CHAPTER SIX
PSYCHIATRY SERVICES IN THE NEW 1 MILITARY HOSPITAL
The working conditions differed between the two parts of the hospital; at the old hospital, everything was restful, and everyone came together for tea and lunch breaks. At the new hospital, everyone seemed to be busier, and tea and lunch breaks passed unnoticed, and one gulped down the occasional cup of coffee while dashing somewhere or other. At the new hospital we all carried 'bleeps' ('pagers') which were continually 'bleeping', causing us to dive for the nearest phone.
The Psychiatry Department operated two wards in the New Hospital. Ward 5 was a women's ward, which we shared with the department of internal medicine. Ward 9 was the male psychiatric ward, and had about twenty beds.
WARD NINE - ADULT MALES
Wards 9 and 24 served essentially the same purpose, except that Officers and NCOs were much more likely to be admitted to Ward 9. The two wards could hardly have been more different; Ward 24 was one big dormitory with about forty beds, and opened out onto a lawn and garden. Ward 9 was on the eighth floor of the new hospital, and was divided into little wards of three beds each, which gave patients much more privacy than that enjoyed by patients on Ward 24.
Most people that arrived at the hospital's casualty department, who 'smacked of psychiatric problems' would be referred to Ward 9, whereas Ward 24 was used mostly for patients referred less urgently by Doctors from Unit sickbays.
I didn't have any formal connection with Ward 9 until after I returned from the Border, when I 'covered' for Rene's leave. I would often visit Ward 9, to discuss patients with the staff there, or to see patients who were under the jurisdiction of the Consultation Team.
Conversation at a brief gathering of psychiatry staff at the new hospital discussed how unfortunate Ward 9's patients are being cooped up on the eighth floor, and not having a garden to frolic in. Someone told a story of a Ward 24 patient catching a lizard in the garden, and wanting to keep it as a pet - said he wanted to 'raise it'. Its accommodation was to be a soup plate, with a magazine as a roof.
"I must say," says Dr. Dave S. through his RAF moustache, "that keeping a pet lizard in a psychiatric ward shows a certain amount of initiative."
Dave was very good to me, and he would 'debrief' me, or allow me to express my frustrations, which developed from Wimpie's lack of decisiveness. I appreciated that!
There are different cliques in the department of psychiatry; and a lot of outsiders. These meet during lunch and tea times, and often on Friday afternoons when generally we aren't particularly busy, but we're not allowed to go home, although we may have worked late on each of the other four days. Most of our patients have already gone on weekend passes, and the rest are too sick to do anything for, or are sulking because we have not allowed them to go on a weekend pass. I'm part of the 'progressive fantasy' clique. Another member is Dave S., from Cape Town and hence very English. He is a red wine connoisseur, and completed a wine tasting course. He also studied a year of psychology 1 through UNISA in his spare time.
Another is Rene V., another Psychologist, whom I didn't like much in 1986 because she seemed to go along with whoever seemed to be winning the argument at the time, but now that I've been working closer to her, I have gained much more respect and friendship for her. Other members come and go, but I would describe the three of us as the core at the moment.
We do a lot of gossiping, and a lot of this is about Wimpie, my immediate superior - the psychiatrist. Our work, by its very nature, is emotionally demanding, and consequently we form very strong bonds amongst the staff (Those who do the work - anyway!), even though we may know very little about each others' personal lives.
The particular progressive fantasy occurred in the ward kitchen, a tiny cramped little room, where we were making toast. I mentioned to the others that we seemed to experience spates of different psychiatric disorders, in that the last three patients that I had evaluated, I had diagnosed as having 'Adjustment Disorder with Depressed Mood' based on 'Strong Traits of a Schizoid Personality type.' (Talk about Jargon!)
Following this, I suggested that I might decide to have a 'disorder of the week', and I would decide what diagnosis I would use for all the patients I would see the next week. This became the basis for a progressive fantasy. It was suggested that the staff should conspire with this, to confuse the consultant Psychiatrist. They always come in for a fair amount of leg pulling - behind their backs.
We thought about presenting a patient to a psychiatric panel, with one diagnosis with a initial intake interview, a mental state examination, psychological tests, and social work background report all to support that diagnosis, and then presenting exactly the same patient with a completely different set of data a few days later, and watch the psychiatrists have nervous breakdowns.
Then we thought, why limit the disorders to the patients. What about us? So we decided that we would select a particular psychiatric disorder which all the staff would present with - of course we wouldn't let the psychiatrists know what was going on. "What diagnosis shall we kick off with?"
"Paranoia!" Rene suggests.
So we talked about this for a while. One of our schizophrenic patients does not believe the smoke detectors are smoke detectors. He blew smoke in to one to test it, and nothing happened, so he decided that he had been right all along, and that they really were all microphones.
"He's got a point," Dave agreed. "If they don't react to smoke, what DO THEY DO???" After that we went to search the ward for bombs. There were no patients there to watch us.
Commandant Anton P. was the Consultant Psychiatrist on Ward 9. In some ways he seemed to have a 'death wish' for a psychiatric foothold in the prestigious New Hospital;
"With the choice of the use of Ward 9 in the big new 1 Mil hospital, and ward 24 at the old recovery wing, what prompts him to keep the noisy, disruptive patients in the new hospital, where they can and do cause trouble?"
Consultants and senior people from other wards, who complain about Ward 9 objectively, are accused of being unstable people if they feel 'threatened' by such patient's obnoxious behaviour. This was construed as being 'personal pathology' on the part of the complainant.
In the opinion of most of the lower level members of the department, many of the patients are putting on an act, "Playing the Game", and seeing how much they can get away with. I certainly thought that many complaints from other Wards were entirely justified.
Having licence from the Commandant to display destructive and obnoxious behaviour, some patients seemed to make their behaviour even worse, in the anticipation that they would get away with it.
It would have been much more diplomatic to send noisy and disruptive patients over to Ward 24, where they would be much less noticed!
One patient, distressed at being returned to his unit, smashed a glass door on the way out. The shattered glass, and a bloodstain remained unrepaired for some time, illustrating the objection that other wards had against unruly 'psychiatric' patients being kept so close to their quiet, clean wards.
The Commandant also undermined the discipline in Ward 9 on occasions, by granting weekend passes to patients who have lost that privilege by not co-operating with the ward programme.
Departmental and Ward staff often felt a little resentful when they had to cover for the absence of people from the department who were presenting aspects of courses organised by our department, but which we were never invited to attend.
Commandant P. ran a psychodynamic group for drug addicts, and the patients for this group would be kept on Ward 9, a situation not liked by most of the staff. Drug addicts are not generally popular to work with, and especially in the military situation, their motivation to be helped is often suspect. After the hour-long group meetings, the air in the room in which the group took place was filled with cigarette smoke. The Commandant's aim was to get them off illegal drugs, most commonly Cannabis, and he didn't even try to get them to reduce their tobacco smoking. (Also see Chapter 10)
We had an anticipated police raid on the ward, to look for drugs. There was a sniffer dog, who failed to find anything, though in the (openable) ceilings above the wards, some hypodermic syringes were found, which were not the type used in the hospital. They were sent off for analysis, and I never heard the outcome.
Ward 9 staff brought their own cups and mugs in to work, as such were not provided for our use. The kitchen was supposed to have been out of bounds for patients, but we often had to go searching through the wards to get out cups. The patients muttered when we moaned at them for taking our personal property. Our concern with material possessions was seen to be 'very uncool', and they thought that mental health workers, which we all were should be amenable to sharing what was ours with them.
Did this image carry through when you had to search for your cup, and find it with the dregs of a coffee with a cigarette end floating around in it?
Ward 9 had a secretary call 'Tannie' ('Auntie') E.. She had been on Ward 9 for a number of years, and decided she wanted a change. She organised this, and we got a replacement, Hester, who was really great. Tannie Hester was a large middle aged and very maternal Afrikaans woman, who plied all the staff with piles of toast every time we ventured near the ward kitchenette, and brings all sorts of goodies and cookies to work with her to feed us (staff and patients). She was a pleasant homely soul, whom I think helped to create a therapeutic ward spirit.
After a while, Tannie E. got bored with the job that she had gone to, and pulled strings to come back. She must have had considerable influence, for Hester, her lovely replacement, disappeared, and she returned.
Tannie E. would often be visited by her husband, whom I think was a retired NCO. The husband would engage staff members in conversation, about the patients; "the youngsters not being able to take it." He wasn't welcome, but no one took it upon themselves to tell him this.
On some occasions her son arrived; he had done national service as an armourer in the Air Force. He showed a similar lack of understanding/interest, reporting how his buddies had 'fought over opportunities for Border duties to go to Ondangwa.' I don't think that this counted, as the Air Force always looked after their people better than the army or the SAMS, and Ondangwa had never been attacked. Not with all the helicopter gun-ships that were based there!
Hester developed problems in her life; her daughter went 'off the rails' and shacked up with a suspected lesbian. Hester had them both admitted to ward 5 and placed on 'sleep therapy'; ? and etomine drip? I don't know how she organised it.
VOLLEYBALL FOR THE WARD 9 PATIENTS
Commandant P. decided that we should arrange an outing for the psychiatric patients of Ward 9, and the date that he chose fell on my 26th birthday. The idea at first was that patients who deserved to go on an outing would be taken somewhere away from the hospital for a picnic. When it was decided which patients had co-operated enough with the ward programme to be rewarded with an outing, it was found that only three of the fifteen qualified. The Commandant then felt that this was too small a number to arrange an outing for, so he decided that all the Ward 9 patients should be included; therapy patients, observation patients, patients that had been administratively forgotten about - all fifteen patients that were on the ward at the time.
Then came the question of which staff should be allotted to taking these patients on the outing. Most thought that one or two of the nursing staff should go along to chaperone the patients - none of those fifteen were actually psychiatrically 'sick'. But the Commandant thought that 'We should all go!'
Never before have I seen a bunch of medical professional people looking more dejected. "But we don't want to spend any more time with our patients than we do now," was the most common sentiment. Training in psychology and psychiatry emphasises the importance of keeping a professional distance from one's patients. But the Commandant wanted us to go and socialise with them, and worse - play volleyball against them. Surely he knew we would loose?
The 'powers that be' (Hospital authorities) said that we could have our picnic, but we would have to stay in the hospital grounds. We ended up having a 'braai' (barbecue) on the sports fields at the old hospital, and the Commandant, as always, insisted that we (the staff) play volleyball against the patients. We are mostly academics in our mid twenties, and the patients (very few of whom actually have anything wrong with them) are athletic nineteen year olds. We got wiped out.
Hester, the lovely ward secretary, was really in her element, buttering bread, and helping not only all the staff, but all the patients to gorge themselves.
Edith D. was the Ward Sister whom I became closest to on Ward 9. She was a lovely person, and we had great fun teasing each other.
Dr. Leslie G. also worked on Ward 9, but I had most to do with him when I returned from the Border, so he features in Chapter 14.
In spite of the story above in 'National Paranoia Week', a belief that one of the patients decided to test the fire alarms, and this resulted in the sprinklers going off, causing damage to documents etc. I believe efforts were made to make him pay for the damage, which amounted to thousands of rand.
WARD FIVE - FEMALE PSYCHIATRIC PATIENTS
Ward 5 was located directly below Ward 9, and was shared between the disciplines of Psychiatry and Internal Medicine. The Consultant Psychiatrist for Ward 5 was Commandant Wimpie, who was also the Consultant Psychiatrist for the Psychiatric Consultation Service, on which I was the psychologist. For this reason, I tended to gravitate around Ward 5, seeing it as my base.
Captain Naas R. was the psychologist who worked on Ward 5. He was a couple of years older than me, but I don't know how many, nor do I know very much about his life outside work. I must have spent many snatched tea-breaks with him, and we certainly got on very well, but I can't think of many anecdotes to tell about him. We used to compare notes about the attractiveness of the various nursing students who rotated through Ward 5.Ward 5 had a ward secretary who called herself 'Tossie'. She was small, middle aged and neurotic. She would keep up a constant barrage about the work that she was required to do, mostly typing. She would try and play the different medical staff off against each other, and tell us that the reports which we wrote, which she had to type onto the central computer were too long. (There is certain information that needs to be included.) I suppose that she did have some grounds to complain, as doctors working in Psychiatry must generally write a great deal more than doctors in most other disciplines, in view of the detailed history that must be taken of each patient.
There was a formidable Matron on Ward 5, with whom we had some fun, but she tended to be very serious.
Not quite as serious as someone who replaced her when she went on maternity leave; I introduced myself to the replacement, being friendly. She was a fellow Captain - 'What is your first name?' I asked, trying to be friendly.
'Kaptein', she told me. Well, at least I tried!
THE GOLDFISH THAT GUARDED WARD FIVE
There was a goldfish in a little goldfish bowl at the nurses station of Ward 5. What must life be like for a fish on a psychiatric ward? It has delusions of grandeur, and it plays games with the patients; it swims around the bowl close to show everyone what a small and inoffensive little goldfish it actually is - 'why don't you come swimming with me?' - and then it goes sulking off to the back of its bowl, and then you just see a large (grossly magnified) dorsal fin, as the goldfish plays 'shark shark' and imagines devouring the patients/staff it has enticed into its bowl. (Have I been working in Psychiatry too long?)
Another thought about the goldfish; what would be the effect of patients dropped their medication into the water in which the fish lives. Imagine a psychotic goldfish. The mind boggles!
At twenty-five years old, and registered as two different kinds of psychologist, I do not see myself as cute! One flamboyant patient told another patient - who told me - that she thought that I was so cute that she was going to bring a little box to take me home in. (I presume my interpretation was right, but with psychiatric patients one cannot just make assumptions like that!)
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