Adam nodded. ‘You are right of course.’ This was aimed at Anna, with a cursory nod to Peach.
Dr Peach smiled benignly. ‘Shall we see her?’ he asked rhetorically.
When Tim brought Libby into the room Peach stood up to welcome her but, on noticing that when she saw him she stopped walking and stared at him, he sat back down again.
‘Hello Libby, would you like to sit down?’
‘I can’t sit down.’ Libby scanned the room, turning a full circle as she arrived in the middle of the chairs and taking in everyone. ‘I haven’t got a body.’
There were too many people here, too many strangers. Peach could tell that, and he knew that whatever he wanted to do had to be done quickly.
‘Well Libby, how have you been lately? It’s been a while since I saw you in here, I think.’ Peach was courteous and skilled but Libby wasn’t listening. She pointed at Phoebe and said: ‘Look at her looking at me.’ Phoebe blushed.
‘Libby,’ Peach said, trying to distract her, but Libby just kept turning in a circle on the spot, looking at everyone.
Adam waited until she was facing him and said quietly: ‘Do you want tea, Libby?’ Libby stopped for a moment. ‘If you could just give us two minutes, Libby, and let Dr Peach talk to you, I will arrange for some tea. OK?’
Libby didn’t answer but she did stop circling and Peach took this as acquiescence.
‘Libby, we were wondering how you would feel about leaving the hospital, or at least having a look at a lovely new house round the corner that they have built for people like you, older people who have spent a lot of time in the hospital, to live in.’ Libby began to chew on her bottom lip. The thumb of her right hand hooked into a button hole on her light blue cardigan. She looked like a wrinkled child who didn’t understand what was being said. Adam unconsciously mimicked her lip-biting. ‘Libby,’ continued Peach, ‘do you know Anna here? She will take you on a visit soon. Show you round, see what you think. Is that OK?’
Libby looked at the floor, at her slippers and then up again. ‘You can do as you please, it’s easier for you, you have bodies. I don’t have a body. I don’t even have feet.’ She stared at her slippers. ‘I don’t know how those slippers got there. They aren’t mine.’
After she had gone Peach turned to the students. ‘Observations?’
He was looking most directly at the spot-twiddling ECT fan, who reddened, shuffled in his seat and said: ‘She appeared confused, unresponsive, almost mute until the bit at the end. I wonder about depression.’
‘Do you?’ Peach said without looking at him. ‘I wonder where they get medical students from these days. Miss Tandy, might you help them?’
Adam looked at Tandy and saw a bird getting ready to peck at a dead animal. After Libby had left the room Adam had found himself feeling embarrassed. Rationally, what he had said was appropriate, it made some sort of clinical sense and when he conceded the case with a shrug he had done it without petulance. Nor had he shown more emotion than was appropriate, which was the rule in most exchanges but almost cardinal in a so-called clinical setting. However, he felt exposed. Exposed as caring, attached and involved. He felt seen. And he felt the effects of the drugs he had taken before the ward round seeping through his body, bouncing off of the inside of his skin and ricocheting into his liver and the back of his eyes.
And it was the way he felt that dominated him. Thinking was sculpted by the emotions that bubbled up through him. Thoughts that Libby should be left alone, not forced into a community that would mock her and not wrapped in new routines and wallpaper that will make her feel misplaced and unsafe, these were not well-shaped clinical responses to change but rather guardians to the overwhelming and humiliating feeling of loss he experienced when he pictured coming to work and not seeing the eighty-five year old deluded patient, who probably didn’t even know his name.
‘The nihilistic delusion is interesting,’ Tandy said directly to Peach. ‘Clearly fixed, clearly fully integrated into the way she both sees the world and functions in it. It is hardly worth saying that not having a body enables her to never actually be anywhere. She certainly managed to not stay here didn’t she? Didn’t even have to sit down, such was her ability to not stay where she didn’t want to be. I suppose it is reasonable to wonder if perhaps she doesn’t have a body because she doesn’t want to actually be in this place. To her, her body is elsewhere. Waiting, perhaps. Who knows, maybe she will find it in her new house?’
Peach was nodding and Casells looked pleased. Adam and Anna caught each other’s eye and shared a moment’s contempt. Tim distracted himself by looking at the next set of notes. ‘Of course, there might be another possibility.’ Adam was surprised by his own voice. ‘Perhaps she had her body when she got here and something happened to it. Something unkind. Something she cannot countenance. Perhaps, even, it wasn’t just ‘something’ but a series of things. She has been here a long time and, as you said Walter, experienced many things. Maybe whatever happened to her body means she doesn’t want it back?’
‘All the more reason for her to spend her last few years away from here and in a place of comfort.’ Anna had spoken without thinking and instantly regretted it. She felt disloyal, even though she had no reason to be loyal to Adam.
But Adam nodded. ‘Yeah.’ He sounded tired. ‘But if you don’t have a body I imagine the comforts of pine bedframes and soft furnishings are a bit irrelevant.’
There was a moment’s silence, just enough to mark a polite pause before moving on. ‘Let’s see how she gets on with her visits and discuss again in a couple of weeks, OK?’ said Peach rhetorically. ‘Who’s next Tim?’
‘Another for discharge, we think.’ Tim spoke distractedly as he picked up the notes. ‘Maureen Marley, also known—mainly to herself—as George. Should I offer a brief summary?’ Tim looked at Peach, who waved his hand and closed his eyes. ‘Maureen, in essence, believes herself to be a man. She has had several diagnoses ranging from the current schizophrenia to an initial belief that she had suffered a seizure that had brought about changes in her brain… Anyway, she has a fixed delusional belief and no amount of drugs or indeed therapy—goodness knows, Maureen has been seen by more people than Tottenham Hotspurs—is shifting that belief and so we have been looking at discharge and maybe even some work?’
Anna swallowed and said ‘I went with Maureen to visit the house she is currently being considered for, and I have to say I don’t think it went very well.’ Peach offered a well-mannered surprise. It was less an expression of shock and more a way of establishing that he was going to require some convincing. ‘I know of course that Maureen is a woman.’ Anna felt she sounded ridiculous. ‘And I am not suggesting that we base our care on colluding with her belief that she is not. However…’ She looked at Peach who, along with Casells, was impassive and attentive. ‘If we are going to discharge Maureen, despite her delusional belief, we are acknowledging that she is not only capable of living with that belief but that it is now part of her reality. Therefore, if we move her into a house that is only for women, we are either contradicting that acknowledgment about her belief and how she chooses to live with it or we are doing something cruel. I think she should be in a mixed house. A house where she can be herself.’
‘Interesting point.’ Casells nodded approvingly.
‘What are your thoughts, Tim?’ asked Peach.
Tim was staring at the floor. ‘At first I wasn’t sure,’ he said, ‘but I think I agree with Anna. If we are agreeing that hospital treatment is no longer required it is because we cannot ‘cure’ her. If we cannot cure her, our next responsibility is to help her to live as effectively as possible and I think that is most likely in a mixed house. In fact I think I may have an idea, sir.’
Peach looked unhappy at the prospect of an idea. The house Maureen had been assigned to was a house he needed to fill. ‘And what is your idea, Tim?’ he asked.
‘Well, I believe that you are the consultant for a house on Elm Grove, sir, and I understand that one of the older patients—a Mr Singer, I think—was admitted to the Royal Free following a stroke last week. I spoke with the doctor Mr Singer was under and he does not anticipate Mr Singer being able to return to anything like independent living. In fact, he is far from convinced Mr Singer will be discharged at all, sir. Now forgive me for filling dead men’s shoes, so to speak, but as I understand it that is a mixed house in every sense and unless you have someone else in mind for that place…’
Peach thought for a moment. He didn’t have anyone else lined up and he would have to make the bed available to another consultant’s patient if he did not fill it himself, which had both administrative and financial implications. ‘Any thoughts, Adam?’
‘I think soft furnishings would drive Maureen up the wall, to be honest.’
Peach smiled. ‘I wonder who I could put in that house, though?’
‘Well,’ offered Anna quickly. ‘I was there this week and I don’t think they are ready to open just yet. That gives us time to find a suitable person and I have several assessments to do over the coming fortnight. I am sure we can find someone, Dr Peach.’
The room fell silent for a moment.
‘OK,’ said Peach finally. ‘Assuming Mr Singer is unable to return to his home—and I will talk to his consultant later today—then let’s place Maureen in there. I don’t think there is any reason to see her, do you Tim?’
‘Er, no sir, no. I or Anna can talk with her later.’
‘Right, thank you.’ Peach sounded slightly more abrupt now and to his credit probably noticed. He looked at Adam who had been concentrating mostly on breathing steadily and not thinking about Libby. ‘We are emptying this place quicker than I thought we would.’
Adam nodded. ‘Yes, but we haven’t got to the really tricky ones yet, have we?’ He smiled at Peach with something approaching affection.
‘No, but it won’t be long and then… there’ll only be us left.’
Adam smiled genuinely. ‘That is who I meant when I referred to the tricky ones, Walter.’
Afterwards, Anna found Adam in the medicine room standing beside the sink staring at the wall. ‘You used up a lot of energy in there.’
‘Is that how it looked?’ Adam was hunched forward, still breathing deeply and feeling like a fool.
‘It’s in the bag, you know.’ Anna sounded more tender than she had expected.
‘Yeah, probably.’ Adam sighed and turned to face her.
‘And actually, for Libby Hoffman, it may be a good thing.’
‘Probably,’ he nodded.
‘So what is the problem, Adam?’ Anna had closed the door.
‘We decide what is best for people according to what is best for us,’ he said, realizing as soon as the words were out that he sounded lazy and naive.
Anna shrugged. ‘Yeah, and we call it progress. So what?’
There was a knock on the door. It was Grace. She came in, looked at them both and said: ‘What’s going on?’
‘Libby is being discharged,’ Anna said.
‘Yeah, she’s all better now,’ said Adam.
‘Good,’ Grace snapped, looking at Adam. ‘I think she has a lot of bad memories tied up with this place. She probably deserves to finish her days somewhere a little nicer, don’t you think?’
Adam let out a single breath that was meant to take the shape of a laugh but sounded a little as if someone had poked him in the stomach. He wasn’t railing against what was happening to Libby. His instincts had been OK even if they had made him feel faintly ridiculous: to protect her from change, because in this environment change had always meant some sort of assault. It was the bottom line for a professional carer: to do no harm. He looked at Grace, curled his lips into something suggesting that she was being a pain and nodded.
Another knock at the door. This time Tim came in looking angry, so angry that he forgot to blush.
‘Thank you Tim,’ Anna said. ‘I’m grateful for your support over Maureen.’
‘You are very welcome. Any doubts I had about my own judgement have just been removed.’
‘How so?’ asked Grace, prompting Tim to blush.
‘My consultant has just castigated me in front of the medical students. He feels I should not have gone looking so actively for another bed for Maureen and I should have talked to him in private first before giving my opinion in a ward round.’
‘I’m sorry…’ said Anna.
‘No, don’t be. He didn’t offer any logic, any science, he didn’t correct my clinical reasoning. He criticized me for being politically naïve. For not serving the economic imperatives of community care and managing his future income. He made himself look a fool.’
‘So why are you so cross?’ asked Grace.
‘I’m cross for not knowing the right thing to do without you putting it in front of me, Anna. I wonder about my judgement and I’m cross at having give my time and attention to self-serving businessmen rather than medical practitioners and I’m cross that nobody seems to notice that for all the talk we do not appear to be making anybody better.’
‘Eh?’ Adam said.
‘Well that is the point isn’t it? Of medicine? To make people better? Not argue about which diagnosis makes us look clever.’ Tim paced as he talked, looking at the floor and particularly making a point of not showing his red face and pursed lips to Grace.
‘You might need a drink, Tim,’ suggested Adam.
‘We all might,’ said Grace. She reached out and touched Tim’s arm gently. ‘Five o’clock in The Swan across the road. I’ll buy you all a drink.’
Tim blushed again. He looked at Grace with such adoration that even Adam and Anna smiled. ‘Thank you,’ he said. ‘I would like that very much.’
6. In My Secret Life
The grounds of the hospital were at their most striking in late September. A thin sparkling mist laced the grass and the only noise that spread across the wide former farmland that surrounded the asylum was the singing of birds and the echo of laundry carts being dragged around the corridors.
If you walked down the long drive from the real world that ended at the large black gates and you had no idea what the imposing brown Victorian façade housed, you would consider both building and setting to be beautiful. You might, however, begin to wonder what it was as you drew nearer to the wooden doors, surrounded by half-hearted graffiti—‘You’d have to be mad to live here’ and ‘Jesus already came back: he’s inside’—and the smell of mildew.
The staff didn’t notice the grounds or the architecture any more. The building was flavoured by its purpose, not its aesthetic. The greenery, the long majestic building with its intricate tower and rows of thin windows, were lost on the people who saw them the most. There were however some beautiful trees: the largest, a weeping willow, was over a hundred years old and stood behind the east wing that was now empty, rendering the tree unseen. It had boughs you could build a boat from and in the height of summer was shrouded in greenery that cascaded from uncountable branches like a thick sea. Very occasionally a patient would sit beside it smoking, sheltering from the rain or the sun or the nurses, but mainly it went unseen.
One winter a flurry of snow attracted a flurry of photographers to the hospital. A grand Victorian building in a yellowing light with a cover of white: it would be on Christmas cards for years to come. The snow meant there was a bustle of concern over how dangerous the path down the drive was becoming. A catering assistant had fallen and broken a hip, and a handful of nursing auxiliaries threatened to not come to work unless grit was applied—ironically, the last thing anyone ever imagined a nursing auxiliary needing. But the aesthetics were irrelevant.
Leaving the hospital, despite its imposing architecture and muted grace, was the fading of an anaesthetic. The ordinary road at the to
p of the drive, that stretched along the front of the hospital and into suburbia, was lent character by a bus route and five shops which included a dry cleaners and a bookies. The real world was characterized by engine noise. From the point of passing through the hospital gates to the moment, about three and a half minutes later, that Adam, Anna, Grace and Tim entered ‘The Swan’ pub, nobody spoke. Instead they adjusted their senses, breathed in the fumes and each made private decisions as to what time they would make their excuses and leave.
The pub had been modernized quite recently, which meant there was a carpet and a series of booths built against a long wall at the back where once there had been round wooden tables. There was a juke box currently playing Phil Collins, and there was even a small non-smoking section that nobody was sitting in because it was a bit embarrassing.
Adam bought everyone a drink. He had whisky with coke, both women had gin and tonic and Tim had a pint of real ale. They sat in a booth and Anna offered Adam a cigarette.
‘We are going to have to do something about the music,’ Adam said. ‘Does anyone have any change?’ Tim fumbled for fifty pence. ‘That’ll do for a start,’ Adam said and wandered over to the juke box.
‘He is a bit of a fascist when it comes to music,’ said Grace. ‘He once unplugged a juke box because someone kept playing Meatloaf.’
They talked about pubs. Good ones in Stoke Newington, which had live bands and lock-ins. Bad ones in Wood Green that watered their drinks and wouldn’t serve people who ‘dressed funny’. Grace talked about Manchester: how much better the music was and how much cheaper the drink. Anna said the same about Birmingham.
‘What bloody music has come out of Birmingham?’ asked Adam.
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