Hayley had tried to hide her disappointment by passing a hand in front of her mouth, but Claire had noticed the swift movement and had mistrusted the girl.
The plan had not worked then.
And now?
It looked as though her life teetered even more on the brink than usual.
She glanced at her watch. No time for reflection. Time for the multidisciplinary meeting about Stan. Another of her concerns.
She listened to one after the other of the reports.
As she had feared, Stan’s paranoia had intensified and now was focused largely on the staff. He was convinced they were plotting to kill him and this had made him aggressive and difficult to manage. Claire was reluctant to sedate him merely to regain control. In fact the guidelines had recently tightened up over the sedation of difficult-to-manage patients. These days the old-fashioned ‘chemical cosh’ was actively discouraged, viewed as robbing patients of their human rights. But it could be difficult finding a compromise between protecting the staff of Greatbach and preserving patients’ rights. It was a balancing act. Currently Stan was detained under a Section 3, for his own protection initially; but since his behaviour had become more aggressive, it could also be justified on the grounds of protecting the public at large. There was no question of him going anywhere. Physically he wouldn’t cope. These days he could only be attended by two nurses at a time and was kept in the locked ward. But Claire had noticed his deterioration and had been wondering. Was Salena right? Was there another reason – apart from misuse of drugs – for his deteriorating condition and worsening behaviour?
And then there was the matter of that one, solitary fit he had suffered.
TWENTY-THREE
They were halfway through the case conference on Stan when Rita knocked on the door and whispered that DS Willard was outside, wanting to talk to her.
‘Make him a coffee,’ she whispered back. ‘And tell him I’ll be just ten minutes.’
Rita melted away and they continued.
Salena Urbi, her registrar, had previously worked at Broadmoor and was well used to the management of violent, paranoiac patients, so Claire let her take the lead on Stan. ‘It’s his unpredictability that makes him difficult to manage,’ she said. ‘One minute he’s a charm offensive, quiet and polite, the next he’s lashing out.’ She frowned. ‘It’s a sort of blind fury. He doesn’t target particular members of staff. It can be anybody.’ She was thoughtful. ‘It’s only a matter of time before he causes someone serious injury.’ She looked at Claire. ‘I wondered whether we should consider referring him to Broadmoor. What do you think?’
Claire was silent for a minute then she held up a finger. ‘I just want to run something past you all,’ she said. ‘Salena, Teresa, Astrid …’ The forensic psychiatric nurse glanced across, impassive. Since Claire had spoken to her, relations between the two had remained strained.
‘And you too, Siona.’ She smiled. ‘And you, Edward.’
Edward responded with his usual gentle form of politeness. ‘I’m all ears.’
She had their full attention.
‘When Stan was admitted, we knew that he had a long history of drug taking, both hard and soft drugs, heroin, cocaine, hash, meow-meow, ketamine and so on.’ She couldn’t resist a swift grin. ‘He’d tried just about everything. And we also know that many of these drugs have long-term side effects – in particular, paranoia.’ They were all listening with rapt attention now, waiting for her point. ‘But once we’d sorted out the cold turkey bit, his mental state initially began to improve.’
There were nods of agreement and she continued. ‘But over the last three weeks he’s been getting worse. More unpredictable, more violent.’
Again nods of agreement.
‘We know from his blood tests …’ she gave a cynical smile, ‘and the fact that he has no visitors that he has no access to further illegal substances here, so it isn’t that.’
They all frowned, thought about it, nodded.
‘And then there’s that fit.’
Silence until Edward said casually, ‘Could have been a result of withdrawal. It’s not uncommon.’
‘Yes – but … you know the old adage. Exclude the physical before you focus on the psychological.’
There were grudging nods of agreement and she continued. ‘I just wonder if something organic is happening.’
Siona spoke for all of them. ‘Such as?’
‘I was considering two options,’ Claire said. ‘One is that he has some form of degenerative disease such as early Alzheimer’s due to his substance abuse.’
‘And the other one?’ Again Siona spoke for all of them.
And this was more difficult. ‘I’m worried he has a brain tumour.’ She looked around the room and read varying degrees of surprise.
Salena Urbi was frowning. ‘But I’ve seen no physical signs,’ she said. ‘No ataxia; his pupils are equal and reacting normally to light. His gait is normal.’
‘Come on, Salena,’ Claire said, ‘you know as well as I do that Stan Moudel should have a brain scan.’
There was a pause for thought around the room and then slowly they all agreed. And, as they all agreed, they also knew that they would never be able to scan his brain without a general anaesthetic. There was no way Stan was going to keep still and allow himself to be subjected to a brain scan. It was going to be complicated. And then there was the question of capacity. Did Stan have the capacity to accept or decline a test? Would he understand the implications of a further diagnosis?
Probably not, so they were almost certainly going to have to make the informed decision for him.
But in the end there were nods of agreement right round the room. Claire stopped speaking. Doomed. Together with ‘homeless’, it had been the adjective used to describe Stan. She gave Astrid another hard stare. The nurse looked away.
These meetings were an opportunity to keep the staff up to date with all their patients. Claire drew breath. ‘I’m afraid that Dexter Harding failed to turn up for yesterday’s appointment. Felicity doesn’t have a clue where he is. He’s not been seen at the hostel since the weekend. He’s still under a Community Treatment Order. As he has broken the terms of this, the police have been alerted and a DS is waiting outside to interview me. I don’t need to tell you this is bad news,’ she said. ‘He’s under our supervision and, considering his violently doltish history, I’m just hoping he isn’t planning something as misguided and dangerous as before.’ She paused, suddenly worried at her phrase. What exactly was Dexter up to? Why had he defaulted on yesterday’s appointment when for two years he had never even been late?
What cataclysmic event was about to happen? ‘I don’t suppose any of you can shed any light on this?’ But there were only shakes of the head and blank looks. She moved on. ‘I had another DNA in clinic, who is less of a concern. Maylene Forsyte, a histrionic personality.’ She frowned. ‘I don’t think any of you know her.’ The expensive butterfly. Or did they? Again she focused a sharp look in Astrid’s direction but again her face was bland – almost uninterested.
The others were more engaged, so she filled them in. ‘She’s never been an inpatient. She’s a fantasist who has also lived a fantastic life. Her husband is extremely long suffering, but I don’t have any concerns for her safety. And she’s no danger to anyone.’ She hesitated, reluctant to conjure him up. ‘And then there is the newly married Jerome Barclay.’
She didn’t miss the worried glances exchanged between the members of staff or their deliberate silence. Unlike Heidi, her predecessor, they had never seen Barclay as much of a threat.
None of them saw why he should be under any sort of supervision order, apart from a purely voluntary one; it had been partly due to their opinion that Claire had been persuaded to let him off the leash, realizing that there was no solid reason for – or benefit to be gained from – continued contact. She knew full well that she didn’t have the backing or the sympathy of her colleagues, and her clinics were always
overbooked. They were all urged by the Hospital Management Team to avoid following up patients unnecessarily so appointments could be freed up for new referrals.
Her colleagues had responded in various ways when she had mentioned she was going to his wedding. Astrid and Edward had wondered why she had been invited but had not ventured an opinion. The rest had responded with various degrees of interest – or lack of it. They all had enough of a caseload without concerning themselves with Jerome Barclay. On that one, at least, she was on her own.
Worse was the fact that she believed one of them had spoken to Barclay, given him details of some of her patients. This was not just unprofessional – in Barclay’s case it was dangerous. So who, out of this circle of colleagues, was communicating with Jerome? Edward? She glanced at him. He returned a smile. No, surely not Edward.
Salena? She smiled as her eyes rested on her registrar. No way. She dismissed this without any thought. She would trust Salena with her life.
Teresa? She eyed the nurse with her long dark hair, slightly plump in jeans and a shirt. Teresa was looking thoughtful, frowning. But Teresa was a good sort. Reliable.
No, for her money, it was Astrid. The nurse had pointed features which tended to make her look angry. Disgruntled, envious, as though she should be earning more money, working less hard, having a more successful life, more recognition. She had a chip on her shoulder. Why had she left Broadmoor and moved here, to Stoke-on-Trent? She wasn’t a native of the Potteries. She had not been promoted; she wasn’t earning more money. She never seemed as though she enjoyed her job, so why was she here? What was behind this woman? More importantly, was this chip large enough for her to risk her career by leaking information to a psycho like Barclay?
All questions to be considered and then, if possible, answered.
But ruminating who was sharing information with Barclay was alienating her from her colleagues.
It was by planting these poisonous seeds to sprout and grow inside her brain that Jerome Barclay had successfully driven a wedge between her and them. But this suspicion not only isolated her from her colleagues – even she had to acknowledge that her behaviour was bordering on the paranoid. This is what happens when you do not know whom you can trust. You soon come to think you can trust no one, soon believe you are surrounded by enemies.
She returned to the present and their mainstream inpatients. ‘Salena, perhaps you’ll try and arrange Stan’s brain scan?’
‘I’ll do my best,’ she said, ‘but I think he’ll be passed from pillar to post. No one’s going to want to pick him up.’
‘I know that, but just remember after he’d been in and clean for two months, he was becoming quite a reasonable man. I was hopeful we’d be able to rehabilitate him, get him into Psyche-o-more, but we can’t send him there while he’s like this. We either have to sort him out and treat him, or consign him to Broadmoor. Let’s just make absolutely sure we’re not missing any pathology.’
There was a moment’s silence before they moved on again.
She filled them in on Hayley’s latest progress report and watched all of them look reflective. Teresa spoke for all of them. ‘What’ll be will be,’ she said. ‘She’ll eat or she won’t eat. Live or die. We’ll just have to see how she does, and if she does get well enough for us to discharge her again, she’ll decide for herself.’
There was no answer to this. In the end humans do have a choice to live or die.
TWENTY-FOUR
4 p.m.
Detective Sergeant Zed Willard proved to be a bulky man with unruly dark hair and a pair of honest-looking large blue eyes that gave him a look of boyish innocence. He quickly got to the point, took down her details and made notes.
‘When did you last see Mr Harding, doctor?’
‘Two weeks ago yesterday. I have to see him every fortnight.’
‘And the community nurse …’ He consulted his notebook. ‘Felicity?’
‘She makes contact with Dexter every couple of days. If she’s on annual leave someone else keeps an eye on him. And of course the hostel would report back to us if they had any concerns.’
The blue eyes fixed on hers. ‘So what’s his daily life like?’
Claire sighed. ‘Not great,’ she confessed. ‘He’s pretty much unemployable once we’ve disclosed his mental history. He lives at the hostel in Hanley and goes to a day centre a couple of days a week. The rest of the time he’s supposed to be on a literacy course, but he often doesn’t turn up.’
DS Willard looked up. ‘Literacy course?’
‘That’s how we believe he torched the wrong house,’ Claire said. ‘He can’t read numbers and certainly not words.’
‘I see.’ DS Willard frowned. ‘So … mobile phone?’
‘He gets a friend to punch in the numbers. He can’t text.’
‘Or travel?’
‘With difficulty.’
‘Can he drive?’
‘Not legally,’
DS Willard drew in a long, deep breath and asked the million-dollar question. ‘How dangerous is he, Dr Roget?’
‘Claire, please.’ She was warming to the detective’s blue eyes; such innocence in a policeman was rather endearing.
He was waiting for her response.
‘It’s hard to say,’ she said. ‘He tends to lash out when disturbed or upset. The arson attack supposed to be on his ex-girlfriend’s house was quite something for him – the planning, the buying of the petrol and even the act itself.’
Something seemed to strike Willard. ‘The ex,’ he said, frowning slightly, ‘is she still around?’
‘I believe so.’
‘In your opinion, doctor, is she in danger?’
‘I don’t know,’ she said frankly. ‘The original crime was five years ago. He’s certainly been compliant for the two years he’s been under my care. But …’ And she felt the heaviness of her job pressing like a lead weight on her shoulders.
After a moment’s silence, Willard took out a Tablet and looked at her expectantly. ‘Her name?’
Claire frowned. ‘Sheridan,’ she said. ‘Sheridan Riley.’
Willard typed the name into his Tablet. ‘She lives in Blurton,’ he said. ‘Maybe we should get over there, take a look …’ his eyes met hers. ‘Just as a precaution.’
She smiled acquiescence.
‘Has he ever missed before?’
She shook her head. ‘When he came here I spelled out in no uncertain terms what the conditions of his Community Treatment Order were. I told him then that if he missed an appointment the police would come looking for him and I had the power to detain him under Section Three of the Mental Health Act.’
DS Willard looked at her curiously. ‘And how did he respond to that?’
‘He didn’t have much choice, DS Willard. He agreed to it.’
‘You have a lot of power.’
She smiled wearily. ‘It doesn’t seem like power, Sergeant Willard. It seems like a responsibility, doing your best to protect the public in general.’
‘So …’ he said slowly, ‘the public in general. Are they in danger now?’
‘I don’t think so but I can’t be sure.’
‘And Sheridan Riley?’ he asked reflectively.
‘If she’s living in Blurton, he’s had plenty of opportunity to contact her before now.’
‘Maybe,’ DS Willard said tentatively, ‘something’s happened to trigger him off?’
‘Hey,’ Claire protested, smiling now. ‘Who’s the psychiatrist here?’
‘We’re all psychiatrists,’ Willard said soberly. ‘In the Force we try to anticipate crimes, look into someone’s actions, prevent crime if possible, look for motive and habit.’ He made an attempt at levity. ‘The old MO. You know what I think …’ There was the tiniest hesitation and a small, tentative smile, ‘Claire? I think we’re all psychiatrists.’
She liked the blue eyes more at this comment and the regular white teeth even more than the eyes. ‘That’s a very profound thought
, Detective Sergeant Willard.’
He looked embarrassed, then laughed. ‘Oh, I’m deep,’ he said self-deprecatingly. ‘Deep as ditchwater. Now …’ His manner became more business-like. ‘We have a photo of him back at the station which we’ll circulate. This—’ he handed her a card – ‘is my mobile number, station extension and email address. You can get me any time if he turns up. Umm …’ He hesitated then grinned. ‘I’ll need some way of getting hold of you.’ He tried her name out again, ‘Claire.’
‘Yeah.’ She gave him her card with all her details, plus Rita’s telephone number. He pocketed it carefully. ‘Good,’ he said. ‘Thanks. I also have Felicity Gooch’s contact details. If you or she hears anything, I would appreciate it if you would get in touch with me right away. But actually …’ He looked uncomfortable. ‘I’ve read the report of the house fire. I’m really not sure this guy should be out there at all, walking the streets.’
‘Neither am I,’ Claire confessed. ‘I’ve always had my reservations, but he had a very powerful counsel who made much of his compromised mental state. An IQ of seventy, illiterate. Evoked some pity amongst the jury. And then there were the inevitable—’ she wiggled her fingers – ‘“voices”. Before we knew it, having basically murdered four completely innocent people, he was walking free.’
She was silent for a moment while DS Willard watched her curiously, wondering. The truth that lay beneath was her misgiving that the nationality of the murdered family, Iraqi Kurds, might have played a part in the light sentence. It was something Claire had always been concerned about. Human rights are human rights. They shouldn’t depend on class, colour or creed. But it could be hard to treat all people exactly the same. Had they been a middle-class English family of four, she had always felt the sentence would have been life with no get-out-of-jail card – whatever his circumstances. ‘And then he was out on the streets again under a Community Treatment Order.’
‘So if he doesn’t comply, you said the terms are …?’
‘We can readmit him.’
Dangerous Minds Page 13
