Psychiatry, the Crossroads of Dead Ends
Translation: Isabelle Aubert-Baudron,
corrected by Jill Fryer (1st Dec. 2003)
He arrived one afternoon after a brief stint in the cardiology ward. He had lived for several years in an retirement home. The director of this place had asked some time before that he be followed up by the staff of the psychiatric ward over some troublesome behavior which he attributed to a persecution complex: Mr. Lambkin accused him, as well as one of the nurses, of withdrawing money from his savings account. However some visits from a male nurse and the treatment given to him did not modify by one iota his so-called troublesome behavior and Mr. Lamb persisted in his charges with some virulence and so the doctor in charge of the retirement home had requested that he be hospitalized.
Mr. Lambkin was ninety-four years of age. He was a small man, only about a meter and a half tall, bald and frail. He was always well turned out: he wore a spotless cream suit and supported himself with a cane with a pommel of carved ivory. On his arrival at our psychiatric ward he greeted all the members of staff present in the office with a smile and shook hands with everyone. Then a male nurse accompanied him to his room and after he had put his things away he came and installed himself in the dining room in front of the television set.
Shortly before dinner he knocked at the office door and showing much irritation he said: « Tell me what’s going on! I don’t understand. I was told I was being hospitalized for medical treatment but that is not what this place is for. I am in the midst of these poor mad people. » He indicated with his cane towards a little man with a head like a sugar loaf who used to chew cigarette butts and, for the fiftieth time was offering his hand, the fingers of which were covered in the brown saliva he used to wipe off his lower lip. Someone replied to Mr. Lambkin that the ward for medical treatment was full at the moment and he had been assigned to the psychiatric ward for a few days while waiting for a bed to become available. This explanation seemed to satisfy him. He went around telling people about his concerns about the director of his usual residence whom he suspected had been stealing from him, adding that he kept track of his bank accounts, and had indeed done so all his life, having worked as an accountant in the public (civil) service.
Some days passed uneventfully. Mr. Lambkin was notable for his courteous treatment of everyone. He became friendly with an elderly Armenian lady and they spent long periods sitting together exchanging reminiscences. He was happy to participate in any of the little entertainments organized in the ward, reciting some poems he had written to his sweetheart when he was young and telling some amusing anecdotes.
On his second day of hospitalization his room at the retirement home was taken over by someone else. After six days nothing in his behavior could justify him remaining in the psychiatric ward and the doctor declared that he should be released but first it was necessary that he, with the backing of the town doctor attached to this place, should approach the director of the retirement home about Mr. Lambkin repossessing his room. The state of affairs there was not typical, this retirement home was amongst the best in the area: residents, most of them comfortably well-off, had their own apartments with their own furniture, a small kitchen and private bathroom. The building was light and well ventilated and had nothing in common with some of those sinister buildings from the previous century where old people were stuck in vast dormitories from one year to the next with no hope of leaving other than feet first.
The director accepted the fact that he would have to take Mr. Lambkin back with very bad grace after having obtained a guarantee that if there were any more problems he would be taken back to the hospital. A male nurse was assigned to visit him regularly but two weeks later he was still accusing the director of robbing him and the director was still complaining about the insanity of his client. At last the director managed to get him certified and hospitalized when Mr. Lambkin had attempted to leave the place, pretending, the director said, that someone there was trying to poison him.
Mr. Lambkin arrived back at the psychiatric unit anxious and agitated. He was reinstated in the room he had left three weeks before and found his place in the dining room besides the elderly Armenian lady who welcomed him warmly. Some days went by and Mr. Lambkin asked to be able to manage his own affairs. He expressed his dissatisfaction at being hospitalized again, saying that the director of the retirement home wanted to get rid of him and accusing the doctor here of working hand in glove with him by agreeing to take him. As before his room at the retirement home was reassigned which confirmed his suspicions. Having no family to assist him he had decided to do what he could to leave, take charge of his own business and get the welfare officer and doctor to find a place for him in another retirement home. His furniture and personal objects were transferred to the hospital. His bank book appeared to have been lost but it finally turned up: the director of the residence said that he had possession of it and would return it soon.
Mr. Lambkin’s general condition began to deteriorate. He wrote to the doctor, asking for his assistance. No other accommodation could be found in any of the surrounding residence and this added to his anxiety. He was eating very little and was getting weaker. He became so sick that he was hospitalized for three weeks. He returned from that tired and more desperate than ever at finding himself in a psychiatric ward. He undertook to write to the Minister of Justice to make a statement about his situation but this document, covered with his trembling handwriting only went to enlarge the « correspondence » of his « medical file » and never reached its intended recipient. He then decided to go on a hunger strike, the doctor’s visits had by then become infrequent and he hoped by this means to gain more consideration from him. The nurses and the student doctor went to see him, trying in vain to get him to reconsider his decision and explaining to him the risks he was taking in refusing to eat. He accepted liquid nourishment but this was not enough to stop the degradation of his health. He wrote a second letter to the Minister of Justice, even more tremulous than the first one and which followed the same path as that one, and he continued his hunger strike, expressing his desire to finish his existence. After one week of this diet he was too weak to walk anymore. He was then transferred into the general hospital. After two days a nurse telephoned the psychiatric ward to announce that Mr. Lambkin had just died. A little late some distant nephews who had never appeared while he lived claimed from the hospital a cane with an ivory pommel.
We forgot about Mr. Lambkin until, a few months later an article in the local newspaper was devoted to the director of the retirement home: he was accused of extortion of money from the residents of that place, having actually withdrawn money from their bankbooks by means of a proxy they had signed on his behalf. The personnel in the hospital and the home then realized that Mr. Lambkin’s assertions might not have been as groundless as they had assumed and now saw the past events in a new light. His enforced hospitalizations appeared then as cases of abuse. During a briefing some of the nursing staff tried to discuss the issue but the doctor declared the matter was closed and moved on to another subject.
Extracts from the file of Mr. Lambkin
19.5.8: Mr L. 94 years old. Comes from the retirement home of X. Seen by the assistant (intern?) on his arrival. Sleeping in the second last room on the left of the main corridor. Same treatment as at retirement home for now. Speaks often of his papers, unreasonable. The cardio brings back a pair of his socks with 80Fr inside them: puts them in cupboard B. He says that someone is stealing his money. Where is the truth here? Is he altogether delirious? Needs to be looked at more closely. To make a B.W. tomorrow morning. (Bordet-Wasserman: a test for detecting syphilis.)
Night: good night.
20:5: Seen by the doctor in charge who has contacted the retirement home. His room there is no longer available.
Night: Fell twice from his bed when wanting to get up to urinate at 11pm: a bump on the head and slight wound to the scalp. Was looking for the light cord. Hard to make him return to bed. Had a tablet of R at 5am, new problems getting up. Finds the bed too high.
21:5. Morning. If insomniac give him a tablet of E.
Afternoon: See treatment. Had to undress him two evenings. Changed room.
Night: problems getting up to urinate. Good night.
22.5: Given a tablet of M for constipation.
Afternoon: At bedtime he speaks again about an expected receipt for money he deposited in the hospital safe: he deposited the money there when he was in the cardio ward; check this with the supervisor of this service.
23.5: Morning. Wishes to see the doctor in charge, does not want to stay here, wants to be reinstated at the retirement home as soon as possible. Motion this morning.
Afternoon: « The time hangs heavily on me, » he says. Very diplomatic.
24.5: Morning. Phone call from one of his friends who wants to know the visiting hours. At the retirement home his place has been taken; according to the head doctor he will be leaving this week. We’ll need to sort out where he can go. This is to be discussed amongst the retirement home, its doctor, this friend and us…
Afternoon: Seen by the intern.
25.5: Morning: The doctor in charge must see the doctor from the retirement home about the arrangement. He will be leaving. We hope he will be able to return to the retirement home. If he relapses he will come back here.
Afternoon: Bitter this afternoon. Does he know that his place at the retirement home has been taken? « That is my home, my place, » he tells us.
26.5: Afternoon: Slipped on the floor. Nothing serious. His money (1700Fr that he claimed was left in the hospital) was deposited in the savings bank. (noted in the file)
27.5: Morning: We need to have more contact with the staff at the retirement home; departure foreseen, doctor in charge must phone the doctor at the retirement home.
Afternoon: Has lost 100Fr or it has been stolen from his room.
31.5: Morning: The doctor in charge has phoned the doctor at the retirement home in order that the latter contact the director of that place. He (Mr. L.) could return there before the weekend.
2.6: Morning: Leaves at 1:30pm. If there are any new problems he will come back to the psychiatric unit. He will be seen by a home visitor (V.A.D.) So and So
16.6: Home visitor So and So: some problems at the retirement home.
22.6: Retirement home phoned. Mr So and So will go and see him tomorrow morning.
23.6: Home visitor coming between 1 and 2pm.
27.6: Morning: Sent (here) this morning in « voluntary placement » (voluntary on the part of whom? It sounds close to what we would refer to as being ‘certified’) by the doctor and nurse of the retirement home after having been brought back several times by the cops. This morning thought that someone wished to poison him. Very voluble and anxious. Because of loss of memory is very fearful about being robbed, particularly in connection with paperwork he handles. Seen by the intern and head doctor who will see him this afternoon for processing. At midday had 20 drops of M. Good digestion. Recognized his former room.
Afternoon: A little lost in the ward but at least recognizes certain people.
Night: Good night. Held a monologue (talked to himself?) for half an hour.
28.6: Good this morning. More quiet and relaxed. Had dose of M in the evening.
29.6: Afternoon. Keeps asking to see a doctor. Stayed in bed. Seen by the intern. Spoke as before about the director of the retirement home.
2.7: Morning: the retirement home must bring his cloths this afternoon. Some facial pains this morning.
Afternoon. Had to call again to the retirement home to get them to bring over his clothes and toilet articles.
3.7: Morning. Retirement home will forward his effects tomorrow at 9am.
4.7: Morning: Retirement home has sent some of his personal effects. His electric razor is missing.
Night from 6-7.7: Looks for his pyjamas. Mr So and So has seen the director of the retirement home. Made an appointment for tomorrow at 11am at the retirement home with the welfare officer.
12.7: Morning: Has read his mail. Does not understand very well. To see the welfare officer.
13.7: Afternoon: Has a talk with the welfare officer about his retirement and his future. Asserts that he is quite capable of managing his financial affairs. No decision made yet. To be followed up.
17.7: Afternoon. Wonders what he has been doing for 21 days. Thinks the director of the retirement home wants to get rid of him.
20.7: Afternoon: Faintness after lunch without falling or loss of consciousness.
23.7: Morning. Has two falls this morning.
Afternoon. Visit from a mate.
24.7. No falls this morning.
Afternoon: Again speaks of ill treatment here. Thinks someone is upset with him.
25.7: Morning: Seen by doctor in charge.
26.7: Morning: Has been seen by doctor in charge and home visitor, M. So & So. Informed he no longer has a room at the retirement home. Not happy. Doctor in charge will try and see the director again.
27.7: Afternoon: Wishes to see head doctor. (see business card) Goes to movies.
29.7: Afternoon: Wishes to see head doctor to find out more about the following events.
2.8: Morning: Doctor in charge tries to contact director of retirement home. If Mr L’s cannot get his place there back will see about another retirement home.
3.8: Morning: A new letter to « Mr Dr Psychiatrist » (see file)
Night: Fell when getting up to go to toilet. Does not complain about anything.
4.8: Afternoon: Wants to see the doctor in charge about eventually finding another retirement home.
5.6: Morning: Bathed this morning. Seen by the doctor in charge on the subject of the retirement home. He is thus now aware of his situation. His bank book has been found (between the hands of the director). If possible when Mr So and So will be there in the morning we must get his possessions (clothes, papers) back for him. He will not be returning to the retirement home. Would like to go to X. Before accompanying him to the retirement home phone to be sure the director will be there. What is to be done with his furniture if X does not accept him?
Night: Very disturbed at the start of the night because he cannot sleep and needs to urinate every 15 minutes. Holds his urinal badly, wets his clothes, accuses ‘someone » of making a hole in the urinal. Falls asleep towards midnight. Awakens early in the morning.
6.8: Morning: Got up for breakfast and tidied his room. Slept the rest of t he morning. Says he is very tired.
Afternoon: Sleeps all day, refuses to eat in the evening. Stays in bed.
7.8: Morning: Gets up in good form, quite rested.
Afternoon. Droops in the afternoon, has difficulties walking, stretches out on his bed until the evening meal. Little appetite (no meat). Taken to his room in a wheelchair. Was hot: temperature 40degrees: pulse: 104, T/A: 15/9. The assistant, warned, prescribes a cough syrup, A 500 in two doses, T. 500 in tablet form. To check. At 10pm: 39, 12/8. 84. To give him A500 at 10:30pm; check vital signs again at 11pm. Get him to drink.
Night: 10pm: 84, 38degrees, 12/6; 1am: 84, 37.8degrees, 12/7. Blood tests to be done in the morning. Again take pulse, temperature, tension.
8.8: Morning: 38degrees, 84, 12/6. Blood tests done. Seen by intern. Pulmonary radio (lung tests) at 5pm. Prescribed T.500 for 4 days then D. for 3 days.
Afternoon: Had his pulmonary radio. Seen blood test results. 38.3degrees, 87, 15/10.
9.8: Morning: Ate little this morning (coffee) and at lunch (soup). Mrs P is now wanting a room at the X retirement home. His savings book and other papers will be returned soon.
Afternoon: 38.4degrees, 16/9, 88. Had blood culture done at 7:30pm. Went to pass his radio which had been seen by the intern.
Night: Agitated sleep. Much movement.
10.8: To be transferred to the medical this afternoon. No room at X for now.
Afternoon: Moved to the medical. His possessions are in the room at the end of the corridor.
31.8: Afternoon. Transferred to medical. Very tired. Did not wish to eat this evening. See treatment card. Has had his injection of G.
Night. Urinated in his bed because he could not find the urinal in its usual place. Slept well.
1.9: Morning: Slept part of the morning. Opposed getting up.
Did not want to get out of bed. Not happy about being brought back here. Slight change in treatment.
Afternoon: Change of room. Wishes to see the doctor in charge. Wrote a letter, didn’t want to come to the dining table. Took only a little soup.
2.9: Morning: Got out of bed. Did not have any breakfast.
Afternoon: Tired. Ate very little, only soup.
3.9: Morning: A little better. Ate a little.
Afternoon. Ate nothing. Unable to stay up.
4.9: Refused to eat (after tasting it) as long as no significant persons (ie pysychiatrist of minister for Justice) come to see him. Impossible to make him listen to reason. Stayed in bed all day saying that he wanted to be left to die because life under these conditions does not interest him. Accepts his medicine in the evening but moves away everything that anyone brings him.
Night: Wakes up each time he is checked on.
5.9: Morning: Very oppositional/stubborn. Refuses to ear. Rests his head on the table. Very pale. T.A.: 10/7. Vomits mucus at 1pm. Put to bed.
Afternoon: Smiling at each visitor. Takes a half cup of coffee at 4pm and in the evening is satisfied with a little water. Appreciates his hours of rest. Takes the evening medicine without problems. T.A.:12/8.
Night: Very little sleep.
6.9: Morning: Eats lightly.
Afternoon: Tastes a bowl of coffee. Gets up for dinner: bowl of soup, after that he wrote a letter to Mr Badinter (Minister for Justice). Wants to pass a test of honesty and loyalty to the Communist party. Seen by the assistant.
7.9: Morning: After getting out of his bath faints with loss of consciousness and muscular spasms, eyes rolled back showing whites. Dribbled a little. Significant flow from left ear. Has been examined by the intern. Did not eat at all.
Afternoon: Bowl of coffee at 4pm. Drank glass of water in evening and that’s all. Always going on about justice. Didn’t want to get up this afternoon. Wants a ECG, appointment with ear, nose and throat specialist.
Night: Good night.
8.9: Morning: Faints when getting up. Unable to take breakfast. Did not want lunch. Examined. Seen by intern.
Afternoon: Always takes very little food: bowl of soup. Writes another letter to the Ministry of Justice. Faints again (with fits?)
Night: Little sleep.
9.9: Morning: Refuses food. Wants justice. Given injection. Must have a radio at 6:30pm. EEG at 2:30pm.
Afternoon: Radio and EEG done. No feeding.
10.9: Morning: Accepted a little breakfast (5 biscuits) and his medicine, but refuses lunch. To the question « Why are you refusing to eat? » he answered: « So as not to grow up. » Given injection. Small fits towards 9am. Impossible to get him to walk. Unable to walk alone. Has not eaten normally for seven days, (since 3.9).
11.9: Morning: Refused all food this morning, not coffee, not biscuits; only accepted his medication. « I have decided to commit suicide. It will be him or me » (meaning the Minister of Justice) « I wish to die today. » Remained curled up on his bed, urine was of a dark color, cold, given last injection.
Afternoon: Did not want to eat or drink, just took his medication.
12.9: Morning: Refused all food, even his medical treatment. After the intern announced to him that he was leaving for the hospital he accepted his medication and ate lightly. Leaving this afternoon. Ambulance booked for 3:30pm.
Afternoon: Taken to the general hospital. (for the last time?) Might he go on to convalescents?
14.9: Afternoon: Died this afternoon. Confusion about finding the address of his heirs and the card leaving his body to science. The doctor cleared it up. His possessions are at the hospital.
This lamentable story is one of a man who considered that, after working honestly throughout his life, he had the right to spend his old age in an establishment of his choice. He had always believed in the institutions of his country, thinking that he was living in a democracy where everybody was free, whoever he was, to express himself and be treated with respect.
In the space of five months he saw all the convictions on which he had based his life collapse and he did not survive this experience.
« Sad, shrinking face. He died during the night. He died very unhappily. » William Burroughs, Port of Saints.