The Silent Patient (8 page)

“Danger for whom?”

“For Alicia, of course.” Diomedes wagged his finger at me. “Don’t forget she was highly suicidal when we first brought her here. She made numerous attempts to end her life. And the medication keeps her stable. It keeps her alive. If we lower the dose, there’s every chance she will be overwhelmed by her feelings and be unable to cope. Are you prepared to take that risk?”

I took what Diomedes said seriously. But I nodded. “It’s a risk I believe we need to take, Professor. Otherwise we’ll never reach her.”

Diomedes shrugged. “Then I shall talk to Christian on your behalf.”

“Thank you.”

“We’ll see how he reacts. Psychiatrists don’t often respond well to being told how to medicate their patients. Of course, I can overrule him, but I don’t tend to do that—let me broach the subject with him subtly. I’ll tell you what he says.”

“It might be better not to mention me when you talk to him.”

“I see.” Diomedes smiled strangely. “Very well, I won’t.”

He pulled out a little box from his desk, sliding off the cover to reveal a row of cigars. He offered me one. I shook my head.

“You don’t smoke?” He seemed surprised. “You look like a smoker to me.”

“No, no. Only the occasional cigarette—just now and then … I’m trying to quit.”

“Good, good for you.” He opened the window. “You know that joke, about why you can’t be a therapist and smoke? Because it means you’re still fucked-up.” He laughed and popped one of the cigars into his mouth. “I think we’re all a bit crazy in this place. You know that sign they used to have in offices? ‘You don’t need to be mad to work here, but it helps’?”

Diomedes laughed again. He lit the cigar and puffed on it, blowing the smoke outside. I watched him enviously.

CHAPTER THREE

AFTER LUNCH I PROWLED THE CORRIDORS
, looking for an exit. I was intending to sneak outside and have a cigarette, but I was discovered by Indira by the fire escape. She assumed I was lost.

“Don’t worry, Theo,” she said, taking my arm. “It took me months to get my bearings around here. Like a maze with no way out. I still get lost sometimes and I’ve been here ten years.” She laughed. Before I could object, she was guiding me upstairs for a cup of tea in the “goldfish bowl.”

“I’ll put the kettle on. Bloody miserable weather, isn’t it? I wish it would just snow and get it over with.… Snow is a very powerful imaginative symbol, don’t you think? Wipes everything clean. Have you noticed how the patients keep talking about it? Look out for it. It’s interesting.”

To my surprise, she reached into her bag and pulled out a thick slice of cake wrapped in cling film. She thrust it into my hand. “Take it. Walnut cake. I made it last night. For you.”

“Oh, thank you, I—”

“I know it’s unorthodox, but I always get better results with difficult patients if I give them a slice of cake in the session.”

I laughed. “I bet you do. Am I a difficult patient?”

Indira laughed. “No, although I find it works just as well on difficult members of staff too—which you’re not either, by the way. A little bit of sugar is a great mood enhancer. I used to make cakes for the canteen, but then Stephanie made such a fuss, all this health-and-safety nonsense about food being brought in from the outside. You’d think I was smuggling in a file. But I still bake a little on the sly. My rebellion against the dictator state. Try it.”

This was not a question but a command. I took a bite. It was good. Chewy, nutty, sweet. My mouth was full, so I covered it with my hand as I spoke.

“I think this will definitely put your patients in a good mood.”

Indira laughed and looked pleased. I realized why I liked her—she radiated a kind of maternal calm. She reminded me of my old therapist, Ruth. It was hard to imagine her ruffled, or upset.

I glanced around the room as she made the tea. The nurses’ station is always the hub of a psychiatric unit, its heart: staff flow to and from it, and it is where the ward is run from day to day; at least where all the practical decisions are made. The
goldfish bowl
was the nurses’ nickname for the station, as its walls were made of reinforced glass—meaning staff could keep an eye on the patients in the recreation room, in theory at least. In practice, the patients hovered restlessly outside, staring in, watching us, so we were the ones under constant observation. The small space did not have enough chairs, and the ones that were there were generally occupied by nurses typing up notes. So you mostly stood in the middle of the room or leaned awkwardly against a desk, which gave the space a crowded feel, no matter how many people were in it.

“Here you are, love.” Indira handed me a mug of tea.

“Thanks.”

Christian ambled in and nodded at me. He smelled strongly of the peppermint gum he was always chewing. I remembered he used to smoke heavily when we were at Broadmoor together; it was one of the few things we had in common. Since then Christian had quit, got married, and had a baby daughter. I wondered what kind of father he made. He didn’t strike me as particularly compassionate.

He gave me a cold smile. “Funny seeing you again like this, Theo.”

“Small world.”

“In mental health terms, it is—yes.” Christian said this as if to imply he might be found in other, larger worlds. I tried to imagine what they might be. I could only imagine him in the gym or in a scrum on the rugby field.

Christian stared at me for a few seconds. I’d forgotten his habit of pausing, often lengthily, making you wait while he considered his response. It irritated me here just as much as it had done at Broadmoor.

“You’re joining the team at rather an unfortunate moment,” he said eventually. “The sword of Damocles is hanging over the Grove.”

“You think it’s as bad as that?”

“It’s only a matter of time. The Trust is bound to shut us down sooner or later. So the question is, what are you doing here?”

“What do you mean?”

“Well, rats desert a sinking ship. They don’t clamber on board.”

I was startled by Christian’s undisguised aggression. I decided not to rise to the bait. I shrugged. “Possibly. But I’m not a rat.”

Before Christian could reply, a massive thud made us jump. Elif was on the other side of the glass, hammering at it with her fists. Her face was pressed up against it, squashing her nose, distorting her features, making her almost monstrous.

“I won’t take this shit no more. I hate this—these fucking pills, man—”

Christian opened a small hatch in the glass and spoke through it. “Now is not the time to discuss this, Elif.”

“I’m telling you, I’m not taking them no more, they make me fucking sick—”

“I’m not having this conversation now. Make an appointment to see me. Step away, please.”

Elif scowled, deliberating for a moment. Then she turned and lumbered off, leaving a faint circle of condensation where her nose had been pressed against the glass.

“Quite a character,” I said.

Christian grunted. “Difficult.”

Indira nodded. “Poor Elif.”

“What’s she in for?”

“Double murder,” Christian said. “Killed her mother and her sister. Suffocated them while they slept.”

I peered through the glass. Elif joined the other patients. She towered over them. One of them slipped some money into her hand, which she pocketed.

Then I noticed Alicia at the far end of the room, sitting by herself, by the window, looking out. I watched her for a moment.

Christian followed my gaze and said, “By the way, I’ve been talking to Professor Diomedes about Alicia. I want to see how she does on a lower dose of risperidone. I’ve brought her down to five milligrams.”

“I see.”

“I thought you might want to know—since I heard you saw her for a session.”

“Yes.”

“We’ll have to monitor her closely to see how she reacts to the change. And, by the way, next time you have a problem with how I medicate my patients, come to me directly. Don’t sneak off to Diomedes behind my back.” Christian glared at me.

I smiled back at him. “I didn’t sneak anywhere. I have no problem talking to you directly, Christian.”

There was an uncomfortable pause. Christian nodded to himself, as if he’d made his mind up about something. “You do realize Alicia is borderline? She won’t respond to therapy. You’re wasting your time.”

“How do you know she’s borderline if she can’t talk?”

“Won’t talk.”

“You think she’s faking?”

“Yes, as a matter of fact, I do.”

“If she’s faking, then how can she be borderline?”

Christian looked irritated.

Indira interrupted before he could reply. “With all due respect, I don’t feel umbrella terms like
borderline
are particularly helpful. They don’t tell us anything very useful at all.” She glanced at Christian. “This is a subject Christian and I disagree on frequently.”

“And how do you feel about Alicia?” I asked her.

Indira pondered the question for a moment. “I find myself feeling very maternal towards her. That’s my countertransference, that’s what she brings out in me—I feel she needs someone to take care of her.” Indira smiled at me. “And now she has someone. She has you.”

Christian laughed that annoying laugh of his. “Forgive me for being so dense, but how can Alicia benefit from therapy if she doesn’t talk?”

“Therapy isn’t just about talking,” Indira said. “It’s about providing a safe space—a containing environment. Most communication is nonverbal, as I’m sure you know.”

Christian rolled his eyes at me. “Good luck, mate. You’ll need it.”

CHAPTER FOUR

“HELLO, ALICIA,”
I said.

Only a few days had passed since her medication had been lowered, but the difference in Alicia was already apparent. She seemed more fluid in her movements. Her eyes were clearer. The foggy gaze had gone. She seemed like a different person.

She stood at the door with Yuri and hesitated. She stared at me, as if seeing me clearly for the first time, taking me in, sizing me up. I wondered what she was concluding. Evidently she judged it safe to proceed and walked inside. Without being asked, she sat down.

I nodded at Yuri to go. He deliberated for a second, then shut the door behind him.

I sat opposite Alicia. There was silence for a moment. Just the restless sound of the rain outside, raindrops drumming against the window. Eventually I spoke.

“How are you feeling?”

No response. Alicia stared at me. Eyes like lamps, unblinking.

I opened my mouth and closed it again. I was determined to resist the urge to fill the void by talking. Instead, by remaining silent and just sitting there, I hoped to communicate something else, something nonverbal: that it was okay for us to sit together like this, that I wouldn’t hurt her, that she could trust me. To have any success at getting Alicia to talk, I needed to win her trust. And this would take time—nothing would be accomplished overnight. It would move slowly, like a glacier, but it would move.

As we sat there in silence, my head started to throb at the temples. The beginnings of a headache. A telltale symptom. I thought of Ruth, who used to say, “In order to be a good therapist, you must be receptive to your patients’ feelings—but you must not hold on to them—they are not yours—they do not belong to you.” In other words, this thump, thump, thumping in my head wasn’t my pain; it belonged to Alicia. And this sudden wave of sadness—this desire to die, die, die—did not belong to me either. It was hers, all hers. I sat there, feeling it for her, my head pounding, my stomach churning, for what seemed like hours. Eventually, the fifty minutes were up.

I looked at my watch. “We have to finish now.”

Alicia lowered her head and stared at her lap. I hesitated. I lost control of my reserve. I lowered my voice and spoke from the heart.

“I want to help you, Alicia. I need you to believe that. The truth is, I want to help you to see clearly.”

At this, Alicia looked up. She stared at me—right through me.

You can’t help me,
her eyes shouted.
Look at you, you can barely help yourself. You pretend to know so much and be so wise, but you should be sitting here instead of me. Freak. Fraud. Liar. Liar—

As she stared at me, I became aware of what had been troubling me the whole session. It’s hard to put into words, but a psychotherapist quickly becomes attuned to recognizing mental distress, from physical behavior and speech and a glint in the eyes—something haunted, afraid, mad. And that’s what bothered me: despite the years of medication, despite everything she had done, and endured, Alicia’s blue eyes remained as clear and cloudless as a summer’s day. She wasn’t mad. So what was she? What was the expression in her eyes? What was the right word? It was—

Before I could finish the thought, Alicia leaped from the chair. She threw herself toward me, hands outstretched like claws. I had no time to move or get out the way. She landed on top of me, knocking me off-balance. We fell to the floor.

The back of my head hit the wall with a thud. She bashed my head against the wall again and again, and started scratching, slapping, clawing—it took all my strength to throw her off.

I scrambled along the floor and reached up to the table. I groped for the attack alarm. Just as my fingers grasped it, Alicia jumped on me and knocked the alarm from my hand.

“Alicia—”

Her fingers were tight around my neck, gripping, choking—I groped for the alarm but couldn’t reach it. Her hands dug deeper—I couldn’t breathe. I made another lunge—this time I managed to grab hold of the alarm. I pressed it.

A wailing scream instantly filled my ears, deafening me. I could hear the distant sound of a door opening and Yuri calling for backup. Alicia was dragged off me, releasing her choke hold—and I gasped for breath.

It took four nurses to hold Alicia down. She writhed and kicked and fought like a creature possessed. She didn’t seem human, more like a wild animal; something monstrous. Christian appeared and sedated her. She lost consciousness.

At last, there was silence.

CHAPTER FIVE

“THIS WILL STING A BIT.”