Consider Phillip. He lies in his hospital bed, a person unknown. Deep in the stupefaction of alcohol he lies as one asleep. Possibly he is asleep.
I stand silently and watch Phillip and I consider him.
The police were alarmed when he vomited violently in their lockup. They called the ambulance that brought him to my one-doctor hospital. The nurses, veterans in the management of all forms of intoxication, called me, troubled by his scatterings of impulse, his wildly fluctuating state of mind and mindlessness.
I arrive to find a thin man of twenty-five lying on his side, inert. His body has curled into the position of a foetus in a textbook. Phillip’s narrow face, tapering downwards to a thin chin and a Ho Chi Minh beard, buries itself in a pillow. His eyes are closed.
I address him: “Phillip.”
Not a flicker.
“Phillip, I’m the doctor. I’ve come to help you…Phillip!”
Only minutes before my arrival the nurses found Phillip conscious and verbal. One moment he was weeping for the death earlier in the day of an aunty in his hometown on a nearby island; the next he was wolfing the sardine sandwiches the nurses prepared for him.
Now he is immobile, unhearing, a narrow form, a closed face, a straggle of black beard.
In these parts the death of “an aunty” can signify unbearable loss. And the access to alcohol can trigger irresistible impulse to harm.
I stand and consider Phillip.
Do I leave him lie – the chicken option? Or stir him up, revisit loss, possibly unleash the grog-drugged demons?
“Phillip, show me your tongue.”
Eyelids flicker, the eyes open. A mute question on a busy face: What – show my tongue?
“Phillip, I am the doctor. Please show me your tongue.”
Lips part, a pink lizard shows itself and retreats. Now it crawls from its dark cave and rests, clean, a healthy pink. But dry.
Phillip’s chart records a low blood pressure reading. Less than 100/60, it might betoken the relaxant action of alcohol on blood vessels. Equally such a reading might simply reflect his norm, his youthful good health. He’s a stranger here. We don’t know his normal BP. And it matters.
Abruptly Phillip sits up in bed. A pillow goes flying, bedclothes are flung aside. Phillip’s scrawny arm reaches behind his back, deep into his undies. He scratches furiously. He looks around. A wildness in his movements. He lies down and begins to whimper. He buries his head in the crook of an arm and weeps now, regular little bleating sounds, a child giving way to grief. Before I arrived, the nurses tell me, Phillip squatted on the floor, folded his head in to his torso, his body a concertina; at the same time he drew his arms against his chest and his fingers into the attitude of prayer – the nurses were taken by the strange gracefulness of his fingers – and he began to cry.
This second weeping exhausts itself. Quietness falls in the darkened room.
Without warning Phillip’s fingers race around his belly, scratching in a frenzy. Now they plunge to his undies and pull them down, exposing a circumcised member. Meanwhile my own hands yank bedclothes upwards to restore what? – dignity? – modesty? For the exhibition is so insistent, so obscure, so confusing, I feel alarmed and I am sure my alarm is for the women around me, anxiety occasioned by the actions of the thin man in the bed, actions quicker than thought, movements without reason or purpose. As the bedclothes jump and subside before me I am reminded of the inscrutable movements of the unborn. And indeed there is much that is infantine about Phillip, his way of looking at and into the attending nurse or at me, his helplessness, his mute, unknowing enquiry, his submission to tenderness.
I decide on an intravenous saline infusion to rehydrate Phillip, to wash out the grog and to lift his BP. And not incidentally, to provide immediate access to a vein in case of urgent need. I am thinking of sedation that might short-circuit a fatal impulse. On the other hand, sedation can further lower a low pressure and depress grogged breathing.
First I have to sell the deal. Phillip is (still) a voluntary patient of whom involuntary treatment would be assault.
“Phillip, we’re going to give your body a drink. We’re going to put a needle in your vein so we can make you feel better.”
The busy face, thinking what?
“We’ll put a needle in here.”
Phillip looks at the finger I have placed on his arm vein as at something mystic.
Nurses bring the gear for a drip. The nurses who are due to go off duty do not go. Every able bodied person in the hospital gathers around Phillip. No-one has expressed it but all of us feel anything might happen.
The sharp trochar pricks Phillip’s cubital skin. Beneath my sentinel palm that rests gently on his shoulder I feel his muscles bunch. Now his hand flies up towards the face of the cannulating nurse. Her face tightens and darkens, her voice finds steel: Don’t. You. Think. Of It.
A moment that freezes. Ten eyes stare, Phillip subsides, we breathe out.
“Midazolam, 2.5 milligrams, now!” My command is a whispered shout. Moments later Phillip is sedated, leaving nurses and doctor unsedately measuring blood pressure and monitoring respirations.
Two hours later the nurse in command calls me, apologising needlessly: “Phillip is agitated again, should we repeat the sedation?”
“Should we? We have to!”
Incidentally the nurse’s midnight enquiries to the clinic on Phillip’s island confirm that his BP is always low. The pressure of a healthy child.
Sleep will not come. The eye in memory sees a teenager, crazed, sad, helpless, feeling everything, understanding nothing, terrified of the feelings that clamour and hammer in his head.
At length a question crystallizes and brings me back to Phillip’s bedside. We two are alone in his dark room. His eyes are open, his body at rest. Before I can pose my question Phillip has one of his own. He gazes at the inside of his elbow. He fingers the bandage that holds his cannula inside the vein. The white bandage is bright in the gloom. “What if I pull all this out?” His finger explores dangerously, his voice asks innocently. I beg Phillip not to touch the tubes, not to disturb the bandage. “We want to help you Phillip.”
Now for my question: “Phillip, what else have you had today – apart from the beer?” There has to be something else. I don’t see this behavior with grog alone. And more than that, Phillip stays beneath the roof a special house in this community. It is the house of an older white man. A white man with many younger black visitors and residents. A nurse at the hospital says: “We treat a great deal of sexually transmitted disease among the young residents of that house, and too many drug-taking people.”
Artlessly Phillip gives answer: “I smoked ganja today doctor. You know, dope.” He looks to me, that look he has, free and clear of adult care, of consequence. He looks to me, the grownup. Aunty has passed: it is for me to know, for me to be a parent.
Copyright, Howard Goldenberg, 27 February, 2014.