Further Confessions of a GP

Mr Goodson

‘HELLO MR GOODSON. CAN YOU HEAR ME? IT’S THE DOCTOR.’

I was kneeling on a doorstep in the pouring rain shouting through a letter box.

I had received a phone call that morning from Mr Goodson’s worried niece. She had been receiving increasingly odd letters from him over the past few months and wanted me to go and make sure he was okay. At this point, I wondered whether as his closest relative she might want to demonstrate her concern by visiting herself, but she gently pointed out that she was phoning me from her home in New Zealand, so as his GP responsibility for his wellbeing fell to me.

Mr Goodson doesn’t have a phone and he had previously always communicated by writing kindly letters to his niece in New Zealand. Recently the letters had been becoming increasingly paranoid in nature, warning her of a conspiracy regarding a dangerous network of computers controlled by the British royal family and the Kennedy family in America. According to him they were plotting to control the world by placing a grid of electromag-netic energy around it that would have power over our minds. In the most recent letter she had received, Mr Goodson had accused her of being part of the conspiracy too, and it was at this point that she decided to give me a ring.

I hadn’t met Mr Goodson before. He had been registered at our surgery for years but, despite being 73 years old, his computer records suggested that he didn’t have any health complaints. He didn’t answer our letters advising him to come in for flu jabs and health checks and so up until now we had always respected his choice to keep away and left him in peace. The phone call this morning changed all that and I couldn’t ignore his niece’s concerns. It would appear that his paranoid thoughts were likely to have been ongoing for some months now, so there wasn’t any real reason to rush round that same day, but just last month I’d discovered that one of my patients had lain dead on his sofa for four months without anyone realising. I didn’t want another of my patients to suffer the same fate, hence the situation I now found myself in, shouting through a letter box in the pouring rain.

After five minutes of yelling and banging on the door, I was on the verge of giving up and hoping he was simply out rather than lying dead somewhere inside. I knocked on his next-door neighbour’s door, who helpfully told me that she was fairly sure he hadn’t been out in days, so I returned for a few last desperate shouts through the letter box.

‘IF YOU DON’T LET ME IN I’M GOING TO HAVE TO BREAK THE DOOR DOWN.’

This last-ditch attempt to persuade Mr Goodson to open the door was an empty threat. I really didn’t have the strength or inclination to break down a front door, but just as I was ready to give up and go back to the surgery, I thought I heard some stirring from within the house. I kneeled down again on the doorstep to peer through the letter box and to my surprise this time I saw a pair of eyes staring straight back at me.

‘You can’t come in,’ he told me calmly. ‘You’re contaminated.’

‘Er, I don’t think I am,’ I answered feebly, suddenly a bit thrown that I was having this bizarre conversation through a letter box.

‘Yes you are,’ Mr Goodson responded confidently. ‘What do you want anyway?’

‘I’m Dr Daniels, your GP. Your niece called me. She’s worried about you.’

‘She’s contaminated too. I tried to warn her but she wouldn’t listen.’

‘Can I just come in for a chat?’

‘You’ll need to decontaminate first. Hold on.’

With that, Mr Goodson stood up and shuffled away from the door. Some moments later a nearly empty and very old bottle of Johnson’s baby oil was pushed out through the letter box and landed at my feet.

‘The electromagnetic rays can’t get through this. It repels them,’ he explained.

Looking at the grubby bottle, I wondered how far I should go along with Mr Goodson’s delusions. I tried rationally suggesting that I had already washed my hands carefully before leaving the surgery, but Mr Goodson made it very clear that this wouldn’t be sufficient. There was a limit to the amount of time that I was prepared to spend shouting through a door while getting drenched by a November downpour, so I gave in and picked up the bottle of baby oil. I made a show of rubbing some of the lotion over my hands while Mr Goodson watched me suspiciously through the letter box.

‘Right, I’m all, erm… decontaminated now.’

‘Your face isn’t. That needs doing too.’

I looked down at the grubby-looking bottle and wondered at its age. Did I really want to rub this stuff on to my face? Johnson’s baby oil is harmless enough, but I couldn’t be entirely sure that, in his paranoia, Mr Goodson hadn’t added less savoury ingredients to the bottle. I stood for a few moments, trying to come up with a better method of gaining entry than smearing this stuff on my face, but when nothing came to mind I reluctantly rubbed the cream over my face, and to my relief I heard the clunk of his front door unlocking.

Once inside I was amazed that Mr Goodson really thought that some sort of contamination was going to arise from the outside world rather than from the filthy state of the interior. It took a while for my eyes to adjust to the darkness, but once they had I was greeted by a stark and miserable sight. Mr Goodson himself was in a terrible state. He had clearly once been a tall man but now he was hunched over and his ragged looking shirt and trousers were baggy on his bony frame. The floor was a bare lino, sticky with grime, and the walls were brown from the tar staining of decades of cigarette smoke. Plates of half-eaten meals and empty food packaging were piled high in one corner of the living room and an awful stench of what smelled like sour milk seeped into the pit of my stomach making me want to gag. All his windows were blocked out by rows of tin foil and empty egg boxes, which were crudely Sellotaped to the glass in what I could only imagine was another attempt by Mr Goodson to deflect the electromagnetic forces he so feared.

‘Do you have a computer, Doctor?’

‘Well, yes.’

‘You need to get rid of it right away. They’re sending messages through it.’

‘What, like emails?’

Mr Goodson looked at me blankly and I could see that the concept of an email was completely alien to him; we stood in silence for a few moments, with Mr Goodson shuffling around me, his suspicious gaze fixed on my face. Having made such an effort to gain entry to his house, now that I was in, I felt at a bit of a loss as to what to do next. I had successfully confirmed that Mr Goodson was alive and also that he was floridly paranoid and delusional. He was clearly very suspicious of me, so my next step was going to be tricky. I decided I needed to try to gain his trust, but cordial small talk has never really been something I’m any good at.

‘So, how have you been?’ I asked with false brightness.

‘I’m just trying to stay alive, Doctor.’

‘Yes, erm, aren’t we all…? Pretty bloody awful weather, isn’t it?’

‘Water helps conduct the radiation. It can spread in rain water.’

The small talk wasn’t really getting me very far, so I decided to try to address the elephant in the room.

‘So, why do you think everyone is contaminated?’

Mr Goodson went on to describe in some detail his fears about global plots and bizarre conspiracies. Such was the intensity of his paranoia that I knew that there would be no benefit in trying to challenge his beliefs. Mr Goodson needed to have antipsychotic medication and ideally be admitted to a psychiatric unit where he could be safe and looked after until his delusional paranoia settled. I gently introduced the subject of him taking some medication to help make the unpleasant thoughts go away, but he wasn’t having any of it. As far as he was concerned, he was the only one who accurately understood the truth and it was the rest of us who were unwell.

Sectioning is not a decision that anyone takes lightly and it really is used as a last resort, when there are no other feasible options available. Some people manage to stay living independently at home with quite marked chronic delusional symptoms, but Mr Goodson’s symptoms were such that it was preventing him from being able to look after himself. Once someone’s illness leads to the potential to harm themselves or others, the person can be judged as unwell enough to be admitted to a psychiatric unit against their will. Sensibly, such a grave decision isn’t one that I’m allowed to make alone. It requires the joint decision of a GP, a psychiatrist and a specialist social worker, and so when I returned to the surgery I made some arrangements to return the next day with the cavalry.

The following day I met the psychiatrist and social worker outside Mr Goodson’s house. They looked a little surprised when I took from my bag a bottle of Johnson’s baby oil that I had taken from my own bathroom cabinet that morning. When we knocked on Mr Goodson’s door, he made me push my bottle of baby lotion through the letter box. After it passed his careful inspection, it was posted back out and he intently watched all three of us smear ourselves with the stuff before letting us in.

My biggest fear at that point was that Mr Goodson would point-blank refuse to be admitted to hospital, leaving us no choice but to get the police involved to forcibly detain him. In his paranoid state, this would be terrifying for him, and he was in such a physically frail state that if he put up a fight I was scared he might get badly injured.

Fortunately, the social worker was brilliant. She had a very calming way about her, and without either colluding with his delusions or openly refuting them, she managed to persuade Mr Goodson that he would be safer and better off under the care of the mental health team. It took some time to reassure him about levels of contamination in her car, but eventually off they went and he was able to get the care and treatment that he needed.

Psychosis is a terrifying condition for the sufferer. The strange thoughts and paranoid ideas that can seem ridiculous to us feel absolutely real to the poor person with the condition. The antipsychotic medications available aren’t perfect, but they do help clear away the delusions and return people to reality. Since starting these drugs, Mr Goodson is much better. He is still undeniably eccentric, but the tin foil has been taken down from the windows and I no longer have to smother myself in baby oil in order to gain entrance to his house. Most importantly, he feels safe again and is able to live something resembling a normal life.