A Conversation with Dr Black-Boot’s

“I shall be with you in a moment Henrietta”. Dr Black-Boot’s walks past, forced smile; giving others around her the impression, she is hurrying. I am not convinced.

She enters a room to the right hand side of the waiting area, the small, claustrophobic duty room. I can hear murmurs of conversation, the rustling of paperwork, movement.

I wait, listening to the ‘toneful’ melancholy of Dylan through my headphones.

My psychiatric nurse appears in front of me. Lynn, big hair, quietly spoken, matter of fact. It has been a long time. She looks uncomfortable, I wonder why.
She sits next to me, diary in her hands, and tension in her face.

“Where have you been I ask?” Lynn looks defensive, I get the impression she doesn’t want to have this conversation.
“I called you Henrietta,” she states, leafing through her diary “I left messages on your answer machine and on your mobile phone”.

This is news to me!

I explain that I have not been aware of any phone calls and that I haven’t picked up any messages.

It has been eight weeks!

“Let us go and see Dr Black-Boot’s anyway – I will come in with you”. She is up, moving forward. I follow.

‘You haven’t called me either Henrietta’ she says, looking at me questioningly, as she holds open the door that leads to the Psychiatrist’s office. “I thought to myself, oh, she doesn’t need me anymore”. She looks at me, disappointment on her face.

This has become familiar over the last two years. Does she want reassurance again, I wonder. Her need to feel needed only too evident.

We walk into the Psychiatrists office. Green walls, grey carpet, desk and chair for her, two plastic chairs for patients, a filling cabinet and a pc, formal and impersonal.

“How are you?” Dr Black-Boot’s asks.
“I’m okay”. I explain briefly about a physical health issue I have been contending with which has been difficult to deal with.

She looks puzzled.
She always looks puzzled.

I tell her about my degree that I am due to start. “That must take a lot of motivation, organising it all,” she says.
There is something about her tone that unsettles me, my anxiety begins to increase.

I have a couple of things that need signing concerning my studies; I ask her politely if she will. She is happy to write the letter outlining what Bipolar Affective Disorder is but is unwilling to provide a countersignature for my passport, instead suggesting I see my G.P. Lynn enquires as to what is involved, I explain and she agrees kindly to sign the paperwork. She does so immediately.

As my nurse completes the paperwork, Dr Black-Boot’s asks, “Is there anything else you want to talk to me about Henrietta”?
I wonder how patients manage to. I cannot talk to her. I have never been able to.
“No” I say. When will this be over I think to myself?

I think about all the things I could say to her. Topics I could discuss, topics I would like to discuss; periods of low mood each month, lasting for roughly a week at a time, feelings of overwhelm, the struggle to deal with situations that occurred last year………..

I decide not to. In the past, I have ventured into this territory and on every occasion been thoroughly disappointed with Dr Black-boot’s responses, advice and interpretations. She has always been somewhat confused by most conversations, seeming to have an inability to grasp what I am saying and often responding with answers that have little to do with what one is talking is actually about. She has little emotional intelligence, limited understanding of psychology or people in general and a complete lack of empathy or compassion for her patients.

Lynn who has sat watching, interrupts my thought process.

She is saying something; it is incoherent, she’s rambling, though I do manage to hear the word abandonment.

I start to become frustrated.

“What are you talking about” I ask, irritated

She informs me that she has been offered a promotion which she has duly accepted. She will be the new manager of the centre. She says all this looking rather pleased with herself.

Should I say congratulations? I decide not to. I wonder how she will cope with being a manager.

“We’re not abandoning you,” she’s repeating herself, whilst also beginning to share my psychiatrists penchant for condescension. I am not sure why this word ‘abandonment’ keeps being repeated, it is beginning to annoy me and at the same I wonder why this is the word of choice today. Maybe it’s because it is absolutely fitting. “I have been scaling back my caseload, seeing how people cope without me. I haven’t seen you, for eight weeks”

“Oh, so it was test?” I snap, shocked at what she has just admitted.

“Of course not Henrietta!” She tries to look stunned but she just manages to look more defensive.

I am not reassured by her assertion. Anxiety is quickly turning to anger – I need to leave the room.

Lynn has never been what I can call a reliable nurse. When she does turn up for our sessions, I have enjoyed talking to her and have found her supportive at times but the fact that on average she only turns up for two out of every four appointments has always been incredibly frustrating. Often when cancelling, she will leave a message on my answer machine and reassure me that she will be in touch shortly to rearrange. Shortly, never transpires, it is usually between three to four weeks before I see her again. However, just as frustrating is the fact that she is continuously off work. Admittedly, sometimes she is unwell, but most of the time she is simply on leave, at home either with her children or going on holiday or simply taking odd days off here and there. She has even taken leave after being away from work due to illness, deciding she wanted to go to a Pilate’s class.

“So what happens now?” I ask, though already knowing the answer.
“You will still see your Dr Black-Boot’s”.
I look at my psychiatrist, huge quantities of despair, anger and anxiety now mixing generously in my mind. I’m concerned that I might actually lose my temper.
“What about a psychiatric nurse?” I ask.
“Many people don’t have a nurse Henrietta; it’s very common to just have a psychiatrist”. I smile, the rationalisations people will find to help them deal with their less than appropriate behaviour.

Should I feel grateful that I still have a useless psychiatrist?

“What if I was to become unwell?” I ask, not that I am planning to but it’s a valid question.

“We won’t leave you without a nurse if that was to happen but right now, you need to focus on how well you’re doing, how far you have come”.

I know what she is referring to – last year was a particularly interesting year for me. I found my birth mother, had a relationship with her for six months, which was problematic from the start and eventually walked away. I also left a long-term relationship, which wasn’t easy. As much as my nurse was supportive during these events in my life, her understanding of the emotions and processes involved were limited at times. Especially in relation to my birth mother, she failed to see that just because I had made the decision to walk away, this did not in itself serve as a form of closure or prevent any of the numerous and painful emotions that surfaced afterwards needing to be worked through.

Dr Black-Boot’s agrees with how far I have come, nodding her head, fixing me with another one of her irritating smiles. It is ironic as she did not know of any of last years events until after the fact, and yet with only Lynn’s interpretation of events, she strangely agrees that I am doing well anyway. However, aside from the occasional smile, she is obviously comfortable to leave all explanations of the changes afoot to my nurse.

“What happened to Yvonne” I ask”
“She’s off sick and then she’s leaving, as she has another job” Lynn’s response is flippant.

My nurse must have been aware (one hopes) that I hadn’t seen my support worker for some weeks, therefore not having my regular weekly sessions with her. Added to this, I would most probably not be seeing her again, therefore loosing one crucial aspect of my support system. Therefore, I was surprised at her flippancy and total disregard.

Yvonne had informed me a few weeks before that she was leaving. It didn’t come as a surprise to me. She had been desperately unhappy for some time with the bureaucracy, ideologies and uniformity of this specific mental health trust that prevented her from doing her job in a way that she saw fit. With an extroverted, lively personality, a desire to learn, a dedication and generosity to all those that she supported and worked with and an ability to think for herself and hold her own court, she was viewed as a round peg in a square hole. She had enough, her frequent tears or low mood indicating that she was unbelievably stressed and unhappy. A week after her revelation, she cancelled our appointment and the week after that, I turned up as arranged, but she did not appear. No phone call or text message, she just simply vanished and I was left to wonder what an earth had happened. Though often late for appointments, she also was one of the most reliable people I knew, so I was obviously concerned about her, especially with recent events.

Not seemingly prepared to have a conversation about Yvonne, talk returned once more, to how well I was doing. I queried the phone calls that had apparently been made, the phantom messages left.

My psychiatrist looked uncomfortable as Lynn opened her diary. She informed me that she did indeed call, but when pushed she only has one record of a call being made, some five weeks earlier. I asked why this was the case, why it was seen as satisfactory or even sufficient to make one call to me and when I did not return the call, to not endeavour to contact me again. This question was obviously too difficult and/or uncomfortable to answer.

‘You haven’t been in touch yourself Henrietta’ my nurse once again reiterates. ‘Look at how well you have been, I haven’t seen you for over eight weeks”
‘How do you know that I have been well?” I snap. “As for contacting you, do I ever get in touch?” I ask. “No, I just get on with things, as you know full well. I manage my own moods, look after myself”

I often do not have much choice I think to myself but I do not verbalize this.

“This shows how well you have been doing!” She responds with a smile on her face.

I know that I am going to loose my temper. It is better if I leave the room. More importantly, I have had enough. I am far too overwhelmed by my emotions, anxiety, anger, disappointment, incredulity, irritability; the only way to calm myself down is to leave the situation.

I stand up and grab my bag; they both ask me not to leave. I am no longer listening. I tell them angrily and frustratingly that this is all a load of crap and walk out of Dr Black-Boot’s office.

Here is the question. If someone with mental illness does not contact their Psychiatrist or Nurse over an extended period (who they are normally supposed to see fortnightly) does this mean that they are well? If you are deciding that they are well, on what basis are you forming this decision?

If they have a diagnosis of Bipolar Affective Disorder, could they be too depressed to get in touch with their health care professionals or if manic, do not have the essential insight that they may need help?

Can heath care professionals reasonably have a conversation about a patient and how they are, when they have not seen that patient recently? Is it reasonable to presume that the fact that they haven’t had contact with them is due to them being considerably well right now – what facts or evidence do they have to make this decision or is it enough to simply believe the fact? More importantly is it appropriate on the basis of this flighty presumption, to withdraw the majority of their support system, rather than withdraw it gradually as is normally the given procedure.

I stand outside, searching through my bag for my beloved headphones, relieved to be outside, to feel the air on my face. No longer sitting in the small oppressive room, two sets of eyes staring at me as I try to manage my emotions. Suddenly with a feeling of dread, I realise that my nurse still has my passport! Realising that I will have to approach reception and ask them to call through to my psychiatrist’s office, my anxiety increases once more.

Just as I begin to walk back through the automatic doors Lynn appears, my passport and paperwork in her hands. I immediately ask for it, not wanting to become involved in another conversation that will only further agitate me. Assuming being a psychiatric nurse and more specifically my psychiatric nurse, she will understand my need for space right now, I am surprised and disappointed when she once again tries communicating with me. However, it soon becomes clear that she is not interested in how I am.

“How can you treat me like this Henrietta?”
“Lynn, can I have my passport?” I ask, as she plainly stands there waving it about as she plays up to her apparent hurt feelings.
“I’m really hurt and upset that you can behave like this towards me; especially after all we have been through”
“Can you just give me the passport” I ask agitated.
“How you can think I would treat any of my patients in the way that you’re impplying, that I would set out to test them”
“Can I have my passport?”
“Henrietta, I can’t believe this, you’re not being fair treating me in this way”
“Will you just give me my passport!”
Finally, she relents, hands it over and moves forward to continue speaking – at which point I stuff the paperwork in my handbag and walk off.

She watches me walk away, all the while with a pained expression on her face.

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