‘We’re going out for tea,’ announced Anna. ‘And we may look in at a house I have been telling Libby about.’
‘Have a nice time, Libby,’ said Adam. ‘Bring me back some cake.’
‘I’ve nowhere to put cake,’ Libby said dismissively. ‘It’s not like I have a stomach.’
‘We’ll be a couple of hours,’ smiled Anna. ‘We’ll get something to eat while we are out.’
‘Well, OK. But don’t let her drag you off dancing.’ That was aimed at Anna but for Libby’s benefit.
Libby’s face filled with contempt. ‘Can’t go dancing,’ she mumbled. ‘Don’t have any feet.’
Over Anna’s shoulder Adam could see the blazered David Cassells and the birdlike Carla Tandy approaching. ‘Look out,’ he said conspiratorially. ‘Psychologists at six o’clock.’ Anna turned and Cassells smiled. ‘Ms Newton, how lovely to see you. And Ms Hoffman too. Are you two ladies going out?’
Libby started hopping from foot to foot; agitated and uncomfortable with the attention and sheer weight of staff numbers that were surrounding her.
‘We are,’ said Anna, and then to Adam: ‘Play nice now.’
Adam and the psychologists watched them leave and as the ward door closed Cassells smiled and said to Adam: ‘Mr Sands, I wonder, do you have a few moments?’
‘Of course,’ said Adam.
‘Is the office OK, or would you prefer a side room where we won’t be disturbed?’
‘The office is fine. I don’t want to keep you.’
Turning to his colleague Cassells said dismissively: ‘Carla, would you mind giving us a few minutes alone?’ before walking into the office, leaving her outside looking cross.
‘Mr Sands, I sensed we got off on the wrong foot, not helped perhaps by my eager, promising but sometimes clumsy trainee trying to undermine you.’
Adam looked at the man in front of him. He was confident, relaxed, good eye contact. And he clearly wanted something. ‘How can I help you, Dr Cassells?’ he asked gently.
Cassells smiled and put up his hands. ‘OK, I’ll come straight out and say this and trust that you will treat my… my curiosity with an open-minded professionalism.’
‘I’ll do my best.’
‘Well,’ said Cassells, ‘while I obviously hold Dr Peach in the utmost regard, and I am grateful that he has helped me settle in, I have some concerns about one or two things I have witnessed, and where I come from if one has concerns one speaks to the charge nurse.’
‘What things?’ Adam had been expecting something a little more self-serving, like unlimited access to any interesting looking patients or to take Maureen Marley home for the weekend for a DIY project.
‘Well, as you will recall, you asked Carla to do some work with Michael Wells. It was a good idea, indeed it is doing her some good and I would like to think it might be of some use to Mr Wells if he wasn’t so—’
‘Mad?’
‘No. So drugged. I checked his drug chart, Mr Sands. You are giving him too many drugs.’
Adam looked at Cassells. The words began to form in his head: ‘We administer what is prescribed.’ But they didn’t come out because he knew they would sound like ‘We simply do as we are told.’ So he went instead with: ‘Yes, I was speaking with the doctor about that very thing this morning.’
‘Right,’ said Cassells ‘So you and, perhaps more importantly, Dr Leith know he is being over-medicated.’
‘I think everyone knows, Dr Cassells.’
‘Well, what are you going to do about it? Sorry. What are we going to do about it?’
‘Tim is going to talk to Dr Peach today. I wonder if Michael’s inability to talk to his therapist might also be fed back?’
Cassells nodded. ‘I could have a word about that. And what about you, Mr Sands, will you be contributing?’
Adam sensed he was supposed to rise to this, to either align himself to Cassells’ crusade for justice or be seen to collude with care that amounted to cruelty. Instead he smiled and shrugged. ‘Did you come here to ask if I will side with you in a row with the consultant, Dr Cassells?’
‘I wouldn’t put it quite like that, Mr Sands, but I suppose I wonder where you might stand, given that you already know the treatment plan you are administering is at best excessive and at worst toxic.’
Adam had the sense that every part of Cassells was a lie, except his words. He was right, the more people who pointed out a concern the more chance it would be heard. He didn’t trust the man or his motives but that was not the point. He also felt embarrassed.
‘I’ll feed back my concerns to Dr Peach. Firstly noting that Michael is struggling to function because of the medication and secondly, noting that in asking my nurses to administer a dosage that is not recommended I am putting them in a very difficult position.’
Cassells nodded. ‘Thank you. I don’t think you like me, Mr Sands, and I can live with that, but I suspect we might be on the same side.’
Adam shrugged and smiled thinly. ‘I wouldn’t worry too much about my tastes, Dr Cassells: I don’t really like anyone.’
Not long after Cassells had left it was lunchtime. Lunch was brought to the wards in a steel trolley by a grubby kitchen assistant and Adam could tell the time by the arrival of the smell of mashed potato and something that was green and overcooked. But still the patients came, even Michael, sitting when and where he was told and murmuring thanks when his dinner, a gathering of vegetables around some boiled chicken, was put in front of him. Michael liked puddings best. Adam knew that if you wanted to talk to Michael the best time to try was just after pudding, which was treacle pudding and custard. Michael would stay at the table on the off-chance that there were seconds.
When Adam sat down beside him Michael was looking at the trolley hopefully. He had custard on his beard.
‘How are the voices Michael?’ Adam asked quietly. Michael shrugged. ‘Do you want another pudding?’ Michael nodded. ‘I’ll sort that out in a second. Tell me about the voices, please.’
‘Bad,’ Michael said.
‘Are the drugs helping at all?’ Michael looked away. ‘Michael, are they helping, do you think?’
‘Can’t tell. Can’t sleep. Voices are louder during the day.’
‘Well, you have your biggest dose in the morning, Michael, so I’d expect them to be quieter during the day, wouldn’t you?’ Michael stared at the trolley. Adam turned to the nursing assistant who was dishing out puddings for the remaining patients. ‘Can you do an extra one for Michael please?’
‘Michael has had one,’ she snapped.
‘Well, he can have another one,’ said Adam without looking round.
‘I think you are on too many drugs, Michael, but we need to cut them down slowly so you don’t get ill.’ He thought he saw Michael laugh. ‘But we will cut them down and see, each day, if anything gets better or if anything gets worse. OK?’
Michael seemed to be just staring at the trolley, ignoring Adam until the extra pudding arrived, tossed on to the table in front of him. Before he began to eat he looked at Adam for the first time, held his gaze for a moment and nodded.
Adam went to the room Anna used for counselling her soon-to-be-discharged patients. He closed the door, sat in the large worn armchair that the patients slumped in when being assessed and lit a cigarette. Looking out of the window he watched as the kitchen staff unloaded a van full of processed food. Large boxes of powdered egg and semolina; wooden crates full of tinned beans; big tins of cheap coffee. Originally the hospital had been run as a working farm. Patients had worked the land and grown their own food, selling what they didn’t need to the local town. At one time the hospital had been close to self-sufficient; it struggled to make the milk go round the three thousand inpatients but the cows were hardy and waste was frowned upon. They made their own bread. They had a woodwork shop where they made furniture
, some of which they sold, which gave them money for cigarettes, fruits which struggled to flourish in North London, and fuel. At harvest time, when the potatoes needed picking on the larger farms further north, then the hospital would provide workers in exchange for potatoes and a less-than-average but better-than-nothing wage.
But, as the idea of what sickness was became more sophisticated, the cultural acceptability of the hospital as working farm faded. Sick people, all of them, required treatment and picking potatoes or milking cows was not a treatment. If anything, it smacked of punishment, cheap labour, slavery almost. So they turned the mad into patients and sold the cows to an abattoir in Harlesden. Patients were people you did things to and, as long as you could call them patients, then whatever it was you did was called treatment. The mid-twentieth century was a relatively dark age for madness, and the problem with an asylum when it emerged into the light was that everything looked like progress: insulin therapy, electricity to the head, psychosurgery, drugs. These were the gifts of science and science civilized us, made us modern and better. Especially the drugs.
Adam didn’t like Cassells. It wasn’t just the power he seemed to have been presented with on arrival. Or the pious manner and annoying student, or the fact that he came into his office and articulated Adam’s own concerns as if he had mined them. There was more to it than that: he disliked Cassells more than Peach in the same way that he had always claimed—certainly when drunk—to dislike liberals more than conservatives. Ultimately they do greater harm by vaguely civilizing the damage done by others and they get to feel clean afterwards. ‘We can find all sorts of ways to excuse what we do here,’ thought Adam. ‘We can imagine we reduce pain, police against evil, even do some good, but we can’t feel clean. That is simply too much bad faith.’
Adam put out his cigarette and walked back to the office. He picked up the phone and called Tim. ‘Have you spoken to Peach yet?’
‘No, but I will.’ Tim sounded slightly put out that Adam was reminding him.
‘I think you should wait, Tim. I think I should speak to him first.’
‘Why?’
‘Well, for one thing I think it is my job, but I also think he would feel less threatened if it were me, a nurse, asking if we are doing the right thing rather than you, a doctor, reminding him that we are not.’
Tim paused for a moment. ‘That doesn’t seem terribly fair. You make it sound like a game.’
‘Well, we both know it is a game, Tim, and I like to think that we are both more interested in winning this particular part of it than we are in making a stand against the fact that it’s a game.’
‘Eh?’
‘Look, Peach is more likely to listen to me than you.’
‘Oh, thank you very much.’
‘That’s not about you, Tim: it’s about me and my shared history with your boss.’
Outside the office the laundry cart had arrived. The driver, a plump bald Greek, got off the cart and lit up a cigarette. He looked around and momentarily appeared to be moving to unload the cart of the clean sheets, nightdresses and towels when Maureen Marley appeared, grinned and set about unloading it for him. The driver said something about a horse race from the day before and Maureen said what seemed to be a full sentence in response. After the cart had been unloaded the driver offered Maureen a cigarette. Maureen took it, put it behind her ear and began loading the dirty laundry on to the cart. She laughed—not a sustained laugh but a short, genuine laugh—at something he said about the three o’clock at Goodwood. She shook her head and said something and he took out a newspaper from his back pocket, looked at it intently and said something back. They were comparing racing tips, or Maureen was giving them and the driver was taking her seriously. He took a small pen from his shirt pocket and circled something in his paper. Maureen finished the loading and accepted a light for the cigarette. The driver got back on to his cart and drove off the ward shouting: ‘See you tomorrow, George.’ Maureen was smiling. She was muttering something to herself as well, and smoking, walking back to the day room and nodding, but mostly she was smiling.
Adam picked up the phone and called Walter Peach’s secretary. ‘Hello Anne, how are you? How are the kids? Five? Already? It’s lucky we don’t age as quickly as they do, isn’t it? No I’m OK thanks, not too bad… Listen, is Walter available at any point today? I need a quick word with him.’
And then he went and found Grace, who was sitting on an armchair with its back against the wall in the day room watching the once-high-as-a-kite Mary Peacock slumped in a chair on the opposite side of the room, wrapped in a grey-skinned misery.
‘Grace, I need to go and see Peach now. Will you be OK here?’
‘Yeah, we have enough people on the ward to cover.’ She didn’t look at him as she spoke, and, aware that he would pick up on that, she added: ‘Mary is struggling today.’
‘So are you. What’s the matter?’ Grace ignored him and he crouched down beside the chair and said quietly: ‘Grace?’
‘Not now,’ she said quietly. ‘It’s just man trouble.’
Adam waited a moment. Not now and not here made sense. ‘I’ll catch up with you later, OK?’ and he touched her arm gently before getting up and walking off the ward.
Peach’s office was on the other side of the hospital grounds in a newly built annexe about three-quarters of a mile from Adam’s ward. He had to walk the full length of the central corridor and out of a side door before crossing what used to be a flower garden but was now a bench with some wasteland around it, followed by a small car park and then the new building which was named after a tree: ‘Elm Annexe.’ Nobody knew why.
As he came out of the main hospital into the light he saw the young man he’d encountered in the corridor on the night of Stephen’s party. He was sitting, quite elegantly, on the wooden bench wearing sunglasses and a cheesecloth shirt, looking up into the branches of a large oak tree. He didn’t turn to face Adam when he said: ‘Hello again.’
‘Hello,’ said Adam. ‘Have you lost a kite?’
The young man smiled and turned to face him. ‘I like trees, what can I say? How goes your day?’
‘Oh, so-so. How about yours?’
‘Mine’s OK, mostly waiting, but I suppose ultimately that’s what we are all doing one way or another. I just try to make sure that while I am waiting I am doing something that pleases me.’
‘Like looking at trees?’
‘Yep.’
The young man never stopped smiling. Definitely a hippie, thought Adam. In the daylight his eyes were even more strikingly blue and, although he was pale, his pallor wasn’t that of a patient. Adam wanted to ask if he was a nurse or patient but it felt such a lame question, as though in asking it he would have somehow failed a test.
‘This used to be farmland, you know.’ The boy smiled. ‘And I believe this bit here was a flower garden,’ added Adam. ‘Not sure what happened, I suppose people just stopped wanting flowers.’
The boy nodded. ‘People are strange,’ he said.
‘Have a nice day,’ offered Adam as he walked past him and into the car park.
‘You too. And don’t forget what I said about the dew.’
‘Patient,’ Adam thought.
Elm Annexe smelt of pine and carpet freshener and it had a proper receptionist who noticed when someone came in. It housed not only offices for the consultant psychiatrists but also therapy rooms for the clinical psychologists and psychotherapists. This place always made Adam think he should wipe his feet and so he made a point of not doing. It was pristine and modern and he knew he didn’t belong. He didn’t speak to the receptionist, instead walking through the double doors marked ‘staff only’ and wandering down the plush carpeted corridor to the door that said ‘Dr Peach’. Walter’s secretary held up a finger to Adam as he entered, designed to ensure that he wait while she phoned through to her boss to let him know that he had
a visitor. Adam would, in other circumstances, have ignored the finger, but today was a day to make friends.
‘He can see you now.’ The secretary had fair hair and pursed lips. Her large bosom and purple shoulder-padded blouse lent her the sort of severity you’d find in a West End bouncer. Adam nodded but didn’t look at her as he entered Peach’s office and quietly closed the door.
‘This is rare, Adam. Is everything alright?’
‘Thank you Walter. Yes, I think things are fine. I just have a bit of a worry and I wanted to talk to you about it in private, if that is OK?’
‘Of course.’ Peach sat down behind his desk and settled back with his hands in front of him, fingers touching each other like a steeple.
‘Well,’ said Adam. ‘I am a bit worried about one of our patients, Michael Wells: he’s not sleeping and he should be. He’s on enough meds to knock out Poland but they aren’t touching him and now they aren’t even sedating him. I’m worried we are doing damage with the drugs and I wanted to talk directly to you about that, Walter.’
‘Are you questioning my clinical judgement, Adam?’ Not said aggressively but direct and genuinely enquiring.
Adam didn’t speak immediately. ‘Well, I suppose to be honest, Walter, that depends on what sort of mood you are in. I think what I am doing is being collegiate and open with a consultant I have worked with for a while and expressing some legitimate concerns about a treatment that may be doing more harm than good, but if you are in a place where you experience any discussion or concern as an assault… Well I’m on a loser, then, aren’t I? Because we both know you don’t have to even entertain me, don’t we?’
Peach nodded and half smiled. ‘Dr Cassells was in here this morning talking about the same patient Adam.’
Adam reddened. ‘Ah, right. Saying the same thing, no doubt? And I suppose that begins to look like a conspiracy.’
Stranger Than Kindness Page 11