Free The Sleep Room by F. R. Tallis Page B

of two months and treated her with bromides. This approach was successful, insofar as she became less agitated and expansive, but a depression followed, and thereafter this pattern of alternating mood states was repeated, usually resulting in an admission during the manic phase of her illness.
    At the age of twenty-three, Miss Stevens became pregnant and she was not able to identify the father (although it seems very likely that he was one of her drinking companions). This proved to be the final straw for her parents, who subsequently threw her out of their home. Miss Stevens was taken in by a women’s refuge and the baby was removed for fostering three weeks after its birth. The sad consequence of this was a severe depression, which culminated in a suicide attempt by overdosing. Fortunately, Miss Stevens was discovered in the act and immediately given an emetic.
    Since that time, Miss Stevens’s condition has not improved. Indeed, I regret to say that (in spite of my own best efforts), if anything, her symptoms have got worse. During manic episodes, her delusions are more florid than ever – she talks incessantly about how beautiful she is and how she is destined to be an international starlet – and when she is low she feels utterly useless and wishes that she were dead.
    When I took over the case from Dr Meadows, I discontinued her bromides and replaced them with lithium carbonate. This was very effective and her mood swings flattened out but, sadly, she developed several side effects – nausea, tinnitus, blurred vision and, more alarmingly, attacks of arm hyperextension. I was forced to reduce the dose from 1200 mg to 800 mg daily. The side effects disappeared but, alas, so did the benefit.
    Once again, I am most grateful for your assistance. Miss Stevens is an interesting example of cyclical mood disturbance with accompanying delusions and I very much look forward to receiving your advice concerning her management.
    Yours sincerely,
    Joseph Grayson
    Dr Joseph Grayson
    MB BChir., MRCP., D.P.M.

6
    I discovered Sister Jenkins in the sleep room. She was sitting behind the desk, scrutinizing a rota. One of the bathroom doors was ajar and I could see Mary Williams, through the opening, energetically mopping the tiles. The air smelled of disinfectant.
    As I approached the desk, Sister Jenkins altered her position and said, ‘Good morning, Dr Richardson.’
    ‘Sister Jenkins,’ I responded happily. ‘I have something for you.’
    She looked at me askance. ‘Oh?’
    I took the ring from my pocket and raised it up for her to see. She permitted herself a faint smile. ‘Did it come out – finally?’
    ‘No. I found it in Alan Foster’s room.’
    ‘Where?’
    ‘Under the radiator.’
    ‘How strange. I looked there myself.’
    ‘It was behind the valve. Right in the corner.’
    I gave her the ring and I was rather surprised by her reaction. She didn’t put it on immediately, as I had expected. Instead, she extended her arm into the cone of light that spread out beneath the lampshade. She manipulated the ring, turning it over – first one way, then the other. Her eyes showed suspicion and her brow creased. Then, pinching the ring in such a way as to suggest that it might be dirty, or contaminated, she placed it with a precise action on a pad of lined notepaper. Her expression was a combination of disappointment and irritation.
    ‘Is there something wrong?’ I asked.
    ‘It isn’t my ring,’ she said bluntly.
    ‘But it must be.’
    ‘Dr Richardson, I know what my wedding ring looks like.’ Sister Jenkins realized that I would need some persuading. She reached for the ring and pushed her fourth finger through its centre. It was clearly too tight. ‘See?’ she said. ‘It doesn’t fit. My ring was larger, the gold more yellow. This ring is much smaller and made from gold that is very pale – whitish.’
    ‘Then whose ring is it?’
    She shrugged and said, ‘It doesn’t belong to any of the patients,