. These days it was populated by a bizarre combination of largely unproductive individuals; managers, clinical staff and patients all circling around in a costly carousel of bureaucracy, political correctness, over-dependence and inertia. But I was part of it, so I ran my eyes over the three tiers of sooty red 1860 brickwork and made my way around the back, across the car park and up to a door marked ‘Rehabilitation Unit’, which I found locked from the inside. This was unusual at 7.00a.m., and a variety of intriguing possibilities rushed through my mind as I recalled the tale of two night duty staff sleeping most of their shift and waking up to find that the unit had been burgled. Rumours had always abounded, of course, about staff nurses copulating with students all night, and even though this was generally apocryphal, it did provide me with my first jolly thought of the morning. Indeed, I found myself wishfully musing about alien abduction and mass walkout, but unfortunately the truth was much more prosaic; the staff had simply forgotten to unlock the door.

I was eventually allowed in by a tired and relieved looking agency nurse, and then instantly transported back into the surreal world of mental health nursing, just as though I was in a ‘golden key’ book of the sort my young son was currently reading. People often say that smell is the most redolent and evocative sense, as memories of childhood, holidays and social situations are quickly prompted by a characteristic fragrance from those times. So it was with psychiatric wards, as the hellish combination of stale urine, fresh faeces and rampant body odour never failed to remind the recipient of his or her first wonderful experience of in-patient mental health care. Yet mercifully the mind can often habituate a constant stimulus, and after two or three minutes of nausea and revulsion, the stench miraculously faded (thus ensuring its continuity, I suppose).
Taking note of the assembled staff in the office, I withstood the first wave of playful insults and disingenuous greetings.
“Here he is.”
“Hello, everybody - what an expected displeasure.”
“He used to turn heads when he was younger, you know”
“Yes… but now he turns stomachs”
“Ho ho”
“He’s the life and soul of every party.”
“Especially the Stalinist Party.”
“Ha ha.”
“He’s been tossing and turning all night.”
“Especially tossing.”
“He he.”
(etc. etc. ad nauseum)
The Health Care Assistant sitting at the desk (where the qualified nurse usually sat) was the original poison dwarf; an individual who had to be flattered at all times, otherwise his angry inferiority complex filled the room like a huge inflating lifejacket. But I gazed at the kilogram of chemical scaffolding he used to build up his semi-Mohican haircut, and I just couldn’t resist a dangerous ruse.
“That hairstyle really suits you, Zebulon… It makes you look three inches taller, actually.”
“What…really?” he replied, his face buckling into a wary, hypersensitive scowl.
“Yes, indeed.” I reassured him. “…It must have added a good 10% to your height.”
“Well, I always try to look my best, Steven” he laughed, fully restored to his bumptious norm. “Unlike you.”
I glanced around, and caught a sly acknowledgement from the harassed night nurse who was perched on the windowsill. At least two of us knew what 100% added up to, if 10% was three inches.
And once I had such high hopes for myself.

But the clock was always ticking on a psychiatric nurse, as you wished your life away in the tick tock world of stress and release. Anticipating the end of a shift, craving days off, booking holidays with the drooling relish of a mad dog waiting for the final kick, and absolutely dreaming of retirement. Cottages in Wales, cruises in the Caribbean, fawn jackets and bowling woods, illness and death. A lager at the end of the desert crawl.
So I consoled myself by thinking about my night out ‘with’ Kate on Saturday.
Only two days to go.

Kate
2005

Well, I turned up at the ‘Tar and Feathers’ with my Oswald Moseley black shirt, fashionable wrap-round sunglasses and suede winkle-pickers, but that was where my jolly daydream (previously mentioned) quickly fell apart. Kate just winked at me from the wrestler’s embrace of her Brad Pitt look-alike boyfriend, while the rest of the crew generously made room for me around the corner, amidst the vinegary empties and heaped ashtrays. Even there, I could still observe the wrestler’s hand creeping up Kate’s tights under the distant table, so I glanced away and drank quickly.
I was about two pints behind everybody else and consequently Martian, but I eventually caught up and began to enjoy the general melee. Some of the crowd knew me, which is more than I did, and we exchanged ritual vulgarities until about 10.00 p.m., when I slouched to the bar for my last intended drink. Unfortunately, Brad Pitt was now holding court behind me, and I involuntarily cringed as each of his punch lines reverberated around the room like a dart scorer’s one hundred and eighty and his well-trained audience guffawed and squealed with rapturous delight. A punk rock choir in purgatory would have made a more welcome noise, and I quaffed the frothing beer with grim resignation, ready to leave.
There was an unhealthy collection of vintage whisky bottles running around the top shelf of the bar and I was just about to congratulate the publican on his ingenious wasp trap, when…..
“Hi, Steve.”
It was Kate.
“Hi, Kate. Are you all right?”
“Yes, fine. Sorry we haven’t had a chance to talk, but you were sat so far away I’d have needed a loud hailer.”
“Well, you’ve had one stuck down your throat all night.” (I thought), but instead I said “ Yeah, I was a bit late arriving. But there’ll be other times.”
“Oh…. but I thought you were bringing a bottle back to my place?”
“I’d love to, but it’s getting a bit late now and you’ll probably have a house full anyway.”
“No, most of them are going on to a club. Come on Steve, you’re not getting too old for it are you?”
“Well, if you’re sure?”
“I’m sure.”
“Oh, all right then” I laughed; capitulating too readily.
“Do you know Percy?” she said, pointing to Brad Pitt.
“Not in the biblical sense” I replied with false bonhomie (acknowledging him graciously).
“Ha ha…very good…. I’ll see you later then.”
“Okay.”
So, I bought a bottle of Chateau Shite and followed the crocodile back to Kate’s flat, where Brad Pitt (surprisingly) made his spit and polish farewell, and joined the disco-bound majority. Kate and I sat a lot closer together this time, and as I admired the soft whiteness of her recently licked skin, I wondered whether this would be the ideal opportunity to talk about a variety of profound subjects, laugh hilariously at each other’s jokes, and exchange beautifully synchronised non-verbal cues (as previously imagined).
It wasn’t.
In fact, we were two opposites. She had extremely correct, code of practice-worshiping views about psychiatric nursing, while I was lost on the roundabout somewhere to the right of Genghis Khan, yet well to the left of Karl Marx. She was tender and kind, while I was jaundiced and insensitive. She was occasionally wry and whimsical, while I was constitutionally sardonic. We were both direct. We argued about anything and everything.
We liked each other.
But the evening began to taper off as the loo filled with noodles, Leonard Cohen filled the speakers, one guest fell down the stairs after another…. and my confidence left with them. There was definitely a spark in the air, but I was never a chat-up merchant and didn’t dare fan the flames, so Kate and I lingered on the doorstep for awkward non-committal moments, while the milkman floated by, and the cats howled. Telepathy failed me just when I needed it, and as Kate moved slightly towards me, I simply launched a clumsy kiss at her left cheek, and hoped for the rest. She smiled brightly, and closed the door with a gentle click.
I went home then; with a future as well as a past.
Or so I thought.
(to be continued)

See www.windowsofmadness.co.uk for full story.
Paperback available at www.booklocker.com/books/4150.html