Warning: mentions of mental illness and suicide.
Neurasthenia. A catch-all term for 'female maladies', about one rung above hysteria on the ladder of male-dominated psychology refusing to accept any nuance in the diagnosis of female mental illness.
Women who suffer from abnormal moods following pregnancy are, Patsy has learned, much more common than people like to think, preferring to talk about the joy of childbirth as an absolute certainty. This has the unfortunate side-effect of leaving many new mothers with guilt and confusion piled on top of any other emotional irregularities, and often with nobody to talk to. Mrs Fenwick, the newest mother on Patsy's round, is exhibiting all the textbook signs (low mood, lethargy, lack of emotional bond with her new child), and Patsy is becoming rather worried.
"Do you believe the child to be in danger?" Sister Julienne asks. She sits across the desk, the calmness of her voice betrayed by trembling hands. Patsy had only mentioned her concerns conversationally as she and the other midwives sorted out their instruments for the autoclave, but Sister Julienne overheard and curtly requested Patsy attend to her office immediately.
"No, Sister Julienne," Patsy says, feeling like a naughty child explaining herself to a teacher, "Mrs Fenwick's sister is looking after baby for the time being, and she's got two of her own. I'm more concerned for Mrs Fenwick."
"What seems to be the problem?"
Patsy explains how the small flat that impressed her with its tidiness when she first dropped round to give the young mother-to-be her delivery pack has descended into disarray. How dishes are piled high next to the sink, clothes are strewn about the floor, and the bed – on the rare occasion that Mrs Fenwick isn't passing the day away in it, crying or staring at the walls – lies unmade.
"I see." Sister Julienne says after a moment's reflection. "Thank you for bringing these concerns to my attention."
"What would you like me to do?"
"Please continue to visit Mrs Fenwick on your usual rounds and ensure she is all right, and let me know of any changes. I will include her on my own district rounds to make sure she is seen as often as possible. I shall be in touch with Mrs Fenwick's sister and husband and see if I can gain a better understanding of her… emotional changes. If things continue, I think we may have to involve Dr Turner and possibly have her referred to St Bernard's."
"I see." says Patsy, moving her hands to her lap as they begin to shake.
It is bad form to discuss patients outside of work, but Delia is a nurse, there is nobody around in the park to overhear them, and Patsy is desperate for the reassurances and support that only Delia can give. They sit together on a bench, close but not too close, and Patsy recounts her meeting with Sister Julienne.
"Oh Pats, I'm so sorry," Delia says, her face frowning in sympathy. Patsy knows she wants to reach out and touch her, and feels the familiar pang of guilt that accompanies denying Delia.
"It's all right," Patsy says, taking out a cigarette so she has something to do with her hands; it takes her three attempts to light it. She takes a drag and exhales, and the smoke is instantly whisked away in the breeze. "I've read about it, and heard about it so frequently I thought I was prepared. But it's rather difficult, watching it happening to one of my mothers."
Delia smiles a little at that; she loves that Patsy has taken to midwifery so well, even though moving from male surgical has taken her away from Delia. Of all the things she loves about Delia, she is forever amazed at how much she gives Patsy space. Over the years, Patsy has pulled away, physically and emotionally, more times than either of them can count; Delia's capacity for patience and understanding is equal to that of the nuns at Nonnatus, and Patsy is forever grateful.
"How is she?"
It is almost easy to discuss Mrs Fenwick; Patsy talks about her patient's lack of appetite, the rejection of her new child, her fear of the room where she gave birth to her baby, and her refusal to leave it. Patsy's voice cracks once or twice, and she raises her head, staring up at the leafy horse chestnut tree above them to blink back tears. Delia listens patiently; engaged with everything Patsy is saying, but never interrupting.
"And how are you?" Delia's eyes lock with Patsy's, and she refuses to let her avoid answering. Delia is asking the question even Sister Julienne has missed, and Patsy has trouble finding the words. She looks up at the tree for several long moments.
"It's reminding me of my time on the mental health ward." Patsy says eventually. Her cigarette has burned down to the filter, and she resists the urge to immediately light another because she knows Delia would disapprove. In her pocket, she clutches her lighter tightly.
Mental health nursing was, in retrospect, a truly terrible idea. Patsy saw the darkness in the human soul at such a young age, and it sparked within her a curiosity about the mind (about her mind); people's cruelty, sadness, trauma, resilience.
All her working life, she's been (more or less) able to put on her brave face and crack on, even in the face of stillborn babies, whole-body sepsis, and tropical disease cases that send her straight back to the camp in Singapore. But her first experience with electro-shock therapy came the closest to breaking her. The patient hadn't – couldn't – consent, and the spasms and shudders horrified Patsy to her core. It was like watching her mother fitting on the cot, but the knowledge that they – not some disease borne of humidity and filth - were the ones intentionally causing it was traumatic. Her hands were sweaty and shaking as she removed the electrodes from her patients' head.
It's for their own good, it's for their own good was Patsy's mantra as she carried out her time on the Ellis Ward at St Bernard's, waiting for her secondment to come to an end. Each day she would walk up to the imposing gate under the gaze of the panopticon tower. She couldn't imagine what it must feel like for the patients brought into the former asylum, locked up and treated like prisoners.
(Patsy knows a lot about prison)
But it was true; the shock therapy remains the only effective treatment for the poor people who would otherwise turn to the bottle, to the gas in their oven, to a length of rope and a chair. But the knowledge was little comfort when she had to watch people's eyes roll back in their heads each day, leather in their mouths to ensure they wouldn't bite their tongues out.
Patsy is acutely aware that electro-convulsive therapy was historically used as a cure for people like her. She knows that her job, her life that she has worked so hard to build, could come crashing down if certain things in her private life were made public, but she is perversely grateful that at least it wouldn't condemn her to the sanatorium. At least Mr Amos' drugs were preferable to the aversion therapy she's read about in the British Journal of Nursing, nestled between articles about air pollution and palliative care.
Delia knows all of this, has been told bit by bit in quiet shared moments, and Patsy knows she remembers each crumb, holding the stray pieces in her heart, discovering where they fit against one another, slowly piecing together Patsy's past like a jigsaw puzzle. It's been difficult for both of them, but Patsy finally has someone who can ask the right questions.
"Shall we go and get some tea?" Delia asks, "my treat."
"I'd like that," Patsy says, and they make their way back through the park, hands gently brushing as they walk. Delia hooks her little finger around Patsy's, and rather than panic, the touch fills her with calm. Her hands finally stop shaking.