Letters from Alice

by Petrina Banfield

  Alice stood at the foot of the trolley and watched as Billy fought away, his eyes bulging. ‘Keep it on, love, it will do you good,’ Nell said sternly, bustling over and elbowing a space for herself at the head of the trolley. She raised the mask to the boy’s nose but his panicked arms flailed outwards, almost knocking her sideways.

  Moments later, Tilda arrived in the doorway, her younger son in her arms. ‘Oh, my poor boy!’ she cried, rushing into the room and gulping back a sob. Billy’s eyes widened, his distressed mother exacerbating his condition so severely that his lips gained a bluish tinge.

  ‘Doctor will be with us any minute now,’ Nell said, her voice tense. The air of urgency in the room sharpened.

  At that moment Dr Harland appeared. The medical team parted reverentially to make room for him at the head of the bed. ‘I’m the doctor here,’ he said, running a calm eye over the distraught child. ‘There’s nothing to worry about. You’re at the Royal Free and we’re going to take good care of you.’

  Billy gaped at him, hands clawing at the air. ‘Help him!’ Tilda screamed. ‘Do something!’ Her baby’s face turned puce, his eyes widening in alarm. He began to bellow.

  ‘Get her out of here,’ the doctor snapped quietly. As one of the nurses guided the hysterical woman away, Dr Harland dismissed two of the staff gathered around the bed and directed a request for some ephedrine towards one of the medical students. After checking that the boy’s airway was clear, he took the syringe that was handed to him wordlessly and injected it into the top of the boy’s thigh. Within seconds the drug took effect, the boy calming enough for a nurse to administer some oxygen. His thin body sagged back against the trolley, although he was still blue around the lips and struggling to breathe.

  ‘I want a chest X-ray taken as soon as he’s stable,’ Dr Harland said as he pressed his stethoscope to the boy’s chest. ‘And would someone please fetch some more pillows to prop him up.’ He then asked the remaining nurse to find out whether the child had been exposed to any specific irritants. She blushed hotly and left the room.

  ‘Now, young man, there’s no need to take such drastic action just because you’d like to spend the afternoon somewhere warm,’ the doctor said smoothly, either oblivious or entirely disinterested in the adulation from the staff around him. He eased the child forward and ran the stethoscope across the top of his back. The boy lifted his head. ‘Don’t look at me like that,’ Dr Harland continued above the loud whistles emanating from the boy’s chest. ‘There has been a run of you lot lately and I’m not happy about it.’

  Billy made no response but his eyes became alert with interest, his rapid breaths slowing with the doctor’s every word. ‘You look like a man with a discerning palate to me,’ the doctor continued. ‘Am I right?’ The boy gave a weak nod then closed his eyes, the effort of trying to draw breath draining him. With his attention focussed on the child, whose teeth were chattering beneath the mask, the doctor addressed one of the students: ‘A cup of strong coffee, if you please.’

  The boy opened his eyes, his brows creasing in puzzlement. ‘It’s for you, young man, not me. It will help loosen your airways.’ Billy’s head lolled against the trolley as the doctor shone a light in his eyes and ran practised fingers along his clavicles then upwards, around his neck and the back of his head.

  Dr Harland gave a quiet commentary during the examination, his voice low and calm. The remaining medical students listened intently and scribbled notes on their pads as he spoke. After several minutes, once the bluish tinge to the boy’s lips had been replaced with a healthy pink colour, the doctor grabbed a chart from the wall. He scrawled some notes, and then looked up, his gaze flicking to Alice for the first time. ‘Doctor,’ she said stiffly. He dipped his head in reply, told Billy he would pop in to see him later, then left the room.

  ‘That’s it, my love, you get that down you,’ Nell Smith clucked, as the boy sipped at a cup of steaming coffee a few minutes later. Painfully undernourished, his ribs bulged prominently beneath the skin of his pigeon chest, the skin on his arms wrinkled and pale. Poor nourishment meant that many of the Royal Free’s patients were at risk of losing their lives to ordinary childhood diseases like whooping cough, scarlet fever and croup. Measles, for example, had taken the lives of more children in the past century than any other illness, largely because its victims were weak before the illness had even struck.

  Parents regularly dragged ailing children from the dank basements in which they lived, through the doors of the hospital, hoping that doctors might offer a magic cure. Once under their radar, the almoners did what they could not only to improve the day-to-day lives of the underprivileged children, but also to bolster their chances of survival, should another illness strike.

  Billy grinned between mouthfuls, apparently chuffed to have been offered such a sophisticated brew. As he sipped, Nell turned to Alice. ‘You can say what you like about that man,’ she said quietly, ‘but he’s fabulous when it comes to emergencies, especially with the children. He really is a marvel.’

  Perhaps in appreciation, or at least in recognition of his skill, Alice pursed her lips and said: ‘So it would appear.’

  Chapter Fifteen

  The first question is not ‘Is this person deserving?’ but ‘Can we in this instance effect an improvement or cure?’ There must be a quality of sternness in the kindness that is to stamp out vice [but] many lives made hopeless by pressure of circumstances and by association with vice, would be made saved [by a] fresh start.

  (C. S. Loch, How to Help Cases of Distress, 1895)

  Alice’s footsteps echoed on the floorboards of the hospital chapel a few minutes later, muffling the faint rustle as her long skirt swept against the pews. Gaslight flickered through the arched windows above her, lifting the colours from the stained glass and directing them to the board of honours on the other side of the space, where the names of all those associated with the Royal Free who had sacrificed their lives in the Great War were displayed in letters of black and gold.

  The stillness of the chapel, its rituals and muted light, offered patients and their relatives a temporary reprieve from the struggles that were waiting to engulf them in the outside world. Generations of Londoners had sought solace in the silence that echoed off the stone walls, delaying the moment when they had to step back into their everyday lives.

  Tilda was sitting in the front pew, the nurse who had escorted her out of the examination room holding her in a half-restraining, half-comforting hug. Walter, her baby son, was crawling around in the space between pew and pulpit. All three of them looked up when Alice approached, and then Tilda sprang to her feet. ‘He’s going to be alright,’ the almoner said in a hushed voice. The woman’s shoulders sagged with relief. Walter looked between his mother and the newcomer in mild puzzlement, then ventured over on hands and knees to examine the dust collecting at the base of the font.

  ‘Can I see him?’

  Alice took a long breath and placed gentle hands on the woman’s upper arms. ‘He’s stable,’ she said, her breath fogging the cool air. ‘But let us allow the nurses some time to do what they must.’

  Tilda nodded. She and Alice thanked the nurse and, as the chapel door fell shut behind her, the almoner motioned for Tilda to sit next to her on the pew. They sat in silence for a moment, and then Alice angled herself sideways. ‘You do realise, Tilda, that high emotion and anxiety are bound to exacerbate your son’s condition?’

  The woman stiffened and turned away. ‘I know how tempting it can be to gloss over the truth, but the longer you stay silent, the more dangerous your situation becomes.’

  Tilda burst into sudden tears. Walter stopped trying to catch the dust motes and looked up, his bottom lip wobbling. Alice handed Tilda a handkerchief and then picked the baby up. She positioned him so that he was facing the stained-glass windows, angled away from his mother, and bobbed him up and down on her knees. His mother dabbed at her cheeks. ‘It’s my fault he’s so ill!’ she gasped between sobs. �
�You don’t have to tell me. I know it’s all my fault!’

  Walter whimpered. The almoner patted his back and turned to Tilda. ‘Your fault? Quite how exactly is any of this your fault?’

  Tilda took a tremulous intake of breath. ‘I’ve tried to be a good wife, a good mother,’ she whispered, ‘but I’m afraid I’ve just messed it all up. Everything.’

  Alice looked at her. ‘Things don’t always work out as we would hope,’ she countered, ‘but it seems to me that you have been trying your best and, given the circumstances, been rather too harsh on yourself in the process.’

  Tilda shook her head and lifted Walter onto her own lap, his back resting against her swollen stomach. She lowered her forehead to the nape of his neck and cried softly. Alice folded her hands in her lap and waited. When Tilda turned her tear-streaked face towards her again the almoner asked: ‘What contribution is your husband making towards this ambition of a happy home?’

  Tilda’s eyes flicked away. She stroked the hair back from Walter’s forehead, stared into the middle distance and sniffed. ‘Because if my assessment of the situation is anywhere near accurate,’ Alice continued, ‘his contribution is entirely negative.’

  A few moments passed, and then Tilda turned to face her again. She took a deep, shaky breath. ‘I can’t seem to make out my head from my tail these days,’ she admitted quietly, a single tear rolling down her cheek. ‘I used to be able to soothe his anger, but now, well, it’s not so easy when you’re carrying babies, is it? I mean, look at me.’ She looked down at herself and then up again. ‘He’s lost interest, and who can blame him?’

  Alice’s nostrils flared. ‘I’m afraid I have never held with such old-fashioned views, Tilda. A wife is not a pet or a slave. We are moving towards an era where women will be valued as people with equal worth to men. There will be blood and tears along the way, and it may be decades before we get there, but each of us must make our own efforts to bring that day closer. You bore your husband two wonderful children and you have another on the way. He should be thanking his stars for it and cherishing you all.’

  Tilda raised an eyebrow and looked at Alice askance as if wondering whether she’d heard her right. There was another silence, and then the almoner said: ‘We can fix Billy’s body, but what of his mind? Returning him to the same environment will only arouse the same symptoms.’ Her gaze sharpened on the expectant mother and then she added: ‘And what if, on the next occasion, he doesn’t make it here in time?’

  Tilda eyed Alice over the top of Walter’s head, tears rolling down her cheeks. ‘What choice I got?’ she demanded. ‘Every woman needs the protection of a man, especially them what’s in my condition.’

  Alice scoffed, staring pointedly at the bruises beneath Tilda’s eyes. The woman flushed. She lowered her son to the floor and hung her head over her bump, the hanky she was holding flitting from one trembling hand to the other. The silence expanded. Alice eventually placed a gloved hand on top of hers. ‘Allow me to help you, Tilda.’

  As well as their efforts to support lone parents, the almoners did their best to help women who were suffering domestic abuse. By shining a light on new pathways opening up to them, new possibilities that were never before imagined, they helped to release the powerless from the prison of abusive marriages.

  The woman looked up. ‘Help me? How would you do that? You mean by sending me and the kids off to the workhouse?’

  Alice shook her head. ‘I am not talking about the workhouse. I may need some time, but before Billy is discharged, I hope to have found a place for you. In the meantime, you must stay here, at the hospital, where you’ll be safe.’

  Tilda stared at her considering, then burst into a fresh wave of tears. After a moment Alice spoke again. ‘You will mourn your marriage, I understand that, just as you have had to grieve for the love you hoped to have, but I have seen lots of women build new lives in place of the old. You must believe that you can too, for the sake of your children, if not for yourself.’

  Tilda bunched her hanky up into a ball and dabbed her eyes and agreed that, yes, she did believe. The almoner let another few moments pass and then said gently: ‘Your parents are probably still downstairs, if you would like to see them?’

  Tilda looked up in surprise. ‘They’re here, at the hospital? Why?’

  Alice pressed her lips together. ‘It is not for me to say. But I know they would love to see you.’

  ‘I can’t.’

  ‘Why not?’

  Tilda threw her hands up in the air and stared at Alice. ‘Why do you think I haven’t seen them for months?’ She balled her tongue up into the inside of her cheek so that the partially healed gash at the side of her lip bulged outwards. ‘I can’t let them see me like this! It would turn them right over.’

  Alice levelled her gaze. ‘Not if they know you don’t have to live that way anymore.’

  Perhaps it was the prospect of an existence free from fear, or simply the act of unburdening herself, but the floodgates opened then, Tilda disclosing the grim details of late-night beatings, with Billy getting caught in the crossfire as he sought to protect her. She paused now and again, glancing at Alice as if to gauge her reaction.

  The almoner expressed no surprise. She listened silently, giving an impression of unfazed calm, offering only the encouragement of a nod, or an ‘Um’ when the gap between disclosures stretched out for too long. ‘I did think of running to my mum and dad loads of times, but it wouldn’t have been fair,’ Tilda said, after a particularly long silence. ‘They got hardly no space as it is, and besides,’ she added bitterly, ‘Rich threatened to burn their place down if I ever breathed a word to them.’

  When it was clear that she had nothing else to add, Alice squeezed her hand. ‘You have been so very brave, Tilda. Now, how about we go and see your son?’ Tilda gave the almoner a tearful nod and then leaned over awkwardly, picking up her toddler. The scent of fresh flowers in the air mingled with incense and ancient oak as they walked side by side down the aisle, adding to the renewed sense of calm.

  It was almost 6 p.m. when Alice approached Ted and Hetty in the outpatients department. They looked up in surprise, startled at her announcement that she had some special news. Tears sprang to Hetty’s eyes when Alice told her the details. ‘Oh my Lord, what a terrible thing!’ she said, shaking her head. As she followed Alice into the chest ward, her husband looked equally choked beside her.

  Alice guided the pair into the side room where Billy and his mother were waiting, and then stood by the door, waiting in silence as the couple gathered their sobbing daughter into their arms. Billy, whose cheeks had gained a healthy pink glow, beamed at them from his bed, his own eyes filled with tears.

  When the three of them pulled apart, Ted cupped his daughter’s bruised face in his hands. His own eyes grew shiny as he touched the pad of his thumb gently over each of her injuries, shaking his head in regret. ‘It’s alright, Dad, it’s over now,’ Tilda said softly, taking his hands and grasping them in her own.

  Often, the almoners came into contact with patients when they were going through the lowest points in their lives. Vulnerable and bewildered, many opened up about their pasts, admitting to family secrets that had long since been buried.

  Hetty stretched her arm out to Alice. ‘Thank you,’ she mouthed quietly. ‘Thank you so much.’

  Alice and Sister Nell Smith spent the next half an hour raiding wards and store cupboards until they had sourced all the equipment they needed to transform Billy’s side room into a temporary home for the small family. They placed a cot at the end of Billy’s bed and a mattress on the floor beside it, leaving a narrow path between the two so that the nurses could move freely around.

  Dr Harland’s mouth fell open when he came in on the hour to review his patient and found the room full of people. ‘What’s going on here?’ he snapped, his gaze falling accusingly on Alice.

  ‘Supper,’ the almoner answered simply, as Nell opened the door with her hip and bustled in with
a tray of tea, bread and dripping, and cold cuts of meat. Billy and his mother and grandparents stared at the bounty as if they’d never seen such wonder in their lives.

  ‘This is a hospital, Miss Hudson, not a Lyons’ tea shop!’ the doctor roared.

  ‘The good physician treats the disease; the great physician treats the patient who has the disease. Isn’t that what Sir William Osler used to say, doctor?’ Alice said coolly in reply, the tilt of her chin giving the impression that she was prepared to brook no further argument. After a moment she turned to help Nell as the nurse bustled around, handing out cups and saucers and plates. The doctor followed her with his eyes as she moved across the room, then conceded with a small nod; one that perhaps had more to do with lack of sleep than any leaning towards magnanimity.

  Chapter Sixteen

  The almoner may in the course of his work have occasion to deal with cases of lunatic persons, or he may have to make arrangements for cases of pauper lunatics and cases of lunatics wandering at large.

  (C. S. Loch, How to Help Cases of Distress, 1895)

  The first Friday afternoon in February found Alice back at Banstead Mental Hospital.

  Thirteen miles south of the centre of London, Banstead was a town well known for its fresh air, as well as its horse racing. Ironically, considering that it was the destination of choice for depositing horse manure by rail from the streets of London, physicians regularly sent their ailing patients to convalesce in what Sir Robert Hunter, Honorary Solicitor to the Commons Preservation Society, described as ‘perhaps the most bracing [neighbourhood] to be found within a short distance of the city … to roam and gallop over such commons is the breath of life to those who have emerged from the smoke and noise of London, while to those who never set eyes on a blade of grass from one year’s end to another they still serve as a reservoir of pure air’.