Written by Administrator

Thursday, 01 February 2007

If youíve ever been a psychiatric inpatient you will have had a discharge summary.  A discharge summary is a report written by hospital staff which is sent to your GP and becomes part of your medical notes.  Itís worth getting hold of a copy of yours if you have one – it can be quite an eye-opener.

This piece originated in a project set by a creative writing tutor.  She found a story on the internet about humans spending time in an ape enclosure at an Australian zoo.  A psychologist was incarcerated with them and the experiment was supposed to lead to improved conditions for apes at the zoo.  We were to write a story about this situation.  Now, I donít know much about zoos – except I wouldnít want to be in one – so I imagined an alternative experimental scenarioÖ

Pongoís Discharge Summary:

On admission, Pongo was agitated and confused, showing highly disturbed behaviour.  He bounded around the day room and swung from the curtains.  He refused to engage with staff and shrieked at them from the top of the bookcase.  He appeared to staff to be responding to auditory and visual hallucinations.

The team considered that Sectioning and medication were the way forward. Pongo was commenced on Haloperidol (20mg) and Diazepam (10mg) – which initially had to be administered by the Control and Restraint team.  After a few days Pongo settled well and his behaviour showed a marked improvement.  He queued up for his medication at medication time, and was fully compliant. He spent the 8 hours per day he was awake slumped on the sofa watching Channel Five with the other patients.

Pongo was observed to have dietary issues and often flung instant mashed potato around the dining area.  However, he liked the syrup sponge pudding with custard and frequently had seconds. On Friday afternoon – when fresh fruit is made available to the patients – Pongo became disruptive.  All the fresh fruit was subsequently discovered hoarded in Pongoís room.  As a result he lost garden privileges.

Our Consultant diagnosed an acute schizophreniform disorder with psychotic features.  There is also pencilled-in an alternative diagnosis – chimpanzee? – but this condition does not appear in any of the psychiatric textbooks.

Pongoís behaviour on the ward was generally appropriate, except on one occasion when he helped himself to the night shiftís Chinese takeaway.  The Control and Restraint team were called and rapid tranquillization took place.  Thatíll teach him.

During Pongoís stay a Mental Health Act Commissioner visited the Unit.  She was impressed by the facilities, spoke privately with several of the patients and noted their concerns. One of the more deluded patients apparently complained that there was a monkey on the ward.  The Mental Health Act Commissioner recommended in her report that the ward obtain a new TV aerial so that the patients could watch channels other than Five, and mentioned that she enjoyed her visit, especially the excellent lunch she had with the Ward Manager.

Pongo was discharged – prematurely in the opinion of many of the staff – when an RSPCA Inspector made an unexpected visit and closed the Unit with immediate effect.  A prosecution for cruelty is pending.  Our defence will be that a doctor ordered it as treatment and therefore no cruelty was intended, or indeed took place.* Doctors are nice people and always have the best interests of their patients at heart.  Patients may complain, but their perceptions and experiences are not as valid as those of the doctors because, well – theyíre mad.  Who says theyíre mad?  The doctors do.  And the doctors are always right.

Prognosis – good, provided Pongo continues to take his medication.  We will be sending the Home Treatment Team round to make sure that he does.

Florence Nytol

Staff Nurse


* I heard at a mental health conference once about an anonymous patient ( I think from Germany) who took a case to the European Court of Human Rights.  This person was strapped to a bed and force fed.  The court decided that this does not constitute cruel, degrading or inhumane treatment for – as I understand it – much the same reasons as detailed above.