mental health

a bit of a drama

~ jim clayton ~ Leave a comment

The living room is as brilliantly lit and formally arranged as the opening scene in a play. A man and a woman sitting side by side on the two-seater sofa in the bay window, stage left; me with my folder on my lap on a matching armchair just downstage from them, and then an elderly woman stage right, the focus of attention, sitting on a dining chair turned sideways to the table, her hands neatly folded in her lap. A bright and pleasant room, crowded bookshelves, pictures on the walls, a giant fern in a green pot, and a plain-framed mirror over the mantelpiece casting back that light pours in through the windows.

And if it was a scene from a play, the director might well decide to hold it there, curtain up, and not have anyone speak their lines for a beat or two, giving the audience time to settle, take it all in, and wonder about the four characters. What assumptions might they make?

They’d know I was official, and not just from the obvious stuff, the uniform and lanyard, bag and folders. They’d probably think there was something a little self-conscious about the way I was sitting, a conciliatory duck of the head, maybe, a professional sharing of attention between the other three. They’d think the other man was a relative, the son, no doubt. He’s the right age, of course, but he looks like someone who’s spent a lot of time in this room, one way or another. And the way he massages his hands and jogs his knee up and down. He looks like someone who’s been brought here over some distance, at some inconvenience, still wearing the suit he was in when he took the call. A nice, professional son, then, worn down by circumstances he finds more difficult because they’re out of the normal run of things, and hard to quantify in the usual way. The woman sharing the sofa is sitting so close to him they must be in a relationship. There’s something resolutely straight-backed about her posture, and the encouraging smiles she shares around the room. There’s something about the way they are together that suggests long conversations and negotiations. They’ve arrived at a decision – he, more reluctantly – resolved to face it together, shoulder to shoulder. The elderly woman has a bewildered look. There’s a vagueness about her in strange contrast to the sharp delineation of everything else, as if the bright sunlight flooding the stage is causing her to lose definition rather than gain it.

‘Tell me about the whole bath thing’ I say. ‘I didn’t get the whole story.’
‘Well it does sound a bit crazy, even to me,’ says Helen, the elderly woman. ‘You see – I took a bath as I usually do in the evening, but then I blacked out, and it was some time before I was found.’
‘How long?’
‘Three days.’
‘That’s a long time.’
‘Yes. It is.’
‘Was the bath filled with water? You were lucky not to drown.’
‘No. The water had gone.’
‘Who drained it?’
‘It must have been me, although I don’t remember.’
‘Three days in a bath! I’m surprised you didn’t freeze.’
‘It’s a warm flat.’
‘When did you regain consciousness?’
‘The whole thing’s quite blurry. I’m not really sure.’
‘It’s perhaps a strange question to ask, and I’m sorry for asking it – but had you been incontinent?’
‘No, I hadn’t.’
‘So you passed out in the bath. Came round at some point. And then couldn’t get out of the bath. Is that right?’
‘I suppose so. Although it sounds pathetic when you put it like that.’
‘Who found you?’
‘Maria, the cleaner. She comes every Wednesday morning.’
‘And did she call the ambulance?’
‘Yes.’
‘And they took you to hospital?’
‘They did. And I had a whole series of tests. The works. And all they found wrong with me was a silly little cut on my toe. Would you like to see it?’
‘Maybe in a minute or two.’
‘I don’t know how I did it. Probably on the tap, I should think.’

She looks at her son, Matthew, who sits on the sofa with his knee jogging up and down. Matthew’s German wife, Helga smiles brightly back at Helen.
‘We will get things sorted,’ Helga says. ‘Don’t worry.’
‘Absolutely!’ I say, flicking through the discharge summary, at the normal blood results and scans and so on, the recommended follow-ups. ‘We’ll figure something out.’
‘I do hope so,’ says Helen. ‘It’s all a bit of a drama, I’m afraid.’

a head for depths

~ jim clayton ~ Leave a comment

Craig has the key so we agree to meet outside Sally’s flat at midday, when he’s due to make her lunch.
‘Have you been here before?’ he says, bending down to stretch some blue plastic covers over his trainers.
‘I hear it’s bad,’ I say, taking some out of my bag.
‘It’s not the worst, but you’ll definitely need these.’
Craig seems tired, a reflection of my own state of mind. It’s not so much the number of patients on the list and the number of miles we cover, hurrying from place to place. It’s more the endless parachuting in to situations that are failing in one way or another, trying to set them straight – or, at least, straight enough so you can feel some kind of progress is being made, and that things might change for the better.
An adult safeguarding report has already been put in on Sally, but it’s complicated. In the meantime, we’re going in to do what we can to ameliorate the situation.
‘Ready?’
‘Ready.’
‘Okay then.’
He knocks on the door and then opens it with the key.
‘Sallly? It’s Craig – and Jim. From the hospital. How are you doing?’

He’s right. Whilst it’s not as bad as many places I’ve been in, it’s definitely the kind of place you have to start with shallow mouth-breathing for a minute or two, till you’ve adjusted sufficiently to breathe normally through your nose. Walking down the hallway, our covered shoes make the ticky-tacky noise so characteristic of encrusted and unsanitary surfaces, and the air has a familiar and gloomy sag to it.
‘Hello?’

Sally’s waiting for us in the lounge, in an armchair so low and squashy and discoloured it looks less like a piece of furniture than some giant, malignant bloom. She’s wearing an electric blue silk nightie with a green cardigan over the top. Her bare legs are mottled, swollen, pressed together at the knee. She smiles easily, reaches up to shake our hands, but her conversation is muddled and difficult to follow. One of my tasks is to take some blood, to determine whether infection is making her more confused, but I can see I’m going to have to sidle up to it.

Whilst Craig busies himself preparing a microwave meal in the kitchen, I chat to Sally about this and that, and take her observations as carelessly as I can, almost as if I’m as surprised as her to be doing it.

When Sally talks it’s the equivalent of pretend writing. The patterns of her words, the fact that they follow a line, and start and stop in the usual way, with the usual loops and flourishes, everything looks superficially like conversation. But the truth is, I have to make assumptions about what she might mean, and reflect it back to her, and she’ll either laugh or frown, or wave her hand in the air, and we’ll move on, as if something’s been said, though neither of us really knows. But there’s the reassurance of the tone of what we’re saying, if nothing else, and it does seem to be working. She’s distracted sufficiently to let me take some blood, and whilst she obviously doesn’t have mental capacity to refuse, I take the fact that she doesn’t pull her arm away as consent.
Just before I actually puncture the vein, I ask her some more about her family, particularly her father, who (I think) she said was a miner.
‘Have you ever been down a mine?’ I say, preparing the needle.
She answers with a laugh and a string of garbled words that, if they were in a foreign language and I was forced to guess the meaning, I would say: That was a long time ago now / He was a lovely man / He worked so hard.
‘He sounds great!’ I tell her. ‘You know – I’ve always quite fancied the idea of going down a mine.’
She laughs again.
The blood flows into the tube.
‘God knows, it must be a difficult job.  But I quite fancy seeing what it’s like. I mean, when you think where it all came from, what it was, all that coal. Millions of years ago, all these giant trees and plants in some wacking great swamp somewhere, and then it all gets buried and changed into black rocks you can burn. I know I probably wouldn’t pay much attention to any of that if I had to go down in a cage every morning and swing away with a pick. If that’s what they do. I’ve really no idea.’
She listens to me with a tolerant smile on her face, tutting at some things, frowning at others, but keeping her arm still so I can get what I need.
‘There! All done!’ I say, taping a piece of gauze to the crook of her arm. ‘You’re a model patient!’
Meanwhile, Craig has come through with lunch. He’s standing just behind me with a tray of Lancashire hotpot.
‘You thinking of a career change, Jim?’ he says, helping Sally get set up in the chair, ready.
‘Me? Maybe,’ I say, stashing the phials of blood and peeling off the gloves. ‘I don’t know though. I’m not sure I’ve got a head for depths.’

the story of Old No.7

~ jim clayton ~ Leave a comment

Before I go up to the first floor I stop by the warden’s office.
‘Pete? He’s what you might call a colourful individual,’ says the warden. ‘He’s certainly done a lot in his life, what with his boxing and his business interests and his running around. I’m not so sure about the Krays, though. You have to take a lot of what he says with a shovel of salt. But y’know – we’re all worried about him. Pete’s always had a short fuse, but he’s gotten a whole lot crankier. The carers are having to double-up.  For safety – y’understand? God knows he’s got a lot on his plate, poor bastard, what with his eyes and his back. We take his meals up and try to rouse a bit more of a spark in him, but.he’s retreated to his room these last few weeks, and short of dragging him out by the feet, there’s not a lot else to be done. It’s like he’s given up.’
‘They’ve sent me round to take some blood this morning.’
‘Yeah? Well good luck with that!’ says the warden, shaking his head and leaning back in his office chair. ‘My advice? Keep it simple. Don’t fuss. And wear a tin hat.’

Pete is standing waiting for me in the doorway to his flat. A tall, pale, withered figure, dressed in boxer shorts and a string vest, he peers out at me as I approach along the corridor.
‘What took you so long?’ he says.
‘Sorry, Pete. I stopped by to have a word with Gerry.’
‘What for?’
‘Just a quick hello. He’s a nice guy, isn’t he?’
‘If you say so. Anyway. What’ve you come for? I’m sick of all these people barging in all hours of the day and night.’
‘It must be annoying,’ I say. ‘But I suppose it’s just because people are worried about you. They want to make sure you’re okay.’
‘What people?’
‘Carers, nurses. The usual.’
‘Well, I’m fed up with it.’
‘So how are you today, Peter?’
He shrugs, but lets go of the door handle and turns to walk back to his armchair.
‘Just be quick,’ he says.
‘I promise I won’t keep you long.’
He settles back into his chair as I get my things ready.
‘What are you? Some kinda nurse?’ he says.
‘Nursing assistant.’
‘Ah!’ he says. Then after a pause: ‘In Spain you’d be called a practicado.’
‘I like that. Practicado. That feels about right. So – how come you know Spanish?’
‘Well I should do. I lived there ten years. I had a bar on the Costa del Sol.’
‘Wow! That sounds great. Hard work though, I expect.’
‘See that bottle up there,’ he says, pointing to an ornate glass bottle on the top of a shelf of sculptures and photographs. ‘That’s a traditional Spanish whisky, about a million per cent. So spicy it’ll blow your tits off.’
‘I bet.’
‘I haven’t touched it in over twenty years. Don’t suppose I ever will now.’
‘You know – the worst drunk I ever got was on an American whiskey. Something called Wild Turkey. I was knocking it back because it was so smooth and easy. And I was thinking This is all right! This is great! And the next thing I knew, I was lying flat on the floor with my eyes going round and round, like the red spot on one of those old electricity meters.’
‘American whiskeys are the best,’ he says. ‘Have you ever had Jack Daniels?’
‘Yep. Love it.’
‘D’you know the story behind it?’
‘Was it something to do with the Civil War? Or was that Colonel Sanders?’
‘No! He was the chicken man, you numpty. What I mean is – why’d they call it Number Seven?’
‘Don’t know’
‘It’s because his first batch was just seven barrels, and they all come loose in a storm and rolled down the mountain, and the only one they never found was this number seven. And it’s still out there now. So if you went and found it, you’d be a millionaire.’
‘I’ll just take this blood and then I’ll be off.’
‘Ye-es, mate. I’ve lived all over the world. Spain, Italy. America. I’m no good now, though. I mean – look at me! And then have a look at me on the beach.’
He nods over at a bookcase as I tape a wad of gauze to his arm. Shaking the vials of blood, I go over to the picture. A young man in his twenties, doing that greased-up, muscle-man thing of leaning forwards whilst flexing his arms and shoulders, smile-grimacing into the lens.
‘You look quite a prospect.’
‘Wha’d’ya mean, prospect?’
‘I mean you look handy.’
‘I could take care of myself, don’t you worry.’
I sit down to write the vials up when he says, in a surprisingly shaky and vulnerable change of tone: ‘What d’you suggest I do about all this, then?’
‘About what, Pete?’
‘About all this what I feel. I’m no good any more. I’ve got pain the whole time. I can’t hardly see nothing. The doctors have run out of ideas.’
He licks his lips and then adds: ‘Do you know what irony is, Jim?’
‘What – d’you mean it’s ironic you were so fit and now you’ve got all these health problems?’
‘No. The irony is – a few years back everyone wanted to kill me, and now that I’m properly fucked and want to die, they all want to keep me alive.’
‘I’m sorry you’re feeling so low. It’s not surprising, though, given all the things you’ve got to put up with.’
‘Yeah, well,’ he says.
‘I can refer you on to our Mental Health nurse. She’s really good – and she can start figuring out ways to help you feeling better again.’
‘If you think,’ he says.
‘Good. I’ll speak to her when I get back to the office.’
I’m just putting my stuff away when he leans forwards and says:
‘Have you heard the one about the two psychiatrists in Chicago?’
‘No. Go on.’
‘So there are these two psychiatrists in Chicago, both working in the same building, nodding to each other when they pass in the lobby. The first one’s always bright and cheerful, dressed nice, expensive hat, big cigar, whilst the second one, he drags himself around looking shabby and down at heel, with a face like a smacked arse. So anyway, eventually, this second, sad psychiatrist, he can’t take it no more, and he stops the first one in the lobby, and he says: I don’t get it, mate. We spend all our time listening to the same old dreary problems, none of which we can’t do nothing about, and yet there you are with this big smile on your face. And the first one, he turns round, and he says: ‘Who listens?’

out out

~ jim clayton ~ Leave a comment

When I was little we used to play a game called Jack Straws. You had a box of plastic tools – ladders, shovels, brooms, rakes and so on – you dumped them in a pile in the middle of the table, and then you took it in turns to try to hook as many away as you could. If the rest of the pile moved, you were out, and you passed the hook on.

Talking to Paula is a lot like playing Jack Straws, but instead of tools it’s walking sticks, letters, appointment cards, blister packs, items of food and then – the biggest category by far – people, dozens of them, in all shapes and sizes, some of them old, some of them young, some of them in uniform. And it’s difficult to resist the idea that the box got emptied on the table about the time her partner Eric died.

I’d been given the background story by someone else. Twenty years ago Paula and Eric had left their respective partners and children to start a new life together in a different part of the country. Paula had always been an anxious person, something that deteriorated in later years to the point where Eric had been acting as her carer. His recent, unexpected death cut Paula adrift, and everyone around her was struggling to cope. She’d been calling the ambulance a great deal. The police, too. Carers had been arranged but quickly dismissed, accused of laziness, rudeness, or the latest, making faces and going through her things. Everyone was trying to help. No-one was getting anywhere.

I’ve been sitting on the sofa struggling to think of a new angle to come at all this. It doesn’t help my situation that Paula’s friend Nigel is so aggressive. No doubt he’s stressed, too, but I don’t get the impression he’s normally easy. He has that way some men have of walking slightly back on his heels, arms out to the side, like it’s an effort to accommodate so much masculinity in such a short frame.
Right at the beginning of the meeting I’d checked Paula was okay with him being there.
‘Nige? He’s taking me shopping,’ she said. ‘Of course I want him here.’
‘That’s fine. I just needed to make sure.’
‘What’s up?’ said Nige, wobbling back into the room.
‘He says he wants you to go.’
‘Does he?’ he said, poking his glasses back into position with a finger as hard as a nail gun. ‘Why’s that, then?’
‘Don’t worry, Nigel,’ I said to him. ‘It’s fine. It’s just standard procedure when I’m talking to a patient about private stuff.’
‘Private stuff, yeah?’ he said, then thrust a doctor’s letter out for me to read. ‘Well go on, then. What are you going to do about this private stuff?’

*

It’s the end of the meeting. Physically Paula seems fine. The only positive contribution I can think of to make is a referral to social services, although I’m pretty sure they’ll already be well aware of the situation.
‘I just want to go back up north,’ she says. ‘Can’t you find me nowhere?’
‘How d’you mean?’
‘A house or a flat. Back up near my daughter.’
‘Well – that’s a little beyond what we normally do. But there’s nothing to stop you or your daughter looking for properties yourself.’
‘How?’
‘I don’t know. Online. There are loads of good websites.’
‘I haven’t got a computer.’
‘Your daughter, then.’
‘She doesn’t want me near her.’
‘She doesn’t?’
‘No!’
‘I’m sorry to hear that.’
‘So what are you saying, then? You’re not going to help me?’
‘I’ll see what I can do.’
‘But I can’t go on living here, can I? I can’t cook. I can’t look after myself. I can’t go out.’
‘I thought you said you were going shopping with Nigel?’
‘No,’ she says, taking out a cigarette, her hands trembling. ‘I mean out out.’