A young woman wearing a maroon overall came into the room carrying a tray of drinks. Agnes asked her about Lily.
‘You’re best talking to Mrs Knight,’ she suggested. ‘I think she’s in the office at the back. Do you know the way?’
Agnes nodded She squeezed Lily’s hand, told her she wouldn’t be long and straightened up.
Mrs Knight, the matron, exuded competence and efficiency. She provided us with chairs, sent for cups of tea and made notes as we talked. She wore a dark blue nursing uniform and a hat. Her hair was thick and black and cut in a pageboy bob that seemed to emphasise her long face and drooping eyes.
Agnes introduced me as a family friend and asked about Lily.
‘Mrs Palmer was rather disturbed in the night. I’m afraid she suffered some incontinence, which obviously distressed her, and she was quite hard to settle. She was given a sedative. That may have left her a little groggy.’
‘She doesn’t even recognise me,’ said Agnes.
‘I’m sorry,’ said Mrs Knight. ‘I realise how upsetting it must be for you. It is a common symptom but it won’t necessarily persist. You may find a great improvement on your next visit.’ The words were sympathetic but there was no warmth in her manner. ‘Mrs Valley-Brown probably explained to you that we’re dealing with a slow degenerative illness. It proceeds unevenly. Although we can’t halt the disease we can make life as comfortable as possible for Mrs Palmer until such time as she needs additional care.’
‘What would happen then?’ I asked. Out of the corner of my eye I saw Agnes freeze, the teacup halfway to her mouth.
‘Excellent care is provided at the psycho-geriatric unit at Kingsfield.’
Agnes’ hand was shaking so badly that the cup clattered as she put it down. Everyone had heard of Kingsfield – one of the vast, old-style asylums.
‘I thought it was shut,’ I said. ‘I thought they were closing all those places down.’
‘Many wards did close and much of it has been put to other use but there’s a very successful psycho-geriatric unit.’ Mrs Knight seemed oblivious to Agnes’ distress. ‘The staff have a great deal of skill in dealing with confused and frail elderly
people. We do recognise that community facilities aren’t appropriate for some patients, or they simply aren’t available. Kingsfield still has a role.’
Agnes cleared her throat. ‘I was wondering whether Lily’s problems might be due to a physical upset. There’s something I’ve read about called acute confusional disorder.’
Mrs Knight nodded. ‘The doctor ruled that out. The state you’re referring to is quite easy to identify because we can connect the confusion to a particular physical illness. In Mrs Palmer’s case there was no such link. She was given a complete medical on her arrival here. It’s something we offer all our residents – we even arrange X-rays at the hospital so we can be absolutely sure that people have no physical problems that have gone undetected.’