Dangerous Minds

by Priscilla Masters

  ‘Does he know anyone close to you?’

  ‘Not that I know of.’

  ‘Is he likely to harm you?’

  ‘That’s the trouble. I don’t know.’ She tried to lighten their mood. ‘Not during his wedding. That really would be a first.’

  They both laughed uncertainly at that, but Julia reached out a hand. ‘Be careful,’ she said, and Claire nodded. ‘I will.’

  They chatted until ten. Claire offered to drop her friend off but Julia declined. ‘It’s a nice night,’ she said. ‘I’ll walk.’

  It was only a short journey home but Claire was thoughtful. She felt very alone. Discussing her domestic problem with Julia had clarified the situation. She did need to speak to Grant – not pleading with him to get in touch, to explain himself, to come home. Nothing heavy – just a business call. She needed to know what his plans were and whether he was willing for her to put the house on the market. Unfinished?

  No. The decorating must be done.

  She turned into her drive and stopped. A car had pulled up right behind her, its headlights on full beam. For a moment she was both dazzled and alarmed. She climbed out of her car, shielding her eyes from the light, trying to see who was driving. For one heart-stopping moment she had wondered whether it could possibly be Grant, stopped by – at last. But he drove a battered Peugeot and this was a black Volvo gleaming under the lamplight. There was no sound coming from the interior but she could just make out the fact there was no passenger, only the male driver. She could see his silhouette. She waited, convinced that this was not someone who had pulled up by chance, just to use a mobile phone, make a call or send a text, or even waiting his chance to make contact with one of the Professional Ladies who sometimes hung around this area, but someone who wanted to make contact with her personally. She took a step towards the vehicle and heard it slip into gear and rev up the road. It was only as she inserted her key into the front door that she started to think. That had been deliberate, someone targeting her. And the only person she could think of who was likely to do that was Barclay.

  She closed the door, deadlocked it and shot the bolt across before doing the same with the back door and the French windows. Even then she didn’t feel quite secure. He was watching her.

  THIRTEEN

  She should have learned one of the cardinal lessons of psychiatry by now. She’d been a consultant for five years. Take your eye off the ball and mayhem results. While you are looking the other way the game continues. It’s just that you are no longer an active participant.

  David Gad, the haunted Jew, was still an inpatient currently having CBT, and this time he was responding well, apparently. But he was a man who kept his feelings buried deep, and since his confession to her he had said little more about his damaged past. When she had been in his room she had looked out for any more cards. She hadn’t asked him because she didn’t want to bring up the subject. But as far as she had seen there were none.

  Hayley, the hungry child, continued to tease: eating one day, vomiting the next. They were monitoring her blood levels. If her potassium dropped below a certain level she would be transferred to the Royal Stoke University Hospital. It had had its name changed from the North Staffordshire University Hospital to distance itself from the ill-fated Mid Staffs. Hospital. But it was as though Hayley had an almost supernatural instinct for the cut-off point. When she was almost there she would eat – soup or half a piece of bread. Just enough to keep her with them, at Greatbach. She wore an air of defiance always, and Claire knew the phrase ‘you do not need to eat’ had had its effect. One day she would ask her which particular friend had fed her this mantra. She could guess.

  But these days it was Stan, the doomed homeless man, who was the main worry. He was not responding to treatment as quickly as they had hoped. If anything he seemed a little worse. Claire watched him with concern. His mental state had improved but his blood levels were abnormal. He was losing weight in spite of eating and he seemed very tired, finding getting out of bed, washing, eating, even staying awake an effort. She watched him and worried. She asked him who had given him the drugs. His eyelids had drooped. ‘Nice guy,’ he said. ‘Nice guy.’

  ‘Did you have to pay him?’

  Stan shook his head. ‘No, man. Benefactor.’

  ‘What did he look like?’ She already knew the answer.

  ‘Ordinary.’

  That was just how she would describe him.

  ‘Smelt like cake, you know?’ Stan gave a toothy smile.

  ‘How did you meet him?’

  ‘Came up to me in the street – you know. Nice guy. Offered me some.’ His voice trailed off. He was almost asleep.

  More and more she found herself using Barclay’s descriptions of her patients. They were astute. And that was bad, not only because it meant he had access, somehow, to their case notes, but also because this knowledge was influencing her judgement. Dexter Harding, the stupid clever, continued to turn up for his fortnightly appointments, and the consultations were of as little use as they had ever been. There was no progression, nor would there ever be. The fortnightly meetings were simply a loose check on his whereabouts.

  Jerome Barclay – no description of himself, she noted – was keeping a low profile before his nuptials. Which suited her. Had it not been for the invitation card on her mantelpiece and the John Lewis debit on her card, she might almost have thought the wedding was simply the result of a nasty nightmare.

  To be fair she had had her distractions. While Grant was still in her mind he was not as vivid as he had been. His memory was fading, or least less brightly coloured. Less real. It was as though he was floating downstream, away from her, sometimes snagging on a branch, staying there for a moment, smiling back at her, water lapping over him, before floating farther and farther away. She no longer woke missing his muscular body next to her in bed, or reached out to touch his chest in the middle of the night; neither did she wait for his key in the door or miss the scent of a house being renovated or the aroma of cooking, the spicy scent of his deodorant. The place seemed curiously sterile. Without photographs to remind her (all in a drawer), his features were blurring, and she had to think hard to remember what his voice had really sounded like, while the house waited, stagnant, for the next chapter in its existence.

  She wasn’t ready to meet anyone else romantically just yet, but she was learning a sort of contentment on her own. Maybe one day, she thought, I will find someone to replace him. And next time they will stay.

  But there was the giant practical problem she had touched on with Julia. Though she had been the one to pay the mortgage, he had been the one who had done the lion’s share of the renovation work – plumbing, some building work, electrics and so on. He had also done all the decorating. Both their names were on the deeds, and so if she sold she would have to get in touch with him, even if it was simply for a signature. But she had no address. She didn’t have a clue where he was. His passport was gone, along with all his other possessions, clothes, CDs, et cetera, but she didn’t know whether it was an accidental inclusion and had simply found its way in amongst his clothes, or if he had deliberately taken it. But it meant she didn’t even know whether he was in the country. She’d never met his family, who lived somewhere in Cornwall, and they had few mutual friends. No one who would know where he was.

  And then, without warning, she saw him.

  Saturday, 27 September, 3 p.m.

  It was a busy Saturday, the last one in September, and the cold had seemed to be creeping up the road, forewarning her that winter was in its wake. She had spent the morning clearing out her wardrobe, trying on clothes from the previous winter and deciding which could be carried on to this season. Some of the items, like her winter coat, were a little tired and would need replacing. It was a twice-yearly ritual with her; one she rather enjoyed: spring and autumn clothes selection. Top of the list of wants was a pair of high-heeled black leather boots. And so she had set out at lunchtime to the Potteries Shopping C
entre in Hanley. There were plenty of shoe shops there and they had all their new stock in. She tried on a couple of pairs with wedge heels. Comfortable, but they made her legs look clumpy. However, she wouldn’t be able to wear the ones with high thin heels every day or for long. And they would be too hot to wear around the unit. Now the ones with high thicker heels were the obvious choice. And two pairs fitted the bill admirably, but she couldn’t make up her mind and she definitely didn’t want both.

  So she went for a coffee to have a think. She was queuing up at Costa Coffee when something alerted her to a couple in the corner, heads together. Thick, curly, black pirate’s hair, a low voice. Casual jacket and jeans. Grant. Her heart twanged. She hadn’t seen him for almost six months.

  And the girl?

  Quite a bit younger than him, mid-twenties at a guess, very slight, almost emaciated frame, shoulder-length raggedly cut blonde hair, lots of jangling silver jewellery, wearing a scruffy brown leather jacket. And periodically she jerked her head. Either disagreeing or a meaningless habit.

  Grant, eyes fixed on the girl, oblivious to everything and everyone around him, moved his head closer and stroked her cheek.

  Claire fled.

  And the appetite for a new pair of black leather boots flew away.

  She was shocked. She drove home too quickly, opened a bottle of red wine, drank an entire glass in a gulp, trying to blot out the picture of those two heads practically locked together. The care, the affection, the solicitude in the gesture of stroking the girl’s cheek. She didn’t remember him ever being that attentive towards her.

  She had fooled around, pretending, pretending, that Grant would come back. That he loved her – really. That he was just going through a crisis. And now she had seen the truth and it hurt like hell, as though she had had her guts pulled out, twisted and stuffed back inside her.

  She took another sip of wine and half closed her eyes. So … The oldest story in the book.

  He’d found someone else and hadn’t had the guts to tell her.

  Well, she thought, putting her glass back on the table so angrily that some of the wine sloshed over the rim and threatened the cream-coloured carpet, you might have bloody well told me.

  She forced herself to watch a film in the evening, taking none of it in. And Sunday? A long walk through horrid cold rain. Then a hot bath and tears.

  Monday, 29 September, 9 a.m.

  She was glad to go back to work, but the feeling in her guts was still there, twisting, stretching, pulling, wrenching, which is why she was working with only half her attention. Dangerous.

  Hayley was deteriorating, and at fourteen years old the child would die unless they intervened somehow. She called a case conference about her. The girl’s blood tests clearly showed a deteriorating condition. This time Hayley had failed to rectify her state in time. She had gone beyond the point where a couple of hundred calories would pick her up. Her anorexia was now causing irreversible damage. If there was no intervention, she would almost certainly die within weeks. What they needed to decide was how far they should allow her to control her own fate. When and how they should intervene.

  Capacity is a key factor in many medical decisions. Does the patient have capacity to make a rational decision about their future? is an important question. Do they understand what will happen if they opt for Decision A? – life. Do they understand the consequences if they opt for Decision B? – death.

  Hayley was fourteen years old. They could have made her a ward of court. But she did have capacity – that magic wand. She knew exactly what was going on and understood the consequences of her enforced self-starvation. They could have detained her under a Section to protect herself from herself. They could have force-fed her, but it was not a permanent solution. At some point Hayley would win her fight; ironically – the fight to lose her life. The question was – should they let her?

  Claire eyed her colleagues around the room. Siona, a year off from retiring, had plenty of experience. He had seen cases like this over the years. ‘Attitudes and treatments may change,’ he’d been known to say, ‘titles of illnesses alter over the years, but conditions are the same whatever you call them. Patients are the same as they always were.’

  Privately Claire agreed with him. In many ways psychiatry hadn’t moved that far forward. It wasn’t quite as barbaric as it had been, but they still hesitated to use the word cure.

  She turned her head to take in Astrid, the psychiatric nurse, a self-possessed young woman of twenty-eight or so, with sleek dark hair, a long neck and her face slightly upturned with a calm expression that made you think of a Madonna. She had classical features – a straight nose, high cheekbones, good skin, and yet she failed to make the grade as a beauty. Perhaps, Claire had thought, it was because she appeared so confident, had no apparent vulnerability, never admitted she was wrong, never had self-doubts. She was just too sure of herself. And she was cold. Her gaze slid over the girl and to Edward Reakin, Clinical Psychologist.

  Edward smiled back at her. He was an interesting one, she reflected, smiling back. Claire had been one of the panel who had interviewed him for the job, and within ten minutes of reading his CV and one minute of meeting him in the flesh she had known she really wanted him as a colleague. He was clever. He had written books on the subject of personality disorder. Intelligent, clever books, with stunning insight and original thought. She had read them all and had admired his wit, his use of English, his clear descriptions of various classifications of personality disorders, and lastly his realistic acceptance of what could and could not be done for their patients.

  And she liked his self-effacing manner.

  He was around forty, divorced; usually turned up for work in a shabby, crumpled jacket and either trousers or jeans. He was five ten, medium build, grey, streaked hair, a face dominated by clear, warm, friendly grey eyes. The more she met him, the more she felt this warmth and liked him. So the smile she returned that morning was equally warm.

  ‘I don’t see that we have much choice,’ she said slowly, ‘other than to send Hayley to the general hospital, and if necessary have her detained under a Section 2 for twenty-eight days.’ She couldn’t resist tacking ‘again’ on the end of the sentence.

  ‘We’re not going to win here,’ she said.

  Edward spoke up. ‘We’ve tried everything,’ he said. ‘One of the things that works against Hayley is that actually she’s quite intelligent.’ He said this almost apologetically. ‘She has real insight into her condition. We can’t hoodwink her.’

  Siona spoke up next. ‘I thought she’d put on some weight.’

  ‘I suspect she’d done the old trick of drinking pints of water,’ Teresa, the other psychiatric nurse, chimed in wearily.

  ‘Fourteen years old and what’s ahead?’ Claire mused.

  They all knew the answer to her rhetorical question.

  Not a lot.

  Astrid spoke up. ‘So all we’ve done,’ she said dismissively, ‘was a waste of time. She’ll bounce between here and the hospital until she dies.’

  Edward jerked his head to look at his colleague sharply. ‘Wait a minute, Astrid,’ he protested. ‘There’s no point taking that attitude.’ His grey eyes flickered over her and Claire knew in that exact moment that Edward Reakin did not like the nurse.

  But Astrid was having none of it. ‘Come on, Edward,’ she said, spoiling for an argument, ‘what good have we done her? She’ll soon be in liver failure, for goodness’ sake.’

  Claire tried to pour oil on the troubled waters, butting in to avoid an argument. ‘We have to keep trying, Astrid. We can’t just give up.’

  Edward turned to her, frowning but nodding at the same time. He steepled his long bony fingers together as he spoke. ‘I have to say,’ he said, ‘on reviewing her case—’ he turned to Claire – ‘and considering your efforts, I don’t see what any of us could have done differently.’ He scanned the room, looking at each person in turn as though searching their soul. ‘Anorexia is a d
ifficult condition to treat at the best of times. We might all feel that we would like to intervene …’ His grey eyes grew steely. ‘One could substitute for “intervene”, “interfere”, but we can only go so far, and this is the reason why sometimes these cases end in tragedy.’ There was no doubt who was the target of this comment – his eyes were fixed on Astrid as he spoke. She recognized this and flushed, squaring her chin and flashing her eyes away from him. No one in the room could have misread the stubborn look. Or the anger. She was not going to agree with the psychologist. Claire felt grateful to Edward but was troubled by the obvious conflict between the two. It had never registered before. Astrid was a highly qualified, experienced and competent psychiatric nurse. She had specialized in forensic psychology and had worked in Category A prisons. It wasn’t her experience that Claire had doubts about, but her coldness – her complete detachment from the work, or their patients as people. Astrid knew her stuff all right, but she lacked a conscience, and never admitted when she was wrong, as she had been on a couple of occasions. As they all were sometimes. Psychiatry is not an exact science, and attitudes change from decade to decade. But Astrid’s attitude might cause problems in the future.

  Eventually the decision was made to transfer Hayley to the general hospital.

  They had more patients to consider. It was time to move on. ‘OK,’ Claire said both wearily and resignedly, ‘let’s move on to Stan. Why isn’t he getting any better?’

  Teresa looked up. ‘He had a fit in the night,’ she said, and Claire felt a heaviness press on her shoulders. This was another battle they would probably lose.

  They spent almost an hour discussing Stan Moudel’s latest lapse. They all agreed he was unlikely ever to come clean. There seemed one option open to them. In Fenton there was a safe house called The Sycamores. Those more cynical amongst them called it The Psyche-o-More, but there was a space there. Compared to his lonely bedsit, there was reasonably close supervision. If they could get Stan to agree to this they knew the police would drop charges and he would avoid a prison sentence. He would have to agree to be tagged for up to a year, but it was a small price to pay for his freedom and by far his best option. Claire scanned the watching faces. Astrid spoke.