Cath Staincliffe: Go Not Gently

Moira’s tall, spindly frame filled the doorway. She came in hugging her doctor’s case and a Tesco carrier bag, and followed me through into the kitchen.

‘God, it’s years,’ she boomed, looking round.

‘Still the same,’ I said. ‘Besides, you’re always too busy and I’ve sort of lost the habit of inviting people round to eat.’

‘Should do it again,’ she admonished. ‘Social eating relieves stress.’

‘Depends who you do it with,’ I thought of the children, ‘and who’s cooking. What about Christmas dinner? That’s pretty stressful if you’re the one with the turkey.’

‘Family don’t count.’ She grinned, took off her jacket and scarf and draped them over one of the chairs. Pulled out another one and sat down. ‘Well?’

I explained to Moira the basic facts about Lily Palmer’s decline. Her fall, the dislocated shoulder, her move to Homelea and the change in her behaviour, the confusion, the loss of sparkle. How could I establish whether she was being treated competently?

‘Difficult. Find out what medication she’s on, the drugs and the dosage. People give bucketloads sometimes. Any of the things you mention could be side effects. See the GP. Ask for a diagnosis. What she first presented with, chronology of symptoms. Alzheimer’s, pre-dementia.’ She puffed her cheeks out with air then slowly released it. ‘Whole other ball game. There can be confusion after trauma – the fall, the move. Should have regained equilibrium by now. Two months?’

‘Yes.’ I picked a satsuma from the bowl. ‘Two since she moved, four since the fall.’

‘Don’t do anything drastic,’ Moira continued, ‘no sudden stop on medication. Who’s treating her? Own GP?’

‘I don’t know. Her friend said there was a matron at the home who ran the nursing side.’

‘She wouldn’t prescribe. But once she’d got something from the doctor she could reorder easily enough. Some people go on for years on drugs they should only have had for a couple of weeks.’

‘What about the dosages, if-’

Before I could finish Moira’s bleeper sounded. She switched it off and went to use the phone in the hall.

‘Woman in labour.’ She scooped up her jacket and case. ‘Every time I cover for Dr Wardle one of his mothers gets going. Have a look at these,’ she pushed the Tesco carrier across the table, ‘couple of years old. Most of it’s still relevant. Must go. Later. Ring me.’

I saw her out, watching as she folded herself into the little Fiat she drove.

Two of the books were on geriatric medicine, one of those covered mental health in particular. The other, Medicines, was a family guide. It listed common drugs and what they were used for, and each entry included all of the side effects that could occur. Enough to put anybody off rushing out to buy all those over-the-counter drugs advertised on the telly.

I made a cup of tea and joined Ray in the lounge. He was sprawled on the sofa watching the news. Toys were still scattered about, and plates with remains of crumpets

‘Home visit?’ he asked.

‘No, picking her brains. I’ve got a new case needing a bit of medical background. You know you’ve still got paint in your hair.’

‘Where?’ He ran his hands over his dark springy curls.

‘There, at the front.’

He stood up and peered in the mirror. ‘I told them not to start the painting yet. It’ll only need doing again, there’s that much dust flying around.’ He smoothed his moustache. ‘But they’re in such a hurry. Bonuses for bringing it in by the end of March.’ In between making his own wooden furniture to order Ray took on sub-contract work with a couple of builders.

He bared his teeth, turned his profile this way and that.

‘Ray!’

‘What?’

‘Preening.’

‘Just checking.’

‘What? That there’s no paint on your teeth. You’re just vain.’

‘No. Careful with my appearance. It’s in my blood, style, all Italians have it. You English have no idea.’

‘Yeah, yeah, yeah.’

He turned back to the mirror to smooth his hair again. Bit pointless. Then whistled the dog. Digger came bounding in, Ray did something playful to his ears and the two of them went off for walkies.

I put Moira’s books on one side then swept toys into one corner of the room where I couldn’t actually see them from the sofa. I removed crumpets and crockery. There was nothing worth watching on television so I watched nothing for half an hour. My yawning reached chronic proportions.

In bed I guzzled a couple of chapters of my library book. When the print began to blur I switched out the lamp and hugged the duvet to me.

I could hear the dog down the street yapping. On and on. I felt my shoulders tense with irritation. Noise pollution. Why couldn’t they just let the creature in or remove its vocal cords? I’d time it tonight. Begin to gather hard facts so I could challenge the neighbours. See how long it kept me awake. It was too much effort to lift my head up to read the clock. I fell asleep.

I rang Rachel, my social work contact, at ten a.m. She was busy for the rest of the day: visits, case conference, court reports, the lot. After further prodding and a promise to foot the bill I persuaded her to meet me for lunch the following day. Her office is in Longsight, mine in Withington. We agreed on a friendly Greek restaurant in Fallowfield, midway between us.

I stuck some washing in the machine, then sat in the kitchen and browsed through the books that Moira had left. It became clear that dementia wouldn’t have resulted from either Lily’s fall or from leaving her home. But both the books listed two types of dementia, Alzheimer’s and something called acute confusional disorder. The latter could result from physical illness, like a severe infection or as a reaction to drugs. So it could be treated and would stop, unlike actual senile dementia.

Agnes had described Lily’s decline as rapid, the books said Alzheimer’s developed slowly over several months. But Mrs Valley-Brown had told Agnes that Lily had Alzheimer’s disease, the commonest form of dementia. Presumably the GP knew how to tell the two states apart and for some reason they’d discounted acute confusion. I understood Agnes’ disquiet: at first glance the facts didn’t appear to add up.

I opened my notepad and listed the questions we needed answers to. The more I thought about it the more likely it seemed that there’d been a misdiagnosis. That an untreated illness or an adverse reaction to medication had led to Lily Palmer becoming troubled, confused, unlike her usual self. If we could establish the cause and treat it then Lily would get better and Agnes would have her old friend back. It wasn’t right: Agnes had been anxious enough to come to a private investigator when the Homelea staff dismissed her concerns. They should have been on to it straight away.

I switched the washing to the tumble dryer in the cellar, then made a quick foray to the shops on my bicycle. Withington is a real mix of taste and tack. Discount shops selling brightly coloured, semi-disposable goods made in China and the Philippines nestle cheek by jowl with more upmarket outlets: delicatessens, health food shop, designer clothes boutiques.

I bought pasta, cheese and milk from the small supermarket, then negotiated my way to the greengrocer’s. The pavements were narrow and crowded with shoppers. I wheeled my bike along the gutter to avoid colliding with anyone.

I was tempted by gleaming displays of avocados, imported beef tomatoes, limes and grapes, by bright bunches of hothouse herbs, but I resisted. Our budget rarely ran to the exotic end of the stall. If it was in season or on offer we ate it. Cabbage, carrots, turnips, onions. Fruit was the exception as the mainstay of the battle against tooth decay: ‘No you can’t, have some fruit.’