An open letter to cognitively-impaired patients who I met when I worked at the hospital

By Mark Sadler

You pulled up a chair alongside my desk on the neuro ward, and enquired after the whereabouts of a business colleague from your clouded past. When I gently reminded you of your inpatient status, you told me that you would be happy to wait until he returned to the office.

This biographical moment, that you cling to with such pure conviction, won't come around again in your lifetime. The man who you are waiting for has moved on. I would like to find the words that would convince you to lay down the burden of your work; to cut your losses and run. Shuffle back to your room in your slippers. Stare into the TV, while you pan your ebbing consciousness for glimmers of lucidity; the face of the wife who you still occasionally recognise when she visits.

I went onto the male bay in the ward, to determine whether you were sufficiently compos mentis to sign a release form, allowing access to your doctor's records. You regaled me with tales of your recent battles with Roman soldiers. I tried to reassure you: You are a hospital patient in the early 21^st century. Your family will come to visit you this afternoon. They're here every day. I see them through the wired glass. You nodded in agreement. As I departed with the form unsigned, you called out after me: “They were right bastards to us.”

I enquired who the bastards were.

“The Romans,” you responded.

I wanted to ask you something: Is it even remotely possible that I am man in his 80s with dementia? Or a teenager who fell off the roof of a derelict building and caved-in his skull, so that, post-surgery, it looks like it's been planed at an acute angle? Has that brain damage, however it occurred, formed an alliance with my modest career ambitions, manifesting in the mistaken belief that I am an in-house temp in a provincial hospital?

It's not too much of a stretch to imagine a patient wandering off a ward, sitting down at a desk in front of a computer, with everyone around too busy to notice. One sharp blow to the head, one rogue prion, and you too could be back in 1^st century Britannia, fighting the invading armies of Julius Caesar.

The job has the punch-drunk quality of a lucid dream. Relentless work bludgeons the delicate fringes of the senses, browbeating the personality into stark retreat. The comically-teetering stacks of files and loose notes, occupying the In and Out trays, are like some errant trope from an office-themed cartoon strip, awaiting an off-colour reference to the fall of the twin towers.

Those 15 volumes of medical notes, that collectively tell the story of a single case of childhood cancer, stand taller in a stack than the patient herself, if she could still stand up.

Who is the saner individual: The person who attempts to bring a semblance of order to this burgeoning chaos, or the patient who swallowed their earbuds after listening to The Stereophonics? Jesus Christ, have you heard The Stereophonics? Removing their music from the world, by whatever means you have at your disposal, seems like the action of an enhanced rationality, reconfigured to deal with the unfathomable ordeals that await us in the new millennium.

When the sedatives the junior doctor prescribed to calm you down, instead had you climbing the walls, I gave you the teddy bear that another patient hand-knitted for the ward in thanks. I left you silently cradling it like a child. When I returned, five minutes later, you had torn its head off.

None of this seems real. There's an agency nurse who thinks she can assess the condition of patients by standing outside their rooms and starring through the walls. There's a Christmas tree made from rubber gloves that have been painted green. It looks like the disembodied contents of a mass grave. A bald kid with leukaemia wants to know the Christian and surnames names of all the tropical fish in the tank on the children's ward. He wants to know their relationships to each other, like a family tree. I dreaded his return; his expectation that I would remember the tapestry of lies that I wove with his tacit encouragement, in the hope that it would somehow contribute to his recovery. I needn't have worried. I never saw him again. People wander in and out of here like sketchy presences in a dream.

I saw you standing at the window in your dressing gown, your mouth agape, as if old age had frozen you, warped in position, like an old tree. I was attempting to push a ten-foot-tall wheeled cage, filled with crated medical notes, up a snowy slope in the car park. Weight, gravity and muscle power had settled into an uneasy stalemate, the cage stationary on the incline, my shoes slipping on the ice underfoot, going nowhere, like in Scooby Doo when they attempt to flee from a monster in terror, but their feet can't gain traction and they end-up running on the spot.

It seems ridiculous; surreal. Did it really happen? Or was I the man at the window, attempting to reconcile the dim memory of a cartoon with some foggy present-day notion of my medical quarantine?

You followed one of the haematologists into the pathology lab, in your back-fastened hospital gown, shuffling between the narrowing gap in the security doors before they could swing closed, Maybe that's how we all got here. We just wandered in and began sorting through the incessant tides of samples from the outlying doctors surgeries. On my first day I joined a group of crowing middle-aged women, dressed in white lab coats, holding up a specimen, a body part suspended in fluid, debating whether it was a penis or a big toe, until someone correctly pointed-out than penises don't have nails.

You don't have to be mad to work here, except you probably do. It's a defence mechanism.

Had a hand gently guided me away, back to some sterile room, where a whiteboard on the wall above a bed, displayed my name in marker pen, it would not have surprised me.