A few weeks into the psychiatry placement and things were beginning to become more familiar.  The nerves that had been present when first meeting a patient had all but vanished, the unpredictable behavioural patterns no longer the threat that they had once seemingly posed.

A large man paced the corridor outside the office, dressed in full tracksuit with black hood raised, shouting on occasion.  These shouts consisted of no words, merely noise, a transparent attempt to intimidate the staff and patients.  The attempts of a man that had never and would never act on this fabricated rage.  Other patients milled around the ward seemingly oblivious to the paroxysmal din, all of them watched carefully from behind the gleaming panes of glass that separated the staff from the patients.  The sane from the insane.

The days fell into a routine.  A dull, monotonous routine consisting of lie ins and excessive amounts of sleep, of unnecessary waiting for consultants and patients and whatever the fuck else may have caused the delay.  Of minimal involvement in long, meaningful conversations, the focus instead being on remaining awake in the comforting warmth of various side-rooms having had a lunch break of comical duration that provided plenty of time to fixate on the thought of departing the ward early.

There were undeniably worse situations to find oneself in, but in spite of all the relaxation and free time psych placement was becoming increasingly tedious, the slow pace of the days not conducive to efficient learning.

Regardless, the individual conversations with patients still proved bewildering more often than not and helped to maintain some level of interest.  Audrey was a character that required a particularly high level of alertness in conversation.  She was in fact one of the very first patients with a psychiatric illness that I had encountered, and our meeting had been a somewhat unusual experience.

“Morning, Mrs Watson”.

“Good morning!  Please, call me Audrey.”

All good so far.  Nothing abnormal to report.

“And how are you today?”

“Very well thank you.  And yourself?”

Hmm.  Still nothing to report.  Were they sure she had bipolar disorder?  Surely by this point she should be attempting to climb the walls.

Our dialogue continued in a perfectly normal fashion for some time.  This must have been the wrong patient.  That or some twisted practical joke by the nurses at my expense.  Unsurprisingly, this normality was not to last.

During a mental state examination it is important to enquire about visual and auditory hallucinations while remaining sensitive about the matter.  “Have you ever seen or heard anything that other people might not have been able to see or hear?” is drastically more subtle and polite than a simple – “Are you hallucinating?”

“So are you hallucinating?” queried my placement partner.

Audrey hesitated for a moment before erupting into a seemingly endless onslaught of verbal diarrhoea.

“Well I suppose there’s the lights that are outside in the evenings and they start over there these bright white lights and they flash across the garden in beams I think it’s probably aliens but anyway so I have to tell Jesus and also Paul Daniels, you know the magician you must know him he’s a good friend of mine and then there’s all this business with the Queen because I’m an informant and I wouldn’t expect you to understand because of your inferior intellect but I’m an informant see and I’ve been nominated to remain politically neutral there’s only a handful of us left actually…”

Despite the dreadful attempts of two medical students to conceal their surprise, she continued unwavering.  At this point I happened to cross my legs.

“… but I do want to be here why did you do that you just crossed your legs I’m just trying to work out what that signifies you’re not uncomfortable are you am I making you uncomfortable or nervous even because that’s not…”

The stream continued.  It was almost comical.  Almost.  Such an outburst did raise a number of questions, the principal one being – was she serious?  Two medical students with no experience in psychiatry seemed like the ideal targets for a practical joke.  The perfect opportunity to invent as far-fetched a story as possible, augmenting every aspect of her bipolar disorder to provide some light relief from the monotonous routine of the ward.

In retrospect it is blindingly obvious that this outpouring was genuine, although at the time deciphering this had proved a little more complex.  Audrey had done well.  Her façade had held firm for more than long enough to warrant some doubt, but it had, as always, come tumbling down in typical, spectacular fashion.

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