This week I am delighted and honoured to welcome Dr. Pat Harrold as guest blogger. For his 'day job', Pat is the adored and gifted GP of the people of Nenagh, a trainer of GPs and a teacher to countless cohorts of medical students over the years. Along with his day jobs, Pat is also one of Ireland's leading medical writers, with regular publications in medical and mainstream newspapers. And he is also a prolific and award winning writer of fiction. To add to his 'Renaissance Man' profile, Pat is also a talented musician and a lover of all things artistic. And despite all his skills, talents and passions, you could not meet a sounder, lovelier gentleman in a day's walk.
Pat spent two years working in psychiatry back in the early 90s and his blog is a beautiful and reflective piece of writing on an era that has only recently passed into history. For artistic accompaniment, Pat suggested that I include some images from his artist friend Joe Boske.
Thank you, Pat.
Thirty years ago I handed back the
keys, picked up the stethoscope and left the high walls behind me and I now try
to remember why I swapped the deep waters of Psychiatry for the rapid shallows
of General Practice. I still have no idea why I left, and probably did not
then, in the days when I saw life as something that happened to me, and just
hoped for the best. Probably somebody offered me a job somewhere, which was the
cause of most of my misfortunes and a few happy results.
My first SHO job after the war zone of
internship was in Psychiatry. I did the interview and found them friendly and
more importantly they liked me so that was the next six months sorted. After
the interview I took an optimistic look at the Doctor’s Res and was chased out
by a screaming Senior Reg who thought I was a Drug Rep. I must have had a good
suit.
Along the margins of the unknown tide, 1970
So I got the start, in a huge
Victorian building in the process of what was then called “rationalisation” by
the top brass, and “chucking the residents out“ by the staff. I remembered the Richard Gordon quote
that Psychiatrists chose to hide behind the same high walls as their patients
but it seemed those walls were coming down. I mean no disrespect to
Psychiatrists of today but in those days the doctors were an odd bunch. The
unfriendly Senior Reg, who I was alarmed to see was still there when I started,
had the patients shaking their heads and tapping their foreheads as he passed, twitching
and snarling like an elderly terrier. Of course he had no cop on, and saw
Psychiatry as a Doctrine, which if he obeyed would make sense of a cruel and
bewildering world. I encountered quite a few like that, and some wore their
qualifications in Psychiatry like a Priest’s collar.
I was entranced and appalled at the
size of the place .The surrounding Parkland was the remains of the old farm,
where the patients, most of them from a rural background, had worked in the
fields. It must have done them good if living in a locked ward was the
alternative.
Night tide, 2003
I was loaned a bunch of keys that
would open every door in every Psychiatric Hospital in the UK and was told to
never put them down in an unguarded place. As I opened and locked each door on
my way around the Hospital and I am sure I was not the first person who
remembered the opening scenes of “Get Smart”.
There was a cloud of cigarette smoke
everywhere, dreamily lit by the light from the too high to climb out windows. The
new arrivals were put in dressing gowns and slippers, for all the world like
the Darling children in Peter Pan. The unshaven ones stretched on their beds
with a jug of orange juice by the side were detoxifying from alcohol. The long
term patients wore shabby suits and dresses, like refugees after the war. Many
of them clutched dolls and they all wore straw hats in the summer .A schizophrenic
school teacher taught an imaginary class in the corridor. It was a pleasure to
listen to him skilfully running through Latin Grammar and he obviously had been
gentle and caring with his pupils.
Late one night I was called to a
young man who was so psychotic and suicidal he was literally climbing the
walls. He turned his tormented face, lit by moonlight in the darkened ward to
me and told me he was possessed by the devil and in hell, and there was nothing a doctor
could do for him. He died suddenly soon afterwards, probably as a side effect
of neuroleptics that nobody knew about at that time.
Galway Arts Festival poster, 1991
There was a celebrity patient, a
famous artist who painted with his non dominant hand. He had cut his wrists
smashing through a window and destroyed the tendons in his good hand. Within
weeks he was painting skilfully with his left. He was invariably cheerful but
his paintings were bleak and hopeless.
In the mornings I would cycle from
building to building. In those days the SHOs had to look after the medical
needs of the patients; their psychiatric needs were no longer an issue. None of
the SHOs knew what they were doing as they tried to treat the many conditions
of elderly, sedentary chain smokers. I became fascinated by the old notes, the
crinkly yellowing sheets of paper that summed up a life in a folder. One old
man had been there for sixty eight years and I read his notes from cover to
cover. It seemed that the only time he had seen a doctor in the early days was
for an “annual review “ - a one liner in exquisite copperplate .The review was
short of medical information but long on invective. “Moron, Imbecile, Cannot
read or write”. That was all it took to keep him banged up for another year.
A woman in her late middle age had
been put in by her strictly religious family for rebellious behaviour at 13. She
had done nothing more than wearing make-up and cheeking a teacher. A Locum
consultant wrote a stern report when she was 24 saying she had no evidence of
mental illness and discharged her. When the usual psychiatrist returned from
his holidays he sent the police to bring her back, which they did, and she had
not left since. Sometime in her thirties she became pregnant and of course the
baby was taken from her, never to be seen again. Nobody asked who had fathered
the child in a locked female ward and her pregnancy was seen as further
evidence of her wayward nature. When I saw her she was too institutionalised to
live on her own, and suffered the side effects of years of sedating medication.
Every ward had its nurses. The male
nurses had been hired when there was a height and weight requirement .They were
strapping men in suits, and I quickly discovered that the bigger and scarier
they looked the nicer the person they were. One fearsome looking giant, with
crossed eyes and teeth like an ogre, was one of the kindest and saintliest men
I have ever met. The women nurses wore uniforms .They all listened to the
stories, doled out the fags and medication, and observed their charges like
skilled naturalists.
On Tuesday mornings I administered
ECT. “Shocking weather!” the anaesthetist would say. He said it at every
session, and we smiled dutifully in that sad place, like soldiers in a firing
squad before the prisoners arrived. Then the patient would be wheeled in on a
trolley, given an IV shot and when they had passed out I would press something
like an earphone to each temple. The patient would jerk in a modest seizure,
which we would dispassionately count. Fifteen seconds seemed like an average. Then
they would be wheeled to a recovery room, to lie with the others like children
on a sleepover. It was called the ECT “Suite”, as if it was a splendid hotel
room, and not a collection of iron single beds, a trolley, and a wooden box
full of wires.
We had video training every week,
when we would interview a patient and have our performance analysed by a proper
grown up psychiatrist. To this day I can hear those critical voices when I find
that I miss a cue, or ask the wrong question or stare out the window for too
long in my own office. Then I sit up, and put on my calm psychiatrist’s face.
It does not always work. “You are too soft to be a psychiatrist
Pat.’ She was a patient in her twenties, with a drink and drug problem. She was
from a medical family, and I knew some of them from years before. She had the
scars on her arms that suggested childhood trauma, and I had let her out for
the weekend. The consultant, an oldish young man with a row of coloured pens
in his top pocket, had written in her chart that she was not to be let out, but
her sisters had arrived and I could not see any reason to keep her in.
Night flight, 1982
Nobody
had a mobile phone back then and the consultant was away somewhere and could
not be found. She managed to make it back without getting drunk or stoned or
damaging herself or anyone else. She was, in fact feeling much better. That was
when she told me that I was too soft as the Consultant, without comment,
tippexed out my Saturday afternoon comments on his elusiveness on the Monday
morning. He later confessed to me as he lit a cigarette with a shaking hand
that he had not known that he was on call at all, and had little recollection
of where he had been. He wasn’t the worst, poor chap. He discharged her on the
Tuesday .She did well, as they say, and never looked or went back.
That same Tuesday, rushing from ECT
to Outpatients, my first patient was a lovely man who had been discharged after
40 years inside. It was the height of Punk Rock and he told me how he had
walked, for the first time in decades, down the streets of his small town while
youngsters with multicoloured mohicans and safety pins in their faces stood at
street corners. “And they locked ME up”, he said without rancour.
I spent two years in Psychiatry
altogether. It now seems to me like a place where I once lived, and have not
seen for years, and if I was to go back, would have changed so much I would
hardly know it. The great institutions were already on their way out thirty
years ago. The problem then was getting all the patients out; my problem now is
getting them seen at all, and it is a very rare case who gets to stay even
overnight, never mind sixty years.
Heavy weather, 1970
It was a different world with
different hairstyles and cars and music .There was little in the way of street
drugs, and the old fashioned pint drinking alcoholic was a regular visitor. The
hospital was a home for hundreds and a refuge for dozens. Misunderstood youths,
fragile loners, bewildered spouses, weary parents and heartbroken heroes came
and went and came back again. The nurses gave tea and orange juice and
cigarettes from cartons and listened without judgement.
When I look back on those days I
remember a Doctor’s Res on the top floor; the former residence of the generations
of Chief Psychiatrists and their families; and the view through the Victorian
windows of the fields and the high walls and beyond the towers and spires of
the town which had turned its gaze away many years before.
And one final piece of art, with this image of Pat's home town of Nenagh. The artist is Chris McMorrow
