Go Not Gently

CHAPTER SIX

First thing Monday morning Jimmy Achebe rang. I hadn’t even opened the post. He spoke hurriedly. He wanted me to do the job, he’d drop off a photo later that day. I reminded him to include his address, his home phone number and a note of any regular appointments Tina had. There was no point in my trailing her to aqua-fit and back, then billing him for it. Were there any days in particular he wanted me to cover?

‘Maybe tomorrow and Wednesday – it’s usually mid-week.’

‘And you tried asking Tina about it?’

‘Yeah. She wasn’t having any of it. Told me I was imagining things, says she’s not hiding anything. Told me to stop harassing her.’ I heard him blow out in exasperation. ‘Look, about the money. I’ll get what I can today but the rest, well, like I said..

‘Don’t worry, I’ll check back with you each time I’ve done a stint. That way, if it starts mounting up you can ask me to stop. How can I get in touch?’

‘I’ll have to ring you,’ he said, ‘but you can leave a message here at work. You’ve got the number, haven’t you?’

‘Yeah.’

‘Just say you want me to ring. They’ll pass it on. I hate this. I feel like I’m the one doing something wrong.’

‘Do you want to think it over a bit longer?’

‘No. It’s cracking me up. I just want it sorted.’

There was a lull in my morning after I’d opened and binned the post. I went swimming. Thirty lengths of the local pool and a reasonably hot shower. I emerged into the blank February weather feeling loose-limbed and smug.

Back home Ray had left a note on the kitchen table: ‘Harry knows someone looking for room. Sheila. May ring.’

My heart dipped. In order to make ends meet we needed to let out the attic flat. We rented the house from an ex-lecturer of mine. He’d gone out to do a year in Australia and they kept renewing his contract. We had to cover the mortgage, bills and maintain the place.

Our first lodgers, Joanne and Christine, had been great but they’d moved on once they’d saved enough for a deposit on a place of their own. Their successor, Clive, was the lodger from hell. Since we’d got him out we’d taken a succession of short-term lets: an actor appearing at the Royal Exchange, a teacher who needed a bolt hole while her damp-proof course was done and a German sociologist who was doing a term at the university. They were all a vast improvement on Clive but each time there was the disruption of getting used to a new face at the breakfast table, of negotiating use of the kitchen, the bath and the fridge. And in between we were short on income. We really needed a permanent person but I was still terrified we might end up with another complete wally. My old friend Harry wouldn’t deliberately send me a plonker but sometimes they could be hard to spot.

Not long after lunch I collected Agnes and we drove over to Dr Goulden’s surgery. It was part of a large detached house. Brass plaques on the gatepost and front door showed it also housed Jason and Evers, Architects, and Mowbray Insurance Services. The front gardens had been tarmacked over for parking. Dr Goulden used the downstairs rooms. Reception and waiting room to the left, consulting room to the right.

The receptionist clicked us off on the computer and directed us to the waiting room. Three women were already there. No one spoke to anyone else or made eye contact.

Agnes leant over to whisper to me. ‘When we go in,’ she said, ‘I’ll explain what we want.’

I agreed. ‘You do the talking.’

We were another tedious twenty minutes waiting. I leafed through Marie Claire and Vogue. Gradually each of the three women was summoned by the buzzer and the illuminated sign inviting ‘Next patient please’, and disappeared. Then it was our turn.

Dr Goulden welcomed us with a bright smile.

‘Mrs Palmer.’ He shook Agnes by the hand and gestured to the seat at the side of his desk.

‘I’m Miss Donlan,’ said Agnes. ‘We’ve come about-’

‘I’m sorry,’ he interrupted, the smile replaced by a puzzled look, ‘but I seem to have the wrong notes here.’

‘No, they’re right,’ said Agnes, sitting down. ‘We’ve come about Mrs Palmer.’

‘Aah.’ He regained his composure and fetched an extra chair over from the far corner of the room for me.

‘So,’ he held his hands open to Agnes, ‘how can I help?’

While she explained the situation and her worries I studied Dr Goulden. He was probably in his early thirties, with a square face, thick blond hair, pale blue eyes, sandy freckles. Tall, big-boned. He was impeccably dressed in blue striped shirt, dark blue suit and tie. He probably had to shop at Long and Tall or whatever that specialist shop is called. He sounded solid middle class, no trace of a regional accent. He listened attentively, his head cocked to one side just so you’d know he was listening attentively.

When Agnes had finished he said, ‘I’d just like to clarify a few points. You are a friend of Mrs Palmer’s and this is…’ He looked at me.

‘A friend of the family,’ said Agnes, ‘Sal, Sally.’

I winced visibly. People have a habit of softening my name. But I’ve never been a Sally. Sal was a pet name my dad used. My real name’s Sarah but I’ve been Sal as long as I can remember. Sally makes me feel like a six-year-old.

‘Mmm,’ Dr Goulden didn’t sound all that keen, ‘Mrs Palmer’s son is actually listed as next of kin.’

‘But he’s in Exeter,’ said Agnes. ‘I talked to him on Friday, he’d no objection to me making the appointment. He knows I visit Lily two or three times a week.’ Agnes began to sound defensive.

‘I don’t discuss my patients with other people. Confidentiality is paramount. I’m sure you understand. Mrs Palmer is getting the very best care, Homelea has an excellent reputation-’

‘We could go to the trouble of arranging for Mr Palmer to travel up from Devon to put these questions to you,’ I said, ‘but it seems rather an extreme measure, a waste of time for everyone concerned. We’ve already spoken to Mrs Knight and I’m not aware that there has been any problem about patient confidentiality. If you could answer some of Miss Donlan’s queries we wouldn’t need to trouble you any further.’

There was an uncomfortable pause. We sat it out.

He decided to play ball. ‘Your concern is that Mrs Palmer may be suffering from an acute confusion rather than chronic decline?’

Agnes nodded.

Dr Goulden smiled sympathetically. ‘I’m ninety-nine per cent certain that’s not the case but if you’ll bear with me I’ll scan the notes and see if we could have missed anything.’ He leafed through the papers humming tunelessly. ‘Tum-ti-tum-ti-tum-tum-tum’, a gesture intended to show us that all was well, to demonstrate how competent and relaxed he was.

He patted the papers back into the manila folder. ‘No,’ he said, ‘nothing. I’d have been very surprised if there had been. In the sort of case you’re asking about,’ he explained, ‘we’d look for a certain sort of physical problem, an untreated infection, perhaps, from which we could date the development of the confusion. Now we’ve nothing like that here, absolutely nothing.’ He stressed the words. ‘She had a full medical on arrival at Homelea, sort of MOT,’ he smiled insincerely and waved the folder, ‘and everything I’ve seen of Mrs Palmer makes me certain that she has chronic dementia, Alzheimer’s. I’m sorry. I can assure you we are doing our best for her.’

Agnes suddenly looked much older, the brilliance of her dark eyes dulled. ‘But it’s all been so quick,’ she said. ‘She doesn’t know who I am any more.’ The last words came out in a whisper as she fought to stay in control.

‘There are peaks and troughs,’ said Dr Goulden, ‘as with any chronic disease. The situation may well improve. Often adjusting the medication can help things considerably. With some patients the situation can stabilise and remain so for many months.’

‘What medicine is she getting?’ I asked.

He looked at me. That smile again. ‘She’s currently receiving a controlled-dose tranquilliser, what we call an antipsychotic drug, and she’s given something to help her sleep if Mrs Knight judges it to be necessary. Drugs have a very useful role in Mrs Palmer’s therapy but we use them with caution. The tranquilliser, for example, wouldn’t be given on a long-term basis.’

‘Is it one of the phenothiazines?’ I asked, remembering what I’d read in Moira’s books and hoping I’d got the pronunciation right. ‘What dosage is she on?’

This time the smile was accompanied by a patronising tilt of the head. ‘I don’t see that such detail is of much help to the layperson in understanding our care plan.’

‘We’d like to know,’ I said. No explanation, no justification.

He cleared his throat and rustled papers. ‘Thioridazine,’ he said. ‘Twenty-five milligrams twice daily. And nitrazepam for the insomnia as required.’

‘There can sometimes be side effects, can’t there?’ asked Agnes. ‘The drugs themselves can cause confusion in some people, make things worse.’

‘Yes, on occasion. All drugs carry some risk of minor side effects. But on the whole we feel the benefits far outweigh any risks. I can assure you I’ll be monitoring the response to the medication very carefully. There’s usually a settling-down period before the situation stabilises. If I see any indication of an adverse reaction I’ll reduce or withdraw the medication. I’d be hoping to gradually phase it out anyway. As I say, it’s not something I see Mrs Palmer requiring on a long-term basis.’

‘And you don’t think any of her symptoms are due to the drugs themselves?’ I asked.

‘No, definitely not. The confusion and agitation were what indicated the need for treatment in the first place. They’ve not arisen as a reaction to the medicines, they were present before the drug therapy started.’ He placed Lily’s notes on top of the neat stack on his desk. ‘Once the situation has stabilised, as I’m sure it will, I think we’ll see substantial improvement and we’ll have a much calmer and more relaxed patient.’

He stood up and picked up Lily’s notes, batting them gently against his other hand as he waited for us to leave. Agnes went ahead of me. As she opened the door I glanced back into the room. Dr Goulden was standing at his filing cabinet putting the notes away. But it was his reflection in the mirror above the cabinet that caught my attention. His face was contorted with rage, lips drawn back, taut and white, teeth bared, eyes glaring. My stomach lurched. It was an astonishing sight. I slipped out before he noticed me looking.

It was curiosity made me return to the building. I found it hard to credit what I’d seen and wanted to nose around a bit more. I settled Agnes in the car and then claimed to have left my gloves in the waiting room. The lobby was deserted – we must have been the last appointment.

The words from the consulting room were a little muffled behind the closed door, but I could make out most of what Goulden said, particularly at such a loud volume. ‘I do not see friends and relatives. I’m a doctor, not a bloody support group. I see patients. You make appointments for patients.’ He was furious, spitting out the words, ladling on scorn and derision. ‘Next time you decide to offer appointments to Uncle Tom Cobleigh and all just use your bloody brains, woman.’

I heard a murmur in reply.

‘Tell them you only make appointments for registered patients. Show some initiative, for Christ’s sake. Anything else, you check with me first. Got it?’

Another murmur.

‘I’ve enough to do without being at the beck and call of every silly old bat who gets a bee in her bonnet. They read an article in some half-cocked magazine and next minute they’re God’s gift to medicine. Check next time and if they’re not patients…’

I left. I’d heard enough and I didn’t want the receptionist to know I’d witnessed her humiliation.

In the car Agnes was deflated. Goulden’s certainty about Lily’s illness had put paid to any hope she might have had about misdiagnosis. And he had given us the information we asked for even though we’d had to lean on him to get it. But she hadn’t seen what I had, nor heard him just now.

‘I think he’s hiding something,’ I said, ‘he hated having to see us, he didn’t want to talk to us about Lily.’

I described to Agnes the expression I’d seen on Goulden’s face as I was leaving and the way he’d bawled out his receptionist.

‘He was beside himself,’ I said. ‘That makes me wonder, why did our visit upset him to such a degree?’

‘Perhaps he’s just a very angry man. Choleric they used to call it.’

‘I don’t like him,’ I said, ‘and I wouldn’t trust him as far as I can spit.’