Van Gogh in the department

A young man, quiet, sitting silently on his trolley. His arms are covered in spirals and patterns that seem to twine and coil up his limbs, the brilliant colours shifting and blurring as he moves. He is dressed simply and it is obvious that he normally looks after his appearance - his hands have the roughened appearance of a manual labourer, but his fingernails are meticulously clean and neatly shaped. Streaks of blood have dried on his cheek and beard and in spatters on his jumper.

He looks into my eyes for a brief second, and then stares rigidly into space, as if eye contact was too pressurising. His face is expressionless and blank as he answers my questions.

'I cut my ear. With a bread knife.'

I examine his ear. He does not flinch when I peel off the makeshift dressing he's made, even though a few hairs rip off at the same time. The wound is not bleeding much anymore, but he has almost cut his entire ear off. It's still mostly attached, but not by much.

'It will need stitches,' I tell him, 'But it's too deep for me to do it; I will have to ask the general surgeons, or maybe even the plastic surgery team.'

He assents. His expression does not change. I ask if he's in pain and offer pain killers. He does not move or respond. I tell him that he can ask for pain relief at any time.

As we talk, he tells me more about what has transpired. He suffers with schizophrenia but has been quite well for the last few months without medication, and thought he was free of it. But lately, the voices have returned and they were so loud that they drove him to distraction, drove him into despair, until finally he thought he could rid himself of them by cutting his ears off. He was halfway through when he realised what he was doing and called the ambulance.

His voice is monotonous and heavy, with no inflections, as if it was weighted down by lead.

I ask him about his tattoos. He tells me he designed them himself. I look hard into his face, wondering, hoping even to see the faintest glimmer of pride - but there is nothing.

After we agree on a plan, I leave Van Gogh alone, as I make arrangements to have his ear fixed and for him to speak to our psychiatry liaison team.

It's a very curious disease, schizophrenia. Reality for the schizophrenic has become shattered to such an extent that one cannot ever hope to fathom or empathise with what they go through. People with depression and anxiety and other 'emotional' disorders, we can understand and even identify with them. But psychosis is a realm that most of us have never explored.

There's a theory that schizophrenic patients have difficulty recognising and identifying their own thoughts - that is, they confuse their inner voice with outside stimuli. Imagine if you believed every train of thought in your head had an actual sound that you could hear with your ears. How noisy that must be!

I can hardly imagine what it must be like to live in a distorted and utterly confused world, where reality and dreams are mixed in together in kaleidescopic whirls. It would be so frightening and disorienting.

I remember the paintings I've seen in museums and on postcards - the swirling colours both brilliant and sad. I look at the tattoos on Van Gogh's arms - the deep bruised blues and pale cadaveric greens. I think again about the partially severed ear and the blank, emotionless face, and I know he's trying to tell me something.

I listen and listen.

But it is as if my ears have also been cut off, and I cannot hear him and I cannot understand.