Country Doctor

A Memoir

Ben Dlin

In this memoir of the post-war period of the 1940s and early fifties, Dlin retells the joys and fears of being the person who is called upon in emergencies, the person who has to make the decisions that can affect the patient and the patient’s family for life. Dlin says, “I believed then and still believe now that every student of medicine should spend time in rural practice. Within the novice it creates a lifelong humanistic approach to medicine that remains no matter what specialty is pursued.”

From Chapter Four

The hospital also had its “bedlam” wards, much like that portrayed in the classic movie¬†One Flew over the Cuckoo’s Nest. Most of the staff members were somewhat weird themselves; many of them could, in fact, be easily mistaken for patients, and since the patients could sense illness, it affected their trust in their caregivers. One of the younger staff doctors, an overtly effeminate homosexual, was severely beaten one day for no obvious reason when he went to his assigned job in the closed, disturbed female ward.

Although the most violent and uncontrolled patients, some with and some without clothes, remained locked in padded cells, this one ward housed more than a hundred psychotic women ranging from manic depressives to catatonic schizophrenics. Many were dangerous. They wandered barefoot in drab, shapeless cotton dresses; mumbling, screaming, begging, pleading, masturbating, rocking, or just standing or sitting like statues in one fixed position. When it was time for bed they would be herded to their locked sleeping quarters down the hall.

It was this unit of suicidal, homicidal patients and other psychotics that I was assigned to take over. Naively, I unlocked the door and stepped into a world of bedlam. Almost immediately a huge woman about six inches taller than I and weighing at least 280 pounds walked up to me and said in a heavy, authoritative German accent, “I take care of you!” Whereupon she reached over and picked me up with one arm and began carrying me around the unit. I was safe. I had the protection of the toughest woman I’d ever met in my life. “Vee go here or “Vee go dare,” she would say.

When I felt comfortable enough with her, I’d say, “Take me over dare,” or “Vud you please pud me down und vate for me here,” and she would comply. For the whole time I was in charge of the unit, she was my companion. I never read her chart because I was afraid that I might discover that she had killed her husband and her children. It seemed best just to carry on with the illusion that she was my protector. There was just not enough time to read all the charts, anyway. The focus instead was on handling each crisis as it arose and in dispensing medication.

Most of my chores were directed to dispensing medication for the epileptics, sedatives for the agitated, and electroshock for the depressed.

During these rounds I would also be on the lookout for physical illness or injury. Many women refused to eat, and without daily tube feedings most of them would have certainly died of starvation.

It was interesting to note that open, compulsive masturbation was far more common in the female than in the male units. I wondered if that had to do with the taboo at that time against masturbation. It came to me that the authors of those old textbooks on descriptive psychiatry must have assumed that since crazy people masturbated excessively, it was therefore a part of the reason for their being sick.

From time to time I noticed a thin older woman, with a greatly distended abdomen as she slunk around the ward. She looked nine months pregnant. I thought that she might have a gigantic tumor, but when I finally examined her, I discovered that the cause of the swelling was a massive faecal impaction. The nurse on duty had no idea that she had stopped having bowel movements. There was nothing to be done but to begin removing the faeces manually.

We got her onto a table and I proceeded to remove stool that was mixed with glass, stones and other foreign objects which she had either swallowed or inserted up her bum. I must have torn a dozen pairs of rubber gloves as I dug and dug, filling buckets with her bowel products. I would have preferred using a shovel. All the while this was being done the patient screamed. When I was finished and she was cleaned up, she leaped from the table and disappeared into the crowd like a wild animal running for shelter into the forest.

Three times a week I administered electroshock treatments. Though rather primitive at that time, it was still one of best tools available to help those who suffered from depression, agitation and mania. Unfortunately, it was useless for most other conditions.

Food was not allowed prior to the shock treatment in order to avoid aspirating stomach contents and to decrease bladder incontinence. The patient would lie on a table with two attendants on either side, two holding arms and shoulders while the other two held onto shins and thighs. A fifth attendant would place a roll of gauze into the mouth for the patient to clamp down on, then support the chin and head. This way the body was given some protection when the patient went into the post-electroshock grand-mal seizure, but they were given nothing to alleviate the terrible physical trauma that the body had to endure.

My job was to administer the shock. I felt like some mad scientist from a Frankenstein movie as I set the voltage on the control box so that when the button was depressed an electric impulse would travel through wires that connected to the ice-tong-like instrument that I held. The ends of the tong were wrapped in gauze pads that had been soaked saline solution to improve conductivity. I would apply these wet ends to the patient’s right and left temple, and we were all set for “blast off.” I’d say “Ready,” and all five people would bear down with all their strength. Instantly the entire body went into severe, continuous protracted spasm, which was followed by a series of powerful convulsions that lasted about a full minute. The force was so great that the convulsions often caused compression fractures of the patient’s spine.

On one occasion the nurse forgot to wring out the excess solution from the gauze ends, and some of the brine leaked onto my hands and onto the hands of the nurse supporting the patient’s head and chin. When I depressed the button the patient had a seizure and both the nurse and I followed along with seizures of our arms. It was a crazy morning. I told the nurse that it might well result in our having subsequent personality changes!

Most patients came willingly and without fuss for their shock treatments, waiting in line as if it were a dental appointment. After the treatment they would go into a recovery area, sleep for a while and then be taken back to their wards. Amnesia was both a complication and a blessing of shock therapy. On the one hand, it helped to erase the frightening memory of the event, but it often led to a profound confusion that could last weeks and even months.

There were two other forms of treatment for severely disturbed patients. One was very tricky to manage: insulin shock therapy. Patients were given a dose of insulin to produce severe hypoglycemia or a fall in blood sugar, resulting in profound sweating and stupor. Occasionally, they would have a seizure. Then we would administer intravenous glucose, thereby satisfying the excess insulin circulating through the body. The patient would wake up drenched in sweat, sleep for a while, eat, and then be returned to his or her unit. Other than sedating the patient and providing a lot of attention, I saw little if any benefit from this treatment.

The final form of treatment for the severely disturbed, a very ancient one, was to wrap the patient in woolen blankets soaked in ice-cold water. Within a short time, the body heat of the patient would rise and be kept constant by the wool swaddling. The patient would become calm, perspire profusely and usually fall into a restful sleep. Later he or she would be toweled off, and then indulged with food and fluids. This treatment provided the same temporary effect in tension reduction that one might get by sitting in a hot tub or a Turkish steam bath.

Years later, when I attended a meeting of the American Psychosomatic Society, I heard a very interesting paper dealing with the therapeutic effects of regressive psychotherapy. As I listened, it occurred to me that this is what had been taking place with our swaddled psychotic patients in Ponoka. The technique apparently took the patient back to feeling like a completely dependent child, his entire needs anticipated in such a manner that he was, for all practical purposes, reduced to the emotional age of one or two.

An entirely new process, the prefrontal lobotomy, was done on patients with severe obsessive-compulsive disease and on patients whose violence could not be controlled. Our chief of neurosurgery at the university, Dr. H. H. Hepburn, would drive down from Edmonton to do the surgery, and I was pleased whenever he requested that I assist him. One of the approaches he used was to burr holes through both temples; the other was to approach the brain through the thin bony orbit of the eyes. In both procedures a thin stainless steel probe was inserted into the brain and then the surgeon would sweep the probe in such a manner as to sever each frontal lobe from the rest of the brain.

After surgery it was necessary to re-educate these patients in almost everything. They had become docile little children. However, after all this tedious retraining, they would revert to the way they were before surgery, the crippling mental illness returning with no hope of ever getting better. All was for naught. This “ice pick” operation was a brutal one that illustrates the extent to which frustrated neuropsychiatrists would go to find the ‘cure’ for mental illness. Today, we use simple medications to deal with the same sorts of illnesses.

It always amazed me when some woman approached me in the midst of this bedlam and said in the most rational tone of voice, ‘Doctor, I am okay now.” After spending time with her, I would move her gradually through the various gates to healthier and healthier units until she was discharged. I had no idea why, or how, these patients got better.