14 DECEMBER 1991, Page 11

If symptoms persist.. .

I ARRIVED on the ward last week to find a patient with two prison officers (one must not call them warders these days) sitting at the end of his bed. He had been admitted to our hospital suffer- ing from a condition too serious to be treated in prison.

A nurse whispered to me that he was a murderer: only later did I discover that this was something of an understate- ment. His deep-seated objection to pros- titution had led him to murder several of its practitioners. He stabbed his last vic- tim 29 times before applying the coup de grace with a brick.

As luck would have it, the patient in the bed opposite his was a locally notori- ous male paedophile prostitute (whose life story was abbreviated in the notes to `social problems + +'). Though the mur- derer was still unconscious, the male prostitute was taking no chances and dis- charged himself against medical advice. Before he left, he delivered himself of the opinion at the top of his voice that all doctors were illegitimate.

The murderer awoke. The prison offi- cers were engrossed in the cricket on the ward television. A nurse warned them of the return to life of their charge, but they ignored her. Let sleeping psy- chopaths lie. Surely he would be too weak after his period in coma to try any- thing? Displaying a resolve that would have been heroic had it been attached to a worthier cause, the murderer arose and in a single bound was at the door of the ward.

Of course he was caught and brought back. This time it was decided that he should be guarded by three men. As an additional precaution, it was thought advisable to chain him by the ankles to the bed and to apply a belt that strapped him to the mattress. Never was picking up a bed and walking made more diffi- cult.

I'm glad to say we don't have to treat murderers very often in our hospital. Nor does murder play a very large part in the lives of the population we serve, though domestic violence, in the absence of an adequate vocabulary to express unpleasant emotions, is common enough. It was a coincidence, then, that on the very day the murderer attempted to flee, I had a patient in whose illness murder played no small part.

She was an adolescent with supposedly severe abdominal pain. She had that sullen and resentful manner which so charmingly distinguishes many of our young people, especially the uneducated three quarters of them, who feel that their human rights are infringed when the doctor to whom they have presented themselves asks them how they are. This is not exactly an encouragement to empathy on the part of the doctor.

My patient's behaviour was not that of a person in great pain. Eventually it emerged that her boyfriend had recently been stabbed to death by a rival — in the abdomen. My patient's pain was sympa- thetic; it was the equivalent of the swelling in a husband's belly when his wife is pregnant.

I assured her she would recover.

`I will if they get him,' she replied.

They were her boyfriend's gang, and he was her boyfriend's murderer.

Theodore Dalrymple