Life on hold

Jim McKay was proud of what he had done to turn round the fortunes of Arthur Lodge.  Sometimes seen as ruthlessly kind, he had combined his sensitivity to patients and staff with his understanding of strategy beyond his own areas of operation. He had used his sharp intellect and his strong intuitive skills to mould his ideas.  His Calvinist like belief in public duty had driven him to take more risks than most would dare and to be outspoken with a zealot like fervour.  He had turned a group of angry, frightened and hostile citizens living close to Arthur Lodge, who formed the local residents association, into a group of compassionate advocates for the staff and patients at the Lodge.  He had 'spun' the negative rhetoric of the powerful local MP from '101 Damnations' into a protective shield.  Together with the Medical Director, Liam Parkin, appointed after the 1997 inquiry, he had attracted well-motivated, skilled and competent staff to work at the Lodge.  Together they had raised the phoenix from the ashes and sent it soaring to heights never reached before by such a unit in the NHS.

 

Mckay sat at his desk.  He had just left a difficult meeting with the new Trust Chief Executive Jeffrey Shoemaker who had taken on responsibility as the Chief Executive Officer for a merged set of clinical services and hospital units that were widespread and diverse in nature.  He had described to Mckay and Parkin his plans to reorganise these services in order to bring them together into one large NHS Trust.  To bring the Lodge into line with the other services would require forming a forensic directorate of which Arthur Lodge would be but one component.  A director of forensic services was to be appointed to whom Mckay would be accountable instead of reporting directly to the Chief Executive.  This would also mean the post Mckay held was to be downgraded although his personal terms and conditions would be protected for four years.  He could of course apply for the forensic service director post (said with an inflection of sarcasm).   Parkin sat stony faced in a low chair by the window. 'What a f****n' eejit'  he spat in his smooth south Irish lilt.  'He can't do this Jim after what we have done here.  The whole load of bollocks will just fall apart, again'.

'Then lets convince him Liam' Mckay said with passion.  'We have come this far together, let’s not let it all get fucked up because of a dick head with ambition'

'It'll take some doing.  I think his mind is set' resigned Parkin

'We shouldn't give up so easily Liam.' Urged Mckay ' This is worth fighting for. Besides its us who have to keep this powder keg from blowing the f**k to hell no matter what Shumacher does'

'Shoemaker…Jim, you know I'm with you but you can only take so much of this' replied Parkin

'I'm a long way from finished Liam; I'll take him all the way.  Don't forget we have this to back us' Mckay said holding up his working copy of the Full Independent Review of Arthur Lodge Medium Secure Unit.

'I'm not sure I have the stomach for it Jim' Parkin said with regret, ‘There are other fields to plough where it’s not half as tough' he ended as he stood and headed for the door. 'Must get some lunch, I have a clinic at two' he said as he opened the door and stepped out into the corridor. 

The door had hardly closed behind Parkin when there was a brisk rap and it flew open again.

In stormed Victor Penerio-Fernandez.  Victor was a swarthy, thick-set, stocky man in his early fifties.  Spanish by birth he had spent his whole career in the NHS and the last decade working in medium secure care.  He had progressed from a junior staff nurse, to charge nurse and was now the directorate senior nurse.  As a senior manager on the Senior Management Team he was a key influence within Arthur Lodge.  He had survived the Independent Inquiry without direct criticism although once described as having been part of the problem and certainly not part of the solution when it had been proposed to John McPherson that he was the man to take charge of the service post the Independent Inquiry.

 

Victor was solid and dependable. He worked hard but was hardly dynamic enough to have done what needed to be done to take the service forward.  He was fiercely loyal to his nursing team, to the lodge and in particular to Jim Mckay.  He viewed Mckay as a dynamic leader and vowed to support him through thick and thin. He had proved himself a loyal lieutenant and had put more effort into his work since the inquiry and Mckay’s appointment than at any time in his 30 year career. Mckay and Penerio-Fernandez had much in common.  They shared a passion for gambling and gaming and often went together to casinos or the track for evenings out. Penerio-Fernandez was a practical man, good with his hands, and could turn himself to most DIY projects.  He had often helped Mckay with projects at home and as a consequence they had a close understanding and a firm friendship.  This allowed Mckay to seek to rehearse his strategic thinking or seek advice without compromising his position at the top.  It allowed Penerio-Fernandez to feel supported in his work, to feel he had control over his area of responsibility and therefore to feel great job satisfaction.  It also allowed Victor to speak his mind; something that came naturally to him.

“Jim we have a problem. “ he stated in his thick northern Spanish accent.

“Just the one.” Quipped Mckay,  “that sounds like something that might just fill the next half hour before lunch.”

“This is serious Jim. A patient on the PD unit has gone berserk. He has taken a hostage and has barricaded himself at the end of the ward.  In the confusion two others have got onto the roof and are refusing to come down.  It looks like it could get nasty.”

“Has a major incident been declared?” Asked Mckay in a matter of fact tone.

“Not as yet, I wanted to get your advice first.” Replied Penerio-Fernandez.

“Right let’s get down there.” Mckay said rising from behind his desk with confidence, “We’ll need a negotiator, has Dave Plumber been called?”

“No, I was waiting to see how things developed. It is possible that we won’t need a trained negotiator. Oh and Liam has been notified.” He Reported

“There goes Liam’s lunch.  He’ll be developing ulcers at this rate. No wonder he’s thinking of keeping his head down.” He said with reflection as he grabbed his jacket and marched out of the office in front of Penerio-Fernandez. He stopped at the small office across the corridor and called to his secretary’s in his best Sean Connory accent ‘Miss Moneypenny, I’m going to the PD unit, I may be some time.’ Then he turned, pushed open the door at the end of the corridor and took the steps two at a time.

***

Sonia arrived for her shift and went straight into the ward office for the hand over from the morning shift.  McPherson saw her from the lounge where he sat after picking at his midday meal before moping around the ward until it was almost shift change time. He had positioned himself in his usual chair ten minutes before the late shift were due to appear. He watched Sonia enter the office without even glancing into the ward living area.  He saw her wide smile and could hear the exchanged greetings muffled by the wood and strengthened glass partition that formed the ward office at one end of the living space.

It had been a tense morning.  A patient who had been transferred in from prison was in a very disturbed and restless state.  He was being watched closely on constant observations or constant ‘obs’.  A member of staff never letting him out of sight, even accompanying him to the toilet where the door was left open.  The man had arrived from the local remand prison where he had been taken after assaulting members of the public and causing criminal damage.  He had been admitted the previous evening about four PM and had been constantly ranting as he paced around the ward like a bull in an arena. The night had been disturbed, despite the efforts of the night staff and the extra support drafted in.  There had been a quiet spell from two AM until five-thirty AM followed by commotion and shouting. Another spell of relative quiet had followed half an hour of shouting and banging at the bedroom door nearest to the office.  The new guy had not been at breakfast and the night staff looked bleary eyed and tired.  Just after breakfast things erupted again.  Three nurses had gone to attend to the new patient in the 'safe' side-room but he had attacked them violently on his way to the tiny toilet in the room.  He was a thickset, stocky Afro Caribbean, about five foot nine inches tall. He was rambling insanely but asked to go to the toilet.  He shuffled across the room still rambling and cursing but heading towards the toilet door.  Just as one nurse leant forward slightly to open the door for him he managed to catch him with a glancing blow across the right temple before powering into the other two fists flailing and legs kicking.  It had taken some moments for the nurses to resume control and apply their control and restraint techniques before forcibly injecting him with a powerful tranquilliser to calm him.

 

The ward always felt tense at such times. Breakfast was a quiet affair without the usual mix of silence and conversation.  There was far more silence.  After being injected three nurses had to continue to keep the new patient controlled for a further twenty minutes.  After that the tranquilliser began to have an effect, and although trying to resist the powerful pull of sleep the man succumbed and fell into a deep hypnotic slumber.

Sonia left the handover meeting and began a walk round of the ward with a new nursing assistant.  They walked through the lounge and dinning area pausing only to greet a few patients.  Sonia pointedly looked at McPherson and called a quick 'hi' his way before the pair went straight to the bedroom area to begin making one of several routine ward checks each shift.

 

McPherson watched her go and wondered if she had cooled toward him since last they last had spoken.  He watched the pair progress back up the ward and longed for that physical contact again. 

 

He need not have worried. Sonia completed her inspection and came to where he sat.  Her manner was matter of fact.  She asked if he would mind helping her to change a bed of a patient who had been transferred back to HMP Wakefield.  He readily agreed.  Without speaking Sonia lead him towards the sleeping area, she stopped at the linen room opened the door with her key and drew the required sheets, a blanket, a bed spread and a pillow case.  As they entered the side room she stopped just inside the door turned and kissed him hard on the mouth. It was sudden and unexpected.  Her lips were full and succulent and ate hungrily at him. He felt his blood pressure soar and he kissed her back with fervour. She pulled away and turning began making the bed.  ‘Later’ she said huskily.

***

Dave Plumber was fifty-four and looking forward to his next birthday.  He had worked as a nursing assistant since deciding at the age of fifty that he could no longer work as a gym instructor.  He had enjoyed working in the field of fitness firstly as a Physical Training Instructor in the RAF when he left school, then as a gym teacher in a secondary school and latterly as a gym instructor at a large private club. Unfortunately he had developed lower back problems which led to him deciding to give up the world of fitness.  He still kept himself in good shape though. Since giving up his work in the fitness field he had worked in a variety of local settings, eventually settling in as a nursing assistant at Arthur Lodge after being introduced to it by a golfing partner, Victor Penerio-Fernandez.  He loved his career change and took to his chosen branch of nursing well.  He moved to Arthur Lodge in early 1996 and quickly settled into the culture.  He was an unimposing, affable character who possessed excellent judgement and could strike up a good rapport with all grades of staff and most patients. He was practical by nature and had a witty personality.  He had been selected to complete the three-day hostage negotiation and the five-day crisis management training two years previously due to his ability to engage people and to build trust with them. Negotiators were generally people lower down the ranks, people not in positions of power or authority.  Some were first level nurses and some nursing assistants.  The aim was to build empathy with the hostage taker in a non-confrontational fashion and to seem to build understanding and a rapport with them. Dave was a well-liked and respected individual.  He was also a proud grandfather who doted on his three grandchildren and liked nothing better than to spend time with them, particularly if it meant his two daughters getting a well-deserved break.

 

'Peter' he began, 'It's Dave; Dave Plummer.  We are a little worried about your situation' he said with great concern.  'We don't want anyone getting hurt in any way.  We need to end this as quickly as possible and let you guys get back to normal' He paused for a response.

There was no reply from the men barricaded behind the upturned beds and wardrobes that had been hastily piled against the double fire door.

'Peter the situation is very serious but I understand your frustration. You and I have had a few chats since you arrived and I think we understand each other." There was still no response. 'Peter we believe you are holding Darren Bolton against his will.  That is a serious issue.  Why don't you let Darren come out, then we can sort this thing.' Suggested Plummer.

'F**k off ya ponce!. The only way this wee s**t will git oot a here is in a boady bag if you don't day as I say.'  Came the reply in a thick Glaswegian accent

'Sorry Peter, I didn't mean to upset you, but we need to sort this mess out before it gets out of hand' continued Plummer.

"Wit the f**k di ya mean get oot a hand? Its you b******s that are oot a line" was the shouted response.

"Peter I am here to help us sort this. I don't want anyone getting hurt"

 " 'So f****n' wot. If any aye thay b******s come near I'll slit this wee f****r's throat!.' Came the spat, angry retort. 'Tell them nonce.' Continued the voice beyond the barricaded doors.

' Aaah.....no......aaah.....please.  Mr Plummer don't let him hurt me.' Came a frightened voice.

'Darren, don't worry, just keep calm, everything will be ok.  Peter. It's ok. We have no intention of making things difficult for you.  We just want you both out of there without anyone getting hurt.' Said Plummer in a soft reassuring tone.

'Ya lying wee s**t.  Youse would love ta see me swing fur this.'

"I can see you are angry Peter. I am going to just listen, I'm here for you, I'm sure we can sort this out." Plummer moved cautiously back from the door. The last retort had been a natural end to this stage of the negotiating process.  He went back through the now evacuated ward just out of ear shot and spoke softly to Brian O'Connell a first level nurse who had been assigned to act as 'runner' between the scene and the ward office, which was the command centre for this operation.  Seated in the office were Liam, Victor, Mckay and Helen Thomas Care Co-ordinator to Peter Thompson, small time drug dealer and convicted killer. Liam, Victor and Helen were the designated Crisis Management Team. "We keep calm." Urged Liam "Lets get this dealt with, sure they're only a bunch of psychopaths. If we leave them to it they'll probably top each other."

"Liam this is serious.  It may get more serious if we don't handle it right" cautioned Mckay.

"OK lets follow the procedure to the letter.  Everyone has been briefed and everyone knows what to do. Let’s not forget to keep the information flowing at all times."

"What about the police?" asked Victor.

"Let’s hold that for now.  We have some very capable people.  They know what they're doing. If the police come in they will want to take control the press will find out and then god knows what will happen. Besides with luck we will have it all back to normal by tea time."

"The situation on the roof is contained and we have a good chance of resolving the hostage situation. I am going to do a round of the wards with Anne Armstrong. Don't forget we have to take a whole hospital approach to this situation.  Keep me up to speed on the two way please Victor." He said as he rose and left the ward.

***

David Moore stepped out of the ward office as McPherson was returning from the gym with two other patients and two nurses. “Jim Mckay telephoned from Arthur Lodge while you were out.” He informed McPherson in his Yorkshire accent.  “He wants to come up and see us about the paper for the Canadian conference.  Can you call him back after lunch John, you can use the office phone.” He finished.

***

The walkie-talkie crackled into life. 

"Jim, Victor here."

"Go ahead Victor." Replied Mckay 

"Jim, Things have deteriorated on the roof.  Both patients have started dislodging slates. They have not thrown anything but it looks like things could get pretty nasty. I've instructed the negotiating team to withdraw a safe distance."

"OK but make sure they keep contact Victor, I'm on my way to the scene.  What about the hostage situation? Inquired Mckay.

Dave Plummer took a swig from the bottle of still water.

"Peter." He said in a soft steady tone. "Do you need any drinks or food in there, it's been three hours and I guess a hot cup of tea won't go amiss?"

"Whit say as yiz can drug me? You must think I was born yisterday...... get fucked!"

"Sorry Peter I don't want to upset you.  I give you my word there will be no tricks." continued Plummer in his steady, calm tone. " I just want to know you are both alright in there."

"Jist get me a car wi a full tank and safe passage oot a here.  That's wit I want."

"Peter, I don't have the authority, you know that, I'm just a nursing assistant and I haven't got the seniority to negotiate."

"Thin git me someone hae can; ya f****r!" came the angry retort followed by the sound of splintering wood as a chair was hurled against a wardrobe in the room beyond the barricaded doors.

"Sorry Peter.  I really don't want to upset you. I'm trying to get hold of Jim Mckay but he's off site in a meeting.  He's the only one with authority.  You know me I've always been straight with you in the past, I won't jerk you around now.  I understand how upset you are. Now why don't you let me get some drinks for you both?" Plummer ended with reassurance.

There was a long silent pause.

"Fine. Two unopened cans a Coke an a cuppole a bags a crisps....unopened, and no funny business or this b*****d nonce will get it.....Understand?!  Came the aggressive demand.

"I understand Peter, there will be no funny business. I'll get it for you now" Plummer ended as he withdrew and gave instructions to O'Connell.

The ward was quiet.  The evening meal of semi-edible pork chop, mash and beans had been served and consumed.  A group of patients were being supervised with the washing up by Sonia of the remainder of patients most were sitting in front of the TV or had gone to their rooms. A couple were playing snooker on the table next to the ward office. One member of staff was sitting watching TV, One was engaged watching the snooker match and two were in the office trying to catch up with the paper work.  Sonia ushered the last kitchen helper from the small kitchen as she locked the door behind her and casually walked towards the sleeping area.  McPherson watched her go. A few seconds later he rose from his chair and went to the toilet.  After a few moments he emerged onto the corridor and turned towards his bedroom. He opened the door with his key and closed the door behind him.  Sonia stood to the side of the door smiling.  She came towards him and surrendered her lips up to him, willing him to kiss her full mouth.  Her body was explicit and generous in the messages she radiated as she opened up to their shared desire.

***

"I'm afraid we failed Jim" Victor said apologetically.

"Well that depends how you measure failure" replied Mckay in a considered and reassuring tone.

"Darren Bolton is safe and unharmed, if a little shaken. The rooftop protest is ended with only half a dozen loose slates to replace and Peter Thompson is once more residing at Her Majesties bed and breakfast HMP Lincoln ".

"I for one am pleased that Thompson is back in prison where he belongs" Liam added softly. “I was going to advise his return there at his case review planned for next week”.

"He did say that he thought he would be sent back to serve his time when I saw him yesterday" Helen Thomas informed the group.

"OK" Mckay said with command. "We all agreed to try and handle this one and we should be proud of the skill the whole team displayed, especially Dave for his patient negotiation and Anne for keeping the rest of the unit on track".

"Perhaps we should have seen it coming then Helen?" suggested Dave Plummer

"Well...." she began but was cut short by Mckay.

"This is a critical incident review meeting. We need to focus upon the event and process and unless there are any suggestions of gross incompetence or negligence we need to ensure that the discussion does not become personalised".

It was the day after the hostage incident and rooftop occupation had been ended by a skilful and concerted effort by the local police unit trained in hostage negotiation and civil disorder. By early afternoon it was clear that neither incident was going to be resolved swiftly.  Mckay had weighed the options and not wishing to take the risk of dragging matters on into night-time hours had requested police assistance.

 

The response had been swift and although the local superintendent was later to criticise the delay in involving the police the mere appearance of a large number of officers in riot gear had persuaded the roof top occupation duo to leave their precarious perch and return to the relative comfort of the ward below.  They later confessed that Thompson had persuaded them to do it as a diversion but having failed to get his opportunity to isolate and capture a member of staff to gain their keys he panicked and grabbed Darren Bolton. He resented Bolton in any case as he hated sex offenders, especially where their crimes involved children.  So when it was clear that he was not in a position to act at the time agreed for the rooftop incident to begin, he simply grabbed Darren Bolton and dragged him into the ward sleeping area.  He did not have a definite plan as such and when he heard the police helicopter and saw the riot trained and equipped officers he knew the score and simply gave himself up when asked to by the police negotiator.

 

Mckay was pragmatic about the incident.  His main concern was to avoid any negative press reports that would reflect badly upon the unit, his staff or himself.  An equal concern was the need to avoid any negative inquiry from the Health Authority and the Regional Office of the NHS Executive.  He chose not to make a formal report through the serious untoward incident procedure.  A risk he was prepared to take under the circumstances.

***

The visit had been arranged following a telephone call made from the ward office.  David Moore had been on duty and had allowed McPherson to make the call as it was health service business.  Mckay had arrived half-an-hour before his agreed meeting scheduled for eleven AM. He had left his home in a small village off the outer ring Road north-west of Leicester at just after eight AM.  His journey had taken him on the M1 northbound some 135 miles.  The conditions were fairly easy going as they often were on the M1 north of Leicester.  Once he had passed Barnsley he considered his options for leaving the motorway network for local routes. He could choose to leave at junction 39 which would bring him into Wakefield from the south through the town itself.  Junction 40 would bring him in from the west on the A638 where he could then skirt round the main centre.  Finally he could choose to use the faster route via junction 41, bringing him into Wakefield from the north-west, thus avoiding the centre of Wakefield altogether and approaching via Carr gate on the A650, cutting across to the A642.  He was in no hurry but preferred the more direct route.  He slowed to 65-70 miles per hour and set himself in the inside lane for the rest of the journey, swinging like a letter ‘C’ around the periphery of the town.  He pulled into the car park at Newton Lodge and sat waiting for a parking space to be freed up. After some ten minutes a middle aged man in a grey suit and an electric blue tie came out of the building and drove off in a metallic silver Mercedes car. Mckay swung into the vacated bay and pulled on the handbrake.  He Switched off the ignition and looked at his watch. It was only ten-fifteen.  He lifted his mobile phone from the carrier mounted on the dashboard of the car just to the left of the steering wheel and keyed in a fast dial number. 

 

Ten minutes later he stepped out of the car, locked it and headed towards the main entrance of the low profile 1980s single story building.  He passed the neatly kept beds of flowers and the tall grasses that stood sentry at the entrance and went through the automated double doors of the reception.  He wandered around the small waiting area looking with a critical eye at the various notices, plants and furnishings.  He made a mental note to ensure that he issued instructions that the notice board in the waiting area at Arthur Lodge was updated on a regular basis He had waited no more than three to four minutes when a portly middle-aged woman swept out of the double entry airlock with a shoulder bag and a clutch of blue files tucked under her arm.  On seeing Mckay she did a double take before rushing towards him and giving him a huge rib-crushing hug. “Jim Mckay!” she exclaimed “What brings you to this neck of the woods without me knowing about it?”  With that she linked arms with him, turned on her heals and marched him into the air lock saying cheerily as security checks were made and he was asked to read the list of prohibited articles, hand over his mobile phone for safe keeping and sign the visitors book “Don’t think you can come all the way to Wakefield without spending a few moments with the Linda Lusardi of West Yorkshire”.   She pushed her ample bosom towards him and hustled him into the secure area of the building.

***

Sonia had just completed the lunch time medicine round accompanied by a third year student nurse and had tidied up the clinical room.  She came out, closed the door locking it in one motion with her passkey before heading for the lounge area.  She saw McPherson sitting in his usual seat but purposefully she stopped to pass the time of day with two patients who were about to play snooker.  “None of those trick shots!” she teased as they passed her and headed for the to the ward office to collect two cues.

 

McPherson sat alone watching the end of the lunch-time news on BBC1.

“No activities this afternoon John?”  She enquired across the room with warm sarcasm.  He glanced across at her as she approached him just as the shorter of the of the patients who had gone to play snooker launched himself at her from behind, grabbing her viciously round the neck with his left arm and jerked her head back.

 

McPherson acted instinctively as he would have done if he had still been nursing.  He crossed the short distance from his chair to the attack swiftly and grabbed Simon Villiers round his neck, reaching round and grasping his right arm and wrenching it from across Sonia’s left breast.  He pushed his left knee into Villiers’ back and tore him away from Sonia swinging him violently to the right and using the motion to throw the would be assailant to the floor.  He glimpsed the craft knife as it spilled from the hand of the startled Villiers and scuttled across the smooth carpet where it came to rest under the snooker table.

John McPherson was gathering himself after falling heavily on the attacker as he attempted to pinion him to the floor.  Before he could move Dave Moore and two male staff nurses had moved him aside firmly and had Villiars firmly under control and restraint measures designed to deal with such incidents.  The three experienced nurses carefully lifted Villiers to his feet, Moore constantly speaking to him in a neutral and calm voice as he kept his large muscular hands upon Villiers’ head to keep it bowed and under control. The group moved carefully step by step to the ‘time out’ room where all three kept Villiers under control until Moore judged he could gradually be released as he no longer posed an immediate threat.

 

An hour later Dave Moore stirred a hot mug of sweetened tea and looked across the low coffee table at McPherson. “John, I realise that some folk will criticise you for intervening.  It was foolish but you may have just saved a member of my team from sustaining serious injury.”

“Just doing what I was trained to do.” said McPherson with genuine humility

“That’s the point ‘they’ will make.  The fact is that in your day there was no control and restraint training and let’s face it you have not been in practice for a very long time.”

“I couldn’t stand by and see Sonia hurt.” McPherson excused, “is she OK?”

“I understand.  And I’m grateful.  You will understand that I cannot breach patient confidentiality but you probably saved Sonia from serious injury.  I hope you realise that. Thank you.”  Moore said with emotion, reaching forward and shaking McPherson’s right hand warmly. “Sonia is tough, she wants to continue with her shift but under the circumstances I have asked her to take the rest of the day off.  She won’t go without seeing you first though” He explained. McPherson heard the question and nodded slightly; Moore rose, patted him gently on the back and left the small interview room.

 

Sonia entered the room.  McPherson had sat alone after Dave Moore had left to let Sonia know that he was happy to see her in private so that she could thank him in person. He looked up as she entered the room and met her dark eyes brimming with warmth as hot tears welled over and down her radiant soft skin.  She was smiling broadly.  He stood and took a step toward her.  She came softly into his embrace and he felt her elegant body tremble slightly and surrender as they came together.  Without speaking Sonia rested her head upon his chest. He could smell the fragrance of her hair and thought how fresh it was.

 

In the aftermath of the incident Sonia had been lifted carefully to her feet by strong protective arms and guided to the clinic room by two male staff from the adjoining ward.  There, Rashmi the ward Senior Registrar, had performed a brief physical examination, noting a small incision to the left side of Sonia’s neck.  At first Sonia sat in stunned silence as Rashmi had carried out the examination with gentleness, offering reassuring words to sooth her.  She had suddenly felt cold and began to shake uncontrollably and had been unable to stop herself from sobbing deeply.  She had been involved in numerous difficult violent incidents during her career and several since starting at Newtown Lodge and was largely pragmatic about it.  In this instance she found herself in the grip of emotions she had no control over.  She felt stupid and weak.  Rashmi had just let her sob without trying to intervene or calm this display knowing it was a natural reaction that needed to be fully expelled.  It had taken Sonia half-an�"hour and two hot cups of coffee before she was sufficiently in control of her feelings.  Dave More had then come to the clinic room and in his calm and supportive manner he checked she was all right before suggesting she take the rest of the day off.  Sonia was due to work a long day from eight AM until eight-thirty PM.  At first she had said it would not be necessary but Moore was firm and insistent and she had again become overwhelmed by her emotions for a short time.

***

The Consultant, Dr Shipman, sat in silence contemplating the range of written and verbal reports he had been given.  The ward round was taking place in the larger of the two interview rooms. The meeting had begun at ten AM and in attendance were Dave Moore, a new Registrar, the ward psychologist, two social workers and a student nurse.  They had discussed five cases already and were joined by each patient’s Named Nurse for a report from their perspective. Then each patient had been invited to attend, only one had refused this ritual so far on this occasion, before decisions were made about each case.  They were now discussing McPherson.   It was four weeks since McPherson had thwarted the attack upon Sonia. He had been in the unit for six months and although the psychologists and psychiatrists were struggling to reach a conclusive formulation they were leaning towards the belief that McPherson had been depressed and suffering from a post traumatic illness when he had murdered his ex-wife and her male companion in the sleepy North Yorkshire village of Hemingworth.  The experienced forensic team however knew that this was not enough to prevent the courts from passing a penal sentence.   The degree of planning involved, the time that had elapsed between his ex-wife leaving the family home and the double murder added to the planned nature of the attack, inevitably meant that his psychiatric condition would not be enough to persuade the court to make a hospital disposal instead of passing a life sentence for murder.

 

In that context, with the view that his case was hopeless, he had not been allowed to have any leave for fear he would abscond. This meant he could not go outside the secure area of the building.  The lessening of restrictions was normally done in careful stages.  Firstly patients were restricted to the ward for a period, then, after a suitable period of observation,    they went under escort to onsite facilities.  After that if risk assessments showed no cause to do otherwise, escorted leave into the grounds within the fence was permitted.  Next escorted leave into the nearby local community, the number of escorts determined by the level of risk assumed to be involved.  Finally unescorted leave and even home leave could be permitted as a prelude to returning to live in a normal community setting. 

Despite this fairly hopeless scenario McPherson kept his spirits up and to all intents and purposes appeared to have settled well into life on the unit.  The fact that he was trusted by many of his fellow detainees and was given respect by most staff placed him in a unique position. He co-operated in his treatment plan and given the drive within the NHS generally and specifically within mental health services to have patient involvement his behaviour provided much needed positive reinforcement to the staff and managers.

 

Since his intervention in the attack upon Sonia McPherson was treated with even more respect than before.  Dave Moore spent more time with him and talked him through his case very carefully.  “We have reviewed everything very carefully John.” stated Moore.  “Given the planning you put into your ex-wife’s death we have no doubt you will be found guilty. There was no forensic evidence to speak of but the police believe that they will make a very good case.  We do not believe a judge would be in a position to accept a plea of diminished responsibility because although we will support that you were depressed at the time, the level of organisation would not mitigate the circumstances and allow the judge to recommend hospital treatment.”  McPherson listened to what he knew already.   He was strangely calm despite the constant sensing of being back in prison with its cold, harsh, institutional ambiance and the feeling of constant despair brought about by so many human tragedies warehoused and living out their pain on a day by day basis.  He thought of his time on remand and found it little different to his days on an acute psychiatric ward in the mid seventies.   There were many prisoners with major psychiatric problems.

 

Dave Moore seemed genuinely to be seeking a solution that would save McPherson from prison but he was relatively powerless in the process.  McPherson made a point of letting Moore know that he was grateful and that he would be okay either way.  Inside McPherson was in utter panic at the thought of fifteen years of incarceration.

 

Sonia was even closer to McPherson following the attempted assault upon her.  She managed from time to time to engineer being alone with him and they managed to have intercourse on a number of occasions.  It was risky for them both but the need for secrecy and the risk heightened their enjoyment of these moments.

 

McPherson was granted escorted leave within the secure perimeter with a single member of staff.  Sonia was often the person who took him.  Now and again she would take him in the evening and using her pass key would go with him to the Occupational Therapy suite where they would make urgent and passionate love to each other.  McPherson found himself getting more and more fond of Sonia and she had begun to tell him she loved him.  He cautiously explored his situation with her and she told him she would feel the same even if he ended up serving a long prison sentence.  They laughed about him escaping and them running off together but McPherson kept this low key and portrayed it as impossible as they would have no where to go where they could not be traced and eventually caught; the result being Sonia loosing her job and probably ending up in prison too. The relationship with Sonia gave him some purpose and took the edge off of what he saw as a hopeless situation.

 

Around eight weeks after McPherson intervened to save Sonia he approached the ward office to ask if he could be allowed escorted leave into the grounds.  Sonia had come on duty for a Saturday late shift and he had anticipated she would take him.  Dave Moore was doing a long day and had just returned from an early lunch break.  “I’ll take you.” he intervened before Sonia could volunteer. McPherson saw the brief look of disappointment on her face but himself only showed his surprise for a second before throwing a reply to Moore

“Great.” he said with enthusiasm.

“About two then John.” Moore suggested.

 “Excellent!”

McPerson said with a warm smile before turning swiftly and leaving the office.

 

Ten minutes later Sonia was in his side room after doing a round to check the ward and in the process observing where staff and patients were to ensure it was safe to be alone in McPherson’s side room with him.  She kissed him urgently and pressed herself to him.  He held her tightly and drank in her presence.

“Sorry about that.” She whispered “I was really hoping to take you down to the OT suite this afternoon.” 

“Me too… Never mind we might get a chance this evening.” he soothed.  Sonia kissed him deeply before leaving the room to continue her patrol of the ward.

 

McPherson lay on his bed staring up at the stained greying white ceiling. This time on the ward, after lunch, was invariably quiet. On a weekday lunch would have been over and most patients would have gone to afternoon activities or be in the lounge watching TV or have retired to their rooms for a snooze. He wondered why Dave Moore had volunteered.  Moore had taken patients out before, including himself, but it was not a regular thing as he always seemed to be needed on the ward for something or other.  What puzzled and disturbed McPherson was the way in which Moore had seemed to be trying to stop Sonia taking him.  Perhaps he had become aware of the relationship between them, which in such a closed environment was not beyond the realms of possibility.  On the other hand perhaps he himself was being overly paranoid.  He put it out of his mind.

 

It was just after two fifteen when Dave Moore appeared at the door to McPherson’s 8’ x 10’ room.  He apologised for the delay and asked McPherson if he wished to go out on the field or into the courtyard. McPherson opted for the courtyard as although the sun was shining there was quite a gale blowing and it would be more sheltered in the courtyard.  He and Moore talked about a variety of topics from the sport on TV to McPherson’s view on the proposed amendments to the Mental Health Act.  They always talked easily, more so since the incident. Moore was very professional and never was indiscrete and McPherson avoided trying to get any information from him that might compromise him- unlike his relationship with other staff.  Moore was bright and had two degrees to his name.  He completed them for his professional development not to enhance his career.  They had been in the courtyard for about an hour when Moore suggested they go back as he had some staffing matters to attend to.  McPherson was content and immediately responded.  He was a little surprised when Moore took him on a circuitous route round the link corridor. He thought nothing more of it surmising Moore wanted to let him have a longer walk.  As they approached the door leading to the loading bay where all supplies were received Moore made a comment that seemed to be alien to his normal level of integrity. In a chatty matter of fact way he told McPherson that the loading bay was a concern for the management team.  A patient had escaped three weeks earlier and unlike other cases there was no information, or speculation for that matter among patients about how the guy got out.  Moore told McPherson no more than it was a weak spot which was going to be soon rectified.  The indiscretion was small and McPherson dismissed it from his mind.  They returned to the ward and McPherson thanked Moore for taking him out and Moore promised to get time for a longer discussion on the proposed Mental Health Act reforms.

 

Later that evening after tea was over and McPherson had had several games of pool, he retired to his room. Sonia had been busy as she was inducting a new student nurse to the unit and was chaperoning him round the ward. McPherson had felt a tinge of jealousy seeing her spend so much time in close proximity to the younger man. He needn’t have worried.  At seven Sonia came into his room and asked if he wanted a stroll. After stopping at the office to tell Moore that she was taking him they left the ward and went to the Occupational Therapy suite were Sonia locked the door behind them and kissed him passionately. They petted each other heavily before McPherson began to undress her kissing her all over her firm radiant black body.  They made love; ending up with Sonia astride him and in charge of her orgasm as always. Afterwards he held her closely and stroked her head and body gently for ten minutes until she suggested they needed to get back.  She stood, dressed and kissed him again before opening the door to check the coast was clear and walking back to the ward.  It was almost time for the shift to end and he knew Sonia had two days off before her next shift on Tuesday. He hated Sonia’s days off.  He suddenly felt exhausted and decided to get an early night instead of watching TV. He went to his side room which he opened with his key before putting the light on and flopping onto the made up bed.  Within minutes he had fallen asleep. He awoke in the dark. It took a few moments to recall where he was. He suddenly felt cold despite still being dressed in his day clothing. The night staff had as usual paid little attention to him, leaving him sleeping fully dressed on the bed. He rolled towards the edge of the bed with the intention of getting off and climbing under the counterpane, which covered the single top sheet. As he moved onto his left side he felt something hard press into his left hip. The sudden pain made him roll back to the middle of the bed. He stretched out a hand to feel what had caused his pain. He felt a solid lump, which moved and changed shape as he plied it with his fingers. He flicked on the small table lamp as he reached over and pulled back the counterpane and sheet. There in front of him was a rectangular piece of paper wrapped around something irregular in shape. He laid his hand on it; whatever was wrapped in the paper was hard. He lifted it carefully as though it might explode at any minute and began to open the folds of paper. As he did the object fell onto the bed; a key. He flung the sheet and counterpane back over the object for fear of being discovered. He stared at the door fully expecting it to burst open and several burly nurses to descend upon him, pinion him to the bed and discover the keys.  He wondered if a staff member or fellow patient was setting him up, or both. He switched off the light and lay very still but could detect nothing different in the concoction of sounds that permeate such units during the night-time period.

 

He did not know how long he had lain there listening. He dared not look at the small silver plastic travel alarm that sat on the small bedside table. From time to time he completely held his breath and could almost convince himself he could hear someone on the other side of the door to his side room.

 

After some time he decided he was being paranoid and rolled over, landing gently on the floor in a semi crouch facing the door. He kept stock still for a few seconds then reached under the covers to retrieve the small silver metal key. As he withdrew it he felt the small rectangular piece of paper in which the key had been wrapped. He pulled both from beneath the sheet. He held the key in front of the window to try to identify it in the little moonlight that filtered through. He knew instantly that it was a passkey. He felt a rush of excitement well up in anticipation. He felt in control again. Something he had not felt for many, many months. He suddenly felt afraid that this opportunity might be snatched from him. When they realised the key was missing a lock down would be issued and every patient and every room searched thoroughly. He looked at the key, held it in his hands, gripping it as if about to insert it in a lock. He thought he heard a sound and quickly threw himself back on top of the bed, clutching the key under his torso as he curled up in a sleeping pose.  He listened hard, straining until he felt he had numbed his hearing and had to shake his head to re-establish his senses. Nothing other than the far off sound of a muffled conversation, he gingerly levered himself up from the laying position and stretched off of the bed, moving cautiously to the door. He pressed his ear to it and listened. He could make out the sound of two males conducting a conversation in low tones. Other than this there was no sound. He went back to the bed and risked switching the lamp on again. He looked at his watch; it was now two-thirty-five in the morning. He quickly unravelled the now crumpled piece of paper and read the neatly typed message. He gently opened the side room door a crack and immediately the muffled conversation invaded the room. It was the usual sound of the night staff talking together, probably discussing the football, or politics or page three of the Sun. He heard the conversation burst into a peal of laughter then the sound of a door opening and footsteps heading towards the sleeping area. He saw the two male nurses approach down the corridor before he shut his door carefully so that it would not click shut.

 

He returned to the bed, getting under the covers this time and he waited. He heard side room doors further down the corridor being opened, held for a few seconds and then closed again. He knew the pair were making a visual inspection of each patient, a dictate ordered since the escape Moore had talked to him about earlier that day.

 

Within a matter of two minutes his own door was pulled open and he heard the sound of a smokers wheeze and could smell the stale tobacco as the head of the middle-aged Italian night staff nurse was thrust through the door opening and eyes fixed upon him; only withdrawing when satisfied that he was present in the room and seemed asleep.

 

The door was closed again and the routine continued along the corridor. McPherson realised that the pair were making their way round the ward. This would take at least ten to fifteen minutes and they would well away from the office and main entrance to the ward. His heart began to race as he realised that he had the opportunity to leave the ward if the key in his hand was indeed a pass key.

 

His heart was pounding and his breath was coming in short gasps. He felt the excitement in his stomach mixed with fear. He took a jumper from the small shelf in the wardrobe and pulled it over his head before taking his jacket from the back of the door. He checked his wallet was in the inside pocket He followed the instructions he had read from the note and cautiously stuffed a bundle of clothing under the covers of his bed before leaving the room and silently closing the door. He stopped outside his room and listened, holding his breath as if his breathing might give the game away. He could feel fear spread its cold touch across his face and down through his abdomen into his gut. He could hear the sound of doors being opened and a few seconds later closed. His footfalls were silent as he headed cautiously to the main ward door. There he stopped and listened in fear of someone coming into the ward from another area. After a moment he felt the courage to take the key and insert it in the lock. It turned and he gingerly pulled the lever handle down praying hard that it would be silent. The door opened effortlessly. He quickly stepped out into the corridor looking both ways before turning and closing the door slowly so the latch slipped silently back into place. He took another look around and listened for any sound but there was none.

 

He walked carefully to the door to the link corridor and inserted the key and to his joy it worked once more. He retraced the steps of his walk earlier in the day with Dave Moore and within a few breathtaking minutes he found himself at the loading bay door. He stopped again and listened but is was deathly quiet so he once more inserted the key and held his breath. It turned. He stopped even more afraid with images of the nurses having discovered him missing and raising the alarm. Slowly he eased the door open, a blast of fresh cold air struck him with the effect of smelling salts. He passed through the door and carefully pushed it closed. He was outside the unit in the car park. He knew the car park to be monitored by CCTV but he followed the careful instruction on the note and skirted round to his left, away from the car park so that he hugged the profile of the low single story building. A service road ran along the side of the building and he followed the road round into a short cul de sac. There in the dark he saw the shape he had not dared to see, described in the note. The Peugeot 207 looked ominously calm. He tried the driver’s door and it opened, he jumped in and immediately a feeling of security surrounded him in the shape of this metal carcass.  He felt up in the darkness for the sun visor and for the key he expected to find lodged in its pocket. It was not there. Panic set in. He wondered if this were a trap as the panic began to spread and take hold. He reached for the passenger side visor and as he pulled it down an object fell into the foot well of the passenger seat.  He groped in desperation and clutched out for the ignition key which he found after a feverish scooping about over the rubber mat. He was sweating profusely by this time. He inserted the key and held his breath as he tried to decide if igniting the engine would bring Armageddon to his world. He turned the key and pushed the car smoothly through the gears as he glided out of the turning and out of the car park onto the main internal hospital road. Only then did he dare to press the switch that ignited the headlights. He remembered the instructions and turned left towards the exit.

Reviews

[Claire Twinn]

Lots of excitement and intrigue in this chapter. I found it most confusing about how to feel about the events (in a good way!). He's somehow still the hero, respected by all, yet he's a murderer too. Most interesting....

[John Alexander McFadyen]

life Caire is full of dilemma and confusion.