Saturday, 31 March 2007

Red lorry, yellow lorry

I cut my first psychiatric tooth at St Mary's Hospital, in 1994 (eek). I was fresh from college and full of naive, brittle theories on the nature of man. I was convinced that madness and suffering could be tamed, through the use of empirical knowledge and liberal application of PRN.

In my first ward round, on my first clinical placement, I sat watching a patient being interviewed by the 'Multi-Disciplinary Team' (MDT). It consisted of the Ward Manager, Social Worker, Clinical Psychologist, Staff Nurse, House Officer and the esteemed Psychiatrist. And lil ol' me, of course.

The patient, a small, bearded man, had been led into the inquisition by a nursing assistant. His terror, at being under such scrutiny was plain to see. He shook and lurched his way to the far end of the room, where the last remaining seat had been reserved for him. As he sat, I realised that us 'professionals' had all chosen the high chairs. His, was more of a lounger. So, once down, he was lower than the rest of us. How apt.

In what was rather like a lawyers cross examination, the psychiatrist poked and prodded the mans psyche. With a flourish to the jury, he exposed this man for what he was; utterly, and absolutely crazy.

He was quite mad indeed. He heard voices and believed he was an SAS commander, on a mission to infiltrate the communists running the hospital. He received his orders through codes sent via breakfast TV. He could also command animals to do his bidding.

I'd never seen anything quite like it before.

"Thank you Mr Smith", Psy said, "This has been very useful, if you could have a seat in the day room, I'll be right with you".

And so Mr Smith left the court room.

I half expected the room to explode in raucous laughter, once the door had closed behind him. However, the MDT just sat for a while in quiet contemplation. The Psychiatrist broke the silence;

"Well, I'm afraid I'm going to need to recalibrate our oddometer."

The rest of the team nodded sagely, whilst I stared at him, somewhat bemused.

"So, where would you place him, on this new scale?" The Staff Nurse asked, with a serious look on her face.

Psy considered this for a bit, then announced, "Probably between Red Lorry and Bag of Fish."

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