It’s on the Monday that I bump into Julie. A random encounter that changes everything.
I’m in South London to meet a team who have requested urgent support. When I’d briefly outlined the circumstances at our staff meeting, it was met with a horrified silence, then a flurry of questions that I answered to the best of my knowledge. I understood the need to visualize something, to make a picture from the details. Besides, it wasn’t difficult to understand their shock in the face of the kind of tragedy I was describing.
The community drug rehabilitation team have their offices around the back of Balham High Road. Despite its proximity to the main road, it’s surprisingly quiet. A no-through road, with a newsagent, some flats, and an industrial estate at the end. The entrance to the building is via a car park, with the team name and NHS logo on the wall by the video intercom. There’s a strip of crime scene tape on the railing, flapping back and forth like a yellow ribbon in the breeze.
I close my eyes for a moment as I think about the sequence of events last Friday afternoon. CCTV from the flats opposite showed the man, a Harold Mason, weaving erratically along the pavement, rattling doors and shouting through letter boxes. He stopped in front of this same office, then peered down at the small logo. Three small navy-blue letters. NHS. Letters of hope and salvation, but also of disappointment. I wonder what he was thinking as his fingers pressed the intercom.
When I give my name, I’m buzzed through and I feel a sharp nick of fear as I step into the reception area. It’s tidied up now, of course. The floor’s been cleaned and everything’s neatly back in place. The woman at the desk ushers me through to a windowless room with a bright fluorescent strip light. Orange plastic chairs are arranged haphazardly around a table. There’s a coffee cup and a discarded Metro newspaper. The notice board by the door displays faded leaflets—a needle exchange, infection control, and one about joining the union.
I wait for a full ten minutes until I’m joined by a tall man with dreadlocks. He nods in my direction as he takes a seat. He’s followed by a pale woman in a patterned floaty dress. Minutes later, two others come in, a man and a woman, eyes fixed firmly on the floor. I feel their heavy reluctance. I, too, am filled with a strong desire not to be there. Perhaps in response, the woman in the floaty dress reaches into her bag and brings out bumper-size packets of sweets. “Help yourself,” she says to no one in particular, fanning them out across the table. They are children’s sweets. The brightly colored sort I might have bought for the twins’ birthday parties—Haribo Fizzy Colas, Starbursts. Treats, I think. An attempt to “sweeten” things for what’s to come.
“Are we expecting anyone else?” I ask.
They all look round at one another.
“Some people are off today. Lots of sickness,” the woman says with a vague apologetic smile. The others ignore her and seem irritated by her eagerness to please. There’s a protracted conversation about someone called Toya. Is she coming? Has anyone seen her? The man with dreadlocks wonders if perhaps she’s left a message, and this triggers an agonizing stretch of time as he laboriously scans his emails. He shakes his head. Nothing.
When I introduce myself and ask them to do the same, they shuffle in their seats.
“I’m Angela,” says the woman who brought the sweets. Then the rest offer up their names—Tony, Farzal, and Wendy. I make eye contact with them all except Wendy, who doesn’t look up from her phone, saying her name like a teenager at registration. I carefully write the names down as they are positioned around the table. I’ve facilitated many of these crisis staff meetings. Mostly for support in the aftermath of a patient suicide. Thankfully, what we are here to do today is extremely rare.
“What about Alia?” Wendy suddenly wants to know, her face hard, unforgiving. “Thought she was coming?”
Farzal explains that she rang after lunch from her home visit. “Got stuck in traffic,” he says. There’s another silence. This time, it’s full of envy. Envy for those who have managed to find a reason to avoid coming today.
When I start to explain the purpose of the meeting, I’m interrupted by Farzal, who makes a point of reaching across the table for the Metro newspaper. “See this?” he says, jabbing at the picture. The others lean in. I know what he’s pointing at. I saw it this morning on the train. The face of a Syrian refugee on the beach in Greece, clutching his dead two-year-old to his chest. He flings it back on to the table, and it lands on the bag of Haribos. “It’s disgusting,” he says. “Two ports wouldn’t even let the boat dock. Made me think about my own kid,” and he shakes his head, speechless. There are nods of agreement. Murmurs around the room about the lack of humanity. The lack of care.
“No one gives a shit,” Wendy says, looking up at me coldly.
Resistance and unease have morphed into open hostility. I know I will have to tread carefully. To find a way to understand the anger. Not to alienate them any further. I think about the anguished face on the newspaper and I think about the reason we are here. Another man who was denied a safe haven. Another parent who tried to get refuge for their child.
“It makes me think about Harold Mason,” I say. I know it’s a risk to mention the man. To say his name out loud. There’s a terrible silence in the room. They all stare back at me.
“From the little I know,” I say, “he was also a desperate man. A man who needed something he wasn’t given. And this, too, ended in tragedy.”
I nod over at the newspaper, while looking at Farzal. “How near to drowning do you have to be before you’re offered the safety of dry land?”
Angela and Farzal are both nodding now.
Tony and Wendy exchange a glance. It’s a look of weary resignation. A look that’s weathered the recent years of underresourced mental health services. I see it on their faces. The ward closures. The emphasis on “care in the community.” They say nothing.
I start to tell them about the purpose of the meeting and how I have come to be here, but when I mention the three sessions I’d arranged with Karen Crosswell, Wendy snorts with derision. “Management trying to make themselves feel better by setting up a little support group for us,” she says bitterly.
“They closed two mental health wards this year. That’s why he couldn’t get a bed,” Angela explains, as if for my benefit.
“It’s all about the money,” spits Wendy, looking squarely at me, and the room bristles with a new kind of furious energy.
It’s clear that my very association with Karen Crosswell, and my simply agreeing to the meeting, have somehow implicated me as well. I, too, am another “bad object” in an already rotten system.
I look back at them.
“You’re right,” I say, nodding, “and it feels unfair.”
Wendy looks taken aback.
I comment on their feelings about the injustice. The faults in an already overstretched and underresourced service. I think about our own department’s cutbacks; the long waiting lists, the staff under pressure to do more for less. “The anger you are all feeling is understandable. I feel it, too. I’m guessing that having me sent here feels like putting a Band-Aid on a broken leg.”
I sense a shift in mood—as if the team is letting out a collective breath. Tony is nodding. Angela starts to cry silently.
“It’s important for you to know that I don’t work in your Trust. These sessions are confidential. I’m not part of the investigation and I’m not here to find a way to justify or explain what happened.”
I lean toward them, dropping my voice down low. “I am here because a terrible thing has happened, and you have suffered a great loss.” I pause for a moment. “And I believe that sometimes it can simply be helpful to come together and have a space to talk.”
The silence feels different this time. Thoughtful. Contemplative. The hostility has moved away from me.
Tony lowers his head into his hands. “I just keep seeing her,” he says. “On the floor. Her pale face. The blood.” He presses his fingers at the side of his face. “I want to get it out of my head, but I can’t—”
And like a faltering car, the story begins, stopping and starting, then juddering into life. They tell me they’d had a training session, and were going to the pub. “It was the end of the week,” Farzal said, “we were in a good mood.” They tell me Marion said she’d follow on. Wanted to try one last time to get hold of this GP for one of our service users, “a fifteen-year-old crack addict. She wanted to try to get something set up before the weekend.”
His words trigger a flurry of conversation about Marion. How she was compassionate. Dedicated. Fought for her patients. Had relentless energy for the disadvantaged. The conversation is peppered with clichéd expressions—“a heart of gold,” someone who always “went the extra mile” and was “first in and last to leave.”
“Always fussing over us,” Angela adds. “Making cakes. Buying us stuff from that health food shop. Telling us not to work so hard.”
“Sounds like she really looked after you all,” I comment.
Farzal nods. “Last week I’d hurt my back playing football. Next day, she’s bringing me in this special cushion for my chair.” He shrugs. “That’s the kind of thing she did.”
“She didn’t have kids,” offers Wendy, “said the team were her family.”
“Not just the team. All the patients, too,” Angela says tearfully. “They loved her. Couldn’t bear it when she took a holiday.”
“I can’t remember the last time she took a holiday,” Tony muses.
As I listen to them speak about their team manager, a picture of Marion grows in my mind. I know exactly who she is. My heart swells for a woman who has dedicated her life to her work. A woman who is drawn to disadvantaged groups. Relentless in her drive and commitment. People like Marion are the glue that keeps the crumbling public sector together. They are passionate. Committed. Relentless. But in the bottomless pit of referrals, they are also the people who find it difficult to say no.
“She sounds like someone who really cared,” I venture. “Someone who was really devoted and dedicated to her work.”
Farzal and Angela nod. Tony still has his head bowed.
“Nearly forty years in the Health Service, and this is how it ends,” Wendy says.
“I just wish I’d waited with her,” Tony says. “Five minutes. She told me to get a round in. Mine’s a pint of Guinness. It was the last thing she said.”
Angela picks up the story. And as they take turns, each slowly drawing out the different pieces of that fateful afternoon, it’s like watching a horrific game of Jenga, waiting for the inevitable collapse.
“We rang her from the pub,” she says. “It’s only two minutes up the road. When there was no answer, Tony and I came back—”
They tell me how they found Marion McClusky slumped on the floor behind the reception desk, blood in a small pool at the side of her head. The reception area was in disarray, chairs and tables were upturned, two windowpanes were smashed, the desktop computer wrenched from its socket, and the office printer pushed over, spilling a path of white paper over the carpet. Marion could have been hit by any number of randomly hurled objects, but it was the fire extinguisher that dealt the fatal blow. Half an hour later, Harold Mason was found in the middle of Balham High Road, shouting at the oncoming cars, while slapping and punching at his own face. At the same time, three streets away, his elderly mother was at the local police station asking for help with her son’s volatile behavior.
It would transpire that Harold was a fifty-seven-year-old man with a long-standing mental health problem. He had intermittent psychotic episodes, every three to four years, when he required hospitalization, usually because he’d stopped taking his medication.
“He had a part-time job,” Tony says. “In the local greengrocer’s.”
They tell me how his mother had begged for him to be admitted that morning, but when there was no bed, the bed manager referred him to the Home Treatment Team.
“Care in the community,” Angela adds with sarcasm.
“I knew Harry,” Tony says. “He was obviously distressed. Out of control. He’s a big bloke”—he shook his head—“but I know he wouldn’t have meant to hurt Marion.”
“Was he registered with your service?” I ask.
Wendy and Tony exchange a glance.
“No,” says Tony. “But Marion knew Harry well. From when we both worked on the Community Mental Health Team. The team used to be based here, back in the day—before the service was restructured.”
I look around at the group. There’s an uncomfortable silence.
I know that no one wants to talk about the lone worker policy. The fact that service users aren’t allowed in unless two or more staff are on site. The fact that patients not registered with the service should never be admitted. No one wants to say she should never have pressed the buzzer.
I wait.
“So what happened?”
“She let him in,” Tony says quietly.
“But that was Marion all over,” offers Angela quickly. “She’d have recognized him on the video intercom. Would have seen he looked distressed. Would have wanted to help. Always putting others before herself. She’d never have turned him away. Never have said no. That’s what she always said: We’re the team that never says no.”
“And anyway,” says Wendy, “if he’d been given a bed in the first place, none of this would have happened. Robbing Peter to pay Paul. Now he’ll probably spend the rest of his life in a secure unit.”
“That’ll cost a whole lot more than a bed on a psychiatric ward,” nods Angela, brushing invisible dirt from the skirt of her dress.
Robbing Peter to pay Paul. Blurring the reality of cost savings. Organizational chaos. I have seen it all before. But it’s a neat split that can feel comforting; “good” Marion pitted against the “bad” system. I listen as they talk about the flawed system, about being surrounded by other teams with such high referral thresholds that they refuse to take people on, “so the referrals all come our way.” They talk more about Marion and her boundless commitment. The team that never says no.
I think back to the conversation with Stephanie. How she missed the point about the legacy of Winnicott. An excuse for mediocrity. How, of course, it’s the opposite. That a “good enough” team manager would know the importance of limitations. The need to set boundaries. Would know that a perpetual readiness to say yes is unhelpful. Can be unsafe. Tiring. Destructive. And unsustainable in an already stretched and underresourced system. But while I know this is not the session to talk about this, it feels important to try to sow the seed.
I glance up at the clock. I have a few minutes left. I lean forward in my chair.
“I’m wondering what that was like,” I venture, “to work in a team that never says no.”
There’s a still silence.
Tony’s shoulders slump down. He locks me in a gaze. “Exhausting,” he says.
And there it is. My small shoot of green.
Before people leave, we arrange the next session in four weeks. There’s some uncertainty about the funeral date, and talk of wanting to involve the service users in some kind of memorial. “Perhaps this is something we can talk about next time,” I say. As the team files out, they all make eye contact. There are murmurs of thanks. “See you next month,” Wendy says, and Tony reaches across to shake my hand. Angela walks me to the door. She thanks me again, then lingers for a moment before asking me about my journey back. She seems to want to find reasons not to let me go. In truth, I can’t wait to get out of the building and into the fresh air. My body feels rigid from holding all the emotion. All that sad anger and hostility in that tight, airless room. But also I’m thinking about Harold and Marion, and I am consumed by thoughts of randomness. Small platelets that move and shift and are suddenly and inexplicably monumental in our lives. This is the thought in my head as I step into a seismic shift of my own.
The bright fluorescent lighting has left me with an ache at the back of my head. When I blink, I can still see the strip in a haze of white. As I walk to the Tube, it’s this feeling, this hangover from the meeting, that makes me reluctant to go straight back down into the Underground. I spot the Holland & Barrett on my way to the station, and without thinking I make my way inside. It’s an insignificant decision. A memory about Marion from the session perhaps. I’ve been run-down and tired, I’ll get some vitamins, I decide on a whim, anticipating the almost childlike satisfaction in spending exorbitant amounts of money on small jars filled with multicolored sweets. I’m idly perusing the shelves, the Manuka honey, the bottles of zinc tablets. I can’t say I was thinking about very much at all.
I’m aware of a woman and a buggy to my right-hand side, but only in a vague and unfocused sort of a way. It’s only when the child kicks his legs out and knocks off several jars of magnesium tablets that I really notice they are there. I reach down for the jars as they roll across the floor. I am at eye level with the baby. “Thank you,” I hear the woman say. By then, I am transfixed by the sight of the boy.
It’s a blond-haired baby wearing a blue-and-white hat and denim overalls. I’m staring into the baby face of Tom. I reach out for the frame of the buggy and push myself up to a standing position. It’s then that I see the young woman with a pink fringe gaping at me, openmouthed.
“Julie?” I say in a whisper.