Old mail edited anew:


My stint in Psychiatry

While flipping through a book called “The Holographic Universe” by Michael Talbot, years ago, at Manney’s in Pune; I’d checked out the index for any mention of Carlos Castaneda and turned to the appropriate page to find what had been written. In this case, the author was talking about some psychiatrist at Harvard, who held a double doctorate (the other one in philosophy!) and quote swore by (not at) Castaneda. I only had time to read this far before my companions dragged me away. The very concept was mind-boggling: that a shrink in the bosom of conservative academia could afford to dabble (if a doctorate can be labeled dabbling) in philosophy, and more, his opinions validated a world-view which had shaken me rather profoundly- all this made for heady stuff. More than a decade later, I’m still searching for that elusive book and so far, I haven’t traced it.
I did go on to wind up in a psychiatric facility by and by, and to everyone’s surprise, it was on the acceptable side of the table. As a lowly MBBS, I was one of the 3 “Residents” who handled the ward under 8 “Consultants” (people with postgraduate qualifications in psychiatry). Logistically, they were divided into 4 two-man teams. In fact, they’d organized themselves into two broad cliques , which were at each others’ throats all the time. One guy had the grand sounding appellation of “Ward Coordinator”. Though a postgraduate, he was younger, less experienced and was basically meant to take the rap, should anything ever go awry.
The patients’ arrangement was the traditional division into general wards and private rooms; the only remarkable departure from convention being the absence of bolts/locks in the loos. This is SOP for psychi wards all over- the idea being that someone may rush in and rescue patients bent on killing themselves. Said storm- trooper cum guardian duty was the forte of 1 or more attendant assigned to each patient 24 hrs a day. They were supposed to look after the patient’s well being, prevent the less-than-balanced ones from trying to escape / slash their wrists / hang themselves / attack other people, and shadow them everywhere…you get the idea.The residents’ work consisted of 24 hr shifts on the wards alternating with 4 hr OPD (Out Patient Department) duties. We had to screen patients and their relatives for admission, establish diagnoses, escort the visiting physician etc. for mandatory medical/pre-anesthesia examinations, start treatments ordered by the consultants, handle any complaints from any quarters and when required, go out in an ambulance with staff to fetch uncontrollably violent patients who couldn’t be persuaded by their families to come to the hospital.
The 1st time I was required to do an ambulance call, I was still pretty new to the job. The standard procedure was to go to the given address accompanied by 2 attendants and a nurse packing loaded syringes with sedatives, use any old bullshit to get the patient to lower his/her guard, and before (s)he caught on, have the attendants overpower them, get the nurse to shoot ‘em up with the knockout drugs and load them into the ambulance. The family was advised to stay out of the way during the entire procedure, though they were required to sign certain forms authorizing the hospital staff to do what they saw fit regarding the patient’s treatment (including involuntary admission).
Since every such trip left us 400/- richer, these calls were coveted. On a fairly low-key day, I was summoned to the OPD from the ward with instructions to alert the staff about an ambulance call. In the OPD hall, I was hurriedly introduced to a middle-aged lady and her son as the doctor who’d be accompanying them and left to deal with their hysteria. The lady’s other son had to be fetched from an upper-class neighborhood. Apparently he’d gone berserk the previous night and had trashed all the furniture in the house, including all landline and cell phones. Currently, he was in his room and the only other person in the house was the old father. The urgency of the situation lay in the possibility of his running out (the patient, not the father) with no way to catch or trace him. The real humdinger was that the guy had chosen to ensconce himself in his room with a knife. Guess whose happy task it would be to disarm him?
I gathered both my backups- the muscle and the pharmacology, settled in the ambulance along with the mother while the sane son followed behind in the family car. I figured this was as good a time as any to ask for the background info on the patient. No sooner had I broached the topic than the mom became teary-eyed and defensive. Brilliantly insightful me; I had the epiphany that 1 way or the other; she was the villain of the piece. The average informant wouldn’t start off the answer to such queries with, “It’s not my fault”, followed by a lengthy tirade on the shortcomings of her daughter-in-law.
The boy was 27 yrs old, an officer in the merchant navy, reportedly tall and well-built (worse luck!) and had gotten hitched a fortnight back. The couple had returned happily from their honeymoon but soon as they settled down into the household routine, the no-longer-blushing bride started quarreling with the family and left for her parents’ place, bag and baggage. This precipitated the husband’s breakdown. After making n number of fruitless entreaties and phone calls to the runaway bride, he ran amok one night and trashed the entire house. Just to ensure that he wasn’t interrupted in this edifying pastime, he was brandishing a knife, which he still had on his person, at the time his mom was narrating the tale. There was some more of the self-exculpation stuff as well as her Always –Having- Known- That- The- Girl- Wasn’t- Fit to be her darling son’s wife but how much she was willing to Sacrifice For His Happiness which is why she hadn’t put her foot down…and so on.
Moms and moms-to-be; take note. Deprive your cheerful cherubs of their teddy-bears too soon and someday they’ll curl up in their beds with a meat-cleaver.
A sample of the thoughts flashing through my head during that ride-
1. I should’ve been more regular in going to the gym. Who knows when you’ll need to wrestle with a cutlass-wielding maniac?
2. Why don’t they offer a course called Bravery 101…or something, in college?
3. I really shouldn’t have addled my reflexes with all those years of relentless chemical assaults on my central nervous system.
4. I ought’ve used the opportunity of taking up unarmed combat while I had the chance. All that time spent in a fauji institution… wasted!
5. Will I get to see my loved ones again? Is it a fullstop for the scion of the Maliks this fine day?
6. I went into Psychiatry thinking it would be easy money. I mean, how hard can it be to tell fucked-up people to blame their parents for everything? Ah, the irony!
7. Ain’t I entitled to hazard pay for this kinda situation? It’s a slasher horror pic come to life and a-visitin’ me, isn’t it?
8. How do I get out of this?
As to the patient’s previous history of mental illness, he didn’t have any. So this was a one-off thing. Reached the house and found the terrified father waiting for us- still unharmed. He let us in and directed us to the locked door where the ghar ka chiraag was amusing himself. I asked for and got a thick blanket to shield the deranged man’s assault. Then, gave the family a sickly smile (it was meant to be reassuring), instructed them to get out of sight, checked my pants to ensure there hadn’t been any fear-induced accidents, rallied my staff behind me (Leading From The Front like a good leader must)…and (gasp!) knocked.
It occurs to me that if this were a TV serial, now would be a good time to insert a background clash of cymbals, freeze the scene and stop Until Next Week’s Episode. Alas, no commercial breaks here. No rescue by irritating little brats orgasming in chorus over candy or noodles, no nekkid ladies peddling radial tires for your car. I called out the guy’s name and the door opened. He ignored the proffered handshake and asked who I was. Told him I was a doctor and we’d been summoned by his family because they were worried about his not eating and sleeping well lately. Hey, I know it sounds lame but these patients aren’t supposed to be at their intellectual peak, ok? The important thing is, even while he was scoffing at such claims (“I slept 12 hrs and have just been woken up by you people”), he let us in the room. I approached him warily and said I wanted to talk to him for a while. He lay back on his bed and in an extremely peeved tone, ordered me to lose the blanket. AND to order everybody else out of the room. Oops.
That inadvertent trouser accident seemed a distinct possibility. At least the fencing instrument wasn’t out in plain view. Complied with his commands though, trying to ignore the questioning looks from the staff. Gave `em the ol’ steely eyed glare and jutted out my iron jaw. They shuffled out with dubious looks on their faces. The prospect of going out to fetch a patient and returning to the hospital with a staff fatality must’ve weighed heavy on their minds. Of course, they’d be cheated of the house-call charges as well if all they had to show for the ambulance excursion was a stabbed doctor.
Mind you, this was my 1st such call and I had vague notions about “establishing a rapport”, “winning the patient’s trust” and so forth. With several more such situations under my belt, I would later become an expert at entering the patient’s room with a bright smile, spout some nonsense about checking their BP, and having gained physical proximity, signaling the menials to overpower them, shoot ‘em up, knock ‘em out and carry them out to the ambulance. In fact, this was all the doc is required to do. Exalted professionals aren’t supposed to get their hands dirty with the nitty- gritty of talking to individuals who’re destined to be carried out kicking and screaming to a lunatic asylum for an indefinite period. At that point however, I felt I’d serve the patient’s interest better if I could at least get his side of the story 1st. He certainly seemed rational enough, not quite the rabid, weapon-bearing psychotic I’d been expecting. Sat down at the foot of his bed and started making inane conversation.
The room, like the rest of the house was a mess- he’d overturned the furniture, torn all the clothes and draperies. No rock star could’ve done a better job on a hotel suite. Bummed a cigarette off him, strolled around the room, checked out his CD collection and complimented him on his taste in music (it sucked actually- Britney Spears AND the Spice Girls, I ask you…in a grown man’s collection?!?), swapped background info- we turned out to have passed out from rival public schools in the same year, got him talking about his marriage, plans, family and so on.
Turned out that my hunch about his mom throwing a monkey wrench into the marital machinery was right after all. By his accounts, she was an interfering bitch who didn’t know when to leave well alone. She’d driven his beloved wife to such exasperated fury that she had found living under the same roof with her mom-in-law unbearable…and hence had left. Was silently patting myself on the back by then- figured that at this rate, I’d have him popping open 2 beers and wanting to swap dirty jokes soon, when the question I’d hoped to avoid came up. Which hospital was I with? Since the name of the institution had “mental health” embedded in it and since nothing gets a psycho more suspicious than the awareness that he’s dealing with a shrink (they do have ample experience of interacting with the breed), hemmed and hawed but finally spilt it out. The guy grimaced bitterly and said he wasn’t surprised since “this is the 2nd time they’re doing this to me”.
I pointed out that considering the state he and the house were in, “they” had a pretty strong case for doing whatever he thought they were doing. He clammed up about what the 1st incident had been about. When I inquired what the knife was all about, he said its presence reassured him; his hobby was collecting knives (!!!!!) of different makes and models.
At this stage, I earnestly began persuading him that the best option for him would be to accompany me to the hospital and we’d run some routine tests as an eyewash. It’d serve everyone’s interests- his folks would be reassured that he wasn’t foaming at the mouth anymore, his wife would probably return to him in his time of trial, he’d get a clean chit and it’d end with him riding into the sunset on his ship with his wife the very next day. Felt like a worm while saying all this because of course, nothing of the kind would happen. Nobody’s discharged from a psychi ward in one day, much less to a happy ending. But that’s what I was there for- to lend credibility to the unsavory process of institutionalization. All this friendly prattle had taken more than an hour and I’d fended off several interruptions from the male nurse and attendants waiting outside the door. They were getting impatient because a 5 minute routine job was getting inordinately delayed.
Told my patient to think about my suggestion- what could he possibly lose in one day; told him I’d be back shortly after getting a glass of water, let in the waiting barbarian hordes and sought out his family to inquire about the 1st time he’d been hospitalized. Asked the father because the mother had already proven herself unreliable as an informant when she denied any such previous episodes. Allegedly, the boy had tried to kill himself when he was a teenager because his mom insisted on dragging him to a cousin’s wedding at an inopportune moment- the family pet had just died, the kid was grieving and in no mood to go with his harridan mom to some family function to be cooed over by hideous relatives. When she refused to leave him alone, he grabbed a fistful of whatever pills he found in the house and stuffed them down his gullet. He was hospitalized for poisoning and then given a psychiatric evaluation.
Cut back to the present: there were the expected sounds of a scuffle from the patient’s room. When I entered, he was threatening my staff with dire consequences if they tried medicating him against his will; a threat rather ludicrous under the circumstances. A 6 and a half foot gorilla was sitting on his chest at the moment. Gently reassured him (the patient, not the gorilla) that whatever was being done needed to be done and he should co-operate. Once the drugs were in his blood, he was released and I asked for his knife. He handed it over from under his pillow where it’d been all the time. The staff expertly frisked him other concealed weapons and assisted him to the ambulance. He was already staggering and once in the vehicle, fell asleep. The family- petrified father, fuming mother and concerned brother, all came out and I asked them to come to the hospital for admission formalities.
When the patient was sleeping in his room in the hospital, I took a detailed history from his brother who struck me as the only person halfway sane in that household. By his account, the patient had always been oversensitive, the mother was overbearing and the father was a spineless, henpecked alcoholic. Sure enough, it was the friction between the 2 families, especially the mothers of the bride and groom, starting during the ceremony itself -that led to the breakdown of the marriage. The specific skirmishes themselves were incidents of stupefying inconsequentiality, testifying to nothing so much as the pettiness of the people who used them to prop up their fragile egos and messing up the alliance of 2 happy individuals.
Well, the man stayed with us for 5 days and when I visited him during rounds, reminded me of my promise of releasing him in a day. It wasn’t in my hands to dictate the duration of his stay. That is the consultant’s prerogative. In any case, the accusation was delivered without any real malice. He was doped up to his eyeballs all the time and hopefully the betrayal from a stranger didn’t add much to his burden much. His wife wasn’t allowed to visit and I don’t know if she would’ve wanted to. His brother claimed that she loved him and was amenable to reconciliation right up to the incident that served as the last straw, which made her pack her bags and return to her folks. The mother wasn’t allowed to visit either.
The day he was being discharged, his father came up to me and asked me to talk to his son. “Doctor, tell him to face up to his problems like a man.” Lofty words, coming from you, old man. The same guy who was quaking and terrified the day he summoned us to help his son took leave on this note, “I’d prefer that he die rather than spend his life in a madhouse.”
This was my cue to launch into the spiel about how the stigma against mental illness was unjustified and had gone on for far too long ; how the urban educated elite ought to know better, and also let slip that most psychiatric disorders have some genetic component. I should have told him all this and more.
But I turned and walked back into the ward through the swinging doors.