Usual disclaimers apply – Doc Martin and its characters are property of Buffalo Pictures. I own nothing except my for my own nuttiness – and that I take full responsibility for.
It was early in the morning, too early in fact, and as I drove along the long and winding road, I realized how tired I really was. I had made the mistake of staying up until two thirty in the morning simply preparing for the busy day I had ahead, but it was clearly evident this wasn't a routine I could continue.
It was a bit of a shame actually. Back in the day I'd had no problems functioning on nothing but an hour or two of sleep and a continuous supply of caffeine, but apparently those days were long gone and they were never to return. Perhaps my age was getting the best of me?
…No, that wasn't it.
I continued on but my eyes were heavy and my thoughts a bit clouded. Even the two cups of coffee I'd consumed before I left were not really helping and pretty soon I would need toothpicks to keep my eyes open.
I knew I shouldn't have stayed up so late the night before, but I couldn't control my fascination with some of the new patient files I was given to review.
Three new patients were coming in today, all of whom were placed under my supervision. And after reviewing their files and examining their reasons for admittance, I could barely contain my excitement.
The first of my new patients was a twenty-eight year old male being brought over from Ashworth. He had been institutionalized since the age of fourteen after he was diagnosed with a severe form of PTSD. He and one of his friends were bullied and beaten by a group of teenage boys while walking home from school. Apparently he was hurt quite badly but his troubles really came when he witnessed his friend being tortured and then killed with a pocket knife.
Since then he was housed mostly in medium security psychiatric hospitals. A few years ago, however, he was transferred to Ashworth when his treatments were no longer proving effective. His mental instability led to him assaulting several other patients, knocking a ward nurse unconscious and several unsuccessful attempts at suicide.
The second incoming patient was a forty-two year old married father of two. He was convicted a few years ago for killing a man whom he suspected was having an affair with his wife. The problem with him was that he was diagnosed with multiple personality disorder. He was confirmed as having three alternate personalities, none of whom had any knowledge of the others. You can probably imagine the confusion that followed after he was arrested on murder charges, yet his two alter egos had no knowledge or recollection of it whatsoever.
His personality changes grew worse over time in spite of his treatment. Each personality was becoming more dominant than the other and was changing with frequent successions. It eventually led to extreme disorientation and memory lapses which in turn led to him developing a panic disorder along with agoraphobia. Somehow, he was not considered full syndrome. Apart from the one violently murderous personality, he was more of a danger to himself than anyone else.
The third newcomer was a thirty-four year old who had however, been diagnosed with full syndrome Dissociative Identity Disorder. Apparently this man only had two different personality states, but because he was considered full syndrome, he exhibited a vast array of symptoms which mimicked many types of mental illnesses all at once. It could be anything ranging from paranoia, pseudo seizures, psychotic episodes and biggest of all, suicidal tendencies. Lucky for me, he had them all.
I had twenty other patients under my own personal care and supervision, but these three men were my newest projects, and I couldn't wait to delve in.
They were coming to Broadmoor because this was their last resort. For some, they had exhausted their other options. For others, their treatments had failed them. And whether they were new to the wonderful world of psychosis or could no longer be controlled, they were coming to me for a reason. There was no question that I certainly had my work cut out for me, but it was just the type of challenge that I loved.
The familiar red brick wall was coming into sight and suddenly I felt an extra burst of energy coming on. It was going to be a good day. I could feel it.
As I came toward the main entrance, I pulled off the main road and continued around the walled perimeter of the hospital. To many people on the outside, Broadmoor would seem like a prison. Its high brick-walled perimeter and even higher steel fences keep hidden the massive compound that lies within. Despite the fact that it does maintain the status of a Category B prison, it is first and foremost a psychiatric hospital.
But there is no doubt that if those walls could talk…oh the stories they could tell. The old Victorian style buildings give hints of the notorious events that have occurred throughout its history. But the new modern buildings give rise to advancements and technology; the understanding that the days of torturous lunatic asylums are long gone, but somehow, never quite forgotten.
I've been witness to thirty of the nearly hundred and fifty year history of Broadmoor and I've seen many reprehensible things in that time. Some of the most nefarious psychotic criminals the world has ever seen have roamed the corridors, and some who are still here will never leave these confines again. While they may be unaware or aghast of their environment, I thrive in it. The years of studying and researching and assessing what exactly it is that makes these people tick has never once lost its appeal, and there is nothing that I can foresee taking me away from it.
I drove down to the staff car park and pulled into my private parking spot way up front. Just one of the many perks of having tenure. I grabbed my things and headed off to start what knew would be another adventurous day. I proceeded through my daily ritual of security checks and checkpoints, and being buzzed through one gate after another until I finally reached my office. I dropped my bags next to my desk and switched my computer on. I noticed there was already quite a hefty stack of papers and folders on my desk, all of which needed attention. Most of them were patient files which needed to be reviewed and then signed off on.
There was yet another notice reminding me that it was time for my yearly biometric testing. It was one of the few things that I was regularly required to complete in order for me to retain my employment, but every year they would add something new to the list of things that needed to be done. It was becoming damn aggravating.
The updated files of my three newcomers were also in the stack, along with evaluation forms that required me to give my initial assessment and confirmation of a diagnosis once they arrived. Since they wouldn't be arriving until late this afternoon, it gave me some time to clear away some of the more mundane tasks this morning.
I spent the good portion of an hour simply responding to emails, returning phone calls and finishing up some general paperwork. I looked at the time and noticed it was only a quarter to eight, but I had to hurry because in fifteen minutes, I was supposed to lead a group CBT session for some of the 'milder' patients. But nonetheless, they never like to be kept waiting.
Treatments here are tough. Regimens are intensive as well as emotionally and physically draining and in some cases, they can be even more debilitating than the illnesses themselves. But most often, the end result is usually favorable.
Comprehensive assessments for new patients can last up to three months. Their past history, type of illness, and treatment requirements are what determine the specific type of treatments they will receive for the duration of their stay. But the key element in treatments here is insight. First, it's about getting the patient to first acknowledge and accept that they have a mental disorder. Then, it's about helping them to understand their illness, and find solutions to either help them live with it or overcome it entirely. Of course, don't think that therapy sessions and arts and crafts are the only treatments they are receiving. It's usually in combination with high doses of powerful anti-psychotic medications that help in 'taking the edge off'.
It was the usual group at today's session, comprised mostly of men with various degrees of panic disorders. It wasn't the most difficult of work, considering my expertise was with personality disorders. Most of them were towards the end of the average six year stay here anyhow, which meant they much closer to acting like normal, civilized people compared to the others. Their treatments were proving successful thus far and all of them would probably be ready for release within the next six to eight months.
One focus in today's therapy called for patients to re-examine how their childhood influences may have negatively impacted their levels of cognition, both rationally and emotionally, and whether they acquiesced to those changes by means of a behavioral response.
As each patient shared their insights, for reasons I couldn't understand, I thought of Martin. I don't know why. Obviously he was nowhere near being considered a psychopathic criminal with deranged and murderous tendencies, but the fact is that his upbringing was quite like many of the men trapped within the confines of these walls.
They were all unloved or neglected by their parents or caregivers and were victim to some form of abuse, both mentally and physically. Obviously there are any number of biological causes or genetic predispositions that lead to many of these illnesses, but not always. Sometimes it could be purely environmental.
I was certain the only reason I thought of him was because I had talked to Joan a few days ago. She kept nattering on about Martin and the situation he got himself into with an apparent school teacher. Said he was running away from his responsibilities and so on and what not. I had to admit, I didn't always pay close attention to the topic of conversation and for Joan, it was all she'd been talking about for months.
Although the more I thought about it, the more I had a sneaking suspicion that my sudden concern for him was not unfounded. But for now there was nothing I could do, I would just have to try and shake it from my mind. Maybe once he was settled back here in London, I'd pay him a visit.
After the therapy session was over, I made my way back to my office. It was already lunch time and my newcomers were arriving at three. My stress levels were starting to rise a bit as there was still much that needed to be done before then.
Walking down the corridors, I couldn't help but breath in that hospital smell. I always found it to have a calming effect. It helped me refocus my attention and get me back into my element. By the time I made it back to my office, I felt re-energized and luckily my lack of sleep last night had yet to affect my daily routine. I just hoped the rest of day would go as smoothly.
Just as I had finished a rather hurried lunch at my desk, the phone started ringing. I was hardly in the mood to deal with inane phone calls at the moment, but noticing it was the secretary, I assumed it would be something that needed attention. Fortunately, this new girl Catherine was actually quite competent at her job and only bothered us doctors' when something required our attention or when personal phone calls came through. She was only a twenty-something and rather chipper, but surprisingly efficient and was capable of doing everything to our liking without guidance.
"Yes, Catherine. What can I do for you?" much to my own surprise, I answered the phone sounding a bit chipper myself.
"Sorry to bother you Dr. Ellingham, but you have a phone call. Says he's your nephew. Shall I put him through?"
Confusion immediately took over my thoughts. It seemed my sense of foreboding was right on target today. But why would he be calling?
"My nephew? Martin? Why on earth is calling? It's not Christmas already, is it?"
"Um, no. But he didn't give a reason for his call. Just said he needs to speak to you."
For Martin to make a call himself, it either had to be something work related or something was wrong. And because Martin had never contacted me about anything work related, I suddenly became very nervous.
"Right. Well he must have a reason. He's not exactly one for idle chit chat, so I doubt he's calling just to say hello. You can put him through."
"Right. Just a moment."
I waited on the phone until the light lit up. I really had no idea what to expect.
"Well, this is a surprise. So, to what do I owe the honor of your call? Are you here in London? I heard you were coming back."
"No, I'm still in Cornwall at the moment. There's been…a slight change of plans, for the time being."
"Oh, right. Would it have anything to do with a certain school teacher perhaps? Joan's told me all about your…situation."
"Hmm, why am I not surprised. Listen, Aunt Ruth, I'm calling for a reason."
"I was afraid you were. Well, since you seem intent on avoiding my questions, why don't you tell me the reason for your call then."
"I'm afraid it's about Auntie Joan."
"Joan? Why, what's happened?"
"She was in an accident…"
To be continued…
PTSD – Post Traumatic stress disorder – type of severe anxiety disorder that can develop after witnessing or experiencing a traumatic event that involves the threat of injury or death and an inability to cope. Most commonly seen in life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents or violent assaults, such as rape.
Agoraphobia – repeated attacks of intense fear or anxiety and fear of being in places where escape might seem difficult or where help might not be available. You may remember our man PC Penhale being diagnosed with this particular disorder.
CBT – Cognitive-Behavioral Therapy – type of psychotherapeutic treatment that allows patients to understand their thoughts and feelings and how it affects their behavior. It's one of the most common forms of treatment for most types of anxiety and panic disorders as well as many other types of mental disorders.
Dissociative identity disorder – actual name that refers to multiple personality disorder
Category B prison – In the Uk, male adult prisoners are classified according to Categories A through D, with category A being the most severe form of maximum security and category D being the most minor form of security. According to Wikipedia, Category B is for "those who do not require maximum security but for whom escape needs to be made extremely difficult."