A Plea of Insanity

by Priscilla Masters

  ‘So two unhappy coincidences?’

  He nodded.

  She pursued the point. ‘You don’t think she’d planned to meet Gulio?’

  He frowned. ‘I don’t think so. But how can any of us know?’

  ‘Was Gulio considered a risk?’

  ‘Yes – no – yes. They all are. He was unpredictable.’

  ‘You have no idea then why he might have done it? Had they had words – a disagreement?’

  Fairweather shook his head. ‘No. Gulio was a quiet patient. He’d never been any trouble – not to us. But as I said – to some extent most of our patients are unpredictable.’

  A psychiatric patient who had carried out a frenzied attack, the Mirror had called it.

  But even scanning the newspapers she had not pictured it like that. A quick swipe with surgical precision and then the grotesque hanging of the body on the doorhook whispered to her of something else. Strange, odd, unbalanced but not frenzied. There had been no mention of multiple wounds. Only the one.

  ‘What were the circumstances of Gulio’s original conviction?’

  ‘He set on someone outside a nightclub. It was an unprovoked attack.’

  She had read the opinions of Gulio’s psyche. ‘A little like the original assault on him.’

  The papers had been full of it.

  ‘He fought the bouncers off too.’ Fairweather blew out a long sigh. ‘It was quite an assault. He’s just a skinny guy. After that it was obvious he’d get a custodial sentence and with his past we expected he’d end up with us. The rest, as they say, is history.’

  She nodded and moved on.

  ‘Did Heidi usually interview patients here, in her room?’

  ‘Oh yes. Quite often.’ He rubbed the side of his nose and sniffed – a gesture which reminded her of snuff-taking. ‘If she’d decided a patient needed further assessment or she wanted to take a certain line of enquiry or treatment a bit further. Heidi made her own rules.’

  This, Claire knew, was the truth. Heidi had been that sort of person. An innovator – a clear mind.

  ‘She had some amazing results.’

  Claire bowed her head almost in tribute.

  Fairweather crossed to the window. ‘She had this way, you know, of putting people at their ease. Asking the right questions. A way …’ He stared out at the crowded bench, ‘of getting right behind problems.’

  Claire shifted in her seat. She had encountered this before. Step into someone’s shoes and their colleagues made you feel unworthy. Well, she thought acidly and with a touch of jealousy, if Heidi had been such a paragon she shouldn’t have allowed herself to be in such a dangerous position. Immediately she felt guilty. Forensic psychiatrists are always in a position of potential danger. Any encounter with a patient was a scene of possible assault. They were, by nature, unpredictable and potentially violent. You do not always get fair warning that the pin is out of the grenade.

  She rested her chin on her hands, watched Fairweather flop back into the chair, threw the puzzle back at him. ‘Was there no clue – no suspicion that Gulio’s condition was worsening?’

  The little voice, insistent, nagging. Searching for something that might, one day, warn her.

  ‘Surely she should have picked up on something – poor eye contact, a detachment, flight of ideas, odd behaviour – something?’

  ‘She never said so, Claire. The police asked me to go through Gulio’s notes with them. He had a history of lashing out when roused but there was usually something which had sparked him off.’

  ‘Is it possible that Heidi said something to him that day which touched on a raw nerve? Maybe something about the original assault?’

  ‘Possible. Anything’s possible, Claire.’ A swift, charming smile. ‘But we’ll probably never really know the full circumstances. She hadn’t finished filling in her notes. Personally I would have thought Heidi was too experienced to have interviewed Gulio alone and away from his ward if she’d sensed that he was psychotic.’

  ‘What was the purpose of her interview that day?’

  ‘She hadn’t seen him for a week or two. She’d been away for a couple of days at a conference. She liked to see everyone at least fortnightly. She was considering altering his medication.’

  ‘Maybe he said something which made her decide against it?’

  Fairweather shook his head. ‘No. She’d already written that he would soon be ready for release back into the community. The entry was dated the seventeenth of March. I knew her writing well. There was no doubt about it. There was no reason for Gulio to attack.’

  Again she had this feeling of out of character. Gulio’s crimes were bar brawls brought on by a volatile nature.

  ‘Maybe he misunderstood what she was saying.’ She thought of Mavis Abiloney. ‘Or maybe he didn’t want to be released.’

  But instead of slashing his wrists he cut his psychiatrist’s throat.

  Rolf stood up to leave. ‘As I said – anything’s possible. He had been a bright guy. Heidi was quite fond of him.’

  Claire winced. Fond of him? Right up until the moment when he stroked her windpipe with a knife?

  Rolf shrugged, took a step towards the door, getting bored with the conversation. ‘Anything’s possible, Claire,’ he said gently. ‘But it’s time to move on now. We don’t want Greatbach to be forever linked with Heidi’s murder. We do some sterling work here. Our understanding of personality disorder is among the best in the country. We’re responsible for drawing up the guidelines for the release of Sectioned patients back into the community. This is an innovative unit.’ He took another step towards the door. ‘Besides,’ he said. ‘We’ve tightened up on things since Heidi’s death. A number of changes have been made. You aren’t allowed to see patients alone in your office any more. Either you see them in the interview room on the ward or a member of staff is supposed to be in with you.’

  ‘That’s unethical.’

  ‘Well – just outside the door. And as for ethics –’ There was a quick spark of anger. ‘What could possibly be more unethical than being murdered by one of your patients?’ He looked distressed. ‘Remember. I saw the crime scene that day. It will stay in my mind for ever. The bloody scene. Changes had to be made.’ He swallowed. We have CCTV along the corridors and they’re recording. All the time.’

  ‘And who’s watching them?’

  ‘The porters at the gate. They have the monitors there.’

  ‘But Gulio’s in prison,’ she objected.

  He’d reached the door. ‘Where Gulio came from there are more. People just like Gulio – and worse – are our speciality.’

  He opened the door, his foot almost through it already. ‘We usually have staff meetings every morning at nine-ish – to review cases and plan the day ahead. Hope that’s OK with you. We’ve found it worked very well for us – saved duplicating interviews etcetera.’

  ‘Fine.’

  ‘So – until tomorrow then?’

  She nodded.

  And was once again alone in the room.

  Chapter Two

  By lunchtime she was halfway through ‘G’ in the alphabet and felt she had a reasonable working knowledge of some of the inpatients. They were a motley assortment, many schizophrenics, depressives, severe learning disabilities, all with one thing in common – they had all committed a crime and were detained under Section 29 of the Mental Health Act because they were considered a danger either to themselves or to the wider community. As it had been months since Heidi had left quite a few were probably ready for discharge back into the community. Many were due for review. Claire heaved a big sigh. As always in the Mental Health Service she was aware of a heavy burden which never would lighten, decisions which were hers alone to make.

  At one Rolf knocked on her door and stuck his head round. ‘Sometimes we get sandwiches,’ he announced, ‘and eat them out of doors. Sometimes we eat in the canteen and at others we pop down the pub. I suggest today, as it’s your first day, that we get some sandwi
ches from the canteen and eat them in the quadrangle. Is that OK by you?’

  ‘Fine.’ She appreciated his friendliness. ‘Thanks.’ Then, ‘Are you in clinic this afternoon?’

  ‘Yeah – Outpatients – alongside you.’

  They queued with the inpatients, choosing sandwiches, yoghurt, a bottle of water for Claire and coffee in a lidded, cardboard mug for Rolf. Then they let themselves out into the quadrangle.

  Sheltered from breezes, yet catching the sun, over the wall the tops of the brick-built bottle-kilns just visible. They found an empty bench and sat at either end, their lunch between them.

  ‘So how long have you been here, Rolf?’

  ‘Eight years. It was my second job out of university. I knew instantly I’d stay. Interesting cases, experimental treatments, good senior support. I used to work under a greybeard called Hartshorn. Johnny Hartshorn. He’d written lots of books on clinical psychology. Was a bit of an icon. He left after a few years and I was lucky enough to get the job as a senior clinical psychologist. He was a big influence on my life. He’s well past retiring age now but I still keep in touch with him, ask his opinion on difficult cases. What about you?’

  ‘Oh – the usual. Medical degree, interest in psychiatry, Membership and so on. Good registrar post in Birmingham. And then, like you, my big chance. Here. Only six months too late to work under Heidi.’

  ‘Did you ever meet her?’

  ‘I’d been to lectures of hers, corresponded a little, asking for advice on the thesis I did for my MRC Psych.’ She recalled the small, plump, homely figure in black trousers and clinical white blouse with shining auburn hair which Claire had suspected was her vanity. Not commanding much attention until she opened her mouth and you listened to her words – and wanted to go on and on listening to them.

  Rolf chewed his sandwich with his mouth a little open, casually, like an American, unashamed of the food inside. ‘What was your thesis on?’

  ‘Personality disorder – treatable or not?’

  ‘Mmm. Big subject. No wonder you wanted to work with Heidi.’

  With her, she thought savagely. Not instead of her.

  ‘Exactly.’

  ‘But you still came – even though …’

  ‘I’ve always liked forensic work,’ she said a little defensively.

  He swivelled his head right round to look her full in the face. ‘Why?’

  ‘I think.’ She took a bite out of her ham sandwich and chewed it, cud-like, to help her work this one out. ‘I think it’s the edge. The danger. The little clues that mean so much. I like the clinical responsibility. The thumbs up, thumbs down bit. Freedom, incarceration. I don’t really know, Rolf. Only that it excites me. Interests me. It’s part of civilisation, this dealing with the aberrations.’

  ‘Mmm. Interesting.’ He dug a spoon in his yoghurt and shovelled some in his mouth, licking his lips now almost daintily.

  She swigged the water and knew she always found it difficult to explain why she enjoyed forensic work. All she knew was that crime – and its causes – fascinated her more than pure physical illness. It was less easy to diagnose and treat, more of a mystery. And being less exact there was more scope for personal intervention and innovation. She had always entered medicine with the explicit objective that she would one day understand the criminal mind. What made them lash out in the way they did.

  The shame was that it was rarely treatable.

  They swapped stories about their home life and she learned that Fairweather had lived with the same partner for seven years, (‘She’s a bit older than me, a professor at the university’) while she confessed that she was in a relationship, knowing he would read between the lines that she was bored with it.

  Before heading for the clinic she had been asked to see one patient on the ward, Mavis Abiloney, whom the staff said was agitated. Claire suspected that it was simply an excuse for the nurses to give her the once-over but she went anyway.

  She ran the gauntlet of the staff’s curious gaze and they directed her to the interview room. So this was the first of Heidi’s patients for her to meet. Claire introduced herself to the small, wrinkled lady who stank of cigarette smoke and screwed up her eyes to peer at her. Her hands were almost mummified, as dry, wrinkled and brown as a monkey’s paw. She was dressed in a black, stretch skirt with a seam wandering around the front, saggy where her seat was, a brown V necked sweater, low heeled shoes and thick brown stockings. Her hair showed half an inch of grey roots, the rest tidily hennaed and well cut into a short bob but dry as summer-straw.

  ‘I’m your new doctor,’ Claire said. ‘Here instead of Heidi.’

  ‘Better than that darky,’ Mavis responded moodily.

  Claire winced. Bob Karnoy had been the locum after Heidi’s death. She knew him vaguely from medical meetings. An intelligent, funny and competent doctor from Nigeria. Yet to Mavis Abiloney he was simply a ‘darky’.

  Thankfully our generation is more enlightened, she thought, in some ways. In others we are even less tolerant. Of poverty, obesity, death, illness and poor service. And as for smokers …

  She motioned Mavis to sit down. Little sparrow legs crossed tidily, hands dropped onto her lap, a tentative smile illuminating her face. Her eyes searched around for an ashtray. Claire did not oblige. For all her condemnation of intolerance she couldn’t bear the smell of cigarette smoke – even if the habit did help patients to relax.

  She opened the interview. ‘The nurses told me you were feeling agitated.’

  The fingers started to contort. ‘I knew you were starting,’ she said, dark little monkey-eyes darting around the room. ‘I was worried.’ Mute appeal in the eyes now, staring at her with desperate intensity. ‘I was afraid. I don’t want to go home,’ she finally blurted out.

  ‘Well – surely – you don’t want to stay here, Mavis?’

  ‘Why not?’

  ‘It’s for people who are sick.’

  ‘You know something of my history, doctor. You think I’m well?’

  ‘I think you are a woman who might consider restarting her life.’

  ‘You think that’s possible?’

  ‘With help, Mavis, and support.’

  ‘Huh.’ She tossed her head – and the idea – aside.

  Claire leaned in. ‘I’m going to do nothing hasty, Mavis,’ she said. ‘We shall talk with you and with the others and consider the best way forward.’ She had hoped this would relax her. Certainly the fingers were still again.

  A stay of execution.

  She smiled. ‘So-o … How are you feeling, Mavis?’

  ‘Not bad.’ It was at best a guarded reply. She wasn’t even near to trusting Claire yet as she had, no doubt, trusted Heidi.

  ‘What are you doing with your days?’

  The hands fidgeted again as though she was guilty about her inactivity. Eyes darted around, pinpointing various spots on the wall. ‘Plenty,’ she lied. ‘We talk. We watch the TV. I help cook the dinners – sometimes.’

  ‘Do you go out on the trips?’

  ‘When I want to.’ Evasive.

  ‘Where do you enjoy going?’

  ‘I didn’t say I enjoyed them,’ she snapped.

  ‘Where did you go last time you did go out?’

  ‘Ironbridge Gorge.’

  ‘When was this?’

  ‘Can’t remember.’

  ‘What did you think of it?’

  The brown eyes stared blankly back. ‘Think? I thought it was a lot of fuss about nothing. That’s what I thought.’

  ‘How are your family managing without you?’

  Eyes and head jerked along the skirting board now. ‘They manage.’

  ‘How would you feel about going home?’

  The two monkey paws took on a nervous life of their own, weaving fingers, wringing action. ‘You know what happens when I go home,’ she accused.

  ‘But you’ve been so well while you’ve been here. You’re stable on the new medication. I’ve been reading about you.’
>
  ‘I don’t think I should go home,’ she said firmly.

  Claire was aware that this was neither the time nor the place. She should be seeing the patients in the locked ward at two but sometimes patients open up more to a new doctor than the physician who has treated them for years. ‘Why not, Mavis?’

  ‘I – just – don’t.’ Said flatly. A blind ending.

  Claire drew in a deep breath. She was new here. It would take her some time to get to know the patients well, understand their circumstances. She took the easy option.

  She would talk to Rolf. ‘Perhaps we should meet again in a week or so. All of us together. In the meantime, Mavis, I want you to consider going home for a short, accompanied visit with one of the nurses here.’

  Panic in her eyes.

  ‘Will you think about it?’

  A nod and she was gone, shuffling from the room like a woman twenty years older.

  It was a short walk to the locked ward, where she was due to see four patients due for consideration of release. The first of these was Marcus Bourne. It sounded an innocuous enough name. But the story behind the ordinary name was not usual. Claire glanced through his notes. Newly on remand after stabbing his girlfriend in the lung with a penknife while they were leaving a nightclub. He’d inadvertently taken some Haloperidol which a friend had flogged him for five pounds telling him it was Temazepam and he’d been tipped into acute motor restlessness when she’d stopped to gossip to a friend. ‘She just wouldn’t stop talkin’,’ he’d told the arresting officer. ‘It was the only way to get her to hurry up.’

  The girlfriend had spent six weeks in hospital after contracting MRSA, the hospital superbug, in the chest wound. She had been badly scarred and would bear them for ever. The question was, how responsible for his actions had Bourne been at the time of the assault? There was no doubt that the balance of his mind had been temporarily disturbed, that he had voluntarily taken a substance but been deceived as to what it was and its likely effects. Should the charge really have been attempted murder? And the real question – How much of a danger would he be when released back into the community? After all Bourne had not gone out equipped to maim. He had been carrying a penknife – not a lethal weapon. How much was the drug responsible for subsequent events? There had been no previous convictions for violence. So while the lawyers argued the case she was left to assess the patient.