“You have to understand,” Cat Deerbon said.
“Lizzie isn’t going anywhere. I’m fine, I can manage.”
“Then why did you call me?”
Max Jameson stood at the far end of the long room, looking up at the floor-to-ceiling photograph of his wife. Lizzie herself was curled on the sofa under a blanket, sleeping after Cat had given her a sedative.
“I know how hard this is, Max, believe me. You feel you’ve failed.”
“No, I don’t. I haven’t failed.”
“All right, you feel that by letting her go into the hospice you will have failed. But this is bad and it is going to get worse.”
“So you’ve told me.”
“If this were an easier place to live in …”
“It’s the place she loves. She’s happy here, she’s never been so happy.”
“Do you think she still is? Can’t you see how frightening it is for her? This huge space, those stairs, the height when she looks down from the bedroom … the slippery floors, the way the chrome shines in the kitchen, in the bathroom. Brightness is painful to her now, it actually hurts her.”
“So they’d keep her in the dark, would they? At this hospice? It would be like going into prison.”
Cat was silent. She had been with Max Jameson for forty minutes. When she had arrived, he had wept on her shoulder. Lizzie had been sick again and was sitting in the middle of the floor, where she had fallen, her leg bent under her. Amazingly, she was only shocked, not seriously hurt.
“But how long before she falls down those stairs head first? Is that the way you want her life to end?”
“Do you know …” Max turned to Cat and smiled. He was a tall man and had been handsome but now he was haggard with anxiety and fear. His face had sunken inwards and his shaved head had a blue sheen. “… I don’t actually want her life to end at all.”
“Of course you don’t.”
He walked slowly towards Cat, but then veered away again to return to the wall with the photograph.
“You think she’s gaga, don’t you?”
“I would never, ever use that expression about anyone.”
“OK, what would you say she was?” He was angry.
“The illness has reached her brain now and she is very confused, though there may be flashes of awareness. She is also very frightened for most of the time—fear is a symptom of variant CJD at this stage. I want Lizzie to be in a place of safety so that she has as little to frighten her as possible. She also needs physical care. Her bodily functions are no longer under her control. The ataxia will increase so she will fall over all the time, she has no motor …”
Max Jameson screamed, a terrible howl of pain and rage, his hands pressed to his head.
Lizzie woke and began to cry like a baby, struggling to sit up. He went on bellowing, an animal sound.
“Max, stop that,” Cat said quietly. She went to Lizzie and took her hand, encouraging her to lie down under the blanket again. The young woman’s eyes were wide with fear and also with the blankness of someone who has no sense of their surroundings, of other people or even of their own selves. All was a terrifying confusion.
The room was quiet. In the street below someone went by whistling.
“Let me make the call,” Cat said.
After a long pause, Max nodded.
It had been less than three months since Lizzie Jameson had come to the surgery. She had been walking too carefully, as if afraid she might lose her balance, and her speech had seemed slow. Cat only remembered seeing her once before, on a birth-control matter, but had been struck then by her vibrant beauty and her laugh; she had scarcely recognised the unhappy young woman coming into her room.
It was not difficult to diagnose severe depression but neither Cat nor Lizzie herself could find a cause. She was very happy, Lizzie said, no, there was nothing wrong with her marriage, nor with anything else. Work had been going well—she was a graphic designer—she loved the apartment in the Old Ribbon Factory, loved Lafferton, had had no shocks or illness.
“Every day I wake up it’s blacker. It’s like sliding down a pit.” She had stared at Cat hollow-eyed but there had been no tears.
Cat had prescribed an antidepressant and asked to see her weekly for the next six weeks to follow her progress.
Nothing had changed for over a month. The tablets had barely touched the surface of her misery. But on the fourth visit, Lizzie had presented with a badly bruised arm, and a dislocated finger where she had tried to stop herself falling. She had just lost her balance, she said.
“Has this happened before?”
“It keeps happening. I suppose it might be the tablets.”
“Hm. Possibly. They can cause mild dizziness but it usually passes within a few days.”
Cat had got her an appointment with the neurologist at Bevham General. That night she had talked to Chris.
“Brain tumour,” he had said at once. “The MRI will show more clearly.”
“Yes. Could be very deep.”
“Parkinson’s?”
“That crossed my mind.”
“Or maybe the two things are unconnected … look at the depression and the lack of balance separately.”
They had gone on to talk of something else, but the following morning Chris had crossed the corridor from his own consulting room to Cat’s.
“Lizzie Jameson …”
“Idea?”
“How was her gait?”
“Unsteady.”
“I just looked up variant CJD.”
Cat had stared at him. “It’s very rare,” she’d said finally.
“Yes. I’ve never seen it.”
“Nor have I.”
“But it checks out.”
After her last patient left Cat had put in a call to the Bevham neurologist.
Max Jameson had been widowed five years before meeting Lizzie. His first wife had died of breast cancer. There had been no children.
“I was mad,” he had said to Cat. “I was crazy. I wanted to be dead. I was dead, I was the walking dead. It was just a question of getting through the days and wondering why I bothered.”
Friends had invited him to things but he would never turn up. “I wasn’t going to go to this dinner party, only someone was detailed to fetch me—they practically had to haul me out physically. When I walked into that room I was thinking of a way I could walk right out again, find some excuse to turn round and run. Then I saw Lizzie standing by the fireplace … actually I saw two Lizzies—she was in front of a mirror.”
“So you didn’t turn and run.”
He had smiled at her, his face blazing up with sudden recollected joy. Then he remembered what Cat was now trying to tell him. “Lizzie has mad cow disease?”
“That’s a hideous term. I won’t use it. Variant CJD.”
“Oh, don’t hide behind words. Jesus Christ.”
There was no way of discovering how long the disease had been lying dormant in her.
“And it comes from eating meat?”
“Infected beef, yes, but when, we can have no idea. Years ago probably.”
“What will happen?” Max had stood up and leaned across her desk. “Plain words. What Will Happen? How and When? I need to know this.”
“Yes,” Cat had said, “you do.” And had told him.
The illness had run its terrible course very quickly. From depression to ataxia, with other mental symptoms that were harder for Max to bear—violent mood swings, increasing aggression, paranoia and suspicion, panic attacks and then hours of sustained fear. Lizzie had fallen over, lost her sense of taste and smell, become incontinent, been repeatedly sick. Max had stayed with her, nursed and cared for her, twenty-four hours a day. Her mother had come from Somerset twice but was not able to stay in the loft flat because of a recent hip replacement. Max’s mother had flown from Canada, taken one look at the situation and flown back home. He was on his own. “It’s fine,” Max said, “I don’t need anyone. It’s fine.”
Cat went out of the apartment and down the strange, brick-lined stairwell, which still had the feel of a factory entrance, to the street, where she could get a signal on her phone and leave Max to be quiet with Lizzie.
The Lafferton hospice, Imogen House, had a bed, and Cat made the necessary arrangements. The street was empty. At the end of it, there was the curious blackness which indicated the presence of water, even though there was nothing of the canal to be seen.
The clock chimed on the cathedral tower, a short distance away.
“Oh God, You make it very difficult sometimes,”Cat said aloud. But then prayed a fierce prayer, for the man in the apartment above, and the woman being taken away from it, to die.