Look Back in Hunger Page 16

  I got into trouble academically on a couple of occasions. Once, when I was under pressure to turn an essay in, I copied the essay of a friend who’d got an A grade for it, so felt smugly confident that I could get it through. I was excessively despondent when I received it back with a C minus and was chided for something that was ‘well out of character’s compared to my customary offerings.

  Another time, when I was in a hurry, I copied chunks out of an obscure book. I can remember almost verbatim what my tutor wrote at the end:

  ‘On first reading I believed this to be an excellent piece of work.’ So far, so good. ‘But on re-reading, it dawned on me that you have actually copied numerous, enormous paragraphs word for word from a text not often used in the present day. Please arrange to see me.’ (Why do they have to be such clever bastards?) I did go and see him and he gave me a mini lecture about plagiarism and said things like ‘You are far too clever to be doing this sort of thing.’ It had the required effect. I never did that again.

  Still, I was managing to get through without falling too far behind. So this gave me time for fun. A friend and I became involved in Brunel Radio and had a show answering student problems in a comedy way. We were given far more leeway than Radio Two allowed Jonathan Ross and Russell Brand, and found ourselves getting ruder and ruder, until we were gently sacked.

  One problem at university was money. During one six-month period of each year we were paid as student nurses, so could just about get by, but for the rest of the year, things were tight. This led to some very dull jobs just to supplement my income, perhaps the worst being a barmaid in a trucker’s pub in Uxbridge. And, God, was it grim. I remember one night a huge and hideous trucker arriving at the bar and pulling up his grimy vest to reveal a tattoo of a naked woman with her legs wide open on his fulsome stomach. He virtually pulled my head off trying to drag me over the bar to get a closer look, with the words, ‘What do you think of that, love?’ I didn’t think of anything funny to say at the time but, as with many incidents in my life, it was eventually worked into a comedy routine.

  Parties became wilder and behaviour more extreme. Everyone knows the delicious disinhibiting effect alcohol has on us all. It makes you do things like play truth or dare. One night I lost and was instructed to go and knock on a random door and when the inhabitant of the flat answered, I was to shout, Afghanistan Bananistan!’ at the top of my voice and leg it. As instructed, I picked a random door (it was two o ‘clock in the morning by now) and waited giggling for a grumpy, knackered student to answer. Unfortunately, the door was opened by the elderly mother of a student, whom she’d come to visit for the weekend. Her dressing gown was a vision of pink nylon and she even had her curlers in.

  Still, not one to shy away from a dare, I chanted my pathetic phrase, which of course was related to the Russian invasion at the time, and ran off as quickly as I could, feeling slightly ashamed despite my drunkenness.

  At another party, someone set off the fire alarm. In due course, the fire brigade turned up. It was a fancy-dress party. I was in my little room in halls, which I’d moved back to for the third year. There was a huge banging on the door and someone was shouting, ‘Fire brigade!’ I opened the door and made the assumption that this was brilliant fancy dress. ‘Well done, mate,’ I said, ‘good effort,’ and slammed the door, whereupon he promptly kicked it in, convincing me finally that he was a bona fide fireman.

  The accommodation on offer to students is unsavoury to say the least. Lack of funds dictates that it will either be a swamp, a hovel or a hard-to-let nightmare. In 1980, we found a reasonably nice place above a fish and chip shop (oh joy) in West Drayton (oh horror) owned by a lovely extended Asian family. The one drawback was that the patriarch requested we make our sitting-room floor available every weekend for his twenty-one-year-old son to sleep on in a camp bed. As we were three women and a gay bloke, we didn’t feel very comfortable about this arrangement and a standoff occurred which nearly lost us the flat, but eventually dad caved in. However, this did not stop the family from turning up unannounced en masse from time to time, to sit in our kitchen and drink tea. As we were students and sometimes didn’t get up till Countdown came on at half four, we would arrive in the kitchen to find a huge group of sari-clad middle-aged women nattering away quite happily and eating our biscuits. But we didn’t mind because we lived above a chip shop.

  One of those questions that is often asked is ‘Do you remember where you were when [fill in the blank] died?’

  Well, I remember very well where I was when John Lennon was shot on 8 December 1980. Living above a chip shop in West Drayton. We’d all come home from college and were lying around in various states of exhaustion, having done absolutely bugger all that day again. The news came on and the first item was very difficult to believe: John Lennon had been shot outside his apartment in New York. These surreal moments are difficult to fit into the run-of-the-mill progress of one’s life. Lennon was always my favourite Beatle, despite the reputation he had for being difficult and arsey. He seemed to be the one who had extricated himself from the swamp of pop celebrity and gone his own way.

  These sorts of incidents, the ending of someone’s life at too young an age—and I realise what a cliché it is to say this—tend to crystallise one’s attitude towards the unthinking plodding of one’s existence. The fragility of one’s presence on the planet is something most of us prefer not to address, so it is a relief when the blinkers come down again and one is distracted by a soap opera or a banal problem and settles back into a state of blissfully ignoring one’s mortality. ‘Carpe diem’ and all those other exhortations to change the course of one’s life, to introduce a sense of urgency and excitement, don’t really work on humans unless they exist in a constant state of desperation, like during a war. We smug and comfortable types in the West simply don’t seem to be able to get the balance right. In fact, I suspect most of us actively avoid it.

  So, on the academic side, I suppose I continued to plod. I stood for president of the Students’ Union for a laugh, and it served me right that I only got eight votes, because I didn’t have a campaign, couldn’t be bothered to put up a poster and had not a single policy to speak of. Lord knows what would have happened if I’d actually been voted in. I would have run a mile, I suspect.

  Ah, happy days! Though having said that, entries in my diary—which only appeared when I was depressed, because when I was happy I was too busy to say so—seem to gainsay what my memories are. For example: ‘Brunel is absolutely horrible at the moment. Can’t muster any enthusiasm to do any work.’ And ‘Boring day. Only thing I did was some washing.’

  There seem to have been quite a few days like this. So much for ‘carpe diem’.

  CHAPTER FOURTEEN

  OOH, MATRON!

  Doing a so-called ‘sandwich course’ is for some an unsettling existence, as at regular intervals you move from one arena to another and are expected to just get on with it. For me, though, it was perfect. As a kid we’d moved house a lot, so I was used to the constant changing of an address and a life and it seemed familiar to me.

  So each spring we would pack up our meagre student belongings and head to Camberwell, in the heart of south-east London.

  Most of us, having lost the will to find any accommodation, would settle into the nurses ‘homes, either in Camberwell at the Maudsley Hospital or in a slightly more leafy area seven miles away, West Wickham, where the Bethlem Royal Hospital, Maudsley’s sister hospital, was located. This got its name from the original Bedlam Hospital, famously known for its entertainment opportunities, as the general public were allowed to wander round for a small fee and look at ‘the loonies’ . Obviously we are more sophisticated these days and watch them on television, in shows like Big Brother.

  The aim was that we would qualify as psychiatric nurses or RMNs after four years of training. Normally this training would involve a three-month placement at a general hospital, learning to do all those medical things that even as a psychiatr
ic nurse you are required to do, like give injections, take blood pressures and administer medicine. However, the powers that be felt that we degree nurses were way too clever to spend three months on this sort of placement and it was assumed that we could learn it all by practising on a dummy in the school of nursing. This was their first mistake.

  My first ward was a general psychiatry ward set in the rural gorgeousness of the Bethlem Royal Hospital. The ward had roughly twenty beds and the residents were a mixture of people of all ages and with most conceivable psychiatric illnesses, ranging from depression, anxiety and anorexia to schizophrenia and manic depression (now known as ‘bipolar disorder’ in hideous American lingo).

  Care of patients was organised into four main phases.

  Assessment

  This would happen as soon as someone was admitted and was a combination of observation by nurses and interviews with doctors, who would do something called a mental-state examination to try to work out what was wrong with the individual. So, for example, someone with depression would be asked about their thoughts (perhaps questioned as to whether they had any intention of killing themselves), their daily life and the aspects of it that may have been affected by depression, such as their sleeping patterns or eating habits. Nurses would observe patients and note down signs of depression, such as weight loss.

  For psychotic illnesses like schizophrenia, doctors would need to find out whether the person had Schneider’s first-rank symptoms, as we called them at the time. These are not used any more and psychiatry has moved on to a slightly more sophisticated assessment of symptoms. We would be looking for whether they were hearing voices, if they had delusions—maybe paranoid or grandiose—basically anything that fitted into the typical pattern of their illness.

  Treatment

  On the basis of these observations, a treatment plan would be decided upon. This would often involve a drug prescription, counselling or occupational therapy, depending on what was deemed appropriate.

  I think it’s important here to address that fantasised-about and much-derided treatment, ECT or electro-convulsive therapy, so beloved of films about psychiatric patients. As nurses we were expected to assist with ECT.

  First, we would take them from the ward down to the room where it was to be administered. What ECT does is induce a pseudo epileptic fit, because, put simply, some Italian doctor noticed many years ago that lots of epileptics were a lot more cheerful after they’d had a fit. An epileptic fit is an excess of electrical activity in the brain, an overload, if you like.

  So the patient would be put to sleep with an anaesthetic and two paddles attached to a machine were held to their head. The paddles were like those things they use in casualty for people who have had heart attacks, except smaller and rounder. An electric shock would then be delivered, the individual would convulse briefly— i.e. have a fit—and then they would lie on the bed for a while until they came round from the anaesthetic.

  As far as I can remember, in the film One Flew Over the Cuckoo‘s Nest, an iconic and brilliant movie, the main character, Randle Patrick McMurphy, played by Jack Nicholson, is given ECT without anaesthetic as a punishment. This is certainly not the case in real life, although there has been much criticism of the use of ECT. My opinion is that this is because it is used too widely, on inappropriate forms of depression. There are side effects, such as loss of short-term memory, and these are a major part of the controversy. It seems to me, though, that when used on a very particular form of agitated depression, it can have remarkable results.

  When I was a student, we had a woman admitted with the worst case of agitated depression I have ever seen. She cried out constantly, could not sit still, wandered round the ward all day wringing her hands and clutching at her face and clothes, and was so completely overwrought with emotion, desperate and sad, that it was painful to witness. This woman had about five sessions of ECT and the transformation in her was absolutely unbelievable. She became calm, articulate, relaxed, friendly, communicative and her mood was happy and contented. I could not believe what I was seeing. On the other hand, I witnessed many patients who were given ECT, on whom it had no effect whatsoever.

  Once assessments were done, it was up to the nursing staff, as I said, to administer the treatment and sometimes, for those people who were seriously disturbed and had no insight into their illnesses, their treatment was unwelcome to them. So this would involve giving it to them forcibly. This was always meticulously planned and executed, so that no one, most of all the patient, was in any danger. It is not a pleasant thing to do and no one enjoyed doing it, but the future welfare of the individual was always uppermost and I did it for no reason other than that. We were permitted to do this because the individuals had been sectioned under the Mental Health Act and, although I’m aware that there is the potential for abuse in these circumstances, I very rarely felt uncomfortable in what I was doing.

  Manic depression, or bipolar disorder, is an illness that can be well controlled by a specific drug. This is not without long-term side effects, though, and I felt so sorry for those who had to be on the drug for the rest of their lives. Many of those with bipolar disorder become well through taking the drug, but if they stopped taking it, the whole circular process would start again.

  Discharge

  Once someone was considered to be well enough to go home—and I have to say that in many cases this was a fluid concept because some people never fully recovered and never would because they had chronic, incurable illnesses that could only be managed—it was arranged for them to leave. As nurses, we would make sure their drugs were given to them and help them pack their things up. Most of the time it was a happy occasion, although sometimes you knew you would see them again in a few months when they defaulted on their medication.

  Follow-up

  Mostly patients would attend regular outpatients’ appointments so the doctors could check how they were doing. Very occasionally they would come back to the ward to visit a nurse for an ongoing assessment. And the other option was for them to be followed-up in their home by a community psychiatric nurse.

  The staff on the ward were a mixture of very capable and absolutely bloody useless. One particular nurse had probably been in the job too long and could not resist teasing the patients. On the ward was an anorexic woman in her late sixties (which is very unusual) and each time a plane flew overhead, this nurse would look at the sky and say, ‘Here comes your weekly consignment of sausages.’

  This very thin woman was the first person I was ever let loose on with a syringe, after the sister instructed me to give her an injection—my first piercing of a real human being. As she weighed approximately five and a half stone, this worried me enormously. Armed only with knowledge gleaned from practising on an orange in the school of nursing, I approached her with trepidation. We had been told that we had to inject people in the ‘upper outer quadrant’ of their buttock, and if we put the needle in the wrong place, we could potentially paralyse someone for life. Great.

  But a person who weighs little more than five stone doesn’t actually have a buttock, so, poor woman, I had to get her to lie on her side and then I gathered up as much loose skin as I could to form a pseudo bum cheek. Then, virtually with my eyes closed and my heart beating, I bunged the syringe into her bum and delivered the liquid.

  I was sure I’d got it in the wrong place and was forced to follow her round for the rest of the shift to make sure she wasn’t paralysed. Even after I went off duty, I found an excuse to ring the ward, dropped her casually into the conversation and heard, with relief, that she was still walking around and hadn’t keeled over.

  Being rubbish at the physical side of nursing was a constant theme throughout my training and nursing career. I ran like the wind in the other direction whenever there was an emergency like a cardiac arrest, and I was constantly trying to avoid giving injections or taking blood pressures. However, taking blood pressures is quite a feature of psychiatric nursing and it was hard to sideste
p. Put the cuff on the arm, inflate it and place the end of the stethoscope in the crook of the arm and listen while the cuff deflates. The top figure of a blood pressure measure is taken when the ‘boom boom’ noise starts and the lower measurement is taken when it stops. Problem was, half the time I couldn’t hear a bloody thing. And I felt it wasn’t polite to try to take the readings more than five times. So, I’m ashamed to say, most of the time when I was cornered and had tried my best with no success, I looked at the chart and made up a figure that was similar to the last measurement. Yes, I know it’s a terrible, shameful and downright dangerous thing to do, but I tried always to compensate either by keeping an eye on them or surreptitiously persuading someone else to do it the next time it was due.

  Ditto, injections. I found these an ordeal and I remember that once I had to inject a thick, glutinous substance into some poor woman’s buttock and just found it impossible to get in. After several attempts, the unfortunate woman turned to me and said, ‘Can I just take a tablet?’

  Later on, after I had qualified, a situation arose in which I was required to give a very disturbed woman a forced injection while several people held her still. In a slight state of panic, I pressed the plunger in too quickly and, as I pulled it out, the entire contents of the syringe squirted out of the pinprick-sized hole in her bum and hit me in the face. All I could hear was six people sniggering. Perhaps the biggest drama I experienced on my first ward was on one of my compulsory stretches of night duty. The main thing about nights was that unless you had someone on the ward who was hypomanic (the high end of bipolar) most people slept all the way through, leaving long, uneventful stretches with the other nurse who partnered you at one end of the ward.