Benji Waterhouse - Udderly Terrifying

 

 

I remember when I started at medical school, I was sitting in a great old lecture theatre wearing a stiff white coat. And our plummy dean was saying to us, “Your main job as future doctors is to keep your patients alive.” Into my fresh notebook, I wrote, keep patients alive [audience laughter] and then I underlined it. By the end of the six years though, I realized that I was less interested in the body and more into the mind. And so, I hung up my now stained lab coat and specialized in psychiatry. 

 

I now know that people are quite confused about the difference between a psychiatrist, a psychologist and a psychic. [audience laughter] So, just to quickly explain. Psychiatrists are medical doctors who usually specialize in more serious mental illnesses, things like schizophrenia, and can prescribe medications. And boy, do we. [audience laughter] We also have the power to kind of detain or section people, which is like a strange superpower that allows us to lock a person up in a psychiatric hospital against their will and even force them to take medication without breaking the terms of the Geneva Convention. A kind of sad, but what's considered necessary evil to keep patients and society safe. 

 

There are a lot of unfair, I think, misconceptions about psychiatrists that, like the male ones, all have mad families themselves, and wear cashmere jumpers and have beards, [audience laughter] which just isn't true. This is a machine washable wool polyester mix. So, it is true though that one of my motivations for becoming a psychiatrist was hoping to get my hands on the secret code to fix my own slightly dysfunctional family. 

 

So, I remember turning up optimistically on my first day as a psychiatrist, enthusiastic to get my hands on these secret codes. Instead, I was given a strangle proof lanyard, a panic alarm and self-defense training. [audience laughter] Our judo instructor was this like martial arts guy. He told us before we taught us the throws and the slams and stuff, he said, the biggest bit of advice he would tell us if we wanted to last long on the medical register was that we avoid any of our patients committing homicide. [audience laughter] 

 

I couldn't believe what I was hearing. Like, this was nothing like Frasier. [audience laughter] Or, how psychiatry was depicted in Woody Allen movies. But he said, “Don't worry.” He reassured us, “The chances of a psychiatric patient killing a random member of the public are very low.” Thank God for that. Far more likely, he said, “They'd kill someone they knew, like their family member or a mental health worker.” [audience laughter] And so, he said though, “But don't worry.” The most important thing he said was, “If going to see a patient in their home, the most important thing was that if you're going was that you have to go for safety, always go in pairs if staffing levels allow.” [audience laughter] 

 

So, it was my first week, and I was working in this like inpatient ward which also we also under a consultant. We also had a clinic. A patient one day didn't come to his clinic appointment, which my boss told me could be a red flag that people are deteriorating, so he wanted me to go and check he was all right. So, I was going on this home visit in this first week. I was alone, obviously. I knocked on the front door trying to not look like I was absolutely shitting myself. And the person I was going to see was called Billy. He was a young man with something called paranoid schizophrenia, which contrary to what Hollywood depicts. Isn't actually about split minds and multiple personalities, but more usually delusional ideas and hearing voices. 

 

After knocking on the door, I was pleasantly surprised when Billy opened it. He gave me a warm smile. I told him why I was there. And he said, “Oh, sorry. I can't believe forgot.” He said, “Do you want to come in? Fancy a cup of tea? Slice of cake?” These were early signs that Billy was doing okay. So, yeah, I gratefully accepted that. I went in, and the daytime TV was burbling away in the living room and-- We went through to the kitchen. As he was fixing the teas, Billy told me a bit about himself. He said he lived there with his mum, and he said they supported each other and they like watched TV together. And he said although they weren't churchgoers, apparently, they watched Countdown religiously. [audience laughter] “But she was just out,” he said. 

 

I took the opportunity to ask my generic psychiatric questions that my boss had taught me to ask, like, was Billy sleeping okay? Was his mood all right? Was he thinking of killing himself? “No, no, no, everything was fine,” he said, except for the voices. My ears pricked up. And that probably, I thought, explained the unopened packets of medication that I'd noticed on the side table. I tentatively asked him what the voices said. “They tell me to get milk, which is so annoying because we've already got milk,” he said. I relaxed a lot, because even I knew back then that schizophrenic voices are often more sinister than that. And psychiatrists don't tend to get struck off or make front pages for having patients well stocked in the lactose department. 

 

But for completeness, I asked, “Do they say anything else?” And Billy said, “Well, yeah, they're not going to like me telling you, but yeah, they do also say that I'm the antichrist. And that the only way to wash away my sin is to sacrifice my mum.” I was like, “Oh, yeah, that's more like it.” [audience laughter] “But I just ignore them.” He said, “I just ignore them. They're stupid. I don't do what the voices say.” I let out another huge sigh of relief. It's when patients don't feel able to ignore these so-called command hallucinations that psychiatrists don't sleep so easily. 

 

And so, this wasn't the case with Billy reassuringly. As he was making me this nice cup of tea and I could hear the intro music of Cash in the Attic just starting up from the living room and the sunshine was pouring in through the windows. I was thinking, I think I'm going to quite enjoy psychiatry. And Billy asked if I took milk, and I said that I did. He was busy removing the tea bags with a spoon. So, I thought I'd help. I went over to the fridge and casually opened the door to discover milk. [audience laughter] Cartons and bottles, and cartons and bottles and cartons and bottles of milk filling every possible compartment of the fridge. I froze. I literally couldn't move my body. “Shit, Billy was obeying the voices.” 

 

My eyes were transfixed on this wall of white. And trying to sound calm and normal, I just asked again where Billy's mum was. “I just told you, she's out.” I took one of the bottles out and shut the door. When I turned, I saw Billy was now smiling and holding a kitchen knife. Then he cut us two slices from the lemon drizzle cake [audience laughter] and he asked-- He thanked me for the milk, and he put some in our teas and we went to sit down in the living room in front of Cash in the Attic. It was this incongruous scene where I was just thinking, Benji like, “If you behave normally, everything will be normal.” 

 

But I could barely swallow this cake in my dry mouth, like, trying to wash it down with sips from this scalding hot tea. But my mind was racing through all the worst-case scenarios. Like, I was just replaying that the warning our self-defense judo instructor had told us. Like, “Far more likely they'd kill someone they knew, like their mental health worker or a family member.” I asked specifically where Billy's mum was. “Shopping, apparently.” As we sat there, I said, “But will she be coming back soon?” And Billy went, “Shh.” Just nodded me to the telly. 

 

My eyes kept being drawn to this staircase, like at the back of the room that led up to their other floor. And I asked Billy if I could use. And he said, “Well, yeah, if you must.” I didn't actually need to. Like, the adrenaline surging through my body had seen to that. But he said, “Yeah, it's upstairs, first door on the left.” So, I got to the foot of the stairs, and I looked up at this dark landing and I hesitated. I was like, “Am I really going to do this? This isn't what I fucking signed up for.” [audience laughter] And so, I went up the stairs. At the top of the landing there were two doors, both slightly ajar. I gently pressed open the one on the left. Yeah, it was just a bathroom. Empty. 

 

I let out this breath that I felt like I'd been holding in for the last few minutes. But I knew that there was another door. I could feel my heart like beating out of my chest. My shirt just felt like way too tight, like sticking to my back with sweat. And the thing was, I already knew what nightmare awaited me on the other side of that door, from tabloid front pages and horror films and true crime documentaries. I went to open the second door. Bang. The sound of the front door closing. From downstairs, I heard a woman's voice say, “Hello, love, I'm back. Crazy busy in Tesco today.”

 

As I headed back downstairs, I overheard Billy say to his mum, “Did you remember to get milk" in a loving kind of what are you like kind of way. She said, “Yes, angel, I got your milk.” I managed to avoid sectioning Billy on the condition that he restart taking his medication, which, with much persuasion from me and his mum, we managed to make him agree to. Back at my workplace, in the hospital, I was telling my boss about how shit scared I had been. He told me that actually, people with schizophrenia are more likely to be victims of violence than perpetrators of it. He also told me that alcohol and drugs are far bigger risk factors for homicide than schizophrenia is. So, actually, technically, I was safer being in a psychiatric patient's house than at a psychiatrist's house party. [audience laughter] 

 

It's a weird one, because I am now the consultant psychiatrist with 10 years’ experience now. I've seen thousands of people not dissimilar to Billy. And about a few close shaves, but I'm yet to judo slam any patients, which is a strange thing for a doctor to boast about. [audience laughter] And the dean of my medical school, I think, would be proud of me too. Like, all of my patients, luckily, are still alive, as are the people that they've crossed paths with. But I sometimes wonder at what cost. Yes, with medication, Billy's voices quietened and we got the milk situation under control. But they took away other things. 

 

On this powerful antipsychotic medication, side effects meant that he'd sleep for like 16 hours a day. When he was awake, the lethargy meant that he felt like a zombie. The meds also gave him obesity, and later diabetes and heart disease. During a painfully lucid moment when I was reviewing him later in the year in clinic, he said to me through groggy eyes, “I know you're going to write in the notes that I'm doing well, aren't you, just because I'm taking my meds? But on them, I'd rather be dead.” 

 

So, I'm still very much looking for the secret codes for my family and for the more extreme end people like Billy. It seems that often the solutions to people's lives aren't straightforward. Even psychiatry's modern best cures, best treatments can be as disabling as the conditions that they aim to cure. It's been weird for me remembering that back then 10 years ago, the thing that really scared me was the patience. But now, with the benefit of experience and being more informed, by far the biggest thing that I'm fearful of, is that as a psychiatrist, I am maybe causing more harm than good. But maybe if I wanted things to be black and white, I should have specialized in radiology. [audience laughter] Thank you.