ELEVEN

When I went to join Max, she was fast asleep and I tried not to wake her but, not having a double set of X chromosomes, I failed miserably.

‘Lance?’ she asked sleepily.

‘It’s all right,’ I said softly, because that’s what I’m supposed to say. ‘Go back to sleep.’

But she was awake. ‘What’s happening?’ she asked.

‘Nothing. The police have just left.’

‘What about Twinkle?’

‘I’ve . . . taken care of things.’

She began to cry again. ‘What a horrible thing. Who could have done that to a small, defenceless creature?’

I thought about telling her there and then, but it was late and she was upset and she needed to sleep. Tomorrow, I thought, as I said, ‘It can only be somebody who isn’t in their right mind, Max. Get some sleep, now.’

And so to tomorrow; more specifically, the next morning, as I ate some Sugar Puffs and Max had a mixture of sawdust and rodent droppings going about its business under the unlikely name of ‘muesli’; her reassurance that it was good for me failed to do its job. I didn’t point out that I was a doctor and knew exactly what was good for me. Max already knew about Celia and my previous girlfriend, Sophie, but I had left out the details about Tristan until now. It wasn’t easy telling her how he had killed Sophie’s dog, vandalized her car and then set a fire in her flat; even then, I didn’t mention how or why my relationship with Sophie had come to an end.

‘He did that?’ Inevitably, it was the death of Leo, Sophie’s dog, that affected Max the most. I sometimes wondered if she would have loved me ten times more if I had four paws and panted a lot in hot weather. I nodded, watching her, wondering what would come after the initial shock of this news had passed. Would she be angry that I had kept her in ignorance of all this? ‘And he got away with it?’

‘Yes. I was hoping that he’d had enough and that he was bored with tormenting me, but apparently not.’

She looked scared, and I couldn’t blame her, but it passed almost at once. She said firmly, ‘He’s not going to intimidate me, Lance.’

Much as I admired her certitude, she didn’t know Tristan. ‘That’s good to hear, Max, but—’

She didn’t let me finish. ‘He killed Twinkle. I want revenge.’

The morning surgery was enlivened only by a small boy who had swallowed a rubber band; his mother was convinced that this was as deadly as ingesting bamboo splinters, the only difference being that her beloved son would die by having his insides tied in a knot, as opposed to haemorrhaging to death from tiny cuts. I was able to reassure her with some confidence that death by rubber band had yet to be reported as a cause of death by the Central Statistical Office. Mr Albert Stewart was last in and (whisper it not lest you be overheard) did not perhaps receive the best of my attention; I like to consider myself a caring and dedicated doctor, but after fifteen patients, even the newest recruit to general practice tends to wilt rather. There are only so many earaches, anal itchings, cases of rheumatism and gouty toes that a sane man can cope with. To make it worse, what Mr Stewart came in with was insomnia.

Insomnia is one of those symptoms that are neither here nor there. It is a matter of opinion: one man’s insomnia is another’s good night’s sleep. You may want to sleep for the full eight hours, but maybe your body doesn’t; maybe it only wants seven, or even six, in which case you march off to your local friendly GP and tell them that you’ve got insomnia, while the next patient in will complain because they sleep too much. What is a poor GP to do?

He was new to the practice, in fact this was his first time in. ‘How long have you been in Thornton Heath, Mr Stewart?’

He was forty-two years old and tall with athletic musculature. His face was somewhat square-jawed, although not outrageously so, his eyes were widely but not over-widely spaced and his nose was Roman; in short, the bugger was a bit handsome. ‘About seven months.’

I looked at his medical records, the soft brown cardboard envelope that accompanies everyone – usually at a distance of several months – when they move around the country. He had been born in the area, but had more recently been living in a foreign land – Highgate, North London, to be exact – and had spent his early adult years in the army: actually had spent quite a few of them there. He had been discharged following a severe head injury that had left him prone to epileptic fits and mood swings. He was taking not only anti-epileptics but also lithium. Either could have caused insomnia – most drugs can cause most ill-defined symptoms – but he had been on them for several years and it struck me as unlikely that he would suddenly be having such problems. He was unmarried and had, as a child, suffered asthma and a burst appendix from which he had then developed peritonitis; three months’ hospitalization resulted. He had then contracted meningitis – another seven months of hospitalization – and consequent behavioural problems, including truanting and aggressive tendencies. In what seemed to me to be akin to using a hammer to cure a headache, he had been advised to go into the army to help him ‘get over’ his problems. The result of all this was that he might have appeared to be a strong, fit and handsome man, but he was functionally useless to society.

‘What brought you south of the river again?’

He shrugged. ‘A change of scenery.’ His accent was London standard, giving no real clues as to his future, his education or his attitude; he could have been thinking about decking me or hugging me and I wouldn’t have known from that voice.

‘Most cases of insomnia are because of stress. Has something stressed you recently, Mr Stewart?’

He said it at once. ‘My dog died.’

Pennies – tuppences, thruppences, five pences and more – fell. ‘What breed was he?’

‘He was an Alsatian; a brilliant mate to have.’

The death of Mr Stewart’s dog had stressed more than him; it had upset Max as well. I knew more, though, than to let him in on that particular morsel. ‘Was the dog important to you?’

He showed nothing on his face as he said flatly, ‘Major was everything.’ It was all the more compelling because of the lack of emotion.

‘I can understand that.’ He had dropped his head and I saw only very short but very greasy hair as he nodded. I looked again at his records. He lived in Keston Road; not too bad an address but I guessed he wasn’t a homeowner. ‘He was your life partner,’ I suggested.

His head jerked up to show a face full of emotion, but his voice was still curiously unemotional. ‘Yes,’ he agreed. ‘Exactly that . . .’

He had put an ellipsis at the end, so I waited, like all good doctors should.

‘Or like a comrade in arms.’

It wasn’t the first case of severe depression I had seen following the death of a pet, although the sufferers were usually twice his age and of a different gender. ‘You’ve had similar problems before, haven’t you?’

‘Once or twice.’

‘How does it affect you? Do you have trouble getting to sleep, or do you wake early?’

‘I don’t sleep.’ He said this as if I was being stupid. What else would insomnia be?

‘What about your concentration? Has that been affected?’

With unconscious irony he concentrated for a moment. ‘I don’t think so.’

I went through the usual list of questions one is supposed to ask someone who has depression – about sex drive, about anxiety symptoms, about trembling, about loss of appetite – and all the answers he gave seemed to confirm that he was quite seriously depressed. Having established that, the usual procedure was to move on to the potential consequences. ‘Have you had any thoughts about self-harm?’

He had sunk into a deep well and it was a few moments before he became aware of my question. ‘Self-harm?’ he asked and then frowned.

‘Thoughts of death . . . of dying.’ More moments were born and then faded and I wondered if he hadn’t heard. ‘Mr Stewart?’ I asked. He had dropped his head, but now it came back up slowly and he looked at me – actually, he stared at me – but there were tears in his eyes, making them glitter like windows upon a tumbling stream.

‘Oh, yes,’ he said in a low, level voice. ‘I’ve had thoughts of dying.’

I thought, Oh, Lord. ‘Are you having them at the moment?’

‘They come and go. Not now, I’m not, though I did when Major died.’

‘Have you ever actually physically done anything to yourself?’

He was surprisingly definite as he said, ‘No. Never.’ This, at least, gave me hope. I’m not sure what his next remark gave me, but it certainly wasn’t assurance. ‘I’ve hurt and killed too many people to do that. I know everything there is to know about pain.’

Looking on the bright side – dim as it was – I began to surmise that he was not at immediate risk and I wouldn’t have to go through the rigmarole of sectioning him under the Mental Health Act for his own protection. I considered my options. ‘I think the immediate thing to do is help you get some sleep. Then, when you’re feeling a little less tired, perhaps things will seem a little brighter and we can perhaps think about some sort of psychotherapy.’ He didn’t react, seemed to have sunk again into despond. I went on, ‘I see you’re on Phenobarbital for your epilepsy.’

‘For all the good it does.’

I felt compelled to defend the drug, as if I had invented it. ‘No anticonvulsant can stop seizures completely.’

‘So I’ve been told.’

I gave up. Some patients need to be cynical and there was no reason for it; you have to take it on the chin or else become a vet. ‘I’m going to prescribe you some Mogadon.’

Slowly, he asked, ‘What’s that?’

‘It’s a shortcoming relaxant. It takes away anxiety and calms you down. Also, it’s completely non-addictive too, unlike a lot of similar drugs.’ I wrote out the prescription and handed it to him. ‘Take one at night, about half an hour before you intend to go to sleep. There’s a month’s supply there, but I want to see you for a check-up in two weeks; if you start to experience thoughts of self-harm, come back straight away – don’t hesitate.’

He took the script and read it slowly and I wondered if he had literacy problems. Then he crumpled it up and thrust it into his pocket; for a moment I feared that he was going to ignore my advice, but then he nodded and said, ‘OK.’

As the door closed behind him, it struck me that there was suddenly an awful lot of doom, gloom and dying around the place.