Wednesday, 2 January 2013

My Life in Stalkers 1 - Patients

I thought as a New Year was starting, now would be as good a time as any to run through some of my stalkers - because though there haven't been that many, there have been a few. Enough, in fact, to spread over about three posts I should think. Though Steve will definitely need at least one post to himself. I've actually learned a fair bit about how to spot potential stalkers and avoid them - also about how to deal with them when they happen.

None of this is true about my stalkers who began as patients.

That's because I have never been stalked by a patient from the general out-patient population. I'd be surprised if I had been - I think I mentioned before that I am very good at keeping a professional distance. It's completely different to not getting emotionally involved, because I do get VERY emotionally involved with lots of my patients: I am not one of those people who thinks you can be a good health worker without getting emotionally involved. But I keep things on a very professional level - I would expect my patient to be well aware that I genuinely care for them, but to realise that it is purely in a professional capacity and I am not available for friendship or anything else outside of that capacity. In the whole of my professional career I have only twice had people think any differently - and in both cases it was women who wanted to meet as friends when their treatment ended. I declined and explained my reasons why - that they only knew the professional me and probably wouldn't even like the personal me!

Two of my stalkers were men who had received head injuries, and in both cases there was a similar progression. In both cases, I treated them in the MIU (the intensive care unit) at Birmingham Accident Hospital, through their hospital stay, and then as out-patients. Working with someone who has a severe head injury is extremely intensive - you see them for at least an hour each day, you get to know them and their family extremely well. Sometimes, like in one of these cases, you are the one who realises that they are far more aware than they are able to indicate.

A_ used to scream weakly for most of the day. He didn't talk or make eye-contact so everyone thought he couldn't think, but one day it just sort of clicked that he was trying to respond appropriately to what I was saying. I started asking him yes/no questions, and it became clear that he was in pain with his hip (which he'd broken), he was often thirsty and he was lonely for most of the day except in physio. Once I knew that, the Occupational Therapists (OTs) were able to get him a computer-thingy (this was the early 90s, so nothing fancy) that he could use to communicate, using the one arm he could move. It turned out that much of his mental ability was intact, and once his body caught up with that, over a period of about 8 months, he made a good physical recovery. However, he had profound personality changes and whereas he was previously an outgoing, confident man, he had become quite a dependent, socially awkward person. When he was discharged, he would come back to the hospital to see me almost every week. Then he began to bring me in mix tapes, but I still didn't really click. Until he started following me home from the hospital. Luckily I was a way faster walker than he was, and I was quite capable of nipping on a passing bus to escape him, but it was a bit worrying, so I had a chat with him and said it wasn't really on. He switched to just phoning me every week or so, which was fine.

L_ was older, and was able to communicate well from the third week after his head injury. He had a wife, and she was very supportive, so it was quite a surprise to me that after his discharge, he would often come back to see me, and try to see me in social situations. Initially he used fundraising things as the reason, and so I did go to a couple of functions, which in hindsight wasn't a good idea. But when I began to disengage, he began phoning daily to speak to me and invite me to places. I was quite firm with him, but it didn't make any difference, so the secretaries ended up having to tell him I wasn't available.

I then moved to a mental health hospital, and heard nothing from either patient for about a month. Then, within one week I received a mix tape from A and two phonecalls from L - a new secretary had told them my new place of work! But this hospital was out in the sticks, and not as convenient as the Accident Hospital, which was very central, and so eventually the contacts died out. I think it also helped that the physiotherapy department was very poorly signposted, so any casual callers wouldn't have found it. So I suppose these were both examples where a form of 'No Contact' worked.

For all that these men were a bit of a nuisance, they weren't frightening to me at all, because I knew they were physically frail, and also I knew it was all a product of their head injuries. My next stalker was the only person in my career in mental health that I was frightened of. C_ Christ J_ was in hospital because of bipolar disorder - during a manic phase he had turned his house open-plan - by knocking through to the neighbours' house. So we are talking seriously disturbed. The usual routine was that the physio would assess people for exercise and relaxation classes, and these were done by physios and Technical Instructors on a rota. As physios, we would also sometimes see people for one-to-one sessions for physical problems, or for anxiety management. Now the assessment was interesting because C_ Christ J_ insisted that I sit on a certain chair, always call him 'C_ Christ J_' (this wasn't just me, this was everyone), and never turn my back on him. 'For your own good' he said. It was a bit like having a conversation with a less eloquent Hannibal Lecter. But he agreed to go to exercise and relaxation groups.

He caused LOTS of problems in all the groups. And he hurt his back, so I took him out of classes and saw him alone - initially to treat his back. It was a kind of personal challenge - I would put up with all the bossiness and insults, because I was being paid for this, and I WOULD get this man better. And it worked. He eventually started to go to relaxation, initially in my groups, and he wouldn't act out. Then he went back to exercise groups. Finally, he was discharged.

And then the letters began. He first off just sent a thank you letter. Then a couple of thank you presents - a half-eaten packet of Polos; a cake decoration with no head. Then he began sending letters talking about me and asking personal questions, composed from letters cut out of a newspaper :-O My boss informed his consultant, and probably partly to do with this, he was re-admitted.

Once again I assessed him, and decided I'd better do a one-to-one relaxation just to see how he coped again. Now my boss was already saying maybe I shouldn't be involved in his programme, because of the history, but I wasn't so experienced then, and I wanted to prove myself - to my seniors, but also to myself. It's not a mistake I would make now.

Things came to a head a day later. It was almost Christmas, and a hospital envelope arrived in the internal mail addressed to me. It contained C_ Christ J_'s physio appointment card, folded in two to make a Christmas card - he'd even stuck on a piece of holly. When I opened it, the message read, 'Happy Christmas. It will be your last. Love from C_ Christ J_' And there was a little stick hangman drawn on the opposite page, with my name under it :-O

My boss went completely ape-shit, and ran off to C_ Christ J_'s ward as such a speed I thought he was going to physically attack him. But of course he didn't. Just got him transferred to the secure ward and  it was only with a lot of persuading that he didn't call the Police.

In fact, once C_ Christ J_ was properly well, he was very apologetic about the whole thing - and a completely different person to the person I met on the wards. But this was a big learning experience - know when it is better for all involved to back the hell off.

Once again, No Contact proved to be the best tactic in dealing with stalker-type behaviour. So looking back, although I thought there was little for me to learn about stalkers when dealing with a patient population,  it actually has reinforced what I now know - No Contact is a very useful tool when dealing with stalkers.  But it would be another 20 years before I realised that.

Names of patients and other biographical/medical details have been slightly altered to prevent any possible identification

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