She had tried gassing herself in her garage, using her car. Her neighbours had broken in to find her semiconscious.
She had taken three overdoses, each attempt more potentially lethal than the last. She began with Prozac, then paracetamol and finally tricyclic antidepressants, which have a rather nasty habit of affecting the heart rhythm.
She had cut her wrists a couple of times and been found again by her neighbours. I wouldnt have been surprised if her neighbours ended up admitting themselves.
She had also hanged herself twice. The last attempt while an inpatient in our unit. She was on the spotter list and she was found to be missing (thankfully, I was not on spotter duty at the time).
It was nine oclock at night and pitch black outside; everyone just hoped that she was somewhere inside, otherwise there would be no chance of finding her. As we raced around the unit searching, I heard a scream, followed by yells for help coming from the bathroom.
Its horrifying, but curiously amazing, what people manage to hang themselves on. This patient had managed to hang herself from a door handle, with the use of a shoe lace. The door handle attempt worked and she died. The nurse looking after her that shift was not blamed, but The System was. The System let her down and subsequently more stringent regulations were put into effect, to prevent this happening again, or so Ive been told.
Someone who has made eight pretty good attempts on their life is eventually going to get it right. She was on a five-minute watch, but if someone can be so inventive in their determination to kill themselves, then no matter what safeguards we put in place they would find a way around them.
Mr Townsend
Despite the tragedies I was fascinated by mental health. My colleagues back in the medical ward or real nursing world, as they liked to consider it continued to think I was mad for doing what I was doing. In some respects I could understand their position.
It wasnt real work as they knew it. There were no patients to wash, no wounds to dress, no one to rush to theatre. Instead of the physical things I had previously considered to be the biggest part of nursing, I was learning to listen.
Whats wrong, Mr Townsend? I asked.
Mr Townsend was sitting on his bed with his head in his hands, rocking back and forth.
Im sick of fighting them, he said as he pulled his hands away, wiping the moisture from the corner of his eyes.
What have they said this time? I asked.
I had been instructed that this was the wrong thing to say. Delving into peoples delusions only reinforces them, but sometimes you need to understand what youre dealing with. Personally I think its a balancing act; you need to know enough about whats troubling them to help them, yet at the same time not to dig too deep, or too often.
At 55, Mr Townsend had spent over 30 years wrestling with the voices in his head.
They want me to put a fork in the electrical socket I dont want to do it. I just want them to stop, he pleaded.
Ive seen people survive electrical shocks, but not always and it certainly has to be one of the more unpleasant ways to die. I imagined Mr Townsend with a piece of cutlery in the plug hole, his body convulsing as the current surged through him, his hand turning black and smoke rising from his flesh.
Do you want some more meds? I asked.
Please, he begged.
I went and got him something to relax him. The treatment never got rid of the voices, just moved them into the background a bit, where he was able to ignore them for a while. If it wasnt the electrical socket, it was some other way for Mr Townsend to hurt or kill himself.
Mr Townsend seemed to spend as much time in hospital as out. He was a familiar face in the ward, and his delusions usually had the same theme. They generally involved voices telling him to hurt himself in one way or another. As far Im aware, his voices never told him to hurt anyone else, although you can never be sure.
Once, when Mr Townsend had been reasonably lucid, he had explained that he knew he shouldnt do the things the voices said, but sometimes he got confused as to what was real and what was not. Mr Townsend said that by talking to the nurses, it helped distract him from the voices in his head.
Dans demons
Out of all the madness and chaos that became an everyday part of the job, there was one patient who stood out from the rest. Dan was 16, the youngest patient in the ward, and also one of the saddest cases I had ever seen. Dan lived somewhere else, and it took me four months to get a glimpse of that world.
Dan spent much of his day walking up and down the length of the corridor, on autopilot, smiling to himself. His was almost a caricature of an insane smile, devoid of warmth or humour. Sometimes he would even laugh for a brief second, then quickly stifle it if he realised that he had been heard.
For my first few months in the ward, Dan wouldnt speak to me. When Id say hello, he would just walk on as if he hadnt heard a thing. There were a couple of times when his eyes would lock on to mine, but I didnt like it when he stared at me. His pupils were always so big, as if struggling to cope with all that they were seeing. When I looked into his eyes, it was sometimes hard to see anything human in there; other times, all I could see was a suffering kid. Even when he stared, he didnt really seem to see me; he was distracted, frightened and alone.
All I knew about Dans family history was that he was the youngest of nine children, from the poorest part of our town. He had done what a lot of pre-adolescent children did in that neighbourhood, and began smoking marijuana when he was 12. The doctors believed Dan may have begun to hear voices from as young as 14, although he wasnt officially diagnosed with schizophrenia until he was 15. At the start he only heard voices when he smoked a joint. Then as his use increased, so did the frequency and severity of his symptoms. To me, it didnt take a scientific genius to see the link between Dans smoking and his illness.
It took Dan a long time to work up the courage to talk to me; he must have been pretty suspicious of me, as I was a new face and probably a threat to him, at least in his mind. Our first conversation came about in a rather unexpected way.
What the fuck are you looking at?
Okay, it may not sound like much of a conversation, but it was genuinely the first time he had spoken to me. The ice had been broken and things rapidly warmed between us. Subsequent conversations extended to, Hello and Goodbye.
I soon realised I would never be able to have an even remotely normal conversation with Dan. He was constantly trying to cope with at least two conversations at once. His mind would wander from one topic to the next, unable to focus for too long on anything I said. The only thing he could focus on were the demons in his head and those sitting beside me.
As Dan gradually became more comfortable with my presence, he began to trust me. One day he decided to open up completely with me. It was as if a switch had been flicked inside his head I was no longer an outsider, no longer someone to be feared, instead I had become a small part of his world, like a piece of furniture that he was now comfortable using.
Theres a black demon sitting next to you, he told me. Hes got red eyes. He says youre a fucking cunt.
I glanced briefly over my left then right shoulder, knowing Id see nothing, but unable to help myself. Despite our instructions not to question people about their delusions, I couldnt help myself asking what this demon was saying about me.
Kiss my arse, fuck-head; youre going to burn in hell. He wants me to punch you in the head.
I had to remind myself that Dan was just repeating what the demon had said to him. Dan was smiling that humourless smile.
I felt vulnerable, sitting there facing a truly psychotic patient. I had goosebumps on my arms. I had an awful thought, imagining that what Dan could see was real, and it was I who was unable to see what was really there. But such thoughts are too scary to contemplate; at this rate I would be admitting myself as a patient.
As Dans trust in me grew, I thought I would put it to good use. Over the past couple of weeks, I had been getting patients to join in activities outside of the building. It was nothing special, just kicking a football around, but it made a welcome break from sitting in the lounge watching television a television that was probably broadcasting secret messages into everyones head plus the patients seemed to love it.
Dan had not been outside the unit in over three months. He was scared of something.
I got him as far as the door before he had a change of mind.
I dont want to play. Football is a stupid game, he said.
Why dont you try standing by the doorway? I suggested. If I could get him outside I felt sure I could get him to eventually join in. You dont have to play, just watch. You can always go back inside if you dont like it.
Dan reluctantly followed me out. Many of the staff came out as well, just to see for themselves that Dan had made it outside.
At first Dan stood by the door, watching everyone else kick the ball around, when suddenly he just bolted, straight out into the middle of the field, straight after the football. He wasnt interested in choosing sides; he just wanted the ball for himself. No matter who had the ball, he went after them. Dan laughed the first genuine, normal laugh anyone had heard from him. I could see patients and staff alike affected; we were all grinning from ear to ear.
But the next day Dan would not come outside; he wouldnt even get out of bed. He lay curled up in his blankets, the sheet wrapped around his head with only a tiny gap where I could see two eyes staring out at me. Those eyes showed absolute terror.
Theyre going to get me, Dan said by way of welcome.
Whos going to get you, Dan? Whats going to get you?
Stupid of me. Id just strengthened his delusion; I should have said No one is going to get you. I needed to think before I spoke. I did get an answer.
The dogs are going to get me! I can hear them outside, barking, snarling; waiting for me.
I tried to persuade him to at least get out of bed.
We wont go outside. Well just get out of bed. The dogs are outside, not inside.
I silently berated myself; I kept saying the wrong thing. Id just reinforced his belief that the dogs were outside. I meant well but I knew I was causing more harm than good.