The Other Side of You
Salley Vickers

FOURTH ESTATE • London

For Xopher

Who is the third who walks always beside you?

When I count, there are only you and I together

But when I look ahead up the white road

There is always another one walking beside you

…

—But who is that on the other side of you?

The Waste Land, T. S. ELIOT

Table of Contents

Cover Page

Title Page

Dedication

Epigraph

Part I

1

2

3

4

5

6

7

8

9

10

11

Part II

1

2

3

4

5

6

7

8

9

10

11

12

13

Part III

1

2

3

4

5

Part IV

1

2

3

4

Acknowledgements

Also by Salley Vickers

Copyright

About the Publisher

Part I

When I count, there are only you and I together

1

SHE WAS A SLIGHT WOMAN, PALE, WITH TWO WINGS OF DARK hair which framed her face and gave it the faintly bird-like quality that characterised her person. Even at this distance of time, which has clarified much that was obscure to me, I find her essence hard to capture. She was youthful in appearance but there was also an air of something ambiguous about her which was both intriguing and daunting.

When we met she must have been in her forties, but in a certain light she could have been fourteen or four hundred—though when I say ‘light’ I perhaps mean that subtle light of the mind, which casts as many shadows as it illuminates but in the right conditions can reveal a person’s being more accurately than the most powerful beam.

Once I would have known her age to the day, since it would have been part of the bald list of information on her medical file: name, sex, date of birth. Of the last detail I have a hazy recollection that her birthday was in September. She spoke of it once in connection with the commencement of the school year and a feeling that, in the coincidence of the month of her birth and a new term, she might begin some new life. ‘You see, Doctor,’ —when she used my title she did so in a tone that located it at a fine point between irony and intimacy—‘even as a child I must have been looking for a fresh start.’

Doctors are like parents: there should be no favourites. But doctors and parents are human beings first and it is impossible to escape altogether the very human fact that certain people count. Of course everyone must, or should, count. We oughtn’t do what we do if that isn’t a fundamental of our instincts as well as of our professional dealings. But the peculiar spark that directs us towards our profession will have its own particular shape. I have had colleagues who come alive at a certain kind of raving, who perceive in the voices of the incurable schizophrenic a cryptic language, a Linear B, awaiting their special aptitude for decoding. One of my formidably brilliant colleagues has spent her life attempting to unravel the twisted minds of the criminally insane. It’s my opinion no one could ever disentangle that knot of evil and sickness, but for her it is the grail that infuses her work with the ardour of a mythic quest. My colleague, Dan Buirski, had a bee in his bonnet about eating disorders. I used to kid him, a long cadaver of a man himself, that he liked nothing more than a starving young woman to get his teeth into. I said once, ‘You’re no example, you’re a mere cheese paring yourself,’ and he laughed and said, ‘That’s why I understand them.’ He’s lucky with his metabolism, but his grandmother and his two uncles died in Treblinka. Starvation is in his blood and he’s converted that inheritance into a consuming interest in humankind’s relationship with food. It’s a strange business, ours.

And what was my peculiar bent, the glimmer in my eye which has in it the capacity to lead me into dangerous swamps and mires? For me it was the denizens of that hinterland where life and death are sister and brother, the suicidally disposed, who beckoned. Like is drawn to like. Alter the biographical circumstances a fraction and my colleague who worked with psychopaths would make an expert serial killer: she had just the right streak of fanatical perfectionism and the necessary pane of ice in the heart. And for all his badinage, Dan had a hard time keeping a scrap of flesh on him. I saw him once, after he’d had a bad bout of flu, and I nearly crossed myself he looked so like a vampire’s victim. But despite the concentration camps, death wasn’t his particular lure. That was my province.

It was a landscape I knew with that innate sense which people call ‘sixth’, with the invisible antennae that register the impalpable as no less real than a kick in the solar plexus from a startled horse. To some of us it can be more real. It is said that the dead tell no tales, but I wonder. When I was five, my brother, Jonathan, was killed by an articulated lorry. It was my third day of school and our mother was unwell; and because our school was close by, and my brother was advanced for his six and a half years, and was used to going to and from school alone, she allowed him to take me there unescorted. The one road we had to cross was a minor one but the lorry driver had mistaken his way and was backing round the corner as a preliminary to turning round. Jonny had stepped off the pavement and had his back to the lorry to beckon me across. Although he was mature for his age he was small, too small to figure in the mirror’s sight lines. I was on the pavement and I watched him vanish under the reversing lorry and I seem to remember—though this could be the construction of hindsight—that it was not until the vehicle started forward that I heard a thin, high scream, the sound I imagine a rabbit might make as a trap springs fatally on fragile bones.

I doubt there was a bone left unbroken in my brother’s body when the lorry drove off, leaving the mess of shattered limbs and blood and skin which had been Jonny. I believe I saw what was left of him, before I was whirled away in the big, freckled arms of Mrs Whelan, who lived across the street and had heard the scream and rushed me into her house, which Jonny and I had never liked because it smelled of dismally cooked food, and terrified me by falling on her knees and dragging me down with a confused screech, ‘Jesus, Mary and Joseph, the blessed lamb, may he rest in peace.’

Afterwards, I didn’t know where my brother was but I was pretty sure it wasn’t with Jesus, Mary or Joseph. The belief I clung to was that Jonny was still in the pine tree he had assured me was ‘magic’, on whose stately curving boughs we used to swing together in Chiswick Park. I heard him more than once, when I was allowed back to play there. He was singing ‘He’ll be coming round the mountain when he comes’, which was the song our mother sang when we were fretful, the two of us, on long car journeys. Later, when Mother had my twin sisters, born one behind the other within the hour, she sang other songs to them.

From that time onwards, it was always ‘the girls’ and ‘Davey’. I, Davey, was the wrong side of the unbridgeable fissure that had opened up in our family, and although I’m sure my parents loved me I was a reminder of that small bloody mess they’d left behind. The lorry driver never recovered and had to be pensioned off, unfit for work. But my mother was made of sterner stuff. She had in her a fund of life that was not to be defeated even by life’s only real enemy. She was not a woman who lived on easy terms with her emotions. She was the daughter of a judge and her upbringing, though liberal, had not bred in her a place for the easy expression of the finer shades of feeling. And I knew, too, though nothing in her outward demeanour ever gave this away, that if she could have chosen which son she had to lose it would not have been Jonny.

I didn’t blame her. After that, I was never going to be right for her again. I was the living witness to a calamity, the deeper reaches of which she could not afford to acknowledge if she was to continue to hold her self, and our family, together. Very likely she blamed me for the catastrophe. Why wouldn’t she? I blamed myself for it.

My mother, for my father’s sake, for them to go on together, and for the family to survive, had to set her shoulders and turn her back on the disaster. She faced a choice, and she made it by abandoning me and jumping the ravine which had opened with Jonny’s death to the other side. It was a leap to the side of life and the proof of this came in the form of my twin sisters, apples of my father’s eye and each other’s best companion.

For a long time I was expecting my lost brother to come round that mountain, with all the confidence with which he had stepped off the kerb of the pavement and into the lorry’s fatal path. He was my closest companion, my hero, my single most important attachment to life. And when he didn’t come, and I heard only the echo of his voice in my ear, as I swung alone on the low pine branch, pretending, for my mother’s sake, that I was enjoying myself, a part of me wanted to go after him, for company.

2

AT THE TIME I AM SPEAKING OF I WORKED IN TWO PSYCHIATRIC hospitals in the south of England: a big red-brick, mock-Gothic pile in Haywards Heath, and a cosier, less oppressive place near Brighton on the south coast. In addition, I had a small private practice, where occasionally I saw some paying patients.

From her appearance Mrs Cruikshank might have been one of those. She had the voice and mannerisms of someone born middle class. But I came to learn that this was part of a wellcrafted veneer—like a piece of good furniture, she had a discreet sheen which was far from ordinary. In fact, she was the child of two immigrants, her father an Italian communist, who had come to England before the war, her mother, a refugee from the prerevolutionary Yugoslavia, the illegitimate daughter of one of those two-a-penny Eastern European counts, or so she claimed. When I got to know her better, my patient told me she thought this may have been a compensating fantasy for the fact that her mother worked for a time as a dinner lady in the local primary school, the one her own daughter attended. Possibly the idea had conferred on the child a tincture of the aristocratic. Fantasies, if they are convinced enough, are also an element in the reality which shapes us and there was a tilt to my patient’s narrow nose which might have given an impression of looking down it.

She was the only child of a marriage that, given the natural antagonism of the backgrounds, was bound to be somewhat rocky. The parents were ill-matched in character, as well as history. It was a pattern I recognised. The mother was pushy and ambitious, the father, though something of an intellectual, more passive, content to read about revolution in Marx and Lenin but to let his own life take its course without putting up much fight. They bickered constantly, and as a result my patient left home early, in order to escape an atmosphere which grew increasingly abrasive as her mother’s insatiable discontent was left unassuaged.

My patient was of the type of whom a first impression suggests that either they are phenomenally bright or slightly deficient. When I established that it was the former—though the very bright are almost by definition always also somewhere deficient—I recognised it as the kind of intelligence which is unconscious of its own reach. In my experience this is more often a feature of mental illness than is commonly acknowledged. Living in the world is hard enough, but if you see through it, yet lack the resources to deal with that keener vision, it can be a whole lot harder. I concluded that the school my patient had attended could not have provided the nourishment necessary to feed her potential. There had been none of those inspirational teachers who rescue many hidden intelligences. I thought it likely that the habit of concealment she had perfected at home had acted as a more general camouflage.

The effects of an unhappy beginning are various: shame, rage, anxiety, inhibition, insecurity, self-doubt, a propensity for self-harm; but there is one common factor: a fundamental mistrust, an insidious feeling that the world is not a place where you are welcome or can be at home. It can take a long time to get over that feeling—if it ever can be got over.

My first meeting with Mrs Cruikshank followed her admission to St Christopher’s, the smaller of the two hospitals I worked in. She was a suicide case, a serious one, and it was clear from the start she was not one of your manipulative females trying to make a boyfriend or husband feel guilty with a fistful of painkillers and a bottle of wine. She was saved by one of those chances that make you believe in a beneficent providence. I don’t know why there shouldn’t be one: there’s plenty of evidence of the baleful kind.

The man in the flat downstairs, whom she believed away on holiday, returned unexpectedly over some family crisis and needing his spare key rang my patient. Getting no reply, and assuming his upstairs neighbour was away, and his key being a matter of urgency, he let himself into her flat with a spare key with which he in turn had been entrusted. Having retrieved his own, hanging, as he knew it would be, by the front door, some instinct made him question the state of his neighbour’s flat. He was ex-army, and thus trained in that vigilance which is alert to small disjunctions. Perhaps it was the unusually closed state of all the doors in the hallway, the absolute absence of lights, or notes, or those small signs of incompletion which we leave behind us to remind the world—or ourselves—that we have not wholly gone away. There is a peculiar silence which attends all finalities and maybe this is what Major Wilks noted without quite being aware of what he was sensing. In any event, he defied what I took to be an essentially conservative character and investigated the closed rooms, where he found my patient beneath the heaped blankets, grey-skinned and somnolent and at death’s door.

Indeed, it seems she had all but crossed the threshold and had to be dragged back by medical main force. ‘We nearly lost her,’ Cath Maguire said, in the tone which indicated a suicide was the real McCoy and not a ‘time-waster’ (these were subject to Maguire’s basilisk look, probably more of a deterrent to future episodes of self-harm than any stomach pump). Maguire made sure, if she could, that the suicides got to me. For the reasons I’ve outlined I had a certain success in that department.

My wife, Olivia, would say that I was poor at first impressions. At dinner parties, when people discovered that I was both a psychiatrist and a trained analyst—the two are not synonymous: a psychiatrist is medically qualified and attempts to cure principally with drugs, while an analyst’s training, in Britain at least, is non-medical and the work is done entirely through words—they would often say something along the lines of ‘I’d better watch what I say or you’ll know all about me!’ Irritating, and, as Olivia would be swift to point out, quite off the mark. My disposition prefers to see the best in people until faced with the worst. This is not especially commendable in me: I’m aware that a seeming good nature often stems from fear.

Olivia, however, was adept at picking up the more negative elements of character. ‘A gold-digger,’ she would say contemptuously, when I ventured that some woman we met at a party seemed ‘awfully nice’. Or if I were to suggest that someone was ‘frightfully clever’: ‘Oh, darling, he’s just a stuffed shirt,’ she’d sigh, ‘I had the dullest conversation with him.’ Driving home, as we often were during these exchanges, I would sometimes catch myself flushing in the dark. I’ve often thought it would be no bad plan to drive at night with the light on—people will so often speak their minds in the dark.

In any event, I would tend to spend the first session with any new patient asking pretty mundane questions, hoping I was absorbing the myriad clues which human beings give off even in the simplest transactions: the set of the head, or the jaw, or the shoulders, the arms folded or relaxed, the play of the hands, the flicker of the eyelids, the pallor of the skin, the way the feet make contact with the ground, the pitch of the voice—crucial, for me, I find—the choice of vocabulary, the pace and cadence of the words, how the eyes would meet yours or look away. I could go on: the way the shirt is tucked into the trousers, or skirt, the colours and textures of the fabrics, the way the hair is worn, lipstick, nail varnish, earrings, aftershave, scent, shoes, the telltale signs of smoking, and drinking, the timbre, and frequency, of the laugh, the moisture in the eye, or on the skin, the posture in the chair, the poise of the head, the questions asked, or not asked—particularly not asked.

These signs are all registered subliminally so I have no note of my first meeting with Mrs Cruikshank. Except that I am sure that I asked about her name. Her forename, as I read on her file, was Elizabeth. But when I asked her if she was ‘Liz’, because it’s important to get the name straight from the beginning, she said, in a tone which I can still hear across all the intervening years, ‘No, Elizabeth.’

And there was another thing, though I can’t say I noticed it at our first meeting. She must have had a bag with her because once I had seen more of her I observed she was never without it. A brown leather bag, not bulky, more like a small-sized music case. Although, necessarily, she had to put it down she always made sure to keep it close by.

3

OLIVIA WAS RIGHT ABOUT MY FIRST IMPRESSIONS OF PEOPLE being at sea. But my second impressions, though I say it myself, are often spot on. I had a habit I’d picked up from Gus Galen, who supervised my analytic training. He told me that all he needed to know about a patient could be written down on a postcard. When a course of treatment finished he said he often looked back and saw that everything that had been uncovered could be discerned in what he had noted there. ‘It’s all in how you interpret information,’ he added. ‘It can take years to understand in your head what your gut knows from the start.’

So I do have a record of the next occasion I met Elizabeth Cruikshank since it was after that meeting that I made my notes. I no longer have access to any official files, and anyway I imagine the bulk of my case histories have either long gone through the shredder or are part of a disconnected account on some NHS database. But of my private postcard distillations there are a few I’ve chosen to retain.

Looking now at the card headed ‘Cruikshank, Elizabeth’, I see handwriting which is recognisably mine but bears the marks of someone younger. The letters are more capacious and better formed, as if my script has shrunk in proportion to my person. Nowadays, I’m conscious that my five feet eleven inches has dwindled, but the worst thing about ageing is not the physical diminishment. My belief that I am equal to ordinary events and encounters is beginning to be eroded. I am apprehensive now over matters that would have been unimaginable to me then: of trains, and timetables, major road junctions and mobile phones; that my plumbing will break down—and my bladder; that I will be locked out of my house; that along with my keys I may lose my mind. And, of course, my presence in the world has always had a touch of the provisional about it.

But then, as it seems to me now, from my present vantage point, I was in the thick of things. It is a commonplace that it is part of life’s tragedy that while it must be lived forwards it can only be understood backwards; but maybe it can only be appreciated backwards as well. In any case, in those days I had some sort of notion that I knew what I was doing. Perhaps without that feeling we can’t survive.

There’s a party game in which someone goes out of the room and those left pick a member of the group whose identity is gradually revealed through answers to the ignorant interlocutor’s questions: If X were a film what film would he or she be? If a book what book? If a colour, car, item of clothing, meal, country, dog, flower, painting…? And so on. I don’t know when it was that I found that this was a handy device for formulating an impression of the person whose essence I was in a sense trying to discern. After a couple of meetings I would jot down, for example, ‘red, ferret, Jane Eyre’, or ‘bulldog, jeep, Ian Fleming’, you get the idea. I used this as a kind of shorthand to myself, a way of setting in my mind the co-ordinates of the personality I would be sitting with.

The postcard I’m looking at is a little dog-eared and faded but the writing is firm. The comments are few:

Cruikshank, Elizabeth.

Suicide.

Elegant. Guarded.

Attractive voice. Quiet.

Azure blue. Swallow.

A hinterland person.

Beside the word ‘Swallow’ the initials ‘JA’ have been crossed out.

Another lesson I learned from Gus was to ask, ‘What do I want to do with this patient?’ Not, as he was at pains to point out, should or may I do, or even can I do, but what, in a world without consequences, do I want to do? In theory, this could produce some disturbing answers, though the number of shrinks who actually want to have sex with their patients is fewer than you might imagine. But it’s not unusual to want to hold or hug or touch the hand or shoulder of those we feel for, even in circumstances where to feel for another’s pain is not an inherent part of what is expected of us. Most doctors, if they permitted themselves, would admit to those normal, everyday human impulses which the nature of the work obliges us in practice to check.

Such inclinations take more intangible forms, too. At that time, Jane Austen was my staple reading, a bulwark, I dare say, against my more disturbing professional encounters. For me to think of someone as a character in Jane Austen was a compliment. But, truth to tell, psychiatric patients are not really Jane Austen people. The Austen world has its quota of narcissists, hypochondriacs, low-grade psychotics and the marginally depressed. But none would fetch up in a psychiatric unit. What the postcard, with the crossed-out initials of my favourite novelist, reveals to me now is that here was someone who, from the first, counted for me, and counted enough that I associated her with my own inner world.

My room at St Christopher’s was a pleasant one, overlooking the back garden, and the chairs were arranged to ensure a view both for myself and my patients. In my mind’s eye, I see Elizabeth Cruikshank, looking out at a quince tree. This tree was a refugee from the days when this part of the hospital was a substantial private house, with the kind of garden that included orchards and well-stocked herbaceous borders. Most of this land had been sold off and was now taken up by the blocks of flats surrounding the hospital, whose inhabitants made occasional protesting petitions at being obliged to live cheek by jowl with the mentally disturbed. The beds at the front of the hospital had, by this time, acquired a municipal look: lobelias and scarlet salvias. But where a corner of the original gardens had been annexed, a couple of the old fruit trees had been preserved.

In spring, the quince was lit with a pale pink translucent blossom, but it wasn’t spring when Elizabeth Cruikshank and I met. That autumn the south coast was experiencing unusually foul weather. She arrived regularly and on time, lowered herself, in a way which suggested extreme fragility, into the blue brocade chair which was once my mother’s, and sat, as the wind whipped the branches of the old quince, saying nothing but staring out at the tree, which seemed to hold for her a persistent fascination.

There are different qualities to silences and in my job you learned to read them, like an old-style weatherman observing skies or an experienced fisherman reading surfaces of water for signs of imminent fish. I, for one, welcomed them. There are few jobs where you are paid to sit quietly and in the silences ideas have come to me which voluble transactions would have scared away. My patient sat wrapped in her invisible mantle to protect the wounds which had brought her to me, while I sat, a little at a distance, at a discreet angle from her, saying nothing too. There was no antagonism in her demeanour. It conveyed only a lack-lustre indifference, as if I was part of the furniture of a cell—a nun’s or prisoner’s—an unregarded bystander to her pensive preoccupation.

I have no accurate recall of the number of meetings the two of us sat like this and I became somewhat used to sitting, at my odd angle, alongside her. Her mute presence did not disturb me, other than through my growing sense of the extent of this uncharted pain.

But one day, when the weather was particularly violent, after staring a while at the tree outside, she volunteered, ‘It could blow down in that wind.’

‘Yes, it might,’ I agreed, trying to conceal any off-putting excitement.

She made no follow-up to this, so after a decent pause I hazarded, ‘Do you feel you might blow down too?’ The grey eyes grazed mine and looked away. ‘Or you mightn’t survive a storm?’

She made a gesture, as if shrugging the invisible protective mantle closer round her, but we had made some sort of contact so I pressed on.

I first met Gus Galen at the big biennial conference on anxiety and depression. He would probably be either thrown out or not taken on at all by today’s medical faculties. The son of an East End tailor, he was one of those annoying prodigies who won a scholarship to Cambridge at sixteen, read Greats, became a classics don, gave that up and trained as a medic, specialised in neurology and then found he took more interest in the impalpable than the substantive workings of the mind. By the time we met he’d had, I surmised, a fairly raffish past but there was a childlike innocence in him, which shone in his mild, slightly protuberant hazel eyes. These eyes fixed you with a guileless stare which the susceptible found hard to resist. But he also had a talent for making the kind of simple-sounding observation which permanently affects the way you think and feel.

I met him pacing the pavement outside the hotel where the conference was held and which I’d left to stretch my legs and take a breath of air. He had gone outside to smoke one of the dreadful miniature cigars that I was to learn he was never without.

‘Tell me, dear boy,’ he said (everyone was either a ‘dear girl’ or ‘dear boy’ to Gus, unless they were a ‘bitch’ or a ‘baboon’), darting over to catch my arm—he was a big man but with that nimbleness which big men, in defiance of gravity, sometimes display. ‘What did you think of Collier’s paper?’ Steve Collier was a hard-line drugs psychiatrist.

‘I thought it was pretty crude,’ I risked. For all I knew Gus was Collier’s best friend.

‘The man’s a bloody baboon,’ said Gus, and I felt I had passed some test. ‘Fancy a stroll?’

We walked down to the Thames and alongside the greygreen river, then past the Tate and on up towards the Houses of Parliament where we crossed the road to Westminster Abbey.

‘The question,’ Gus said, punching my upper arm in a gesture which I discovered was as much part of him as the disgusting little cheroots, ‘the question is not how to cure or be cured but how to live.’

It was a comment which dropped like a diamond into the well of my being where its simple brilliance never ceased to sparkle for me. The people we were treating were not so much looking for a remedy for anxiety or depression, they were looking for a reason to be alive. For the most part, the human race takes for granted that life if not a blessing is at least desirable enough to cling to. But for those for whom the business of being alive is a much more vexed question, the illness is the question, or, to put it another way, the illness is how the question may be posed.

For these hesitant souls it is life and not death that holds the terrors and if I recognised the feeling it was because I shared it. But it took Gus Galen to put it into words for me.

‘See there,’ he said, stabbing with a burly finger in the direction of the old church, as if he were about to accuse it of some serious misdemeanour, ‘that’s what places like that should be for. To help us live. There’s no cure for being alive…’

‘There’s no cure for being alive,’ I suggested into the autumnal silence to Elizabeth Cruikshank.

‘There is.’

The ginger tomcat, against which I waged war, as it used the garden as a latrine and attacked the garden birds I liked to feed, was balancing nonchalantly on the fence outside. I waited a little longer. I wanted her to say it.

‘There’s death.’

She seemed a lot further from me across the three feet or so of space between us in the room than the cat outside.

‘So you were attempting that cure? Rather a drastic one.’ I allowed the smallest trace of irony into my tone.

Again she shrugged, looking not at me but out at the rain which had begun to drizzle down on the elderly tree.

‘Not to me.’

‘Not unwelcome, maybe, but drastic nonetheless.’

Something about her made me feel that the distinction might be one she would understand, but it produced nothing. I tried a different tack. ‘I gather you’ve decided not to take any further medication while you’re with us.’

‘I prefer not.’

‘I see. Any reason? I should say I shan’t force anything on you but drugs can sometimes help.’ It was in my mind that it was drugs which had failed to help her leave life, so I could appreciate her antipathy to having them help her endure it.

‘I’d rather not.’

‘Fair enough,’ I said, deliberately brisk. ‘Let’s see how you go.’

I waited again in case she came out with anything more and the silence thickened, hovered for a moment, as if she might relegate it a second time, hung in the air between us and then attenuated and passed over. I felt there was no more to come from her but I made an appointment to see her the following day.

The principal part of the hospital was located in a modern building across the garden from the old house where I had my room. I was about to make my way over there when I heard the unmistakable voice of Lennie, our office cleaner.

Lennie was a recovered schizophrenic. I say ‘recovered’ but more accurately I should say managed. He had stayed on after being brought in for the umpteenth time from under the pier, where he hung out, madder than the vexed sea and covered with sand and pee and some or other form of the more diabolical kind of alcoholic spirit he consumed, and talking wildly to the more other-worldly ‘spirits’ who, on such occasions, invited him to demonstrate his faith in them by committing his body to the deep. I was the duty consultant that night and, I don’t know why, he took to me and I persuaded him that a regular Modecate injection might prove a sensible precaution against the spirits’ more disruptive injunctions.

Lennie took to dropping by my room, where, if I were free, he would stand and smile and I would smile back. As Gus Galen will tell you, there are important conversations which have nothing to do with speech. One day, he pointed at the window which looked out on to the quince, then transfigured by pale pink flowers, and said, ‘You see the blossom better, doc, if I was to wash the window.’ We had problems at the time getting cleaners and, with one of those brain waves which occasionally I act upon, I decided to make an advantage out of the fact that Lennie seemed to want to be useful. The inspiration paid off: Lennie took the job and was by now our longest-standing, and easily most efficient, cleaner, which arrangement allowed me to ensure that he kept up with his Modecate injections. In turn, he cleaned my office as painstakingly as if it were an emperor’s palace.

He was a bulky man, never to be seen without a yellow woolly bobble hat, which sat, jammed on his black head, atop his six-feet-plus frame, like a baby’s bonnet. He had become a popular figure around the hospital: his disposition was as benign as a baby’s and he had only one enemy, Dr Mackie, who was my enemy too.

Mackie disapproved of the informality of my association with Lennie and disliked the way I worked in general with my patients. And Lennie, as is the way with many psychotics, without any tangible information to go on, had picked this up. It was ironic, because it was drugs, more than words, or kindness, which had helped him in the end.

But now I heard Lennie’s usually deep voice risen to a squeaky pitch and hurried down the corridor to find him upbraiding Mackie who was standing in the hallway looking down at his feet.

‘You dumb fucker,’ Lennie was saying. ‘That’s my clean floor you’ve trod your fuckin’ feet over! Get your fuckin’ act together, man!’

From Mackie’s reddening face I could tell he was about to round on Lennie whose arm I now grasped, sternly saying, ‘Stow it, Lennie. Dr Mackie didn’t mean to muddy your floor. Apologise to him, please.’

I don’t know why this public schoolboy style of address came to me when dealing with Lennie, but he responded to it. He quietened down, muttered a sullen ‘Sorry, doc’, and resumed his manic mopping of the hall floor.

I walked through the grounds to the main building conversing politely, and pointlessly, with a flustered Mackie. I knew he wouldn’t easily forgive my witnessing his humiliation at the hands of my protégé.

Luckily, we met Maguire at the entrance so I had an excuse to get away.

‘Good,’ I said, ‘I wanted to catch you. Mrs Cruikshank. How d’you find her?’

‘Always the same. Quiet as a mouse. No bother.’

‘Do you like her?’

‘What’s to like? Haven’t seen enough of her yet.’

‘Well, keep me posted,’ I said. ‘You know how I rate the Maguire nose. And by the way, we can stop trying to push medication on her. She’s safe enough under your beady eye, no need to force things.’

I had to go cautiously, especially with a suicide case, though in those days we had more leeway. God knows how the poor bastards who work in the NHS cope now. But my sixth sense suggested that, her effort to escape from some intolerable anguish having failed her, my patient was less likely to try that solution a second time.

4

AFTER JONNY DIED, UP TO THE TIME WHEN I FINISHED AT university, I dreamed of him regularly, so that I now cannot swear which of my recollections are real-life memories and which remnants of the dreams. Nor can I judge how far my love of reading was a consequence of having lost my brother, but from as far back as I can recall I have always found solace in immersing myself in others’ lives, and worlds. It was therefore natural that my first degree should be in English literature. However, when I decided to go on to medical school, although I dreamed still, the dreams about Jonny seemed to stop.

I missed them—as I had missed him. But I retained the memory of them and in one, which had seemed to recur, he would say, ‘Eat this, go on!’ and on a slender silver spoon was something I expected to be Milo’s ice cream.

Milo’s was the first soft ice cream I ever tasted and it was a treat Jonny and I used to clamour for when we were out shopping with our mother on the Chiswick High Road. In those days Chiswick had a Lyons, where we ate buttered teacakes, and a draper’s shop called Goodbands, where our mother bought buttons for our shirts and thin apricot satin ribbon for her petticoat straps. And it also boasted an up-to-the-minute ice cream bar. In the dream, I would shut my eyes and open my mouth and Jonny would carefully place something on my tongue, and I knew, though I could never recapture the taste on waking, that it tasted remarkable: better than anything in life.

At the time, Olivia and I lived in a flat in one of Brighton’s Regency squares and on the days I worked at St Christopher’s I sometimes took my exercise by walking to and from the hospital. Walking home that evening, this dream came back to me. I knew it was death’s allure I had tasted from Jonny’s cold spoon and I wondered how it had tasted to Elizabeth Cruikshank.

We were due for dinner later at the home of a colleague, Denis Powell. On the whole, I tried to avoid social events during the working week, but the Powells hardly counted and nor did Dan and Barbara Buirski who were invited too.

Olivia was in the bath when I let myself in and she called out to come and find her. At forty-two she was still a pretty sight, and naked, and wet, and without make-up and in her shower cap, she looked about sixteen. I kissed her shoulder and went to pour us both a drink and came back and sat on the lavatory seat and chatted to her about her day. We hardly ever discussed mine.

Olivia and I were a mystery to me. We had next to nothing in common and there were many occasions when with good conscience I could have finished with her during our erratic courtship. In the end, I was always pulled back by something I could never quite put my finger on. It wasn’t simply sex, though sex was part of it. I seemed unable to do without her, and yet we were never a fit.

It was a puzzlement, but I knew this much: the hook was inside me, not in her. She was—well, she was Olivia. Perhaps it was that she was so unequivocally herself that drew me to her. She was substantial, she was on the side of life, especially when that life was hers.

‘No kids,’ she said, when I asked her to marry me. ‘I’ll marry you but I don’t want any brats.’

‘Fine,’ I said. Perhaps because of Jonny I wasn’t sure I wanted any either.

In fact, she did fall pregnant and, after some debate, in which I took a pretty passive position—excusing myself with the alibi that it was for the woman to make the final decision—she had an abortion. Our sex life wasn’t terrific afterwards. I suppose I thought it was the result of the termination, and assumed that eventually things would resume their previous pitch. They never did. And I never liked to enquire why. It seemed a pity, because it was one of the things which had been good between us.

But when we weren’t sniping at each other, or more often she at me, we could be affectionate and sipping my whisky I looked at her naked shoulders appreciatively in the bath.

‘Shall I soap your back?’

‘Would you, darling?’

‘It would be a pleasure,’ I said, and meant it. Olivia would have made a good artist’s model. She had a long back and it was worth soaping.

It was worth seeing her dress too and she scolded me a little, but not unpleasantly, for stopping to watch her put on her stockings. She had nice legs and good taste in shoes.

‘People will think I’m a foot fetishist,’ I complained once when she came back with yet another pair.

‘Perhaps you are. Shrinks are always cagey about their own perversions. I wonder what yours really are?’

I wondered too. Perhaps a trace of masochism. Certainly if there was any masochism at play it was not in Olivia.

I was changed and wearing my silk and wool tweed jacket long before she was ready and I waited while she did her face and sprayed herself with scent and changed her shoes a few times. She was more gregarious than me and liked dinner parties, and this evening she was in an unusually cheerful temper.

Driving to the Powells’, she remained in a friendly mood which had the effect of relaxing me. It bothered me that she was able to alter the atmosphere with one brief phrase, or word, and that in my domestic life I had fallen into a more or less permanently propitiatory position. It might have been masochism or it might have been the desire for a quiet life. The desire for a quiet life can be a dangerous ally, I’m afraid.

Chris was still in the kitchen when we arrived and Denis let us in with his usual exaggerated compliments over Olivia’s appearance. This had once worried me, for Chris’s sake, since she is one of the ugliest women I know. But she is also one of the most likeable and I had come to the conclusion that Denis was genuinely unaffected by physical charms. Or maybe he was just sensible enough to recognise that with Chris he had a gem and to hell with appearances. I admired him for this and it made me obscurely ashamed. Olivia’s glamour had an undoubted appeal, though the appeal had more to do, I think, with how I wanted to be perceived than with a more personal response. Denis’s gallantry was pure good manners: as a skilled diagnostician he recognised Olivia’s need for adoration.

The Buirskis were already drinking wine in the Powells’ untidily hospitable sitting room. Olivia was incapable of getting anywhere on time. I suspected that this was because she liked to make a conspicuous entrance but also because while she was keen on her own shoes she was not much of a one for putting herself in other people’s.

In general Olivia’s self-centredness was indulged. Dan, however, was an exception. He found my wife exasperating and didn’t conceal the fact. And this meant there was often an edginess between them which I would have to smooth down. He made a comment now as we entered the sitting room.

‘Sound the trumpets! The McBrides have graced us with their presence.’

‘Belt up, Buirski,’ I said, ‘and budge up. I want to hold hands with your wife.’

Dan got up and went to poke the fire burning in the grate, which had been ripped out during a renovation of St Christopher’s and would have been dumped for rubbish had not Chris, who had no eye for herself but a magpie’s eye for useful household treasures, rescued it. Barbara Buirski moved along the chesterfield, bought by Chris for thirty quid in an auction, patting the place beside her for me to sit down. Bar was an ex of mine, someone I took up with during one of the ‘off’ periods with Olivia. She was characteristically good-tempered when I explained that Olivia was back and Dan, when I told him, said, ‘You’re mad! Bar Blake is terrific. I’ll have her if you don’t want her.’ And so far as I could tell they’d been happy together. He was right about Bar, she was terrific, but she never got into my bloodstream the way Olivia had.

None of which prevented me from keeping up a flirtatious friendship with Bar. Dan seemed not to mind. In fact, he seemed to enjoy it. As for Olivia, I wondered sometimes if she would care if I slept with another woman. I couldn’t say as I’d not tested it, but certainly she was too secure in her own attractions to bother her head about my harmless flirting.

Bar was a dermatologist, a very able one, Denis was a consultant in geriatric psychiatry and Chris, before she had the kids, had been a midwife. So when the six of us got together the conversation was often work-centred, which meant that Olivia, as the only one of us not medically qualified, sometimes played up. She’d been PA to, and mistress of, a high-powered MP when I met her. He’d dropped her like a hot brick when the press got wind of his extra-curricular activities and rapidly returned to the arms of his plain and uncomplicated Southampton wife. I imagine it was this jolt to her self-esteem which propelled Olivia into my unembarrassed arms.

We met over a medical delegation she’d organised to the House of Commons, where I sat beside her at lunch. The button on the sleeve of my jacket got caught in the lace of her blouse. I’m deft-fingered, and I disentangled it with the occasional flamboyance which can visit me when I am not trying too hard. The episode, conducted across the table from the treacherous MP, acted as a tonic to Olivia’s wounded feelings. Looking back, I can see that her animated responses were designed to put the MP in his place, rather than to encourage me to take it. But she was attracted by my doctor’s status, and maybe, too, by my patina of cultural sophistication, though as is often the way, she liked the idea of this more than its manifestations. When we got to know each other better, and she discovered that my flash of extroversion was atypical, I suspect she was shrewd enough to recognise that this had compensations: I was unlikely either to dump her or gainsay her.

Nowadays, Olivia ran a boutique in the smarter part of Brighton. It was a waste of her intelligence but I’d long abandoned my earlier efforts to steer her career and the job seemed to suit her, mainly because much of the stock found its way on to her person.

‘Livy, that’s a fabulous frock. I’m green with envy.’ Bar, the least envious woman alive, was generous with compliments. Privately, I preferred her outfit, which was a pair of well-cut black trousers and a silk shirt. Besides being good-tempered Bar had a good behind.

‘Like it? It’s Gina Frattini.’ Olivia pirouetted, showing off the dress’s elaborately ruffled skirt.

‘I haven’t a clue who Gina Frattini is,’ said Chris, coming out of the kitchen in a pair of filthy trousers, ‘but she’s obviously posh. I’m afraid I’m as you see me, covered in dog hair as usual.’ The Powells had four children and three rowdy dogs. It was debatable which they spoiled more.

‘You’ve worried Dr McB about his trousers now!’ Dan had observed me covertly brushing at them. It was a subject for badinage among the assembled company that I’m fussy about such things.

The dogs had been shut in the kitchen, but after a good deal of barking they were let out, until Cassius, an excitable Labrador, leapt at Olivia’s dress and threatened to rip it, so, to my relief, they were banished again.

Dan, who showed an easy disregard for his clothes but disliked pets, remarked that ‘Olivia’s narcissism’ had ‘its uses’, which I was afraid might lead to one of their scratchy dialogues. I could see Olivia had gone the pink of her dress and fearing she was preparing a retort I lobbed a comment at Dan as a diversion. ‘I saw someone unusual today at Kit’s.’

‘Man or woman?’ asked Dan, who could be readily distracted by an interesting case.

‘Woman. A suicide but not one of your run-of-the-mill sort.’

‘Darling,’ said Olivia, ‘you sound so blasé, poor creatures.’ She hadn’t a grain of true sympathy for anyone misguided enough to land up in a psychiatric hospital.

‘Method?’ asked Dan. ‘D’you mind if I smoke, Chris?’ Dan, who never ate much at the best of times, had left half his first course untouched. Chris wasn’t the greatest cook, but sometimes I wished he would try harder.

‘I mind,’ interjected Denis.

‘That’s why I asked Chris and not you,’ said Dan, lighting up. ‘This is an inter-course break.’ He always made that joke and I was surprised to hear Olivia laugh. We had all long ago given up laughing at it.

‘She seems to have acquired some Soneryl from somewhere, so either she’s a darned poor sleeper or she’s clever.’

‘Darling, no one says “darned” any more,’ said Olivia.

‘Insomniacs are often clever,’ Denis interposed swiftly. ‘There’s nothing to say insomnia addles the wits. Mostly the sign of the sharp ones, in my experience. If you must smoke, Daniel, use an ashtray.’ He removed the plate on to which Dan had been flicking his cigarette and fetched a Stella Artois ashtray, which one of their kids must have taken from the pub.

‘Well, no, I mean, she must have talked someone into giving them to her with a view to bumping herself off. Soneryl’s a barbiturate. Not easy to get,’ I explained for Olivia’s sake. She couldn’t have cared less but I always felt this need to include her in these conversations.

‘She give any reason?’

‘Not so far,’ I said. ‘I think the reasons may be existential.’ I rather wished I hadn’t brought up the subject of Elizabeth Cruikshank.

‘Darling, don’t be so pretentious,’ Olivia said, smiling at Dan as if to say: Isn’t he impossible?

‘Things too much for her?’ Dan pursued, ignoring Olivia.

‘Spare me people who have to attract attention to themselves in that “look-at-me” sort of way.’ Olivia finally succeeded in terminating the conversation.

For once I was grateful to her. It suddenly felt like a betrayal to be discussing Elizabeth Cruikshank round a dinner-party table.

5

WHEN I SAW ELIZABETH CRUIKSHANK NEXT, THE LATE-afternoon sun was streaming through the window and lighting up my room. It was a big room, with high ceilings, and one weekend, when Olivia had a friend staying, I’d gone in and painted it white because I couldn’t look a day longer at the existing institutional pale blue and cream. I’d also brought from home some paintings which I’d acquired before Olivia and I lived together. ‘Horrible gloomy thing,’ she’d said of the Orpen, a portrait of a sad-faced clown, I’d picked up at Kettle’s Yard.

I have a bee in my bonnet about pictures being crooked on the wall and one thing Lennie failed at was setting them straight. More often than not his big presence disrupted the paintings so, as my patient was settling in the chair, I walked across and adjusted the clown. I felt her eyes on my back and when I returned to my seat she asked, ‘Who is it?’

‘The painter or the portrait?’

‘The clown.’

I could have responded with, ‘Do you feel like that yourself?’ or something equally alienating but more by luck than judgement I chose to answer the question.

‘I’ve always felt it must be an aspect of the artist. What do you think?’ I never told Olivia this but I’d bought the painting because it reminded me of Jonny.

‘You’d need to know sadness to paint that.’

Something I’d picked up from Dan was that he almost never mentioned food to his anorexic patients. ‘Drives them nuts,’ he used to say. ‘They’ve been questioned till they’re blue in the face about their eating habits, having their food weighed to the last ounce, and God knows what, and when I don’t broach the subject at all they get confused. Breaks their control, see.’

‘Do you like art?’ I enquired.

I didn’t want to confuse Elizabeth Cruikshank or break her control but I didn’t want to go head on again into what had brought her to me. The strategy worked because something rigid about her shoulders relaxed.

‘Some.’

‘Any special artist?’ She appeared to frown so I added, ‘It’s not a trick question.’

‘It’s not that.’

‘Oh, yes,’ I said, imagining she didn’t know how to choose. ‘For me, some days it’s Rembrandt, some days Cezanne, or sometimes, you know, it’s Titian.’

The light was partly obscuring her face—I should really have had blinds but I hate to keep out the sun.

‘I used to like Caravaggio.’

That was a coincidence, though nowadays, of course, plenty of people admire the Italian painter. He was Gus Galen’s favourite. In fact, it was Gus who introduced me to Caravaggio that time when we first met.

‘Come, dear boy,’ he said, pushing me along with his hand on my elbow, after a session on anxiety, ‘I need to walk off some of my own anxiety after hearing those baboons.’

Gus walked faster than any man I knew and he was a terror with traffic. Why his life hadn’t ended under somebody’s wheels I’ll never know. He stepped off the pavement without a thought for the oncoming cars so that to accompany him on the streets was like a cue in a comic film for vehicles filled with swearing drivers to come to a screeching halt. A walk with Gus was a definition of a mixed blessing—his company was to die for, and there was always the possibility that one might.

By the time we got to Trafalgar Square I felt that had I been at all of a religious disposition I might have slipped into St Martin-in-the-Fields to light a candle in gratitude for having reached it in one piece. But Gus, still insistently shoving my elbow, steered me up the steep stone steps of the gallery and navigated us rapidly through its rooms, till we stopped in front of a painting I’d not seen before.

Here Gus let out an explosive snort so that the drowsing attendant’s head started up, fearful that this might herald some act of vandalism. But if the sigh expressed violence it was violence of a harmless sort—that of the innate passion which in Gus was always searching for a suitable object.

The picture he showed me was of a young beardless man, seated in darkness, at a table laid with food. Framing him, on either side, their backs half turned to us, were two seated companions. You could see from their posture that the central figure had just revealed something remarkable. The big-boned man to the left of him was caught, dramatically, in the act of rising to his feet, and his astonished elbow was poking through the torn sleeve of his green jerkin. His raw-nosed companion, to the right, had flung his spread arms wide, so that the large left hand seemed to shoot dangerously out of the frame and almost to poke me in the eye.

‘Who are they?’ I asked, though it was clear who the man at the centre of the table was. As I say, I wasn’t too keen on religion, or its art.

Gus stood looking at the painting as if too preoccupied to have heard me so I read the inscription aloud. ‘The Supper at Emmaus.’

‘What d’you think?’ asked Gus, as if he’d produced a gold coin from my nose or a pair of doves from my ears. ‘Marvellous, isn’t it? Beats having to listen to the babble of those baboons.’

At the time, I didn’t marvel. But it would have been rude to say so, especially at a first meeting. But also something of Gus’s passion rubbed off on me. I didn’t like the painting—I didn’t understand it—but what I did like was Gus’s liking for it. His passion bred passion: that he could so openly avow his own love for it made me love him. And now this painting, which I had encountered so many years earlier, gave me my first glimmer of insight into Elizabeth Cruikshank. Beneath that pallid exterior there must be passion too, however carefully concealed. But all I said was, ‘A dear friend of mine, Dr Galen, loves Caravaggio’s work. He’s an analyst, too. A very original one. It’s he who says there’s no cure for being alive.’

‘That’s what you said last time.’

So she had taken it in. ‘Yes. Gus’s words. I’m afraid I’m not original. He feels that people aren’t ill so much as lacking a meaning to live. He thinks our job is to help them to find it.’

‘That might be rather a tall order.’ There was the ghost of a smile in her voice.

‘Yes. And possibly arrogant, you may be thinking?’

‘No, I wasn’t thinking that.’

She lapsed back into silence and I dropped into a reverie.

Some patients, however little they say, keep your attention tied to them so that the silence is an effort. I’ve learned that this is anger. Angry people press on you, hold you down to keep you with them. But it was easy to drift off with Elizabeth Cruikshank. She didn’t mug you with her presence; she let you go as lightly as a dandelion seed.

I was contemplating this when she spoke again. ‘Why on earth would anyone want to bother with people like us?’

For a second I supposed she was referring to the two of us. Then, with a sense of slight shock, I recovered myself and recognised her allusion was to me as doctor and herself as patient.

‘What are people like “us” like?’

She gave one of her little dismissive shrugs. ‘People like me, then.’

‘And what would you say you were like?’

The ginger tom was back balancing on the fence outside. It had an air of entitlement which in a human would be psychopathic. Perhaps that was why I so disliked it. It took for granted something I could never take.

‘Oh, I don’t know,’ she said, listlessly. ‘Not very interesting.’

‘Well,’ I said, ‘I don’t know that anyone is uninteresting once you get to know them.’

‘Really?’

‘Yes, I believe so.’

‘You have to say that.’

‘I don’t, in fact. And I don’t, knowingly anyway, lie to my patients.’ Deliberately, I introduced a note of coolness into my voice.

‘I’m sure you don’t.’

‘There are as many misconceptions about shrinks as there are about—’

‘Their patients? What are the “misconceptions” about your patients, Dr McBride?’

‘That because they have had the misfortune to end up somewhere like this hospital they cannot therefore also be rather bright, for one, Mrs Cruikshank. That they aren’t able to give us the run-around!’

We stared at each other.

‘Do you think I’m giving you “the run-around”, Dr McBride?’

‘I think you are giving yourself the run-around, if you really want to know,’ I said. And then, more gently, after another longish pause, ‘But that’s all right. It’s your prerogative.’

The people who landed up with me were mostly in a state of terror, and one element in it was the fear that I possessed some professional means forcibly to overcome the complex safeguards erected to protect their secret worlds. I didn’t want anyone imagining that, especially not this patient.

‘You don’t, you know, with me, anyway, have to say or do anything you don’t want to say or do.’

6

THE FIRST DREAM I HAD WHEN I STARTED MY ANALYTICAL training took place by the sea and I can recall it as if it were yesterday.

I was walking on a pebbled beach when a man dressed in a loud turquoise shirt accosted me. He had in his hand a lump of sea-smoothed stone and he was shoving it in my face demanding to know what it was. I said, ‘You should ask the archaeologist fellow.’ Then the scene moved inland and I found myself on a steep hillside, by a small church, or chapel, cut out of the rock face. But when I entered the building it proved not to be a church at all but a zoo. There was a skinny-looking puma restlessly prowling up and down the cage, its paces marking the limits of its confinement. In the same enclosure, a huge white barn owl was flying against the high fence, beating its wings frantically on the restraining wires.

When I mentioned the dream to Gus Galen he said that if he had a tenner for every dream he’d heard that began ‘I was walking by the sea’, he would be able to reduce substantially his charges. He was fond of quoting ‘God cures; and the physician takes the fee’, but as with everything about Gus in practice his billing methods were eccentric. A woman I sent him once, the wife of a colleague, said she had to stop seeing Dr Galen because he never sent her a bill and it made her feel guilty. ‘I went to see him because I felt guilty in the first place,’ she pointed out. I sent her, finally, to a less unworldly colleague, who charged a king’s ransom.

Anyhow, in those days I was glad to have the sea on my doorstep so that when I needed to mull anything I could walk along the beach and listen to the tread of the waves, and puzzle over my thoughts by puzzling out, at the same time, what principle enables you to tell where the water ends and the horizon begins, and observe the dark shapes of boats against the sky. Or if I’d got my rubber boots out of the boot of the car, wade through the dirty-cream foam.

Walking is a famous loosener of thoughts. Although I had many other patients in my charge, looking back now it seems it was always Elizabeth Cruikshank I was thinking about when I walked by the sea’s edge, and her story I kept trying to piece together in my mind.

Perhaps it was the reassurance that there would be no compulsion on her to disclose, or perhaps it was the tincture of chilliness with which I prefaced my absolving words, because after that last meeting my patient did yield up a few grudging facts.

After leaving school, with reasonable but unremarkable O levels, she took a job at a local library. From her father she had acquired an appetite for reading and in those days there wasn’t the current mania for formal qualifications, so she went quite a way up the librarianship ladder before deciding to get herself some proper qualifications. By this time, she’d cut loose from her parents and taken a flat in Camden Town.

‘Any boyfriends?’ I asked.

‘I don’t care for the word.’

‘Did you go out with anyone?’

‘I don’t like that phrase much either.’

‘Fine,’ I said, cheerily refusing to be diverted. ‘How about lovers? Are you happy with that term?’

She touched the leather bag she always had beside her in the chair and said, vaguely, ‘Oh, you know, I never really expected anyone to want me.’

I pictured her, as she might have looked then, underweight, unfashionably dressed, a pale young woman. When I met her she still gave an impression of pallor and plainness, though no one looks their best in the aftermath of a suicide attempt and it was a while before I saw Elizabeth Cruikshank smile. When she did I was reminded of an expression of my mother’s: ‘It was as if the moon had taken off her clothes and gone dancing.’

‘But you married?’

‘I married,’ she assented. She gave an impression that if she could she would have denied it.

To augment her library studies, she explained, she enrolled on an art history course, which in those days was run at the old North London Poly. She met her future husband in the polytechnic canteen where she was in the habit of going for a supper before the evening lectures. She’d queued up for her usual soup and bread roll, being economical with her rations, and, searching in her bag for her purse, accidentally tipped the tray so that the plate slid, spilling soup over the man before her in the queue.

‘He was nice about it, though it ruined his jacket. It was light-coloured and the soup was tomato and I was mortified. But he laughed and when I asked how I could make it up to him he said I could come to the pub. So I went. He seemed to like me.’ She sounded apologetic.

‘And you liked that?’

‘I liked being the centre of someone’s attention.’

Up till now, she’d barely held my glance, her eyes always flickering off to the quince tree, or to some point in her imagination projected on to the glass. But now she looked at me with a fierce directness that almost made me smile.

‘Not everyone wants attention,’ I said, and regretted it because she took it as criticism, which I should have foreseen.

‘Yes, wishing to die is seen as attention-seeking, I know.’ Her voice was low and she hardly raised it but at moments of tension I noticed that her diction became precise.

‘I didn’t mean that,’ I said. ‘I’m sorry.’

It bothers me how infrequently people in my profession apologise. Everyone makes mistakes, why would a psychiatrist or an analyst be different? ‘We should learn to make the mistakes as fast as possible,’ Gus says. ‘It’s mistakes that let the light in.’

‘I’m sorry,’ I said again. ‘That was stupid of me. Of course everyone wants attention, provided it’s the right kind.’

She laughed, none too cheerfully. ‘Who knows if this was the “right kind”? It was enough that I was paid any attention by anyone, let alone a man.’

While I was a medical student, I took this tall, thin girl called Wanda Williams out on a date. Because it seemed expected of me, I put my arm round her at the cinema and afterwards she invited me back to her room, in a dismal part of London. When we got in she put on the kettle and then excused herself to go to the bathroom. I was sitting on the bed, leafing through a magazine and wondering when I could decently say I was leaving, when she came back into the room. She’d taken off all her clothes and there was a line round the middle of her waist, where the elastic from her knickers had left a red mark, and another higher up where her bra had cut. I remember that the sight of these cruel-looking red impressions dividing up her pale flesh filled me with pity and dismay. I couldn’t leave after that, so I went to bed with her and watched my unenthusiastic but polite performance with the inner imager I rarely manage to switch off. It would have seemed rude to do otherwise but it depressed me no end.

Several men to whom I’ve confided this story have revealed that they’ve found themselves in similar situations. There was desperation about Wanda Williams and I found myself hoping that it had not been like that for Elizabeth Cruikshank. Somehow I didn’t think it had been. Her despair felt of a different order.

Neil Cruikshank, it turned out, was an engineer, with a research fellowship at Imperial College, employed by the polytechnic to do some external examining. A stocky, squareshouldered, fair-haired man, with a moustache.

‘I should never have married a moustache, Doctor. I might have guessed I wouldn’t get on with one.’

She gave me my title with that faint edge, which seemed to imply: Yes, I know you are a doctor, but somewhere I know, too, that underneath all this, the hospital, the consulting room, the professional qualifications, you are no different from me.

We are most of us badly cracked and afraid that if we do not guard them with our lives the cracks will show, and show us up, which is why we are all more or less in a state of vigilance against one another. Although I paid lip-service to this idea I hadn’t properly acknowledged it in those days. It was Elizabeth Cruikshank who showed me the truth of it. She had a faculty of divination which is not uncommon among psychiatric patients but in her case it was developed to a degree which enabled her to see through to the back of one’s mind. But that was a recognition I had yet to reach, so when she added, ‘You know, don’t you, in advance, I mean, when you do something you’ll regret, like marry someone you shouldn’t?’ I took refuge in a doctorly, ‘Go on,’ that being one of many such mindless phrases I hid behind.

‘But you do, don’t you?’ she persisted, and made a quizzical movement with her hands, which made me think of the wings of a wounded bird.

‘I’m not sure I do,’ I said, being a practised coward.

A few haphazard fruits, which had ripened on the quince, were still hanging, gold and knobbly, on the branches outside. My mother was brought up in India and she used to tell us how if a mango tree didn’t bear fruit they would pierce the trunk with a nail to make it fructify.

‘You could make jelly with those,’ Elizabeth Cruikshank suggested, looking away from me to the garden. ‘It makes good jelly, quince.’

I dropped by Cath Maguire’s office later on my way home.

Maguire was a lesbian but not the sort that doesn’t get on with men. I had occasionally speculated what had made Maguire prefer her own sex. She was an attractive, sparky woman and while not my type exactly certainly could have been many men’s. But when I once tentatively started on this line, she shut me up by saying, ‘You’re not suggesting that women are second best or anything, are you, Dr McBride?’

But one lucky consequence of Maguire’s preference was that we had the kind of good-natured intimacy which is only possible between a man and a woman where sex will never be a factor. And I’d long given over questioning the whys and wherefores of Maguire’s sexuality. What mattered to me was that I trusted her instincts and depended on them to fill out my own.

‘How’re you getting on with Mrs Cruikshank?’ I asked.

‘Elizabeth? I like her. Quiet, like I said. Doesn’t make demands. Probably doesn’t make enough. Always very polite.’

‘Any visitors?’

‘None I’ve seen, anyway. A couple of phone enquiries from her children but so far as I know they haven’t visited.’

So she had children. I wouldn’t have guessed this and there was no mention of them on her record. She looked almost too girlish to have given birth. ‘How many?’

‘Two, I gather. A boy and a girl. The girl was a bit, you know, stand-offish but the boy sounded nice.’

By the phone in her room was a book squashed face down. Maguire read two or three books a week.

‘Does she read?’

‘She’s got a couple of books out of the library, but now you come to mention it, I’ve not seen her read them, unless she keeps them for nights.’

‘What are they? Did you see?’

Maguire screwed up her face as she did when trying to concentrate. It gave her a look of a small girl which always made me feel warm towards her.

‘Not fiction anyway.’

Maguire devoured fiction. Her favourite author was Ruth Rendell but I’d noticed some surprising ones too. For a time she seemed to be reading her way through Proust.

‘She used to be a librarian.’

‘Really? I wouldn’t mind that job myself.’

‘Too late,’ I said. ‘I need your help here.’

‘You know, I don’t know if in the long run a really great story isn’t more help.’

7

THAT AUTUMN, OLIVIA HAD DECIDED TO ENROL IN SOME evening classes and she was out at one of them when I got home. She had a tendency to these sudden enthusiasms. They rarely lasted, and I therefore hadn’t bothered to ask much about this latest. I was never quite abreast of which class was when, partly because I was glad to have an hour or two to myself. Olivia never forbade me anything openly but it’s not so agreeable to listen to Schubert, or Bach, when the person with you would rather hear The Archers. Not that I’ve anything against The Archers—it was more that Olivia had something against Schubert: she assumed respect for my tastes but somehow it had the discouraging effect of dislike.

I had a deadline for a paper I was reviewing for a clinical journal, which was an added reason for preferring my own thoughts. So when the phone rang and interrupted them I was put out till I heard Gus Galen’s voice.

‘Can you beat it?’ Gus was one of those people who never announce themselves, as if one spent one’s time simply waiting to hear from them alone. ‘They’ve got that baboon Jeffries giving the keynote address. What the hell is a “keynote” anyway, when it’s at home?’

‘I don’t know,’ I said. ‘A musical metaphor maybe?’

Gus was referring to the international conference on anxiety and depression which was to take place the following year.

‘Nothing melodious about Jeffries’ approach. It wasn’t so long ago he was advocating bloody lobotomies.’

Lobotomy, or leucotomy, the surgical severance of the frontal lobe of the brain from the subcortical area, became fashionable as a remedy for intractable depression in the late thirties and during the forties and fifties something like 80,000 such surgical operations were performed before it dropped out of style again. But since 1970 there had been a revival of interest in the procedure.

Gus was one of the first modern neurological experts to query the wisdom of this, which, as with everything else, he did vociferously.

‘They claim it worked on monkeys but I wonder what the poor beasts would say about it if they could speak,’ he said, not long after our first encounter. ‘Those baboons haven’t a bloody clue how it works on humans, if it works at all, which I doubt. Monkeying about with the brain like that as if they were God All Bloody Mighty, though God would have more sense than to be so interfering.’ As with many of his other associations, Gus appeared to have some informal access to the mind of God.

There was, and still is, a political division in our profession between an interventionist approach, which roughly speaking means drugs and ECT, and the so-called ‘talking cure’. Most psychiatrists practised a largely unconsidered mixture of the two, but Gus was passionately against the hard-line attitude and his training in neurology combined with his forceful personality gave him clout.

There’s a place for drugs, and with schizophrenia or bipolar states only a fool or a miracle worker would attempt to manage without them. But, by and large, I was of Gus’s mind. In fact—and of course he knew this—it was as a result of seeing the consequences of a lobotomy that I began my analytic training.

Mr Beet was a retired bank manager, a man with a large florid face gone blurred around the edges. He was neat as a guardsman, always in a pressed shirt and jacket and tie, but in the way that a small child is turned out, when the impression matters more to the dresser than the dressed. It was his wife who kept him trim. Her hobby was making padded coat hangers, a distraction, I surmised, from the sight of her husband’s motionless misery. He had been an active man once, she told me with remembered pride, though overactive when the anxiety dominated. By the time it was my job to monitor her husband he sat with his mouth never properly closed. You couldn’t say he stared out of the window—his eyes were too horribly devoid of any directed interest.

Mrs Beet had soft English skin and fine hair and delft-blue eyes and seemed always to be holding on to some part of her husband, his hand, his elbow, his knee, patting it to remind him—or perhaps herself—that she was there. Despair, and loyalty, had taught her to make the hangers, when she came with him to the hospital for his occupational therapy. I imagine he simply sat there and she, like a mother with an awkward child, covered the hangers for him. One Christmas, she gave me three as a present. ‘I don’t suppose you’ll have any use for them, Dr McBride, but maybe your wife would like them, that is if…’ I reassured her that I had a wife. She was a sensitive woman and would have hated to make a mistake about my marital status, or my sexuality. Olivia, unusually, welcomed the gift: the padded contours, it turned out, were useful for her evening clothes.

I speculated sometimes about Mrs Beet and where she had ended up. It was unlikely that her husband lived long in that condition. ‘He was depressed before, yes, Doctor,’ she told me in her deferential yet subtly assertive tone, ‘and anxious. But anxiety and depression aren’t the worst things. They never told us how it would be afterwards. Nothing’s as bad as seeing him like this with all the light, and with all the sorrow too, gone from his eyes.’

‘I agreed to do the response,’ Gus said, ‘but I’ve got this prostate problem hanging over me and there seems to be a feeling I shouldn’t push my luck for the next month or two afterwards. All right if I get you to take my place?’

Mrs Beet appeared unassuming but she had a certain tenacious force which had a way of ensuring that the apparition of her mutilated husband stayed somewhere in the back rooms of my mind. It made one of its haunting reappearances now.

‘Oh, God, Gus,’ I pleaded, trying to dodge the reproachful recollection, ‘I’d much rather not.’

This was a major colloquium and I was reluctant to take on Jeffries, who regarded intellectual opposition as tantamount to declaration of war. He could block the career of those who were hostile to his views and although I wasn’t ambitious I was cautious. As I say, I liked a quiet life.

‘Why not?’ I was aware the tone was being made deliberately peevish. Gus had a whim of iron and didn’t scruple to bend you to it. ‘Time someone other than me made a noise.’

‘I haven’t your enthusiasm for mud-stirring, Gus.’

‘Don’t need to say anything startling. Just say how you might treat a serious-seeming case without zapping their brain cells to smithereens with drugs we don’t understand or bloody electrical impulses ditto. You must have someone you’re seeing who fills the bill.’

When I next saw Elizabeth Cruikshank the year had crossed the shadow line when the clocks change and the late-afternoon light, an hour further from the sun, had begun to fail.

‘Spring forward, fall back’ was how my mother taught us to remember which way the clocks moved at the spring and autumnal equinoxes and, as with many of her proverbial sayings, the words stayed in my mind. They stayed my mind, too, those familiar phrases, providing some kind of outposts of reassurance. Perhaps it was her way of mothering me, or perhaps—more fairly—it was an element of her mothering I was able to accept.

Poor Mother. I rejected her as much as she rejected me—and for the same reason. Neither of us could bear the other with Jonny gone—or, rather, neither of us could bear that he had gone and we were, each of us, the reminder that he had. It was years before it occurred to me that my mother believed I blamed her for Jonny’s death every bit as much as I believed she blamed me. After all, it was she who had been uncharacteristically ill that fatal morning and allowed her two small sons to go off unsupervised.

Maybe I did blame her? I can’t be sure. There’s so little I am sure of now, but I was surer in the St Christopher days. I was sure, for example, that the business of Elizabeth Cruikshank’s marriage was unimportant. It wasn’t, I would have bet my pension on it, the relationship with Neil which had left her knocking at death’s door.

As we spoke, that afternoon, I was aware that I had come to associate his name with the onset of lethargy. Drowsiness stole through me, and I began to feel impatience over the man whose impression remained too nebulous to be the centre of the mystery which had brought his wife to me. As we sat with the room darkening round us, I had an acute sense of her feeding me titbits of trivia.

‘We lived in Hampstead at first. But we moved to be near Neil’s parents.’

‘Did you miss Hampstead?’

‘I missed the Heath.’

None of this told me more than that she was still unwilling to let me into the circumstances of her concealed catastrophe. And, indeed, I had no right to any inroad into it. Besides, there’s a rhythm to all nature, including human nature, and like a good naturalist a prudent analyst knows how to wait.

‘How long were you and Neil together before you married?’

‘A few months? I can’t remember.’

‘He doesn’t seem to have left much impression on your memory.’

‘Neil was all right. It was me that was wrong.’

‘In what way “wrong”?’ I tried to keep the note of curiosity out of my voice but by now I longed to know.

It had grown too dark to see her distinctly and, reluctantly, as I try to avoid artificial light as long as possible, I switched on the bronze lamp, in the figure of Hermes, which I had on the table by my chair.

I’m fond of this lamp. I bought it in Paris when I once took Bar Buirski there, while she was still Bar Blake.

Outside, I made out the shape of the ginger tom poised on the fence and beside him, in weird juxtaposition, I could see a reflection of my lamp and my patient in the blue armchair, the few feet between us expanded into an unnavigable mirage of air.

At that moment she began to speak, and, as she did so, the cat dropped down to merge with her image in the glass in an action so swift I almost jumped up in protest. It was as if a bird was being targeted with that intent feline spring. I can still see the orange shape leaping into the reflection of Elizabeth Cruikshank, as I can hear her near inaudible words.

‘I was faithless.’

‘Can you say more?’

‘Another time. It’s not possible now.’

8

GUS RANG ME THAT EVENING WHILE OLIVIA WAS BESIDE ME in her dressing gown, her toes, like twin neat rows of glossy rubies, resting on my mother’s embroidered footstool. She’d asked my help in varnishing her nails. I sometimes think my mother was right and I’d have made a better career as a surgeon: I’ve a remarkably steady hand.

When I spoke of work in front of Olivia I was always conscious of a slight awkwardness, and there were times, more than made me quite comfortable, when I wished I could leave the room, or ask her to leave. I conducted the conversation with Gus in the shorthand I’d developed for such occasions.

‘I’ve been thinking,’ I said, ‘I’ll do that thing for you.’

‘Great stuff.’ I could tell he was delighted. ‘Got someone up your sleeve?’

‘Exactly how long have I got?’

‘The back end of May. No need for any earth-shattering stuff. Just your natural sweetness and light will do.’

‘Thanks a million. I’ll be crucified by Jeffries & Co. if I go on about “sweetness and light”.’

‘Better men than you have been crucified. I’ll be at your side to fend off the baboons if the bloody medics let me.’

A patient who might have fitted Gus’s purpose for the conference paper was a young Pakistani student studying maths and physics at Sussex University. He’d been found wandering in the early hours on a trunk road outside Brighton. The police patrol that had picked him up reported him ‘disoriented and apparently praying’. He was brought into St Kit’s where a diagnosis of schizophrenia had finally been applied.

Pages of a notebook covered with seemingly bizarre thoughts and disconnected prose, and an inability to name the current British prime minister, had formed the basis of this diagnosis. Later, when the confused young man had been formally admitted, and I was present at his case conference, I pointed out that precious few of us, in a state of distress, would be able to name the prime minister of Pakistan and that the seemingly deranged sentences in the boy’s notebooks were attempts at formal logic. As a result of this intervention he was given over to my care.

He was agitated, desperately homesick, distraught, but not, I concluded, psychotic. I took him off the Modecate injections and tried to restore some sort of equilibrium. They don’t say so in the textbooks but a lot can be effected through patience and calm. Maguire and I were in agreement that if this commodity were available on the NHS there would be far fewer admissions to psychiatric hospitals.

I’m not sure why there is something shaming about having no one to confide in but in my view a good deal of aberrant behaviour stems from unbearable isolation and the socially unacceptable sense of being quite alone. Hassid, I concluded, was suffering not so much a nervous as a social breakdown. Away from his close-knit Karachi family, his religion, his customary diet (food plays a much larger part in emotional stability than is usually acknowledged) and the regular ritual practices he had been raised in, he had lost his bearings.

I can’t pretend to have liked all my patients but those I did like tended to be the ones I found I was able to help most. I could never decide if it was gratitude at having some positive effect on their lives that made me like them, or if liking makes some significant therapeutic difference. In any case, I liked Hassid, I understood that he was lonely, but his character also caught my curiosity and I established his trust through an indistinct memory, that grew to a clear recollection, which enabled me to identify the repeated appearance of ‘iff’ in his notebooks, not as some schizophrenic misspelling, as had been supposed, but the correct logical term for ‘if and only if’. As a result of this lucky strike he confided to me the sad account of what had occurred.

He had gone, nervously, on account of the new and strange environment, to a student party where towards the end of an already confusing evening he’d been slipped a tidy slug of vodka in his soft drink. The unaccustomed alcohol, together with the discovery of what he had innocently imbibed—I gather the idiot who performed this gross act was crass enough also to brag about it—combined to destabilise the poor young man’s mind. His family, he told me, were strict Muslims, and the shame and guilt, along with the physical effects of the alcohol, precipitated a mental crisis. The university suddenly seemed to him a place of evil and satanic darkness, from which he felt an understandable need to flee; which is why the police patrol picked him up shoeless, beating his head and reciting, to them incomprehensible, verses from the Koran.

In those days doctors had more licence. Hassid was patently terrified of returning to his student quarters. I decided the best I could do for him was to keep him with us for a spell. I judged that what he needed most was rest in sympathetic surroundings while he found his feet.

But also there was something in it for me. I enjoyed our sessions together because I discovered that what Hassid wanted, once he had recovered his centre of gravity, was to talk about his passion.

It is a feature of our profession that you are exposed to others’ interests and concerns. Thus, in the course of my duties, I have learned something of seamanship, sheep breeding, tax inspection (and tax avoidance), domestic science, the Petrarchan sonnet, horticulture, dentistry, astrology, astronomy, bell-ringing and the rudiments of how to fly a helicopter.

Hassid’s ruling passion, I discovered, was quantum mechanics. He was mad for Schrödinger’s cat, he idolised Dirac, he worshipped Niels Bohr. What intrigued me most, so far as my limited scientific intelligence was able to comprehend it, was Hassid’s account of their account of the nature of reality.

The structure of existence, which he attempted to convey to me—though often his words flowed by too fast for me properly to grasp them—was a thrilling and disturbing one, a tentative world of ambiguous possibilities rather than things or facts. Electrons, he explained, existed as a sort of misty potential, occupying no physical space in the material world but summoned into being only when a human measurement was made to determine their location.

‘You see, Doctor,’ Hassid said, ‘it is not that electrons are here waiting, like invisible germs to be discovered under the microscope—’

‘Or black swans waiting to be discovered in Australia?’ I interjected in an effort to show I was following.

But Hassid politely dismissed this. ‘Not swans, no, Doctor, not even black ones, because, you see, this is not a question of induction. Electrons are not, in the sense we mean it generally, here at all.’ His expression became sage.

I’ve always thought it remarkable that, while our bodies stand in the visible world, we ourselves are not in the world of three dimensions and our inner life has no position in space. And, equally, how little of another person’s reality is visible to us. We see their form, their features, their shifts of expression but all that constitutes their sense of self remains unseen. And yet this invisible self is what to the individual constitutes their real identity. I wondered, as I limped behind his explanations, if Hassid’s electrons were somewhat similar.

‘It is like a thought before one performs an action. The electron is no place and then’—he waved his elegant hand like a graceful conjuror—‘presto! Suddenly it is here, coming into existence out of seeming nothingness—but it is we’—excitedly he gestured at his chest—‘who bring it out. By what we do to it, you see, we give its state reality.’ His face glowed with intense pleasure at the arcane mystery he was initiating me into.

It wasn’t so surprising, I reflected after one of Hassid’s ‘seminars’, that he’d been mistaken for psychotic. The reality he described had its mad element. For one thing, it seemed to place human understanding at a central place in the universe. But then, great wits are oft to madness near allied. He was an engaging boy. And I warmed to him. But I worried that my feeble scientific understanding was insufficient to aid his adjustment to the ordinary world.

The day after Elizabeth Cruikshank had uttered those cryptic words to me I called by Maguire’s office and found her chatting to Hassid over the library trolley.

‘What’s going on here?’

‘Hassid’s helping us out.’ Making people useful was one of Maguire’s rehabilitation principles.

‘Sister wants me to look after the book trolley, you see, Doctor.’

The greater part of the library collection was the dud end of the old county library supply. Other books had been donated, or left behind, by patients or their visitors. Most of these were crime novels and thrillers, there were a predictable number of romantic novels and blockbusters, some out-of-date travel books, an old restaurant guide and a few uninspiring-looking classics. Wondering who would nowadays read The Swiss Family Robinson, I picked out a tatty copy of Pride and Prejudice.

‘Here you are, Hassid. This is a piece of Englishness which I guarantee won’t corrupt you.’

Hassid looked eager and remembering his tendency to bestow on any light-hearted remark of mine the status of a logical truth, I put the book back. ‘Don’t worry, it’s not doctor’s orders!’

‘Bet you wish it was, though, don’t you, Dr McBride?’ Maguire was aware of my partiality for Jane Austen.

Hassid changed the subject. ‘Doctor, Lennie has asked me to go with him to the match on Saturday.’

‘Lennie the cleaner?’

‘Yes, Doctor.’

I glanced at Maguire who nodded.

‘Sure,’ I said. ‘I’ll let it be known you’ll be out for the day. I hope the home team wins.’

Hassid made off, presumably to find Lennie and deliver the news of my official blessing, and Maguire remarked that Hassid was ‘a nice kid’. ‘Nothing much wrong there that a few friends wouldn’t put right. He’s been chatting with your Mrs Cruikshank.’

‘They’ve something in common now. As I said, she was a librarian, too.’

‘Might she want to help with the books, then?’

I thought this unlikely but I didn’t want to quash Maguire who had a knack of getting recalcitrant patients out of themselves. I could tell she was longing to know how I was doing with this particular recalcitrant. ‘She’s clever, our Mrs Cruikshank. But she keeps her cards pretty close to her chest.’

‘The bright ones do. What’s in that bag she carries about with her all the time?’

‘I don’t know. How did she get it, do you know? Was it with her when she was brought in?’

‘Must have been. Unless it came with her other things. That army man who found her brought some of her bits over for her. Poor fellow. He was ever so distressed.’

‘Did you talk to him?’ Maguire was a conduit for information.

‘Not really. To be honest with you, he couldn’t wait to get away.’

‘I’m glad Hassid’s made her into a friend.’

‘I wouldn’t go that far,’ Maguire said. ‘Like you say, she keeps herself to herself.’

‘Funny, Lennie taking him up.’ I wondered how our cleaner would respond to Hassid’s learned dissertations. It was possible that Lennie’s less conventional mental processes would grasp Hassid’s quantum ‘reality’ more ably than mine.

‘Well, you know,’ said Maguire, ‘Lennie’s an outsider too. To my way of thinking, he’ll do the boy more good than that idle lot up at the university.’

Dan Buirski and I were booked to play squash that evening. He had a late clinic so I caught up with some admin for my secretary, Trish, while I waited for him to ring when he was ready.

I enjoyed my squash evenings with Dan. The exercise, for both of us, was an antidote to the tensions of work. He was a year or two my junior, better toned and fitter than I was, and his nature was more competitive. But I could usually give him a hard game and even occasionally beat him.

The phone rang and expecting it to be Dan I answered, ‘Ready when you are.’

‘Darling,’ said Olivia’s voice, ‘are you still squashing tonight?’

Olivia rarely rang me at work unless over some domestic crisis. ‘What’s up?’

‘Nothing’s “up”. I thought you might like me to collect you.’

‘That would be nice.’

She must have detected surprise in my voice because she said, a shade defensively, ‘My French class is just round the corner.’

Dan said Bar was out that evening so he and I had a drink while we waited for Olivia. She was flushed when she arrived and explained she’d had some difficulty parking and seemed genuinely bothered over keeping us waiting.

‘It’s all right,’ I said, ‘it gave this man a chance to buy me a consolation drink.’ I was aware my defeats at Dan’s hands might disappoint Olivia.

‘All’s fair in love and war,’ said Dan. ‘Olive Oyl, since you’re driving I don’t suppose you’ll want anything, will you?’

Dan’s teasing often had an edge to it and I expected this to annoy Olivia but she appeared to be in one of her accommodating moods and invited him back to our place with the suggestion that there at least we could have a decent drink.

While I was hunting for a corkscrew the phone rang and it was Bar. ‘Is my husband there, by any chance?’

‘He’s next door boozing with my wife. You’d better come over and keep me company.’

‘I’d love to but I’m exhausted,’ Bar said. ‘Tell him I’m home, will you, there’s a lamb. I’m going to take a drink into a hot bath.’

Olivia and Dan were laughing when I came back into the sitting room. I was glad to see them getting on for once.

‘That was Barbara. She says she’s too tired to peel out again to fetch you.’

I was going to add that I’d take Dan home myself when Olivia said, ‘I need to drop something off at the shop. I can give Dan a lift.’ She was trying hard that evening. It was nice of her to offer to go out again when I knew she must be tired.

‘It’s all right,’ I said, ‘I’ll run him home and drop whatever it is off for you,’ but then the phone rang again and it was Gus, fussing about the conference, and then Olivia came into the study and mimed that it was late by pointing at her watch and indicated that she would give Dan a lift after all.

She was a while returning and when she did I was engrossed in Mansfield Park. She went off to have a bath and I read on in my chair for a while so that by the time I came to bed she was apparently asleep and didn’t hear me thanking her for running Dan home.

9

CIRCUMSTANCES AROSE WHICH MEANT THAT I WAS OBLIGED to postpone my next appointment with Elizabeth Cruikshank.

In the days when social policy over the treatment of the mentally ill was more conservative, many hundreds of men and women in Britain had been confined to ‘care’ for the bulk of their adult lives. One of my duties at St Stephen’s, the hospital in Haywards Heath, was to monitor the patients who had been inmates so long that the hospital had become their only home. Among those whom it was my melancholy business to oversee, one case especially troubled me: a man who suffered from the unshakeable conviction that he had a wolf lodged in the upper portion of his skull. His behaviour was always perfectly docile but to his perturbed mind this phantom, to which he was the unwilling host, was a threat not to himself but to the world at large. In fact, as I had said in my report when he first became my responsibility, in my view he was now too institutionalised for the world to be anything but a far more serious menace to him.

Not long after my first encounter with this unfortunate, I found myself, due to some delayed appointment, killing time by visiting Whipsnade Zoo. It was a filthy November day and, walking briskly to keep my circulation moving, I landed up at the far corner of the zoo, by the enclosure which houses the wolves.

I was at once drawn by their lean shadowy forms and their long-legged stilted gait. But what held my attention most was the way their narrow, vigilant muzzles and haunted eyes put me in mind of this man, so much so that I began to speculate whether the captive creatures mightn’t suffer from the fantasy that they had a desperate human being trapped inside their skulls. Whenever I saw this patient now, I thought of those penned-in wolves. I could never decide whether it was the influence of the delusion or being confined like a beast which had rendered him so visibly lupine.

But that he was a harmless, docile wolf, I was convinced, and for more years than I could bear to calculate, he had been stashed away in the upper storeys of the hospital which had originally served as one of the big Victorian asylums.

St Stephen’s had retained in its running a remnant of the asylum policy wherein the madder the inmate, the higher up the large mock-Gothic pile they were placed; and, in the cases of the potentially violent, in locked wards, with confining cells, and with nurses trained to deal with any dangerous outbreaks. We even had restraining jackets, based on the old ‘strait’ kind, though as Gus once said, why a ‘restraining’ jacket was deemed to be less offensive than a ‘strait’ one, beat him. He and I agreed one evening, over a whisky or two, that if we were ever forcibly confined we would rather be straitened than restrained. (‘And while we’re at it,’ Gus had added, ‘what in God’s name is wrong with the old word “asylum”?’)

My purpose in visiting St Stephen’s was to conduct the long-term patients’ annual review, which had been scheduled for the following day. For the most part this meeting was a mere routine of briefly reviewing, and then renewing, existing measures—security levels, medication, treatment plans—but when the wolf man’s name came up I found myself asking, ‘Why, as a matter of interest, do we keep him on level five?’ Five was St Stephen’s top security ward.

I was the consultant and the person who’d known the wolf man longest and, as I had expected, no one had any answer to this question.

‘Have we any evidence of violence?’

Level five’s charge nurse, an Irishman with bad skin and reddish hair, said that, as far as he knew, we didn’t.

‘Has he been any trouble at all, Sean? Anything not on the record we should know about?’

‘Nothing, Dr McBride, so far as I’m aware. Though…’

‘What?’

‘He’s always saying he might do something. Or so I’m led to believe. Can’t say he lets on to any of us.’

‘But that’s his delusion, isn’t it? My point is, why are we pandering to it? We’ve never had the smallest peep out of him in all the time I’ve been here. I think we should try him out on level four, or even three, see how he goes. Anyone got any objections?’

I knew they wouldn’t have. And I caught the train to London with the self-satisfied feeling that I’d performed at least one valuable action that day.

The reason the meeting at St Stephen’s had had to be brought forward was because I was obliged to be in London the following day. I was to appear as an expert witness in a medical case, which gave me an opportunity to visit Gus.

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