The Skeleton Cupboard (17 page)

Harold sighed and rubbed his face hard again.

Überwältigt
. Lost and overwhelmed. I shared that feeling with Harold.

“So, Harold, let me get this right. You know what the landmarks are, but begin to doubt whether the ones you are seeing are the right ones?”

The big man took a breath and looked up at me with a kind smile. “Doctor, thank you for trying to make sense of this for me, to give me a rational—how do you say?—narrative. I am sure you are right.”

Harold was describing visuospatial disorientation, a key marker in dementia.

“That's what I'm here for, Harold, but please don't call me doctor.”

Another smile. Why was this dear man trying to reassure me?

“So I couldn't get home from Moshe's and so I stopped buying the sharon fruit for Sarai because I would be no good to her at all if one day I got lost and disappeared. That's when I knew it was happening.”

The room was hot. I opened my testing case.

“And that's when I began to let her down.”

Because I was relatively inexperienced at this job, there would still be words spoken by those I was working with that would punch hard—turns of phrase that encapsulated everything that was so tragic about their psychological difficulties.

I swallowed and took a breath. “I see you care for Sarai every day. How can you feel that you are letting her down?”

The old man said nothing. He smiled and patted my hand again. His actions conveyed to me that he knew that my lack of a relationship, even life experience, meant that I had completely misunderstood the significance of his not being able to get to Moshe's and back to buy Sarai's sharon fruit.

Harold was too much of a gentleman to point this out to me, but his silence taught me a lesson I've never forgotten when I've worked with others in psychological distress. As human beings, we can mostly sweat out the big stuff—it's the smallest changes in function that often have the biggest meaning and cause the greatest despair. For Harold, it was not being able to buy Sarai's sharon fruit reliably.

I just didn't know what to say and so I stuck to the script.

“Harold, I have to test you so we can see how you are functioning at a cognitive level, how your memory is, what you're doing well and where you might be having difficulties.”

I hated this job.

I knew from the notes that Harold was a research scientist. After the end of the Holocaust he had repatriated to England with Sarai, whom he had met in an internment camp after the war. Sarai made money teaching German to students, while Harold took night-school after night-school course. He earned his degree, followed by a master's and then a doctorate, and when he qualified, he had an impressive career. Up to his retirement he had run an award-winning research science faculty at a London teaching university.

He was a scary man to assess: He knew assessment protocols; I was just learning them.

“I need to establish the presence or absence of cognitive impairment to provide explanations for misunderstood behaviors. I need to establish a baseline of premorbid functioning and then test your current ability, so I can monitor change. Most of all I want to describe your strengths and needs.”

“Misunderstood behaviors? Ah yes, I understand. So now tell me what you need to exclude.”

He was used to mentoring his students and now he was mentoring me. This was the beginning of a process that would end with me telling him what we both knew already. I just didn't want to have to do this.

“OK. First I have to make sure that even if English isn't your first language, you speak it well enough for my testing to be valid and culturally fair.”

Harold told me that his mother was highborn—from the German “aristocracy”—and he had had an English governess. Harold spoke English better than German—in those days the governess was the main caregiver and Tante Agnes had encouraged him to speak English only.

“It was all ‘cup of tea' and ‘God save the King!'” said Harold.

We both laughed.

“OK. English no problem. And next…” I tried to glimpse my pretesting assessment checklist without Harold noticing. He did notice—I was sure of it—but he played along to save my face.

“Alcohol?”

“Ah,
Alkohol: der Nektar der Götter
.”

Nectar of the gods.

“Aber nur Nektar?”
I asked.

But only nectar?

Where had that come from?

“Ja, mein Liebling. Alkohol war nicht zu vergessen, nur zu genießen!”

Despite having a German grandmother, a German father and a decent O level in German, and apart from understanding that he had called me his
Liebling
, his darling, I had no idea what Harold had said.

“My darling, I don't drink to forget, only to enjoy,” he explained.

Fair enough—me too. But if anyone had a good reason to want to forget, it was Harold. I made a note on the assessment form.

“OK,
Liebling
. Next?”

I hesitated, so Harold took my list and read it. “You need to ask me if I am isolated?”

I nodded.

Harold looked down and the pause seemed like forever. “Yes, I believe I am. I have no anchor except Sarai, and now she is … What do I say here? She is
hilflos schwebend
.”

He knew I didn't understand but couldn't ask.

“
Hilflos schwebend
. She is floating away from me. How do you say it? She who is my anchor floats adrift.”

He paused. No sound, just a moment. He passed the broad back of one hand over his bright blue eyes. Then he looked back to the list, focused again.

I knew the next question. Is the patient bereaved?

Bereaved? This was a man who had lost his entire family in concentration camps, had watched his wife become another person.

Harold started singing softly:

Wenn ich Dir die Wahrheit sage, meine Liebe,

Meine eigene Trauer ist dein Geschenk an mich Trauer allein.

Wilde Leidenschaft um Mitternacht,

Wilde Wut im Morgengrauen.

Doch wenn Du abwesend bist, wein' ich dich weg.

This I knew. My grandmother—she of the frontal lobes on the baseboards, a native German—sang this Kurt Weill song to me and my little sister when we were tiny girls.

If I tell truth to you, my love, my own,

Grief is your gift to me, grief alone.

Wild passion at midnight,

Wild anger at dawn,

Yet when you're absent, I weep you gone.

That night, after I left Harold, I went to Heaven.

*   *   *

In the late 1980s a gay club called Heaven was the place to go. It was all about music and sex, sex and music: a London club that let those who were made to feel they didn't “fit in” feel part of an awesome tribe of belonging.

Rosie, Megan and Ali took me there: They knew what I needed and I bloody loved them for knowing that.

It was a wild place, a place of heavenly debauchery. Beautiful men wanting beautiful men and beautiful women wanting those excellently sexy girls who wanted something more than the sexy boys.

Rosie, with her endless degrees and her immense emotional intelligence, had already told Ali (she of the world of human resources) that she knew that Ali wanted all the girls of the world. There had been endless discussions about Ali's sexuality, but they were going nowhere and so we decided to do the scene and help Ali be comfortable in her own skin. And after my day with Harold, I needed to feel comfortable in mine.

After assessing Harold and knowing the results—even if I couldn't tell him before I'd scored them and run them past Chris—I needed to blow my head off. I needed to be so out of my world that the only place I could be was in Heaven.

The idea was that we would stick together, but soon after we arrived, Ali dispatched herself among the glamour-girl tribe and then we were three. And then we were two, as Megan, after a disastrous day in the research lab, drank one too many tequila slammers and needed to puke onto the curb outside the club. Sweet Rosie went to hold her hair back and then get her home in a cab. So then there was only one: me.

I looked at the room: tall girls in sheath dresses and the occasional leather peaked cap; butch girls being tough and sexy at the same time; small girls in killer heels with death-defying stares. I was intimidated, so I escaped to the loo.

“Hey!”

I turned around as I washed my hands. “Hey?” I said to a small blond pixie behind me.

“Hey yourself!” the pixie answered.

I didn't know what to say next, so I didn't say anything. The jammed towel dispenser gave me welcome relief from the pressure to respond; I tugged at the roll.

The pixie ignored my towel-pulling and asked, “You new here? First time to Heaven?”

“Yep. First time.”

“Welcome! Let me be your guide!”

She and I spent two hours dancing. She was gorgeous and fun. She blew my Harold head open, emptied it of death camps and dementia.

Debbie Harry filled the room. I danced and sweated. Eventually the pixie grabbed my hand and gestured toward the bar, but while I wanted to party on, I knew that I had to go home—to sleep and then wake to score Harold's test and to then talk to Chris and, I hoped, have her tell me I was wrong in my assessment, that Harold was fine. I said good night. She wasn't happy, but as much as I hated disappointing, I had to go: Harold took precedence over a pixie in Heaven.

I walked across the dance floor, sweaty and tired, and then, on the other side of the room, I saw Chris and Anne Gee slow-dancing. I was transfixed, my magical thinking telling me that while I stared at them, they wouldn't see me. And they didn't, because they were looking only at each other. They kissed.

Dr. Chris locked lips with Dr. Anne, while Dr. Anne pressed her mouth to Dr. Chris's. I was rooted to the spot.

Actually, though, I'm not sure I was entirely surprised; thinking of my first meeting with the two of them, I remembered the crackle in the air between those two powerful women.

Tomorrow I had to tell Harold that he was losing his mind. I needed Chris, my mentor, as a buffer against the world of people with dementia descending into the horrors of their long-term memory that Dr. Anne had introduced me to. I needed her to be truly objective in her dealing with Dr. Anne on my behalf.

Reality was not what it seemed; those you trust to be on your side let you down.

*   *   *

The next day Harold told me his story. He did this because he knew that dementia would turn him into a different person and he didn't want me to misunderstand him. He needed a reliable account of who he really once was. He wanted documentation before he became whatever his long-term memory would make him as it took him back into the camps.

“In dementia, Sarai only wants to save me; she protects me, as she thinks we are living together in Mauthausen. She is kind. She is afraid, but she is still my protector. I, sadly, will be nothing like her.” He looked out of the window. “When my mind goes, I will not be me.”

“How do you think you will be, Harold?”

Sitting up, Harold fixed his red-rimmed bright blue eyes on me. “I am sorry to tell you, but I will want to kill you and all those who want to look after me.”

“Why would you want to do that? You are a kind and compassionate man.”

But I knew why, of course. I knew where he would be.

Harold had faced his past honestly and with courage—I had to be honest and courageous in preparing him for his future.

I found myself thinking about another patient.

*   *   *

When I was working with Imogen at the adolescent unit, there was a boy called Paul who had been in the unit since he was twelve. The unit was a fully staffed, medium-secure multidisciplinary team setting for children and young people aged between twelve and sixteen for whom life was so unbearable and challenging that their psychological, emotional, psychiatric and behavioral difficulties made them impossible to contain in the community.

Some of these young people came from the backgrounds anyone would expect to legitimize their desperation—they were poor, unloved, neglected and abused. Others came from backgrounds where their neat aspirational families provided a mask of sanity, until the child cracked and broke open a dysfunctional system. Paul belonged to the first group.

When Paul's milk teeth came through, they were black stumps. The back of his head was flat because he spent most of his early life lying down. No one picked him up or cuddled him. This had caused the soft bones of his skull to become flattened against the cot mattress.

A silent boy who had stopped eating, washing and living, Paul had the appearance of a human being but nothing more. He had arrived at the adolescent unit in a sleeping bag smelling of feces, his eyes tightly shut. He was brought in and placed on the floor of the admission room, where he curled into the fetal position, stinking and silent. He made it very clear that he had no intention of continuing his life. By the time we saw him, he'd tried to kill himself twice. Then he embarked on a hunger strike. I had never seen this in someone so young. None of my more seasoned colleagues had either.

To begin with, before we could even address the what, why and how of Paul's helplessness and despair, we agreed that we needed the skills of the wonderful and nurturing nursing team to coax this vulnerable boy out of his sleeping bag and into our care. These nurses were some of the most incredibly empathic people I had ever met.

Paul was put in his room in his sleeping bag and placed on one-to-one observation. That meant he had someone near him at all times, only an arm's length away. The nursing team would sit by this young man in shifts, day and night, and suggest gently and very occasionally that he might want to eat or drink. None of us wanted him to end up being nasogastrically fed—we wanted him to make that decision for himself.