No Way to Say Goodbye

by Rod Madocks

  I was able to see him some weeks later with the early spring sun burning brightly outside. I walked slowly up the B blocks, preparing myself for the encounter. When I reached Brunel and pressed the air lock buzzer there was no response and I cautiously let myself in using my own keys. No-one was there, none of the 24 patients and no staff. On the empty ward, phones were ringing and cell doors were left ajar. I stood for a moment, dazed by the unexpected emptiness of the place, until I realised that they must have left on the weekly shop visit. I wandered in and out of offices and rooms, noting the mug-strewn staff desks, the jokey messages left on staff lockers, the blue caps hanging in the staff room. The seclusion room was empty, the wadded flooring still bearing the impression of the last occupant. I moved along the corridors until I found Kress’s room. There was a stale smell in there, a tumble of bedding, biscuit wrappers, a pair of old stained jeans, and a grey jersey with maroon hoops. I also found a creased picture of a sailing ship sellotaped to the wall. I wondered why it had caught his eye, perhaps a childhood memory of the yachts and barges on Benfleet estuary. As I poked around his room there came to mind a favourite song which Rachel and I used to croon along to — I wish that I’d sail the darkened seas on a great big clipper ship sailing from this land here to that, — and I hummed the song once more as I ran my fingers over his things.

  A succession of thuds and the clank of magnetic locks heralded the return of the ward and I could hear the patients chattering and laughing, excited by their purchases as they waited for the rub-down search in the air lock. I did not immediately see Kress in the throng but sought out a charge nurse who was surprised to see me on the ward. I told him I needed to interview Kress. He did not question me; he just flicked a look at my ID badge and yelled for Kress up the corridor.

  Kress materialised beside me. He appeared taller than I remembered and formed a large dark shape in the corridor.

  “What’s up boss?” he asked in his hoarse voice.

  “Doctor wants to see you now.” Turning to me, the nurse asked, “Do you want any of us in with you?”

  I shook my head. I could handle Kress on my own. The charge nurse unlocked a side room and gestured to Kress to enter by jerking his thumb. He slouched in reluctantly while I took the seat nearest the door.

  Kress sat facing me, rubbing his eyes and looking resentfully at his brown paper grocery parcel that he had brought into the room and left on the floor. His hair seemed longer and was now quite bushy. His face had filled out compared to the gaunt, feral features that I had first seen in the courtroom the previous autumn.

  It was as if the hospital regime had somehow neutered him and smoothed him out. He looked at me with blank eyes, saying, “What’s it about?”

  He seemed uneasy under my stare, moving restlessly in his chair. I shuffled the file, kept my eyes on him, registering everything: the blue shell suit with a crew neck, the food stains down the front of it, his canvas shoes with no laces or socks, the hairs that sprouted on his ankles. I noticed his blunt, thick fingers and wide, grooved nails and wondered what those hands had done. All that I was really aware of was an intense, all-consuming hatred for him. He remained sitting in front of me, a bemused, vague figure, his back to the light. He squirmed in his seat, putting one knee down then lifting it up again in a dystonic movement probably caused by his medication. We went through a charade of questioning and I asked him about his offending.

  “Look first for the eschaton, the known thing,” as Dr Colt used to intone in forensic psychotherapy lectures. I asked Kress about his behaviour with women, what he had actually done in detail in his various admitted offences, his attitudes to children and the nature of his contact with them. He answered me guardedly, monosyllabically, with the stock patient responses.

  “Don’t know boss, what are these questions for?”

  “Can’t remember, it’s me tablets, everything’s fuzzy.”

  “You tell me, it’s all there, written dahn already.”

  I plodded on calmly, asking the same questions over and over, although I could not bear to utter Rachel’s name in his presence and referred to her as the “missing teacher”.

  Suddenly he could not disguise his resentment any longer, “Look… I’ve done nothing,” he interrupted, “made stupid confessions. Don’t know why I’m here. I’ve gone over this already, dozens of times, what do you people expect of me? I don’t know anything about the fucking teacher. Never did do. I made it up after I saw the case on telly. It was all so stupid; I just wanted someone to notice me. That’s it. Can’t you people see that? I can’t talk about it any longer.”

  He snatched up his bag of groceries and half-rose then thought better of it and sat down again.

  “I need help, I can’t stay here, it’s doing me head in, I’ve done nothing, them CID banged me up.” He paused, panting slightly, his divergent gaze encompassing me. “What are you going to do for me, doctor? You have got to help me. I’ve done nothing wrong.”

  I gazed back at him in silence for a moment as I came to my own internal decision, then said, “Oh, I will make recommendations to the hospital that you need help. A move on, I think.”

  “Thank you, I would be very grateful, doctor. Can I go now?”

  “Yes, I have finished with you. You can go,” I said, for in truth I did want to be rid of him, after wanting to get up close to him for so long I now felt disgusted with this pitiful man. He began to rush away, grabbing his food parcel, then he hesitated and turned and put out his hand. I pretended to collect my notes and nodded coolly to him for I had no intention of touching him. He retracted his hand and scurried down the corridor. Before leaving the ward, I left a note in the ward notes: Patient reviewed. Recommend transfer to Eaton Ward for therapeutic regime.

  So began my campaign to transfer Kress to Eaton Ward where I had some control of the territory. I knew that patients could wait years on assessment wards but I thought I knew how to exploit the rivalries and the tender, touchy egos of the medics there. At first I wrote cautious reports recommending transfer, then I lobbied psychology and the ward managers before turning my attention to the committee that met weekly to decide on the movement of the hospital’s patients.

  We usually met in a small room dominated by a large oak table, where panel members had to squeeze in with their looped key belts tangling on the high-backed chairs. On one white painted wall there hung a print of the elder Breughel’s Ship of Fools. The table was heaped with plates bearing sandwiches, canapés and fruit supplied by the canteen. The meeting was chaired by Dr Davidson, the clinical lead for the directorate and an expert on the organic psychoses. An acerbic Scot, he allowed no trace of humour to colour the proceedings and he would turn sharply if Dr Bartram yielded any jovial comments. Bartram was usually there, lounging back in his chair, unselfconsciously grabbing at the sandwiches, dropping crumbs down his bow-tied shirt front, or tugging at his sideburns in a gesture of frustration when the discussion irritated him.

  Other consultants came to this meeting, one or two like Bartram with some commitment to the smooth running of the hospital, some absorbed in parochial concerns, yet others on the edge of their competence, struggling to survive. Tina Reed was there as ever, dressed entirely in black, with her kohl-rimmed eyes blinking nervously behind fashion glasses. Loud, opinionated, elegant Virdee, perching alertly at the end of the table, also contended with the others. Psychology was usually represented by Irina Starsha but her chair was empty because clinical matters came first for her and she was often late or absent for these meetings. Cobb, the head nurse, occupied a corner chair, always uncomfortable among the doctors. He would come to the meeting already armed with the occult power of the nursing view of how things should be arranged, hatched in the smoky review rooms with other ward managers. Lastly there was me representing day services and psychological therapies. I had worked my way onto this committee over the months despite my comparatively low level of seniority. I qualified for my place there by my apparent enthusiasm for th
e job, for my colleagues thought that theirs was only a nominal presence as they considered that most decisions had been carved up already between the medics and the nurses.

  Davidson called the meeting to order and the scatter of conversation hushed. He worked through the previous minutes with pedantic thoroughness and distributed the papers containing the current bed state. I sought out Kress’ name on the Brunel Ward list; an assessment and high dependency ward which decanted patients into my own clinical area of Eaton Ward. Patients moved between wards like a game of snakes and ladders played by the clinicians, and this committee confirmed those promoted up to rehab or going down to high dependency and assessment. Ward movement was slow as usually only death or transfer would allow the movement of patients within the log-jammed wards and barely ten patients a year trickled out as discharges to medium secure facilities in other parts of the country.

  Bartram commented, waving a sandwich in one hand, “Well at last we have a little movement in our area. We transferred one patient to Dove last week because of concerns about security after one patient attacked another. Odd business, we may have to transfer Hobman too if he proves to be the source of the trouble.”

  Davidson rustled his documents and reminded the meeting that the first item on the agenda was ward transfers. The names on the page seemed to shimmer under my gaze as I stared down at them. I ringed that of Kress with my pen, circling it darker and darker until it was obliterated. I knew that at least one patient was in front of him; some of them had waited longer than Kress. I knew how long exactly.

  Tina favoured Ghedi, a knife killer, a round-faced young Eritrean, usually clad in a white dishdash whom she considered half-cured, and Bartram spoke up for Demetrius Jones, a stately, tall, completely deaf black man who had run amok on a north London street dragging his dying landlady after him by a washing line noose around her neck. Bartram saw his illness as tempered and his patient now ready for a rehabilitation stream, even if it was the dead stream of Eaton Ward. Dr Virdee favoured Kress, it was hard to say why although I had lobbied him and made arguments. Perhaps he wanted me to owe him a favour; or then again, maybe he had simply tired of this inert patient.

  Virdee added, “He is compliant with meds, we have stabilised his psychotic symptoms. He will begin to regress if he remains any further on our, let’s say, turbulent ward.”

  I was reluctant to show my hand too readily but as Bartram began to launch into a further appeal for the committee to consider Demetrius Jones I leaned forward and added, “and this man Kress is most suitable for the therapeutic pathways on Eaton Ward in particular.” I spoke clearly, forcefully even.

  Bartram looked surprised.

  “Pathways?” said Bartram. “Is this the road less travelled?” he boomed.

  “We should fit patients to the therapies that we have available for them rather than shifting them to wherever it is expedient to house them,” I responded and indicated the offending behaviour groups that I ran with a psychology assistant on Eaton Ward. There was a brief silence in the meeting since overt conflict tended to be avoided. Bartram seemed to divine that he had been outmanoeuvred in some way and cast a puzzled look in my direction.

  Dr Davidson said, “It looks like Kress has several votes,” and Bartram responded with a shrug of resignation.

  “Well it seems that you have taken the interests of this patient to your heart, Jack,” he said, “however it is I who will have to take responsibility for him on Eaton.”

  Bartram looked round the room, then said, “Alright, I will take the recommendation. Kress will be the next to transfer to Eaton.” He glanced across at me with a tight little smile as we broke up and squeezed out from around the large meeting table.

  It was hard to resist doing a fierce little jig of victory in my office later; a war dance, for yes, Kress was coming, at some time, once the hospital had slowly ground out its processes. He was coming to my ground on Eaton Ward.

  * * *

  Heinie was given me as a case during my first weeks in the hospital; or rather he seemed to pick me out, in a way. He was Heinrich Grau, the longest-term patient on Eaton Ward. A man in his forties but looking older, with the appearance of a hunched, ruffled, elderly vulture. He had a bobbing Adam’s apple and pale eyes that sometimes flickered with menace and which, at other times, were filled with a crushed pathos. He would shuffle up to women visitors and follow them, repeating the same things in a high reedy voice: “I am not a sex man. I am not a sex case here. Demons, demons approach me. Mein Uncle Heinrich he says ‘der ist’.”

  Tough-minded staff would brush him off but Heinie had a talent for finding the polite or the soft-hearted and he would batten on them, jabbering a repetitive refrain of German words pronounced with a Wearside inflection. The cynical regular staff would be amused to see him attach himself to the hospital chaplain, or a lady from the patient befriending service. Sometimes when the female visitor would attempt to move away, a timid hand would hold her sleeve, then would grip more and more tightly as she tried to detach herself from him.

  I first saw him in a ward review meeting on Eaton in the late spring while waiting for Kress to come over to the E blocks. I did not know it then, but my dealings with him were to be prophetic of much that was to take place in the hospital. This particular meeting was chaired by a relief consultant covering for Dr Bartram who was on leave. Once perhaps, she had been a bright-eyed young star of the profession. It was rumoured among the nurses, who usually knew these things, that she had been a Child and Adolescent psychiatrist but had been retrained as Forensic after a clinical disaster. She treated staff and patients alike, with a condescending tone, which I thought probably masked an immense professional disappointment. She took centre stage in the ward review with a pile of notes propped on her lap. A jewelled crucifix on a chain plopped out of her ample décolletage and dangled as she leaned over the notes, and studied the case summaries as each patient rolled in. She did not know the patients at all well and her function was to review medication and deal with crises. However, she could not resist demonstrating her sense of her own forensic acuity and clinical skills with each patient that presented themselves.

  Heinie was called down the corridor when his turn for review came. He sidled in, bobbed and curtseyed in a jerky motion to the gathered ring of seated staff. The well-spoken, modulated voice of the consultant bid Heinie to sit and he did so, glancing around the room with his ears turning this way and that. I thought that he must have attended many hundreds of such reviews down the long reach of his admission here.

  The consultant leaned forward and said in an encouraging voice, “Tell us how you are. Tell us how you are feeling Heinrich.”

  Heinie looked at her with calculating eyes, then he yawned widely showing two blackened tusks. He shut his mouth again with a snap and put a shaky nicotine-stained finger to his lips to signal that he would not speak. A staff nurse in the meeting sighed impatiently and began to interject but the consultant signalled him not to interrupt.

  “I am told that you speak German, Heinrich,” she continued, tapping at the thick file on her lap, “That’s very clever. I speak German too. Would you be more comfortable if we spoke in German?”

  Heinie regarded her then nodded his head in a quick dipping motion.

  “Jetzt mein lieber Herr, sollen wir uns unterhalten?” She said invitingly, pronouncing the words in a slow anglicized way. Heinie stared at her face, then he dropped his gaze to run slowly and frankly over her breasts and thighs. She stirred uncomfortably and visibly attempted to control herself, reaching up a hand to smooth her white collar where it folded over the cardigan.

  Heinie made hissing and spluttering noises while his eyes remained steady on the doctor. He then said very clearly and slowly, “Meine Augen tauschen mich nich. Du bist eine Kartoffel!” “She looks like a potato!” whispered one charge nurse to the other and they both snickered. The consultant flushed and banged her notes down onto the table beside her.

  “Well, we d
on’t seem to be getting anywhere with this patient. Does the ward have any concerns?” She turned for the first time to the two ward nurses who had been trying not to look at each other. Yes, they said. Heinie had been asking to attend Sunday service again. He had been banned for improper conduct at the service some months previously when he had dropped his trousers as the female chaplain was about to address the congregation. The medic rallied and turned once more to Heinie with a fixed smile on her rubicund lips.

  “You have a right to attend church, Heinrich, because spiritual matters are important. They are important to you, aren’t they?”

  Heinie stared fixedly at the dangling crucifix on her shelf-like bust then, lifted his head to shriek out very loudly and suddenly: “You’d betta fookin believe it miss! I’m a fookin believa I am!” Heinie laughed and laughed to himself until he nearly choked. Then became still and grave again, while the clinical staff tittered behind their upraised notebooks. Heinie the enigma, folded in menace, a man from the kingdom of death, who, in other times, would have been put to death. My quest to grasp the nature of evil began with Heinie, my first charge in the hospital.

  I approached him in the ward corridor after the review with the relief consultant.

  “Are you a priest? A priest man?” Heinie asked.

  “No, a therapist, come to help you, work with you.” In that moment I found the man’s being intense and overwhelming and I gazed over Heinie’s head, as if unwilling to look into the fire.