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#NaNoWriMo2016 - Day Twenty-Seven

13 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

27. The Syringe

"FRL-V4" was an act of desperation. He had exhausted every prescription drug that he could buy from overseas. He then tried every research chemical that he could find. The Internet revealed a world of "psychonauts" conducting drug experimentation on themselves. He felt like a human guinea pig anyway, having had a cocktail of different medications prescribed to him by his doctors, all of which had terrible side effects. He was sick and tired of feeling sick and tired.

When he received his first delivery from Frog Eye Wares, he assumed they had accurately weighed out half a gram: 500 milligrams. He poured out the contents of a small plastic bag labelled "TOXIC: NOT FOR HUMAN CONSUMPTION" onto a dinner plate. Then he divided the pile of powder into two equal piles of 250 milligrams each. He divided one of those piles in two, which he assumed must approximately weigh 125 milligrams. Scooping up one small pile of powder, he transferred it to a second dinner plate. Then, he made five lines of powder, each of the same length and width. All of this was done by eye. By his estimation, a single line weighed 25 milligrams.

Taking a rolled up bank note, he snorted half a line up his right nostril. This was the first time he'd insufflated something since the one and only time he'd tried cocaine, at a house party 8 years earlier. The cocaine gave him a feeling of numbness in-between his eyes and down the back of his throat. He could taste a drip from his nasal cavity, but it was not unpleasant and the numbness spread around his mouth in his saliva a little. The "FRL-V4" powder made his eyes water with pain. There was an extremely bitter taste and the smell of solvents filled his nose.

His face flushed, his pulse raced, he needed a bowel movement. In the bathroom, dropping his trousers, he noticed his penis had shrunk as if it was freezing cold. Washing his hands, he looked at himself in the mirror. His pupils were gigantic and jet black; he was sweating. Panicking slightly that he had taken too much of the drug, he rinsed his nose out with some cold water and tried to spit out the residue that seemed to coat the back of his throat.

He'd spent the day feeling productive. He had cleaned the house and had then started playing a computer game until he noticed that it had got dark. Then, he started to feel a sense of panic. 9 hours had elapsed since he had taken the drug and he worried that the effects weren't wearing off. He looked at his watch; then he looked at his watch again. Time was passing incredibly slowly. He started to stare at the face of his watch; the second hand was barely moving. He could feel his heartbeat starting to race. He started to feel like he couldn't breathe; as if there wasn't enough oxygen in the air and he couldn't catch his breath.

That was when he decided to snort the other half of the line.

He'd done a lot of research on the Internet and he knew that some of the drugs he was likely to encounter were "fiendishly" addictive. Most of the negative things that he read seemed to be associated with people having long sleepless binges. It seemed logical to him that the thing to do was to avoid "re-dosing". He would limit himself to a fixed daily dose and that way he would avoid the dreadful binges and the path to addiction that he had read about. However, he hadn't been able to calm down and was feeling really awful. He half considered going to hospital, but instead, he decided to double down.

Snorting with his left nostril, the pain brought tears to his eyes again. Soon, he felt a lot better. The panic attack subsided.

He hadn't eaten all day and he thought he should try and force some food down. Making himself a sandwich, it seemed incredibly dry. He hardly had any saliva to swallow. Everything tasted really strange and unpalatable. He had absolutely no appetite. Realising he'd hardly drunk anything, he gulped down some orange juice, which was pleasant enough. His stomach hurt and he retched a little, but the nausea quickly passed.

The night passed with more computer games and he was surprised to see morning light. Trying to avoid looking at his watch for as long as possible, he knew that there was panic rising in him again. What was he going to do? He hadn't slept in 24 hours. This was quickly turning into a binge. He decided to snort another half a line, to get through the day and then sleep at his normal bedtime that night.

The passage of time was so much accelerated during the segments where he was under the influence of the drug that, whatever he was doing, he found that he was still doing it hours and hours later. He wasn't normally a big fan of computer games, but he had almost completed the one he had been playing. On the pretence of completing the game, he snorted another half a line.

Feeling a little sleepy in the small hours of the morning, he decided to doze. He slept and then suddenly awoke feeling hyper alert. He was acutely aware of the sound of his own breathing, his heart beating, every noise in and outside the house. He could hear the ticking of his watch and time had slowed almost to a crawl. His pulse raced and he was terrified that he was going to have a heart attack. He lay perfectly still on the sofa and tried to calm himself down, controlling his breathing. He fought rising panic for what felt like an agonisingly long period of time before deciding that he had to distract himself. He decided to go out for a walk.

It was a bright morning, still quiet before the commuter rush. He turned left out of his front door and walked 50 metres before deciding that there would be too many people on the main road. He headed the other way, past his house and got halfway down his road before he panicked that he was getting too far away from home if he needed to hide himself away or wait for an ambulance. He walked slowly back at first and then worried that his neighbours were probably watching his strange behaviour, so he hurried back home. Inside, he paced around downstairs, unable to settle himself.

Sitting down at the dining room table, he started to scribble a note explaining what he had done. Screwing up that piece of paper, he started to write down all the medications he had taken without a prescription: dates and dosages. Grabbing more sheets of paper, he wrote a whole set of notes, explaining every doctor's appointment, outpatient visit and inpatient admission that he could remember, along with diagnoses and medications he had been prescribed. On a final sheet of paper he explained that he had bought a research chemical called "FRL-V4" from the internet, but he didn't know what the active ingredient was. He wrote that he feared he had overdosed, damaged his heart or had some kind of allergic reaction. He wrote: "I've had an unplanned binge and I think I'm getting addicted."

Neil knew the idea that you could become addicted the first time you ever tried a drug was ridiculous. There was no such thing as something that was instantly addictive. However, he knew that he'd jettisoned his plan to only take a fixed known dosage and never to binge. He knew that he wanted to take more of the drug, but he also didn't want to take any more because it obviously caused him to have massive panic attacks.

At some point while he was writing, he had calmed down. He now felt quite good; he was flooded with a sense of relief. The feelings of dread and the near-certainty that he was going to die - or at the very least be rushed off to hospital - had dissipated and he spent the afternoon having a shower and eating a little. His appetite and tiredness returned that evening and he slept for nearly 14 uninterrupted hours. When he awoke he felt mostly normal, hungry and a little depressed. However, the drug played on his mind more than he was comfortable admitting to himself.

Having had such a scary experience with the panic attacks, he wanted to flush the remaining powder he had left. Strangely, the memories that stuck in his mind most clearly were how much relief he felt when the panic attacks were finally over, as well as the relief he felt from the panic when he snorted another half a line. Fatefully, he did not flush the powder.

He managed to delay almost a week before he took the drug again. Addiction did not become a daily habit. He seemed unable to snort half a line and then put up with the panic attacks. His binges would last two or three days, until the panic would be accompanied by enough sleep deprivation to bring sleep. As he got more and more tired, he would sleep through the worst of the comedown. In a way, he was functional, because he would eat and sleep to catch up in-between his binges. However, he knew that his life now revolved around taking drugs and addiction had taken hold.

Taking to the Internet to research the unknown chemical that had its hooks in him, he discovered a thread of discussion where people were speculating what the active ingredients in "FRL-V4" were. There seemed to be consensus that it had to contain one of the most feared and notorious 'designer' drugs. Searching online, there were no shortage of horror stories about this chemical, nicknamed "Peony". News stories reported one man had chewed off a tramp's face and a Dot Com billionaire had murdered his girlfriend, while under the influence.

Unwittingly, he was committing the names of these chemicals and where they came from - Chinese laboratories - to memory, while he struggled with addiction and also tried to find information about some less harmful substitute that would help him escape his predicament.

To obtain the pure chemical form of "Peony" would be incredibly dangerous, because it was so potent, but he could try to substitute it with similar drugs that were less addictive and caused fewer side effects. It would take a couple of weeks for deliveries from China to reach him. In the meantime, his addiction raged and he started to go on binges lasting four or five days.

When his weighing scales and the first of his Chinese orders were delivered, things did not improve. He was exhausted and sloppy with his measurements. He had become used to estimating his doses by eye. Snorting a big line of "FRL-V4" and a medium sized one did not make much difference. The difference between 5 milligrams and 10 milligrams of something that was 99% pure made a huge difference. His binges started to last for over a week, because he would be kept awake for days at a time when he snorted a single line of the potent chemicals.

Feeling his life was totally out of control and it would not be long before an overdose meant death or hospitalisation, Neil decided that he was a lost cause. The idea of running away to the caravan started to obsess him. He wanted to spare Lara and his family the distress of finding him dead from his addiction.

He had promised himself that he would never cross one line with his addiction: he would never inject drugs. It was a strange thing to have decided, but everything he'd read suggested that injecting drug users were generally in their death throes. However, he had taken a syringe with him to the caravan.

By dissolving chemicals in half a litre of water, he had an exactly one milligram of drug per millilitre of water. Sucking up the chemical solution into a syringe, he could measure a dose quite accurately without his weighing scales. He didn't even need a hypodermic needle: he could simply swallow the liquid. His stomach acid would destroy about 50% of the chemical, but half of it would reach his bloodstream.

Desperate for something to drink, Neil now reached for a glass bottle that he had dissolved drugs into. The water had reacted with the chemical and seemed to have destroyed it. He took a couple of big glugs from the bottle.

Without any means of measuring the weight of his doses accurately, Neil had been playing Russian Roulette with his life. A small dose could have no effect at all and a large dose would leave him with stimulant psychosis for days, as well as putting incredible strain on his heart. It was miraculous that he had survived so long.

In a state of drug-induced insanity, every bit of powder in the caravan had been consumed, accidentally spilled or destroyed. Neil had been clean for a few days, but he was in such a damaged state that he hadn't had the energy to limp to his van or to the country lane where he might be discovered by a passing driver.

Now, he felt a sharpness return to his mind. His injuries hurt less. His back and joints didn't seem to ache so badly. He felt his limbs start to get lighter. The water had reduced the potency of the drug, but it hadn't destroyed it altogether. Neil was able to sit up and move around. He felt like he could get to the van.

 

Next chapter...

 

#NaNoWriMo2016 - Day Twenty-Six

11 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

26. Descent

She could hear the car crawl to a slow and follow her at walking pace. She had grown accustomed to the sensation of being stalked, stared at. She could feel a pair of eyes burning a hole in the back of her head. With the subtlest of movements she looked out of the corner of her eye at the road. She didn't recognise the vehicle or the driver. There seemed to be somebody in the passenger seat too. The car drew level with her and the passenger wound down their window. She glimpsed short hair full of styling gel, a white tracksuit and prepared herself for unwelcome sexual advances from a dimwitted numbskull.

"Hey!" came a surprisingly hushed call.

"Psst!"

This was not how things usually went. Normally lecherous creeps would lead with their best line, full of false flattery and often beer-induced bravado.

"Hey you!"

It was irritating, but a different and more measured approach from what she was used to. She was sure that as soon as she even acknowledged their existence, they would launch their full chat-up offensive. This was just the preamble.

"Hey!"

She was sure that their patience would quickly evaporate and she would be loudly cursed as a "stuck up bitch" and the car would roar off into the distance with its loud exhaust and bass-heavy music thumping out from their souped-up boy-racer chariot.

"Nah, she doesn't want to know" said the passenger. It looked as though he was addressing somebody in the back seat. Lara risked another glance backwards and sure enough, there was another passenger, slumped low with their coat pulled up high around their face as if they were trying to hide.

"He says he knows you" the passenger tried again.

"Who?" asked Lara, now looking in through the car window and surveying the scene, while keeping walking.

"Sam" said the passenger, pointing his thumb at the back seat. "He's sick. He needs some help getting into his flat."

"Why can't you do it?"

"We're just giving him a lift home. We've got to be somewhere else, pronto. We ain't got time."

"Some friends, you are." Lara mocked.

"Look, just help make sure he gets in OK, can you? We could just dump him nearby, but there's no telling if he'll get into his place on his own in the state he's in."

"What's wrong with him?"

"He's just had too much to drink."

"That's a really shitty thing to do to your friend. To just dump him like that."

"He's not exactly a friend. We hang out, but it's not like that. We're doing him a big favour driving him home."

"Yeah, BIG favour" said Lara sarcastically.

She couldn't help herself peering in the back windows at Sam. He was very dimly aware of what was going on. His head drooped and his eyes were closed, but he wasn't asleep. He didn't look boisterously drunk or like he was going to throw up. He was just intoxicated.

"Alright how far away is it?"

"Just down in the town centre. Jump in."

Sam was reasonably well co-ordinated and not slurring his words. He didn't even smell of alcohol. He could walk and talk without staggering, but he kept slipping into a catatonic state. His sentences would tail off and he would be half-asleep on his feet. As long as she kept repeatedly reminding him where they were and what they were doing, she could coax him towards his front door.

"Come on, Sam. Nearly home!"

"What? Eh? Oh" he said, as he seemed to remember what he was doing and take a few more steps, opening his eyes a fraction. He leant on the front door, dozing.

"Get your keys out, Sam. We're at your flat. This is where you live, right?"

"Yeah, uh. Right" he fumbled in his pockets and unsteadily directed his key at the lock.

With the door flung wide open, Sam made a bee line for his day bed and collapsed on it face down, before rolling into a slightly more comfortable position. Lara was still stood at the threshold, gazing into the large loft apartment, taking it all in.

"OK, I'm going to close this door and go home now."

"Don't go. I need you" Sam said, holding up a hand and beckoning her in.

Lara took a few steps towards the day bed.

"What do you need me here for? You're home now."

Sam patted the bed next to him. Lara didn't get the sense that he was trying to get her to sleep with him, but that he wanted her to sit. She sat awkwardly on the edge of the futon.

"You're home safe now. You can go to sleep. You'll feel better when you wake up."

Sam now opened his eyes much wider and tried to look at her. There was a kind of fear that played across his face.

"You can't let me sleep. I'll die" he said.

"What are you talking about."

"If I fall asleep, I'll stop breathing."

"If that's true it sounds like you need an ambulance."

"No!"

"Why not? What's wrong?"

"Overdose." he said, with the effort of his honest admission seemingly causing him to slump. He relaxed. His face was tranquil. Lara leant over him. He was breathing, but very shallow.

"I'm going to go phone 999. You need to go to hospital" Lara stood up and walked towards the door.

"Nooo! Stay with me" Sam called out, reaching towards her from where he lay. She hesitated at the door and looked back. "I'll be OK soon. Just stay with me a little while."

Babysitting him while he fought through a near-fatal overdose, Lara was torn. She could see his lips getting slightly purple as she fought to keep him conscious enough to keep breathing. In waves, he would get so relaxed and comatose that he would sleep peacefully and could barely be roused. She would be close to running for help. Then, he would come round a little, gasping for air and she would plead for him to stay alert and keep breathing. She knew instinctively that in the time it took her to go away, find a phone and give the address, he could very easily slip away. It took little more than an hour before he started to come round, but it felt far longer.

The experience shook them both and Sam said that he never wanted to risk dying like that again. At first, he was resolute that he needed to quit heroin and that the close call was the wake-up call he needed. He was so grateful to Lara for keeping him alive and for avoiding a hospitalisation. Then, he explained that his body would start to go into a painful withdrawal and he would feel like he "needed" his next fix. Quitting wasn't so easy and he'd need to wean himself off. Would she help him?

He genuinely meant everything he said.

In reality, Lara became his regular babysitter, so that Sam could shoot up big doses of heroin, knowing that there was somebody there to keep him safe if he overdosed. At first, Lara didn't know it. She felt that she was helping him to get cleaned up and off the dope, but after months going round to his apartment almost daily, it was clear he wasn't giving up any time soon.

She adored his tortured soul and his fascinating life. She loved their asexual relationship, which still had a kind of comfortable intimacy. Sam's first love was heroin, but Lara didn't mind being his mistress. She felt like she could make a difference.

Eventually they quarrelled. He had no intention of ever quitting, she said. He did, but it was hard, he explained. He said he'd try harder, but he started to be more secretive. He hid his habit and Lara knew it.

"You'll always keep using if I stay with you" were the last words she ever said to him. He didn't even reply. His eyes were filled with tears, but he knew the truth. Perhaps he would quit one day, but that wasn't the path that their relationship had followed. He used and she was there to keep him safe. That was the way it had been since day one and that was the way it was always going to stay.

She'd gone back to the apartment on the pretence of picking up some things she'd left there, but really she was checking up on him. Making sure that he was OK. He was so alone. His mum had left when he was little and his dad had died leaving him the inheritance that paid for his apartment and his drug habit, but he had no real friends: only drug dealers and addicts hoping to mooch off him. He was no fool, so he didn't indulge the parasites. He had nobody.

Lara knew right away that it was different from the other overdoses that she'd witnessed. There was no life left in his body. He'd been dead for some time.

Poor little rich boy. He had a kind of infamy amongst the local drug users, with many plotting to rob and cheat him out of money. He was even known to the police as a tragic addict: a dead man walking.

By the time she had left him, she was prepared for the worst. Or at least, she thought she was. Of course his death was more traumatic than she could ever have imagined, but she knew that the burden of his life was more responsibility than she should ever have been asked to shoulder. She could forgive herself, but always wondered if things could have turned out differently.

Neil's behaviour was completely different. He seemed in control, even though he was unhappy. It was Neil's desperate wish to be happy and productive again that made him so different from Sam. The addiction that she'd known had no end to it. Without a doubt, Sam would take heroin forever, given an unlimited supply and no consequences. Neil was different. He only ever took his pills begrudgingly and always talked about "recovery". His mental health problems were just a blip, in his eyes. Medication was a means to an end: like a plaster cast on a broken limb, helping it heal.

It seemed unthinkable to Lara, the idea that Neil had lost control and was slumped somewhere, dead from an overdose. She'd known so many years of him being steady and dependable. She'd seen him go through depression and psychotic episodes. However, he didn't seem to be hiding a drug habit and it seemed unimaginable that he could have been consumed by an addiction so quickly that she would never have seen it creeping up. The evidence suggested that somebody flicked a switch and her fiancée went insane. It was impossible to know somebody so well and for them to hide a whole other side of their personality. She knew what addicts were like when they hid their habits.

She confronted Colin.

"You're not telling me everything."

He sighed. "What you don't know can't hurt you."

"If there's stuff you've found out, I want to know."

"I think we just need to let Neil go and keep our best memories of him intact."

"What do you know?" asked Lara, now looking horrified.

"It's a lot worse than we thought" replied Colin with a grim expression.

"I really do want to know absolutely everything."

"He was taking some highly addictive drugs. I'm sure he's gone now. We should probably talk about some kind of memorial service."

"I guessed as much. I've been reading about those legal highs and they're nasty. Not many deaths though."

"Yes, but he was getting some really dangerous ones direct from China at 99% purity. I'm almost certain he overdosed."

"How do you know?"

"I found some traces at the house. I'm so sorry, Lara. I've been waiting and hoping that the body will be found, so we can grieve properly, you know?" said Colin, his eyes pricking with tears.

"You're a good man, Colin. I don't blame you for not telling me" replied Lara, hugging him.

 

Next chapter...

 

#NaNoWriMo2016 - Day Twenty-One

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

21. The Cell

"If you don't mind, please empty everything out of your pockets into this plastic tray."

Neil put his wallet, mobile phone, house keys, loose change, used tissue and a folded piece of paper into the grey plastic tray, which had a sticky label on it with "Neil - Room 8" written on it in red marker pen.

"Do you have anything sharp in any of your pockets that could hurt me? I'm afraid we have to check we've got everything."

"No."

The nurse patted Neil's clothes down and checked the waistband of his trousers and underpants.

"OK, would you mind taking off your belt and your shoes, please. Just pop your shoes down on the table here next to the tray."

Neil complied.

"We have to keep your belt, sorry. I saw you brought a dressing gown and we have to keep the cord from that too. We're also going to have to take the laces from your shoes. We'll go through your bag from home in a minute but you can't have necklaces, cables - such as mobile phone chargers - razors, scissors, keys or anything else sharp."

"OK."

"If it's alright with you, we'll hang on to your mobile phone and keep your wallet safe here at the nurse's station. If you need something for any reason, you can ask one of the staff to get it for you, but we'd really like you to try and relax and get used to the ward for the first few days, so we'll be keeping your phone right here."

The nurse was now coiling the dressing gown cord and putting it in the tray, as he went through rest of Neil's belongings.

"We have to keep aerosols here. If you need your razor you can have it while somebody supervises you shaving."

"I'm not feeling suicidal" Neil said.

"OK, that's great, but there are other patients here who might be. The bedroom doors aren't locked so we have to keep all these high risk items here for everybody's safety."

The nurse showed Neil to his room. The door had a window with a blind which could be opened and closed from the outside. There was a single bed with a foam mattress, a writing desk, a plastic chair, an open wardrobe with drawers at the bottom, a sink and a plastic mirror screwed to the wall. A big window was secured with a wire tether so it could only be opened a few inches. There were no curtains. Across the hallway there was a wet-room with a shower. There was no shower curtain. There were no locks on any of the doors.

"Get yourself settled and then come and sit in the lounge. We try to encourage patients to not spend time in their rooms during the day."

Neil sat on his bed with his bag next to him for a few minutes. He thought about unpacking but he really didn't want to give the impression that he was OK about being detained in hospital against his will. He'd been told to bring a few essential clothes and toiletries. Visitors could bring him anything else he needed once he'd settled in.

In the main part of the ward, there was a lounge at one end with several sofas arranged around a big TV which was hung on the wall. At the other end of the room were a number of tables and chairs. There was a nurses' office and two rooms with sofas in, which had big windows so you could see in and out. There was a doctors' office and an examination room which were private. There was a door leading to the male bedrooms and another one leading to the female bedrooms. A recreation room had a pool table, table tennis table and books in it, as well as a number of patients' artworks displayed on the walls. There was also a small kitchen for the patients to be able to make their own drinks and snacks.

A noticeboard displayed a timetable of the week's events, which had many of the same things that Neil was familiar with from day hospital: art therapy, music therapy, drama therapy and community meetings. A whiteboard had the first names of the 18 patients who were staying on the ward, with their allocated nurse's name written next to it in green marker pen. The ward was at its maximum capacity, with 9 men and 9 women.

There was a dispensary hatch where patients would queue up to get their medication several times a day. There was a door that led out to a small courtyard surrounded by high walls on all sides. That was both the smoking area and the only place that patients were allowed outside without staff supervision.

CCTV cameras were everywhere, except in the bedrooms and bathrooms. The ward was secure but the patients were considered low risk. There was only one locked door between the ward and the main corridor of the hospital that led to the other wards and facilities. For a few days, Neil had to stay on the ward, but then staff members were allowed to escort him to and from the drama studio, art studio and music room.

Some of the patients had obvious scarring on their arms where they had cut themselves. A girl's neck was bandaged. Other patients had problems that were more subtle. A man with a big beard smelt of pooh and always wore pyjamas. Many were quiet and withdrawn and a few would shout randomly, talk or sing to themselves.

"BBC one, BBC two, ITV" a man started. "Channel four" he said, raising his voice an octave higher. He repeated this same phrase over and over in a lyrical and rhythmic way, like he was chanting a mantra. It was quite catchy and Neil found it stuck in his head too.

"I just want to be dead."

This is what Michael said loudly every single morning before breakfast. Neil was a late riser, but he could hear his fellow patient shouting all the way down the corridor.

"OK, Michael. Time for your morning medication" a staff member would coo, coaxing him towards the dispensary hatch. Michael would shuffle along in his slippers. By the time Neil got up for breakfast, Michael would be sat quietly at a table with a vacant stare and a half-eaten bowl of cereal in front of him.

"NEIL! What are you having for breakfast?" Nicole shrieked with excitement.

Nicole was young but some developmental disorder meant that she was even more childlike. Her eyes were always half-closed with her bottom lip protruding. Saliva dripped liberally from her mouth. However, despite her tenuous grasp on almost all aspects of reality, she had latched onto Neil, much to his annoyance.

"I don't know. I might have toast."

"I was going to have toast."

"Actually, I might have corn flakes." he toyed with her.

Nicole hesitated for a moment, looking crestfallen. Then her face lit up.

"I'm going to have corn flakes."

Neil swiftly poured himself some rice crispies and dashed out of the kitchen to find a table with only one spare seat.

"Those aren't corn flakes, Neil." said Nicole, coming out of the kitchen and looking with dismay at her own bowl. "Sit here with me" she gestured, standing by an unoccupied table.

"How's it going?" Neil asked a patient who he didn't know, sat at the table next to him, ignoring Nicole's entreaties.

"Not great" the man replied.

Nicole huffed and sat down to eat her breakfast. A staff member rushed over to join her, fearing there would be an upset outburst if the poor girl felt too overlooked.

In his first three weeks in hospital, Neil saw the psychiatrist three times. He had a few meetings with mental health nurses and a physical health check-up, but his life was one of ordered institutional hospital routine: medication, mealtimes, planned activities and lots of time spent watching TV.

Suddenly losing his liberty had been terrifying and his natural instinct was to yell for lawyers, demand his human rights and to complain about the arbitration that had led to him now being held under lock and key. However, he also feared the power of the state institutions. The police, the National Health Service, the government, the law: he was no match for these massive entities and he knew that he would only make things worse for himself if he made a fuss.

He now deeply mistrusted the system and regretted seeking medical help at all. He felt betrayed by his doctors, he felt that the medications had made him sick, he felt that the crisis team and Lara had conspired to lock him up. He was angry that the police were used for his "welfare" when he really felt they simply provided the muscle to drag him away from his home if he tried to fight for his freedom.

Neil's faith in medicine had been completely shattered, but now, as he lay contemplating his wrecked body he knew he urgently needed medical help. He was dying.

The can of cola that he had found in the shopping bag he'd left outside the caravan had worked its way quickly through to his bladder and he needed the toilet. Grabbing a half-full glass from a nearby shelf, he urinated into it. His urine had been getting more and more cloudy and smelled terrible, but now there was a copious amount of blood present.

His organs were failing. His lungs were flooding with fluid that he couldn't cough up. His chest was tight and his breathing was laboured. His ankles were swelling up as his heart struggled to pump blood around his body. His dehydration and malnutrition had reached the point where his body had start to eat itself and his muscles were wasting away. He was so fatigued that he struggled to move and he blacked out from low blood pressure if he raised his head too quickly.

Death in the filth and darkness of the caravan was nearly upon him.

 

Next chapter...

 

#NaNoWriMo2016 - Day Twenty

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

20. Segmentation

When Lara was working her day shift, she would get home at around 7:30pm and have an hour where Neil was vaguely compos mentis. He would take his medication at around 8pm and by 8:30pm his eyelids were heavy and he would be slurring his words.

"Time for bed, Neil."

Uncomplaining and compliant Neil would be led to the bedroom where Lara would help him undress and get under the covers. It was as if he was blind drunk: barely able to comprehend where he was or navigate the short distance to the bedroom on his own. It was alarming to see how heavily medicated he was, but Lara trusted the judgement of the doctors and had confidence that his health would soon improve.

During her night shift, Lara became aware just how little of the day Neil was awake and active. Sleeping until nearly 11am, he pulled on some clothes and lolloped down the staircase where she heard him collapse on the sofa. The sound of daytime television could be softly heard from the bedroom, but she knew he was half-dozing with glazed eyes, not taking anything in. Before she left to go to work in the evening, his mind seemed a little less cloudy, but he had little more than an hour before he had to take his 8pm dose of medication.

The change from his depressed demeanour was unmistakable. When he was depressed he was present, but also cold, withdrawn and a little passive-aggressive. He was hostile towards the world, fatigued, but his mind was still sharp. Now, he was a shell of a man: he shuffled around, slept and ate, but there was no living spirit within him. He was dead behind his eyes, which seemed more sad than the expression he wore when he said he didn't want to live anymore.

It was pretty clear when Neil skipped his medication. He would be wired: wide awake with manic eyes and an electric energy, restless.

"Did you take your meds?" Lara asked.

"Whose prescription is it? Mine or yours?"

"It's yours."

"OK. Good. You worry about your medications, I'll worry about mine."

He wore a fierce expression. He was upset, defensive, offended that she would question whether he was taking his drugs. It was obvious when he hadn't, but she couldn't press him further on the matter without an explosive argument.

At first, he only skipped doses sporadically. It was as if he wanted to occasionally remind himself what it was like to be unmedicated.

Returning home one day, Neil was not in the snug or in the bedroom. Looking in the box room and the spare bedroom, Neil didn't appear to be in either. As she walked through the hallway towards the kitchen, she heard a sound come from the cupboard under the stairs.

"What the hell, Neil? What's wrong?"

He was in the cupboard completely naked with a bright red mop bucket on his head.

"Get away from me! Shut the door!"

"What's wrong, Neil?"

"Don't let those bloodsucking bastards get in here. Keep the fucking bats away from me" he shouted, with his hands flailing in the air.

"What's wrong with your arms? They're covered in scratches."

This seemed to stir some memory in him that he had forgotten. He started attacking his skin.

"Insects. Ants. Under my skin. Look at them crawling under there!" he picked at something unseen on his arm. A little blood appeared where his fingernail dug in.

"Neil you're seeing things. There aren't any bats. There aren't any insects."

"Fuck off. Fuck off. Fuck off." he shouted, cowering in the corner of the cupboard and pulling the bucket down over his head as if it could protect his whole body.

"Please come out from there. You're covered in scratches. You're hurting yourself."

"Leave me alone. You're a liar. You're a fucking liar."

"What am I lying about, Neil?"

"You know what it is."

"What is it?"

"You know. You all know. Fuck off and leave me alone."

The crisis team convened an assessment with Neil's doctor, a psychiatrist, a social worker and a mental health nurse. Two police officers stood in the hallway. Lara hovered in the doorway of the snug looking extremely anxious. Neil was sat at one end of the sofa in his dressing gown.

"We know you've stopped taking your medication, Neil. You should have refilled your prescription a week ago."

"I told you. The side effects were intolerable."

"Yes, but the medication was controlling your illness. You need the medication to stay well."

"I wasn't unwell before I started taking it."

"That's not true. Your notes say you were very unwell. The crisis team have been in contact for quite a while now."

"I wasn't hearing things. I wasn't seeing things."

"That was because the medication was working."

"The problems started when I stopped taking the quetiapine."

"There you go then, see! The medication was working. Why won't you start taking it again?"

"I told you. I'm OK. I can't stand the side effects. I don't need the quetiapine."

"But you had a psychotic episode. You got very sick without the medication. You need the medication to control your illness, Neil."

"What illness? I was depressed. That was all."

"Neil. You're very sick. You're exhibiting all the symptoms of paranoid schizophrenia. We're all very worried about you. You're not safe if you're not taking your medication."

The social worker from the crisis team got up and took Lara into the dining room.

"Look, we're going to have to take him into hospital to look after him and to assess him."

"OK, when? How long for?"

"I think we're going to recommend that he stays for 28 days. He's really sick and we need to get to the bottom of this. He's clearly not coping at home. You've been doing a great job, but he needs to be looked after in hospital."

"So, you're sectioning him?"

"We need to make our final decision, but it's likely that he's going to go to hospital under section two. He's not well and it's the best thing for him right now."

"What happens next?"

"We'll find a bed for him at a local facility and then he'll be admitted. Once he's settled in you'll be able to visit. He might not have to stay for the full 28 days, but we need to make sure he's in a safe place where the doctors can properly assess him and help him get better."

"He's angry with me. He was furious that I called you guys."

"You did the best possible thing you could. He was a danger to himself. It's really great that you called us and we can start to get Neil the help he needs."

Lara wasn't able to get to the ward during visiting hours until the weekend. Neil didn't want to see her and refused to come out of his bedroom.

"I'm sorry Lara, he doesn't want to see you right now" a nurse explained.

After 3 weeks, Neil appeared back at the house.

"I didn't know you were coming home."

"They let me have some leave. Time off for good behaviour" Neil chuckled darkly. He avoided eye contact and he scowled.

"Are you OK?"

"Would you be OK if you'd been forcibly removed from your own home, bitch?"

Lara drew her breath sharply, as if she had been physically struck.

"Neil!" she sharply rebuked at the harshness of his language, but she was more hurt and shocked than anything.

"It wasn't like that" she said with a concillatory tone. "You were really sick. Do you remember what you were like? Do you remember? You were under the stairs with a bucket on your head. What was I supposed to do?" Lara asked, reaching out to touch his arm. Neil pulled away from her baring his teeth, his eyes flashing with rage.

"Stay the fuck away from me."

She knew she sounded patronising and he felt betrayed. He had been brooding in hospital and the situation was highly charged, but she wanted him to know that she hadn't meant to hurt him. It was painful to see so much anger and mistrust directed towards her.

"Look. I love you. I care about you. I just want to see you get better."

"You got all those people ganging up on me. You turned my own doctor against me. What right do you have to do that?"

"You were having a crisis, Neil."

"Stop using my fucking name. It's just me and you here. There's nobody else here. Fuck."

Neil stormed off. Lara heard the sound of shattering glass and then a yell of pain. She hesitated and then started to walk upstairs. Neil crossed the landing and went into the bathroom. Tentatively, she poked her head in the doorway.

"Fuck off. Fuck off and leave me alone."

Neil was wrapping tissue paper around his hand. There were blood spots on the grey tiles all over the floor around his feet.

"Why the fuck are you still stood there? Fuck off. FUCK OFF" he screamed.

Lara went into the bedroom where a full-length mirror was shattered. The glass was mostly clean but large dark red blood spots were soaked into the carpet, trailing through the hallway and into the bathroom. Neil emerged and walked into the spare bedroom.

"Are you OK?" she asked.

He slammed the door closed.

"FUCK OFF!" she heard him yell, muffled inside.

On Sunday evening Neil left the house without saying a word. Lara waited until about 9pm and phoned the hospital.

"Is Neil back?"

"Yeah he came back a couple of hours ago."

Lara was relieved. She had been torn, not knowing whether to phone the crisis team again or not, knowing that Neil would feel even more betrayed. She sunk into the sofa and convulsive sobs hit her before she'd even put the phone down.

 

Next chapter...

 

#NaNoWriMo2016 - Day Nineteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

19. The Hospitals

His first day in a psychiatric hospital had been spent as a day patient. The crisis team had arranged for Neil to get out of the house and see a different psychiatrist. They'd picked him up in a minibus from home and driven him to another local hospital that Lara had never heard of. It was surprising how many institutions there were in town, dealing with mental health patients.

A breakfast of toast and cereal was provided at the hospital in a large canteen with a huge bay window looking out onto a garden filled with mature shrubs and trees. The hospital itself was an imposing red brick Victorian building, originally built as a sanatorium. There were parquet floors and a grand staircase in the foyer. Otherwise, the hospital had been institutionalised, with fire doors painted glossy pale green, linoleum floors and lots of blue signs with white lettering.

After breakfast, the patients were corralled into a circle in the canteen. Tea and biscuits were served as a support worker went through the day's activities and asked who would like to do what. There was music therapy, art therapy and drama therapy. Neil said he would do all three.

There were long periods of time where nothing seemed to be happening and there was no sign of any staff members. Patients were hanging around in two rooms: the canteen and a lounge. The lounge had an array of different size and shape sofas around the edge of the room and a vending machine in one corner. A tall sash window offered a view out to the gardens on the opposite side of the building from the canteen. Nobody was talking to each other. Some patients sat completely still with glazed eyes, as if in a trance. Other patients paced around nervously, avoiding all eye contact and distancing themselves from others.

After a seemingly interminable wait - there were no clocks anywhere to be seen - a woman appeared asking for Neil.

"Are you joining us for music therapy?"

"Yes, I was going to."

"Well we're starting right now."

Neil followed the woman through a door. She seemed irritated as if he should know where to go and when. The music room was nearly full with about 20 patients holding instruments, sitting around a large square table. He didn't recognise anybody from breakfast. The room had a high ceiling and it was quite dark. The walls were covered with blue fabric covered cork-board and there were many crude paintings and drawings pinned up.

"Choose anything you want and we can start" said the music therapist, gesturing to a corner filled with an array of percussive musical instruments.

Neil picked up a tambourine and sat down in a free chair at the table. The music therapist sat at a piano and began to play a simple melody. Tentatively, a patient started to tap a bongo drum in a staccato rhythm that was not in time with the music. Another patient shook a pair of maracas at random intervals. Neil started to gently jangle the tambourine in time with the woman on the piano and she started to sing, presumably to amuse herself as nobody else knew the words or the tune. Everybody else in the room held their instruments motionless, except for sporadic flurries when they became emboldened enough to briefly make a noise.

Eventually, Neil got bored and started to beat time on the taut skin of the tambourine quite loudly. Following his lead, more and more patients started to join in with the rhythmic bashing of instruments. The sound built and built and the music therapist played louder and wailed badly out of tune. Finally, she stood up and gestured that everybody should calm down, gently shushing.

"We could wake the dead with that racket" she said, laughing at her own joke.

"OK that was a brilliant session. Please help me tidy away the instruments. Thanks everybody. I really enjoyed that."

The patients all disappeared in different directions and Neil made his way back to the canteen. Most of the people who he'd seen earlier were still there. Spotting the patient who had been shaking the maracas, walking through the foyer, Neil intercepted her.

"What happens now?"

"Well I'm just going outside for a cigarette. Get yourself a drink and have some cake. Then it'll be lunchtime."

A table in the canteen had been laid out with large plastic jugs of blackcurrant and orange squash. There was a chocolate cake and a victoria sponge that had been sliced into small portions on paper plates. Neil took a plastic beaker from a stack and was about to pour himself some squash when one of the catering staff rushed over.

"I'll pour that for you, dear."

"It's OK, I can do it" said Neil.

"No I have to pour it for you."

With his drink and a plate of cake, Neil sat down at a table with a girl who was fiddling with her phone. She looked up.

"Are you OK?" she asked.

"Yeah. Bit confused about what's going on. You alright?" he replied.

"No. I'm not good at all" she said, suddenly looking very worried. She studied the floor.

"Do you want to talk about it?" he asked.

She looked up momentarily, made a little half-giggle and then started fiddling with her phone again.

After about an hour of awkward milling around, a servery hatch was opened in the canteen and a trolley with knives and forks on it was wheeled out into the room. Patients started to line up at the hatch, where there was a hot plate and the catering staff were taking off the foil lids on a number of plastic containers. Neil took his place in the queue. There were a number of dishes to choose from including pasta and a meat pie. Neil chose meatballs in a tomato sauce, mashed potato and green beans, which were dolloped onto a large white plastic plate by a lady in a hairnet with a long serving spoon.

"Gravy?"

It seemed an unusual question, but the dish could certainly be improved with some kind of sauce. The lady poured thick brown liquid all over his food from a big aluminium jug. Lunch reminded him of school dinners, but not in an unpleasant way. There was a stodgy pudding with lashings of thick yellow custard to finish the meal and it was all washed down with tap water in tiny plastic tumblers, poured by one of the catering assistants.

As he was finishing his meal, Neil was approached by a camp man with a bright happy smile who almost danced into the canteen. Half lowering himself to table level but not sitting down, he laid his hand gently on the middle of Neil's back.

"You're joining us for drama today. Is that right?"

"Yep" said Neil, covering his mouth which was still half-full of food.

"OK perfect. There's only a few of us but we always have a lot of fun. We'll be in the drama studio in about 30 minutes, alright? Wonderful" he said, answering his own question.

Neil wanted to ask where the drama studio was but the man had skipped away before he could swallow his mouthful and call out to him.

"Oh good. You're here" the drama therapist said when Neil finally located the right room. There were four patients, arranged in a semicircle facing the therapist. Everybody was seated in the middle of a large polished wood floor. Around the edges of the room were chairs stacked up, boxes with hats, props and clothes rails with various costumes.

The session began with some icebreaker exercises where each patient had to say the name of another patient before throwing them a ball to catch. They then re-enacted the story of Goldilocks and the three bears several times, rotating the roles so that everybody played each character. The therapist prompted them with questions while they were doing this.

"How do you feel that your porridge has been eaten, baby bear?"

"Uh. Hungry?" Neil replied.

With more tea and biscuits there was a community meeting where everybody sat in the canteen and somebody asked a sequence of questions about whether anybody had any problems with the facilities or could think of any service improvements. The nurse and support worker who ran the meeting were met with stony silence.

Art therapy comprised colouring in with pencils or felt tip pens. Neil chose a picture of an orange tree and meticulously shaded every leaf. He had almost completed it when a man appeared at the door of the art room.

"Neil. Can I borrow you please?"

Led up two flights of stairs, the man knocked on a door.

"Come" came a voice from inside.

Opening the door, a young doctor held out his hand.

"Neil isn't it? Good to see you. Take a seat please" he gestured towards a plastic chair. "I'm Doctor Akinbole, a registrar psychiatrist here at the hospital. I'm hoping we can do something to help you today."

"Oh.. kay..."

"Now, I come across quite a lot of cases of young men. Fit and active. Productive and happy. Sometimes problems can materialise in your twenties. It's nothing to be ashamed of and I'm sure we can help you get back on your feet."

"Alright" Neil tentatively offered.

"So you've been working full time, you're engaged and you've been in a long term relationship with this lucky lady?"

"Yes, that's right"

"That's great. Great" the psychiatrist said, smiling.

"Well listen, there's a medication that's helped a lot of my patients in a similar situation to yours. It's an atypical antipsychotic, but it's very good with depression too and a whole host of mental health issues."

"Antipsychotic?"

"Atypical."

The psychiatrist reached for a book on his shelf and leafed through the pages.

"OK, what we're going to do is start you on 200 milligrams today, 400 tomorrow and 600 the day after. Then you'll be taking 600 milligrams every night. This medication is great because we can ramp up the dosage really quickly."

"What about all my other medications?" Neil asked.

"Well, we'd better keep you on those for now. We don't want you to have any nasty withdrawal effects. We can taper you off those gradually in future."

The psychiatrist was now scribbling in his prescription pad.

"Here you go" he said, standing up. "Any problems, just phone the hospital and leave a message for me."

"Thanks" said Neil, taking his outstretched hand and shaking it again.

"I'm sure you'll be feeling much better soon. All the best" the psychiatrist said, ushering Neil out of the door.

Descending the stairs and standing in the foyer, Neil felt very lost and shellshocked. After a slow and relaxing day, his consultation with the psychiatrist had been a whirlwind affair and he was shocked at how quickly he had now received a prescription for a third medication. There was also something scary and unpalatable about the word antipsychotic.

On the first day with his new medication he woke up with a very dry mouth and was very sleepy until late morning. On the second day, he struggled to brush his teeth and get into bed because he was fighting to stay awake. On the third day, he needed to go to the toilet during the night and found that he was confused and staggering like a drunk. The dry mouth was terrible, he felt tired all the time and his appetite for chocolate biscuits became insatiable.

After some weeks, the side effects had not abated. Neil's life consisted of taking his medication at 7 or 8pm at night so that he could be awake for a few daytime hours, where he sat semi-comatose watching trash TV. Phone-calls to the hospital and messages had not managed to raise any response from the psychiatrist but eventually he spoke to another doctor. He was told not to reduce the dose, but he could split it into two or three doses throughout the day. This meant that Neil was half-asleep the whole time and barely conscious of what was even happening from one day to the next.

Two months elapsed and Neil was comfortably numb but there was no change or improvement. There was no way he could ever work while so heavily medicated. He booked an appointment to see his GP and halved his dose the night before he was due to see the doctor.

"I want to come off the quetiapine."

"Ok, but you can't just stop taking it until I write to the psychiatrist and ask his opinion."

"I can't stand the side effects and I have no quality of life."

"I understand, but we have to be very careful when you stop taking medications like these."

"It's not helping me. The side effects are awful. I'm just drugged all the time. It's like a chemical straightjacket."

"Let me write to the psychiatrist. I'll get back to you as soon as I can."

 

Next chapter...

 

#NaNoWriMo2016 - Day Eighteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

18. Psychosis, Madness, Insanity and Lunacy

"How did it go at the hospital?" Lara asked.

"Dr Asref has written me a prescription for two medications and he's made the referral to the crisis team" Neil replied.

It was the third time he'd visited the small community hospital as an outpatient and the second time he'd met the psychiatrist. Lara had never even heard of the hospital, even though it wasn't far from their home. The hospital mainly dealt with mental health patients.

The first appointment Neil had as an outpatient was for an assessment with a mental health nurse, 8 weeks after his doctor had made the referral to psychiatric services. He'd spoken to the nurse for about 90 minutes, while a trainee listened in and furiously scribbled notes. The nurse was kind and easy to talk to. He seemed to know exactly what kinds of things Neil was going through and was able to second guess what Neil was about to say, which made Neil relaxed and chatty for the first time in months.

The second appointment was with the consultant psychiatrist. He was not particularly conversational and seemed to be almost rambling to himself about various diagnoses and treatment regimens. He had presented Neil with a stack of photocopies of information on various medications and the consultation was suddenly over. Neil was confused and a little cut adrift. Asking what happened next, he was told to wait for another appointment where he could say which medication he'd like to try.

"Did you get the mirtazepine?" asked Lara.

"Yeah, but the consultant said I should take venlafaxine with it"

"Two medications?"

"That's right" said Neil, rattling two boxes of pills at Lara with a grin.

He seemed happier but his behaviour was worryingly erratic and childish. He would say and do regrettable things with no care for the consequences, or he would burst into tears and leave things in a mess if anything didn't go well.

One day, Neil had suddenly decided to demolish the garden shed with the supposed intention of building another one, but he hadn't purchased any materials to construct a replacement. Lara found him in bed when she got home, dreadfully upset and stressed about what he had done. That evening, she had to move the contents of the shed that could be damaged by rain and store them in the spare bedroom, while Neil cowered under the duvet.

His energy levels had improved, but often he would stay awake all night on the Internet. When Lara came home he would want to tell her about all the things he'd found out about UFOs, conspiracy theories, quantum physics, stock market trading and chaos theory. Neil's eyes would be flashing wide with wonder and excitement, but his thoughts were jumbled up and he was talking so fast she could only pick up every third word. He would get frustrated that she wasn't understanding and storm off in a huff.

"Did you get a new diagnosis?"

"He can't make up his mind. He said he's still convinced that it's major depressive disorder, but he also mentioned borderline personality disorder and bipolar disorder. He wants to treat me as if it's treatment resistant depression" Neil replied.

"Who are the crisis team?"

"Well, it's a number to phone if I'm thinking about hurting myself"

"Are you still having suicidal thoughts?"

"Not really. I'm too busy with my project"

Since losing his job Neil had been obsessed with the idea of creating an out-of-the-box security system bundle that would include wireless CCTV and motion sensors. The house had become increasingly full of equipment from Far-East manufacturers that Neil was tinkering with. Lara worried about how much it was all costing. How did he intend to sell this system if he could even make it work?

"Can I have the crisis team number?"

"Yeah. I'm supposed to give it to you and family so they can phone if they're worried about me" he replied. "And to any employer, but I don't want work sending round their goons to spy on me" he spat.

Neil's employer had become concerned that he hadn't turned up for work and had called his emergency contact - Lara - to see if he was OK. Lara was working and hadn't been able to answer her mobile, so the police had been phoned out of concern for Neil's welfare.

Neil had ignored the knocking on the front door, hoping that the police would just go away. A neighbour let the police into the back garden and they jumped over the fence. Neil heard the officers shouting at the back of the house and knocking on the back door. Yelling from the back windows, the police had insisted he come to the door so they could see he was OK. Neil had begrudgingly complied.

Lara was weary from constant worry about how Neil. She was very much relieved that there was now somebody else to contact in an emergency.

"People care about you, Neil." said Lara.

"Why are you using my name?"

"What do you mean?"

"Is there anybody else here? Why have you got to refer to me by name?"

"I don't know what you mean"

"You're so fucking patronising" said Neil, storming off.

Lara could hear him go into the box room upstairs. She knew he would be pretending to fiddle with stuff, brooding angrily. He would probably sleep in the guest bedroom again, even though it was packed with junk and the bed was covered with stuff from his project. Perhaps he would be awake all night surfing the Internet, following some thread that captivated his interest. They were definitely not going to have any further cordial discussion tonight.

Picking up the tablet on the coffee table - an impulse purchase that Neil had made - Lara searched the Internet. Typing "borderline personality disorder" she wondered what borderline meant. Did it mean that it was a milder form of the illness? As she read the symptoms she decided that it didn't really seem like Neil at all. They'd been together for so many years and they were engaged to be married. The part about unstable relationships didn't seem to fit at all.

Searching for "bipolar disorder" she came across a number of symptoms that sounded much more like Neil's recent behaviour. Rapid speech and disordered thinking, irritability, spending money and risk taking. She read the word "hypersexuality" and felt a knot in her stomach. He'd shown relatively little interest in her recently, but she knew he was watching more and more pornography. With a kind of shamelessness she heard him masturbating at night and found discarded tissues littering the floor. He made little effort to hide his Internet browsing history.

"Delusions of grandeur" and "psychosis" were things that were a little hard to place. Lara had worked a night shift and she heard him on a phone conference call during the day with his boss and human resources. Neil had ended up yelling about how he knew more than "all of you put together" and how he would create a competitor company that would "crush you like a bug". She knew that he had become frustrated and enraged by the conversation which had been ostensibly about sacking Neil, but his crazed response was completely out of character. She put it down to the extreme stress of the situation.

He was withdrawn and distant. It seemed inconceivable that he would be hearing voices or suffering with hallucinations. In her eyes, Neil was still strong, rational, intelligent and in control. She trusted him. They had always been open with each other about household finances and shared the burden of balancing the books. Even though she was cross that he'd thrown away his job, she thought that it was necessary for Neil's health and that he'd easily get more paid employment when he was ready to go back to work. They had enough savings to cushion their loss of earnings in the short term.

Two days later, Neil had disappeared.

"What do you think I should do?" Lara asked on the telephone.

"Have you rung the crisis team?"

"No. I don't know what the best thing to do is"

"Well, he didn't like it when the police got involved" Neil's dad replied.

Neil's dad was a practical man and had become a useful person to phone when she didn't know who else to speak to. Lara's parents were very sympathetic towards Neil, but it meant that they tended to share and exacerbate her worries rather than offering simple clear-cut advice.

The crisis team had promised to arrive within an hour. That was early on a Saturday morning. Neil had returned home in the afternoon, but had barricaded himself in the box room and refused to talk to Lara. Some eight hours after she had originally got in contact, there was a knock at the door.

"Hello, Lara?" asked a balding man, slightly overweight and wearing rimless spectacles. A mousey woman waited nervously behind him in the darkness, clutching a bulging ring binder.

"Yes, Hi"

"I'm Dan. This is my colleague Sue. Can we come in?"

"Please. Please do. I've been waiting all day" said Lara, ushering the two visitors into the hallway. "Neil, there are some people here to see you" she called upstairs.

Dan and Sue stood awkwardly and Lara gestured towards the snug, where they entered and sat down.

"Sorry... Lara was it?" Dan said.

"Yes, Lara"

"We had a number of urgent calls come in."

"That's fine."

"I'm a social worker and my colleague Sue is a nurse. We're here to make an initial assessment and see how we can help. Can you tell me what's been going on? It's Neil isn't it?"

"Yes, it's Neil I phoned about."

Lara noticed that Neil was hovering by the door.

"Ah Neil. These people are from the crisis team. They're here to see if you're OK."

"I'm not" said Neil, half entering the room but not sitting down, surveying the scene with distrust.

"Hi, Neil. I'm Dan. This is Sue" said the social worker, leaping to his feet and offering his hand. Neil took it and shook it. Sue half stood up, but remained quietly in the background. "Can you tell us what's been happening with you?"

"I can't cope anymore. I feel desperate. Suicidal"

"I'm sorry to hear that, Neil. How long has this been going on for?"

"On and off for months. It got really bad this week."

"OK, I need to ask you some basic questions." said Dan, now looking at Sue. Sue opened her binder and readied her pen.

"Do you know what day it is today?"

"Yes. It's Saturday the 20th of August, 2016."

"Do you know who the Prime Minister is?"

"David Cameron. No, er, I mean Theresa May"

"OK, and where are we?"

"We're in my house"

"Are you hearing or seeing anything unusual. Any voices?"

"No"

"Are you receiving any instructions, do you believe you are able to make people say or do things you want?"

"No"

"Is there anything you're anxious or concerned about right now?"

"I'm worried I'm going to kill myself"

"OK. Thanks, Neil" said Dan, glancing at his colleague. "It says in my notes that you've never been in hospital, because of your illness. Is that right?"

"Yeah, that's right. I've never been in hospital in my life except as an outpatient."

"Well, I think the safest place for you right now is at home. Where your partner and family can keep an eye on you. The crisis team can come and check on you, to make sure you're OK. How does that sound?"

"I want to die"

"OK well psychiatric hospitals are pretty crazy places. You wouldn't get a lot of rest there. The staff don't have a lot of time to help everybody. You'll be much better looked after at home. Do you have anything to help you sleep?"

"I've got mirtazepine. That makes me really sleepy"

"That's great. Do you know where it is?"

"It's on my bedside table."

"Lara, do you want to get it for Neil? And a glass of water" Dan prompted.

While Lara was gone, Dan and Sue sat quietly smiling and then Sue's mobile phone rang. She stepped out of the room and let herself out of the house while taking the call.

Lara returned with the medication and a drink.

"OK, Neil. What you're going to do is take your usual medication and then we're going to come and see you tomorrow and the day after. We're going to come and visit you here at home every day until you're feeling better."

Sue now let herself back into the house and popped her head around the door.

"Dan, we've got to go."

"Alright, sorry it was such a flying visit, but we have to attend to an emergency situation" said Dan, standing up and smiling. Pausing for a moment and taking on a more serious expression he said "everything's going to be OK. Hang tight. We'll be back tomorrow."

"OK, thanks" said Lara, following Dan to the door. Sue was already outside, eagerly wanting to get away. Neil was sat on the sofa, a little dumbstruck by the whole experience.

The front door closed, Lara returned to the snug.

"That went OK. There'll be somebody coming to check on you every day. That's reassuring isn't it?"

Neil simply looked at her blankly and then went upstairs to bed.

 

Next chapter...

 

#NaNoWriMo2016 - Day Sixteen

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

16. Self Inflicted

"I should be upstairs saving lives and instead I'm here wasting my time here talking to you" the consultant harshly chided. "I'm needed in surgery helping patients who don't deserve to be here" he continued.

"We're picking up the pieces of your self-inflicted mess and that's not fair."

The staff and patients within earshot of the ward could not help listening in to the consultant's angry tirade. They cringed with embarrassment on behalf of the petite and ghostly white girl who looked the angry doctor straight in the eyes with a contemptuous stare. She seemed completely unmoved, which only enraged him further.

The consultant briskly walked off. Everybody in the vicinity had stood spellbound, watching the scene unfold and there was a moment of hesitation before anybody started to move around. It was deathly quiet before people resumed talking again. A male nurse who had been hovering near the girl's bed now came over to replace an empty drip bag. He studied her face.

"He doesn't know what he's talking about. I didn't choose to come here" said the girl.

"He's very good at his job. He's very respected in this hospital" the nurse replied.

"I don't dispute that. But I didn't want to come here and take up anybody's valuable time" she said.

The nurse stopped what he was doing and looked at her.

"The police brought me here. It wasn't my choice. I didn't want to come."

The nurse wanted to tell her to keep her voice down, but he knew that it would be hypocritical, given that the consultant had launched a loud verbal assault on the silent girl. She hadn't spoken a word to contradict him. In fact, they had never spoken. He had read her notes and marched into the ward to give her a lecture. The other staff were quite sympathetic towards this fragile creature who had been so apologetic that she had ended up in hospital.

Lara had to put two canulas into the girl's pale skin when she arrived on the ward. Inside the crook of her arm and down the length to her wrists, there were scarred track marks and pus-filled abscesses. Lara searched the back of the girl's wrists but couldn't find a single vein that hadn't collapsed.

"I'm sorry. That hasn't worked. We'll have to try again" Lara said as she pushed the thick needle of the canula into a vein in the girl's ankle.

"It's fine. Don't worry. I'm sorry it's so hard. I'm used to it" the girl said.

Lara knew that it must hurt, but the girl didn't make a sound, even when she slightly flinched with pain.

"I bet she can't feel a thing" muttered one of the other nurses to Judy, the ward manager. They were watching through the glass from the corridor.

"She detoxed in intensive care. She's probably in a great deal of pain and discomfort" said Judy with a stern look at her colleague.

The hospital was a fairly nonjudgemental place. Even when the radiographers would gossip about the strange objects that they had seen on X-rays, that had been inserted into mens rectums, there was still a lot of sympathy amongst the staff and sensitivity for the feelings of the patients. "Imagine shitting that out" Anne cackled, talking about a toy car that a man had "accidentally sat down on" and had been unable to remove himself.

On a general ward, those who stayed for any considerable length of time were the geriatric patients. The patients Lara looked after either got better and were discharged, or they got worse and were rushed off to surgery or intensive care. The old people took a long time to recover and had multiple health problems as their aged bodies slowly shut down and died. Young people were a relative rarity on the ward and there was something shocking about seeing somebody unwell when they had their whole life ahead of them.

The young girl on Lara's ward had been admitted with pneumonia, septicaemia - blood poisoning - as well as a number of infected abscesses. She had hepatitis B and C. She was HIV positive. Her blood borne diseases were not affecting her health but would severely shorten her life expectancy. This shocking prognosis was at odds with the defiant and beautiful patient who seemed so strong despite being critically unwell.

As an emergency admission, the girl was still wearing the same clothes that she had been when the police had brought her to hospital. Her thickly applied make-up was still plastered to her face. Her short skirt, boob tube, mascara, black eyeliner and bold lipstick unmistakably identified her as a sex worker. Her uncovered arms betrayed the fact that she was an injecting drug user, but the men who picked up street walkers wouldn't notice or care about such things.

"Do you want me to find you some pyjamas?" Lara asked, trying not to stare at the small scars all over the delicate flesh on the underside of the girl's arms.

"Only if it's no trouble" the girl replied with a grateful smile.

Rummaging in one of the store cupboards, Lara managed to locate some pale green pyjamas and a pair of beige disposable slippers wrapped in cellophane.

"Here" said Lara. "I'll put these on this chair and we'll get you unhooked from all this stuff when that drip bag is next empty" she said.

A drip fed into the canula in the girl's ankle. She had a blood pressure cuff and oxygen level monitor attached to her arm. A machine pumped fluids into her body. A catheter bag hung below the bed, half full of urine. The tentacles of cables and tubes spread out from the white sheets of the bed where she lay, to the surrounding machines and equipment.

Changed out of her clothes and into clean hospital-issued pyjamas, the girl had managed to quickly clean her face in the bathroom. Her complexion was unhealthy but she was clearly very young. Without her makeup, she was just a helpless sick child.

"Are you OK in there?" Anne asked. "Lara, is that you?"

Anne was stood outside the ladies' staff toilet. She had heard somebody sobbing inside. Lara emerged sniffling and dabbing at her eyes with toilet paper. Anne looked around to make sure nobody had noticed them, while Lara fussed with her handbag and tried to walk away as if nothing had happened.

"Whoa there girl! You're not going anywhere. We're going to mine. No arguing" said Anne.

Lara had stifled her sobs as they exited the building and headed to the nurses' accommodation block. It was the end of their shift but Lara had obviously been locked in the toilets for some time because the rush to leave the building had quietened down.

No sooner had Anne closed the front door of her studio apartment behind them, Lara burst into tears again.

"What's wrong? Is it that girl in ward D?"

"She.. she... she's so young" Lara snivelled.

"Yeah. Heartbreaking" said Anne in a flat tone.

"But she's got nobody. Did you hear the way Osborne spoke to her?"

"Well, he's got a point. Nobody forced her to start taking drugs" Anne said, pouring out two large glasses of white wine.

This made Lara sit up and stop crying, although her eyes were still filled with tears.

"That's such a cliché. You think she's to blame for her own problems? You think she chose everything that's happened to her?" asked Lara.

Anne sat down on the sofa next to Lara and handed her a glass.

"No. I'm sure she was abused as a child. I'm sure she was raised in foster care. I'm sure she's had a hard life. I just mean, some kids turn out alright and some don't. They're not born with a crack pipe in their mouths" said Anne.

Lara knew that her friend wasn't being harsh. It was no use for them to wallow in misery over every tragic case that crossed their path. Anne was being supportive and kind by looking out for her and giving her space to talk about this girl away from work, even though she was challenging Lara's sympathetic stance.

"I don't think it's as simple as Doctor Osborne makes out" Lara said, taking a gulp of wine, still unable to look her friend in the eye.

"He shouldn't have spoken to her like that. He was shouting. Everybody heard him."

"Yeah" said Lara weakly.

"I bet he feels bad about it now. He was just mad because it's so tragic that she's messed her life up so badly at such a young age."

"He's not her dad" said Lara.

"Yeah, but he probably feels a bit protective, like a parent. Like you say, she's got nobody."

"There were people from social services, the police, addiction support workers. They're all worried about her. Lots of people want to see her get better. She doesn't seem at all afraid about how sick she is."

"You know this is her third hospital admission this year? Doctor Osborne is as worried as anybody" said Anne.

"You can't lecture somebody like that" said Lara, catching her friend's eye now.

"You can't get so personally involved. I bet that's why you were crying, wasn't it? Because you didn't want to leave her and go home"

"Yeah. Everybody is judging her. Because she's a junkie and a prostitute" replied Lara, starting to cry again.

"It's not your battle. You can't save her. All you can do is make her as comfortable as possible while she's on the ward"

"During my shift" said Lara.

"Yes, that's right. During your shift. You have your own life too."

"Can I sleep on your sofa tonight? I want to get drunk" asked Lara.

 

Next chapter...

 

#NaNoWriMo2016 - Day Ten

10 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

10. Waiting Room

"Do you want me to come and see the doctor with you?" Lara asked.

"No, it'll be difficult for you to take the time off" replied Neil.

"I don't mind. It's important. I can do it if it will help" she said.

Neil was now in his third week off work and he was starting to get anxious about returning to his job.

"I just wish I felt better, but I think I feel worse than I did a few weeks ago" he complained.

"Try not to stress about things. Go and see the doctor again and see what they say" she said in a comforting tone.

He'd left it almost to the last minute - Thursday - but Lara was now coming home expecting to find out what had happened at the doctor's. Neil was sat on the sofa as she came in the front door and hung up her coat. There was no new prescription on the coffee table in front of him.

"So, how'd it go?" she asked.

"They're referring me to a psychiatrist."

"Well that's good. You'll get a specialist's opinion" she said.

"Yes, but it could take weeks, months even before I get an appointment to see a consultant."

"What's the plan for the interim?" she asked.

"The doctor's signed me off for another two weeks. I said I was getting very stressed and anxious about going back to work. He said I should contact my HR department who can involve occupational health."

"He?"

"Yes. I saw a different doctor this time."

"Doctor Hughes?" she asked.

"I can't remember. It'll be written on the sick note, I guess."

"How do you feel about things?" asked Lara.

"I'm anxious about what it's going to be like, going back to work after five weeks off. It's a long time, you know?" he replied.

"People get sick. It happens all the time" Lara said as reassuringly as she could.

"Yes. But not me. And hardly ever anybody else at work" said Neil.

"Everybody will be happy that you're feeling better again when you go back to work. It'll be fine" she soothed.

"We agreed I would keep taking the same antidepressants. It's too early to tell if it's going to have a positive effect yet. It could be weeks before it helps my mood improve" he said. "I've got enough to last me a couple of months now" he continued.

"You refilled your prescription?"

"Yeah. I felt embarrassed in the chemist. All those pills. All those sick people and then there's me" he replied.

"Lots of people have to take medication for all kinds of reasons. There's no shame in it"

"Yes, but I still felt ashamed. I didn't want anybody we know to see me, walking home with that paper bag full of pills from the chemist" he said.

"Awww. You'll feel better soon" she said, pulling his head into the crook of her neck and cradling him slightly. His eyes were downcast and sad.

"The doctor said to keep an eye on things. Go back if there's any problems. There's not going to be any follow-up appointments or anything. I've just got to wait for a letter with an appointment date to see the psychiatrist" Neil said with a resigned tone.

Psychiatry. Lara's only real first-hand experience with psychiatry was helping patients with their prescriptions when they were on the ward. The patients were often quite difficult to deal with, but not because of behaviour that she understood as classical mental illness. She would be pestered all the time by the patients - "Nurse, it's time for my medication" - who would get extremely upset about the disruption to their normal routine. There were endless arguments about their prescriptions.

On the ward, the nurses would do three medication rounds per shift, plus respond to patients who were allowed a certain amount of pain medication on request. Unless otherwise indicated in the patient's notes, Lara could only dispense small doses of paracetamol, taken orally. The patient's own medications were usually locked away in a bedside cabinet that only the nurses had the key to. Any medication that the hospital's doctors had prescribed would be dispensed by the nurses at set times and that was when they usually unlocked the cabinet if there was something else that the patient was taking.

Psychiatric inpatients had their usual medications meticulously recorded in separate notes. Although the patients often knew which pills they had to take and how often, Lara had to follow the notes to the letter. The routine of the general hospital was different from the psychiatric wards the patients were used to and they could get very agitated if they felt they were overdue getting their pills.

It was surprising just how many medications some patients had to take each day. There were mood stabilisers and antipsychotics. There were antidepressants and anxiety drugs. There were sleeping pills and tranquillisers. The night shift would start with two hours of hell, as patients begged for their sleeping pills. The first dispensing round of the night shift wasn't until 9pm, so the nurses would get no peace until then. Mercifully, the psychiatric patients were often knocked out cold until the next morning though, which meant they were less trouble through the night than the others.

When on night shift, trying to sleep during the day was hard. Slamming car doors, traffic noises, people yelling in the street below, children screaming in the back gardens. The world was set up for the 9 to 5, Monday to Friday worker. Nearby builders and roadworks could mean a week with barely any sleep at all. Lara often longed for some sleeping pills herself and she knew that some of her colleagues did use medications to help them get some quality sleep during the day.

The few psychiatric patients Lara came into contact with were the most extreme. She saw the aftermath of self harm, suicide attempts and psychotic episodes. However, on the general ward the patients were heavily medicated. They were dazed and confused, with cloudy minds. They shuffled around. Some of them had uncontrollably dribbling mouths and involuntary tics.

She knew that Neil was going to see a psychiatrist - as an outpatient - but Lara made no association between him and the kind of extreme cases of mental illness she occasionally encountered at work. Neil seemed perfectly healthy and normal to all outward appearances, although she could tell that he was lethargic and more anxious and negative than she'd ever known before.

Later that Thursday evening, Lara attended an engagement party for a couple they distantly knew through other friends. Lara had started to socialise again, but on her own. She could see an expression of exhaustion and stress spread over Neil's face when the topic of going out was ever discussed. It was clear that he really wasn't up to socialising yet.

"How's Neil?" asked Katie.

Katie was Russ' new girlfriend. She was still slowly ingratiating herself with everybody and Lara felt sorry for her, as she struggled to become included in the group. Katie was young and pretty and the other girls treated her as if she wasn't worth getting to know. "She'll just be another casual fling" the girls said behind Katie's back.

None of the other girls had really asked about Neil. They had decided to just ignore the issue. If anybody else had asked, Lara would have dismissed the question with a cheery "he's fine". However, Katie was somehow disarming and approachable. Lara drew her to one side. The rest of the group were engrossed in their usual comfortable conversational routines.

"He's ever so depressed. It's sad to see him like that. I don't know what to do" Lara confided.

"There's not much you can do. Don't beat yourself up. Is he taking anything?" Katie asked.

Lara was taken aback by Katie's directness, but it was good to talk to somebody who seemed to immediately understand what the couple were going through.

"He started antidepressants a couple of weeks ago" said Lara.

"Well, it can take time to find the right one. Don't lose hope if you don't see any quick improvements" said Katie.

"Do you?..." Lara tailed off, worried her question was too personal.

Katie gave a little chuckle.

"It's fine. You can ask. Yes, I've been on antidepressants for a few years now. They do help, when you find the one that works for you" said Katie.

"But you seem. You seem so..." Lara stumbled, not knowing how to finish her question.

"Normal? Happy?" Katie said, grinning.

"Yeah" said Lara, nervously.

"Well, I have my bad days like everybody, but life is mostly OK now. A few years ago I just closed the curtains and didn't get out of bed for what felt like forever. I couldn't face the world"

"That sounds like the stage Neil's at" said Lara.

"Well, it does get better; easier. Recovery can be slow and nonlinear. Or it was in my case, anyway" said Katie, with as much reassurance as she could muster.

"He's just so desperate to get back to work, but at the same time I can see he's anxious. I know he can't face it at the moment. He's barely left the house in weeks" said Lara.

"There's no rushing these things. Tell him there's no rush. It can be a long road"

There was something harsh and brutal about this, even though it was spoken kindly. Katie spoke directly, truthfully, sympathetically. Lara had read things like this on websites, but it hadn't sunk in until now. There had been a sense of denial; there had been false hope.

"Look. Phone me. We'll meet up, just the two of us. You need support. You need to think about yourself too" said Katie.

Lara felt strong emotions welling up inside. She had been holding it all down, holding things together, acting like everything was going to get back to normal overnight. She was worried she was going to cry but she didn't. She was stronger than that.

Katie reached down and squeezed Lara's hand and made a sympathetic face. Lara was grateful to have made a friend who talked so openly, so freely, so directly.

The party was starting to disband and Russ was making his way over to the girls. Katie's face immediately switched to the bright happy expression she usually wore. It didn't seem fake to Lara. It made sense, to present a front and avoid discussing things that most people wouldn't understand.

 

Next chapter...

 

#NaNoWriMo2016 - Day Seven

10 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

7. The Journey

A large black expedition duffel bag contained a red rucksack, which had a thick winter sleeping bag and a few other items inside it. The bags were virtually empty at this stage. The journey was just beginning.

His house was silent but Neil was being extremely cautious to avoid being followed, traced, or anybody interfering and attempting to derail his plans. He left after the morning commuter rush had quietened down. On foot, he made his way to the coach station. His appearance was very much in keeping with the usual way he dressed. In clothes that he'd often been seen wearing by his friends, neighbours and family, the floppy half-empty bag was the only thing that was out of the ordinary, if somebody were to recognise him walking down his local streets.

Coaches to London were regular and there was already one at the station. The coach had offloaded any passengers who wanted to alight and was now awaiting its scheduled departure time. The coach door was open and the driver sat in his seat reading a newspaper. Neil bought a one-way ticket to Victoria station from the coach driver and paid in cash. There were only three other passengers on board, who were sat well apart from each other. Neil stowed his bag above an empty pair of seats and sat down.

The coach was relatively new and clean, but there were common features of coach travel that had been preserved for posterity. The upholstery was grey with streaks of orange, beige and red in a pattern that ran down the centre of each of the seats. The luggage racking above the seats was black plastic with a moulded texture that poorly imitated leather. There were black plastic handles on the seats lining the gangway up the middle of the coach. The carpet and fabric covering the interior roof and underside of the luggage racking, matched the colours and patterns of the seats. Black plastic strips trimmed every edge. More black plastic was used for the air vents and reading lights that were above each seat. The windows of the coach had smoked glass and grey curtains also impeded some light, even though they were tied back. The inside of the cabin was quite dark, despite the bright daylight outside.

There was a hiss of compressed air as the coach door closed and then the engine rumbled into life. The coach would be stopping at several towns on its way to London, to pick up and drop off. The journey was scheduled to take a couple of hours if the service kept to its timetable. Neil had elected to use the coach because the quality of the CCTV coverage on coaches and at coach stations was far inferior to that of the rail network. The first challenge he was setting for anybody who was trying to find him, would be to discover whether he got off at any of the stops before the coach reached London.

By the time the coach reached London, many more people had boarded, but Neil still had two seats to himself. Getting off at Victoria took a little time as bags were retrieved from the overhead racks, but Neil was happy to blend in with a group of fellow passengers. The coach station was crowded with tourists and their luggage. Neil felt comfortably anonymous as he slipped away from the transport hub and onto the nearest busy main street, lined with many well known high-street shops.

Walking away from the coach, tube and rail stations, the shops started to change from national chains to smaller independent businesses. Neil was looking for somewhere that bought and sold second hand and refurbished electronics. He came to a street that had a number of mobile phone repair and accessory shops, along with family-run stores that sold cheap imported goods and had appropriated part of the pavement for the display of their extensive stock.

There was a shop that was painted with garish red gloss paint and had a metal grille permanently affixed to protect the windows. Through the mesh, Neil was able to see a range of electronic goods laid out for sale on glass shelving with prices handwritten on bright yellow stickers underneath each item.

Neil bought the cheapest laptop that the shop had on sale after checking it had the right version of Windows and it booted up OK. The shop owner was most bemused by Neil's request for a very basic phone that only had a monochrome screen and no camera or Internet browsing capability. Imploring Neil to spend an extra fifteen or twenty pounds in order to obtain a far newer and more feature rich phone, the man could not understand why Neil would not want features such as GPS, which would allow him to navigate using a maps application. Neil was firm and resolute: he wanted the most basic phone that the shop had. He purchased both items with cash.

From an electronic accessory store he purchased an inverter, that would allow him to charge his laptop and phone from the 12 volt cigarette lighter of a vehicle. From a newsagent, he purchased a pay-as-you-go mobile phone SIM card and several top up vouchers. Each top up voucher had a silver part that was scratched off to reveal a unique code. Every transaction was made with cash, making the laptop and mobile phone virtually untraceable. There would be no record of serial numbers and identifying codes that was recorded anywhere that could possibly lead back to Neil.

Entering a sports clothing discount store, Neil bought a navy tracksuit and a grey tracksuit with trousers that could be easily removed by undoing poppers down the length of each side. He also bought a black baseball cap and a pair of grey trainers that had black parts on the top and sides. After much deliberation, Neil had selected the trainers because it was hard to decide whether the colour of the trainers could be described as predominantly black or grey.

In a public lavatory cubicle, Neil got changed into the navy tracksuit, and then put on the thinner and baggier grey tracksuit over the top. He pulled on the baseball cap and put on the trainers, stowing the outfit he had been wearing in his rucksack. He then put his rucksack back inside the black duffel bag.

Killing time reading newspapers in a busy fast-food restaurant, Neil waited until night time before returning to the coach station. Arriving a short time before its scheduled departure time, he boarded the last coach to Bristol, which would arrive in the small hours of the morning.

After an uncomfortable night's sleep in the waiting room at Bristol's main coach station, made a little warmer by the fact that he was wearing two tracksuits, Neil now boarded the first coach to Exeter. There was a small cramped toilet on board the coach, but there were no other passengers for the first part of the journey so he was able to unbutton his tracksuit bottoms and stow them in his rucksack along with the tracksuit jacket, baseball cap and the black duffel bag, without the driver noticing.

As Neil stepped off the coach the driver asked "didn't you get on with a big black bag?"

"Nope" said Neil, walking off with his rucksack slung over one shoulder.

Walking safely out of earshot from the coach driver, Neil knew that he hadn't shouted or chased after him. That was the kind of minor incident that would be memorable if anybody was trying to trace his movements, but he knew that he had taken so many safeguards in his journey to this point that it would be virtually impossible to join up the dots.

It was late morning in Exeter, but Neil still had plenty of time to find a van to buy.

In the caravan, on the bed, naked and in pain, surrounded by filth and damp air filled with noxious smells, Neil struggled to reconcile the danger he was now in with his original and meticulously planned desire for total privacy and anonymity: to be in an isolated, remote location. He was virtually impossible to find and it was highly unlikely that anybody knew where he had gone.

It was certain that with inaction his organs would soon fail and his dead body would be discovered by chance months or years later. Decay would set in almost immediately and the smell of rotting flesh would attract flies as soon as spring arrived. Maggots would strip his corpse to the bone in a matter of weeks. The police would quickly discover that his Estonian driving license was counterfeit. Identifying his body would be impossible except using dental records.

With the available evidence, it would be nearly impossible for a coroner to conclude anything other than misadventure or return an open verdict. Neil started to feel frustrated that the secret of the well planned sequence of events that had led to this point, would go to the grave along with him. A fate that was finally sealed by his own inaction, resulting in nothing more than an impenetrable mystery, would be horrible. He started to wonder whether a written note would survive decay in the caravan for long enough to still be read whenever he was discovered.

What on earth could he possibly write in a note to convey the complex reasons why he had started this journey and reached this point? What could be achieved by connecting his last movements at home with his final resting place? It was an impossible task, to try to put things into words with his remaining time and energy.

It seemed important that his death should be understood as a result of deliberate action. Neil started to think about the razor blade he had brought with him. He wondered if the blood stains in relation to where his body and the blade were found, would leave enough clues to show that he finally chose to exit the world through suicide.

Suicide had not crossed his mind recently. He had been thinking about getting to hospital or at least getting to the road, where somebody might find him alive. Before that, he had been consumed by fear that he had been discovered and that his private bubble was about to be burst. He had been so desperate to never be discovered in such an appalling state while alive, that he had never stopped to think about being discovered dead.

Linking his name to the disgusting scene of his final resting place was something he wanted to avoid at all costs, but also, he couldn't bear to think that people would conclude he died by accident.

 

Next chapter...

 

#NaNoWriMo2016 - Day Six

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

6. Into the Unknown

Going to university as a mature student had been hard work but a lot of fun. Lara was only a few years older than most of the other student nurses and their training wasn't like a normal degree course. 50% of the time the nurses did their university work in a building that was a long way from the main university campus. The other 50% of the time was spent in the clinical environment of the local hospital. Lara's university days weren't spent partying and skipping lectures - the workload was relentless and she was soon doing long shifts to gain all the necessary hands-on experience she needed to qualify.

With Neil's salary, savings, some money from her parents and a bursary, Lara and Neil managed to keep their home life relatively unchanged after Lara quit her office job to retrain. A little bit of belt tightening was necessary, but the couple managed to struggle through 3 years without Lara's salary.

Although she avoided living in a dirty and messy student house, Lara didn't miss out on any of the social bonding with the rest of her course-mates. During those three years at university, she made a lot of good friends.

After qualifying Lara's friends had been scattered all over the country. Some of them wanted to specialise. Some of them wanted to get jobs in particular cities or closer to family. There were a lot of jobs in London, which attracted many friends to move there, but Lara wanted to stay in the local area. For a lot of her friends, they were bored of the unremarkable university town they had spent three years in.

Working at a big hospital as a general nurse, there was a lot of variety in the day-to-day challenges. There were a lot of staff. There were a lot of departments. There were a lot of different procedures that could all happen within that large hospital building. The NHS had been closing smaller local hospitals, in preference for larger facilities, so that fewer items of expensive equipment had to be purchased nationally.

One of the few things separated from the general hospitals was mental health care. While the hospital had a handful of mental health specialists, they were in a psychiatric liaison role. Any physical health issues would be treated at Lara's hospital and then the patient would be transferred if they required inpatient care for mental health issues. There was a clear demarkation between general medicine and mental health and the few people Lara knew who had specialised in that area had followed a very different career track from her.

As a medical professional, Lara felt frustrated that she didn't know more about mental health issues and there was little opportunity at work to have a casual conversation with any of the doctors. The doctors in the hospital had specialised in the treatment of physical ailments, disease, surgery. She only knew a few doctors who she should speak to if a patient was behaving strangely. In Accident & Emergency the hospital would treat drug overdoses, alcoholics and people who had physically injured themselves while in a crazed state, quite often accompanied by police officers. The police normally had a better idea of what psychiatric issues the patient suffered from than the hospital staff. It seemed as though the police were at the front line of mental health issues.

Although she had bandaged lacerated wrists and dealt with patients who had swallowed handfuls of pills or poison by treating them with activated charcoal, Lara never really knew the story behind what had brought them to the brink of suicide in the first place, or what happened to them after they were physically healthy enough to be moved to a psychiatric facility. The patient notes for the nurses contained details such as blood pressure and medications. Very few details about the psychological problems that troubled these people were in the notes she saw.

When the weekend arrived, Lara found herself turning to the Internet to find out more about depression and how it was diagnosed and treated. It seemed strange that despite her training and experience, she should have to turn to websites for information, but she didn't know who to speak to. She knew friends had suffered bouts of depression, but it felt insensitive to phone them and say "Hey! You've been down before. What can you tell me?" Those friends who had become depressed never discussed the details of their prescribed treatment openly.

Lara knew her mum had become depressed after giving birth to her little brother. Her mum had sought help from the family doctor. Lara's mum said that a little time talking to the doctor about her feelings had been exactly what she needed. That was over 20 years ago. GPs didn't have much time to talk to their patients anymore. At the local doctor's surgery, Lara seemed to see a different doctor every time she visited.

Therapy conjured up images of whiney New Yorkers, self-indulgently talking about how their daddies didn't love them enough, on a psychotherapist's couch, spending hundreds or even thousands of dollars. Lara thought that to suggest counselling might make Neil more upset. Many people derided therapists as "quacks".

Having spent the week without socialising amongst their usual circle of friends, Lara now faced further isolation all weekend, as the couple cancelled their plans. There was little that Lara could do to help at home. Even asking Neil "are you OK?" could be a barbed question, when clearly he was not. It was very British to say "I'm fine thanks" as an automatic response whenever anybody asked how you were, no matter how dreadful life was feeling at that moment. Neil and Lara's parents had been raised in an environment of post-war austerity, where stiff upper lip and concealment of any inner emotions was considered the preferred way to conduct yourself. The touchy-feely stuff was not dealt with well by either family.

By Monday morning, Lara was relieved to be able to immerse herself back in her work. Throughout her shift she barely had a moment to herself to dwell on personal issues. For the sake of the patients and her team, it was imperative that she was positive and upbeat, concentrating, not distracted. She was expected to be a pillar of strength and exude confidence when patients were scared, in pain and discomfort. Context switching was surprisingly exhausting, but it didn't hit Lara until she left the hospital.

As the week wore on, Lara found that she was less and less able to carry the caring face she wore all day at work into her home. She felt like she had lost the support of both her partner and her social group and she could barely keep her own head above water. By Friday, some tiny slip of the mask must have betrayed how truly drained she felt, because the Ward Manager called Lara into her office at the end of her shift.

"Is everything OK, Lara?"

"My fiancée hasn't been very well for a couple of weeks, but I really didn't want to bring my problems with me to work, Judy, sorry" replied Lara.

"It's OK. You just look a little under the weather. I hoped you weren't coming down with something. Your work has been fine this week. No complaints from me" said Judy.

"Yeah, I'm fine. I'm just going to sleep all weekend and let my batteries fully recharge" said Lara.

"Well, look after yourself. Are you getting the support you need at home?" asked Judy.

"Yeah. We're getting by. I'm sure Neil's going to be feeling better and back to work soon" replied Lara.

"Neil. That was it. I remember you saying you'd got engaged, but I must admit I'd forgotten your fiancée's name. Any news on the wedding?" asked Judy, turning the conversation more light and casual.

"No, we haven't even started planning yet" replied Lara.

"Oh well. No rush" said Judy, glancing down at some paperwork on her desk.

"See you Monday. Have a good weekend" said Lara.

"You too" replied Judy, busily scribbling notes onto a yellow form she had been filling in when Lara had entered the office.

Lara fetched her coat and bag with some sense of relief, but also the nagging feeling that she had somehow trapped herself. Next week at work, she would have to work hard to keep a brave face on things. It would be harder now to admit that she wasn't coping well. All she could hope for was that things would be getting back to normal sooner rather than later.

Anne was hurriedly pulling on her coat as she jogged along the corridor to catch up with Lara, who was making her way to the lifts.

"What was that all about?" Anne asked.

"Oh, she was just asking if I was OK" Lara replied.

"And are you?" Anne asked.

"Not really" said Lara.

 

Next chapter...