I got a condo in Burnaby. The work would be steady with a few surprises. I enjoyed the patients. I worked with the greatest nursing team. The head nurse was a great guy who bred dogs and had terrific stories. I’d do experiments with high dose medications to see if chronic schizophrenics responded to these industrial dosages. One or two did but the anxiety we went through taking the medication dosages into the stratosphere wasn’t worth the modest gains. I did become competent with neuropsychopharmacology and knew Schizophrenia and psychosis better.
There was one fellow who ruled the chronic male unit. I’d bring my dog, Shinto, with me. He’d stay in my Vanagon during the day. At noon I’d walk him over the luscious grounds. Everywhere we’d find ‘bedding’ places, sometimes with condoms, mostly without, sometimes with drug paraphernalia, mostly without.
I noticed this one guy was canny. I asked the others about him and everyone shied from eye contact. Eventually one man told me he was afraid of him and he beat men up he did’t like. I confronted him and asked why he was ‘acting crazy.’ He just got very angry. The next day in the downstairs basement leading from one building to another he tried to ambush and jump me. I turned quickly enough and was apparently more dangerous than he hoped.
“I’ll kill you if you interfere with what I’ve got going here. It took me a year to get moved. Every day I fuck the mentally retarded girls . I have the run of the place. The guys respect me. The nurses do as I say. You’re not going to interfere with me, you hear. I’ll kill you if you do.”
Fairly frightening little shit and very impressive knowing my routine and laying for me in the dark corridors. I was even more ‘devil may care’ when I came back from the island. I was still doing martial arts too and carried a knife and the keys .
The head nurse on this chronic dangerously insane men’s ward was aware of the guy, didn’t know what to do, one of several transferred from the prison to the regular psychiatry ward. It turned out the prison was using the psychiatric ward as an ‘extension’. This guy was clearly a psychopath. Mothers and fathers were leaving their mentally retarded sons and daughters in the asylum and these sex offenders were making their way through the back door to the sexual feeding grounds.
I approached management and surprise! they were simply not interested. “Everyone is thoroughly ‘vetted’. It couldn’t be happening.” Blamed the judges if it was.
If there is one thing to know about the Canadian Communist/Governkment administration is their favourite go to psychotic response is ‘denial’
followed by ‘cover your ass’
followed by ‘somebody else’s problem’
coupled with ‘kill the messenger’
but mostly passive aggressive delaying and ignoring tactics.
The worst which eventually happens is ‘they ‘ form a committee’ which then means the ‘problem’ will not be addressed for 2-10 years.
I took away the guys off ward privileges.
He again tried to jump me in the downstairs halls having escaped from the ward. He had a knife this time. I suppose he called it a schiv. I pulled my knife. I was bigger than him and crazier and he backed down. I didn’t even have to cut him up. Just a bunch of circling posturing and threats.
“I get you next time “ he said. Hadn’t expected a psychiatrist to be armed.
I spoke to the great matron, there are these amazing women in asylums who are like great mothers who just want ‘right’ to prevail and don’t like kids being bad. She rather liked me too. When I described the second attack and the whole circling with knife things she said that the asylum had it’s own solution to such characters. It turned out there was this ward of really dangerously insane men. Very isolated, very guarded and very back ward. She arranged the internal transfer. No easy picking there. He’d probably rot his life away there.
The difference between the jail and the asylum was that in the jail there was a fixed time with potential for parole whereas in the psychiatry ward there was no fixed time, but rather you got out when you were ‘better’. A Governor General’s Warrant was even worse as it could be indefinite. People didn’t generally ‘get better’ on our backwards. They were usually brain damaged and szhizophrenic, often dangerous, and everything had been tried . This psychopath was no longer ‘top reptile’. The girls were safe too.
I was really miffed that the jail was using the asylum for an extended wing too. Patients deemed “mad” are mostly not “bad” whereas the government was turning the foxes lose in the hen house.
I’d spoken to the mentally retarded ward and found out that this was not an isolated incident. This was the height of Aids and there were no condoms in the hospital. Sociopaths and psychopaths were bedding the mentally retarded girls and the mentally ill in the long grass and nearby woods. Everyone in administration was complicit but acting like it did’t happen. My campaign was for condoms and better vigilance with respect to the mentally retarded women.
The atmosphere in government facilities is ‘stagnation’. Any attempt to change anything was met with overwhelming resistance. Just getting condoms into the hospital implied that the mentally regarded were capable of sex and that inmates might well be having sex. Testing for STD was even more disturbing. Yet that’s what I did and it wasn’t at all ‘controversial’ outside the limited intelligence of the PC administration. Mentally ill patients were high risk for HIV and othe STDs and bullying.
There really was a One Flew Over the Cookoo’s Nest was the line up at the nursing station for meds. What was weird was a similar line up at at the bus stop twice a week. I’d prescribe antipsychotics at increasing dosage to decreased aberrant behaviour. The patients would line up at the nursing station twice a day for their pills. Some did the ‘Thorazine shuffle’ and many had Akithesia and Tardive Dyskinesia. Some of these same people would line up twice a week at the bus stop. The ones who needed the most medication and had the most side effects of my medication were the ones who were at this bus stop line.
I investigated as no one seemed to know, or want to tell me. The head nurse told me after a few months that people didn’t like to let me know things as I’d do something about them. He said they liked me so didn’t like to see me get in trouble for ‘rocking the boat’. It turned out twice a week drug dealers took the bus to the asylum and sold their drugs to their customers who would line up just like they did for the nurses. These patients would go more insane and I’d have to give them more drugs and they’d have more side effects.
I approached administration again. I’d only been there three months and had encountered glaring problems, at least they’d be seen as glaring to a doctor but obviously weren’t ‘administrative’.
‘There’s nothing we can do about that.!”
Why not.
“The bus is out of our jurisdiction.
“Call the police. Have them catch the dealers.’
“We don’t’ want to get our patients involved.’
Nothing got done. More violence, longer stays, more tardive dyskenesia.
The tobacco was always a source of conflict in the unit but no one was willing to make the ‘hospital’ wards’ ‘abstinent’. I was a smoker and I understood the addiction. Everyone was smoking. Major smokers in administration and nursing in government health care.
All that happened was patients had cigarettes given on the hour. The fixed incomes and increased costs of cigarettes really impacted the ward with fights and violence and more drugs and ECT until the great head nurses on their own decision began bringing large tins of Drum and letting patients without resources roll their own. The nurses were like sergeants in the army and terrific at practical things. The hospital administrator was like an army general in peace time with syphilis of the brain. The rest of us ‘officers’ were wise not to bother him. I bothered him routinely. He was totally clueless and routinely didn’t even know what I was talking about.
The big administration act of the year was to remove the ‘doctor only’ parking in front of my acute care unit and put ‘administrator only’ parking there instead. I’d actually come into the unit for emergencies at night but this was a major administrative ‘coup’ . It showed doctors who was most mportant. We as doctors were collectively required to park in staff parking a 10 minute walk to the unit while the administrative ‘fat cats’ now didn’t have to even carry umbrellas. I never saw any administrator move faster than the fastest lady walking their tiny poodle. The head actually waddled. But now they could get into the buildings in case of an ‘administrative emergency’ while the doctors who were lean and mean would sprint from their cars to the buildings where people really werehaving cardiac arrests and hanging themselves. Administration is all about status and symbols. 90% unnecessary they played all these adolescent games.
The administrator took over a whole building. There were only about 5 buildings and one became the administrative building. At one time when patients mattered the administration was spread out through the buildings. But that was back when there were thousands of patients. Good medicine and scientific advances had reduced the patients to a rifth of their previous numbers and multipled the administration by as much. There were few doctors and few nurses but a whole building of administration.
Once the head administrator brought the Minister of Health round to view my ward. I immediately confronted him and said that Administration had not notified us they were bringing guests around which is required. Further I’d never seen him before on the wards so couldn’t vouch for him as the Hospital Administrator.he’d have to provide proof , He would eventually provide some identification when he realized I wasn’t joking. .
As to the Minister of Health, I knew him and welcomed him and told him what a good job he was doing and how privileged we were to have him visit us . He was highly amused at the Hospital Administrators embarrassment but the truth was he’d never come round the wards. I toured the Minister of Health around the ward.
Administration never left their building where they made paper forts all day with paper hats and ran about in paper costumes chasing the secretaries with crayons.
The nurses ran Riverview Hospital. It was a great place for patients with immense compassion and competence on the ward and a really good place to heal. The bars were on the windows to keep the insaniety out and for all the patients to have asylum. The craziest building in the whole place was the bizarre perverted administration building with these really weird people who had all learned Monty Python walks to do their jobs.
We had an incident where the girls on the ward started putting clown make up on their faces with crayons. I told them that they had told me they wanted discharge and yet the column the nurses filled in which said ‘personal hygeine’ and ‘behaviour’ now had ‘wearing crayons on their face’. I told them I couldn’t very well discharge them if they persisted in ‘acting crazy’. It wasn’t rocket science, act normal and I can discharge you.
“Then you should let us into our lockers.” She screamed at me throwing a crayon at my face. She was more insane than just crayoning her face insane. But I was curious so went to the head nurse and told him what had just happened.
‘What’s with the lockers.”
“We hoped the problem would be solved before you found out.”
‘What problem.”
“The hospital got all these new lockers this month.”
‘What was wrong with the old lockers”
“Nothing’
“What’s wrong with the new lockers.
‘The locks don’t work.”
“Don’t work.”
“Yes, when the patients shut them they can’t open them again.”
“So all the girls make up kits brushes etc are locked in the lockers and they’ve all been looking like street people these last two weeks hecause they can’t get at their kits.”
“That’s about it”.
“What’s being done about it”.
“Maintenance is going ward to ward fixing all the lockers. They’re due here next week .’
‘Why did we get lockers that didn’t work in the first place.
“I don’t know but there’s an election coming up and the old timers say that some big wig with a lot of lockers that didn’t work gave money to one of the government parties so he could get this government contract and unload all his lockers which didn’t work on us.’
“Really.”
“That’s what they say. Makes more sense than anything anyone else can come up with .”
‘Administration knows.’
“Oh yes.’
“I wasn’t told.”
“Correct.”
“So for 2 weeks I’ve been holding patients accountable for behaviour well beyond their control and holding off dicharging them because they looked insane when the insaneity was in the system not in their individuals brains.”
“Correct’.
“Wouldn’t it be better to have told you.”
“Maybe, But we were afraid you’d do something. Everyone likes you and we don’t want to lose you. We were afraid you’d do something.”
“Bloody right”
Right there and then I picked up the phone demanded to speak to the hospital administrator and said.
“Do you know about these lockers that don’t work worth shit and my patients can’t get their hair brushes for weeks because they’re locked in these fucking lockers that don’t work worth shit and you had them installed here?”.
“Yes. Dr. Hay. I’m fixing the problem. Maintenance is going around the wards making the repairs. “
“If you don’t have these lockers fixed immediately I’m getting a tire iron right now and solving this problem myself!”
Well, the administrator was a physical coward and very much a mommy’s boy , sort of drooled a bit when he had to think which caused a terrible strain on his very tiny but unused brain. . Staff were all laughing shortly after because they’d seen his brown stained pants racing out the door and him speeding away in his Cadillac. Word followed that he actually thought I was going after him with a tire iron. He told everyone that as he ran.
His grandiosity was severely out of control. Not even a 5 year old kid would need a tire iron in a fight with that little girl.
“Does any one seriously think I’d need a tire iron to fight him.Wouldn’t I just beat him to death with my bare hand? I told him I wanted the lockers fixed today so I could discharge patients who didn’t need to be here. I was going to use the tire iron to open the lockers to retrieve their make up and hair brushes.”
I don’t know if the administrator ever got the brown stain our of his grey trousers but the lockers were fixed that day. The next day three women who’d been well for 2 weeks were discharged . More beds were made available for new patients.
Where ever I went I reduced the length of hospital stay by usually half with active therapy.
At VGH inpatient I had caused a scene when a patient was admitted who became depressed and had a history of staying 6 months in hospital. He refused to leave his bed and insisted he wasn’t going to attend any of the ‘therapy’. I lay down in bed beside him There were a dozen staff on rounds with me.
He looked at me , big bearded guy, ‘What are you doing”.
“I’m not working just like you.” I replied
“Get your own bed.”
“I like this one “ I said. That got him out of bed.
There was a real shortage of beds. People were in the halls and streets and lying in front of doors and these hospital beds were at premium. $2000 a day. Therapy wasmedication and a whole lot of psychotherapy, music therapy and physical therapy. Patients were here to attend therapy. Just like a surgical ward. We couldn’t have surgical beds full of patients who didn’t want surgery when there’s a line up for surgery.. It didn’t make sense. But nothing makes sense when the administration is working on some agenda of their own unrelated to patient care.
When He got out of bed, having no where else to go he got involved in our active therapy program.
Meanwhile the VGH inpatient head nurse who was just getting to know me, had had already sent some one for the head of psychiatry to tell him Dr. Hay’s gone mad.. she told me months later that the head called the ward and she had rescinded the request for help.
The guy who’d moments before looked like he was going to hit me had got out of bed and attended the therapy,
We had 6 hours of therapy a day. When I came hardly any of the groups were full and most of the staff were working half time in their full time positions. After I was there every one was full time in therapy. The lengthy of stay went from 6 months to 3 months and 3 months to 6 weeks. The staff who liked doing therapy loved me. They had these really exciting groups and patients really improved. The staff who liked fucking the dog were angry now that they had work and hated me.
The female head of the inpatients was a brilliant doctor but she was doing three different jobs getting paid three times the rest of us using her time strategically with other activities. Her ward was the longest stay in the acute care. She filled it with ‘dependent personality disorders’ , women who were chronically needy, suicidal and hypochondriacal. They loved her because she mothered them, let them stay for months and gave them what they wanted . A paid vacation.
I did an Amytal interview on a dependent personality disorder on the ward, the worst, most entitled , most demanding, and least ill in a psychiatric sense, though truly a narcissistic sociopath.
“My husband doesn’t make enough money to give me a vacation in Hawaii each year. Mommy and Daddy took me to Hawaii every year when I was young. My husband was rich when I married him but he’s no good at business. Not as smart as Daddy or me. Won’t listen to me. So I found that I can come to the hospital for 3 months and the staff will take care of me. They’re not as well trained as the waitresses and hotel staff I’m used to but it’s the best I can do. I’ve been coming here for a few years and thought maybe I’ll try a different hospital to see if they have better servants.”
This came out as a result of my simple questions. We discharged her shortly after. The nurse who was “offended” by the interview and sided with the patient claiming she was a victim, by her behaviour according to group analysis identified herself. I discussed her with the head nurse who disclosed a nurse was stealing narcotics. I said it was likely her and with the pharmacist set up a sting that caught her the next day. That was at the Asylum.m
The VGH head was displeased as suddenly her ward of very happy patients were complaining that I was requiring them to attend therapy rather than reading fashion magazine in bed and doing their nails. She actually asked me if demanding patients attend therapy wasn’t cruel and unusual therapy. She caught herself and laughed. She certainly didn’t want to see sick patients on the ward so transferred me to another ward. Her patients would be protected from the terrible demands of attending music therapy, yoga, CBT and all that other nonsense .She felt that beds were for patients to lie in while she gave them medication orders and 6 months later discharged them. She was really smart and she knew this gang of groupies who came every year were dependent personality disorders with dysthymia but she really had more important things to do than attend to hospital patients. That was the ‘wards’ responsibility’ . The ward wasn’t going to do anything either because everything I proposed involved ‘work’. The whole work and cost of psychiatric hospitals was the admission and sicharve of patients.
In Canada people get government jobs to avoid work. That and the high pay and great pensions and powerful unions. The minimum work gets done but only the minimum. There is absolutely no incentive for excellence or meritocracy in the Canadian Health Care System. Infiltrated to the max by communist ideals everyone works to the least. I was an aberration.
I arrived at the Asylum and the suicide rate was 30 attempts per year on my unit and 5 death. The gp who I took the ward from not trained in psychiatry had been rewarding the suicidal patients with attention and interest and regular gold stamps. The women were killing tthemselvs for his love and adulation. A really nice guy but like having an untrained Monkey doing surgery. The trouble was a a system without respect for specialists. In Canada doctors have been collectively reduced to being called ‘health care workers, comrade”.
Having worked in Brandon Mental Hospital where I stopped the suicides and having stopped suicide epidemics on the reserves I trained the nurses in prevention and recognition and minimized the response to the suicide attempts treating them as fever rather than a rock star event. Basic Skinneraian reward and extinction mechanism. Knowing attention is the gold and favouritism is the platinum of the psychiatric ward, I change the economy to reward good behaviour., getting well, participating, making discharge plans etc. You give attention to ‘sane’e behaviour rather than ‘insane’ behaviour. Passes and everything were rationalized under the new regimen.
When I left there had been no completed suicides on ‘my watch’ and ‘attempts’ had dropped from 30 to 10.
I also had taken borderline personality disorder as my special interest on completion of psychiatry. Borderlines were the best love/hate suicide/homicide folk.
There was one girl who killed herself in the community. She had far more attempts in the hospital than in the community but I really regret not admitting her because she’d literally burnt out the community psychiatrists in the classic borderline pattern of destroying her hinterland of relationships and moving along to the next. She was 6 months in hospital and 6 months out. We’d learned that the short stay Unit was the treatment of choice for borderlines but I’d stepped back int the time before people realized these long stay only worsened coping and increased likelihood of death. I did the right thing but she killed herself in the community and while I avoided her killing herself in the hospital on my watch she remained one of my regrets. I could have done better,
In my house and in my care my year at Riverview was a great success.
I had a lot more stories.
The drug research and an attempt to kill me were certainly interesting moments. But I’d also met my next wife there and was off to the proverbial races. Obviously you shouldn’t marry a girl you meet in a provincial psychiatric asylum even if she is another doctor.
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