Regeneration (31 page)

Sassoon roused himself. ‘You’re off first thing, aren’t you?’

‘Yes. The six o’clock.’

‘So this is goodbye, then.’

‘Only for a fortnight. I’ll be back for the Board. Meanwhile…’ He stood up. ‘Keep your head down?’

Rivers stayed overnight with the Heads and then moved into his new lodgings in Holford Road, a short walk from the RFC hospital. The floor below was occupied by a family of Belgian refugees whose demands for better food and apparent indifference to rationing irritated the landlady, Mrs Irving, beyond measure. She was inclined to stop Rivers on the stairs and complain about them at considerable length. The other lodgers were apparently more easily satisfied, and gave no grounds for complaint.

The nights were disturbed by air raids, though less by German action than by the guns on the Heath that boomed out with a sound like bombs falling. Everybody congregated in the basement during these raids, the Belgian refugees, Mrs Irving, her unmarried daughter who worked at the hospital, all the other lodgers, and the two young girls who lived in the attics
and between them did the whole work of the house. As far as he could make out, they sat around, or under, the table, venturing out to the kitchen to make endless cups of cocoa. He was invited to join these parties, but always declined, saying that the air raids didn’t bother him much and he needed his sleep.

He managed to sleep through some of the raids, but on other nights, the guns made sleep impossible. He was not particularly well, but he didn’t want to take more sick leave, and he had no routine leave due to him. He spent a lot of the time with the Heads, who turned up one night and swept him off to the theatre to see the Russian ballet. They came out, still dazed with swirling light and colour, to find another raid in progress. In Leicester Square they stopped and looked up at the sky, and there was a Zeppelin floating like a strange, silver fish. Rumour had it they were piloted by women. It seemed incredible to Rivers that anybody should believe this, but he soon discovered that most people did. Mrs Irving knew it for a fact.

As soon as he started work at the hospital he became busy and, as Head had predicted, fascinated by the differences in severity of breakdown between the different branches of the RFC. Pilots, though they did indeed break down, did so less frequently and usually less severely than the men who manned observation balloons. They, floating helplessly above the battlefields, unable either to avoid attack or to defend themselves effectively against it, showed the highest incidence of breakdown of any service. Even including infantry officers. This reinforced Rivers’s view that it was prolonged strain, immobility and helplessness that did the damage, and not the sudden shocks or bizarre horrors that the patients themselves were inclined to point to as the explanation for their condition. That would help to account for the greater prevalence of anxiety neuroses and hysterical disorders in women in peacetime, since their relatively more confined lives gave them fewer opportunities of reacting to stress in active and constructive ways. Any explanation of war neurosis must account for the fact that this apparently intensely masculine life of war and danger and hardship produced in men the same disorders that women suffered from in peace.

So he had plenty to think about, and before long it was clear he would have plenty to do. Many of his old Craiglockhart patients who were living in London or the south of England had already written to ask if they could come to see him. That, by itself, would supply him with a great deal of work.

He was due back at Craiglockhart on the 25th of November. On the 24th he’d accepted an invitation to visit Queen Square. The invitation had been issued several times before and he’d always found a reason for refusing, but now that he was one of the small number of physicians in London dealing with the psycho-neuroses of war, he judged it rather more expedient than pleasant that he should accept. And so, at half past nine on the 24th November, he walked up the steps of the National Hospital. His night had been even more disturbed by the guns than usual, and he was feeling distinctly unwell. If he’d been able to cancel or postpone this visit without giving offence, he would certainly have done so. He gave his name to the receptionist. Dr Yealland was expecting him, she said. Go up.

He took the lift to the third floor. He pushed through the swing doors on to a long, empty, shining corridor, which, as he began to walk down it, seemed to elongate. He began to be afraid he was really ill. This deserted corridor in a hospital he knew to be overcrowded had something eerie about it. Uncanny. Almost the feeling his patients described, talking about their experience of the front, of No Man’s Land, that landscape apparently devoid of life that actually contained millions of men.

The swing doors at the far end of the corridor flapped open. At first Rivers was pleased, expecting to be received by some bustling nurse or VAD, but instead a creature – it hardly resembled a man – crawled through the door and began moving towards him. The figure made remarkably rapid progress for somebody so bent, so apparently deformed. His head was twisted to one side, and drawn back, the spine bent so that the chest was parallel with the legs, which themselves were bent at the knees. In addition one arm, the left, was pulled away from the body and contracted. The right hand clung to the rail, not sliding along it, but brought forward step by step, making repeated slapping sounds on the wood.

As they converged, the man turned his head, insofar as he was able to turn it, and stared up at Rivers. Probably this was dictated by no more than the curiosity patients always feel at the appearance of a doctor on wards where nothing else ever happens, but it seemed to Rivers that his expression was both sombre and malevolent. He had to drag his own gaze away. At that moment a VAD came out of a side ward and said in that bracingly jolly way of theirs, ‘Nearly ten o’clock. Let’s have you in bed.’

The morning round. Rivers wondered if he was in for that.

He was. Yealland came out of his room, flanked by two junior doctors, shook hands briskly and said that he thought the best general introduction was perhaps simply a ward round.

The party consisted of Yealland, the two junior doctors who were being put through their paces, a ward sister, who made no contribution and was invited to make none, and a couple of orderlies who hovered in the background in case they were required to lift. Yealland was an impressive figure. In conversation he did not merely meet your eye, but stared so intently that you felt your skull had become transparent. His speech was extremely precise. Something in this steady, unrelenting projection of authority made Rivers want to laugh, but he didn’t think he’d have wanted to laugh if he’d been a junior doctor or a patient.

They did the post-treatment ward first. The bulk of the conversation was between Yealland and the two junior doctors, with occasional asides to Rivers. Contact with patients was restricted to a brisk, cheerful, authoritative greeting. No questions were asked about their psychological state. Many of them, Rivers thought, showed signs of depression, but in every case the removal of the physical symptom was described as a cure. Most of these patients would be out within a week, Yealland said. Rivers asked questions about the relapse rate, the suicide rate, and received the expected reply. Nobody knew.

The admissions ward was next. An immensely long ward, lined with white-covered beds packed close together. On both sides windows reached from floor to ceiling, and the room was flooded with cold northern light. The patients, many displaying bizarre contractures of their limbs, sat, if they were capable of
sitting, upright in their beds, as near to attention as they could get. Rivers’s corridor acquaintance was just inside the room, lying face down on his bed, buttocks in the air, presumably the only position he was capable of maintaining. It couldn’t be said he added to the desired impression of tidiness, but the nurses had done their best. The little procession came to a halt by his bed.

Yealland’s previous performance had been perfunctory. Rivers suspected he lost interest in the patients once the miracle had been worked. Now, though, he turned to Rivers with real zest. ‘This one’s fairly typical,’ he said, and nodded to the ginger-haired doctor.

A shell had exploded close to the patient, who had been buried up to the neck and had remained in that position for some time under continued heavy fire. For two or three days after being dug out he’d been dazed, though he did have a vague recollection of the explosion. Six weeks later he’d been sent to England, to a hospital in Eastbourne where he’d been treated with physical exercises. During this time the abnormal flexure of the spine had grown worse.

The sheets were pulled back. It was not possible to bend the trunk passively, the doctor said, demonstrating. The patient couldn’t eat from a table and, as they could all see, he couldn’t lie straight in bed. He complained of considerable pain in the head, which was worse at night. And when he woke up there were coloured lights dancing in front of his eyes. Some right hemianalgesia was present. There was tenderness – probing – from the sixth dorsal spine down to the lumbar region. Free, but not excessive, perspiration of the feet. A mark made on the sole of the foot lasted an abnormally long time.

‘
And?
’ Yealland said.

The young man looked frightened, a fear Rivers remembered only too clearly. The missing fact came to him just in time. ‘No sign of organic disease,’ he finished triumphantly.

‘Good. So at least we may be encouraged to believe the patient is in the right hospital?’

‘Yes, sir.’

Yealland walked to the head of the bed. ‘You will receive treatment this afternoon,’ he said. ‘I shall begin by making your
back straight. This will be done by the application of electricity to your spine and back. You have power to raise your head, indeed you can even extend it. I am sure you understand the pain is due to the position you assume. The muscles are in too great a stretch and there is no relief, because even when you rest the same position is maintained. The electricity may be strong, but it will be the means of restoring your lost powers – the power to straighten your back.’

It was extraordinary. If Yealland had appeared authoritative before, it was nothing compared with the almost God-like tone he now assumed. The patient was looking distinctly alarmed. ‘Will it hurt?’ he asked.

Yealland said: ‘I realize you did not intend to ask that question and so I will overlook it. I am sure you understand the principles of the treatment, which are…’ He paused, as if expecting the patient to supply them. ‘Attention, first and foremost; tongue, last and least; questions, never. I shall see you this afternoon.’

And so on round the ward. Yealland stopped in some triumph by the last bed. ‘Now this
is
interesting.’

Rivers had been aware of this patient ever since they entered the ward. He sat up very straight in bed, and followed their progress with an air of brooding antagonism.

‘Callan,’ Yealland said. ‘Mons, the Marne, Aisne, first and second Ypres, Hill 60, Neuve-Chapelle, Loos, Armentières, the Somme and Arras.’ He looked at Callan. ‘Have I missed any?’

Callan obviously heard the question, but made no response. His eyes flicked from Yealland to Rivers, whom he looked up and down dispassionately. Yealland leant closer to Rivers and murmured, ‘Very negative attitude.’ He nodded to the junior doctor to begin.

Callan had broken down in April. He’d been employed behind the lines on transport at the time, perhaps because his nervous state was already giving cause for concern. While feeding the horses, he had suddenly fallen down, and had remained unconscious for a period of five hours. When he came round, he was shaking all over and was unable to speak. He hadn’t spoken at all since then. He attributed his loss of speech to heatstroke.

‘Methods of treatment?’ Yealland asked.

The patient had been strapped to a chair for periods of twenty minutes at a time, and very strong electric current applied to his neck and throat. Hot plates had been applied repeatedly to the back of the throat, and lighted cigarettes to the tongue.

‘I’m sorry?’ Rivers said. ‘What was that?’

‘Lighted cigarettes to the tongue. Sir.’

‘None of it persevered with,’ Yealland said. ‘It’s the worst possible basis for treatment because the electricity’s been tried and he knows – or thinks he knows – that it doesn’t work.’ He walked to the head of the bed. ‘Do you wish to be cured? Nod if you do.’

Callan smiled.

‘You appear to me to be very indifferent to your condition, but indifference will not do in such times as these. I have seen many patients suffering from similar conditions, and not a few in whom the disorder has existed for a much longer time. It has been my experience with these cases to find two kinds of patients, those who want to recover and those who do not want to recover. I understand your condition thoroughly and it makes no difference to me which group you belong to. You must recover your speech at once.’

As they were leaving the ward, Yealland drew him aside. ‘Do you have time to witness a treatment?’

‘Yes. I’d very much like to.’ Apart from anything else he was curious to know how strong ‘strong’ was when describing an electric current. It was a matter on which published papers were apt to be reticent. ‘Would it be possible for me to see the man we’ve just left?’

‘Yes. Though it won’t be quick. And I can’t interrupt the treatment.’

‘That’s all right. I’ve no afternoon appointments. I’d like to see
him
because of the the previous
failed
treatments.’

‘Oh, quite right.
He’s
the interesting one. The others are just routine.’

They were walking down to the MOs’ dining room for lunch.

‘You do only one session?’ Rivers asked.

‘Yes. The patient has to know when he enters the electrical room that there’s no way out except by a full recovery.’ Yealland hesitated. ‘I normally do treatments alone.’

‘I’ll be as unobtrusive as I can.’

Yealland nodded. ‘Good. The last thing these patients need is a sympathetic audience.’