‘But he’s in Exeter,’ said Agnes. ‘I talked to him on Friday, he’d no objection to me making the appointment. He knows I visit Lily two or three times a week.’ Agnes began to sound defensive.
‘I don’t discuss my patients with other people. Confidentiality is paramount. I’m sure you understand. Mrs Palmer is getting the very best care, Homelea has an excellent reputation-’
‘We could go to the trouble of arranging for Mr Palmer to travel up from Devon to put these questions to you,’ I said, ‘but it seems rather an extreme measure, a waste of time for everyone concerned. We’ve already spoken to Mrs Knight and I’m not aware that there has been any problem about patient confidentiality. If you could answer some of Miss Donlan’s queries we wouldn’t need to trouble you any further.’
There was an uncomfortable pause. We sat it out.
He decided to play ball. ‘Your concern is that Mrs Palmer may be suffering from an acute confusion rather than chronic decline?’
Agnes nodded.
Dr Goulden smiled sympathetically. ‘I’m ninety-nine per cent certain that’s not the case but if you’ll bear with me I’ll scan the notes and see if we could have missed anything.’ He leafed through the papers humming tunelessly. ‘Tum-ti-tum-ti-tum-tum-tum’, a gesture intended to show us that all was well, to demonstrate how competent and relaxed he was.
He patted the papers back into the manila folder. ‘No,’ he said, ‘nothing. I’d have been very surprised if there had been. In the sort of case you’re asking about,’ he explained, ‘we’d look for a certain sort of physical problem, an untreated infection, perhaps, from which we could date the development of the confusion. Now we’ve nothing like that here, absolutely nothing.’ He stressed the words. ‘She had a full medical on arrival at Homelea, sort of MOT,’ he smiled insincerely and waved the folder, ‘and everything I’ve seen of Mrs Palmer makes me certain that she has chronic dementia, Alzheimer’s. I’m sorry. I can assure you we are doing our best for her.’
Agnes suddenly looked much older, the brilliance of her dark eyes dulled. ‘But it’s all been so quick,’ she said. ‘She doesn’t know who I am any more.’ The last words came out in a whisper as she fought to stay in control.
‘There are peaks and troughs,’ said Dr Goulden, ‘as with any chronic disease. The situation may well improve. Often adjusting the medication can help things considerably. With some patients the situation can stabilise and remain so for many months.’
‘What medicine is she getting?’ I asked.