19. The Hospitals
His first day in a psychiatric hospital had been spent as a day patient. The crisis team had arranged for Neil to get out of the house and see a different psychiatrist. They'd picked him up in a minibus from home and driven him to another local hospital that Lara had never heard of. It was surprising how many institutions there were in town, dealing with mental health patients.
A breakfast of toast and cereal was provided at the hospital in a large canteen with a huge bay window looking out onto a garden filled with mature shrubs and trees. The hospital itself was an imposing red brick Victorian building, originally built as a sanatorium. There were parquet floors and a grand staircase in the foyer. Otherwise, the hospital had been institutionalised, with fire doors painted glossy pale green, linoleum floors and lots of blue signs with white lettering.
After breakfast, the patients were corralled into a circle in the canteen. Tea and biscuits were served as a support worker went through the day's activities and asked who would like to do what. There was music therapy, art therapy and drama therapy. Neil said he would do all three.
There were long periods of time where nothing seemed to be happening and there was no sign of any staff members. Patients were hanging around in two rooms: the canteen and a lounge. The lounge had an array of different size and shape sofas around the edge of the room and a vending machine in one corner. A tall sash window offered a view out to the gardens on the opposite side of the building from the canteen. Nobody was talking to each other. Some patients sat completely still with glazed eyes, as if in a trance. Other patients paced around nervously, avoiding all eye contact and distancing themselves from others.
After a seemingly interminable wait - there were no clocks anywhere to be seen - a woman appeared asking for Neil.
"Are you joining us for music therapy?"
"Yes, I was going to."
"Well we're starting right now."
Neil followed the woman through a door. She seemed irritated as if he should know where to go and when. The music room was nearly full with about 20 patients holding instruments, sitting around a large square table. He didn't recognise anybody from breakfast. The room had a high ceiling and it was quite dark. The walls were covered with blue fabric covered cork-board and there were many crude paintings and drawings pinned up.
"Choose anything you want and we can start" said the music therapist, gesturing to a corner filled with an array of percussive musical instruments.
Neil picked up a tambourine and sat down in a free chair at the table. The music therapist sat at a piano and began to play a simple melody. Tentatively, a patient started to tap a bongo drum in a staccato rhythm that was not in time with the music. Another patient shook a pair of maracas at random intervals. Neil started to gently jangle the tambourine in time with the woman on the piano and she started to sing, presumably to amuse herself as nobody else knew the words or the tune. Everybody else in the room held their instruments motionless, except for sporadic flurries when they became emboldened enough to briefly make a noise.
Eventually, Neil got bored and started to beat time on the taut skin of the tambourine quite loudly. Following his lead, more and more patients started to join in with the rhythmic bashing of instruments. The sound built and built and the music therapist played louder and wailed badly out of tune. Finally, she stood up and gestured that everybody should calm down, gently shushing.
"We could wake the dead with that racket" she said, laughing at her own joke.
"OK that was a brilliant session. Please help me tidy away the instruments. Thanks everybody. I really enjoyed that."
The patients all disappeared in different directions and Neil made his way back to the canteen. Most of the people who he'd seen earlier were still there. Spotting the patient who had been shaking the maracas, walking through the foyer, Neil intercepted her.
"What happens now?"
"Well I'm just going outside for a cigarette. Get yourself a drink and have some cake. Then it'll be lunchtime."
A table in the canteen had been laid out with large plastic jugs of blackcurrant and orange squash. There was a chocolate cake and a victoria sponge that had been sliced into small portions on paper plates. Neil took a plastic beaker from a stack and was about to pour himself some squash when one of the catering staff rushed over.
"I'll pour that for you, dear."
"It's OK, I can do it" said Neil.
"No I have to pour it for you."
With his drink and a plate of cake, Neil sat down at a table with a girl who was fiddling with her phone. She looked up.
"Are you OK?" she asked.
"Yeah. Bit confused about what's going on. You alright?" he replied.
"No. I'm not good at all" she said, suddenly looking very worried. She studied the floor.
"Do you want to talk about it?" he asked.
She looked up momentarily, made a little half-giggle and then started fiddling with her phone again.
After about an hour of awkward milling around, a servery hatch was opened in the canteen and a trolley with knives and forks on it was wheeled out into the room. Patients started to line up at the hatch, where there was a hot plate and the catering staff were taking off the foil lids on a number of plastic containers. Neil took his place in the queue. There were a number of dishes to choose from including pasta and a meat pie. Neil chose meatballs in a tomato sauce, mashed potato and green beans, which were dolloped onto a large white plastic plate by a lady in a hairnet with a long serving spoon.
It seemed an unusual question, but the dish could certainly be improved with some kind of sauce. The lady poured thick brown liquid all over his food from a big aluminium jug. Lunch reminded him of school dinners, but not in an unpleasant way. There was a stodgy pudding with lashings of thick yellow custard to finish the meal and it was all washed down with tap water in tiny plastic tumblers, poured by one of the catering assistants.
As he was finishing his meal, Neil was approached by a camp man with a bright happy smile who almost danced into the canteen. Half lowering himself to table level but not sitting down, he laid his hand gently on the middle of Neil's back.
"You're joining us for drama today. Is that right?"
"Yep" said Neil, covering his mouth which was still half-full of food.
"OK perfect. There's only a few of us but we always have a lot of fun. We'll be in the drama studio in about 30 minutes, alright? Wonderful" he said, answering his own question.
Neil wanted to ask where the drama studio was but the man had skipped away before he could swallow his mouthful and call out to him.
"Oh good. You're here" the drama therapist said when Neil finally located the right room. There were four patients, arranged in a semicircle facing the therapist. Everybody was seated in the middle of a large polished wood floor. Around the edges of the room were chairs stacked up, boxes with hats, props and clothes rails with various costumes.
The session began with some icebreaker exercises where each patient had to say the name of another patient before throwing them a ball to catch. They then re-enacted the story of Goldilocks and the three bears several times, rotating the roles so that everybody played each character. The therapist prompted them with questions while they were doing this.
"How do you feel that your porridge has been eaten, baby bear?"
"Uh. Hungry?" Neil replied.
With more tea and biscuits there was a community meeting where everybody sat in the canteen and somebody asked a sequence of questions about whether anybody had any problems with the facilities or could think of any service improvements. The nurse and support worker who ran the meeting were met with stony silence.
Art therapy comprised colouring in with pencils or felt tip pens. Neil chose a picture of an orange tree and meticulously shaded every leaf. He had almost completed it when a man appeared at the door of the art room.
"Neil. Can I borrow you please?"
Led up two flights of stairs, the man knocked on a door.
"Come" came a voice from inside.
Opening the door, a young doctor held out his hand.
"Neil isn't it? Good to see you. Take a seat please" he gestured towards a plastic chair. "I'm Doctor Akinbole, a registrar psychiatrist here at the hospital. I'm hoping we can do something to help you today."
"Now, I come across quite a lot of cases of young men. Fit and active. Productive and happy. Sometimes problems can materialise in your twenties. It's nothing to be ashamed of and I'm sure we can help you get back on your feet."
"Alright" Neil tentatively offered.
"So you've been working full time, you're engaged and you've been in a long term relationship with this lucky lady?"
"Yes, that's right"
"That's great. Great" the psychiatrist said, smiling.
"Well listen, there's a medication that's helped a lot of my patients in a similar situation to yours. It's an atypical antipsychotic, but it's very good with depression too and a whole host of mental health issues."
The psychiatrist reached for a book on his shelf and leafed through the pages.
"OK, what we're going to do is start you on 200 milligrams today, 400 tomorrow and 600 the day after. Then you'll be taking 600 milligrams every night. This medication is great because we can ramp up the dosage really quickly."
"What about all my other medications?" Neil asked.
"Well, we'd better keep you on those for now. We don't want you to have any nasty withdrawal effects. We can taper you off those gradually in future."
The psychiatrist was now scribbling in his prescription pad.
"Here you go" he said, standing up. "Any problems, just phone the hospital and leave a message for me."
"Thanks" said Neil, taking his outstretched hand and shaking it again.
"I'm sure you'll be feeling much better soon. All the best" the psychiatrist said, ushering Neil out of the door.
Descending the stairs and standing in the foyer, Neil felt very lost and shellshocked. After a slow and relaxing day, his consultation with the psychiatrist had been a whirlwind affair and he was shocked at how quickly he had now received a prescription for a third medication. There was also something scary and unpalatable about the word antipsychotic.
On the first day with his new medication he woke up with a very dry mouth and was very sleepy until late morning. On the second day, he struggled to brush his teeth and get into bed because he was fighting to stay awake. On the third day, he needed to go to the toilet during the night and found that he was confused and staggering like a drunk. The dry mouth was terrible, he felt tired all the time and his appetite for chocolate biscuits became insatiable.
After some weeks, the side effects had not abated. Neil's life consisted of taking his medication at 7 or 8pm at night so that he could be awake for a few daytime hours, where he sat semi-comatose watching trash TV. Phone-calls to the hospital and messages had not managed to raise any response from the psychiatrist but eventually he spoke to another doctor. He was told not to reduce the dose, but he could split it into two or three doses throughout the day. This meant that Neil was half-asleep the whole time and barely conscious of what was even happening from one day to the next.
Two months elapsed and Neil was comfortably numb but there was no change or improvement. There was no way he could ever work while so heavily medicated. He booked an appointment to see his GP and halved his dose the night before he was due to see the doctor.
"I want to come off the quetiapine."
"Ok, but you can't just stop taking it until I write to the psychiatrist and ask his opinion."
"I can't stand the side effects and I have no quality of life."
"I understand, but we have to be very careful when you stop taking medications like these."
"It's not helping me. The side effects are awful. I'm just drugged all the time. It's like a chemical straightjacket."
"Let me write to the psychiatrist. I'll get back to you as soon as I can."