Letters from Alice

by Petrina Banfield

  Half past ten on the morning of 5 January, three days after the birth of Charlotte’s infant daughter, found Alice escorting a reluctant Hetty Woods up to the chest ward.

  After booking her in with Nell at the main reception desk, the almoner led her along the corridor to a small, tucked-away waiting area, its rows of benches packed with other patients. Several glanced up, their faces glum. Alice guided Hetty to the end of one of the nearest benches and supported her arm as she lowered herself between an elderly gentleman with a hacking cough and a younger woman in a wheelchair. Hetty wrung her hands in her lap and looked up anxiously at Alice. ‘Are you sure you don’t want your husband with you, Mrs Woods? I’m happy to fetch him for you before I head off.’

  The woman waved the suggestion away with a flap of her hand. ‘No, he’ll only fuss and make it worse. And please, call me Hetty.’

  Several patients turned in unison at the sound of approaching footsteps. At the appearance of Dr Harland, one or two gathered their belongings and gave him a hopeful look. He scowled when he caught sight of Alice. ‘Right, come this way,’ he said, exhaling loudly before striding off. One of the women clucked in annoyance as Alice helped Hetty to her feet, another mumbling something about jumping the queue.

  ‘Well, I’ll leave you with the doctor now, Hetty,’ Alice said when they reached the examination cubicle where Dr Harland was waiting.

  The elderly woman gave her an anxious look. ‘Actually, duck, I wouldn’t mind a bit of company, if you can spare the time?’

  The almoner looked at the doctor, who sighed in reply and said: ‘You won’t mind if a few students sit in on this, will you?’ It was a statement rather than a question, and as Alice guided a pale-faced Hetty up onto a couch and into a half-reclined position, five white-coated men and one woman formed a semi-circle around them.

  The doctor expanded a moveable screen across the opening to the cubicle and waved Alice out of his way with an impatient nod. She edged around the examination table and stood to Hetty’s right. Without preamble the doctor asked: ‘What are your symptoms, Madam?’

  Hetty glanced at Alice, who gave her a reassuring smile. She turned back to the doctor. ‘I-I’ve … it’s my chest, doctor. I have a sore chest.’

  Dr Harland pressed his fingers to Hetty’s wrist. He kept them there and stared into the middle distance. After half a minute he asked: ‘How long for?’

  ‘A few months now, though it’s been a bit worse lately.’

  The doctor shone a light in Hetty’s eyes. ‘When you say soreness, do you mean chest pains? Light-headedness?’

  ‘Not exactly,’ Hetty said evasively, looking back at Alice. The almoner reached for her hand and gave it a quick squeeze. Dr Harland pulled the stethoscope from around his neck and fitted the ear-tips in his ears. Wordlessly, he sought permission to listen to Hetty’s chest by raising the silver chest-piece and glancing at her from beneath his brow. She nodded hesitantly, biting down on her lip and closing her eyes as he parted the cardigan she was wearing and slipped the scope under her top.

  A sour smell wafted into the air. Almost immediately, the doctor’s expression changed. Slowly, he withdrew the scope and looked at her. ‘Please undress,’ he said, his tone marginally softer than before. Alice’s puzzled gaze flitted from the woman to the doctor and back again. The doctor turned to a silver trolley, handed Hetty a blanket and then motioned for the students to leave. ‘We’ll return in a moment.’

  When he came back, Hetty was sitting bare shouldered with her feet dangling over the side of the couch, a grey blanket clamped to her chest. ‘Come on, Hetty,’ Alice said, her cheeks drained of colour. She rested her hands gently on the woman’s shoulders. ‘It will be alright,’ she said as the woman shuffled back and leaned against some pillows, the blanket pulled up to her neck.

  Alice gave the doctor a grim nod. Gently, he eased the blanket down to Hetty’s waist, exposing one pale, sagging breast, the other shrivelled up and pitted with fungating wounds that oozed bright yellow fat and a pus-like fluid. The distinctive smell of rotting flesh immediately invaded the air. One of the male medical students gasped and took a stumbling step backwards. Another lifted his hand to cover his nose and mouth. A small whimper escaped Hetty’s lips. ‘It’s alright, Hetty,’ Alice said, stroking the older woman’s arm. ‘You are being very brave.’

  Another medical student decided he had seen enough and averted his gaze, but Dr Harland made a contemplative noise in his throat and leaned closer to examine the wounds. ‘Gentlemen,’ he said as he straightened. ‘And ladies,’ he added as an afterthought, his gaze sweeping over the assembled group. ‘This is actually very rare to witness,’ he said in a tone that revealed an interested fascination. ‘A tumour of the breast has clearly broken out onto the skin.’ He turned and leaned over again to get a closer look. ‘You’ll notice how the nodules have coalesced to form a mass of rotting tissue, some of it already turning necrotic.’

  Several of the students shifted from foot to foot. ‘Doctor,’ Alice snapped, glaring at him. Peter Harland looked up. She tilted her head meaningfully towards Hetty.

  He cleared his throat, straightened and pulled Hetty’s blanket back in place. ‘Madam, your condition is not one I’m able to deal with here on the chest ward. I’ll ask one of the nurses to dress the wound and then you will be referred to one of my colleagues.’

  ‘Thank you very much, doctor,’ Hetty said reverentially, but when he left, the students filing out obediently after him, her careworn features crumpled further. ‘I thought he was a chest doctor? I don’t want to go showing this monstrosity to someone else as well.’

  ‘It’s not his field, I’m afraid, Hetty,’ Alice said gently. ‘You need to see a specialist.’

  The woman chewed her bottom lip. ‘It’s bad, isn’t it?’

  Alice patted her hand. There was a pause, and then she said: ‘It has reached a difficult stage, but there are things that can be done to ease your discomfort.’ She levelled her gaze. ‘What prevented you from seeking help before now? You must have been suffering for quite some time.’

  Hetty’s rheumy eyes filled with tears. ‘I tried to push it out of my mind, I think, duck. I thought if I kept applying the poultices, it would sort itself out. Truth be told, I was too ashamed to tell anyone.’ There was another pause. ‘What can be done, do you think?’

  Alice looked at her. ‘The breast will have to be removed, and then some radium therapy perhaps. We will have to see.’

  The almoner sat with Hetty while one of the nurses applied liniment and dressings to the wound, then supported her as she made her way back to Ted, who was still waiting in outpatients. Since Hetty sat down without a word and took up her knitting, the task of explaining to Ted that his wife would need extensive surgery fell to Alice.

  Alice regularly found herself called upon to speak to patients by doctors who recognised that their bedside manner wasn’t quite what it might be. Ill at ease with breaking bad news and dealing with the subsequent emotional fall-out, they often called for an almoner to be present in the relatives’ rooms, sometimes even scarpering before the deed was done.

  The almoner finally resumed her office duties at half past eleven. With a pile of paperwork weighing down her desk, it was another half an hour before she had managed to extract herself to make her first house call of the day.

  The skies over the capital that morning were a cloudy, gunmetal grey, the wind that had dominated throughout the early part of the month persisting as the almoner made her way to Dr Harland’s sister’s house on Fenchurch Street.

  The clock on the mantelpiece in the living room struck 1 p.m. as Elizabeth Harland ushered Alice inside. In stark contrast to the smart, immaculately turned-out woman they had called on at the beginning of the year, her long gown was covered in damp patches across the chest, her shoulder-length hair hanging in uncombed tendrils around her face.

  The room was warm, the fire in the hearth emitting a comforting amber glow. The logs piled up beside
it were the most ordered objects in the space. Almost every other surface was covered with badly folded piles of linen and soiled clothing, where before they had been adorned with highly polished ornaments and neatly stacked china.

  ‘I hope you do not mind my descending on you unannounced,’ Alice said as she rested her bag and folded cape on one of the few uncluttered spaces left on the sideboard. ‘But I plan to visit Charlotte as soon as I am able and I would like to give her some news of the infant.’

  Before Elizabeth could respond, a small mewing sound from across the room drew her attention. Alice followed her to the sofa, where Charlotte’s baby lay tucked up in a wooden drawer padded with blankets. Tightly swaddled, she blinked up at the almoner and emitted another contented coo. ‘May I?’ Alice asked, inclining her head towards the makeshift cot.

  Elizabeth nodded. The almoner removed her gloves and lifted the small bundle into her arms. ‘I was about to give her a wash, but we can take tea first if you’d like?’ the doctor’s sister said, after gesturing for Alice to take a seat.

  ‘Oh, no, you go ahead,’ Alice said, sitting down next to the drawer. She smiled down at the baby and slipped her forefinger into her tiny palm. ‘Do not worry about tea for me.’

  Elizabeth bustled out of the room. She returned a few minutes later, carrying some linen and a jug of water. ‘Come on,’ she said briskly, taking Daisy from Alice. Immediately the baby vomited on her shoulder.

  Elizabeth’s arms shot out, her face reddened in alarm. The baby hovered at arm’s length, her legs dangling below the unravelling blanket. A moment later, the woman recovered. She dabbed at her dress with a cloth, mumbled something in a mildly chastising tone then sat on a stool by the fire. She settled the baby on her lap so that the small head was resting on her knees, her tiny feet nestled against Elizabeth’s plump middle. With fingers that were still slightly clumsy, she fumbled at length with the baby’s nightgown and lifted the tiny body up. The skin on the soft limbs protruding from her cloth napkin was already less saggy than it had been a few days earlier, a healthy pink glow replacing the grey.

  ‘Is she all right?’ Alice asked. ‘She’s terribly small.’

  ‘You’re perfectly fine, aren’t you?’ Elizabeth answered, directing her answer to the infant. ‘She’s a hungry little madam. She takes a whole three ounces a time, and she cries for it before her four hours are up. I’m feeding her with Nestlé.’ Condensed and evaporated milk were widely used for babies in the early twentieth century, with Nestlé promoting their products as ‘safe and nutritious’.

  Elizabeth frowned in concentration as she wrapped the baby in a towel and cleansed her skin from top to bottom with a soft linen cloth. The baby watched her with silent, sleepy interest, as if she knew that she was in a safe, albeit awkward, pair of hands.

  When she was back in a nappy, dressed in nightgown, bootees and bonnet and wrapped in a woollen shawl, Elizabeth leaned down and gave the baby’s minuscule fingernails a brief kiss. ‘So, you may tell the young lady that Daisy is quite well, thank you.’

  ‘I will. Thank you so much for what you’re doing, Elizabeth. Charlotte will owe you a great debt of gratitude when she’s reunited with her little one.’

  Elizabeth gave a curt nod as she shifted the baby upright against her chest. ‘Well, if that’s all?’

  Alice nodded and got to her feet. She gathered up her cape and bag and turned in the direction of the door, but then she stopped mid-step. ‘May I just ask, Elizabeth, whether your brother ever treats patients in a private capacity? I forgot to enquire with him when we last met.’

  ‘I don’t believe so,’ came the curt reply. ‘He spends every waking moment on duty at the hospital, as far as I’m concerned. The only time I’m honoured with a visit is when some imminent disaster is afoot, as you witnessed only a few days ago.’ She placed a hand on the infant’s back and got to her feet. The baby’s tiny head lolled sleepily over her shoulder, her small hands clasped, one at each cheek. The woman turned and looked at her. ‘But surely that’s something you should be asking him yourself?’

  Chapter Eleven

  I have never smelt such a stench in my life. The stench was so great I felt almost suffocated; and for hours after, if I ate anything, I still retained the same smell; I could not get rid of it; and it should be remembered that these cells had been washed out that morning, and the doors had been opened some hours previous.

  (The banker Henry Alexander, on his visit to the lunatic ward of a nineteenth-century workhouse in Devon)

  It was another four days before the opportunity arose for Alice to visit Charlotte Redbourne.

  The almoner took a taxicab from the Royal Free Hospital on Monday, 9 January, arriving at Banstead Mental Hospital at 11.15 a.m. Two stray dogs circled her feet as the porter emerged from his lodge and fumbled with the keys at his leather belt. They tried to barge through the gap when he opened the tall wrought-iron gates and yapped at the drizzle in the air as he eased them away with one foot and slipped a heavy iron key back in the lock.

  The almoner followed a horse-drawn cart as it wobbled its way down the narrow track beyond the gates towards the main hospital building. The panes of the windows of Block A reflected the weather, perhaps giving visitors the impression that it was raining inside the wards as well as outside.

  The care afforded to Banstead Mental Hospital’s patients was a world away from the beatings, purges and rapes doled out by attendants in the madhouses of the past. Advertisements of staff vacancies placed in local Surrey newspapers sought those of a kind and caring disposition, possessed with the nurturing qualities that would allow them to converse with patients as well as to firmly guide them.

  Nurses in mental hospitals were generally afforded less respect than those in the medical sector, as well as less pay. The nursing of mentally ill patients was considered in some circles to be a profession that might appeal to those from the lowlier classes. It was almost as if asylum staff were tainted with the same stigma that clung to those they treated.

  Regularly scrubbed by patients on their hands and knees, the tiles covering the internal passageways of the hospital glimmered faintly under the dim gas lights fixed to the wall as Alice followed one of the nurses to Block A’s day room. The sound of weeping and the smell of wax and polish accompanied their footsteps, punctuated every so often by a loud wail.

  They passed several wards along their way, the interior of each almost entirely white, but for the black iron bars at the windows, the coarse grey blankets and the leather-bound Bibles at the side of each bed. The nurses wore starched white uniforms with white aprons on top, even the colour of their hair hidden from view beneath stiff white caps.

  Alice’s guide, a plump nurse wearing steel-framed glasses with thick lenses that magnified her eyes, stopped in the doorway to the day room. ‘She’s still a bit delusional,’ said the nurse in a loud whisper. ‘She’s been diagnosed with hysterical neurosis, but there’s a bit of paranoia in the mix as well, if you ask me. Still, who am I to venture an opinion, eh?’

  The day room smelled of cigarette smoke and something sharply antiseptic. There were French doors on the far side of the room, with a view of a courtyard garden beyond the glass. Cream and brown striped wallpaper gave the space a more homely feel than the wards, the fireplace at the far wall and the deep armchairs arranged around it adding to the sense of warmth.

  Charlotte was sitting on one of the armchairs, staring into the distance with unseeing eyes. She started when the nurse touched her shoulder. ‘Now, don’t start working yourself up, there’s a good girl,’ she said in a tone that, in the outside world, would pass as heavily patronising. She grabbed Charlotte’s upper arm, pulled her forward and tucked a pillow briskly behind her. ‘You’ve got a visitor, pet.’

  Charlotte blinked between the nurse and Alice. ‘Ten minutes, no more,’ the nurse said, with a stern, short-sighted nod at the almoner. ‘I’ll not have her wearing herself out,’ she added, before bustling to the door.
<
br />   A woman in a shapeless long smock trudged slowly through the same door seconds later. The smocks issued to patients were heavy and unforgiving, especially designed to be resistant to tearing. Supported by a uniformed porter, the woman’s feet slid along robotically without any part of the soles leaving the floor. She sank with sloped shoulders into a chair by one of the windows and began rocking silently back and forth.

  Alice’s gaze lingered on her for a moment and then she stepped forward and leaned down in front of Charlotte. ‘Hello, Charlotte. It’s Alice.’

  ‘Alice,’ the teenager repeated croakily, as if she hadn’t spoken in a long time. She winced and touched her hand to her slightly swollen stomach.

  Alice tucked her bag under the armchair opposite. She took a seat, draped her cape over her lap and asked: ‘How are you feeling?’

  The girl peered over her shoulder at the door, rubbed a hand over her forehead and then focussed her eyes on the almoner. ‘It ain’t safe to talk here,’ she said in an urgent whisper. ‘Just tell me, is she alright?’

  ‘She’s quite well,’ the almoner said. ‘She’s putting on weight and coming on nicely.’

  ‘What about Elsa and the others? They alright?’

  When Alice reassured her that she would call in on her family to check on their welfare, Charlotte’s face lost its pinched expression. She nodded, then frowned again. ‘What day is it?’

  ‘Monday.’

  ‘So I’ve only been here a week? It feels like so much longer.’

  Alice leaned forward and patted her hand. ‘You’ve had a difficult time, Charlotte. But there is hope. I will find a place for you, I promise. You must try not to worry.’ In an effort to demonstrate their worth, but perhaps also to encourage and motivate their colleagues, the almoners’ year-end reports highlighted many cases they had been involved in that had been resolved with happy endings.