The front door slammed open and crashed against the wall. All the staff heard the noise and came running to the reception area, where Mr Brown was being carried in through the front door. He was a big, strong, healthy looking man, perfectly capable of walking. But it is rather hard to walk when your feet and arms are handcuffed.
‘Don’t just stand there,’ the police officer in charge said, noticing me staring. ‘Lend us a hand.’
As he spoke, the man in handcuffs suddenly jerked his body to the right, sending the officer on that side crashing into the wall.
The only coherent words that could be heard from all the shouting were ‘fuck’ and ‘kill’ from Mr Brown. I leapt into the fray, grabbing hold of his wrists by the handcuffs.
As I pulled the patient along, I got my first close-up glimpse of him. His eyes were red and watering from the pepper spray the police had used to subdue him. Despite this, he was putting up quite a struggle, writhing, almost spasming in our grasp. As we carried him towards the seclusion room, he threw all his weight again, this time to the left, and managed to end up on the floor. The unexpected movement ripped the handcuffs from my hands and left me with a few less layers of skin. This was rapidly looking to be the most violent, acutely psychotic patient I had seen yet. It was an intimidating sight.
As we picked the patient up off the floor I heard a shout from one of the officers: ‘Fuck!’
As he had leant forward to pick up Mr Brown, he had left his arm exposed within reach of Mr Brown’s mouth, and he hadn’t wasted a chance to sink his teeth into flesh. The skin was broken, but at least there wasn’t a chunk of flesh missing.
We took Mr Brown into the seclusion room. This barren room with a solid wood door with several locks was our answer to those whose energies got out of control. The room was designed to prevent the patient causing themselves harm; it also helped to provide staff and other patients with a safe environment. The room was meagrely furnished, with a thick plastic mattress and a paper bucket to use as a toilet, along with a paper cup full of water. Any patient placed in this room was stripped of their clothing and dressed in a thickly woven gown that was impossible to tie into knots, meaning there was no way a patient could strangle him or herself with it.
‘He nearly killed one of us before,’ the officer in charge remarked.
The next trick was to remove the handcuffs and escape in one piece.
The leg handcuffs came off first, and Mr Brown remained still.
‘Watch him, boys,’ the officer in charge warned. ‘He’s just waiting for his hands to be free.’
He was brought down to the ground, face first. In this position he wouldn’t be able to use his arms to hit us as the handcuffs were removed.
There was nothing more we could do until the psychiatrist arrived, which we had been told would be in about 15 minutes. It was time to leave. I instructed the officers holding the legs to go first, then next the officers holding the hands, followed very quickly by me. The secret to a safe exit is simple: move as fast as you bloody well can, slam the door and lock the bolts.
As the bolts were thrown home, Mr Brown charged for the door pounding on it with fists and feet for several minutes, before giving up and sitting back down on the mattress, staring at the door.
‘I think he needs a male to look after him,’ said the charge nurse, kindly volunteering my services.
The police left and I was given the job of sitting outside the seclusion room door and peering in through the tiny reinforced window every five minutes. An urgent call had gone out for the psychiatrist to come as soon as possible. Mr Brown needed some serious sedation; his mind and body needed to rest.
As we waited, Mr Brown came to stand by the door, inches from where I sat, and tried to plead with me to let him go.
‘I’ll be good now. You can trust me. I’ll do as you say. You can even open the door and I’ll just sit here. Just open the door, that’s all.’
I ignored him. It wasn’t long before he changed tactics.
‘Let me out, or I’ll fucking kill you. You’ll be the first. I’ll make it hurt. Let me out now and you’ll live. Do you want to die? You’re gonna die, with my hands around your throat.’
He began to kick the door, the old wood taking a hell of a battering. I checked all three locks, to make sure they were all bolted securely. I endured several minutes of some very graphic abuse, before he tried the pleading tactic again. In total I suffered 20 minutes of this barrage of begging and threatening, before the psychiatrist arrived.
Dr King took one look in through the window and ordered a very strong dose of tranquilliser.
‘He does appear to be in a very bad way, wouldn’t you say?’ he asked casually.
I wasn’t sure if he expected an answer or not.
‘You sort out Mr Brown and I’ll draw up the injection,’ Dr King ordered.
He didn’t appear to be the least bit worried by the situation. Of course, at the age of 59, he would have no hand in the upcoming restraint.
The problem now was how to get in there and administer the injection. Since the police had left, I had to ask the staff to assist me and I was sure that help would not be forthcoming. For a start, I was the only male on that shift and, second, the average age of the women was at least 40.
‘Um, I’ve got a bad back; hurt it during my last restraint,’ said Jane, the only nurse my age.
The other women didn’t even bother with an excuse; they said flat out that they did not have a death wish. I had no option but to call in the police.
Before long, the same four officers who had brought Mr Brown in were beside me, peering at the patient who had by now realised we were coming. If there had ever been any notion that Mr Brown was going to make things easy for us, and that he might have calmed down a bit, his shadow boxing performance soon put an end to it. It seemed as if madness had lent strength to Mr Brown.
I motioned for the officers to lead the way.
The officer in charge, Sergeant Perkins, looked at me and said, ‘He’s your bloody patient; you go first.’
It had been worth a try.
There is a strategy we use when taking down a violent patient, it involves each person being designated a specific body part, that is, right arm, left arm, right leg, left leg or head. If you are responsible for a body part then that is all you aim for. This strategy requires feeling confident that your partners do their job and concentrate on their body parts. If I was to grab Mr Brown’s right arm but my partner was to fail to take the left arm I would end up with a very swift hook to the side of the head. It’s all about trust.
It’s also about speed; we needed to try to overwhelm Mr Brown with speed and organisation. The door was opened quickly (which was actually rather hard since it had three locks) and I led the charge, my head down and my eyes glued to Mr Brown’s right arm. I caught a couple of glancing blows to the shoulder and head, but luckily nothing connected properly and soon we had his arms and legs pinned. The last officer came in and supported the patient’s head and we slowly lowered him to the ground. We had done a good job; we had our man immobilised and no one was hurt – not even the patient.
As we lay there, the doctor calmly waltzed in and complimented us on such a nice takedown. He jabbed a very big injection into Mr Brown’s buttocks, then calmly removed himself from the room. It was now time for us to make our exit.
At least this time I wasn’t the last out. The two lads restraining the legs exited first, and then Sergeant Perkins and I left, as we had the arms, followed very closely by the last officer who had held the head. The door slammed shut and the bolts were thrown across. Mr Brown didn’t bother to get up; he just lay there staring at the wall.
It’s pretty hard to forget some of the more colourful characters and even harder to forget some of the more violent ones. It is an unfortunate fact that violence is not uncommon in a psychiatric ward, whether it is to oneself or to others. Some days it seemed as if the unit was a big cauldron, brimming with pent-up anger and excitement. Such strong emotions, such raw energy, are not easily diffused in a closed environment; they have nowhere to go.
As I resumed my vigil outside Mr Brown’s room, I thought about how having another male or two in this place would help. Thankfully the unit eventually hired a full-time muscle man, a giant of a guy that even a crazed patient would think twice about crossing. Some nurses felt this was not needed and sexist; I just thought it common sense.
Jeneil had walked at least half a dozen lengths of the ward, and it was time to put a stop to it. The problem was I’d never had a confrontation with her. Thus far, our working relationship had been polite, brief, and very superficial. The nurses never allocated Jeneil to me as I was still relatively inexperienced. I lacked the knowledge necessary to deal with the complexity of an anorexic patient, but today was different. Due to a shortage of staff, my name had been put on the board next to Jeneil’s.
‘How’re things?’ I asked her as I trotted alongside. She was walking at a cracking pace, and I was nearly jogging to keep up.
‘Fine, and you?’ she replied.
‘Good, good, although today’s a bit different. I’m your designated nurse for today.’
Jeneil gave me a big smile.
‘Then it’ll be an easy day for you. You don’t have to do anything for me. I can take care of myself.’
Her words stressed how out of contact with reality she was. She was a walking skeleton. Jeneil looked so frail and thin, a stiff breeze might knock her over, and the fall would break every brittle bone in her body. She had fur on her limbs and face – fine, soft white hair that covered her like a soft, silvery white coat, which grows because the body needs to provide some insulation since the patient no longer has fat stores to help keep them warm. Marching like this was one of the tactics she used to lose weight when confined to the ward.
‘Well . . .’ I paused, trying to find a safe way to say what I needed to, without sounding confrontational, but it just wasn’t possible. ‘I’m sorry, but you’re going to have to stop walking.’
She began to walk faster.
‘Who are you to tell me what to do? Just stay out of my way.’
I had seen what my colleagues had done in the past if she wouldn’t cooperate, but I didn’t want to have to confine her to her room.
‘You know the rules, Jeneil, and besides, you agreed you’d go along with them,’ I reminded her.
Jeneil reached the end of the ward and did an about turn. I again found myself playing catch-up. We walked in silence for another length of the ward. She suddenly stopped and turned towards me, her mask of polite civility was gone, her eyes were smouldering.
’You don’t know me. You’re new here, and you think you know how to help me. Is that what you’re trying to do, help me?’ Her voice began to climb an octave or two. ‘You don’t know a thing, and besides, we all know you’re struggling anyway. This place isn’t for you. Get out before you hurt someone.’
I had been told that anorexia sufferers could be very manipulative, but I was not prepared for how cutting Jeneil’s comment was.
This was a huge change from the chats we’d had before – conversations about the weather, news, events – although at the time, even these had felt strange; it was odd to happily chat away, all the while ignoring the matter of her weight.
‘Well, if that’s the way you feel, I’ll get someone to take over your care for today.’
Jeneil didn’t respond, but went to the lounge and sat down in front of the television. I retreated to the nurses’ station.
‘She’s got a sharp tongue, hasn’t she?’ remarked Mary, one of the senior nurses on that day. Mary had spent 20 years working in psychiatry, and she’d dealt with many people like Jeneil.
‘It caught me off guard, that’s for sure,’ I replied.
‘Don’t argue with her, just stay calm, and be firm. If you have any doubts, she’ll sense them, and tear you apart.’
She was right, of course, but what disturbed me the most was how rational, nice and intelligent Jeneil was when she wasn’t confronted. It was so sad. I still didn’t understand how someone so sweet could be so messed up. I went home hoping that I would not have to look after Jeneil the next day.
The following morning I found Jeneil confined to her room; in fact, not only confined, but on bed rest. Mary, who was sitting by her side, stood up, and motioned for me to follow her outside the room.
‘She’s dropped below her minimum weight, so she’s confined to her bed,’ Mary explained.
Jeneil’s target weight was 45 kilograms, and she was now 44. Jeneil could manipulate her weight as easily as she could people. She could gain or lose a kilogram or two just by altering the amount of fluid she took in one day. At one point, her room had to be searched as she would hide a bottle of water under her bed or in her wardrobe, and quickly drink a litre of it before being weighed. A solution we came up with was to do random, unannounced weighs. She also used to try to hide things like a mobile phone or some other object in her underwear or clothing to affect the reading. Now she was only weighed in her underwear.
Another tactic was employed at dinnertime, when she would cut up the vegetables and meat, and move them around the plate to make it look like she had eaten something.
I was not given any patients that day. My job was to sit by Jeneil’s bed and make sure she didn’t get out and walk. I didn’t speak to her and she didn’t speak to me. Ignoring a patient was the opposite of what nurses do; it felt unnatural, but then again, there was nothing natural about this whole situation, and not speaking, in this case, was safer.
Just when it appeared things couldn’t get any worse, they did. Jeneil began writhing around the bed. When she wasn’t writhing, she was lifting her legs, or raising her head and chest, off the bed. She was exercising. With a sense of utter helplessness I rang the call bell. Mary entered the room and tried to reason with Jeneil.
Unfortunately, there was no reasoning with Jeneil. Her weight dropped to 40 kilograms and she was transferred to the intensive care unit.
The psychiatric department had a meeting about Jeneil’s transfer to the intensive care unit. All the nurses and all the doctors were there. We were not a specialist anorexia unit, and some suggested maybe Jeneil should have been in one, but she had already been in the best anorexia hospital in the country, multiple times, with no success.
Now 26, Jeneil had battled with anorexia from the age of 16, although it wasn’t until she left high school that her weight loss had become so noticeable that her family sought medical intervention. She had no apparent reason for her condition. She came from a normal family, with a brother and sister who were healthy, and seemed happy. It just didn’t make sense.
Jeneil died in the intensive care unit. Her heart gave out. Even if she had somehow been able to change, and had started eating and leading a healthy life, she would have had to live with permanent damage: her organs had suffered; her growth was stunted; her bones were brittle; and she would never have been able to have children.
Jeneil’s death was tragic, but I’m not sure if it was avoidable. I’ll never forget the head psychiatrist’s words when news of Jeneil’s death reached us: ‘When they get to the stage Jeneil was at, it’s almost always fatal.’