Upside-down Psychiatry

By Khaldoon Ahmed*

Photo by Sid Ali on Pexels.com

I am a psychiatrist working on a ward in an inner city hospital in London. Every day in the small nursing office the psychologist asks the staff how they are coping on a scale of green, amber and red. We are now more green than amber, and are now used to the “new normal” in this upside down world.
The hospital is part of a National Health Service (NHS) Mental Health Trust in a dense urban area which was historically known for poverty. We serve a mixed population of immigrants and their children, and well paid professionals who work close by in the financial centre of the City. London is the quintessential global city, and it is no surprise the pandemic swept through here like a howling gale that still rages.
In late February the pandemic was ravaging Italy and Iran. About then I developed a dry cough worse at night, with a fever. It was strange as there were few confirmed cases reported the UK, and I had no idea if I had the virus. I had mild symptoms and took a week off work. On my return there was still no social distancing in place. I attended meetings in packed rooms, feeling incredibly self conscious that I might be infective to others. The sweatiness I felt was as much from fear as infection.
Two weeks later I was redeployed to the the psychiatric ward. The Trust wanted doctors to stay at one site rather than move between sites. I arrived in another world, half of the staff were unwell or self isolating. A psychiatric ward usually is a strange place, but now it felt eerie. Patients wandered the corridors confused. There was no-one to organise the daily exercise sessions or board games. 
We tried to explain social distancing to the patients, none complied. Some had grandiose delusions and thought they could cure the virus. One patient demanded to leave the hospital to go to Buckingham palace so he could meet Prince Phillip to distribute aid for the pandemic. When this is over we will find out the true horror of how many patients in psychiatric wards in the country died because of the virus.
There was only enough PPE (Personal Protective Equipment) to see patients with confirmed infection. This did not make sense. So many staff were developing COVID19, the patients needed protection from us as much as we needed from them. 
We then had our first patients with the virus. They generally had mild illness, but had to be put in isolation rooms. One manic patient alternatively thought he was Prophet Mohammed or the head of the CIA. He was infected with coronavirus and could not understand why he was forced to stay in the isolation room. He came out 7 days later, free of both of infection and mania, but described going through hell. It was a double incarceration – of being forced to onto a psychiatric unit, and then being forced into a locked isolation room. 
The following week our PPE arrived. We put on our blue surgical scrubs and face masks. Our transformation symbolised a new identity, and the complete change happening inside and outside in the world. 
At night I followed with gripped anxiety the discussions on doctors’ facebook groups. How oxygen saturation drops suddenly in infected patients, and how catastrophic immune responses can result in death. I suddenly longed to work in hospital medicine again, as I did when I was a junior doctor. A small part of me still thought that being a psychiatrist was not the same a ‘proper doctor’. I could not convince myself that I was on the front line. Of course we were all on the front line as NHS workers.  The mentally ill are the most neglected in both society and the health system. To be here looking after them when everything was falling apart was after all, important.
Things are still upside down. This week we started to check the temperature of all the staff as they arrive to work. Why did we not do this earlier ? We ask the same thing of the government who are only now monitoring arrivals from international flights. Trauma specialists advise against psychological therapy immediately after a disaster. To recount what has happened too soon deepens the trauma, like opening wounds stops healing. We are a long way from the point where we can process this.

*Khaldoon Ahmed is a consultant psychiatrist and creative non-fiction filmmaker. He was born in London to a Pakistani family. He did his medical training at University College London where he also completed a masters degree in social anthropology. His short films have screened in festivals around the world from the Berlinale to Sheffield Doc/Fest. He just completed an experimental film about madness and architecture called ‘John Meyer Ward’. Khaldoon has taken creative writing courses at Under the Volcano, in Tepoztlán, Mexico.
Instagram: Khaldoon_ahm_d
Facebook: Khaldun Ahmad

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