I was in the room with this man who’d been admitted for taking children hostage. He’d been arrested for violent behaviour. He was psychotic, an early jihadists but that wasn’t his problem. His problem was he felt God was telling him to kill people, at least his voices were but who those voices were in his deranged mind was then associated with the “power symbol’ at the time. There were wars in the Middle East. There was the taliban on the news. This man was schizophrenic. He was totally psychotic. When he was overwhelmed by the noise and despair in his mind he acted out. Threatening to disembody his neighbours trying to take children hostage, saying it was Allah, all was just insane. I don’t even think he’d ever been in a mosque. He certainly was’t muslim. Not like other militant radical deceitful Muslims who are dangerous and indeed out to kill anyone and everyone that interefered with their plan of world domination. This was not such a man. He was a bit player on the side lines. A deeply disturbed individual who would have said aliens were taking over his mind and telling him to kill beings if that was the story in the news.
I was told I had to discharge him. He wasn’t my patient.
“You have to discharge him.” The shifty male nurse said. I’d oddly been warned by the nurses on my ward to ‘watch your back?, ‘What do you mean?” ‘Just watch your back.” “That’s the scuttlebutt. You’ve pissed people off, so just be careful.”
Then this weird demand that I go over to another ward and discharge a man who is not my patient. His doctor should be the one to discharge him. It was all highly suspicious and the behaviour of the nurse confirmed there was something very not right.
But I am fond of the ‘charge of the light brigade.’ I probably would have been a Calvary officer in the past. It was Friday and on Friday I’m tired and irritated and just want to get home. Friday is the day when shennanigans happen in government institutions. The staff are leaving. Everyone’s mind is on the weekend. No one is paying attention. That’s the time to call in the butler and get the body out of the building.
The patient was in a locked ward in the violent section. Not normally a sign that the patient was ready to be discharged. More suspicious behaviour. Finally the nurse unlocked the door. On this ward. Ididn’t have the keys.
‘Where’s the chart”.
“It’s in the room.’
“With the patient’
“Yes.’
I entered the room. The nurse locked the door. He disappeared. Now that is not at all normal. When a patient was in a locked room on dangerous wards, the nurse entered with the patient or waited outside. Standard protocol.
“You’re Dr. Hay’>, the patient said, no eye contact.
“Yes.
“They told me they’d bring me to you.”
He was a really big dishevelled unkempt fellow. He was leering at me.
“They told me you are the one that won’t let me leave the hospital.”
“No,” I said. I had seen the man and remembered he diagnosed as .Schizophrenic. That had just been at admission when he was transferred from a regular hospital where he’d violently attacked staff after he’d been arrested by the police for hurting the family and taking the children hostage at the bus stop. I was very very peripheral in his care. He’d been undere the care of the doctor in this ward and other doctors the many months he’d been in Riverview since I’d seen him.
“You’re going to let me go. God wants me to be free. I have work he wants me to do, I have to leave so I can do what I’ve been told to do.” He said, Standing. Looking down. Words tumbled from his mouth, sideways.
“God has told you thi? Does he speak to you?.” I”m always a clinician, curious. Here was a sick man. What could I do for him.
I looked at his chart. I thought it odd they’d stopped his meds the day before. There was the order too at the end
“Dr Hay wanted to assesss the patient before discharge.” You don’t stop meds the day before discharge. I’d never discussed this patient or his discharge with anyone.
I’d said no such thing. I turned and banged on the door for the nurse to let me out. I had that challenge to keep an eye on the patient and get out of there.
When a doctor is in a locked room with the patient the nurse waits outside the room and never leaves. Normally they come into the room with the doctor.
I remember registering all this and being ‘aware’. Playing it through. I wanted no ambivalence. No “deniability”.
“God speaks to me. He tells me I have to leave the hospital now. The other doctor said You were the only one stopping me leaving. They all told me that they wanted me to go. They said Dr. Hay was the only one who didn’t trust me and said that I had to stay. They told me you didn’t trust me. They said you were the only one stopping me from leaving.”
“That’s not true. I’m not even your doctor.”
His eyes were gleaming. That’s a sure sign. He was gloriously psychotic. Might as well have taken many hits of LSD but his insaneity came naturally. He didn’t need drugs. His mind was on hyperdrive and he was moving about the little space working himself up.
Despite all your training and experience the natural thing is to speak rationally with the irrational and hope it works. I also banged ont the window so loudly that the sound would echo through the whole of the ward. Still no one came. The man moving now. He was working himself up.
“If I kill you I can leave.” He said suddenly stopping his pacing.
“All the doctors and nurses said they wanted me to leave. Everyone wants me to leave except you Dr. Hay. Everyone likes me but you Dr. Hay. Everyone knows God speaks to me and I must do what God says.I can’t do that here. I must kill.” He was spitting the last words.
“Will you let me go Dr.Hay?” He suddenly asked, childlike
“I don’t have the keys. I’ll get the nurse to let us both out!”
I banged more on the door. We’d be there an hour. The nurse would come by a couple of times and look in. aI’d scream let us out. He’dsmile and walk away. Naturally I didn’t like turning my back on the patient. But I had to look out the little window at the smug nurse who was looking a little more concerned each time he looked in. I wasn’t afraid. I was furious. My mood was melting the door with my anger.
Meanwhile the patient was working himself up again, pacing int the tight space.
“God wants me to kill you.” He said.
“No God does not. “ I responded with authority. “Even if I was dead right here and now you couldn’t get out of the room because I don’t have the keys.That nurse has the keys. He locked us both in here. What did you do to the nurse that he won’t let us both out. If I can get out then I can get you out”
“I can kill you and then he’d let me out. He told me he didn’t like you.” The patient said.
“He’s lying. He wants you to get into trouble.”
“God says I should kill you Dr. Hay.” Id cause him to backtrack and revert to script.
There’d been long pauses while the fellows brain was computing slowly. Eachtime he’dspoken he’s had more conviction like he ‘d had a conversation off screen ,listened to another person and again speaks to me.”
“I’m going to kill you.”
“No you’re not. God does not want me dead. If you try to kill me I will kill you. I will kill you. I will kill you. But the nurse is your enemy. He’s got the keys and wont let us out. He wants me to kill you. That’s what’s going on here. “
It’s was very tense situation. This fellow was now swaying back and forth at me. He hadn’t touched me yet but he’d begun circling again. I was banging on the door behind me,hard and loud, rhymicallt like a war drum . I never stopped watching him. Just as he looked like he was about to spring, timing is everything, I plowed suddenly forward, my chest pushing him back. the bed. I screamed at him,
“God, I don’t want to kill him. Don’t make me to kill him. Please God don’t make me kill him.”
He curled up in a fetal position, confused, whimpering. I felt so badly I’d had to do that. The fucking nurse and this utter bullshit. The guys sick and vulnerable and crazy.
He’began keening.The nurse’s face appeared at the window. He couldn’t see me because I was in the blind spot. The patient was in the fetal position rocking and keening. The nurse unlocked the door.
I was out like a flash. I slammed the door behind me so the patient couldn’t follow. Then I literally lifted the nurse against the wall by the throat, choking him, pinning his body and legs..
“What the fuck was that all about you fucking piece of shit?! I’m going to kill youright now if you don’t talk. You fucking piece of shit!”
So there’s the nurse dangling from my very strong right hand strangling his hands trying to free my hand all the while turning blue in the face.
I didnt even pummel him. I let him down.He was sucking air and coughing,
“Talk!” I demanded.
“You’re costing everyone money. They said if you were hurt you’d be off and everything would continue . No body wanted you killed. They just wanted the patient to hurt you. Break your arm ,smash your nose ,that sort of thing. “
“You wanted to use the patient to hurt me . The patient told me he was supposed to kill me. And you say he was just supposed to break my arms and face. :
I punched him in the side of the head . It seemed reasonable to do. A kind of reflex thing I couldn’t stop.
“You wanted him to do that to me. Break my skull, break my arm. For money. You wanted the patient to be your fucking hitman”
“It wasn’t my idea. We all wanted it.”
I let him live. There are people who are alive because I have let them live. I always figure that one day they will realize that their life has persisted because I’ve let them live. It’s an honor thing . I know weasels and insectoid species don’t get it. I feel good when I do it. I feel I can take his life anytime I want afte that. He’s had his chance.
That day the Asian doctor went on holidays. I was covering his ward. I was called to the ward because the nurse thought it was odd that another doctor had come and started the patient on an experimental antidepressant. I went to the ward and stopped the medication and wrote that the patient wasn’t depressed but demented.
“What is your mood like.? ” I asked. This sweet little old lady looked at me like a bird.
I’m in heaven.” She said.
“You really are happy.
“Yes, I’m in heaven. Everything is so good here. You’re a lovely boy. You remind me of my sisters’ boy. Aren’t the flowers lovely.” She was not depressed. Demented, yes. Depressed, no. The chart said she ‘d been like this for a year or more.
She was definitely not depressed. My Asian colleague, a really good guy, solid pscyhiatrist had diagnosed her with dementia and everything about her care was normal until today when there was a one line entry, patient depressed, begin x medication.
I wrote that the patient had dementia and recommend ‘palliative care’.
In palliative care the main concern is the comfort and well being of the patient. No cure is available so all effort is made to make the patient comfortable. If treament is considered its for potentially beneficial then the reasons are recorded.
There’s a condition called ‘pseudodementia’ and it’s not unreasonable to begin a new drug as ‘trial of therapy’ for a person who has a condition so far unresponsive to treatment. But experimental treatments require a legal ‘release’ and ‘agreement’ specifically ‘consent’ . There was none of these. Worse the whole ward of demented patients was to begin this medication and I’d just seen the first patient. This was planned because the Asian doctor whose ward it was had already said he’d not have this done on his ward before he went on vacation .There was an end run being done on him and they’d hoped somehow for some reason to get me in their schemes. It would turn out the plan was to have me , an independent doctor, outside of this sordid internecine dispute I knew nothing about, say the patient was depressed. Then they’d say the Asiandoctor made a mistake and then they’d take the ward and put all the demented patient on this experimental anti depressant. The Asian doctor thanked me when he returned, filling me in on some of the politics and history.
I’d ruined the plan by diagnosing correctly dementia and making the thing a whole lot worse by saying the treatment of choice was ‘palliative care.”
This was the chronic care end state geriatric psychiatry ward with hundred year old patients. Palliative care wasn’t a new concept. It was standard in medicine and psychiatry was a division of medicine.
What I didn’t know was that there had been an agreement way above my pay grade that if a drug wanting licensing in Canada was used safely on 500 Canadians then it could get licensing. The sooner the license the greater the profits. Really not a bad idea for checking on the safety of a medication even if it’s been through all the trials in the US or Europe. What was the problem was the vast incentives that the drug company was giving certain doctors including equipment and multiple trips to Hawaii. The perks extended to the nurses. I’d unwittingly stepped into the shitsand.
I would tell people after my experiences “You can kill people in your own office but don’t kill people in my office, leave the body and expect me not to say anything about it.”
Suddenly there’s this whole investigation of me and my diagnostic skills and my recommendation of ‘palliative care’. My friend was the head of the palliative care unit at UBC. It wasn’t rocket science. IT was just caring for patients. You just had to show that the potential for benefit for a patient had to outweigh the potential for side effects . It was compassionate care.
I did nothing wrong. I did good medicine. I’m a good psychiatrist.
But there’s suddenly this pretty low brow nurse screaming at me that I don’t care for people. That I want people to die. That I’m wanting palliative care for people who could be saved.
None of the drugs were used for treatment for Alzheimer’s dementia. There was no cure for alzheimer’s dementia or multi infarct dementia. The new medications had potential to affect heart and blood pressure and could could hasten death.
But the patients chart , who was now my patient, was not supposed to be removed from the ward. Here was this nutbar nurse who actually wasn’t from that ward having this chart and brandishing it in my face and saying I was a killer for not letting this patient have this “as like” antidepressant drug.
Weird. Corrupt. Greedy. Stop the virtue signalling, holier than thou behaviour, and become partial to $500 shoes. My decision threatened her wardrobe costs.
I hate when people force me to investigate something because I just want to do my job. Now I’m being accused of being a bad doctor which I’m not. I’m told I’m a Nazi wanting to kill people which I’m not. Strange. Whatever could motivate this. Money, sex o status.
I know that one always first ‘follows the money trail’. So I looked into the matter. I asked about. I made calls. I talked to staff. I’m always impressed that the vast majority of people don’t like bad things and yet a small dedicated group can do a whole lot of evil because no one wants to get involved. I didn’t want to get involved but they forced me. Really.
It turned out that this ‘drug of the month club’ was running in the government asylum. All these experimental drugs were being used without ‘consent’. The drug of the month went with the changing diagnosis of the moth club. Budkowsi should have worked here and written a book. The patient’s couldn’t consent and their families didn’t know.
A whole lot of people were involved and the amounts of money were impressive. Lots of Hawaii vacations.
The interesting thing I’d learned working in the jails and now in the asylum is that both institutions don’t have an independent ‘board’ or even ‘quasi independent board’. Other hospitals have a community board so are protected more. Whatever goes on in asylums and jails is directly a response of the government in charge. The politician may not know as in British comedy skits “up the doctor” or “up the hospital”. The bureaucrats did however.
The local jail had been cited dozens of times for abuse by the ombudsman and every other body. Nothing had been done about the complaints of favouritism and abuse there . Here it was the same , all manner of silly buggers was apparently going on. The key was that the head had died and there was only a ‘caretaking head’. This made things worse. No daddy or mommy there. The new Daddy or Mommy yet to be appointed. In the interim time all manner of nefarious things can occur. It’s just politics and administration. No it’s not right. But it’s surely happening on a large scale. Those in the know know to take advantage of the changing of the guard. The interim’s never have the same power and indeed in this case the interim was a really good doctor just trying to ensure the patients got good care. He wasn’t involved in the wheeling and dealing. Several people were, most just turned a blind eye. That’s what I liked to do. Only in this occasion I was invited to dance. Don’t kill people in my office and leave the body. I can’t say how many times I’ve had to tell people that and this was one.
Because of the ‘cover up’ and that so many agencies were involved in this I sent a letter to those governing agencies with the oversight who were responsble, pharmacy, nursing, university. There was a strict policy about ‘consent’. There was a strict policy about ev3erything.
I was just doing my job and suddenly all hell broke out.
Before I sent the letter, the nurse tried to have me killed. Apparently the staff who’d been getting perks thought that they were going to stop and that the best thing to do was get me hurt and off on ‘sick leave’ so the party could continue.
I don’t like having my life threatened and I don’t like little shits.
I asked my colleague who was an immigrant why he hadn’t said anything. “I did but then I was told my wife wouldn’t be able to come to Canada.”
“Really?”
It turned out that half the staff were immigrtant doctors, some of the best of the best, and this was a common ‘threat’. One told me crying that he’d been told if he didn’t go along with this he’d not have his ‘visa’ sponsorship approved. Because they were all here in the country being sponsored by the doctors involved in such schemes they would not only lose their jobs but they and their families would lose their visas’. Obviously none of this was official but it was a very effective extortionate technicque and rather common I’d learn from my colleagues. Power corrupts. Absolutes power corrupts absolutely.
At the time the government began refusing a ‘contract’ to the doctors in the asylum. No contract. Really. The government. They also wanted to bring in time clocks so that we would have to punch in and punch out. They called us ‘workers’ to and were constantly making disparaging comments about the ‘workers’ . Meanwhile these silly little administrative folk with their expensive suits and Monty Python walks trying to imitate lawyers were most uneducated. They were especially greasy with the immigrant doctors.
I didn’t have a stake. I wrote my letter. I said I never did plan to play on a team that could’ve win and I left. It was so bogus. All this politics and all these back room deals and all the standard government stuff with corruption or what appeared to be corruption but wasn’t corruption because of technicalities or whatever. I had this thing when I just want to be a doctor , or the right thing, and wondered always if it wasn’t time to be a missionary doctor. When I wasn’t thinking suicide I was thinking missionary doctor. Passing thoughts. Not something I dwelled on .But I did like money and I had this thing for the girl. I liked having a partner and was often lonely and afraid despite my own identification with Clint Eastwood and my desire to ride off into the High Plains.
I did my job but it was fucking hard to help patients with all the money deals going on around the poor people. We’d joke when we worked up north saying that for ‘every Indian of the Indian problem there were at least two or three white collar bureaurcrats making hundreds of thousands of dollars to make sure there was an Indian problem.”
A retired government psychologist told me. “It’s just caregivers and victims.”
It was easy to get jaded and cynical. But really, the vast majority of people were doing good work and the really surprising thing was that despite the system and it’s obvious flaws, people got better and got good care in the long run.
I made a lot of enemies. Sending my letter to 5 agencies meant that the Colleges couldn’t ‘kill the messenger.’ That’s their favourite move. They hate doctors and sacrificing doctors while claiming to save the patients was their normal ‘feint’. The trick, for anyone in security or pleasing, is not to kill everyone but to actually get a reputation for saving lives then kill just one for profit. I watched a colleague ‘let one go’ as it was said in the industry and he was one of the more virtuaous folk I’d worked with in the jails. It’s complicated. The silly people, usually calling themselves activists, and getting on tv and radio, aren’t anything but contributions because they are so stupid. It’s not black and white. It’s all grey. Most of the bad guys are mostly good. Arendt called it the ‘banality of evil’ and that sums up bureaucratic graft and corruption. Just “banality”. If you really are ‘threetening power or money’ you yourself will be hurt or jailed or put in an asylum. Entrenched forces of money and corruption don’t like to lose their cash or power.
Screwtape Letters by C.S. Lewis is the best book on corruption. None ever better. It’s kind of sad and cute and tragic all wrapped in one. There’s usually beautiful people involved too and bad people have children so it’s not even with out its innocence.
The trouble occurs when you stumbled into the quickstand and you didn’t see it soon enough to go around. The older I’ve got the more I’ve been able to avoid the quicksand. The trouble with experience is that to get it you have to make mistakes.
Looking back I’d have just walked away. Seeing how bad the College of Physicians and Surgeons and Ministry of Health behaved was a repeat of watching the callousness of the Indian Affairs. But again I always have to remember is that this was them having a bad day. These are vast machines and they need tweaking and I only get involved in the tweaking because a whole lot of other people weren’t doing their jobs.
Recently it was found that billions of dollars were being money laundered in British Columbia. That only occurs because people aren’t doing their jobs. No one has yet been lined up against the walls. All that’s happened is that the people who left the door open for the raccoons to get in have now closed those doors so the door will be opened elsewhere.
A door was closed when I walked away. I was punished for upsetting the apple cart. Now people who had a good deal going had to look elsewhere for their money for their lush lifestyles. The doctor was involved in this caper were making millions of dollars. Not me. I was just getting paid the base rate and working extra shifts to do the work that others were not because they were doing more profitable things.
It was disgusted. I was so disappointed. I was so sad to. The doctors who ‘got blamed’ were the junior doctors. None of the ‘big wigs’ got even their hands slapped. The patients got better care and the female nurse who had gone batshit crazy turned out to be batshit crazy and her husband and she separated and he turned out to be okay. She wanted more and more money and he was really a ‘hen pecked husband.’ Funny.
Tv Dramas really do mirror life at their worst.
They miss the good stuff. My memory goes to this because my life was threatened but days and weeks and months of my time at Riverview Hospital were just fine. That’s what’s wrong with journalism and the media. It never reports the hundreds of patients we helped and all the people working day in and day out doing the hauling of water and hewing of wood. Obviously the administration was and is a huge problem The principle failing of the CAnadian Health Care system today is gross mismanagement and corruption but even most of the people in administration don’t know their idiots. Idiots just want to get paid and go along with the job because they’re somebody’s retarded cousin. They don’t think.
Everything is above my pay grade. Some days I feel like the old Greeks who came up with the idea of Gods fucking each other and fucking the animals to explain their lives. That’s what goes on in the world of administration. it’s so far removed from reality and there’s just so many of them. They breed like cancer and the whole body of the country is dying because they suck the life out of everything. Constipated silly buggers doing Monty Python walks.
I tried tostay as far away from them as possible. Being around them makes me want to kill myself. I understand Arendt. I pray more. I ‘m also thankful that when I travel especially to so called third world countries I see how much worse things were. So as bad as things are here I know they are better than they were. The key is to compare them not against perfection but against a real comparison.
I didn’t have family I was trying to get out of a worse place to be able to live here. I didn’t want to do this anymore. I don’t like B team movies. I decided to get out and do something different. Thankfully Psychiatry and Medicine allows for lateral changes.
The fact remains integrity has cost me a million wort and I sometimes wish I had more sociopathic make up so I could be as immoral and unethical as some of my superiors who act so holier than thou.
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