‘Do you want to play draughts?’ Peggy whispers. ‘Or dominoes?’
But Nora isn’t up to playing games.
By the next morning, Peggy is more agitated than ever. She sits in her chair, rocking back and forth, then hauls herself up. One of her slippers doesn’t seem to want to stay put so she shuffles along, sliding her right foot to keep the offending slipper on. After a few steps she lets it go and proceeds with one foot bare. She pulls at Nora’s sleeve.
‘Nora, you have to eat. You have to look OK. If you don’t, they’ll say you’re really sick and then bad things happen.’ She pauses and watches, then pulls on Nora’s sleeve again. ‘Nora, you have to be all right.’
‘I’m not all right,’ Nora moans.
Peggy bends closer. ‘I know. But if you tell them you’re all right and let them see you’re all right they’ll leave you alone.’ Nora’s neck remains bent, like the stalk of a dying flower. ‘Nora, you have to. You don’t want them to give you treatment.’
‘Go away.’ Nora slips into disconsolate sobbing, while Peggy, unsure of what to do, wrings her hands until, after a while, she trudges back to her window.
Suddenly, there’s a flurry of activity as two nursing aides march down the ward. Peggy, standing by her window, starts to panic, and she grabs at her chest, pain etched on her face. Her knees wobble and she clings to the window frame, a low moaning sound escaping on her breath. Please don’t let them hurt her. She steadies herself, her back against the cool glass, and takes long breaths. Dry sobs wrack her body and her shoulders tremble. Nora, they’ll hurt you. Sit up. Be all right.
Without a word, the two burley aides, one male and one female, tie Nora’s hands to the chair with old bandages. She pulls against the restraints, a futile act that the staff completely ignore. A piece of mutton cloth is tied around her neck to act as a bib. And then it begins. Peggy lowers her head, tears trickling down her cheeks. She can’t bear to watch.
Nora thrashes around, desperate to avoid the spoon. Food splatters everywhere. The two aides continue until one of them, now with a glob of food on her cheek, snaps. At some silent signal, they move in unison. The man clamps one hand to each side of Nora’s head to hold it straight while the woman prepares a spoon of mashed-up food. Then she holds Nora’s nose until she has no choice but to open her mouth to breathe. She forces the spoon home and dumps the contents into Nora’s mouth. Nora gags and dollops of mush erupt from her mouth. A hand clamps over it until she has no choice but to swallow, and now coughing erupts, spraying spit and porridge everywhere. Her wrists, red and sore from previous similar episodes, jerk on the restraints, and she squirms in the chair, inadvertently kicking the female aide who stiffens and looks intently at the man.
‘Warwick,’ she yells, and Stan comes hurrying down the ward. Everyone feels the shift in pace and urgency. Patients start to mutter, moan, wail and stamp their feet. Some of the women shield their faces, while others just look away. One of them prays out loud. Those tied to their chairs twist and turn, wrenching on restraints, rattling buckles, rocking back and forth, beating a loud tattoo on the wooden floorboards. Those with unrestrained feet kick. One straitjacketed woman starts to scream. Peggy pulls her hair, shifting her weight from one foot to the other. It sounds like Bedlam.
Before Stan can reach the harassed group, Nora kicks out again. Peggy wants to scream. Nora, for God’s sake, just eat.
‘Can I try?’ he asks. But the aides are not about to relinquish their authority now.
‘Just hold her feet,’ the man barks. Stan goes reluctantly down on his knees in front of Nora and holds her ankles.
‘Nora,’ he croons. ‘Come on, Nora. You have to eat something.’
‘Look, you little bitch,’ spits the woman. ‘You’re going to eat this, no matter how long it takes us.’
And with Stan gripping her feet, someone steadying her head, and her eyes as tightly shut as she would like her mouth to remain, the battle continues. She hardly has time to swallow before they stuff her mouth full again, and from time to time it looks as though she’ll choke. She writhes about and bites down on the spoon. Then, as it’s forced from between her teeth and back again, she accidently sinks her teeth into the finger of the hand torturing her. A vicious slap across her head makes her neck snap backwards, and the half-empty bowl of slop falls to the floor, splattering Nora’s smock, her hair, her face and also the staff.
A rough hand pulls on the knot of the bib and wipes Nora’s face with it, smearing food and saliva everywhere. Then the restraints are untied and they haul Nora out of the chair. She slips in the mess on the floor, stumbles and falls, crying out in pain. The male aide grabs a handful of the back of her smock, and with it some of her hair, and drags her along the floor towards the isolation room. Stan looks on in dismay and someone appears with a bucket and mop.
Peggy pulls her hair as a hissing sound emerges from between her clenched teeth.
The next morning, Nora is not in her usual place. It’s almost eight o’clock and Peggy is frantic, tugging at her hair with her dirty nails, plucking at her smock, picking off imaginary fluff. She drops her head into her hands and starts to scratch her scalp until it bleeds.
Stan watches from the nurses’ station and elbows his old friend, Gladys, who is busy beside him. These two have nursed together for almost ten years and they’ve seen some dreadful things, but it never gets any easier to witness. ‘Gladys. Have you seen Peggy?’ They both look across at Peggy, who has been here since before they came as probationers all those years ago. Without a word, Gladys puts down the laundry she’s holding and makes her way to Peggy’s side.
‘Peggy,’ the voice is kind and motherly even though Peggy is twenty years her senior. Peggy stops scratching her scalp and sits perfectly still, her hands, bloody now, still in her hair.
Gladys, round and homely, bends down until her head is level with Peggy’s and gently lifts her hands out of the tangled mass of her hair and places them in her lap. ‘Peggy, what’s the matter?’
‘What have they done with Nora?’
‘Now Peggy, don’t get in such a state,’ Gladys cajoles. ‘She needed some time alone. She’s fine. Don’t worry. She’ll be back on the ward soon.’
‘Is she having shocks?’ Peggy whispers tremulously.
‘No, Peggy. She isn’t,’ says Gladys, but Peggy continues to peer at her suspiciously. ‘She’ll be back, Peggy,’ Gladys reassures her again. ‘Don’t worry. Will I bring you a cup of tea?’
Peggy doesn’t answer but Gladys waddles off to make some tea anyway.
The smell of urine is unmistakable when Dr Stilworth enters the isolation room. He surveys the scene in dismay and anger rises within him like fire. The only item in this padded, windowless cell is a stained mattress lying diagonally across the floor of the room. Nora lies prostrate upon it. She’s naked – God forbid that she should eat her clothing or strangle herself with a sheet! But at least she isn’t straitjacketed, he thinks.
Nora’s hair is matted and her face caked with yesterday’s slop, and a wave of shame washes over Dr Stilworth. This woman is hardly recognisable as the beautiful girl he met that first morning just a few months ago. What have we done? He wants to scream and shout and bang his fists, rip away the brass observation peephole with its welded peg on the inside of the door that prevents the cover from being removed. No wonder those who are trapped in here behave as they do, regardless of the threat of further punishment. How can they win?
He struggles down on his knees beside Nora, trying to somehow screen her nakedness with his body, and his fury synthesises into two words that now roar out from him. ‘Sister Cummings!’
Sister Cummings arrives and stands in the doorway, seemingly unruffled by the angry summons. Dr Stilworth wonders which is the greater assault on his senses: the smell of urine, or the floral perfume the sister is wearing in the presence of this poor wretch of a human being for whom she is supposed to care.
‘Yes, Dr Stilworth?’ Her beautifu
l face with its sharp blue eyes has a spiteful, haughty air that makes Tom shiver. And I’m a doctor. What about the patients?
‘Why is Miss Jennings here?’ he demands.
‘Miss Jennings,’ says Sister Cummings, pausing to allow her sarcastic tone to register with this young pup who hardly knows his way around the institution and dares to question her authority, ‘Miss Jennings violently assaulted one of my staff.’
‘How did she do that, Sister?’ he asks.
‘She bit her.’
Dr Stilworth pauses, sure he can’t have heard correctly. ‘Bit her?’
‘Yes, Miss Jennings here was resisting being fed and bit one of my aides.’
‘Why was she being fed?’
‘She’s refused food almost every day since . . . these last three weeks or so, and she’s lost weight, so now she has no choice in the matter. She will be fed.’
‘And how was she being fed, Sister Cummings?’
‘As we always feed people, Dr Stilworth,’ she retorts, her eyes holding his with a taunting glimmer.
‘Yes, I’ve seen that a couple of times. If you were to try to feed me like that, I would bite too,’ says Dr Stilworth, struggling to remain professional. ‘Sister, I want her bathed and dressed – gently,’ he orders, ‘and please wash her hair and then return her to her own bed in the dormitory.’ He stands up. ‘Then please call me and bring her some tea and toast with butter. Her lack of appetite is caused by grief, not defiance, and she should not be treated in this way.’ His eyes are cold but their depths hold fury longing to erupt, and this is enough, at last, to silence Sister Cummings, who watches him as he limps out of the room without a backward glance, anger punctuating every painful step.
But it’s not over. Sister Cummings is furious, too. There’s a hierarchy to be respected and she will make sure he learns that. As she moves back into the ward, her lips thin and tight, with a snarl ready to erupt at a moment’s notice, the staff are prepared. When she’s in this most implacable of moods, anything could happen. Someone will have to pay for this humiliation – and it won’t just be Tom Stilworth.
Dr Stilworth limps along the corridor towards Dr Mason’s office, cursing the disability that prevents him from marching in with his head held high. He knew it wouldn’t be long until news of yesterday’s debacle reached his boss, and sure enough the summons came as soon as he got in this morning. He knocks at the door ready for a showdown, whatever that might mean.
‘Ah, come in, Tom.’
Tom? He never calls me Tom.
‘Come, sit down.’ Dr Mason waves Dr Stilworth to the fireside chair and takes up the one opposite. ‘I’ve been wanting to have a chat with you.’ Dr Stilworth takes the chair offered him, puzzled and wary of this odd change in Dr Mason’s attitude. ‘Tom, you’ve been here about a year now, I think?’
‘Almost.’
‘Yes . . .’ Dr Mason pauses and pulls at his waistcoat. ‘Tom, you’ve had a very privileged upbringing – Eton and Oxford, I understand – and I must say that we are very happy to have you here with us.’ Ah. So that’s it. He’s been doing some homework. ‘You could have a great career in psychiatry. But I do think we need to talk about the hierarchy here,’ the older man continues, ‘the cogs that keep the wheels of the hospital turning, as it were. A couple of reports from the nursing staff make me question whether you’ve quite understood the dynamics, Tom.’
‘Maybe I haven’t, though the disagreements I’ve had here – if I can call them that – have been about philosophy, not dynamics.’
‘Quite so. I believe you studied philosophy before turning to medicine?’ Dr Stilworth nods. ‘As you know, we have around six hundred patients here, some with serious mental illness and others with issues of dependency and institutionalisation. If we’re to accommodate all their needs, we must run a tight ship and respect the chain of command. We cannot stand on each other’s toes and cause ripples.’
Dr Stilworth thinks how important it is to have ripples and challenge to the command, but says nothing.
‘I advise Matron Endsleigh of what I expect and she passes those expectations on to the nursing sisters, who then hand them on to the nurses and eventually to the nursing assistants and so on. Of course, as a doctor, you report directly to me.’
‘I understand. But where is my place in that hierarchy? It would seem that I have no place – or power – whatsoever.’
‘Ah, come, Tom. It’s not about power.’
But Tom is in no mood to be placated. ‘Isn’t it? I don’t actually want power, but I do expect that some daily decisions about patient care could be mine, and I see it as my duty to comment when I think that what happens is not about care at all.’
‘And do you think you have witnessed such instances?’
Tom stares. Is the man blind? ‘Indeed, I have. And often several times a day.’ Dr Mason looks genuinely shocked. ‘May I speak freely?’ Tom asks.
‘You may.’
‘With respect, sir, I don’t think you see what happens on the wards. I don’t think that anyone dares to tell you. And so, I’m afraid that it appears that you collude with decisions that are punitive rather than healing.’
‘Collude? Punitive?’
‘Yes, punitive. I thought of mental institutions as places of refuge. I hoped that this hospital would give people shelter from the storms of life, with an atmosphere that would encourage and nurture their growth and help them return to the world as useful human beings. Instead we appear to demand that they’re obedient, grateful dogs, despite their suffering. Surely that just demeans them and prevents them from ever becoming responsible human beings.’
Dr Mason leans back in his chair, a surprisingly genuine look of interest on his face. ‘Go on.’
‘The patients who make no fuss and obey the rules are regarded as “good”. But often they behave that way only because they’re cowed into being passive and dependent. I’m glad to see that we haven’t yet damaged Miss Jennings to that point.’ He shakes his head, sadly. ‘If someone tried to force food into my mouth, I would kick and resist. Wouldn’t you? And if I were locked in that dreadful airless room with my anger and pain, I’d scream and hammer on the door to get out.’ He pauses as his voice dies a little, smothered by the emotion he’s been trying to hold back. ‘The patient in question today is that same young lady whose child was . . .’ His voice breaks a little and he pauses again and breathes until he regains control. ‘Whose child died not a month ago. She has been abandoned by her family. She is desolate, grieving, possibly with postpartum depression to boot, and probably the last thing she wants to do is eat. She was being quite brutally force-fed when she rebelled. Actually, I’m delighted that she objected. It means there’s still hope.’
‘You’re sounding rather messianic, Tom. That young woman may well have been in prison had she not been admitted here. And her family have made a sensible choice to get on with their lives and let their daughter settle.’
‘I’m sorry, sir. I’ve read the file and I understand that the diagnosis, in the eyes of the law, would lead to her being here for many years, if not for the rest of her life. But can that be right?’ He stares into the empty grate, shrinking low in his chair. ‘Are we just seeing the diagnosis rather than the person? I just wonder who Nora Jennings really was before she made the mistake – or series of mistakes – that led her here.’
Neither speaks for a long moment, and it is Tom who breaks the silence. ‘I have a painful moral dilemma, you see. As I see it, there are two options. If I do what I believe to be the right thing, which is to prompt them to grow and get well, I know they’ll need to go through a phase of being even more angry and frustrated about being here. That will get them into trouble, and they will be punished. The second option is to stand by silently and watch as they collapse in on themselves and become empty shells that no longer resist being here at all, but that means sacrificing all hope of them ever being well again. But, as doctors, aren’t we supposed to be helping them get wel
l?’
‘Do you think that those are the only two options?’
Tom looks sideways at his boss, who he really does try to respect. ‘I’m still trying to find another,’ he says with a faint smile. ‘At present I’m forced to conclude that I cannot in my integrity – nor do I have the moral right to – do less than be faithful to my Hippocratic oath and try to prompt their recovery, whatever their fate. Otherwise I am no longer the doctor I aspired to be.’
A trace of sadness crosses Dr Mason’s face and a pained silence descends between them.
‘Sometimes, I think we cater more for the needs of the institution than the needs of the patients,’ sighs Dr Stilworth. ‘If we have quiet, tidy wards, we look no further. Many of the patients who have been here a long time have become almost invisible – examined maybe once a year unless there’s a problem, and simply maintained in their sad state with no attempt to do more than keep them alive.’
‘Tom, these people are here to be cured if possible, but there are some cases that are beyond hope of cure. Miss Jennings is one of them. The moral defective is genetically programmed to behave that way.’
Dr Stilworth searches the older man’s eyes sadly, looking for something – anything – on which he can pin his hopes. ‘What if we’re wrong about that? What if there is no such gene?’
Dr Mason starts tugging on his waistcoat, a tic that Dr Stilworth knows signifies his discomfort. Next, he’ll be checking the time. And, yes, the pocket watch flips open right on cue. Dismissal is imminent. ‘Tom, great minds are still working on these things. But I agree, we must try to strike a balance. Let’s see if we can do that, shall we?’
Dr Stilworth nods. ‘Yes, sir.’
‘When you have any further observations or complaints, would you be kind enough to bring them directly to me? I won’t have Matron undermined, nor the nurses humiliated. But I’m impressed by your passion.’
‘Thank you, sir. I will.’
Dr Mason’s eyes are wistful. ‘You remind me in some ways of my younger self,’ he says. ‘It came to me as a sad shock that no one really gets well. Yes, they quieten over time, but maybe you’re right. Perhaps it would be a healthy sign if they protested more – and if we let them do so.’
The Girl Behind the Gates Page 7