CHAPTER FIVE
MY MOVE OVER TO THE NEW HOSPITAL IN 1987
I continue to work at 1 Military Hospital, but I've been promoted to being THE Psychologist for the 'Consultation firm', which is where patients from other wards in the hospital are referred if it is suspected that there might be psychological or psychiatric factors involved.
I like the sound of it as it is exciting crisis- intervention work. I get a 'bleeper' which makes one look important. I won't be doing much long-term therapy, which can drag; seeing the same old patient week after week, without there being any improvement. I will also be working at both the new hospital and the old hospital, and the Officers Club is between them, so I can drop in for tea, if I choose.
I'm not sure whether I'll keep my old office at the old hospital, or whether I'll keep my present room in the mess, but I'll be doing interesting work with people I know fairly well - the job description I have been given is much better than I expected - I thought I would end up being the shrink on the neurotic women's ward. I'm really very chuffed!
Although I don't have an office, and I don't have a telephone, so I live out of my briefcase, and seize any available writing space to scribble off my reports (Its actually very exciting working like that).
Although more than two thirds of the patients I have seen in January were referred after suicide attempts, I am finding the work very exciting and interesting. This is what Psychiatry - the traditional home of psychology - is all about.
I am also getting exposure to more types of people than last year, when I worked mainly with National Servicemen, and of these, most just felt that they 'couldn't handle the army'. I am seeing more middle aged people this year, both men and women, although I am still seeing a fair number of National Servicemen.
THE PSYCHIATRIC CONSULTATION TEAM (1987)
I evaluate the patients, in co-ordination with a psychiatrist, a doctor and a social worker, and we decide what treatment (if any) the patient needs, and then we refer the patient elsewhere in the Department of Psychiatry.
COMMANDANT "WIMPIE"
Commandant "Wimpie" was the Consultant in charge of the Psychiatric Consultation Service. In the material that follows, he will appear to be a figure of fun, but I have to state that I did like him, but as time wore on I found him more and more frustrating to work with. He was a brilliant man, academically, and he was also very kind; when I had to take my car in for a service, he offered and came to collect me from the garage, which was on the other side of Pretoria from where he lived. I liked him as a person, and respected his knowledge, but he was difficult to work for.
Wimpie was small, which I think made him a target for 'little man complex'-type comments. He looked boyish, and would have looked more so if he had not grown a rather colourless moustache. He bore a passing resemblance to Paul Simon, of `Gracelands' fame..
An early impression:
"Wimpie has a reputation of never being able to make a decision, but we haven't had any problems with him this year (we present our cases; 'This is what I think of the patient, and' - hurriedly added - 'this is what I think we should do with him' - no place for tedious non-decision making.)
"Wimpie is making a very determined and successful effort to make us into a team, and he commends us on work well done - which everyone must find encouraging. He also knows a great deal, and he shares this with us - 'I know something that I found interesting and I want to tell you about it' - which he makes very interesting, and we learn a lot from him."
"Wimpie wanted to have a psychologist just for the Consultation service throughout last year, and now he's got me, and all the feedback that I am getting from him is positive. I enjoy working with this team."
Compared with a note made some five months later:
"Wimpie, has been getting on my nerves a lot lately - not doing his share of the work, and always being afraid to take the decisions which his position demands him to take. If I wasn't going to the Border, I would be 'rotated' back to the old hospital, to do the same kind of work that I had been doing last year for the next six months."
Wimpie was, sadly, notorious, and apparently there were people who had refused to work with him. Most people that I expressed my frustrations to seemed to understand. It wasn't just me; consensual validation suggested that Wimpie was a difficult person to work for.
Wimpie always tries to avoid making decisions, and refers most of the patients we see on for further evaluation, which irritates me greatly, as I feel that most of them need no further observation. He is a very irritating person to work with, but a pleasant friendly human being when you do not have to.
I think that part of Wimpie's lack of decisiveness was based on the idea that everyone has problems, and that it would be wrong to say that there was nothing wrong with a particular person. To conclude that a person didn't have problems just meant that you hadn't looked hard enough. I think he felt too insecure to commit himself to making a professional decision - what he was paid to do!
I often get so irritated with him that I have to go to other sympathetic psychologists or doctors, and unleash my feelings by admitting that 'I'm going to hit him! I'm going to hit him!' Over an extended tea break, I fantasised with like-thinking professionals about phoning him, waiting for him to answer, and then snarling savagely and then putting the phone down.
He's naturally paranoid, so it would be fun to watch him after that. We're daring each other to do it, because we all want to be in his office when he received the snarl-call. It should be good to watch.
"He will see that something is worrying you," Johan T. points out, "and he will push you to tell him what your problem is. If you tell him - it doesn't matter what your problem is - he'll tell you that he's got an even bigger one." I recognised what Johan was talking about, and I've found that I notice that he does this every time.
Wimpie asked Dave S., in the lift at 1 Mil, what Dave suggested he should do that night. Should he go out to a restaurant and then on to a movie, or should he stay at home and drink a good bottle of wine? Dave did some quick thinking and realised that if he recommended the night out he might be asked to recommend a restaurant and then a movie. He advised Wimpie to stay at home with that bottle of wine.
But Wimpie was not going to let Dave off so easily; "Which wine would you recommend?" he asked.
As a psychologist, I had to keep notes of all the patients that I saw, and these notes were typed on to the military hospital computer network. The number of such reports could be extracted from the computer, and could serve as an indicator of how hard a particular member of staff was working. Wimpie felt that any patients I saw should be credited to him, as I worked under him, and I came across cases where he had taken my hand-written report, and crossed my name out, and written his in. This was very unprofessional of him. He was supposed to write his own notes.
In 1987 the department of psychiatry had an afternoon off as a team building exercise, and we went to 'Waterworld' at Verwoerdburgstad, a nearby suburb of Pretoria. This place had all sorts of aquatic entertainments, including a pool with an artificial wave maker.
Marius's joke; 'Did you hear about the person who swam too far out at Waterworld and got run over by a passing car?"
Wimpie became strange about this, and with a wicked glint in his eye, he said that Commandant P. had decreed that all the men had to wear 'speedo' swimming costumes. On the actual day, Wimpie did not arrive.
Wimpie was single, and lived with his mother, or she lived with him. He seemed to be preoccupied with conflicts with his neighbours, which got so nasty which solicitors became involved. Wimpie would recount these exploits to us, eating into the time we had allocated for the psychiatric panel. He would also accept lengthy telephone calls from his mother, and would sometimes keep the whole psychiatric panel - and sometimes a patient - waiting while he had such a conversation.
Taking telephone messages for Wimpie involved a lot of work. On a number of occasions, he would quiz me about whether the person had sounded 'angry' or 'okay'.
One day Wimpie was listening to his tape of 'Phantom of the Opera' on his Walkman. He delayed the panel while insisting that we all take it in turns to listen to a particular piece.
Wimpie delayed another panel by warned us about a film called 'Blue Velvet' (David Lynch, 1986) which he had taken his mother to see the previous night. In his opinion it should be banned because it contained elements of sado- masochism, necrophillia and "Various Other Perversions". The rest of the panel went that evening to see 'Blue Velvet', just in case it was banned!
Wimpie's trick reported to me by Dave; when you were pinned down in some boring conversation from which one could not escape, there was a way of getting one's bleeper to go off, so that one could dash off to go and answer the supposed 'urgent' phone call for which one had just been summoned. The way to do it was to push in the 'squelch' button, as this action served to get the beeper to magnify all calls being sent, not just those directed to your bleeper. You could watch other people trapped in conversations, frantically pushing in the squelch buttons of their bleepers in the hope of rescue. What if one was in a tedious conversation with someone who might know the same trick? Would you risk doing it?
MICKEY MOUSE AND THE BLUE BULL
We had a particularly extraverted woman admitted to Ward 5. She had an alcohol problem, but was certainly one of the most entertaining patients we have had on the ward. She made up nicknames for all the staff. I learned about this as follows:
Wimpie called me into his office, and in hushed tones asked me how I handle 'shocks'. I told him 'very badly!', and that I don't like surprises, and that I would rather remain ignorant of something if I can get by without knowing about it. (I didn't know what on earth he was talking about, and I don't know how he expected me to react.)
Then he told me that it wasn't too bad, and that the patients had been sitting chatting, and had thought out nicknames for the three males on the team; and he warned me that I might be shocked at my nickname. Watching me, and virtually monitoring my pulse and blood pressure, he told me that my nickname was 'The Blue Bull', which he hastened - still watching me like a hawk - to explain was because I wear blue clothes when I'm not in uniform, and because of my big chest and shoulders. (The 'Blue Bulls' are the nickname of Pretoria's rugby team, so its quite a compliment. I don't mind it at all)
Andries, the Doctor, is 'Slow Joe' because he is very quiet and walks very slowly, and his face is always expressionless. He admits to having a 'schizoid' personality.
Lastly Wimpie admitted that his nickname was 'Mickey Mouse - "Why on earth would they want to call me 'Mickey Mouse'?" he asks me, watching hawk-like, feeling my pulse and measuring my blood pressure.
"I have no idea," I lied. "Mickey Mouse the psychiatrist" - it fits him down to a T! I like him, so its not criticism, but 'Mickey Mouse' is the best nickname I could think of for him, but he has absolutely no idea why. Now Mariaan, the Social Worker, and I refer to him as 'Mickey' behind his back!
I overheard Wimpie trying to explain to someone else his theory about why the patients call him 'Mickey Mouse'. He said that patients believe that he plays 'Cat and Mouse' with them. I hope he believes that. No one else does!
Sadly, I don't think Wimpie ever understood why people became so upset with him. I am sure he thought he was friendly and supportive, and this was partly true. He would have probably managed with people who were dependent on him, not advocating decisions that he was too insecure to take. I believe that Wimpie left the army in 1988.
POSTSCRIPT (1997): I understand that `Wimpie' committed suicide on Sunday 6 July 1997. He had apparently been suffering from depression for some time. He was forty years old. Tempted as I have been, I have not altered the material that I had written about him seven years before he died.
CAPTAIN ANDRIES V.
Andries V., the medical doctor who works in the four- person psychiatric consultation unit. He describes himself as being 'lazy', but he seems to be totally immune to people around him - he doesn't mind them, but he doesn't need them, and he won't be affected by them. These are some of the characteristics of a 'schizoid' personality.
He is married to a kindergarten teacher, and they have two young daughters. Andries makes comments to the effect that he liked children until he had his own, but now he doesn't like them any more. He says that his wife gets upset when he says things like that - he could use a little more tact!
Anyway, his wife packs him a lunch box to bring along to work each day, and being sleepy first thing each morning, she sets out his lunch box along side the girls', and puts the same things into each. This results in him arriving at work with all sorts of childish food in his lunch box, biscuits etc. - he doesn't get a bottle of cooldrink, but that is the only difference. Andries doesn't mind. He says he likes biscuits anyway.
MARIAAN, THE SOCIAL WORKER
Mariaan was the social worker assigned to the Psychiatric Consultation Team, amongst assorted other time consuming activities, as appears to be the lot of social workers.
She was rather timid, but a very hard worker, and eager to please. Naas mixed with her socially once or twice, and said that on her home ground she became fairly demanding, asking him to fix things for her.
I spent many hours in her company, waiting while Wimpie sorted out his mother's life over the telephone, but I can't remember many anecdotes to tell about her.
LIEUTENANT LESLIE K.
Les seemed to alternate with Andries V. in the role of being the medical officer on Ward 5, and on the Psychiatric Consultation Team. Les was a great chap, but it takes a long time to get to know him. He tries very hard to create the impression that he is bitter and twisted, and determined to be miserable in spite of all the friendship and warmth amongst the staff. He speaks softly, and mumbles between tight lips.
We can all see through his facade, but he works hard to maintain it. He says that he doesn't have friends because no-one deserves to be burdened with his friendship, etc. - but he is an excellent Doctor, and we get on very well.
I was writing up my notes on a corner of his desk when his phone rang. In a playful mood, I answered (in Afrikaans) and announced that I was Dr. K.'s secretary. This was too much for Les (and his impression of total misery) and he started to shake with laughter. This was contagious, and I wanted to laugh as well, but there was another doctor on the phone, wanting to refer a suicide attempt to us. And there we are, both trying semi-successfully to suppress giggles. Not very professional behaviour, and I'm going to be more careful in future. But psychologists and psychiatrists are supposed to be mad themselves, aren't they?
Les had a healthy cynicism about psychometric testing. Apparently he had done an IQ test at school which indicated that he was of low-average or average intelligence. He was a qualified medical doctor, intending to specialise when he finished with the army. "I'm an incredible over-achiever," he explained.
Les was supportive of me, and some of the teething problems that I had in liasing with non-psychiatric nurses. I picked up some heavy flack from one when I reported back that there was no psychiatric diagnosis to be found in a patient referred from her ward; "I can see that there's something wrong with this boy. If you can't see it, we should take your qualifications away from you." Les consoled me, saying that there were many nurses around, who feel that it is their job to 'train doctors'. I was just getting this kind of treatment.
Les recently had difficulties interviewing the parents of one of his patients. He asked them how they had coped with their son's first suicide attempt, which created a problem as they had not known about this suicide attempt. Les's second question was how long had they been aware that their son was a drug addict? It was not difficult to find out the answer to that question. The first time they had become aware that their son was a drug addict was when Dr. Les K. asked them when they had become aware that their son was a drug addict. After that Les had to spend an hour and a half helping them to come to terms with these new insights into their son.
Dolf, Head of Clinical psychology, commented about Leslie K.; "He's a little Jew ['Joodtjie'] but he certainly knows his stuff". I wouldn't have thought the two aspects were mutually exclusive.
LIEUTENANT LEIGH J.
Leigh J., was a camper psychiatrist, who was normally one of the teaching staff of the University of the Witwatersrand medical school, and, according to Les K., he was an accepted expert in his field.
Wimpie was the section head, but now he had, structurally under him, someone who was better qualified, and infinitely more self-confident. Wimpie felt very threatened.
I learned a great deal from Leigh in the month of his camp. He was very interesting to talk to. I remember him saying that "at present the state of the art of psychiatric medication is like using bulldozers to swat flies!"
INEVITABLE CONFLICT BETWEEN CONSULTATION AND PSYCHOLOGY
Wimpie's lack of decisiveness meant that we had to refer many of the patients we assessed on to psychiatric wards for 'further assessment and or treatment'. This referral on usually meant to Ward 24, where there was more space and more personnel - certainly regarding psychologists.
The distance between the two hospitals meant that there was ample opportunity for a breakdown in communication:
"Psychology staff at the Old Hospital complained that patients were being referred on to them without a treatment plan. Weren't they supposed to be professionals able to decide on treatment plans themselves - I was tempted, at the end of the next referral, to refer them to the most elementary text book on therapy that I could think of. The channels of communication were flushed, and the situation was resolved."
I wrote detailed histories on all the patients I assessed, which was the vast majority of patients who were referred to the Psychiatric Consultation Service. At first I would conduct the interview without writing notes, and write them up afterwards - I have a good memory - but then I found it was a time-saver, and common practise to make notes during the interview.
My notes would then be placed with recommendations of the psychiatric panel in the patients' notes in the Ward from which they had been referred, where their ward secretaries would eventually type them on to the hospital computer.
Where the problem probably arose was that the psychologists who picked up the referrals didn't look at the patient notes in the ward, or failed to request a computer print out on the patient.
But the situation was resolved, and I never heard any more about it.
POSITIVE FEEDBACK FOR ME
Dave S. says that Commandant P., the Head of Department must have a high opinion of me - I think that he hardly knows me - because, Dave points out, the nature of my work brings me into contact with staff of other departments more than any other member of the department. (I only see patients who are lying in wards other than psychiatric.) Dave says that my job is an important one of public relations, and that I would be seen by other departments as representing the Psychiatry Department, and the Commandant would not allow just anyone that responsibility. I won't argue. Let me just bask in the compliment!
During my first six months working on the Psychiatric Consultancy Service, before going to the Border, I had contact with a wide range of doctors, with whom I would not have made contact if I had other work. One advantage of this was that I arrived on the Border to find two doctors that I knew well would be working and living with me at Oshakati for more than two thirds of my stay there.
One doctor from internal medicine had a reputation for being socially inept to the extent of being rude to people. He referred quite a few patients to the consultation team, and I was always friendly to him, in spite of his surly manner. I noticed that he became less surly with me, and even learned my name. Before going to the Border, I went around to the different departments from which patients were referred to the consultation team to say goodbye - and also to protect my reputation, in case the person chosen to take my place did not take the work as seriously as I did. I didn't want anyone to think that I was still around, but just slacking off!
I said goodbye to this doctor, Hendrik, and wished him well. He took an interest in where I was going, and said that he hoped I would come back to the consultation team when my Border duty had finished, as he said 'I can work with you'. Quite a compliment, indeed.
After my return from the Border, Hendrik asked me if I had a private practise as well as my army job - this is allowed if permission is given. I told him 'no'. He said that this was a pity as he had a private patient whom he would have liked to have referred to me. I took that as quite a compliment, especially in the context of who had paid it to me.
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