Go Not Gently

by Cath Staincliffe

  Agnes followed me back to the reception area. Mrs Li told us that Lily had fallen early the previous evening. Dr Montgomery had been at the Unit and was able to assess her immediately. He recommended her transfer to the Manchester Royal Infirmary. He suspected that the fall had caused a small bleed to the brain. A scan and X-rays would show whether that was the case and whether there was any need to operate.

  ‘Oh, my goodness,’ said Agnes, ‘how is she? How did she fall?’

  ‘I really don’t know, I wasn’t here. We do get a lot of falls,’ she tried to reassure us, ‘problems with mobility. It was fortunate she was seen so promptly and I’m sure she’ll get the very best treatment there. She’s gone to the Regional Neurosurgery Unit, Mr Simcock’s the consultant. He’s very good,’ she persisted, ‘one of the best neurosurgeons there is anywhere.’

  The phone rang and we waited while she answered it.

  A woman with ill-matched clothes and lank grey hair had been hovering nearby, muttering repeatedly to herself. She moved closer, her hands clasped in front of her.

  ‘Did she fall or was she pushed? Answer me that. Humpty Dumpty fell, Baby Bunting fell, atishoo, atishoo, all fall down. They fell. She didn’t.’

  ‘Lily,’ I said, ‘Lily Palmer, did you see what happened? Did she fall?’

  The woman shook her head on and on. Did she mean Lily hadn’t fallen or that she hadn’t seen anything?

  ‘I do not like thee, Doctor Fell, the reason why I cannot tell; But this I know, and know full well, I do not like thee, Doctor Fell. They took her, just like that.’ She kissed the air, turned and wandered away. It was impossible to know whether she really had something to tell us or whether she was living in a world of her own.

  Mrs Li finished her call. ‘I’m sorry, is there anything else?’

  I asked her which ward Lily was on.

  ‘I’m not sure. If you find the Neurosurgical Unit and ask there, they’ll tell you.’

  It was a fairly direct route up Princess Parkway towards Manchester and the Infirmary. The dual carriageway was always busy; it was one of the main links to the airport and motorways.

  ‘That woman,’ I said, ‘the other patient, she seemed to think Lily hadn’t fallen.’

  ‘Or that she’d been pushed?’ Agnes sighed. ‘It’s one thing after another. First her getting ill, then she’s so bad they send her to Kingsfield, now this…I do hope she’s all right.’

  ‘She has fallen before,’ I pointed out. ‘She can’t have been that steady on her feet. It could well be just one of those accidents.’

  ‘I wish there’d been someone…’

  I braked sharply to avoid the lorry ahead, whose brake lights were conveniently covered by a lowered tailgate. ‘Sorry, go on.’

  ‘It would have helped to talk to someone who’d been there

  at the time,’ she said. ‘I didn’t get any idea of how serious it

  might be.’

  ‘I don’t think they’d take her in so quickly unless it was urgent. But Mrs Li said they’d do X-rays and scans before they decided if surgery was needed. I suppose they’ll know from those how bad she is. It sounded as if she might be all right without any operation.’

  ‘Oh, I hope so. You know, if they are doing a scan,’ she said, ‘they should also be able to see whether there are changes in the brain, lesions or plaques they call them. There were pictures in one of those books I read. They show up quite clearly on scans, apparently. It could confirm once and for all whether Lily has got Alzheimer’s.’

  ‘You’re still not convinced about that?’

  ‘No. Not until they prove it to me.’

  ‘But Dr Montgomery, he thinks it’s Alzheimer’s, doesn’t he?’

  ‘Yes. They all do. Charles said they were intending to book Lily in for a scan eventually to look at the extent of the disease but she’d have to go on the waiting list. It’s an expensive piece of equipment.’

  We reached the Moss Side junction and I turned right past the old Harp Lager place and into Moss Lane East.

  ‘And eighty-five-year-olds aren’t exactly a high priority,’ she added dryly.

  Manchester Royal Infirmary, another redbrick Victorian edifice, sits on the fringe of the university sector just up the road from the Rusholme curry shops. Day and night flocks of students can be seen parading to and from lectures and social events. We parked in the car park at the back and made our way to the main corridor. Murals and mosaics relieved the monotony of the long walk to the ward. The wide corridor bustled with a mixture of staff in various uniforms, visitors in everyday clothes and patients in varying degrees of undress – often swathed in cellular blankets.

  At the Neurosurgery Unit we stopped off at the nurses’ station. Four nurses were there. They appeared to be discussing papers and one of them was standing and entering notes on a white-board. She looked across as we hovered at the door.

  ‘Can I help you?’

  ‘We’ve come to see Mrs Palmer,’ said Agnes. ‘She was transferred yesterday evening from Kingsfield.’

  ‘Oh yes, she was admitted last night,’ said one of the seated nurses.

  ‘She’s gone up, I think,’ said another.

  ‘Yes,’ said the nurse at the wall, ‘she’s in pre-op at the moment. It could be quite a while before she’s through. There’s a waiting room round the corner or you could ring in later.’

  ‘Is there someone we can talk to?’ I asked. ‘We’ve only just heard about the fall. We don’t know any of the details.’

  ‘I’ll see if we can get one of the doctors down to have a word. Would you like to take a seat in the waiting room?’

  We went into the lounge, which was empty apart from one woman in a tartan tracksuit watching a quiz show. There was a drinks machine in the corner. I got us each a dubious-looking tea, then went off in search of the toilet.

  When I came back Agnes was sitting ramrod straight, looking anxious. ‘I’ve just seen Dr Goulden,’ she said.

  The tracksuit woman flicked her eyes our way, obviously interested by the tone in Agnes’ voice.

  ‘With another man, very tall,’ said Agnes.

  ‘Moustache?’ checked the woman.

  Agnes agreed.

  ‘That was Mr Simcock – he’s the brain surgeon. They reckon he’s up for a knighthood. Ahead of his time and all that.’

  ‘You know him?’ I asked.

  ‘He’s looking after my dad. Simcock’s done his very best for him. Four operations he’s had, counting the one today. Four. Last one took eight hours. Brilliant man. If he’s on your case you know you’ve got the best.’ The credits rolled on screen. ‘Time for a fag,’ she laughed and padded out the room.

  ‘Which way did they go?’ I asked Agnes.

  ‘That way – towards the main corridor.’

  I had a look round but the two men had gone. Why on earth would a humble GP like Goulden be here with the great brain surgeon? My scant knowledge of how the NHS worked told me that GPs and consultants usually communicated by letter, not in person. I determined to find out a bit more about Simcock and Goulden.

  It was almost half an hour before a fresh-faced junior doctor appeared and introduced himself to us. We asked him to tell us what he could about Lily.

  ‘She was admitted after a fall,’ he began. ‘I think Dr Montgomery suspected there might have been a small bleed, what we call an extradural haematoma. She’s in theatre now so they’re probably removing a clot and they may need to tie off an artery.’

  ‘But you’ve not seen her?’ Agnes asked.

  He hesitated. ‘No. Mr Simcock did and he’s doing the operation. I’m afraid I don’t have her notes here so I can only give you a general idea of what’s going on.’

  ‘Can’t we see Mr Simcock?’ said Agnes.

  ‘I’m afraid he’s got a very busy schedule today. If you make an appointment, that would probably be best.’

  ‘How serious is it?’ I said. ‘Is this…is it life-threatening?’

  ‘It
can be, yes. The fact that she’s been seen quickly and that she’s not in coma so they’ve been able to operate, those are grounds for optimism, but there’s no denying it is a critical situation. They could be up in theatre for a while but you’re welcome to wait or you could ring the ward for details later.’

  Agnes agreed there was no point in waiting.

  ‘Very well,’ said the doctor, ‘goodbye.’ He made a point of shaking hands with both of us before he went.

  I dropped Agnes off and offered to take her back later – it’d have to be after six as I’d got to pick the children up and feed them. She would ring the hospital to find out when Lily was back from theatre.

  I called home for a sandwich and stuck a load in the washing machine. I walked round the corner to work. Where the pavement had flooded, the water had frozen into puddles of ice. The city’s low lying, the land’s flat and full of clay, there are countless underwater streams as well as the River Mersey to swell and seep every time it rains. If it’s not falling on your head it’s creeping up your ankles.

  CHAPTER EIGHTEEN

  The office was so cold I could see my breath. I switched the convector heater on full and began to defrost. Mused over Lily’s moves, from her own home to a residential home, then to the psychiatric hospital, now the Infirmary. Dr Goulden had been very quick to get Lily Palmer out of the community and into the Marion Unit at Kingsfield. There hadn’t been any waiting about. Was that unusual? Hoping that Dr Goulden was still out of his surgery I rang his receptionist.

  ‘Hello, it’s Jean Brown here from Social Services. I’m just checking on current clinic arrangements between general practitioners and local nursing and residential care homes for the elderly. Now I’ve got Dr Goulden down for Homelea – does he still run a clinic there?’

  ‘Yes,’ she replied, ‘and he does Aspen Lodge as well.’

  ‘Oh, yes! Over the page! Thanks for your help.’

  Aspen Lodge was in the phone book. This time I was Monica Saunders researching transfers to the Marion Unit for the Health Commission.

  ‘We’re doing an audit now to assess the current attainment targets and the efficiency of the Unit. I need the details of any transfers over the last twelve months.’

  ‘Hang on,’ said the woman at the other end, ‘I’ll have to check the card index.’

  ‘Would you like me to ring back?’ I was keen to sound plausible.

  ‘No, it shouldn’t take long.’ She put the phone down and I could hear the flick of cards and the sound of a radio in the background.

  ‘Hello? We’ve had four in the last twelve months – since March. Do you want the names?’

  ‘Yes, please,’ oh yes, please, ‘and dates of birth. Then I can crosscheck with our records.’

  ‘Mrs Rose Mary Connelly – fourth of the ninth, 1914. Miss Margaret Anne Underwood – eleventh of the sixth, 1905. Mr Philip Braithwaite – sixteenth of the first, 1903, and Mrs Winifred Saltzer – twenty-third of the tenth, 1916.’

  ‘And have they remained at Kingsfield?’

  ‘You’d have to check with the hospital. None of them came back here.’

  ‘Thank you.’

  Would Homelea be as forthcoming? Not if I got the icy Mrs Knight. I steeled myself. I got her. I did my spiel and waited.

  ‘Where did you say you were from?’

  ‘Resources, research, monitoring and management – we come under the Health Commission administration. We were only established this year so you may not have heard of us before. I can leave my number if you’d prefer to ring us back with the information.’

  ‘Yes.’

  I sat watching the phone repeating my alias over and over to myself. I let it trill twice before picking it up.

  ‘Resources, research, Monica Saunders speaking.’

  ‘Sorry,’ mumbled a voice at the other end, ‘wrong number.’

  ‘Who is it?’ I yelped.

  ‘Is that Sal?’

  ‘Yes.’

  ‘It’s Diane. What are you playing at?’

  ‘Work. Look, can I ring you back? I’m waiting for a call.’

  ‘Oh, go on then.’

  As soon as I replaced the handset it went again. I picked it up and said my bit.

  ‘It’s Homelea here,’ said Mrs Knight. ‘We’ve had two transfers to Kingsfield this year.’

  ‘Can I check the names and dates of birth with you? I’ve only got a Mrs Palmer listed and that was very recent.’

  ‘The other was Mr Ernest Theakston.’

  ‘Now, we’ve not got him down for some reason. I’ll have to check the records again. What’s the date of birth?’

  ‘Second of the twelfth, 1922.’

  ‘Thank you for your help. Goodbye.’

  Six patients transferred to Kingsfield in the last year, from just two homes. Homes with the same GP. And the Marion Unit wouldn’t have a large number of beds. Apart from Saltzer, they were all common names, not that easy to track down. I checked the phone book. There was a Saltzer in Gorton and one in Chorlton. I tried the Gorton number first, they’d never heard of Winifred. But the man in Chorlton had. He was her widower.

  ‘She passed away in October,’ he said. ‘Who is this?’

  I didn’t want to lie but I couldn’t tell him the bald truth.

  ‘My name’s Palmer, Sal Palmer. My great-aunt has gone into Kingsfield – she was at Aspen Lodge for a while. My grandmother is beside herself with worry. I thought it might help if I talked to relatives of other patients – then I could tell Grandma what people thought of the care there. She’s talking about going private, you see, but we really can’t afford it.’

  He didn’t ask how I’d got his number or anything. ‘Well, we’d no problem with the setup there. They did all they could, lovely staff. But…I don’t know…what happened to Winnie, it’s not going to be that reassuring for your grandmother, is it? She had Alzheimer’s, you see, and there’s no treatment yet. Mr Simcock, he’s the neurosurgeon at the Infirmary, he was very good as well. She went there for a scan, you know; they can see exactly what’s going on. But there was nothing they could do for her really. It’s a terrible thing.’

  ‘I am sorry. Had she been at Aspen Lodge for a long time?’

  ‘Three years. I couldn’t manage her at home. I’ve angina myself and she was wandering a lot. She settled in all right. It was a lovely home – well, you’ll know yourself. Then she started getting very agitated, last summer. She became very confused, she wouldn’t eat. She didn’t know who I was any more, couldn’t remember her own name from one minute to the next. Dr Goulden thought she’d be better off at the Marion Unit. Like I said, they really did their best for her. She was in there just two months before she died.’

  I thanked him for talking to me.

  There were some similarities in the path that both Winifred Saltzer and Lily Palmer had taken, although from the sound of it Winifred had been ill for several years before going to Kingsfield – nothing like the sudden deterioration that Lily had undergone.

  Mr Saltzer’s willingness to help prompted me to try contacting relatives of some of the other patients. I thumbed the phone book and started by calling the names listed as living in South Manchester. I spent an intensive hour on the phone. My luck held. It was one of those days when everyone was in and happy to talk. I was flying. Some days I get nothing but answerphones or people being cagey, obstructive, stroppy.

  I’ve always wondered what determines the pattern – me or them.

  I crowed as I put down the phone after the last call. Did a little dance round the office. I’d found everyone bar Ernest Theakston.

  The information I’d assembled didn’t tell me anything earth-shattering but there were some interesting facts.

  Of the six patients transferred by Goulden to the Marion Unit at Kingsfield three suffered a slow decline and were moved there not long before the disease killed them. Ernest Theakston was an unknown and the other two people – Lily Palmer and Philip Braithwaite – had become ill m
ore rapidly. Mr Braithwaite had not only had dementia but a scan had revealed a brain tumour. A biopsy had been done at the MRI but Mr Simcock felt it was too late to operate.

  ‘He was on tablets,’ his daughter had said, ‘to try and calm him down but there wasn’t anything else they could do for him.’ As it was the tumour hadn’t killed Mr Braithwaite: he’d caught flu while in hospital and died there.

  Was Ernest Theakston dead too? It wouldn’t be unexpected. These were elderly, often frail patients, so ill that they could no longer be nursed at Aspen Lodge or Homelea.

  Time for school pick-up. I still needed to ring Diane back, I wanted to give Moira a nudge over the tablets and I hadn’t done anything yet to find out more about any links between Goulden and Simcock. I didn’t get a chance to do anything until after six o’clock. The kids were both in needy mode. Tom had developed a cold, which gave him a pair of permanent green nose-candles and an uncharacteristic tendency to whine. Maddie couldn’t bear the diversion of attention and promptly came up with tummy ache and a sore ear. I dispensed drinks and toast and honey and proceeded to read stories to them – the only activity they’d both go along with.

  At half-five we had beans on toast and when Ray came in I asked him to take over. He loaded Snow White into the video.

  I spoke to Diane first, arranging to meet up later in the week. There was no answer from Moira’s. I rang the surgery; she’d appointments booked up until seven o’clock.

  Agnes had got through to the hospital, though, and Lily was back on the ward. We could visit any time before eight o’clock but she’d still be asleep.

  ‘I could get a taxi,’ Agnes offered.

  ‘No, you’re fine,’ I replied. ‘Are you ready now?’

  I explained to Ray and the children that I needed to pop out. Maddie burst into tears and clung to my leg.

  ‘But I don’t want you to go. I want you to put me to bed.’ She wasn’t going to listen to logic. I promised to come and check on her as soon as I got back. Together Ray and I prised her off.

  ‘Mummee,’ she wailed, ‘Mummee, don’t go, please, Mummee.’