Sister: A Novel Part 12

'Did you tell Tess that?'

'I suggested to her that might be the case, yes.'

'And she cried?'

He looked surprised that I knew. But I've known you all your life. At four years old you could have grazes on your knees, a b.l.o.o.d.y nose but you never cried - unless someone didn't believe you when you were telling the truth and then your streaming tears would express your outraged indignation.

'You said at the time you a.s.sumed them to be a cold caller or wrong number?' I asked.

'Yes. Later I realised that Tess wasn't depressed as I'd first thought, but was suffering from puerperal psychosis, more commonly called post-natal psychosis.'

I nodded. I'd done my homework. I knew that puerperal psychosis simply means the six weeks after the birth.

'Anyhow,' continued Dr Nichols, 'once I realised that she was suffering from puerperal psychosis I realised that the phone calls were, most likely, auditory hallucinations. In lay terms, "hearing voices" or in Tess's case the sound of the phone too.'

'You changed your diagnosis after she was found dead, didn't you?' I asked and saw a flash of emotion over his crumpled face, momentarily hardening it. There was a moment before he spoke.

'Yes. I think it may be helpful if I tell you a little more about puerperal psychosis. The symptoms can include paranoia, delusions and hallucinations. And the consequences, tragically, are a highly increased risk of suicide.'

From my own research, I already knew that.

'I'd like to get this clear,' I said. 'It was after she died that you changed your diagnosis from depression to psychosis. And it was only then that the phone calls became "auditory hallucinations"?'

'Yes, because auditory hallucinations are a symptom of psychosis.'

'She didn't have psychosis. Puerperal, or post-natal, or any other kind.' He ineffectually tried to interrupt me but I continued, 'How many times did you meet my sister?'

'Psychiatry isn't about intimate knowledge of a specific person, as you get in close friends.h.i.+ps or with family members, nor in acute cases is it anything like the long-term relations.h.i.+p a psychiatrist has with a patient as a therapist. When a patient has mental illness the psychiatrist is trained to recognise certain symptoms that the patient demonstrates.'

For some reason I imagined him practising all this in the mirror beforehand. I repeated my question, 'How many times?'

He glanced away from me. 'Just once. She was automatically referred to me, because of her baby's death, but she discharged herself from hospital almost immediately after the birth, so I couldn't visit her on the ward. She was given an emergency out-patient appointment two days later.'

'Was she an NHS patient?'

'Yes.'

'On the NHS your waiting list is four months. That's why I am paying to see you.'

'Tess was an emergency. All potential puerperal depression and psychosis cases are dealt with immediately.'

'Dealt with?'

'I'm sorry. What I meant was in terms of jumping any waiting list.'

'How long is an NHS appointment?'

'I'd rather have more time with each patient but-'

'With a waiting list of four months you must be under a great deal of pressure to get through them.'

'I spend as much time as I possibly can with each patient.'

'But it's not enough, is it?'

He paused a moment. 'No. It's not.'

'Puerperal psychosis is an acute psychiatric emergency, isn't it?'

I thought I saw him flinch that I knew this, but I'd done my research beforehand.

'Yes, it is.'

'Requiring hospitalisation?'

His body language was rigidly controlled, arms held determinedly at his sides, his corduroyed legs a little splayed, but I knew that he wanted to cross his arms over his chest, and put one leg over the other, to give physical expression to his mental defensiveness.

'Many psychiatrists would have interpreted Tess's symptoms, as I did, as indicators of depression rather than psychosis.' He absent-mindedly reached down and stroked his dog's silky ears as if he needed comfort and continued, 'Diagnosis in psychiatry is far harder than in other branches of medicine. There aren't any X-rays or blood tests to help us. And I didn't have access to her notes so I didn't know if there was a history of mental illness.'

'There isn't any history. When was her appointment with you?'

'The twenty-third of January. At nine a.m.'

He hadn't consulted his diary or looked at his computer. He had come prepared for this meeting, of course he had. He'd probably been on the phone all morning to his medical defence union. I saw in his face a beat of some genuine emotion. I wondered if it was fearfulness for himself, or genuine upset about you.

'So you saw her the day that she died?' I asked.

'Yes.'

'And you thought the morning she died that she was suffering from depression not psychosis?'

He could no longer hide his defensiveness, crossing one leg over the other, huddling into himself. 'At the time I didn't see any indicators of psychosis. And she didn't show any signs that she was considering hurting herself. There was nothing to suggest that she was going to take her life.'

I wanted to scream at him that of course there were no signs because you didn't take your life; you had it violently cut from you. I heard my voice sounding distantly quiet against the shouting in my head. 'So it was her death that rewrote your diagnosis?'

He didn't reply. I no longer found his rumpled face and corduroys endearingly scruffy, but hopelessly negligent.

'Your mistake wasn't that you diagnosed her with depression when she was actually psychotic.' He tried to interrupt me but I continued, 'Your mistake is that you didn't once think that she might be telling the truth.' Again he tried to interrupt me. Did he interrupt you too as you tried to tell him what was happening to you? I thought psychiatrists were meant to listen. I suppose in an emergency NHS appointment probably shoe-horned into a full clinic there's not much time for listening.

'Did you ever even consider that the phone calls threatening her were real just as the man who followed her to the park that day and murdered her was real?' I asked.

'Tess wasn't murdered.'

I thought it strange he was so adamant. After all, murder would have let him off the misdiagnosis hook. He paused, then forced the words out as if they physically pained him.

'Tess was having auditory hallucinations, which I've told you about, and we can disagree about the interpretation if you wish. But she was also having visual hallucinations. At the time I interpreted them as vivid nightmares, not uncommon for a patient who's depressed and bereaved,' continued Dr Nichols. 'But I've reread her notes and it's clear they were hallucinations, which I missed.' The beat of upset in his face I'd seen earlier seemed to spread across his features. 'Visual hallucinations are a clear signifier of acute psychosis.'

'What were the "hallucinations"?'

'I have to respect patient confidentiality.'

I thought it strange he suddenly thought of doctor/patient confidentiality when it hadn't hindered him up until now. I wondered if there was a reason for it, or if it was just another incidence of his incompetence.

'I asked her to paint what she saw,' he continued and his face looked kind. 'I thought it would be helpful to her. Maybe you could find a painting?'

The secretary came in. Time was up, but I didn't leave.

'You must go to the police and tell them you have doubts she had puerperal psychosis.'

'But I don't have any doubts. The signs were there, as I said, but I missed them.'

'You're not the reason she died, but you could be why her murderer gets away with it. Because of your diagnosis no one is even looking for him.'

'Beatrice . . .'

It was the first time he'd used my Christian name. The bell had been rung; it was after school, so now he could be intimate. I didn't stand up, but he did.

'I'm sorry, but I can't help you any more. I can't change my professional judgement because you want me to, because it fits with a construct that you have put onto her death. I made a mistake, a terrible misjudgement. And I have to face up to that.'

His guilt was seeping out around the edges of his words; a trickle to start with before becoming the mainstream subject. It looked as if it was a relief to finally give way to it.

'The harsh facts are that a young woman with puerperal psychosis went undiagnosed and I must take my share of blame for her death.'

I thought it ironic that decency can be harder to argue with than it's self-serving reprehensible opposite. The moral high ground is just too certain, however uncomfortable.

Outside the open office window it's raining, spring rain, collecting the scent of gra.s.s and trees before falling onto the concrete pavements below. I feel the slight drop in temperature and smell it before I see it. I have almost finished telling Mr Wright about my meeting with Dr Nichols.

'I thought he believed he'd made a terrible mistake and was genuinely appalled with himself.'

'Did you ask him to go to the police?' asks Mr Wright.

'Yes, but he maintained he was certain she had puerperal psychosis.'

'Even though it reflected badly on him professionally?'

'Yes. I found it surprising too. But I put his motive down to misplaced moral courage; agreeing with me that Tess didn't have psychosis but was murdered would be a cowardly option. By the end of our meeting I thought he was a hopeless psychiatrist but a decent man.'

We break for lunch, Mr Wright has a lunch meeting scheduled and I leave on my own. Outside it is still raining.

I never did answer your email and tell you the real reason I saw a therapist. Because I did go in the end. It was six weeks after Todd and I had become engaged. I'd thought getting married would stop me feeling so insecure. But an engagement ring around my finger wasn't the new hold on life I'd thought it would be. I saw Dr Wong, a highly intelligent and empathetic woman, who helped me understand that with Dad leaving and Leo dying within the s.p.a.ce of a few months it was hardly surprising I felt abandoned and consequently insecure. You were right about those two wounds. But it was being sent to boarding school, the same year, that felt the final abandonment.

During my therapy sessions, I realised that Mum wasn't rejecting me but was trying to protect me. You were so much younger and she could s.h.i.+eld you from her grief, but it would have been far harder to hide it from me. Ironically, she sent me to boarding school because she thought it would be emotionally more secure.

So with Dr Wong's help, I came to understand not only myself better but also Mum, and quick facile blame trans.m.u.ted into harder-won understanding.

The problem was, knowing the reason I was insecure didn't help me to undo the damage that had been done. Something in me had been broken, and I now knew it was well intentioned - a duster knocking the ornament onto the tiled floor rather than it being smashed deliberately - but broken just the same.

So you'll understand, I think, why I don't share your scepticism about psychiatrists. Although I do agree that they need an artistic sensibility as well as scientific knowledge (Dr Wong majored in comparative literature before going into medicine), and that a good psychiatrist is the modern version of a renaissance man. As I tell you that, I wonder if my respect and grat.i.tude towards my own psychiatrist coloured my opinion of Dr Nichols; if that's the real reason I felt that he was fundamentally decent.

I get back to the CPS offices earlier than Mr Wright, who hurries in five minutes later, looking ha.s.sled. Maybe the lunch meeting hasn't gone well. I presume it's about you. Your case is huge - headline news, MPs calling for a public inquiry. It must be a big responsibility for Mr Wright but not only is he adept at hiding the strain he must be under, he doesn't load any pressure onto me, which I appreciate. He turns on the tape recorder and we continue.

'How soon after your meeting with Dr Nichols did you find the paintings?'

He doesn't need to specify, we both know which paintings he means.

'As soon as I got back to the flat I looked for them in her bedroom. She'd moved all her furniture out apart from her bed. Even the wardrobe was in the sitting room where it looked ridiculous.'

I'm not sure why I told him that. Maybe because if you have to be a victim I want him to know that you're a victim with quirks, some of which used to irritate your older sister.

'There must have been forty to fifty canva.s.ses propped up around the walls,' I continue. 'Most of them were oils, some on thick board, a few collages. They were all large, a minimum of a foot across. It took me a while to look through them. I didn't want to damage any of them.'

Your paintings are staggeringly beautiful. Did I ever tell you that, or was I just too concerned that you weren't going to earn a living? I know the answer. I was anxious about no one buying enormous canva.s.ses with colours that wouldn't go with their decor, wasn't I? I worried that the paint was so thickly applied that it might snap off and ruin someone's carpet rather than realising you'd made colour itself tactile.

'It took me about half an hour to find the ones Dr Nichols had told me about.'

Mr Wright has only seen the four 'hallucination' pictures, not the ones you did before. But I think it was the contrast that shocked me the most.

'Her other pictures were all so . . .' What the h.e.l.l, I might as well go for it. 'Joyous. Beautiful. Explosions on canvas of life and light and colour.'

But you painted these four paintings in the palette of the nihilists, pantone numbers PMS 4625 to PMS 4715, the blacks and browns spectrum, and in their subject matter you forced the viewer to recoil. I don't need to explain this to Mr Wright, he has photos of them in the file and I can just glimpse them. Made smaller, and even upside down, they still disturb me and I look hurriedly away.

'They were at the back of a big stack. Paint from the front of one had smeared the back of the next. I thought that she must have hidden them quickly, before they'd had time to dry properly.'

Did you have to hide the woman's face, her gash of a mouth as she screamed so that you could sleep? Or was it the masked man, dark with menace in the shadows, who disturbed you as violently as he did me?

'Todd thought they were proof that she had psychosis.'

'Todd?'

'My fiance at the time.'

We are interrupted by Mrs Crush Secretary who gives Mr Wright a sandwich; clearly his lunchtime meeting didn't include any lunch and she has thought about this, looked after him. She barely glances at me as she gives me mineral water. He smiles at her, his open, winning smile. 'Thanks, Stephanie.' His smile is going out of focus. The office is dimming. I can hear his concerned voice.

'Are you all right?'

'Yes.'

But the office is in darkness. I can hear but not see. It happened at lunch with Mum yesterday and I blamed the wine, but today there's no scapegoat. I know that I must keep calm and the darkness will clear. So I continue, forcing myself to remember back - and in the darkness your dull-toned paintings are vivid.

I was crying when Todd came in, my tears falling onto the paintings and becoming drops of inky black and mud brown sliding down the canvas. Todd put his arm around me. 'It wasn't Tess who did these, darling.' For a moment I was hopeful; someone put them here, someone other than you had felt like this. 'She wasn't herself,' continued Todd. 'She wasn't the sister you knew. Madness does that, it takes away someone's ident.i.ty.' I was angry he thought he knew about mental illness; that a few sessions with a therapist when he was thirteen after his parents divorce made him some sort of expert.

I turned back to the paintings. Why had you painted them, Tess? As a message? And why had you hidden them? Todd didn't realise my silence had been filled with urgent mental chatter.

'Someone has to tell it as it is, darling.'

He'd got so redneck all of a sudden; as if being resolutely wrong was being masculine; as if he could turn the aftermath of your death into an Iron John weekend. This time he sensed my anger. 'I'm sorry, mad is maybe too blunt to describe it.'

At the time I silently and furiously disagreed with him. 'Psychotic' sounded far worse to me than 'mad'. I thought that you can't be psychotic as a hatter or a march hare. No playful light-hearted storybook images for psychotic. Nor was King Lear psychotic when he discovered great truths in the midst of his ravings. I thought that we can relate to madness as emotion experienced at an intense and troubling level, even respect it for its honourable literary pedigree, but psychosis is way out there, to be feared and shunned.