by F. R. Tallis
‘Will it clear?’
‘Who knows. Sometimes it does – sometimes it doesn’t.’
‘I wonder if you could help me. My name is Dr Richardson. I’m expected at Wyldehope Hall: the new hospital on Dunwich Heath?’ The stationmaster showed no sign of recognition. ‘The public telephone is out of order. Might I use yours instead? Otherwise I fear I might be stuck here all night.’
The stationmaster escorted me back to his office and I called Mr Hartley, who was, on this occasion, less understanding. ‘I suppose I’d better come and get you,’ he grumbled. The stationmaster informed me that Dunwich Heath was only five miles away: ‘You won’t have to wait for very long.’
He locked his office and we walked down the platform together. When we reached its end, he mounted his bicycle, said ‘Goodnight, sir’ and coasted down the ramp, ringing his bell.
I positioned myself beneath the projecting roof of the station and gazed out into a featureless expanse. The quiet was extraordinary. Dense and absolute. A car passed, driving very slowly, and I did not see another one until Mr Hartley arrived some thirty minutes later.
Mr Hartley was a big man with a pockmarked face and bulbous features. His hair was brushed to one side and he wore spectacles with circular lenses. He was not particularly talkative, although this was quite understandable given the circumstances. I apologized several times for my lateness, but this had no effect on his manner. He was still disinclined to make conversation. We passed through only one village on our way to the hospital, a place called Westleton, after which, thankfully, the mist began to lift and Mr Hartley was able to drive faster. A mile or so further on, the road became uneven and I had to press my palm against the dashboard so as to prevent myself from being thrown around. We passed between two square columns and I saw a cluster of faint lights ahead.
‘Wyldehope,’ said Hartley.
As we drew closer I realized that I was not looking at one building, but several – a central block flanked by outhouses. The car ground to a halt beside a stone porch, and when I got out, I took a few steps backwards to get a better look at my new home. It was too dark to see very much detail, but I was able to discern mullioned windows, mock battlements and a tower. A background noise was impinging on my awareness, and when I gave it my full attention, I realized that I was listening to the sea.
‘This way, please,’ said Mr Hartley. He was standing in front of the car with my suitcase.
We walked to the porch and the caretaker produced a bunch of keys from his coat pocket. He unlocked the door and we entered a spacious but dimly lit vestibule. It was decorated with wallpaper that I supposed must be Victorian – gloomy maroon stripes enlivened by a floral motif of faded gold. A suit of armour, evidently unpolished for centuries, stood guard by the stairs. I followed Mr Hartley up to the first-floor landing, where we passed beneath a stag’s head with glassy black eyes. When we reached the second-floor landing, Mr Hartley unlocked another door, switched on a light, and invited me to enter a wide hallway which had rooms adjoining it on both sides. He handed me a key. ‘You only need the one, sir. None of the other rooms on the second floor are occupied.’ I was shown a bedroom, a study, a small kitchen and a bathroom. The furniture was solid and functional, except for an antique writing bureau which was elegant and beautifully crafted. I imagined myself seated at it, writing a monograph.
‘Would you like your breakfast brought up, sir?’ asked the caretaker. ‘Or would you prefer to join the nurses in the staff canteen?’
‘If it isn’t any trouble, I think I’d like to eat here.’
‘I’ll tell Mrs Hartley. Seven o’clock suit you?’
‘That would be very good.’
‘Oh, I almost forgot – Dr Maitland called. He’ll be arriving tomorrow at ten thirty. I think you were expecting to see him a little earlier.’ Mr Hartley put the keys back in his pocket. ‘Well, I think that’s it, sir.’
I wanted a cup of tea, but dared not ask. ‘Thank you so much. And thank you for collecting me from the station. That was most kind of you.’
The caretaker appeared indifferent to my gratitude and said, rather brusquely, ‘Goodnight, sir.’
I locked the door to the landing and set about unpacking my suitcase. After hanging my shirts in the wardrobe, I filled a few drawers with the remainder of my clothes and distributed the rest of my possessions (mostly books and documents) in the study.
When I had finished, I walked down to the bathroom, where I washed my face and brushed my teeth. The sink was deep and its surface broken by fine cracks. Each of the taps had a circular enamel medallion at its centre, on which black letters spelled out the words ‘hot’ and ‘cold’. Raising my head, I looked at my reflection. I placed a finger under one of my eyes and dragged the loose skin downwards, exposing a crescent of pale, pink flesh.
There was a sound – a familiar sound – a sigh, and it seemed to come from just behind me.
I stared into the mirror, registering the emptiness of the bathroom.
That someone might be lurking in the hallway seemed very unlikely. I had heard no approaching footsteps, only the curious, breathy exhalation. Nevertheless, I found myself checking, and even peered into a few of the adjacent rooms to make sure that I was truly alone.
The tap was still running, and I was about to go back to the sink in order to turn it off, when an obscure intuition made me hesitate. I was reminded of the superstitious wariness that arrests one’s progress the instant one perceives that the path ahead proceeds beneath a ladder. Irritated by my own irrationality, I marched over the linoleum, grasped the tap handle, and rotated it until the flow of water stopped. I looked at my reflection again, perhaps more carefully than before, and I was forced to concede that I was not looking my best: my complexion was sallow and my eyes bloodshot. It had been a long day and I was clearly overtired. A painful throbbing in my head accompanied each beat of my heart.
I returned to the bedroom, put on my pyjamas, and got into bed. As I listened to the subtle music of waves on shingle, London seemed very distant. I thought again about what had happened in the bathroom. If the ‘sigh’ had been produced by natural means – an obstruction in the pipes, the acoustical properties of the environment, and so on – then it was remarkable how chance events and processes had duplicated the effect with such fidelity: an intake of breath, the slow release of air from the lungs, a suggestion of descending pitch. It had been most disconcerting.
I slid down further between the crisp, clean sheets, and reached out to turn off the lamp. Although I was exhausted, it was some time before I closed my eyes.
2
I will always remember entering the sleep room for the very first time: descending the stairs that led to the basement, Maitland at my side, immaculately dressed, talking energetically, cutting the air with his hands, the door opening and stepping across the threshold – a threshold that seemed not merely physical, but psychological. The nurse, seated at her station – a solitary desk lamp creating a well-defined pool of light in the darkness – the sound of the quivering EEG pens and, of course, the six occupied beds. All women – in white gowns – fast asleep: one of them with wires erupting from her scalp like a tribal headdress.
Narcosis, or deep-sleep treatment, had originally been developed in the 1920s, although, according to Maitland, prolonged sleep was one of the oldest treatment methods in psychiatry. Distressed individuals had been using alcohol to ‘knock themselves out’ for thousands of years, and in the nineteenth century a few enterprising doctors had attempted to treat insanity with opium and chloroform, but it wasn’t until the arrival of barbiturates that narcosis gained wider acceptance. Maitland was pioneering a new form of the treatment, which combined continuous sleep with the latest drugs and electroconvulsive therapy.
On that first morning, Maitland explained the regimen he had devised. ‘The aim is to maintain narcosis for at least twenty-one hours a day. Every six hours, patients are woken up, taken to the lavatory, washed, and given
drugs, food and vitamins. ECT is administered weekly. Careful records are kept of blood pressure, temperature, pulse rate and respiration; fluid intake, urinary output and bowel function are also noted. Due to the risk of paralytic ileus, regular laxatives are used and abdominal girth measured daily. Enemas are given immediately if there is any suspicion of failing bowel activity.’
Maitland walked from bed to bed, examining the charts, and making comments. ‘All of the patients receive six-hourly chlorpromazine: one hundred to four hundred milligrams. Lower doses are given if the patient is sleeping well, higher doses if the patient is agitated or not sleeping. In addition to chlorpromazine, the more agitated patients also receive sodium amylobarbitone. Because this drug has been associated with withdrawal fits, EEG measures are taken regularly to identify those who might be at risk.’ He indicated the woman with the wires sprouting from her scalp.
I asked Maitland about the patients’ diagnoses and he replied, ‘Schizophrenia and schizophrenia with depression.’ When I pressed him for more details, particularly concerning the individual cases, he was not very forthcoming. ‘They are all very sick,’ he said, in a tone that suggested the severity of their psychopathology made discussion of specific histories irrelevant. ‘Treatment is our priority.’
It transpired that one of the patients was due to receive her ECT. ‘We might as well do it now,’ said Maitland, running his finger down the chart. ‘I’ve made a few practical modifications to the standard procedure which might interest you.’
The patient was young, probably in her late teens. Her mousy hair had been cut short and her nose and cheeks were lightly freckled. She looked quite boyish.
Maitland rolled a trolley to the bedside. The flex that trailed across the floor tiles connected an electric shock machine to a wall socket. It was an old unit – older than I had expected. The outer case was made of a dark, reddish wood, and when the lid was lifted I saw a control panel of black plastic. White lettering identified each switch, two of which were surrounded by circles of ascending numbers. Through a crescent-shaped window it was possible to monitor the mains voltage. Bulky electrodes – Bakelite handles with rounded metal termini – were stored in a side compartment.
I was wondering why the nurse wasn’t summoning her colleagues. Maitland registered my expression and said, ‘I’ve invented a simple expedient which means that we will only be needing one nurse.’ He drew my attention to a bolt of material suspended under the bed. He crossed the patient’s arms and unrolled a canvas sheet, pulling it across the sleeping girl before securing it tightly so that no movement was possible. ‘You see, it does the work of four nurses!’ I looked at the patient’s chart and saw that her name was Kathy Webb. The nurse was cleaning the girl’s forehead. ‘Of course,’ Maitland continued, ‘the great advantage of administering ECT while patients are asleep is that they experience no anxiety – which means one can prescribe longer and more intensive courses.’ He picked up some lint pads and soaked them in a saline solution. He then deftly enclosed the electrodes in the pads and offered them to me, his hands raised slightly. There was something almost ceremonial about his attitude.
‘Would you mind?’
‘No. Not at all.’
I took the electrodes and positioned them on the girl’s temples. Maitland rotated the mains switch and the needle in the meter window moved, tracing an arc from one extreme to the other. I noticed that the ‘voltage’ and ‘time’ controls had been set at their uppermost limits. When I remarked on this, Maitland replied that ‘difficult cases’ required a ‘greater stimulus’. While we conversed, the nurse was inserting a rubber gag. This was done in order to prevent the patient from swallowing or biting her tongue.
‘Are you ready?’ Maitland asked his helper.
The nurse gripped the girl’s jaw and nodded. Maitland then looked at me. ‘Ready?’
‘Yes,’ I replied.
He smiled and his eyes directed my attention to a particular switch on the unit which could be flicked from left to right, between the words ‘safety’ and ‘treat’. The switch moved easily and made a soft click. At which point, the needle in the meter window suddenly dropped and the patient grimaced. Maitland turned the machine off and I replaced the electrodes in their compartment.
A tendon stood out on the side of the girl’s neck and she made an involuntary grunting sound. I could see the mounds of her knuckles beneath the canvas as she clenched her fists. After about ten seconds, there was some rhythmic twitching around her eyes, and both of her feet, which were poking out from beneath the sheet, began to jerk. The seizure lasted for at least a minute, during which time none of us spoke. When the girl’s twitching and jerking had subsided, Maitland unfastened the canvas cover and wound it back onto its drum. Finally, he checked the patient’s respiration and pulse.
‘Good.’
The nurse returned to her station and Maitland and I walked to the door. Before leaving, something made me stop and I turned to look back.
‘How long have they been asleep?’ I asked.
‘Some of them have been asleep for a few weeks, others for several months.’
‘And how long will the treatment last?’
‘At least three months. Possibly four.’ I had never heard of sleep being artificially prolonged for that length of time. My surprise must have shown, because Maitland gave me a hearty slap on the shoulder and said, ‘New ground! That’s what we’re doing here at Wyldehope, breaking new ground!’ An echo returned his final word to us from walls that receded into shadow. One of the patients sighed and the nurse looked up. ‘Now,’ said Maitland, ‘let me show you upstairs.’
There were two wards on the ground floor, one for men, the other for women, and all of the patients were accommodated in separate rooms with large windows. Unfortunately, the iron bars in the casements were rather ugly, dividing the otherwise fine view of the heath into mean, narrow segments. Both wards were very quiet, and when we reviewed the patient records the reason for this remarkable calm was immediately apparent. Maitland believed that if a patient did not respond to medication, then the dose should be doubled, and if there was still no improvement, the dose should be doubled again.
I had assumed that the ward patients would be less sick than those in the sleep room. If they were, it was only by a small margin. They had all been diagnosed with chronic forms of psychosis and depression and almost all of them had either contemplated or attempted suicide. While we were looking through the files, Maitland said: ‘It’s humbling to consider what these poor wretches must go through every day of their lives: the demons they must struggle to overcome, the abject terror, the appalling anguish.’ Naturally, I agreed, and he continued, ‘Have you ever known a patient, suffering from a physical illness, to be in so much pain that they killed themselves to escape it?’ I hadn’t. ‘Can you imagine? To be in so much pain that putting your head in a gas oven seems to be the only solution? That is why our work here is so very important.’
In due course, I would become accustomed to such ardent asides, but on that first day I was somewhat taken aback. It was as though Maitland had been wearing a mask, and that it had suddenly slipped, revealing an altogether different person: a more emotional, compassionate person. I saw the ‘doctor’ rather than the bluff radio personality, or the social engineer who had made it his mission to eradicate mental illness by the end of the century. In years to come, I would hear cynics say that these impassioned speeches were calculated, all part of his ‘act’, but that isn’t true. I think they were genuine and exposed a facet of his personality that he usually chose to conceal. He was a complex man – more complex than the obituary writers ever credited.
After we had finished our business on the wards, Maitland took me to the kitchen and dining area. I was introduced to Mrs Hartley, a plump, frantic woman, who was washing up pots and pans with a young assistant. She dried her hands on her pinafore, compressed my fingers in a raw, red clasp, and asked me about my culinary preferences. She seemed to app
rove of my likes and dislikes, and said with solemn pride, ‘You can’t beat Suffolk pork, doctor. Best there is!’ As we were leaving, Maitland asked her to prepare some corned beef sandwiches and a pot of tea. She didn’t quite tug her forelock, but she made a gesture that came very close to it.
When we reached the first floor, Maitland showed me a suite of rooms that had been set aside for ‘outpatient’ consultations. He was anxious to stress, as he had done in my interview, that we were only obliged to provide the local community with this service on an occasional basis. He wanted to reassure me that I would not be overworked.
Further on we came to a shiny black door. ‘Just a moment,’ said Maitland, halting to remove a key from his pocket. ‘My office.’ I heard the bolt retreat and Maitland pushed the door open. ‘After you,’ he added, gesturing for me to enter ahead of him.
I stepped into a room that combined the dusty serenity of a museum with the ostentation of a royal apartment. The decor was high Victorian: a marble fireplace, stuffed birds beneath domes of glass, and a massive ox-blood Chesterfield; there were oil paintings, standard lamps, and clocks festooned with silver and gold foliage. The only incongruous feature was a drab grey filing cabinet. On his desktop, Maitland had placed two photographs. One was a formal portrait of an attractive woman in her mid to late twenties – an old photograph, taken before the war. The other showed Maitland standing with three men of a similar type in front of the Statue of Liberty. I guessed they were American colleagues.
We carried on talking and after ten minutes or so the kitchen girl arrived with our sandwiches and tea. While we were eating, Maitland handed me a typed manuscript. It was an as yet unpublished theoretical paper that sought to explain why prolonged sleep was therapeutic. ‘I’d be grateful if you could read it,’ he said, still chewing. ‘If you think any of the arguments are weak, then please say so. There’s no need to rush. Take your time.’ I was flattered. When we had finished eating, Maitland announced that he had some administrative work to complete and that he would be driving back to London at four thirty.