The Sleep Room Page 6
‘Walter Rosenberg?’
‘An old friend.’
The name was familiar. ‘Didn’t he work with Kalinowsky?’ Kalinowsky had championed the use of ECT in the United States.
‘They published several important papers together.’ Maitland paused and I heard him light a cigarette. ‘I’d like you to be present when I show him around.’
We talked briefly about Rosenberg, who was in charge of a massive asylum on Long Island. ‘Fifteen thousand beds!’ Maitland exclaimed, permitting himself a dry chuckle. ‘They do things differently in America. I’m afraid that British psychiatry will be left behind if the authorities don’t learn from the American example.’ Then, in a more lively tone: ‘Good God! Is that the time? I was supposed to be dining at my club tonight. I’ll see you tomorrow.’
When I got out of bed the following morning, I crossed the corridor and looked out of one of the west-facing windows. Maitland’s Bentley was already parked on the drive. I ate breakfast in the dining room and performed a quick circuit of the two wards and the sleep room to ensure that everything was in order. By half past ten a Jaguar – as long as a hearse – had appeared beside Maitland’s Bentley. A chauffeur was standing next to it, holding a transistor radio up against his ear.
I had returned to the men’s ward and was reading through the notes when I realized that Sister Jenkins’s wedding ring had still not been recovered. The job of sifting through Alan Foster’s faeces was, understandably, very unpopular, and I wondered if the trainee – eager to get the noisome task completed as quickly as possible – had failed to exercise due diligence. In which case, Sister Jenkins’s precious ring would now be lost in the sewage system. As I contemplated the absurdity of the situation, a new nurse – just up from London – sidled up to me and said, ‘Excuse me? Dr Richardson? Dr Maitland would like to see you in his office.’ I hastily put the notes back in the filing cabinet and made my way upstairs.
Maitland greeted me with his characteristically firm handshake. ‘James, do come in.’
I had expected to see only one guest, but when I entered I saw two men seated on the Chesterfield. The older of the pair I immediately recognized; he was one of the three ‘American colleagues’ in the framed photograph on Maitland’s desk – ten years older, perhaps, but still slim, dapper and tanned. The other man was much younger, square-jawed, athletically built, and with hair cropped so short that it was little more than a shadowy cap of stubble. I was introduced to Walt Rosenberg first, and then to his companion, Buck Stratton, whom I later discovered was an employee of a US drug company.
Maitland and Rosenberg talked incessantly. Yet, I did not feel excluded. I was quite content to sit quietly and listen. Indeed, I considered it a privilege to be a spectator as these giants of psychiatry sparred and floated ideas. At one point I went to Maitland’s desk to get Rosenberg an empty ashtray. The bottom drawer of the grey filing cabinet had been left open and I saw that it contained some files. I only had a moment, but it was enough to read one of the names. The bold capitals spelled out the name ‘Kathy Webb’.
Rosenberg was an amusing raconteur, with a comedian’s sense of timing, and I was still laughing at one of his jokes when, unexpectedly, Maitland asked me to summarize the results of my Edinburgh research. He was particularly keen for me to discuss my final study – a demonstration that the sleeping brain can still respond to emotionally meaningful stimuli. I had discovered that whispering the name of a person’s wife or husband was all that it took to produce a surge of EEG activity, irrespective of how deeply they slept. Stratton, who had been silent until that point, suddenly sat up and asked me some very technical questions. I thought it odd that a drug company representative should be so well informed about sleep research.
‘Is this study published yet?’ asked Rosenberg.
‘No,’ I replied, ‘I’m writing it up now.’
‘Sir, I’d be grateful for an offprint,’ said Stratton, who reached into his pocket and produced a business card. I was not accustomed to being addressed so respectfully by someone of my own age and felt a little awkward. The card showed only his name and an address on East 42nd Street, New York.
‘Well, gentlemen,’ said Maitland, clapping his hands together, ‘shall we proceed?’ There was a hum of general agreement and we followed him to the door.
We walked out onto the landing where Maitland halted and stroked the carved banisters. ‘These charming woodland creatures are believed to be the work of Robert Greenford, a friend of William Morris and an associate of the Pre-Raphaelite Brotherhood.’
On the way down we found Hartley treating the banisters with a clear, oily fluid. He was on his knees, with a rag in his hand, but as we approached he stood, almost to attention, and inclined his head as we passed. When we reached the ground floor, Maitland indicated the suit of armour and claimed that it was early fifteenth century. We visited the men’s ward first, and then the women’s ward, but it was the sleep room where we tarried longest. Over an hour, in fact.
Rosenberg asked numerous questions about our drugs, vitamin supplements, and whether or not we used insulin to stimulate appetite. He circled the beds, studying the faces of the sleeping women, occasionally listening to their hearts with a stethoscope. I felt possessive and wished that he would leave them alone. Stratton had positioned himself near one of the walls, deep in shadow, his legs slightly apart and his hands behind his back. It was one o’clock, and the nurses were preparing to wake and feed the patients. Rosenberg wanted to stay and watch.
Sister Jenkins managed the complex choreography of waking, feeding, administering drugs, voiding and exercising with her usual brisk efficiency. While the patients were eating, Rosenberg tried to engage Kathy Webb. He introduced himself and asked her to perform some simple arithmetic, but the young woman only sucked on her fork and stared into the distance.
‘Yes,’ Rosenberg said, looking up at Maitland. ‘Ours are much the same.’
‘How long have your cohort been asleep now?’ asked Maitland. It was an unusual choice of word – ‘cohort’.
‘Five months,’ Rosenberg replied.
Maitland started. ‘Five months?’
‘Yes,’ Rosenberg replied. ‘Though things haven’t gone exactly to plan. We lost two.’
‘Bowel problems?’
‘Chest infections. We were unlucky.’
Maitland nodded. ‘And how long do you think you’ll keep them under this time?’
‘As long as it takes,’ Rosenberg replied. ‘I’ll let you know how things are progressing.’
When the patients were all back in their beds and asleep, Maitland congratulated Sister Jenkins. ‘Well done,’ he said softly. Again, his attitude reminded me of a military man. The Americans accompanied Maitland back to his office and I returned to the sleep room. Before parting, Rosenberg had seized my arm and said, ‘If you ever come over to New York, be sure to call me up.’ His eyes were bright with raw intelligence.
I thanked him for the invitation.
The Jaguar was still parked outside Wyldehope at half past three. When I looked out of a window two hours later, both vehicles – the Jaguar and the Bentley – were gone.
That evening I sat at the bureau and added a few more paragraphs to my unfinished paper, but I wasn’t satisfied with what I had written. The language was too dense and the sentences didn’t flow. Forcing myself to concentrate was giving me a headache. I smoked a cigarette and thought about Jane. When I closed my eyes, the recollection of her kiss became so vivid it was like a repetition of the actual experience. I could feel the pressure of her lips against mine and their slow parting; I could detect a trace of her perfume in the air.
Since returning from our trip to Southwold, only a single opportunity had arisen for private conversation. I had said that I wanted to see her again, preferably alone, the following weekend, but she had already made arrangements to visit her mother in London. She had squeezed my hand and said: ‘Never mind. We’ll sort something out.’ I wasn’t sure what she had
in mind.
A blast of wind shook the windowpane and its loud rattle disturbed my musings. I drew diagonal lines across the two paragraphs I had just written. It simply wasn’t good enough. I stubbed out my cigarette, tidied up my notes and put them in the bottom drawer. The Reserpine was still there. I hadn’t bothered throwing it away. I picked up the container, looked at the wastepaper basket, but found myself oddly disinclined to complete the action I had started. Instead, I put the container back in its usual place. Consulting my watch, I noted that it was eleven thirty.
I shuffled along the hallway, yawning, until I came to my bedroom door. Reaching into the darkness, I slid my hand along the wall until I felt the light switch. It emitted a soft ‘click’ and the room instantly materialized: the large iron bedstead, the chest of drawers, the bulky wardrobe. In the middle of the carpet, about a yard or so in front of me, a metallic gleam caught my attention. I crouched down to take a closer look.
‘It can’t be . . .’ I was conscious of my words as if they had been spoken by someone else. They sounded abnormally loud.
I picked up the object and let it roll into the palm of my hand. It was a wedding ring. I tried to slide it onto my index finger and found that it was too small to get past my knuckle. Without doubt, it belonged to a woman.
Was I the victim of a prank? Hartley possessed a spare key, identical to my own, but it was patently absurd (I realized after a moment’s reflection) to suppose that he and Sister Jenkins shared a common interest in playing practical jokes. Had Hartley been persuaded then by Sister Jenkins to plant the ring in my bedroom in order to accuse me of theft? Again, the idea was totally absurd. My brain generated a number of equally unsatisfactory theories, which I promptly rejected on account of their utter implausibility, until only one remained: Alan Foster must have slipped Sister Jenkins’s ring into the back pocket of my trousers, and it must have fallen out while I was getting dressed that morning. The fact that I had not detected its presence earlier was perhaps a measure of how distracted I had become.
I was about to call Sister Jenkins on the telephone, in order to inform her that I had recovered her ring, when it occurred to me that telling her the truth might not be such a good idea. She would think me unobservant or, even worse, absent-minded, and very likely share her views with Maitland. After giving the matter some thought, I decided that I would invent a harmless lie, something that would clear me of any fault or blame. I placed the ring on my bedside cabinet and pulled back the cover and blanket.
As I was falling asleep, listening to the sound of the sea, the memory of Jane’s kiss returned. Great black waves rolled through the room and I was carried out across a vast ocean of forgetfulness.
Dr Joseph Grayson
Department of Psychological Medicine
London Hospital
Whitechapel
London E1
23rd June 1955
Dr Hugh Maitland
Department of Psychological Medicine
St Thomas’s Hospital
London SE1
Dear Dr Maitland,
Re: Miss Isobelle Joyce Stevens (d.o.b. 12.10.1929)
The Old Alms House, 28 Rope Street E2
Thank you for agreeing to see the above patient, who we discussed today on the telephone. She has been in my care now for fifteen months and I would value your opinion with respect to her future treatment. She is twenty-six years of age and in her relatively short life she has managed to collect several diagnoses, some of which are rather exotic. These include folie circulaire, melancholy and catoptrophobia. My own view is that she suffers from a severe manic depressive illness with pronounced psychotic features.
Her background is as follows: her father cannot work on account of a major injury he sustained during the war, and her mother is a seamstress who is employed by a clothes’ manufacturer in Bethnal Green. She has one sibling, Maude, who is her junior by three years. Miss Stevens was a premature baby and slow to develop. She did not talk or crawl until quite late and she missed much of her early schooling because of a recurrent chest complaint. Be that as it may, she eventually caught up with her peers and on leaving school she was able to get a job as a waitress in a cafe.
Soon after her nineteenth birthday she is said to have gone through a change of character, becoming, in turns, increasingly indolent and impulsive. She also became fearful of mirrors and insisted that her parents cover all reflective surfaces in the house. When asked what she was afraid of, her responses were nonsensical. She was attended by her family doctor, Dr Fletcher, a man sympathetic to Freud and psychoanalysis, who attempted a talking cure which was, as one would expect, wholly ineffective. Miss Stevens’s behaviour became increasingly erratic and she lost her job as a consequence.
After a period of several months, during which she hardly stirred from her bed, Miss Stevens’s mood improved and her fear of mirrors remitted; however, one set of symptoms was immediately replaced by another. Miss Stevens could not sleep, she became garrulous, and she began to express grandiose ideas: for example, that she had been in conversation with a representative from a New York casting agency and that she was going to be a successful actress in Hollywood. She took to wearing flamboyant clothes and frequented local public houses, where she received a great deal of attention from men. Needless to say, she became the subject of much gossip and when her parents learned of her behaviour there were heated arguments at home. Some of these altercations must have been quite ugly, because Dr Fletcher noted the appearance of bruises on her face and a swollen, twisted ankle. At last, recognizing the limitations of his chosen method, Dr Fletcher referred Miss Stevens to my predecessor, Dr Meadows, who admitted her to the Royal London for a period of two months and treated her with bromides. This approach was successful, insofar as she became less agitated and expansive, but a depression followed, and thereafter this pattern of alternating mood states was repeated, usually resulting in an admission during the manic phase of her illness.
At the age of twenty-three, Miss Stevens became pregnant and she was not able to identify the father (although it seems very likely that he was one of her drinking companions). This proved to be the final straw for her parents, who subsequently threw her out of their home. Miss Stevens was taken in by a women’s refuge and the baby was removed for fostering three weeks after its birth. The sad consequence of this was a severe depression, which culminated in a suicide attempt by overdosing. Fortunately, Miss Stevens was discovered in the act and immediately given an emetic.
Since that time, Miss Stevens’s condition has not improved. Indeed, I regret to say that (in spite of my own best efforts), if anything, her symptoms have got worse. During manic episodes, her delusions are more florid than ever – she talks incessantly about how beautiful she is and how she is destined to be an international starlet – and when she is low she feels utterly useless and wishes that she were dead.
When I took over the case from Dr Meadows, I discontinued her bromides and replaced them with lithium carbonate. This was very effective and her mood swings flattened out but, sadly, she developed several side effects – nausea, tinnitus, blurred vision and, more alarmingly, attacks of arm hyperextension. I was forced to reduce the dose from 1200 mg to 800 mg daily. The side effects disappeared but, alas, so did the benefit.
Once again, I am most grateful for your assistance. Miss Stevens is an interesting example of cyclical mood disturbance with accompanying delusions and I very much look forward to receiving your advice concerning her management.
Yours sincerely,
Joseph Grayson
Dr Joseph Grayson
MB BChir., MRCP., D.P.M.
6
I discovered Sister Jenkins in the sleep room. She was sitting behind the desk, scrutinizing a rota. One of the bathroom doors was ajar and I could see Mary Williams, through the opening, energetically mopping the tiles. The air smelled of disinfectant.
As I approached the desk, Sister Jenkins altered her position and said, ‘Good morning
, Dr Richardson.’
‘Sister Jenkins,’ I responded happily. ‘I have something for you.’
She looked at me askance. ‘Oh?’
I took the ring from my pocket and raised it up for her to see. She permitted herself a faint smile. ‘Did it come out – finally?’
‘No. I found it in Alan Foster’s room.’
‘Where?’
‘Under the radiator.’
‘How strange. I looked there myself.’
‘It was behind the valve. Right in the corner.’
I gave her the ring and I was rather surprised by her reaction. She didn’t put it on immediately, as I had expected. Instead, she extended her arm into the cone of light that spread out beneath the lampshade. She manipulated the ring, turning it over – first one way, then the other. Her eyes showed suspicion and her brow creased. Then, pinching the ring in such a way as to suggest that it might be dirty, or contaminated, she placed it with a precise action on a pad of lined notepaper. Her expression was a combination of disappointment and irritation.
‘Is there something wrong?’ I asked.
‘It isn’t my ring,’ she said bluntly.
‘But it must be.’
‘Dr Richardson, I know what my wedding ring looks like.’ Sister Jenkins realized that I would need some persuading. She reached for the ring and pushed her fourth finger through its centre. It was clearly too tight. ‘See?’ she said. ‘It doesn’t fit. My ring was larger, the gold more yellow. This ring is much smaller and made from gold that is very pale – whitish.’
‘Then whose ring is it?’
She shrugged and said, ‘It doesn’t belong to any of the patients, that’s for sure. Only Mr Cook and Mr Murray are married and they are big, strapping fellows. And none of my nightingales are married – although Sandra Perkins and Margaret Thomas are engaged.’ Her expression became uncharacteristically wistful when she added this afterthought.
For a few seconds I was speechless, but I felt obliged to continue my charade: ‘Then I suppose this ring must have been lying behind the radiator for quite some time.’