by Clark Nidaserialised here by permission of the author.

“Now on to the report proper. Confused and disorientated. Others you’ll get to see are quiet and cooperative (if there is nothing to report), abusive and uncooperative and violent and abusive.” 

She pointed to the next entry: Patient was unwilling to take a bath… 

“You’ve got to understand that they’re not generally doing it out of cussedness. They’ve probably never taken a bath in their adult lives with someone else standing there in the bathroom – and now they’re being expected to do it in front of a total stranger. Reassure them that you’re a trained nurse (you’re not – but they don’t have to know that) and they’ve got nothing you haven’t seen already, lots of times. Don’t say it in so many words.” 

Alan said “I see that she came round in the end. Do we force people to take a bath?” 

“I’ve never known it.”

“Then why did Miss Arden write verbal persuasion? It looks a bit sinister, that.”

“If the patient resists you, you have to say how the situation was resolved. Did they comply voluntarily, or was some threat or coercion necessary?”

She pointed at the page again. “Now look at this: lesions on forearms. Her arms are bruised and scratched. We don’t know how she’s done it – and she won’t say. When the patient is undressed for a bath, note any marks on the body. Get the patient to say how she got them. (You’ll only be bathing men, mind.) Note whether there are any more marks to be seen than there were last time. Assistant Matron will want to know. We’ve got to cover ourselves.”

“What do you suppose has happened to her?”

“The police found her down by the seafront, wandering in a confused state. She might have been trying to commit suicide. It’s not for you to decide whether or not the patient is suicidal – that’s why she’s in here. For observation. But note down anything which might be diagnostic.”

“Diagnostic…? Like what?”

“Well, there’s something further on, but you might not appreciate its significance.” Mrs Wirral levelled her eyes at Alan. “…When was her sister coming for her?” 

“Well… when?” 

“What if there is no sister?”

“Oops.” Alan put a finger to his mouth. 

“Yeah – right.” Mrs Wirral turned away. “Mr Sugar – he’s the District Mental Health Officer – tells us that there was a sister, but she’s been dead years. Now if she had died recently, then Mrs Codrington might simply have been grieving for her.”

“Well,” said Alan, “I suppose that’s bad enough…”

“This is worse. Grief is one thing – but confusion is something else entirely. We’ll have to see what Mr Sugar says. He was planning to come and take her home tomorrow afternoon. He says she will be all right if she keeps taking her drugs.” 

Mrs Wirral pointed at the page again. “Now I’d better just show you this: …noises in the overhead pipes. You can hear them. I can hear them. Everybody can hear them. The water is often hot enough to boil inside, so they make little sizzling sounds.” 

“Yes,” said Alan with feeling. “Could be damned annoying, if you can’t get to sleep.”

“It’s worse than that. Sometimes they seem to whisper. It upsets the patient, if they’re the tiniest bit paranoid. And as for the patient complaining that it’s too hot – I can have nothing but sympathy with that. It’s always too hot down here. You can’t open a window – you certainly can’t open the door. There is an extractor fan – as a last resort you can put that on. But it’s so noisy that you’ll be relieved to switch it off again and put up with the heat. So will the patient, as a rule.” 

“Why don’t they do something about it?” 

Mrs Wirral put her hands on her hips and stutted. “We’ve complained about the noisy fan again and again. Nothing’s been done. So now, if the patient makes the slightest mention, we put it down in the ward book. We’re hoping that the constant repetition will drum it into their thick heads to do something. But you see – it’s not broken…” 

“Why doesn’t somebody break it?”

“Then it will never get mended. Not essential equipment.”

They turned back to the ward book. “I see she keeps asking the time,” said Alan. “Why does she do that? She’s not got a bus to catch – she’s not going anywhere…”

“There isn’t a clock on the wall, you’ll notice. Patients have no way of telling the time in here. It’s intentional, that. But when they’re bored and anxious it’s the sort of thing they keep on asking. It needs a lot of tact and understanding. Mr Schank tells them ‘about four minutes since you last asked’. But if you can find it in your heart to be a little less cruel than that…” 

Alan smiled to himself. Mr Schank was nice enough to him, but he did tend to err a little on the abrasive side where patients were concerned. Adult patients who could talk, that is – he was fine with the kids. He just wasn’t one to suffer fools gladly. 

“Finally, no matter how calm the patient looks to you – be ready for anything. Someone with schizophrenia can attack you without warning. Someone who’s just had an epileptic fit too. Post-epileptic crimes. They can kill you… and afterwards they won’t recall a thing.”

Mrs Wirral smiled. “And that just about wraps it up. Would you have guessed you could deduce all that from just a few lines in the ward book?”

Alan shook his head. He knew now how Dr Watson must have felt each time Sherlock Holmes sorted his ideas out for him. 

Mrs Wirral shut the book with a snap. “Well, let’s just hope her sister doesn’t come for her…” 

There was a gentle tap on the door. It was 5 o’clock and Miss Arden wanted to go. In a low voice she murmured “The patient is sleeping at the moment. She didn’t get much sleep last night so I’ve let her. But I think she should be woken up with a cup of tea in half-an-hour or so. Or she won’t get to sleep tonight either.”

Glancing at Alan, Mrs Wirral said “I’ll bring one down for her when I bring down Alan’s. Does she take sugar?”

“Three heaped spoonfuls, she says – but don’t give her all that, of course.”

Alan peered round the door of Room One. The patient was sleeping on her back, her open hand slung across her forehead. Alan could clearly see the scratches on her forearm, plus one enormous bruise. His heart went out to the woman. 

Just three or four lines in the ward book summed up her poor life, charting an iceberg of misery, of which only a fraction was showing above the surface.

…to be continued.


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