Dr Charlotte Standon was concentrating on what the patient was telling her, quickly filling her page with notes. This clinic was one of the ways to stem the flood, she thought – that perceptible tide of shifts in the patients’ conditions that swelled and receded endlessly.
The panel convened for this clinic consisted of the ward’s chief psychiatrist, Dr Adams, the ward manager, Gideon, and Charlotte. They had congregated in Dr Adams’ small corner office, the low autumn sun filtering through the blinds, as patient after patient appeared before them.
Charlotte would be the first to admit that she was in over her head with this placement, but her natural enthusiasm had overcome her initial doubts. Recently qualified, she’d accepted the three-month rotation at the psychiatric clinic, thinking that in karmic terms, she’d get the longed-for paediatrics place in turn. But three weeks into her placement, the clinic had pulled her in. She was moved, not least by the apparently hopeless cases, those long-term inmates who had been all but abandoned by their families. Some had been sectioned and were so institutionalised that, even if they’d been miraculously cured, they would struggle to re-enter the outside world they’d forgotten, and which had forgotten them.
After noting down changes in the patient’s condition, and adjusting their medication regime in careful consultation with Dr Adams, Charlotte took a much-needed smoking break on the sun terrace. This was shared with the patients, some of them raising their heads and nodding to her now.
Dragging on her cigarette and smoothing down her tailored trousers, Charlotte could hear her mother’s warning echo in her head: ‘You’ll never get a man Charlotte! You’re so headstrong, so unladylike, carrying on like you do…’
Charlotte smiled at the recollection. Since she had qualified, she could go where she pleased, and the move from London to Bristol was partly to put some distance between them and get her breathing space back. The only thing she’d inherited from her mother, she thought wryly, was her long tangle of red hair and occasional fiery temperament. The rest – the fascination with medicine, the endless optimism, the excitement that came from trying new things – all those came from her father.
Gideon’s large, dependable frame filled the doorway to the terrace, as he motioned her back from her break.
‘Oh!’ That single syllable was full of meaning. Gideon knew of her particular interest in this patient, had even supplied further information based on his own daily observations. Some of the staff had begun to call Nathan ‘the professor’ and they were only half in jest. Nathan was a man of thirty, who had previously lived with his mother as her full-time carer. Soon after she’d died, only six months previously, Nathan’s delusions had started. When his behaviour could no longer be attributed to shock or grief, and the delusions became more extensive and severe, his remaining family had requested he was admitted to the clinic. What appeared strange to Charlotte, looking at the case notes, was that there was no family history of mental instability, no genetic precursor that could explain his delusional state.
Nathan intrigued Charlotte for two reasons. One was professional: his delusions had become all-encompassing and she wanted to help him escape back to normality. Secondly – and Charlotte was embarrassed to admit this, given he was a patient and she the physician – she found him undeniably attractive, especially when he fixed his appealing blue-eyed gaze on her and stared beseechingly, willing her to understand the world he inhabited.
As she re-entered Dr Adams’ office, Charlotte shook her head slightly to rid herself of the thought. Long working hours, coupled with the lack of a social life in a new place, gave rise to introspection and fantasy. She needed to get out there and start dating, in the real world.
Nathan walked quickly into the room. For someone apparently so unstable, he was confident and articulate. Despite the stuffy office and relatively warm autumn day, he wore a thick knitted jumper and skinny black jeans. Combined with the wavy hair falling over his forehead and jet-black beard, he had the air of a Beatnik poet.
Today, Nathan’s depiction of his world was unwavering from when she’d heard it previously. Charlotte leant forward like a child at storytime. The year was 1894, the place: Somerset. He had inherited the family farm upon his mother’s death. As a psychiatrist, he had little understanding of husbandry or an active interest in the farm. What interested him was people, and how their minds worked. According to Nathan, he was married – to a Charlotte (at this, the modern-day Charlotte shivered), who had taken on the responsibility of running the farm, like Nathan’s mother before her.
The level of detail was impressive, particularly Nathan’s understanding of psychiatry, despite the out-dated theories and practices he espoused. How did he know all this? She had asked Dr Adams. An amateur interest, said Dr Adams. His mother had slid inexorably into dementia, and the family said he’d started to research a book about the deterioration of the mind.
Dr Adams was determined to bring Nathan back to talking about his mother – he questioned how Nathan had felt, inheriting the farm so unexpectedly. Instead, Nathan described his wife and the admiration he had for her management of the farm, especially as she made improvements against the will of the workers. Most of these people were wedded to the past and suspicious of the new. Like Luddites, they were justifiably wary of anything that might replace human labour.
Then suddenly, Nathan stopped mid-sentence, and fixed his gaze on Charlotte. ‘You look a lot like her, you know. I didn’t see it at first, it’s the way you have your hair. But the resemblance…’
Charlotte’s blush crept steadily up her cheeks. She felt Dr Adams’ sideways glance and then saw him scribble ‘transference’ in his notepad. Ah yes, of course, the patient begins to feel something for the physician, who has been placed in the position of carer. And she did care, of course, who wouldn’t? And Nathan was so clearly starved of care. But when the patient mistook professional care for love..?
Nathan leant forward further still in his chair, almost tipping it over in his haste to get his words out and addressing Charlotte directly again.
‘Do you want to leave?’ he whispered urgently.
‘Leave where, Nathan?’
‘Here. We can go together, you know.’ He smiled – that same beseeching look that kept re-appearing.
‘I’m afraid you can’t leave Nathan. Your family would like you to stay here until you are better.’
‘There’s really nothing wrong with me though. YOU know that.’ He lasered her with that intense gaze. ‘But if you think we should stay…’ he tailed off, looking disconsolate. ‘That’s the problem with this place. Once you’re here, you can never leave. The living and the dead mingle here, like there was no division between the space that breathing souls inhabit and those already departed.’
Charlotte stared, thinking she should make some notes about his archaic turn of phrase, but finding that her pen was unwilling to move. Dr Adams wisely chose this moment to intervene: ‘Nathan, why do you think you are married? And why did you bring your wife to the farm?’
‘Because I am married. And because Charlotte is there, and here.’ A small nod in Charlotte’s direction. ‘There’s no division between then and now, between the ghosts of the past and those who think they are alive today. That’s what I’ve spent these last weeks trying to tell you. I’m aware of how mad that might make me sound. But no medication you give me will change this.’
‘Thank you Nathan.’ Dr Adams sounded bemused. ‘I do appreciate you are convinced of this… theory. But if your theory is true, how do you explain the millions of people who are convinced that this is 2016, that the combine harvester has long since replaced manual labour on British farms. A mass collective hallucination perhaps?’
Nathan didn’t look at all shaken, just slightly tired, as if he was trying to explain something complicated to a small child. ‘I can see how ludicrous it sounds. I’m a man of science, of rational thought. I'm telling you that there are alternate realities to the one we are currently in. In my mind, I’m convinced of my reality. It’s just that reality is a lot more fluid than you suppose.’
Once Nathan had left the office, accompanied back to the ward by his silent guardian Gideon, Dr Adams turned to Charlotte. ‘What do you think?’
‘It’s a compelling, intricate delusion. He’s really built his own world. From a professional perspective, I find that impressive.’
Dr Adams sighed to himself. ‘It’s not atypical of this type. Trying to convince a madman that he’s mad, in order to cure him. That’s the difficulty, especially when he truly believes everything he’s saying to be true, rational observation. I suggest we delve more into his relationship with his mother. There was clearly a strong co-dependence. She relied on him, but equally she was everything to him. Perhaps… this other relationship, the one he’s built in his mind…’
‘Yes, the wife. She could be a projection of the love he felt for his mother.’
Dr Adams paused again, lowered his head, then added: ‘I’d watch how he’s projecting onto you. The same name, the supposed physical resemblance... I can rely on your professionalism?’
He didn’t seem to expect an answer, so Charlotte nodded, thinking privately how compelling she found Nathan’s constructed world, and resolving to find out more from Gideon.
Later that evening, Charlotte let herself in to her fifth-floor flat on the quiet outskirts of Bristol. She was tired and tempted to skip cooking dinner and just ring for a takeaway. But cooking was enjoyable and therapeutic for her, and she put on some upbeat music and poured herself a large glass of Soave while she made supper.
After dinner, she ran herself a long bath, then afterwards sat in bed in her dressing gown and caught up with the world: texts, Whatsapp, Instagram, Facebook. In London, she’d had a lively, active set of friends, and on her ‘to do’ list in Bristol was to sort out a social life – and soon.
Lulled by the wine and the bath, she found it easy to drift off to sleep. In her dreams, she became aware that she wasn’t alone in the bed. ‘Charlotte.’ He put his arm tightly round her waist and she shifted to accommodate him, thinking vaguely how happy and fulfilled she was.
When she woke the next day, Charlotte couldn’t shake off the dream. She hadn’t slept so well or so deeply since she’d arrived in Bristol. She felt strangely disappointed when she saw only the faint indentation of her shape on the sheets. What did she expect though – roses left by her ghostly bedfellow? She smiled at how ludicrous that was.
Sitting down at the vanity table, she brushed out her long red hair. She would leave it down today. She felt like a change.