Mad Worlds (22 page)

The god was back. Escorted by two white-coats, John stood watching the shiny pate of the bird-like man bowed over a file and drumming fingers on the desk.

He knew the sentence. There was no Sarge around, only Deputy Jackson. But he'd been told earlier by a harassed-looking Jackson, “The boss has written in your file that you need a leucotomy, and what he says goes with the god.”

The god looked up, beaming while he adjusted his specs. “A pleasure to meet you again, Chisholm.”

“What a charmingly evil snake you are.”

This seemed to go unnoticed. “I see Mr Parker suggested a leucotomy, and I would concur with that.” The god was frowning now, looking down at the file. “Hmm. But meanwhile you will restart ECT, then I shall review.”

Phew – no leucotomy. He could survive ECT. But ‘meanwhile'? Ominous?

The god snapped the file shut and pushed it toward Jackson. “Madness,” he muttered. “Three doses a week from tomorrow for four weeks, then review – unless I get this ludicrous ruling overturned before then.”

“Sir.” Jackson took the file.

“Next patient,” the god commanded.

*

No great prospect, having ECT again. At least John knew the drill. The problem would be his memory. But after the last battering, he'd eventually been able to remember. Maybe his brain hadn't suffered permanently.

He'd pondered a lot about Heather and Becky. It was hard to imagine how convinced he'd been that Heather was having an affair. She had been ice-cool towards him. But the post-natal depression could have been prolonged.

She did seem pally with the mental man. Maybe by now they'd teamed up.

He could hardly blame her – with a loony husband locked away, probably for life. And he was surely a nightmare to live with, before they took him to this dump.

Two white-coats approached. “We're off to the circus, Chisholm.” And so began his next set of encounters with the Shocker.

The Edinburgh train puffed towards Birmingham New Street and drew to a halt outside. Its driver awaited the signal. Its stout-hearted engine hissed loudly.

Jamie Macdonald opened his eyes. It had been restful to drowse en route. He could feel a buzz. A change of train and a bus journey and he'd be there.

The offer of the job as Springwell's medical superintendent had come two days after he got home. He'd read the letter aloud, and Gill rushed to embrace him. He replied to accept, from 1
^st
February 1957. This allowed time for him to wind up at Dingleton, and for recruiting his consultant successor.

Soon after, he'd received a welcome note from Liam Kenney. Kenney's boss, off sick and past retirement age, was to leave at the end of October. Kenney would act up for three months, and wondered if Dr Macdonald and his wife would care to spend a weekend as guests to familiarise themselves with Springwell.

The only decisions were when, and whether Gill would come. In her fourth month of pregnancy with what would be their first child, and struggling to keep up her GP work, she'd decided to rest at home. He was glad. The pain of three miscarriages over their time together was still pretty acute. ‘When' was easy – as soon as possible.

The train stopped. Springing out onto the platform, he trotted along. He wanted to see all he could of Springwell.

*

Macdonald reached Springwell late in the evening. His host's cordial greeting helped him relax. He declined the ‘proverbial nightcap', and opted for a mug of cocoa.

After the small talk, Macdonald said, “Wonder what the Royal Commission will come up with.”

“Dunno. Reform's long overdue. You know Jamie, I've been ashamed of some things I've been party to.” Kenney gulped his drink. “We need more emphasis on trying to help patients, less on protecting the public.”

A surprise. He'd assumed Kenney would defend the system. “I agree. They should report soon. The grapevine tells me they'll move in that direction.” He sipped his cocoa. “What brought you to psychiatry, Liam?”

“I was a biochemist when my wife died giving birth prematurely. Our baby lived a few hours. Life was hell. I threw myself into work, felt an urge to be a doctor and got interested in psychiatry. I came here as a consultant only three years ago.”

“Quite a new boy then?”

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 thirty, 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.”