Sister

When you saw Dr. Nichols in his NHS clinic, he would have worn a white coat, but in his private consulting room he was in faded corduroys and an old lambswool sweater, looking scruffy against the regency striped wallpaper. I put him in his late thirties; do you think that’s about right?

He got up from his chair and I thought I saw compassion in his rumpled face.

“Miss Hemming? I am so very sorry about your sister.”

I heard the sound of thumping from beneath his desk and saw an ancient Labrador dozily chasing rabbits in her sleep, tail wagging onto the floor. I realized that his office smelled slightly of dog, which I liked more than the lilies of the waiting room. I imagined the receptionist dashing in between patients with air freshener.

He gestured to a chair near his own. “Please take a seat.”

As I sat down, I saw a photo of a little girl in a wheelchair prominently displayed and I liked Dr. Nichols for being unconditionally proud.

“How can I help you?” he asked.

“Did Tess tell you who was frightening her?”

Clearly taken aback by my question, he shook his head.

“But she did tell you that she was getting threatening phone calls?” I asked.

“Distressing phone calls, yes.”

“Did she tell you who made them? Or what the person said to her?”

“No. She was reluctant to tell me about them and I didn’t think it helpful to pursue it. At the time, I assumed they were most likely a cold caller or someone phoning a wrong number, and it was because of her depressed state of mind that she felt victimized by them.”

“Did you tell Tess that?”

“I suggested to her that might be the case, yes.”

“And she cried?”

He looked surprised that I knew. But I’ve known you all your life. At four years old you could have grazes on your knees and a bloody nose, but you never cried—unless someone didn’t believe you when you were telling the truth and then your streaming tears would express your outraged indignation.

“You said that at the time you assumed them to be a cold caller or wrong number?” I asked.

“Yes. Later I realized that Tess wasn’t depressed, as I’d first thought, but was suffering from puerperal psychosis, more commonly called postpartum psychosis.”

I nodded. I’d done my homework. I knew that puerperal psychosis simply means it occurs during the six weeks after the birth.

“Anyhow,” continued Dr. Nichols, “once I realized that she was suffering from puerperal psychosis, I realized that the phone calls were, most likely, auditory hallucinations. In lay terms, ‘hearing voices,’ or in Tess’s case, the sound of the phone too.”

“You changed your diagnosis after she was found dead, didn’t you?” I asked and saw a flash of emotion over his crumpled face, momentarily hardening it. There was a moment before he spoke.

“Yes. I think it might be helpful if I tell you a little more about puerperal psychosis. The symptoms can include paranoia, delusions and hallucinations. And the consequences, tragically, are a highly increased risk of suicide.”

From my own research, I already knew that.

“I’d like to get this clear,” I said. “It was after she died that you changed your diagnosis from depression to psychosis. And it was only then that the phone calls became ‘auditory hallucinations’?”

“Yes, because auditory hallucinations are a symptom of psychosis.”

“She didn’t have psychosis. Puerperal or postpartum, or any other kind.” He ineffectually tried to interrupt me but I continued, “How many times did you meet my sister?”

“Psychiatry isn’t about intimate knowledge of a specific person, which you get in close friendships or with family members, nor in acute cases is it anything like the long-term relationship a psychiatrist has with a patient as a therapist. When a patient has mental illness the psychiatrist is trained to recognize certain symptoms the patient demonstrates.”

For some reason, I imagined him practicing all this in the mirror beforehand. I repeated my question, “How many times?”

He glanced away from me. “Just once. She was automatically referred to me because of her baby’s death, but she discharged herself from the hospital almost immediately after the birth, so I couldn’t visit her on the ward. She was given an emergency outpatient appointment two days later.”

“Was she a National Health Service patient?”

“Yes.”

“On the NHS, your waiting list is four months. That’s why I am paying to see you.”

“Tess was an emergency. All potential puerperal depression and psychosis cases are dealt with immediately.”

“Dealt with?”

“I’m sorry. What I meant was in terms of jumping any waiting list.”