Sister полностью

“Anyhow,” continued Dr. Nichols, “once I realized that she was suffering from puerperal psychosis, I realized that the phone calls were, most likely, auditory hallucinations. In lay terms, ‘hearing voices,’ or in Tess’s case, the sound of the phone too.”

“You changed your diagnosis after she was found dead, didn’t you?” I asked and saw a flash of emotion over his crumpled face, momentarily hardening it. There was a moment before he spoke.

“Yes. I think it might be helpful if I tell you a little more about puerperal psychosis. The symptoms can include paranoia, delusions and hallucinations. And the consequences, tragically, are a highly increased risk of suicide.”

From my own research, I already knew that.

“I’d like to get this clear,” I said. “It was after she died that you changed your diagnosis from depression to psychosis. And it was only then that the phone calls became ‘auditory hallucinations’?”

“Yes, because auditory hallucinations are a symptom of psychosis.”

“She didn’t have psychosis. Puerperal or postpartum, or any other kind.” He ineffectually tried to interrupt me but I continued, “How many times did you meet my sister?”

“Psychiatry isn’t about intimate knowledge of a specific person, which you get in close friendships or with family members, nor in acute cases is it anything like the long-term relationship a psychiatrist has with a patient as a therapist. When a patient has mental illness the psychiatrist is trained to recognize certain symptoms the patient demonstrates.”

For some reason, I imagined him practicing all this in the mirror beforehand. I repeated my question, “How many times?”

He glanced away from me. “Just once. She was automatically referred to me because of her baby’s death, but she discharged herself from the hospital almost immediately after the birth, so I couldn’t visit her on the ward. She was given an emergency outpatient appointment two days later.”

“Was she a National Health Service patient?”

“Yes.”

“On the NHS, your waiting list is four months. That’s why I am paying to see you.”

“Tess was an emergency. All potential puerperal depression and psychosis cases are dealt with immediately.”

“Dealt with?”

“I’m sorry. What I meant was in terms of jumping any waiting list.”

“How long is an NHS appointment?”

“I’d rather have more time with each patient but—”

“With a waiting list of four months, you must be under a great deal of pressure to get through them.”

“I spend as much time as I possibly can with each patient.”

“But it’s not enough, is it?”

He paused a moment. “No. It’s not.”

“Puerperal psychosis is an acute psychiatric emergency, isn’t it?”

I thought I saw him flinch because I knew this, but I’d done my research beforehand.

“Yes, it is,” he replied.

“Requiring hospitalization?”

His body language was rigidly controlled, arms held determinedly at his sides, his corduroyed legs a little splayed, but I knew that he wanted to cross his arms over his chest and put one leg over the other to give physical expression to his mental defensiveness.

“Many psychiatrists would have interpreted Tess’s symptoms as I did, as indicators of depression rather than psychosis.” He absentmindedly reached down to stroke his dog’s silky ears as if he needed comfort, and continued, “Diagnosis in psychiatry is far harder than in other branches of medicine. There aren’t any X-rays or blood tests to help us. And I didn’t have access to her notes, so I didn’t know whether there was a history of mental illness.”

“There isn’t any history. When was her appointment with you?”

“The twenty-third of January. At nine a.m.”

He hadn’t consulted his diary or looked at his computer.

He had come prepared for this meeting, of course he had. He’d probably been on the phone all morning with his medical defense union. I saw in his face a beat of some genuine emotion. I wondered if it was fearfulness for himself, or genuine upset about you.

“So you saw her the day she died?” I asked.

“Yes.”

“And you thought the morning she died that she was suffering from depression not psychosis?”

He could no longer hide his defensiveness, crossing one leg over the other, huddling into himself. “At the time, I didn’t see any indicators of psychosis. And she didn’t show any signs that she was considering hurting herself. There was nothing to suggest that she was going to take her life.”

I wanted to scream at him that of course there were no signs, because you didn’t take your life; you had it violently cut from you. I heard my voice sounding distantly quiet against the shouting in my head. “So it was her death that rewrote your diagnosis?”

He didn’t reply. I no longer found his rumpled face and corduroys endearingly scruffy, but hopelessly negligent.