My receptionist sent me a screen message: “Aggie is creating quite a scene – she doesn’t seem very well.”
It always pays to listen to reception. I ignored the patients ahead of Aggie in the queue and opened up her records. Other than well-controlled Type 2 diabetes she’d gathered little in the way of medical problems during her 68 years.
There was a letter from A&E, though, from just the day before. Police had been summoned to a local supermarket, where Aggie had been pulling things off the shelves. They’d detained her under the Mental Health Act, which empowers officers to convey someone who appears to be mentally ill to a place of safety. A&E had ruled out organic pathology then referred her to the liaison psychiatry team. A nurse had assessed her, found her to be of sound mind, and discharged her.
This seemed a surprising conclusion. Within seconds of coming into my room, Aggie – five feet nothing and as Scottish as a thistle – had grabbed my hand and was rubbing it on her cheek, where she told me the skin felt oddly rough. I managed to extricate myself and get her to sit down, whereupon she proceeded to regale me with tales of police brutality, persecutory shop assistants and an exciting new career she had planned involving training Labradors as classroom assistants.
People with mania often have an infectious elation, and though her ideas were fizzing and crackling with dizzying speed, there was discernible logic there – if the blind and deaf can be aided by canine companions, why not pupils? But manic patients also characteristically display irritability, and Aggie took great exception to my asking who had brought her to the surgery.
“You know the answer to that already, don’t you, you stupid idiot!”
Eventually I managed to ascertain that her husband, Andrew, was sitting outside in the car. We went together – me walking, Aggie marching – and she slammed her palms against the driver’s window, startling the exhausted man trying to catch forty winks inside.
“Come on!” Aggie yelled through the glass. “Doctor wants a word!”
Andrew shed some light. Aggie’s twin sister had died a couple of months before. Initial grief had given way to sleeplessness and increasingly erratic behaviour. As Andrew answered my questions, Aggie kept delivering volleys of verbal abuse. Eventually she stormed out. Andrew’s face was the definition of bewilderment. He looked all-in.
We made a plan for her immediate safety, then later, after the psychiatric nurse sent to make preliminary contact had been soaked in the front garden by a hose-wielding Aggie, I joined a further Mental Health Act assessment at her home. Heather, the duty psychiatric consultant, was superb at diffusing her irritability and gamely pretended to be a dog undergoing classroom assistant training. Then we professionals squashed in the back of Chloe the social worker’s Citroën to complete the paperwork for committal.
Chloe came off her mobile with a despairing groan. “There isn’t a single adult bed in the entire country.” I left her and Heather escalating the situation and returned to the practice. Several hours later, Chloe rang with the news that a bed had finally become available. Only it was in Nottingham, some four hours away.
“The next problem,” she told me, “is how to get her there.” The specialist crews that undertake psychiatric transfers are stretched beyond breaking point by the national bed crisis. A crew can be taken out for an entire day having to convey a patient hundreds of miles to the only available placement.
Andrew slept solidly after Aggie was eventually transferred late that evening. Energy restored, he began spending hours behind the wheel and nights in a Travelodge in order to visit her. Fortunately, she responded swiftly to medication and was home a month later, back to her normal self, mortified and needlessly apologetic at how grief had temporarily unhinged her mind.
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This article appears in the 06 Jan 2021 issue of the New Statesman, Out of control