Midnight Madness
Foreword: In my junior and senior years of medical school I worked as an “extern” at Timberlawn Psychiatric Hospital, a swanky private institution of a type now extinct after improved psychoactive drugs emptied mental hospitals.
I took call every third night from my room. The pay was measly—$50/month, all I could eat if I was there when the kitchen was open, and a bed in an old house on the hospital grounds. I helped the night staff with minor problems and performed admission physical exams and mental assessment on new patients: one night a wild-eyed NFL quarterback raving the TV was reading his mind; the next a jumpy bipolar in full blown mania leaping onto the stage during an opera to show he could sing better than the diva. I loved it. I saw interesting patients and the staff called me “Doctor,” a subterfuge I furthered by wearing a good tie and pristine white coat with a stethoscope ever so carefully coiled to show from a side pocket.
But room, board and $50/month wasn’t enough to live on so I sought other work, sometimes as a night shift private duty nurse, and once a week I did pre-surgical physical examinations at a small hospital. On top of it all my medical school schedule sometimes required being on call every third night from a dormitory next door to Parkland.
One night I was on call at Timberlawn, the seventeenth consecutive night I’d been working or on call. Exhausted, I turned in early and fell quickly asleep.
Timberlawn Psychiatric Hospital, Dallas
The phone jangled me awake.
“Sorry to bother you Doctor McConnell. This is nurse Midge on Unit D. I’m calling about Miss Spacey.
“Uh, hmm.”
“Remember, she’s the loopy one you admitted last night. The one who has a history of Miltown abuse,” she said, referring to a new tranquilizer that I knew could cause seizures upon sudden withdrawal.
“Uhm, okay.”
“She’s had a seizure. What shall I do?” she asked.
“Well, uhm, just give her a couple of Miltown pills.”
“Doctor McConnell, she’s too out of it to cooperate. She’s been vomiting. I’ll never get her to swallow them.” This was no surprise. I knew that after a seizure patients were usually drowsy, confused, and nauseous. I should have remembered without the reminder, but my brain wasn’t working very well.
“Hmm. Okay. Er, uh, uh, hmm, just give it to her by injection. That ought to do the trick.”
“Doctor McConnell, Miltown is not available in injectable form.”
“Just a minute; uh, just let me think,” I groaned. Jesus! I knew I should get out of bed and go over there, but I was so drugged by fatigue I couldn’t think straight. To get out of bed seemed impossible. I needed to think of something, anything, that would satisfy the nurse so I could go back to sleep.
“Uh, do they make it as a rectal suppository?” I asked.
“No, sir; tablets are all I have.”
I considered just telling her to forget it, but the threat of repeated or prolonged seizures was not a risk I was willing to take.
There is a saying in medicine that desperate situations call for desperate measures. This was one. I invented a therapy.
“We’re going to have to get it into her rectally,” I said. “Make up a warm saline solution and crush four pills. Dissolve them in as little fluid as you can. We don’t want her passing them into the toilet. Push the tube as high as you can,” I continued, as if I’d done it a dozen times.
I expected the nurse to object, but she didn’t. I went back to sleep and the phone didn’t interrupt again.
The next morning I awoke with a start. I couldn’t recall exactly what had happened. Was it a dream. I couldn’t sort it out. Did I really order a tranquilizer enema?
I didn’t ordinarily eat breakfast, but this morning I walked over to the hospital break room for coffee and a doughnut before driving across town to Parlkland. Maybe I could engineer a discreet inquiry of the day supervisor about the nightshift report. As luck would have it, the supervisor was in the break room chatting with several other nurses.
“Good morning, Doctor McConnell,” the supervisor said.
Did I catch a hint of sarcasm in Doctor McConnell? Paranoia is not confined to schizophrenics. Were they gossiping about me, the idiot extern who ordered the tranquilizer pill enema? I couldn’t bring myself to be direct about it.
“So, ladies, I trust nobody escaped last night,” I said jocularly, hoping to prod one of them into making a comment about the night shift.
“Oh, no sir, just the usual oddities,” one of them said. Was a tranquilizer enema an oddity?
I hesitated for a moment, waiting for them to bring up the topic. They didn’t, which compounded my fear that they had been talking about me.
“Well, I’ll see you later,” I said, ending the awkward silence, and headed for Unit D.
After being buzzed in through the security door, I plopped into a chair at the nursing station and did my best imitation of a psychiatrist checking the charts. First, I made a diversionary move and looked at several other charts before picking up Miss Spacey’s chart. With anticipation as great as I felt opening a final exam, I flipped through the pages until I got to the nurses notes. There it was: the sleeping pill enema episode described with matter-of-fact detachment. Hourly follow-up notes revealed the patient slept quietly the remainder of the night and had no more seizures.
It was the first and last therapeutic enema of my career.
English