CHAPTER SEVEN
This section consists of stories of my experiences at 1 Mil which were written in 1987:
"NEED TO KNOW ONLY"
I was seeing a patient in Dr. Andries V.'s office when there was a knock on the door. I opened it to find myself confronted by a Major and a Sergeant Major, both infantry, both with 'parabat' wings on their chests. They were busy with a board of enquiry ['raad van ondersoek'] into a suicide attempt which I had evaluated. Typically, they had left everything until the last minute, and hoped to pressure me into giving them a statement there and then. I was not going to be intimidated, and I knew how to handle the situation. I asked the patient I was busy with to wait outside, and then asked the major if he possessed signed permission from the patient for us to release that information.
No, they had to admit, they had not.
I told them I would have to phone the Registrar of the hospital, Commandant Horn, to ask permission to release the information if they did not have the person's signature. They waited, but I could not get through. I asked them to accompany me while I went down to her office, and they followed, leaving their briefcases in my office. We arrived at Commandant Horn's office, and after a brief wait, she took us in. I told her what the problem was. She soon understood, and placing herself between me and them (to protect me?) she told them that no information could be released until they had obtained the person's signature, and had followed the correct channels.
And then she told me; "And then you write a report - do not give them a printout." So that was that! I had obtained a final ruling from a Commandant, and did not have to feel at all responsible or intimidated. We returned to the office, the Major sullen, and the SM saying things like "Well what if the guy was unconscious..." but he was just unhappy, and I did not have to answer him. They were very 'paraat'; with the SM walking in step, one pace behind the Major.
I was disorientated, and led them out at level 5 instead of level 4, and showed them into the office one level above Dr. V.'s. I opened the door and ushered them into Dave S.'s office, where he and Clive W. were having an argument, and were almost at each other's throats.
The major hesitated, seeing that this was not the office in which he had left his briefcase, but I was outside, urging him on in. Then I saw Dave and Clive, and I think I actually asked them what they were doing in my office, before I realised my mistake. I don't think that major will dare go anywhere near a psychologist again.
THE 'HALF NELSON' STORY
(With Footnotes) 87/04/21Something of an epic story coming up now; something of the 'state of the art' of the work I am doing this year, and my most interesting day as a psychologist this year. There are any number of issues which are touched on here, but lets get on with the story:
A referral to the consultation service arrived at our receptionist from an orthopaedic ward, and their staff were agitated about the patient, and wanted to hand him straight over for us to admit him to a psychiatric ward (1). This is not our function, and they have to keep him until we have seen him and decided what psychiatric intervention - if any - is required.
The information in the consultation was that the 19-year-old National Serviceman had been admitted to their ward 10 days previously after having fallen off a ladder. Their doctors had intended to discharge him the previous day, but had delayed this as he did not have his uniform with which to return to his unit. He had been seen by a psychologist from Department of Medical Psychology, who said she thought he was malingering, and she suggested that he be referred to us for further evaluation. (1)
The patient himself reported having family problems, saying that his parents were divorced (2), and that his father, whom he hadn't seen or a long time was coming to visit him. Next morning, bright and early, he slashed his wrists, and then went into a catatonic state (3), and responded only when a chaplain pricked him with a pin (4).
After tea (5) I went to see the patient. He was lying on a bench in the patient's lounge, huddled up in the foetal position, being watched over by about four medics who had been told not to let him try to kill himself.
Enter Fowler - wonder psychologist! - I called him - no response! I tapped him on the shoulder - no response! Then I started to lift him up, and he went berserk, lashing out. I was ready for this - cowards are careful! - and (surprising myself!) I had him in a Full Nelson wrestling hold almost immediately. One of the medics grabbed his legs, and he was immobilised.
Right, now we've overpowered him (6) - what next? He's stopped struggling. I call for them to bring a wheelchair which arrives, and the medic and I physically manhandle him into a sitting position in the wheelchair. I've still got him in a Full Nelson, and I don't want to release him in case he goes berserk again, so I asked them to get something to tie him into the wheelchair with. He is duly tied into the chair with a sheet around his stomach, and he's gone catatonic again, so I wheel him down to my office (7).
I try to get him to talk to me, but I get no response. After about twenty minutes, and still no response, I conclude that we should admit him to a psychiatric ward. I'm not allowed to authorise this (8), as I am only a psychologist. The doctor was not there, so I went to the Psychiatrist, my Boss, Wimpie, leaving the catatonic patient tied into the wheelchair, in my office.
Dr. Leslie G. (10) was speaking to Wimpie, who was Acting Head of the Department, trying to get him to authorise the discharge of an uncooperative patient because the ward was full, and we needed a spare bed. (I had already found the patient to fill the bed that Les was trying to empty!)
Wimpie can't make decisions, and he was getting bogged down with trying to decide what to authorise with Les's patient, so I stood in the queue in Wimpie's office, awaiting my audience with the great man.
Then I remembered that I had left a suicide risk patient alone in my office (9), so I dashed back upstairs to the office. He hadn't moved, but I rolled him out into the corridor and asked some of our patients to keep an eye on him because he was 'very sick'.
Then I went back down to Wimpie who was delaying making any decisions, and both Les and I were getting agitated, as we couldn't get on with other work until we had resolved our little crises. Wimpie told me to go and get a tray of coffees, which I did. When I returned with it, he immediately pushed both of us out of his office (11), saying that he was just going to see an out-patient for '5' minutes, after which he would give us his undivided attention. (12)
Pushed out, we stood side by side in the corridor, chatting, but not able to work elsewhere until we had resolved our present crises. After twenty-five minutes, Wimpie's patient emerged, but Wimpie did not emerge to call us in. We waited for him - he might just be jotting down notes - but after a quarter of an hour, we barged into his office and found him on the phone, on obviously private matters, (13) advising whoever he was speaking to what to buy so-and-so as a farewell present. We were standing there, breathing down his neck, but that didn't speed him up any.
Eventually the conversation ended, and we had his attention for all of a minute, before someone who had worked with us last year - Retha E., whom he didn't even like - burst in to say 'Hi!, she was back in town!' and Wimpie immediately turned his attention on to her, and asked her about her new job.
At this stage I was exasperated, so I interrupted, and politely asked him to 'bleep' me when he had time, and left.
I went back to my patient, who hadn't moved from where I had left him in the corridor. The nurse came to tell me that he seemed to be tugging at the restraining sheet. He was doing this, but still apparently oblivious of what was going on around him.
I them tried to get hold of the RSM to ask for some medics or guards to help us with him if he became violent, and to get the Social Worker to try to get some background information because we knew virtually nothing about him. There were problems with the switchboard, and I couldn't get through to either of them.
Then I heard the sound of tearing coming from the where I had left the patient. I turned to see that, (still zombie- like) he was tearing his way out of the sheet. I reached him as he had torn through the whole thing, and was starting to get up. (14)
I grabbed hold of him, but I was too late to get a good grip on him, or to force him back into the chair. I did manage to stop him, but he was struggling blindly again.
There were no medics around, so I called to some of the patients to come and help me, speaking rather matter of factly 'I say Chaps, could you possibly come and give me a hand? [ . before this person kills me. I forget I'm a coward!] The big Macho-patients wandered over, and we soon had him overpowered and on the floor.
Les arrived then, and was willing to inject him with Etomine (used as a knock out drug) but he couldn't do that because he wasn't the patient's doctor. In the whole hospital, Wimpie was the only doctor who could authorise that injection. Leaving Les in charge of the patients who were holding my patient down (and he had stopped struggling again), I dashed down to go and fetch Wimpie. It was now more than two hours since I had first tried to get him to take a look at my patient.
Wimpie was sitting at his desk, writing something, and he smiled a greeting as I burst in. I convinced him to come with me, and he was soon staring down at the patient. The other patients were now standing back, keeping a wary eye on the patient.
Wimpie - the wonder psychiatrist! - was now going to take over. (15) He tried to make contact with the patient, as I had done, but with no more success. Then he said that he would leave the patient to decide whether he wanted to speak to us or not (16), and got everyone else to back off for a while, leaving the patient lying on the floor with his head propped up on a pillow.
Wimpie sent me off to phone the medical psychologist who had already seen the patient before he had stopped communicating, and I grabbed the phone from the receptionist's office, and after dialling the number, I leaned in the doorway to watch the patient in the distance. (I didn't want to miss anything!)
As I was standing there, two 'Dankie Tannies' (17) pushed past, pushing trolleys of goodies towards the ward in which all the drama was taking place. They said 'You look as though you're working very hard,'(18) and gave me an Easter egg! I warned them not to go into the ward yet.
I couldn't get through to the psychologist - it was lunch time (5) - so I returned to where the action was; nothing had happened - the patient was still lying on the floor - possibly contemplating Wimpie's ultimatum?
Wimpie decided to inject him with 40 mg Etomine (Les had intending using 120 mg for starters) as part of the 'chemical straight-jacket' we use nowadays. With the help of the other patients, we restrained the patient, and he was given the injection, and 'restrained' until he seemed to be under the influence.
Next step was to move him to the nearest bed - a bad image for the hospital having patients lying around all over the place. Untidy! This is the army, remember. Perhaps if they were all lying in rows ...?
While the five big patients carried him to the bed, he started struggling and lashing about again, and I leaped in again and helped to 'restrain' him further.
We got him on to a bed, (in a 3 bed ward) and restrained him, waiting for the Etomine to knock him out, but he struggled and rested, struggled and rested for another twenty minutes. Another patient I had assessed sat in the same ward, quietly minding his business and carrying on with the jigsaw that he was working on. He seemed totally oblivious to all the activity going on 3 meters away from him.
Something ironic about psychiatry is the way you can be forcibly restraining the patient, while at the same time trying to calm the patient by talking soothingly. You can be saying, "Calm down. You are very tired. Try to rest. We are trying to help you. Relax and let us help you ... (Then the patient starts to struggle, and you shout:) Quick! Grab him! He's fighting!"
Wimpie consented to give another 40 mg Etomine (total = 80 mg) and this also took a while to take effect. During this stage, the patient started to smile and laugh - the first sounds we had yet heard him make. This was not a side effect of the medication, and we were still 'restraining' him, not knowing when he would next start to struggle.
Eventually he did go to sleep, which solved the immediate problem, but we still sat with the problem of what to do with him now, as there were no vacant beds in the ward in which he was at present, so we would have to arrange for him to be transferred over to Ward 24 at the old hospital. The doctor there, Clive W., thought that we were trying to dump (1) the patient on to him, and he put up a bit of a fight.
After a while, Wimpie, who had wandered away was called in to 'officially request' (19) that Clive accept the patient, which Clive reluctantly agreed to. An hour or so later, the patient, still sleeping, was taken over to the old hospital in an ambulance.
I don't know what finally happened with the patient. We handed him over to another psychiatric panel, and they continued with his treatment. Clive W. saw him, and described him as 'objectionable and manipulative' - Clive said that the patient, who was speaking by this time, just sat there in Clive's office, glowering and threatening to try to kill himself again, 'and then we'll all be sorry!'
Two days later he came to excuse himself from attending my early morning running group, for some rather lame excuse. (Pardon the pun!) It was then that I realised how easy it had been for me to control him - I'm a lot bigger than he is. We only had him lying, sitting or struggling, so I didn't realise it at the time.
Our conclusion was that he was faking the whole thing - a good performance, but faking nevertheless.
FOOTNOTES:
(1) A phenomenon called 'batting' or 'turfing', meaning handing over a 'hot potato' for someone else to see. (See 'The House of God' by Samuel Shem)
(2) His parents believe they are happily married we found out later.
(3) Holding rigid body positions, and seeming to be totally unaware of what is going on around him.
(4) This is actually the Doctor's job.
(5) I work for the state.
(6) Shown him who is boss.
(7) The one I happened to be 'squatting' in that day.
(8) I've been reprimanded for showing initiative here, although I haven't broken any rules.
(9) I hate getting blood on my briefcase!
(10) Les is not part of the Psychiatric Consultation Unit, so he couldn't authorise the admission of my patient.
(11) He had listened to my whole story, but I knew that he would get me to repeat the whole thing by the time he felt ready to address himself to my patient's problem. Unfortunately he's the only one with the authority to authorise admissions from our unit, but he is the team member least able to make decisions.
(12) ... And we'd probably have to start explaining from the start again
(13) This is characteristic of Wimpie. He thinks nothing of holding up a whole psychiatric panel (Doctors, Psychologists, Social Workers, Ministers {who hold an elevated position in the SADF} etc.) while he returns phone calls to his mother, consults his lawyer about suing his landlady (See Chapter 5), speaking to his favourite art dealer, or speaking to estate agents about the house he is considering buying. After such protracted conversations, he will say 'I hope I'm not boring you', and then proceed to tell us all about what he has just been speaking of over the phone. And we're supposed to be working!
(14) We don't have straight jackets, any more. This patient was a suicide risk, and had already been violent. He might be psychotic {crazy}, and there was no telling what he would do if he got free. We can't take risks like that.
(15) I secretly hoped that the patient wouldn't just open up to Wimpie, after I'd already struggled so much. One-upmanship!
(16) I felt that the patient had already made himself quite clear on this matter.
(17) 'Thank you aunties', nickname of members of the 'Southern Cross' charity organisation, who arrange for Christmas cake to be sent to the 'Boys on the Border'.
(18) I was frowning with concentration, had sweated through my shirt, and had just been involved in a variation on a wrestling match.
(19) Read: "Order"
LECTURES ON HOMOSEXUALITY
The departments of Psychiatry and Psychology were continually being approached to give lectures to various groups:
THE EXPERT ON GAYS
Last year [1986] I ended up being given the job of running psychological support groups for Gay (Homosexual) National Servicemen who were experiencing difficulties during basic training. Some of them were very pleasant people, but there were plenty whom I found to be incredibly irritating, and I picked up a fair amount of leg-pulling flack at work and in the mess for this - an occupational hazard for psychologists. I don't know if I managed to do anything to help any of them, but I found it interesting, and I saw the group's main function as being to monitor their psychological functioning, and to catch them in time, if any of them looked as though they were going to make a suicide attempt. There are a great number of homosexuals in the general population who are called up for National Service - and they are no longer exempted. We only see those people who have psychiatric-psychological problems as well as sexual identity problems.
I gained the reputation of being the department's 'Expert on Gays', although there are members of the department who are much more expert in the area - from personal experience. But they are discreet.
The upshot of this, as the department's 'Expert on Gays', I have had delegated onto my shoulders the task of going around to certain units to give lectures to various Instructor-Officers training courses, to give lectures on 'What Gay people are,' and 'How to handle Gay people in the army.' [Details of the lecture appear in Chapter 12]
Some officers - and social workers, and even one old psychologist! - think that anyone they identify as being Gay must immediately be referred to the Department of Psychiatry.
We wouldn't be able to cope with this, so we discourage it. If we can prevent referrals at the source we will save ourselves a great deal of unnecessary work later on, so it is in our interest to make these Officers to be aware of these problems.
I gave the same lecture twice in the week proceeding the Easter Weekend. The first were to a group of Medical Services Candidate Officers, some of whom were so rude as to go to sleep during my lecture - and I thought most people found sexual deviations interesting!
I knew that my objective with the lecture had failed when the first question was 'Can we have a smoke break?', the second was 'What should we do if we catch some homosexuals?', and thirdly, 'Could you give us more information about how we can identify these people?' This was after my having told them, 'Leave them alone, or treat them for specific psychological or disciplinary problems.'
One Candidate Officer knew of a gay chap somewhere in the unit, and offered to go and fetch this person for me to have a look at.
I had spent about two and a half hours driving my car to go and give that lecture.
The second lecture was to Air Force Candidate Officers who were generally older and more mature, but the 'class captain' apologised to me in advance that their class had attended a compulsory Formal Dinner the previous night, which had gone on until 5 am, and if any of them drifted off to sleep, it was not because they were disinterested in my lecture, but that they were suffering from a lack of sleep. Quite a lot of them did go off to sleep. They gave me some applause at the end, which - surprisingly - made me feel happier. I didn't mind giving the lectures as much as I thought I would. They were nice simple lectures given to lay people. At the continuing education programme in the Psychology and Psychiatry departments, there is the danger of finding oneself lecturing to an audience that knows more about your topic than you do. That's happened to me before, and it is embarrassing.
SYMPOSIUM ON HOMOSEXUALITY FOR BRIGADIER DIPPENAAR
I was recently given the dubious honour of being invited to be a guest speaker at a symposium on homosexuality run by someone reputed to be the most savage Brigadier in the whole of the Medical Service. Brigadier Dippenaar was the Officer Commanding of Northern Transvaal Medical Command, whose headquarters was located right next to the old buildings of 1 Military Hospital.
The army is rigidly condemnatory of homosexuality, while the Psychology/Psychiatry view is that it is not a problem is the particular person is happy being homosexual. I saw it as an invitation to commit professional suicide in front of 150 assorted high ranking officers. The other speakers were both renown experts in their fields, in their late forties or fifties, and non-military (and as such could say what they liked with impunity).
I told Wimpie that I didn't want to speak at the symposium. He told me that it was a great honour (Thanks a lot!) to have been invited to speak at the symposium, and that our department had only been approached because those who had invited me had believed that our department would produce good speakers. (They could not have been aware of what a disaster one of my lectures was last year).
Then having said this, Wimpie seemed to start enjoying my discomfort. He told me that he was glad he was not in my shoes, and then asked me to try and arrange an invitation to him (that's his way of doing things - do nothing for himself, delegate everything down to his reluctant henchmen). Wimpie had a lot of problems - of which he is blissfully unaware, and he must be the most gossiped about person in the whole department.
Next I appealed to the BOSS, Commandant P., to get me out of the symposium (which shows how important I think Wimpie is). The boss listened sympathetically, and then told me what an honour I had been given, and he instructed me to give the lecture, and to do a good job of it.
I was far more worried about that symposium than I am now [at time of writing] about going to the Border.
Before the lecture, I was summoned for an audience with Brigadier Dippenaar, who told me what content he wanted in the lecture. I wasn't going to argue with him. [I certainly stayed well within the parameters of what he told me, but that could not have cramped my style, or I would have asked Commandant P. what to do about this.]
I did a good job of the lecture, I was told, and I participated on the discussion panel afterwards, to which questions from the floor were addressed. That was where the 'most feared Brigadier' came into his element; walking up and down behind the seated panel, carrying the microphone, commenting on the questions addressed to the panel, handing the microphone to the panel member, and then commenting again on the panel member's answer.
The Brigadier was apparently well pleased with my performance, although he didn't tell me this himself. I was subsequently invited to give two more lectures - less threatening this time - to staff under his command. The office of the chief of the army have now requested a copy of my lecture, via the symposium organiser, who assures me that they are just interested, and not wanting to make trouble.
Wimpie now reckons that they might be wanting my lecture to help update the army policy on homosexuality, and he must now be working out how he can now claim the lion's share of credit for the lecture. Anyway I'll be safely on the Border for three months after they read my lecture. [Maybe they will leave me there!] I don't think I have anything to worry about, but the army breeds paranoia.
After the symposium, Brigadier Dippenaar invited me and the other two guest speakers to lunch with him at the special function room at the SAMS NCOs Mess. One does not dare to consider turning down such an invitation. I put on my best table manners, and (except for eating) kept my mouth shut.
A topic of conversation was national service, especially as the other two guest speakers were civilians. The Brigadier's opinion of this was predictable: "Of course we need national service. Who in their right mind would join the army to be a rifleman?" Some countries manage!
I believe that Brigadier Dippenaar's house had been damaged in the mortar attack on Voortrekkerhoogte whenever that was, some time in the early 80's.
The Department of Clinical Psychology was approached by a psychologist from the Department of Prisons, who wanted us to work with him in developing ways of identifying homosexuals by using psychometric tests, as they were having 'problems' with prison warders who were homosexuals. I don't remember the details, but we decided very firmly not to participate in such a study.
In the last months of 1987, I gave a lecture on 'Suicide' at a supplies unit. It seemed that I had to organise my own transport, though when I arrived there, I was told; 'Oh, If we'd known it was a problem, we would have sent a driver for you.' The OC, who attended the lecture, was of Portuguese origin, which was a novelty in the SADF. The lecture went well, and if I remember correctly, I alternated between English and Afrikaans in my presentation. Afterward, he had a chat with me about suicide risk, and we discussed the irony of having the bravest and fittest in the front line, whole those least capable stay at home and produce future generations. This has been said about the 'Battle of Britain'; where the cream of Britain's youth became fighter pilots, with an expected combat life span of some hours. ("Their finest hours?")
FEAR OF LIBRARIANS
I developed a fear of librarians. (I see this causing conflict in the family, what with my sister being a librarian.) I developed this phobia in the medical library of 1 Military hospital, and I notice that I avoid spending spare moments there because of the librarians. There are two of them, and they both know that I am a psychologist. They see me browsing, and come over to chat - whether I want to chat to them or not.
One of them was becoming quite insistent that I refer patients to her for 'bibliotherapy' which seems to be that she will give them a novel to read about someone who had a problem similar to the patient's, which will inspire them to overcome their problems in a similar way. I don't believe there are enough such books, and most of the books I have read about people with psychological problems either say how good the psychologist was - when written by the psychologist - or say what a bunch of idiots medical and related professionals are.
I dashed into the library to trace a journal article the other day, and one of the librarians pounced on me. She said that she had a psychological problem because she had accidentally put on non-matching socks while dressing that morning, and she wanted a solution. I laughed cordially, and dived into the journals. On my way out, she blocked my way, and said that I couldn't go because I hadn't given her a solution. What about a frontal lobotomy? Now I avoid the library.
NOT WHAT YOU KNOW, BUT WHO YOU KNOW
Ex-P.F.C. Myrtle the Turtle. The Officer Commanding the hospital has a secretary whom he describes as 'the best secretary in the world'. She probably told him she was! She is the real life equivalent of Ex-P.F.C. Wintergreen from Joseph Heller's 'Catch 22'. She is "The Right People", and it helps to stay in her good books. She collects little china frogs, and the way to her heart is to keep on giving her little china frogs.
Wimpie, the psychiatrist I work for, makes sure that he stays in the best books with the right people, and probably has an account with Little Green Frogs (Pty.) Ltd. Her name is Myrtle B., nicknamed 'Myrtle the Turtle' by one of the doctors, because of her interest in amphibious creatures.
Recently the O.C. phoned my friend Fred the Vet, and mentioned Mrs. Turtle's desire to have her cat spayed, and could he see his way clear to performing the operation for him, as a favour? Very often in the past I have assisted Fred with spayings of private pets, like last Sunday, but I thought that there might be people who would be prepared to pay vast sums of money to assist with the spayings of "The Right People"'s cat. Like Wimpie perhaps, who spent seven years becoming a medical doctor before doing his four years specialisation to become a specialist. He is qualified to perform operations himself, but only on humans. With my friends in Ward 9, amongst whom Wimpie is a constant topic of gossip, we wondered how much we should charge Wimpie for the privilege of assisting with the spaying of "The Right People"'s cat. We decided that three thousand rand would not be unreasonable.
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