windows of madness (part five)

Kate
2005
“That’s five-turdy” the assistant said in an odd accent, difficult to place.
I was at the supermarket check-out, watching a line of six people juggle their credit cards, consider cash-back, redeem multifarious vouchers, wait for the crashed link to restore itself, wrestle with impenetrable plastic bags, and deliver the latest instalment in their riveting life stories to a goon-like operative. All around me, there seemed to be armies of unsmiling hermaphrodites with excruciatingly short haircuts, dark-tinted glasses and voluminous grey trousers, like psychopathic attendants in a 1960’s Hollywood asylum, waiting for the tiniest excuse to wade in with meaty sticks. An avalanche of hatred and venom seemed to be only one misplaced word, or deed, away.
So, when I started mentally unrolling my sleeping bag, ready for a long wait in the cashless world, and somebody tapping me on the shoulder, I jumped like a scalded cat.
But it was only Kate.
Only.
“Hello Steve” she said.
“Hello Kate.” I replied. ”Day off?”
“Yes”
“You look pleased with yourself.”
“Guess what?” she enthused. “ I’m starting the training next month.”
“Oh…… marvellous…….well done” I said, rather unconvincingly.
It was one of the saddest things in my life that people could actually aspire to the sort of job that I had, as if it was a peak achievement of humankind and the best thing that they themselves could possibly imagine doing. After three years of ‘the training’ and another three of the dream, they were likely to think differently – but there was no point in saying this to a new convert. Ergo:
“May I congratulate you in traditional carnal fashion?” I winked.
“No thanks Steve” she laughed. “You’re too thin and your ears stick out.”
“Well, if you’re absolutely sure…”
“Oh, go on then” she giggled.” Just for old times sake.”
“But there aren’t any old times.”
“Well let’s make some then.”
“Really?”
“Really.”

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Falling Madly in Love
Without noticing the intervening distance shrink, I suddenly felt a warm kiss and a hint of velvet tongue, the taste of strawberry bubble-gum, and thighs subtly interlocking with mine. A line of dominos began to fall, and they fell rapidly.
I couldn’t believe it, but almost as though I was on page 82 of an escapist novel, I found myself walking up the stairs to her flat, watching the slight rise and fall of her wonderfully curvaceous cheeks; and feeling a delightful scrotal twitch. There was absolutely nothing in the way of preliminary coffee or verbal chess, just a quick tangle of limbs and some theatrical panting, as we crashed onto the bed with animalistic crudity, and her top came off like a magic trick.
For half an hour or so the world lay forgotten, as delicious thrills neutralised moral guilt, our flesh talked and fingers walked. I could have stayed for a lifetime, but when Kate gripped my behind with claws of steel and started the old hula-hoop routine with her hips, a bolt of lightning seemed to arc between my gonads, and that was that. Hot spasms transported me to the minor gods, perfume wafted and there was a touch of silk.
Gulp.
Mars was surely in conjunction with Venus.
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“Christ, what did I do to deserve that?”
“Nothing, I was just in a good mood that’s all.”
“But what about you’re boyfriend?”
“He isn’t really my boyfriend Steve. We’ve had our moments, but it’s nothing serious.”
“Anyway….”
“Anyway….what?”
“What about your wife….that’s more to the point.”
So I told her about the state of play, both at home and at work. I pulled no punches, made no excuses, just laid it all out like a lacklustre picnic on a cold day. She made no comment, and with the coffee appearing a little later, I settled for the dock and she for the jury.
“The pub’s open. How about celebrating?”
“Celebrating my R.M.N. training….. or celebrating us?”
“Both”
The pub was like all pubs that are real pubs, and we lolled in a dark corner, feeling the warmth of a smoky fire, admiring the anachronistic brass, watching a few regulars through the forest of ebony pump handles, and feeling so good it couldn’t be bettered. This was the stage of rose-coloured spectacles, where disagreements didn’t occur or didn’t matter, bodily functions were only pleasant ones, blemishes remained unnoticed, and a shared present blinded us to a divergent future. The mundane seemed new, anything was fine, and the beautiful became divine.
I remembered one young couple who were so in love, they could even make a joke about who left the longest stools in the toilet every morning. I wondered what they were doing now.
“Did you hear the one about the two cowboys?”
“Go on then.”
“One bet the other one that he wouldn’t take a drink from the saloon spittoon for twenty cents.”
“And?”
“He not only took a drink, he completely emptied the spittoon in one swig.”
“Yuk.”
“The first cowboy paid the twenty cents and asked why the second cowboy had decided to drink the lot, because a sip would have won the bet.”
“And?”
“The second cowboy said he had no choice, because it was all in one lump.”
“Ha ha ha!”
I wondered where we would be in ten years.
A shiny black cockroach walked around the brass footrest, and a fat man slumped to the floor in a pool of piss, while his pals knocked their dominos on the rough-grained table, and we savoured our unspoken pact. Two bags of salted peanuts later, we left, and I followed those perfect shapes up the rickety stairs.
Once again.

“Fancy a joint, Steve?” she said later.
“Oh, I thought you were vegetarian?”
“You’re always joking…. Now get rolling.”
In everybody’s life there is usually one glorious idyll. A few weeks, or months, of pure bliss. A time when heaven is glimpsed.
A ride on the beautiful bubble.

* * *

The door of my dream opened easily, and an orange-green vortex seemed to suck me down the corridor, surrounding me with a mass of dazzling, darting colours. I was in the unit (apparently) floating towards the office, guided by half-remembered landmarks, and wondering how the vile miasma of sweat and excrement had somehow changed into the floral vapours of a delicate perfume.
It was a bit disorientating, to say the least, and I was rather relieved to see three of my colleagues sat around the desk; until their laughter gave way to side-ways looks, ill-concealed whispers and a sudden rush for the door.
“Oh….goodbye” I said to their retreating backsides.
“Shut your crap…er….trap” they threw back.
A group of unusually jocular residents then passed the office, turning their heads towards me with leering looks and demonic chuckles. Down the corridor they went, suddenly twisting around and pointing at me, cackling like witches and hurling abuse. Their faces were pictures of loathing, their Gorgonian eyes seemed to stare straight through me, and their huge mouths opened like scream masks, propelling me back into the office with a gale of crippling halitosis.
Then they charged after me, and I wasn’t at all surprised to see them drop their trousers and excrete on the carpet, although the sight of my nursing assistant joining them did momentarily stun me. They all hooted with derision, and then seemed to evaporate in front of my eyes, leaving the stinking piles of poo to pulsate and steam, while horrendous tapeworms made their way to the surface, and winked. I thought of escape through the office window, but all I could see was my own reflection looking back, changing hideously as I visibly aged, paled and shrivelled.
Like a death.

“Wake up Steve!”
“W…what is it?”
“You were having a horrible dream, I think.”
“Oh…Christ…. sorry”
It’s okay….I shouldn’t have woken you up really, but it’s getting late. Aren’t you expected back?”
“Yes….you’re right…I’ll go now.”
“What was the dream about?”
“It was weird……. I don’t really know…….”
“You look as though you’ve seen a ghost.”
“The ghost saw me, I think.”
“Poor baby.”
“When will I see you again?”
“Soon.”

****
The Unit
2005
Today, some of the patients needed new stocks of toiletries and cigarettes, so we began the formidable task of accessing their cash. The patients’ finances were now kept off the unit in the cashier’s office, which was only open at certain times on certain days, depending on whether the part-time cashier was on duty, on leave, on sick, on training courses, or on the toilet. We made our way through the waving mass of memo’s on the notice board, and ascertained that the cashier was indeed available between 10.15a.m. and 11.15a.m. today, so the lucky patients could leap through a rare window of opportunity and withdraw their own money.
Or should I say, the taxpayers’ money.
Heartened by our discovery, we then moved on to the inevitable paperwork, which involved taking the patients across to the cashier’s office, requesting the amount on a form signed by two nurses and the patient, returning to the unit and entering this amount in the cash book with signatures from patient, nurse and ‘witness’, and then signing for any change obtained after purchases, with receipts. Because the locked cash tins and books were kept in the locked filing cabinet in the locked office, this process dovetailed wonderfully with the great keys fiasco (see earlier), and often left patients frothing at the mouth while the correct tinny little keys were extricated from the two hundred and fifty-five keys available, and inserted in the generally unyielding locks.
But at last the performance was over, and the waiting patients dispersed around the unit. Cecilia (who had been jumping up and down like a frog in a drain pipe) opened the front door, immediately turned on her heel, and loped back towards the smoking lounge with the parting comment:
“I’m not going out in that!”
“Oh, come on, Cecilia” said Sidney, “you’re a big crapping lass.”
“You what!” she shrieked in full retreat.
“You’re a big strapping lass. No need to be afraid of the cold.”

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Cecelia
February 1972
Cecilia didn’t like school much, so she didn’t go there very often, preferring to sit around the house drinking gallons of tea and eating garibaldi biscuits. Her parents had tried to challenge her on the subject, but she was a big girl with a frightening temper, and they were afraid of her. Cecilia’s mother disappeared to the shops and her father disappeared to the pub, or work, or the employment exchange, and Cecilia continued to drink tea, slowly fulminating in her resentful world; a rebel without a cause, or an effect. Sometimes the authorities would prevail on her to attend school for a while, and she would sit in class preserving her ignorance like a talisman, determined to learn nothing.

Eventually school could hold her no longer, and she migrated to the dole queue, taking casual jobs when she was forced to, sucking the life out of anybody who was unwise enough to call her friend. She saw successful people around her, and boiled with irrational rage, striking out when drunk, stealing while sober, repelling men she wanted to impress, eventually spiralling into prison. She became a soft hard nut, an asocial wastrel, and a wreck. Then things got a good deal worse.

She spent some time in the psychiatric wing of a prison, enjoyed the better conditions, observed the conduct of her fellows, and decided to join them. She was soon ‘hearing voices’ and talking in riddles, demonstrating inappropriate emotion, and alluding to a difficult childhood. The therapists were in business, Cecilia’s psychiatric career had begun, and she was soon convinced of her own problems, and the escape from responsibility which they guaranteed. She learned the ropes, found the boundaries, and played the game.

At 38, Cecilia had lost most of her teeth because she ate five bags of sticky sweets everyday and wouldn’t use a toothbrush. She’d seen her mother into an early grave, transferred her over-dependence onto one or two nurses who humoured her, and now cost the tax payer around £200 a month in broken windows and fittings alone, as she reacted with violence to every minor difficulty she faced. She had scarlet fever if she was asked to clean her room, pneumonia if she had to go outside without a taxi, and stomach cancer if she was asked to eat vegetables.

Hospital was home.
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It had stopped snowing, but there had been a fairly recent shower of hailstones and it was a bit breezy, so I gave up on any idea of persuading Cecilia to return. Our patients were generally very sensitive to inclement weather, and often refused to leave the unit even if it was only lightly raining on a spring morning. There would be a major problem indeed if ‘bad’ weather coincided with a patient’s regular arrangement to visit a relative or the shops, because a compulsion would then be blocked by a phobia. The only solution sometimes was to book a taxi, and smuggle the patient out of the door with an old mackintosh over their head, as though they were a celebrity leaving the High Court. One lady was completely obsessed with the weather, spending long periods ruminating over the forecasts, gazing out of the windows, and getting extremely angry if it “took a turn for the worse”.
Being in England, she was generally apoplectic.
Yet, some of the unit outings had become legends, as in the case of the trip to Scotland, where the hired minibus was crashed on arrival, stranding ten patients for five days in a remote slate hostel, with no T.V., radio, telephone or other ‘mod cons’. One gentleman quickly became bored, and started to walk the two hundred plus miles home, while another developed concussion because she repeatedly cracked her head on the bunks she couldn’t get used to. On one camping holiday, staff woke up to find a patient missing, and eventually recovered him from a pleasure park nine miles away, while holidays at sea side resorts were eventually abandoned because of the difficulty in explaining wet and soiled beds to understandably irate landladies. Stately homes were not usually a success either, as patients normally walked past the finest works of art looking at their shoes and complaining about the no smoking regulations, or they set off alarms by sitting on priceless Chippendale furniture and (in one famous case) lying on the Royal half tester bed.
Even short shopping trips could be classically embarrassing, with patients disappearing as if by magic, some helping themselves to cans of lager and consuming them in front of bemused check out assistants, and others becoming noisily deluded. One young chap specialised in dropping his trousers when using the public urinal. Many patients, of course, would leave the unit by themselves (officially or unofficially), and reports would frequently come in of temper loss in the town centre or at relatives’ houses, violent acts, patients experiencing fits, and others hopelessly lost on the way back to the hospital. A man who had not left the unit by himself for ten years because he was extremely disorientated and had very limited communication skills, suddenly got up from his chair one day and was not seen again for three hours, being eventually discovered by the police in a town centre estate agents.

My Learning Journal
When I was a student nurse, our tutor advised us to keep a ‘learning journal’. This was intended to document and reinforce all our learning experiences on the wards or in the classroom. Like a professional diary, it would be completed after each shift or session, and serve as a chronicle of our progress. We knew that it could be requested by the college as part of our final examinations, so most students stuffed their journals with heart-rending accounts of stoicism, self-sacrifice, honest endeavour and penance.
I didn’t do that, but I’ve kept the habit going all these years. Since 1990, in fact.

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Mad Hospitals
Excerpt 1990
Large mental hospitals are often stereotyped as horribly old-fashioned places, with sadistic staff, strait jackets, endless dormitories, batch living, and fearful experimental therapies, but this couldn’t be further from the truth. Since the 1970’s, most of these large hospitals in the U.K. have been offering a very high standard of care which is also quite diverse in nature, including short stay treatment with community follow up, and challenging therapeutic communities, as well as long stay care. In most cases, the institutional care itself does not involve the mindless depersonalising routines, or the cruel herding together of brainwashed victims that’s often depicted in sensationalist fiction. It’s more like a thriving community with its own church, farm, shops, cricket team, light industry, and social clubs, as well as the more ‘modern’ facilities of occupational therapy, physiotherapy, chiropody, art therapy and clinical psychology.
But you can’t stop change, I suppose.
What a shame.
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Yes, it’s frequently forgotten that the ‘dreadful’ asylums actually helped many long-term patients to continue living meaningful lives, because their regular participation in social activities, religious services and a whole variety of work situations gave them a crucial sense of self-esteem and inclusion. This idea seems alien to many people working in the new community care units today, because policy-makers have sanctified the rights of patients to choose, without showing a proportional interest in their social responsibilities. As a result, work is no longer prioritised as therapy, patients can opt out of most personal or social responsibilities with impunity, and their largely hedonistic lives remain ungrounded, unbalanced, and ultimately frustrated.
Tragically, rehabilitation units for people with ‘functional’ problems are threatening to become the preserve of tea drinkers, cigarette smokers, T.V. watchers and sofa sleepers, while the acute units are developing into refuges for drug addicts, alcoholics and ‘welfarists’ who have turned hospital admission into an art form. Even the ‘successful’ ex-patients in the community, are often occupying a world of endless social security benefits, coffee bar drop-in centres and regular hospital readmissions. Indeed, when some staff were recently asked to suggest a name for a ‘state of the art’ new ward, the most popular unofficial choices were ‘Dunroamin’, ‘Journey’s End’ and (from the intellectuals) el loco parentis.
One of the declared objectives of community mental health care was to reduce the need for psychiatric hospitals, but instead we seem to have created one big psychiatric hospice.

“Hello there!” barked a loud Scottish voice in my left ear.
“Splash” went my biscuit into the oily coffee, as an unwanted head appeared through the office window like an old cover of ‘Mad’ magazine.
“Oh…er….hello there” I echoed feebly.
Because he was allergic to the front door, this was the nearest our ‘Locality Director’ ever got to the unit and we lived in dread of one of his rare unannounced visits coinciding with our tea breaks. He invariably appeared at the window when we were admiring the lingerie brochures which fell out of the local paper, or when we were stuffing ourselves with purloined sandwiches from the food trolley, or when we were pulling our flies up. He always reminded me of the old silent film Nosferatu leering through the porthole of a Whitby bound ship at a young maiden preparing for bed; blissfully unaware of her fate until she turned around. He had the ecstatic grin of a sadistic, inbred Mediaeval torturer.
“Is your manager anywhere about laddie?” he roared.
“Aye…..er……yes…..er….no” I said. “He’s in another meeting with the inspectors.”
“What are their main impressions?” he boomed.
“Er….well….I’m not really sure, but most people can do Frank Spencer and Prince Charles…..”
“No! No! What do they think about your unit?”
“Oh…sorry…..er…..I don’t really know….. but Richard said he had things well in hand.”
“I’ll let you get back to work then laddie!”
“Slam!”
The old sash window fell like a well-greased guillotine on the King’s scrawny neck, and I watched with grim satisfaction as the Director’s purple lips slowly mouthed the words:
“Oh, God. Please help me”.
“Speak up would you?” I said “You seem to have got something stuck in your throat.”
“Help…. Help”
“Oh, very well then, but I’ll have to ring the porters first – they wouldn’t want me to encroach on their job description.”
“Help…Help”
“Please don’t be impatient. I’ll have to complete the incident form first, just in case I forget some of the facts.”
“Help.”
“Oh, my goodness!”
“What? What?”
“I thought I saw a donkey with an erection coming towards you, but it was just an illusion.”
“Oh, please help.”
“I’m sure there’s a protocol for this in the new Trust Non-Personnel Policy Yellow binder Edition 12. Or perhaps that was the one applicable to chimpanzees who happened to get their heads stuck.”
“Help.”
“Sorry for being apparently awkward, but I wouldn’t want the unit to be exposed to any litigation if I accidentally dropped the window as I was lifting it without proper training and authority.”
“Help.”
“No, I’m not at all happy with this. We ought to have a planning meeting first and invite half the Administration Block for coffee and sandwiches.”
“Help.”
“It would only take me an hour to set up the flipchart stand. Or perhaps a full Powerpoint presentation would be more professional. I feel strongly that everybody ought to be up to speed on this, before we begin. Yes, a presentation would be the best solution, I think”
“Help. Help. For God’s sake help.”
“Oh, very well. On your head be it” And I lifted the window.
“Crash!”
“Eeeeaaach!”
“Oops, sorry - I am a butter fingers. Don’t worry, I’ll try again”
Up it went.
“Thank you” he croaked.
“I’d go home sick, if I was you”.
“Yes…Yes…I was going to do that tomorrow anyway” he agreed ”sob…..sob.”
“Oh, dear. There’s no need to get so upset. It’s just a bit of shock setting in.”
“No (sniff) it’s not that.”
“What is it then?”
“I’m a bit disappointed about the donkey, that’s all.”

If only I could turn these fantasies into realities, how happy I would be….

“Bang!”
The front door slammed shut, and I saw Richard roll down the corridor like a released hostage thrown out of a moving car.
“I need tea now” whispered Hettie in my left ear.
“We’re having a meeting this afternoon – things don’t look too good with the inspectors I’m afraid” whispered Richard in my right ear.
“Well I’m sure you’ve got everything well in…..”
“I need tea now!” Hettie roared. She was a woman who deeply resented other people interrupting her interruptions.
“Follow me then” I said.
“I’m going to discharge……”
“Sooty and Sweep to receive O.B.E. claims insider” boomed the radio.

With lunchtime approaching, I sidled off to the dining room to lay the tables, secure in the knowledge that by the time Richard was roasting on the spit, I’d be at home. The man on the kitchen radio said:
“A boy was beaten to death, his body sliced up, and the limbs dumped around a nearby town, a court has heard.”
“I don’t think that was mine” said Sidney.
“Sorry?” I said.
“I’m waiting for a defecation.”
“A defecation?”
“Yes, a dedication on the radio. It’s my wife’s birthday today.”
I took the plastic box full of cutlery to the tables, noted the unsavoury black grit which had gravitated to the bottom of it, and then stopped because Richard had entered the room, and was saying:
“’Phone call for you, Steven.”
I went through to the office, and on picking up the receiver I could hear in the background a stentorian voice booming something about cans of lager and a picnic basket. Then, a thin, quavering voice (obviously belonging to the same person) was turned to the ‘phone, murmuring pitifully:
“Oh, hello….. I’m s-s-sorry to ring up so late….b-b-but I won’t be able to get in this afternoon. I’ve been sat on the toilet all morning. It shouldn’t be more than two or three days. I’ll ring tomorrow sometime. Sorry. ‘Bye.”
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My Learning Journal
Sick Notes
Excerpt 1999
Our staff are entitled to spend six months sick leave every year on full pay, and for many this is a temptation far too generous to decline. There seems to be an unofficial roster which staff use to co-ordinate their sick time, and it’s quite possible to predict the next period of sickness for particular nurses by observing their patterns over previous years. One nurse is completely unselfconscious about taking the same two weeks off every year just before Christmas, while another specialises in taking all his normal holiday entitlement in the first eight months of the year, so that ‘sickness’ can provide the necessary breaks later on. Great care is taken by the malingerers to ensure that only two staff at any one time are on long-term sick, because any more than this and the unit could grind to a standstill, forcing the managers to leave their dream worlds and examine the situation more closely.
Time and again, supposedly sick staff are observed drinking pints of bitter in beer gardens, laughing uproariously on main shopping streets, and leaving the town to go on foreign holidays. One nurse was recently seen drinking a tin of lager at home with their feet up on their T.V. set fifteen minutes after phoning in sick with ‘nausea’, and another famously broke their arm during a house removal when they were already off sick with a bad back. Classically, one person who regularly visited their G.P. surgery for sick notes, was once mysteriously absent for about six weeks:
“Oh, I haven’t seen you for a while” said the doctor cheerfully.
“I know. I’ve been ill” replied the staff member.
A large percentage of our nursing staff are on antidepressant medication, and almost as many have regular sessions with psychologists or counsellors, not only because they consider themselves to be desperately unwell, but because these measures are an essential part of their ongoing ‘sick role’ presentation to managers.
There’s really an unspoken agreement between our managers and the malingerers, that providing the administrative procedure of occupational health appointments, sick note production and return to work interviews is correctly followed, then the malingerers can continue to abuse the system indefinitely. This wonderful quid pro quo enables local managers to avoid messy confrontations with staff and their union representatives, while at the same time demonstrating that they’re doing their jobs ‘according to the book’. As a result, the situation on the unit has become absolutely absurd, with staff claiming more physical and mental illness than the patients they’re supposedly looking after.
Duties and job descriptions are effectively rewritten to accommodate the delicate sensibilities of ‘poorly’ staff, and our unit has become a sort of leper colony where the most troubled staff in the area are sent to rehabilitate. Over a ten year period, we have received reforming alcoholics, people with terminal disciplinary records, those recovering from marital and other breakdowns, one person who had conducted a homosexual relationship with an ex-patient, and of course large numbers who have alienated their previous colleagues with prodigious sick time and time worn excuses. There are virtually no able bodied people left in the entire place, and staff demands on management are like those of spoilt rock stars at the height of their fame, yet managers can only save face by fully endorsing this conduct and pretending it’s justifiable. The joint cost of sick pay and replacement bank/agency staff for our Mental Health Trust alone is now approaching a princely £500,000 a year.
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I was now left with an hour and a half to get another qualified nurse to cover the afternoon shift, or I would have to stay on until the night staff came on duty at 9.00p.m. My head began to throb, while the room itself seemed to darken a little, with tiny diamond dots dancing in the middle distance.
“I’ve really had enough of this place” said a voice.
But it didn’t seem to be my voice.

Then a brief feeling of intense anger gave way to dispassionate disdain, and I seemed to stand outside myself, watching the ugly little world with cold, remote precision; knowing that something was about to happen, and certain I couldn’t stop it. Mad, bad and glad, in one beautiful, liberating thought.
Tick tock.

(to be continued)
Full story on www.windowsofmadness.co.uk.
Paperback available at www.booklocker.com/books/4150.html