Cath Staincliffe - Go Not Gently

‘Are you sure?’

‘Yes. I know a lot of my generation like to keep to the formalities but it really doesn’t matter any more. There’s hardly anyone left to call me Agnes now, you know.’

‘OK. How was Mrs Palmer on Tuesday?’

‘Very restless. Other times she just dozes off.’

‘That could be the side effects of the medicine. Anyway, I just want to meet her today and get a look at the place. I’ve had a word with a GP I know and she’s suggested we find out from Mrs Palmer’s doctor exactly how the trouble started and what drugs she’s on. It’s possible that there’s been a wrong diagnosis and that she hasn’t got Alzheimer’s at all. I was reading this book…’

‘Acute confusional disorder,’ said Agnes.

‘Yes.’ My surprise showed.

‘I’ve been reading too,’ she smiled. ‘I got some books from the library.’ She pointed. ‘It’s left here.’

We turned into a gravelled driveway between large stone gateposts. I parked in front of the house. It was a huge place with outbuildings beyond and a conservatory along one wall of the house. Homelea was probably built by one of the Manchester merchants, a visible statement of his wealth and success. It even boasted a small turret on one corner.

I let Agnes lead the way. There was a ramp as well as steps up to the front porch. Agnes rang the bell. The door was opened promptly by a young woman who recognised her and invited us in. She disappeared. My first impression was of warmth and tasteful decoration, everything in cream, pale green and rose. The aroma of fresh coffee. The broad entrance hall had a large room off to each side, stairs ahead and more doorways at the bottom. Those led to the kitchen and dining room, I assumed. The door to our right was closed; I could hear the murmur of television. But Agnes went through to the room on our left.

This was a corner room with two bay windows. In the recess of the one at the front there was a table with high-backed chairs. A woman sat writing. In the other bay two women, deep in conversation, sat on a chintz-covered sofa. Each held a cat on her lap.

Around the rest of the large room were three clusters of high-backed easy chairs and side tables. People were sitting in some of these, reading papers and books, sewing and playing chess. The atmosphere was relaxed, quietly busy.

‘She must be in the other room,’ said Agnes.

We crossed the hall and opened the door. The room had the same decor but a semicircle of chairs faced us, arranged to focus on the television set, which was blaring out. There were six people there. A couple looked up as we went in. Agnes moved over to the woman sitting nearest to us, on the outside of the group.

‘Lily, hello. How are you?’

The woman turned to face her. She stared blankly, unwavering, at Agnes for two or three seconds then turned back to the television set. I heard Agnes sigh. I put my hand on her arm. The poor woman. Her closest friend had no idea who she was.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘Who’s her doctor?’ I asked.