He looked at me. That smile again. ‘She’s currently receiving a controlled-dose tranquilliser, what we call an antipsychotic drug, and she’s given something to help her sleep if Mrs Knight judges it to be necessary. Drugs have a very useful role in Mrs Palmer’s therapy but we use them with caution. The tranquilliser, for example, wouldn’t be given on a long-term basis.’
‘Is it one of the phenothiazines?’ I asked, remembering what I’d read in Moira’s books and hoping I’d got the pronunciation right. ‘What dosage is she on?’
This time the smile was accompanied by a patronising tilt of the head. ‘I don’t see that such detail is of much help to the layperson in understanding our care plan.’
‘We’d like to know,’ I said. No explanation, no justification.
He cleared his throat and rustled papers. ‘Thioridazine,’ he said. ‘Twenty-five milligrams twice daily. And nitrazepam for the insomnia as required.’
‘There can sometimes be side effects, can’t there?’ asked Agnes. ‘The drugs themselves can cause confusion in some people, make things worse.’
‘Yes, on occasion. All drugs carry some risk of minor side effects. But on the whole we feel the benefits far outweigh any risks. I can assure you I’ll be monitoring the response to the medication very carefully. There’s usually a settling-down period before the situation stabilises. If I see any indication of an adverse reaction I’ll reduce or withdraw the medication. I’d be hoping to gradually phase it out anyway. As I say, it’s not something I see Mrs Palmer requiring on a long-term basis.’
‘And you don’t think any of her symptoms are due to the drugs themselves?’ I asked.
‘No, definitely not. The confusion and agitation were what indicated the need for treatment in the first place. They’ve not arisen as a reaction to the medicines, they were present before the drug therapy started.’ He placed Lily’s notes on top of the neat stack on his desk. ‘Once the situation has stabilised, as I’m sure it will, I think we’ll see substantial improvement and we’ll have a much calmer and more relaxed patient.’
He stood up and picked up Lily’s notes, batting them gently against his other hand as he waited for us to leave. Agnes went ahead of me. As she opened the door I glanced back into the room. Dr Goulden was standing at his filing cabinet putting the notes away. But it was his reflection in the mirror above the cabinet that caught my attention. His face was contorted with rage, lips drawn back, taut and white, teeth bared, eyes glaring. My stomach lurched. It was an astonishing sight. I slipped out before he noticed me looking.