"Keep his arm still, he's spitting it out!"

I held the 72-year-old man's arm harder against his mattress, the other three nurses firming their grip on his other three limbs, as the Senior Staff Nurse pushed the tube into his mouth.

Bertie spluttered and coughed as Ken, the senior nurse carefully syringed the formula down his throat, while trying not to let him aspirate on the stuff.

"Fuck, I did not sign up for this.." I struggled to hold back my own bile as I watched Ken's muscular arm covering the old man's mouth, preventing him from spitting it out. It was like something from a twisted and tragically one-sided wrestling match. The other nurses shifted uneasily and tried to offer words of encouragement to the striken old man.

Ken spoke his own words of encouragement and comfort to the frail skeleton of a figure helpless in his lap. Incongruous with his stranglehold-like demeanour, he also picked up on the group's discomfiture..

"We had Bertie here two years ago, didn't we Bert. Last time he'd managed to lose nearly 4 stone (25KG) and couldn't even get out of bed. His son and daughter were beside themselves.."

Bert gargled and thrashed as he desperately tried to expel the liquid which was helping him to stay alive.

Ken continued, partly to try and reassure Bertie, partly for the benefit of the senior students (and junior staffs) for whom this kind of treatment seemed to go completely against anything they'd ever encountered in their short careers.

"We tried coaxing and persuasion, Ken's son and daughter pleaded with him. But he said nothing and ate or drank nothing. Just sat and stared at the wall. He pulled out the drips so there was no point in trying NG tubes. And now his weight's dropped so low that unless he takes in some nourishment he's likely to go into organ failure."

"So how long do we have to go on like this?" asked Andy.

"Until tonight. Tomorrow Bert's scheduled for ECT. It's the only thing that seems to work for him.

Andy nodded. Not a great fan of modofied electrocunvulsive therapy, he had nevertheless seen it make a difference for some patients. Some people considered it a slightly controversial treatment, partly because in the past it had been used indiscriminately, overused for all sorts of diagnoses. Andy remembered reading it had even been used as a form of behaviour modification or punishment.

These days, treatment was usually given as a last resort, after counselling and medications had been tried. Except in emergencies, the patient's consent was required, after a full explanantion of the procedure and possible side effects. The 'modified' bit meant patients were given a pre-med, muscle relaxants and a full but short-lasting general anaesthetic. The electrodes placed against the temples transferred a minute current, just enough to produce a generalised seizure, lasting about 10 seconds.

If it worked, the results were almost instantaneous. A few more treatments plus adjunctive pharmacotherapy often saw the patient leaving with a marked improvement. But to this day I've never seen an improvement from ECT like I did in dear Bertie.

On admission he would sit in his chair and stair at the wall. Totally mute. He would do nothing for himself, acknowledge no-one and he actively, physically resisted any attempts to help him. He even defeacated where he sat. This was one of the most profoundly depressed people I had ever seen. And the physical assaults on the poor man to ensure he got nourishment was also taking its toll on the staff morale.

Other patients too were aware of the old man in the sideroom who just stared at the walls. They saw the doors close behind the nurses who went into his room and were surely aware of the existential struggle going on within.

After just one ECT session, Bertie started to eat food and shower. After two ECT sessions he was smartly dressed, clean shaven and digging into his hospital food. We started to see his true character. Bertie would walk around the ward, sharing jokes with others, sticking his head into the Nurses Station to pass a wry comment, popping out for a puff on a cigarette as he walked with his son and daughter around the hospital grounds.

It was a total transformation in which the whole ward, patients and staff revelled; it seemed to bring everybody closer in a collective, reflecitve hope for our futures. It was almost as sad when Bertie left with his grateful son and daughter as when he'd arrived and the whole ward community waved him off.

Corollary

An application on the part of the hospital canteen manager, for all staff to receive compulsory routine ECT treatments in order to 'promote appreciation of the canteen's profound gastronomical efforts' was turned down by management on the basis that ".. most mental health nurses are manic enough as it is, thank-you very much."