‘Of course, Dr Richardson,’ she responded. ‘Where will you be?’
‘In the sleep room.’
I had been so preoccupied that I hadn’t noticed the nurse’s appearance. She was wearing one of the newer uniforms: short sleeves, bibbed front, shoulder straps and a pillbox hat. The nipped waist showed off her trim figure. Although she was quite tall, her ankles and wrists were pleasingly slim. Her features were delicate and her eyes were a striking green.
‘Thank you, Nurse . . .’ My sentence trailed off awkwardly.
She came to my assistance: ‘Turner. Jane Turner.’
As I was leaving the ward, I glanced back. She was still standing outside Mr Chapman’s room, and when our eyes met she rewarded my interest with a subtle smile.
I stepped out into the vestibule and was in the process of locking the ward door when the kitchen girl appeared carrying a stack of trays. She nodded at me and then descended the basement stairs. I was curious to see how the sleep-room patients were managed when they were woken up, so I followed her down. A senior nurse, Sister Doris Jenkins, was directing two subordinates – another nightingale and an alarmingly young-looking trainee. Sister Jenkins was extremely deferential, and I had to stress that I was not there to interfere, but simply to observe their routine.
The patients were difficult to rouse. Indeed, they never achieved what I would call lucid, waking consciousness. They remained heavy-eyed and extremely drowsy – even when they were eating. Their jaws moved with the slow determination of cows chewing cud. Out of bed, they needed the steady arm of at least one nurse for support, otherwise they would have simply fallen over. I tried introducing myself to Kathy Webb, the girl who had been given ECT, but she looked at me with vacant eyes and said nothing.
I was very impressed by the nurses. They worked together with machine-like efficiency. Their movements were so well coordinated, so well rehearsed, that I was reminded of a factory production line. The patients were fed, washed, and taken to the lavatory, before being guided back to their beds and given medication. In their long white gowns, they looked like compliant ghosts. When they were all properly asleep again, I became aware of an unpleasant stench. The smell of the voiding, the enemas, and food, had no means of escape and tainted the air.
Although Sister Jenkins was deferential with me, she was brusque with her juniors. I suspected that she must be a strict disciplinarian. When she was ready to leave she said to the trainee, ‘I shall return at eleven o’clock. Do exactly as instructed.’ She then left with the nightingale. The trainee nurse sat behind the desk and took a copy of the
British National Formulary
from one of the drawers. After studying it for a few seconds she put it back and gazed into the darkness. Her expression soon became blank with boredom.
I walked around the beds, examining the latest entries on the charts, and decided to run an EEG on a patient called Sarah Blake – one of three being given sodium amylobarbitone in addition to chlorpromazine. She was in her early twenties and possessed an interesting face, with features that are often unsympathetically described as ‘witchy’: long black hair, a pointed chin and a bridged nose. Yet, cast in a certain complimentary light, one could imagine those same features transformed, becoming something closer to devilish beauty. Her most recent ECT had been administered almost a week earlier, so I judged that the recording would be interpretable – within reason. EEGs taken shortly after ECT are often spurious. The paper rolled beneath the twitching pens, producing irregular peaks and troughs, the big slow waves of sleep.
A curious hush descended and I was reminded of something that I had read many years before about the healing rituals of the ancient Greeks. The sick and troubled in those remote times were frequently instructed by a holy man to spend a night in an underground temple. There, they would have a dream that would cure them. It seemed to me that the sleep room was a modern-day equivalent.
I was familiar with sleep laboratories. I had studied and worked in Cambridge and Edinburgh and they all had in common a strange, unreal atmosphere. But the sleep room at Wyldehope was different. The atmosphere was more intense, almost religious. It evoked feelings in me that I associated with certain churches – experienced in solitude and usually at dusk. In the hush and the shadow that enveloped those six beds were unexpected registers and suggestions of something beyond the reach of the senses. The subterranean healing ritual of the ancient Greeks was called ‘incubation’. An apposite word, because it is composed of elements that produce the literal translation ‘lying in the ground’.
Before leaving the sleep room, I removed the electrodes from Sarah Blake’s head and examined her EEG results. The red ink looked unusually vivid on the white paper, like thin trails of blood. There was nothing remarkable to see: slow waves with brief bursts of faster activity originating from the frontal lobe of the brain. I wrote some comments in her notes and said ‘goodnight’ to the nurse.
‘Are you going already, doctor?’
It struck me as a rather peculiar thing for her to say.
‘Yes,’ I replied. ‘Why? Did you want to ask me something?’
Her face reddened and she said, ‘No. It’s all right. Goodnight, Dr Richardson.’
I returned to the ground floor to make sure that all was well in the wards. Michael Chapman was still awake, but he had remained in bed and only his frown persisted from his former agitation. I may have spent a little more time on the men’s ward than was strictly necessary, chatting with Nurse Turner. She had been at Wyldehope since its opening. I asked her if she missed London. ‘Not really,’ she replied. ‘Although I do go back about once a month. To see my mother – and my friends. The summer here was lovely.’ I wanted to ask her more questions, mainly about herself, but I was wary of seeming unprofessional and brought our conversation to an end.
As I ascended the stairs, I was quite preoccupied by the day’s events, but not so inward-looking as to be oblivious of my surroundings. I heard what I thought was the sound of someone following close behind, and glanced back over my shoulder. I was surprised to discover that my senses had been comprehensively deceived. Nobody was there. This was confusing, but not confusing enough to halt my progress. I continued climbing to the top of the stairs and crossed the landing. I was just about to tackle the next flight when, once again, I heard a noise, but on this second occasion it was quite distinct and easily recognized. An initial impact had been succeeded by a second, suggesting that something had dropped onto the carpet and bounced.
Turning around, I noticed a pen on the floor. I assumed that it was mine, but when I picked it up, I saw that it was only a cheap biro. My own pen, a silver-plated Parker, was still in my pocket. I had no recollection of taking the biro from the sleep room or the wards, but that was surely what I must have done.
In the study, I set about getting my papers in order. I was placing some drafts of unfinished articles in the bureau when I discovered an air-tight container in the bottom drawer. It contained three scored white tablets. I read the label:
Reserpine. Protect from light.
I wasn’t familiar with this drug, but at the same time I had an inkling that I had perhaps encountered it, or at least heard about it before. I tipped one of the pills out. It was careless of my predecessor, Palmer, to leave what must have been his own medication, here, for me to find. Particularly so, because I suspected that Reserpine was psychoactive. I was reminded, again, of what Maitland had said about Palmer having resigned unexpectedly. A vague disquiet – like an echo, arising out of silence – made me put the pill back in its container. The room must have been dusty, because my nose felt stuffed up and I couldn’t breathe very easily. I opened the window and looked out across the sea. Its unusual colour was a darker shade of brown in the evening light. I closed the window, drew the curtains, and prepared for bed.
Dr Angus McWhirter
Maida Vale Hospital for Nervous Diseases
London W9
26th February 1955
Dr Hugh Maitland
Department of Psychological Medicine
St Thomas’s Hospital
London SE1
Dear Hugh,
Re: Miss Kathy Webb (d.o.b. 3.1.1937)
Walsingham House, 26 Lisson Grove NW1
I would be most grateful if you would see Miss Webb: a young woman with a history of schizophrenia and severe mood disturbance. She was born in West London and is the youngest of four children and her eldest brother, Charles, also has a history of psychotic illness. Her father is a market stall holder and her mother, originally from Dublin, is a housewife. Miss Webb attended a Roman Catholic primary school but was expelled at the age of nine on account of her truancy. Apparently, the nuns were staunch advocates of corporal punishment and she was beaten regularly. In her mid-teens, Miss Webb started running away from home and it was soon after this that she reported hearing voices for the first time, most of which were critical and accused her of committing sins. Her mother believed that her daughter was possessed by the devil and took her to see a priest, who, fortunately, recognized that the poor girl was unwell and made sure that she was seen by a psychiatrist at St Mary’s. Over the next several months her condition rapidly deteriorated and she was transferred to Friern, where she spent over a year as an inpatient and was treated, in my view, somewhat conservatively, with a combination of sedative drugs and occupational therapy. Three months after her discharge the voices returned. She resumed her habit of running away from home and consequently became known to the police, who would discover her, usually in a confused and dishevelled state, wandering around Notting Hill in the small hours of the morning. One must assume that it was during one of these episodes that she was taken advantage of, because in June last year she was declared three months pregnant (although Miss Webb herself claimed to have no memory of being seduced or sexually assaulted and identified her pregnancy as an instance of immaculate conception). It was decided that it was probably in her best interests if she had an abortion and this was performed in due course by Mr Herbert at the City of Westminster Clinic. By this time, Mr and Mrs Webb could no longer cope, the eldest son having also suffered a relapse, and Miss Webb was moved to Walsingham House (a charitable hostel run by the Catholic Church) in the autumn. Her condition deteriorated again and she was referred to my department by Dr Simmons, who works at St Mary’s and with whom I believe you are acquainted. Miss Webb was hearing voices almost every day, some of which were now telling her to ‘end it all’ and she was also convinced that several of the staff were ‘devils’ in disguise. I immediately reviewed her medication and gave her a course of ECT; however, she is still very ill and suicidal. She has also begun asking for her ‘baby’, which she now believes was taken away from her. Unfortunately, we are not equipped at Maida Vale to offer Miss Webb the kind of help that she so clearly needs. When we last met I recall you mentioning a new treatment centre and your renewed interest in deep sleep therapy and wondered whether Miss Webb might be a suitable candidate? I would be most grateful if you could assess her with this possibility in mind. Her notes can be forwarded by my secretary on request. Forgive me, Hugh, for being so brief, but I’ve been rather tied up this last week with some people from the Health Board who I have been obliged to show around the hospital and I am now rather behind with my paper work. You, more than anyone, will appreciate what a nuisance all this red tape has become for us. Thank you in advance for your opinion.
Yours sincerely,
Angus
Dr Angus McWhirter
MB ChB, D.P.M.
3
Over the next two weeks, each day became more and more routine: I monitored patients, ran tests, administered ECT, and made sure that our pharmacy was well stocked. Due to Maitland’s tendency to prescribe high doses of drugs, the patients were, on the whole, undemanding, and I frequently found myself at a loose end. When this happened I was tempted to go back to my room in order to write up the last of my Edinburgh experiments, but I thought it wise to remain visible, particularly when Sister Jenkins was abroad. If she suspected me of being work-shy I was sure that Maitland would be informed without delay. Life at Wyldehope might have become quite oppressive, if it wasn’t for the fact that there was little else I could do. A rainy spell eradicated the possibility of enjoying any excursions, and when I looked through the windows, out onto the damp, blustery heath, I had no desire to brave the elements.
The majority of my time was spent on the wards, attempting to familiarize myself with the patients. They were, by nature, solitary creatures, but sometimes two or three of them would emerge from their rooms and wander down to the recreation area – dressing gowns open, belts trailing along the floor. Once seated, they might initiate a cheerless game of dominoes, or engage in oblique conversations in which certain observations or phrases were repeated over and over again. Sometimes, they just stared at their slippers.
In my second week – I think it was on the Wednesday – something rather peculiar happened on the men’s ward. I was with Sister Jenkins, undertaking an examination of a patient called Alan Foster. He was in his fifties and his predominant symptom was a very specific delusion of control. He believed that his actions were being manipulated by a reptilian civilization that had evolved on the rings of Saturn. Unfortunately, Mr Foster had developed bedsores and it was necessary to treat them with a topical antiseptic. I was putting the ointment and lint back on the trolley and Sister Jenkins was standing at the sink, scrubbing her hands. She turned the taps off and I was dimly aware of her crossing the room. There was a rummaging sound, some impatient tutting, and when I looked up Sister Jenkins was on her knees, peering under the bed. She leaped to her feet with surprising agility, placed her hands on her hips and said, ‘All right, Mr Foster – where is it?’