“Yes, sir.”
“Then you know that it is likely Miss Sumner punched you because the two of you disagreed on the planned treatment. That bothered you, and when the patient struck you, she was acting on an impulse that you, yourself, felt.”
“I’m sorry?”
“She punched you because, unconsciously, you felt the urge to punch her.”
The urge to roll her eyes almost won, but she kept that in check.
This morning, Alice was quiet and on guard, squeezed into a ball at the end of her bed with her back against the wall. Occasionally, her right hand rose, and she pointed at something unseen on the ceiling. Marion followed her finger. Nothing was there but a light fixture.
“Good morning, Alice,” Marion said gently. “How are you feeling today?”
The patient shook her head violently, then she pressed a finger to her lips. “Shh! He’s listening.”
“Who is listening?”
“I don’t know. I don’t know, I don’t know, I don’t know,” she whispered, eyes bulging. She stretched her legs out in front, and her ankles rotated so that her feet drew circles in the air. “Can you hear that?”
All this quick chatter and movement told Marion that Alice was more worked up than usual. A quick check of her medications, then Marion made a notation on her chart, raising Alice’s daily dosage of chlorpromazine to 500 mg. Recent studies had proved that effectiveness of the antipsychotic improved noticeably once that threshold was reached.
Marion kept her expression open. “Can you tell me what I am listening for?”
Alice dropped her chin and flung her arms out to either side. “It’s veryloud in here,” she murmured. “I have tickets for the opera in my purse, you know.”
Some appointments went more smoothly than others, and Marion clung to the good ones. In particular, she liked to remember a young woman named Deborah. Deborah had lived at the hospital for four years, suffering from acute anxiety and never speaking a word. By the time Marion had graduated, Deborah was attending daily art therapy classes at the hospital. As she expressed herself through art, she began to verbalize words, one at a time. The last time Marion had seen Deborah, she was smiling and pointing out two of her paintings displayed on the wall of the Administrative Building. Deborah’s was the kind of success story for which they all strove.
This morning, after Marion finished seeing her last patient in the new building, she sat in on a short meeting with some of the other doctors on their rounds and two of the senior nurses, comparing notes. Then it was time to visit the last fourteen of her assigned patients. Those were all men, and they lived in the original building.
To Marion, stepping into the old asylum was like entering a different world. It was one of the saddest places on earth; she could feel it in the walls. Layers of misery and neglect had seeped in then hardened into the brick and mortar. Some of the treatments and abuse that had happened in the original hospital—even as recently as five years ago—were shameful and often inhumane. Even today, the building was over capacity by two hundred inmates. That meant less personal care, more overworked nurses and staff. A recipe for disaster.
When it came to deinstitutionalization, the building made a good case against itself. Demolition and delegating psychiatric services to community centres certainly seemed like common sense.
But how could it be rational or practical if a good percentage of these patients could barely feed themselves, let alone live independently? The most severe cases would have extended in-hospital treatment, but what about those on the cusp?
Marion visited with three patients in the old building, all of whomseemed content, then she squinted through the window of Ward 6B, where the “incurables” lived. Most were gathered in their common room for now, and she spotted her patient, Big John, in one corner, playing checkers with another man named Ian.
Marion took a final breath of fresh air then stepped through the door and was instantly assaulted by the reek of the place. The nurses and staff tried to stay on top of the problem, but it was a Sisyphean task. Most of the men in 6B were incontinent, and they didn’t use utensils when they ate. This area was as close to medieval times as Marion ever wanted to get.
“Good afternoon, Dr. Hart,” a stout, bald man called loudly, giving her a toothless grin. “I know it’s afternoon because we had lunch.”
“Hello, Burt. Good for you for remembering.” He had given her the same sort of update almost every day for six months now. It had been sweet at first. “How are you feeling today?”
“Today’s a happy day,” he reported.
“I am delighted to hear that,” she replied, still walking toward the checker match. “Can you think of another word to describe how you feel?”
She saw in his expression that he’d anticipated the challenge. “Cheerful.”
“Excellent, Burt.” She shared her smile with the room, purposefully meeting each man’s vacant expression, always hoping for some kind of recognition or acknowledgement that she was there. Not for her own gratification, but as a sign of a patient’s improvement. “Hello, Francis. Hello, George.”
“Hello, Dr. Hart. Dr. Hart. Dr. Hart.”
“Hello, Mr. Thicke,” she said to the stooped man by the window. Mr. Thicke had been brought here by his family ten years before, when they could no longer deal with his senility. He had a sweet, uncomplicated face, and the messy white wisps of his hair looked as confused as he was. On some days, the old gentleman turned with a vague smile to greet her. Today, he did not recognize his own name.
“Good morning, Bruce,” she said, watching a redheaded fellow with akathisia pace up and down the edge of the room, twitching and talking to himself. She knew he wouldn’t respond, but she said it just in case.
“Good morning, John,” she said, reaching her patient. “Are you having a good day?”
