‘You do know she’s had three CPNs beforehand who she’s not got on with?’ he said (you had to love his management style – so encouraging).
‘Yes. I think I did know that.’
‘Although, she’s particularly requested a woman this time, so, you know, you might be okay.’
He told me how he’d been Grace’s CPN for years; that they went back to the year 2003, when she had her breakdown and came into the system.
‘Oh, so you know her well, then?’ I said.
‘Yes. And I can tell you, she has a very definite cycle.’
I laughed. ‘A cycle? That makes her sound like a washing machine.’
He frowned, a bit affronted.
‘What I meant was, if you would just let me finish, is that she runs like clockwork. She has …’ He paused, belching quietly into his hand. ‘And no, I won’t make any apologies for this, ’cause it’s true. She has a very definite “cycle” of behaviour.’
‘Okay,’ I said. ‘So what does this cycle consist of?’
‘Well, she has an episode every May, without fail, like we’ve just seen now, when she’s generally found wandering the streets at night, starts hearing voices, saying people have broken into her flat at night. Then June, we’re not usually too bad, but come August and we’re downhill again. Always mid-August. Always the same time.’
‘Is she not on a CTO this time?’ I asked. It would make sense after so many admissions. A Community Treatment Order meant she’d have to sign a form to say she’d come into hospital for an injection, because she couldn’t be relied upon to take her medication herself.
‘I don’t know,’ Jeremy said, a bit defensively, like I was trying to get one up on him, which I wasn’t. ‘But this will be something you can discuss up at the hospital.’
He bit into his sandwich and chewed, breathing noisily through his nose. ‘Sorry, you don’t mind if I eat this now, do you? Molls is potty training – we had several accidents this morning, including a number two, and I didn’t get time for breakfast.’
‘No, not at all,’ I said, although ‘breakfast’ and ‘number two’ in the same sentence made me gag.
‘So, has anyone got to the bottom of Grace’s … “cycle”? Why episodes happen at certain times?’ I asked.
Jeremy carried on chewing. ‘Well, it’s obvious, isn’t it? I mean, the summer – like Christmas – can be a very alienating time for people like Grace. Everyone’s having barbecues, going on holidays …’
This seemed tangential but I nodded anyway.
‘And also she’s got this thing with taking people’s photos – I’m sure they’ll fill you in when you get there. Needless to say, it gets her into trouble on the ward. She’s got no idea of personal boundaries.’
Having finished his sandwich, he started applying some cream to a flaky red patch on his elbow.
‘Sorry,’ he said. He made a wincing noise as the cream touched his skin. ‘Psoriasis. It’s really flared recently.’
I couldn’t wait to meet Grace now. I’d read her case notes and there were things that chimed with me, things people had said to me about her, that reminded me of things people said about me, when I was younger, before Mum happened and that summer happened, and I probably grew up ten years in one: ‘She’s a handful, that Robyn King’; ‘She’s not at all as sensible as her big sister.’ It made me want to rise to the challenge of her. To show Grace what I was made of.
When a patient was about to be discharged to the homecare team, us CPNs often went along to the hospital for ward round and what was called a ‘discharge planning meeting’, so we could meet the patient beforehand. As discharge planning meetings went, Grace’s was pretty painless. Dr Manoor was Grace’s consultant, which made things easy, because we’ve got quite a rapport going now, Dr Manoor and I. Whenever he calls me up to come in and assess, we always have a joke: ‘Who’ve you got for me this time, Ramesh?’; ‘Are we going to need a stiff drink after this?’
As well as Dr Manoor, there was Michelle, the OT – occupational therapist – who never seems as frazzled as the rest of us. I like Michelle. It was the senior nurse I didn’t take to – someone called Brian Hillgarth, who I’d never dealt with before. He had dandruff and this off-putting habit of never meeting your gaze when he was talking to you. I didn’t like the way he spoke about Grace either. He kept saying things like, ‘Like all chronic schizophrenics, she has fixations about things …’ What did he mean, ‘Like all schizophrenics?’ (Like all people called Brian, you never meet people’s eyes when you’re talking to them.) I felt like he spoke about her as if she was beyond help, beyond hope.
There was also this matter of her taking photographs.
‘The problem is, she was putting that camera in patients’ faces,’ Hillgarth was saying. (I couldn’t help thinking there were worse places she could have been putting her camera.) ‘Taking pictures of them brushing their teeth, or in the art room. I mean, these patients are paranoid enough.’ There was a pause during which everybody looked at one another as if to say, We know, Brian, it’s a mental hospital.
‘So, can I ask, what’s with the photography in the first place?’ I said. I was curious. ‘Is Grace generally interested in photography? Is it something she does as a hobby?’
This seemed to completely confuse Brian, who said, ‘I think my point is, she’s abusive with it.’
‘Abusive? What, with a camera? How do you mean?’ Everyone sort of looked at the floor. As CPNs went, I was probably quite outspoken.
‘She gets a bit upset, I think,’ said Michelle, ‘when people don’t want their photo taken, you know.’ Michelle was such a softy; if Grace had been beating people over the head with a mallet, she’d have put it down to her just being ‘a bit upset’.
‘No, I’d definitely say, she’s abusive,’ Brian said. ‘Personal and insulting when people don’t want their picture taken. She told one rather large patient that they were supposed to “eat what’s in the fridge, not the fridge itself”.’ I had to bite my lip so I didn’t laugh. I’ve always liked the naughty ones.
The meeting went on for forty-five minutes. It seemed Jeremy was right about one thing at least: there was a pattern to Grace’s admissions (May and August figuring strongly), but nobody had got to the bottom of why.
‘So she’s not on a CTO?’ I asked.
‘She was trialled,’ said Dr Manoor. ‘But there were side effects with the injections: tremors, weight gain …’ Often the side effects were worse than the mental illness itself but, without the CTO ensuring Grace would agree to come into hospital to have her injections, I’d have to work hard to keep her compliant.
Eventually, they called Grace in. She was tiny and ever so sweet-looking, with this delicate, fawn-like face and these big brown eyes shining out from beneath the Yankees baseball cap she was wearing. The skin on her face had been ravaged by fags and booze and emotional pain, but there was still a girlishness to her; then, she spoke.
‘Wotcha?’ she stuck a tiny hand out and I shook it. ‘I’m Grace, and you are …?’
‘Robyn.’
‘Robyn,’ she said, screwing her tiny nose up. ‘Isn’t that a boy’s name?’
‘And a girl’s,’ I said. ‘Although, my theory is, my parents wanted a boy and so didn’t really have any proper girls’