Go Not Gently

CHAPTER FOUR

‘Lily,’ Agnes bent over close to her friend, ‘it’s me, Agnes. I’ve come to see you. Lily?’

‘She had a bad night,’ a man sitting in the centre of the semicircle spoke up, ‘wandering about. They’ll have given her something to calm her down.’

There was no response from Lily, who continued to stare at the television.

‘I think there’s too much of it myself,’ the man continued, ‘pills. Take a pill for anything these days. People go to see the doctor and they’re not happy unless they come away with a bottle of tablets. Look at her, you couldn’t say she was well, could you? Just keeping her quiet. Doped up.’

‘Shush.’ The woman on his left glared at him.

‘I’m just saying they’re too quick with their tablets. There’s some folk in here would rattle if you shook ‘em…’

‘Be quiet, will you? I can’t hear the television,’ his neighbour admonished him.

A young woman wearing a maroon overall came into the room carrying a tray of drinks. Agnes asked her about Lily.

‘You’re best talking to Mrs Knight,’ she suggested. ‘I think she’s in the office at the back. Do you know the way?’

Agnes nodded She squeezed Lily’s hand, told her she wouldn’t be long and straightened up.

Mrs Knight, the matron, exuded competence and efficiency. She provided us with chairs, sent for cups of tea and made notes as we talked. She wore a dark blue nursing uniform and a hat. Her hair was thick and black and cut in a pageboy bob that seemed to emphasise her long face and drooping eyes.

Agnes introduced me as a family friend and asked about Lily.

‘Mrs Palmer was rather disturbed in the night. I’m afraid she suffered some incontinence, which obviously distressed her, and she was quite hard to settle. She was given a sedative. That may have left her a little groggy.’

‘She doesn’t even recognise me,’ said Agnes.

‘I’m sorry,’ said Mrs Knight. ‘I realise how upsetting it must be for you. It is a common symptom but it won’t necessarily persist. You may find a great improvement on your next visit.’ The words were sympathetic but there was no warmth in her manner. ‘Mrs Valley-Brown probably explained to you that we’re dealing with a slow degenerative illness. It proceeds unevenly. Although we can’t halt the disease we can make life as comfortable as possible for Mrs Palmer until such time as she needs additional care.’

‘What would happen then?’ I asked. Out of the corner of my eye I saw Agnes freeze, the teacup halfway to her mouth.

‘Excellent care is provided at the psycho-geriatric unit at Kingsfield.’

Agnes’ hand was shaking so badly that the cup clattered as she put it down. Everyone had heard of Kingsfield – one of the vast, old-style asylums.

‘I thought it was shut,’ I said. ‘I thought they were closing all those places down.’

‘Many wards did close and much of it has been put to other use but there’s a very successful psycho-geriatric unit.’ Mrs Knight seemed oblivious to Agnes’ distress. ‘The staff have a great deal of skill in dealing with confused and frail elderly

people. We do recognise that community facilities aren’t appropriate for some patients, or they simply aren’t available. Kingsfield still has a role.’

Agnes cleared her throat. ‘I was wondering whether Lily’s problems might be due to a physical upset. There’s something I’ve read about called acute confusional disorder.’

Mrs Knight nodded. ‘The doctor ruled that out. The state you’re referring to is quite easy to identify because we can connect the confusion to a particular physical illness. In Mrs Palmer’s case there was no such link. She was given a complete medical on her arrival here. It’s something we offer all our residents – we even arrange X-rays at the hospital so we can be absolutely sure that people have no physical problems that have gone undetected.’

‘But it happened so swiftly,’ Agnes went on, ‘it wasn’t gradual.’

‘I know all the books talk about Alzheimer’s progressing very slowly,’ Mrs Knight clasped her hands on the table and leant forward as she spoke, ‘but quite often early symptoms go unnoticed. Mrs Palmer may well have been forgetful for some time without it causing anyone undue concern. In a new environment some of these symptoms stand out more clearly.’

‘She’s always had an excellent memory,’ insisted Agnes.

‘That was just an example,’ remarked Mrs Knight, unsmiling, ‘but I’ve been in nursing for twenty-five years, I’ve specialised in geriatric care and I’ve no reason to think Mrs Palmer has acute confusional disorder rather than progressive dementia.’ Subject closed.

‘Who’s her doctor?’ I asked.

‘Dr Goulden. He holds a regular surgery here every week. Mrs Palmer transferred when she moved in.’

‘So we could ask him about this?’ I ventured.

‘By all means. But Dr Goulden is only going to repeat what I’ve already told you.’ Her voice was icy.

‘Do you have his number?’

‘Certainly.’ She gave me it then rose from her chair. The interview was over. Then she made an effort to redeem the atmosphere. ‘I hope he’ll be able to set your minds at ease. We do feel it’s important that friends and relatives have all the information they can about each individual care plan here.’ Still no smile, though. It was unnerving. A missing bit of body language that made it feel that the whole conversation was askew. Well, the exchange had hardly been harmonious. Medical types sure don’t like their judgement questioning.

Agnes wanted to sit with Lily for a while so we returned to the TV lounge. Lily didn’t resist when Agnes sat beside her and took her hand. They were like that for ten minutes or more. Lily staring at the box, Agnes, her eyes cast down, looking up at her friend every now and then.

Lily was small, her feet barely reached the floor. Her neck craned forward and the top of her spine was curved with age. She had steel-grey hair, tightly permed. Her face was round, crosshatched with fine lines. A pair of modern glasses with pink and cream frames rested on her small nose. A trickle of saliva edged its way down from the side of her mouth. Agnes wiped it away with her hanky. Lily didn’t notice.

I pretended to watch a feature on how to cook borsch.

Agnes stood up and said goodbye, told Lily she’d come again tomorrow, bent forward and kissed her cheek. No reaction.

We were halfway back to Agnes’ house before she broke the silence. There were tears in her voice, and determination. ‘I want you to see that doctor, talk to him about the diagnosis. I wasn’t at all satisfied with that woman’s explanation. She hardly gave much consideration to concerns.’

‘Made up her mind already,’ I said. ‘People like that don’t believe in uncertainties. She’d never admit they were wrong, I bet. Too much at stake. She was frosty, though, wasn’t she? Did you notice she never smiled, not once?’

‘It’s all happened so quickly,’ said Agnes, ‘that’s what I was trying to tell her. Lily got ill suddenly, not progressively, and today she’s much worse.’

‘You’ve never seen her like that before?’ I asked.

‘No. She’s always known me, known…’ she shook her head, grappling for words to explain, ‘known herself, even if she’s been quiet or distressed. I’m so worried.’ She broke off.

I pulled up outside her house and turned the engine off. It ticked as the metal cooled.

‘I want to see that doctor and I’d like you to be there. Sometimes people are a little dismissive because of my age. I realise you’ll want a fee and I’ll be happy to pay for your time. And I’ll ring Charles, Lily’s son. He should know. I’m sure he’d want to.’

‘Is he close to his mother?’

‘Not really. I think he functions on guilt. He sends money. He’s a very busy man.’ There was a bitter edge to her voice. ‘I must sound harsh. It just seems so unfair. Still, I shall talk to him.’

‘It might be worth contacting Lily’s former GP as well,’ I suggested. ‘The doctor I talked to said to get the whole physical history, find out the order in which things happened.’

‘Well, that’s Dr Chattaway. He’s my doctor, too. I’m sure he’ll help if he can.’

‘I’ll try and make an appointment with Dr Goulden first,’ I said. ‘Are there any days that are bad for you, any regular appointments?’

‘Nothing I can’t break.’ She smiled. ‘So you don’t think I’m being silly, wanting to know more?’

‘No, not in the least. In the end we might find that Goulden’s diagnosis is right but there’s enough doubt in my mind to ask a few more questions.’

Agnes nodded. ‘Thank you. I’d never forgive myself if there was anything…’ She sucked in a breath and let it go, unbuckled her seat belt. I got out and opened the door for her.

‘I’ll ring as soon as I’ve fixed a time.’ I waited until she’d opened the front door before turning the ignition. She waved and I drove off. It was twelve thirty, I was ravenous and a Greek feast awaited.