Visiting time on the medical and surgical wards is always chaotic.
There are never enough plastic chairs. Families crowd around beds, despite the rules. Relatives (understandably) hunt down doctors for information. There is no point trying to do anything for a patient during visiting hours, because you would often have to wade through a vast sea of people in order to do it.
Visiting time on a mental health ward sometimes passes unnoticed. There are, of course, patients with incredibly supportive friends and families – support that plays a huge part in helping recovery – but for many people, visitors are few, and often completely absent. Occasionally, someone wants to keep their admission a secret, because the stigma attached to a psychiatric admission, sadly, has many and long-lasting repercussions. Usually, though, this happens because the patient has spent a lifetime alone. Families have broken apart, friends have drifted away. Here, often, are people who live on the periphery, people who are never included and rarely acknowledged. In every town, in every village, even on your own street, there will be someone who is isolated and ignored. Chances are, they are also suffering from a mental illness.
It’s difficult to imagine how that exclusion might feel, but if you work in psychiatry, you will occasionally see a glimpse of it.
A few years after my first experience of psychiatry, I was working on a different ward for a different NHS trust. I had only been there a couple of days and, in the confusion of a new routine, I left my swipe card and lanyard at home. Because the unit I was working in was locked, it meant, for that day, I had to rely on other staff members to let me on and off the ward. It was a nuisance. So much of a nuisance, I knew I wouldn’t forget my swipe card again.
I had just left the ward to collect some patient notes from one of the secretaries when I found myself a short distance behind a social worker in one of the long corridors. I knew her from a different job, many months ago. We’d only met once, but she had very distinctive red hair, and I recognised her straight away. She also happened to look after one of my favourite patients. We were the only people in the corridor.
‘Hello!’ I said. ‘How is Leo doing?’
She was only a couple of steps in front and she turned. There was no reply, she just glanced at me, up and down, and then she turned back and carried on walking.
I was puzzled. She definitely heard me. She even looked at me. ‘You take care of Leo, don’t you? I just wondered if he was okay?’
She kept walking, quickened her step. I quickened my step too.
We turned into another empty corridor.
‘Excuse me,’ I said a little louder. ‘How is Leo?’
Still I was ignored. If anything, she walked faster, an occasional trot in between the steps.
It was baffling. I came to a halt. Gave up.
‘It’s Doctor Cannon!’ I shouted, in a last-ditch attempt.
Finally, she stopped. She turned around and walked towards me.
‘I am so sorry.’ She gestured to her neck, where my lanyard would normally sit. ‘I thought you were a patient.’
The many quiet acts of cruelty directed at mental health patients must accumulate. Before I started working in psychiatry, I had spent a brief few months on the wards feeling as though I didn’t belong, and I had the smallest taste of what it means to not fit in. I still had a home and a family, I still belonged somewhere, but even then I wasn’t able to cope. To spend your entire life feeling that way, with no shelter, no respite, is unimaginable.
A few months after I had chased a red-headed social worker down a corridor, I was standing at the nurses’ station on the ward, talking to some of the other staff. There were quite a few of us – nurses, a pharmacist, support workers. I liked being at the nurses’ station, rather than shut away in an office, because it’s impossible to learn anything if you don’t spend time on the shop floor.
It was almost break time and we were talking about nonsense – food and holidays and television programmes. One of the patients came over and joined us. Rob had been on the ward many weeks. When he first arrived, he was agitated and paranoid. He was convinced that the ward was filled with cameras and he was being watched. He thought we were all working for the government and a chip had been placed in his ear to monitor all his activities. Each day he would beg me to remove the chip and set him free. With a change in medication and the right support, Rob had slowly improved. There is no greater privilege than to witness the symptoms of an illness fade and to get to know the person who waited beneath them. Rob was a wonderful man. He lived on a canal boat with his dog, and he loved art and poetry. He knew more about nature and the countryside than anyone you will ever meet. He reminded me a little of my dad.
Rob and the nurses and I were laughing about something we’d all watched on TV the previous evening when the ward clerk came out of the office. She was new, very pleasant and deeply efficient. It was break time and she had decided to make us all a drink, but – being new – she needed to count the teas and the coffees, the milks and the sugars. She systematically went down the line of people standing at the nurses’ station, asking us all what we would like. When she reached Rob she just skipped over him and asked the next person. As if Rob wasn’t there. As if he was completely invisible. I caught the eye of one of the healthcare assistants and we both stared at each other.
It wasn’t the ward clerk’s fault. She was new. She wasn’t supposed to make tea for the patients. But still.
In the end, I made Rob a cup of tea myself. It felt like the only thing I could do to make the situation a tiny bit less painful. When I handed it to him, he smiled at me.
‘Don’t worry, Dr Jo,’ he said. ‘It happens all the time.’