Poppet (17 page)

She sighs. Pinches her nose. ‘I’m sorry, Jack. I thank you for what you’ve done, but no. I’ve thought about it and thought about it – gone through and through it in my head and really this is the best way. The safest way. I’m really, really sorry.’

Starbucks

ISAAC HANDEL WAS
the pudding-basin haircut guy who alerted AJ to what Moses was doing with the spoon in the breakfast room that day. Until yesterday morning when he was released into a halfway house, he had spent all of his adult life in Beechway High Secure Unit. He was admitted to the acute ward as a referral from a juvenile unit seven years before AJ arrived, and according to all the stories from that time he didn’t start off as the easiest patient.

He was eighteen years old. Acned, greasy, and disorientated. He smelled awful – everywhere he went the smell trailed around with him. He also insisted on carrying two doll-like figures he called his ‘poppets’ tucked in the crooks of his arms – ugly things that smelled as bad as he did. He wouldn’t be parted from them – not ever.

The smell got worse and the staff had to employ physical tactics to get Isaac to wash. Three orderlies took him to the shower and managed to undress him. But when they tried to prise the poppets away from him they were rewarded for their efforts by having Isaac urinate liberally on them. After that they never again tried to take the dolls away from him.

Slowly, as the medication and therapy began to take effect, Isaac calmed. He started showering and stopped being so smelly that no one would sit near him. His collection of dolls grew – he bought materials with his allowance and in art-therapy classes with Jonathan Keay he was always sewing and painting the damned things. Keay used to help him a lot, in fact AJ often wondered if Keay favoured Isaac above some of the other patients. The poppets were freaky, with individual little teeth and lifelike eyes in woollen-crocheted faces. Or faces moulded from porcelain fired in the therapy-centre kiln, eyes outlined in red. But Isaac would not be separated from them. He’d carry as many as possible with him, the rest would be in his room, piled on the bed – distorted, lolling, squished together like miniature corpses.

AJ can’t keep still. Despite his promise to Melanie he can’t stop thinking about Isaac Handel. Weird little Isaac. He waits until one of the office secretaries gets up to take a bathroom break and calls after her retreating back, ‘Can I use your station – check a rota?’ When she waves a dismissive hand, he slips into her seat.

AJ has never known – never wanted to know – what put Isaac in Beechway in the first place. By the time he arrived at the unit, Isaac was a different person – silent and pliable and non-confrontational – he took his medication without fuss. In fact, in a weird way, AJ got on with the guy. The only thing he didn’t care for was the way Isaac behaved whenever Melanie made an appearance. Sometimes he’d stop and stare at her when she passed him in the corridor, like a horny dog watching a bitch – as if she was leaving a hormone trail. He’d ask AJ inappropriate questions about her:
Where does she live? How old is she? Is she married?
AJ’s used to the male patients reacting this way to Melanie – she’s a conundrum that their drug-pickled brains can’t decipher. In the grand scheme, Isaac wasn’t much more intrusive about Melanie than the rest of the patients. AJ had no other good reason to dislike him.

The secretary whose desk he’s sitting at is the appointed MHA administrator on the unit’s review tribunals. It’s her job to transcribe the tapes of the meetings. AJ finds Isaac Handel’s transcript on her desktop instantly – she’s extremely organized and neat – and he swiftly downloads it on to a gimicky memory stick Patience was given as a loyal customer by the betting shop. It’s in the shape of a horse’s head. AJ is old enough for it to bring to mind the dead horse’s head in the
Godfather
movies – but the stick serves its purpose, and he pockets it.

He can’t read this here in the unit – he imagines Melanie coming in and catching him. If she finds out he’s not letting this go it will be the last time he’s invited back to her house in Stroud. He knows this. He sends her a text:
Got to disappear bit earlier babe, Patience just called – Stewart acting up. See you later xxx. PS you look beautiful on no sleep. Must be good genes
.

He drives to the nearest Starbucks, orders the first thing on the menu – which turns out to taste more like a heated-up coffee milkshake than a proper coffee – and sits in the corner, his back to the rest of the customers, his laptop open. He calls up the transcript of the tribunal:

Isaac Peter Handel v MHRT
Wednesday, 10 October
Beechway Psychiatric Unit
Chair: Mr Gerard Unsworth, QC

AJ was at this tribunal. He’s been to hundreds of these over the years and there wasn’t much about it that made it memorable. Ancillary staff had set up and cleaned the conference room on the admin block and provided a slew of sandwiches and Thermoses of tea and coffee. AJ was only there briefly as a witness to present the Patient Nursing Report to the panel. It was all routine shit: he talked through Isaac’s response to his meds, the logging of his behavioural markers, his level of engagement with therapy and his relationships with other patients.

Most reviews that recommend discharge are little more than a formality; usually an informal decision has been made in the routine tribunal six months previously. Isaac and his solicitor were therefore already primed: as long as he’d toed the line since the last hearing he’d be recommended for discharge. There were a few hoops to jump through, the usual protocols to be observed, but it was all routine.

With the exception, AJ realizes in hindsight, of Mrs Jane Potter.

On every tribunal panel there must be a lay person – someone responsible but objective. Jane Potter is part of a pool of lay people and AJ has seen her on panels before – she’s president of the local Women’s Institute and is an Ofsted inspector. This time he recalls noting, briefly, that her posture was different from how it usually was. She sat stiffly, her hands clenched, as if she was angry – or shocked.

Now he wonders what had made her so tense. He takes a sip of coffee-flavoured froth and skims the transcript for the sections before he came into the room. He wants to see if something had happened to make Jane Potter react like that. His lips move silently, fast-forwarding through the usual stuff:

… panel will consider an application for conditional discharge of Isaac Peter Handel … appellant present, and Ms Lucy Tripple, appellant’s advocate … panel consists of chair Gerard Unsworth, QC; Dr Brian Yeats, consultant psychiatrist, responsible clinician to the appellant; Ms Melanie Arrow, clinical director; and Miss Bryony Marsh, Mental Health Act Administrator; Mrs Jane Potter …

In the transcript each panel member is given an acronym: IPH, LT, GU, BY, MA, JP. There is the usual stuff of people introducing themselves: The QC explains who he is – that’s a laugh because they all know Unsworth. He’s chaired numerous tribunals, and before he rose to the bench he prosecuted a number of high-profile cases against hospitals on behalf of patients detained under the Mental Health Act. With Unsworth in the chair everyone who worked on the unit was on high alert. Melanie in particular must have been stressed. Was it just after she and Jonathan separated, AJ wonders? That would have made it worse.

Unsworth gives a little introductory spiel, noting that Handel has been on the unit for eleven years, that he was previously detained elsewhere under the Children Act between the ages of fourteen and eighteen, then transferred to Beechway under Section 37 of the Mental Health Act. AJ wasn’t aware of any of this – he’s never heard Isaac mention a word about his childhood.

The QC takes time to outline some of the basics – for the benefit of the lay person, who may not be familiar with the law.

Mrs Potter, I realize you’ve been with us before, but just to remind you: Section 37 is used by the courts to send an offender to hospital for treatment instead of prison. Mr Handel is s37/41. A Section 41 is a restriction order imposed to protect the public from serious harm. Any applications for leave or discharge must be formally approved. Today we can recommend Mr Handel’s discharge, or decline his application – but the final decision rests with the Home Office. Now, there has been a non-disclosure request on parts of the report because there are aspects of this case that might cause harm to Mr Handel if he were to read about them or be reminded of the particulars.

AJ frowns at the screen. This is something else he’d forgotten – when he came in to give evidence he’d noticed several pages of the tribunal bundle – the reports and medical documents collated by the MHA administrator – had been stamped with the words: ‘
Not to be disclosed to the patient without the express permission of the tribunal
.’

Put simply, Isaac could not, for his own protection, be reminded of the acts that put him into the mental-health system fifteen years ago. It isn’t the first occasion AJ’s come across the wording; at the time it didn’t seem unusual or noteworthy, but maybe Jane Potter had seen whatever was in the reports of Handel’s sectioning and that’s what had distressed her.

He skips down the page, stopping at the point where the panel were going through the Clinician’s Report.

GU: Mr Yeats – can you give us a snapshot of where the appellant is with regard to medication.

BY: Yes, of course. Isaac has had a range of adverse reactions to antipsychotics over the years, but last year he was put on new meds which he tolerated well. He’s suffered mild cognitive impairment as a result of his illness, however his recent IQ scores on these meds are ten points higher than any previous measurements – for him, these meds simply don’t cause what the patients usually term ‘brain fog’. Added to that, the method of administration was changed to depot injections – which ensure compliance.

GU: Because a patient can’t forget or refuse to take the meds, once the depot is in place?

BY: Exactly. Now if you turn to page 33 of my report you’ll see I’ve outlined his response to the anxiolytics and antidepressants used to lower his anxiety. Also his history of responses to a range of antipsychotics – and we’ve tried many. Haloperidol, droperidol, Stelazine, flupenthixol, and chlorpromazine, which are first-generation antipsychotics, also called typical antipsychotics—

GU: I know what antipsychotics are, but perhaps for the benefit of us all you would …

BY: Yes, of course, they’re a quite commonly used medication – their purpose is to … Their purpose is … Mrs Potter?

GU: Mrs Potter, are you … ? A drink for Mrs Potter perhaps? Can someone … some water …

JP: I’m sorry – sorry – I just …

GU: Please, will someone get Mrs Potter a …

JP: I’m fine.

MA: Bryony, open a window. Are you OK, Jane? Here – take a sip …

JP: Thank you.

GU: Should we adjourn this …

JP: Please, no – keep going. I’ll be fine. Please keep going.

GU: Are you sure?

JP: Yes – it’s just – looking at Mr Handel’s original sectioning – what he did – what the pathologist said about it is … well, a bit … I didn’t know any of it. I shouldn’t have read it – I realize it’s not relevant.

GU: Yes – the clinicians want to keep certain aspects from the patient. Perhaps they should have extended the same concern to the panel members.

LT: Is this entirely necessary? There’s a reason for a non-disclosure clause and—

GU: I think it’s time we adjourned this meeting I …

JP: Please, I mean what I say. I’m fine. It’s just that I used to live near Upton Farm … I don’t remember seeing it in the papers. They never reported the details.

LT: My client was a minor at the time. It’s a shame it wasn’t noted that you, Mrs Potter, had some personal connections that might affect your position on the review panel.

JP: I DON’T have personal connections. I happened to live nearby, that’s all. I’m fine now. Please continue.

GU: Thank you, Mrs Potter.

LT: Well, with your permission, I’d like to remind everyone present that the details of my client’s sectioning are provided for context only, and that your deliberations should and must be focused on Mr Handel’s current state of mind.

GU: Absolutely. Absolutely.

MA: Naturally.

LT: So, do I have everyone’s agreement – we concentrate on that?

GU: Yes yes – now, where were we? Doctor Yeats, I believe you were giving us an overview of antipsychotics …

Sitting with his cup of froth in Starbucks, AJ cannot drag his eyes from the screen. Like Jane Potter, he knows Upton Farm. It’s only about four miles from Eden Hole Cottages. He’s known for years that something happened up there, but he’s never been sure quite what. And he’s certainly never connected it to Isaac until now – he didn’t even know that Isaac was local.

All these years he’s never wanted to know what his patients have been in the unit for. Now he’s starting to wonder exactly how smart a decision that was.

Elf’s Grotto

THE MENDIPS IS
a range of limestone hills, running east to west, about twenty miles south of Bristol. The hills have been mined for two thousand years, until the late nineteenth century, mostly on a small scale. Less than a fifth of the original sites are still quarried and many of the abandoned workings, now flooded, shelve steeply twenty metres from water’s edge to clifftop, and up to sixty metres more below the teal-blue surface of the water. One string of quarries is connected via underground channels to a network of natural caves known as the Elf’s Grotto, featuring pillars and curves and twisted ceilings – like the catacombs of an ancient cathedral – carved not by man but by the water that floods the entire system.