Herein is the chapter “She Is Like Me” from Sarah Moss’s Signs for Lost Children. Ally Moberly Cavendish, recent qualified as one of a very few women doctors in late nineteenth-century England, is working at an asylum in Cornwall while her husband travels in Japan. Ally is determined to change the treatment of female patients with “hysteria.” When her innovative approach is thwarted by the entrenched assumption that these women need discipline, not care or understanding, Ally reaches a breaking point herself. — Rohan Maitzen
The fields lie bare to the plough now, and in the hedges the berries shrivel and drop, mouldering under the rotting fingers of hawthorn leaves and dead grass. Rain drifts around the peninsula. It is not cold, not cold enough to light a fire for one person, but the nights lengthen and the rain drips day by day. It is a preparation for the spring, Ally reminds herself. There will be wild flowers, violets and bluebells, that she will take to the asylum whatever the nurses say, and the white cottage will be bright in the sun, but meanwhile there is water seeping from the earth and running down the wall in the kitchen, and a musty smell in the cupboard in the other bedroom led her to find her blue wedding gown spotted with mildew. She can smell mould in the way the house exhales when she opens the door. It’s important to keep the windows open, Tom said, even when the fire’s lit, but for some days it has been no drier out- side than in. One winter, she thinks, Cornwall will simply dissolve and slide back into the sea, perhaps leaving the jagged cliffs of the north coast as a memorial and a hazard to shipping. Probably Atlantis did exist until the north Atlantic rains washed it away. She will write to Annie, who enjoys such whimsy and has been fretting that Ally is falling prey to low spirits and nervous strain at the asylum.
The stationmaster at Perranwell has somehow managed to keep his roses blooming, although each flower hangs heavy with rain and the soil in the flowerbed glistens wet. There is no nightfall these days, only a gradual dimming. Ally gets off the train and feels the saturated sky press low over her head. She thinks of Aunt Mary in London and Annie further along the south coast. Somewhere out there, somewhere upcountry, there will be room to move and breathe between the earth and sky, perhaps even a line of sight to the stars and sun. The solar system is still there, beyond the clouds.
She hurries home, her skirts gathered in her hand away from puddles and mud. Up the hill to the main road, from which she can see the estuary and the boats rocking at anchor, and then down past the taverns of Killigrew Street, brightly lit and leaking music and talk. A door opens and a man comes out with a woman clinging to his arm. A ship must have come in. She turns along Dunstanville, past the captains’ houses, where lamplight and firelight glow like beacons in the great bay windows. The curtains have not yet been drawn, and she sees a family gathered around a table where a maid in a white apron brings food, and two doors down a woman stitching at an embroidery frame by the fire. They would not sit so cheerfully, she thinks, if they had seen the back wards. If they knew that tomorrow, Mary Vincent who is not stupid and understands perfectly well what is happening to her, is to be moved to a place where she will spend her days sitting with deranged and incontinent women whose only advantage is that most of them are – probably – too mad to know that they will be there until they die.
When she wakes, her linen pillowcase is soft with moisture and the outside sheet is clammy to the touch. She rests her hand in the dry hollow where she has lain all night and then on Tom’s side, chill and damp. She pushes back the covers and stands up, knowing even before drawing the curtains that Falmouth is still swathed in rain. Some drops bead the window and some roll slowly down the glass, drawing trails thin as the finest etching. She watches a droplet roll into another droplet and gather speed, finds herself tracing their progress with her finger on the glass. Come now, Ally tells herself. She makes the bed, entombing the warmth and dryness under heavy blankets, and puts on layers of clothes. Her stockings cling and wrinkle on her legs as if she had just had a bath. This evening, it may be time to light a fire, for the house and for Tom’s possessions if not for herself. She remembers the verse on the bedroom wall in Manchester: Lay not up for yourselves treasures upon earth, where moth and rust doth corrupt. Even so, even Mamma might agree that the balance between the wastefulness of lighting a fire for one person and the carelessness of allowing cloth to rot and books to moulder is beginning to tip. Or perhaps the books and clothes are merely a specious excuse for self-indulgence, perhaps she imagines their peril worse than it is because she wants a fire. We have followed too much the devices and desires of our own hearts. There is no health in us. I do not believe, she thinks. I do not believe.
And at the top of the hill, the rain clears, and she can see that there is white sky raised high over the north coast. Ally pushes back her hood, her vision unblinkered for the first time in days, and feels the wind on her ears and neck. The asylum stands before her on the hill’s apex, looking like Janus in two directions. To the south, Truro disappears into the mizzle, the spire of the new cathedral haunting the cloud like pencil under watercolour.
She has spent most of her time on the back wards and not been to Ward Four for a few days. Dr. Crosswyn, summoned for a consultation at the hospital, has left a message saying that Mrs. Elsfield seems to be failing and Ally should examine her. A medical problem, at least. The kind of call any doctor would make. She makes her way slowly up the stairs, noticing how washed sunlight floods through the high window over the landing and down the wooden stairs. There is dust on the ends of each tread and inside the spindles, and she can see where a patch on the wall has been repainted a slightly different colour. Perhaps it will be a different nurse on duty, someone who hasn’t already concluded that Ally is incompetent.
‘She is still with you,’ says Mrs. Ashton. ‘Stronger day by day.’
Ally straightens her skirt. ‘Good morning, Mrs. Ashton. Still sleeping well, I hope?’
‘She won’t leave, you know. Not until you hear her. Did anyone listen to her while she was among us, I wonder? Was she carrying secrets too heavy for her?’
Aubrey, she thinks. But what May did with Aubrey, with Papa’s friend, is on the wall of the Manchester Art Gallery for all to see. Not secret at all. Ally takes a breath. One can see how it would be so effective, the suggestion that the dead had terrible secrets. One would need to pick over the past, reimagine and re-examine the actions of dead hands and the words of a dead tongue, and then, presumably, one would pay a woman who claimed to be able to finish the story.
‘Oh, we all have our secrets,’ she says. The living and the dead.
The red-haired nurse backs out of the linen closet. ‘Oh. Good afternoon, Mrs. Cavendish. Sorry, Doctor. Come to see Mrs. Elsfield, have you? She’s on her bed. Not much a firm hand wouldn’t cure, in my view.’
Mrs. Ashton looks up. ‘She tried that. A firm hand. Didn’t you, Nurse?’
The nurse puts down her armful of sheets. ‘Now then. We don’t like liars on this ward, Mrs. Ashton. And you wouldn’t want to go upstairs, would you?’
If there are no bruises, Ally thinks, I can do nothing. And one has to pretend to trust the nurses more than the patients or the whole system will collapse.
Mrs. Elsfield looks oddly small lying on her bed with the swathes of a dress fallen over her body like a shroud. She lies on her right, facing the wall, and has turned her face into the crook of her arm. Apart from the blackberries, Ally has never seen any sign that Mrs. Elsfield is in any way disordered.
‘Good morning, Mrs. Elsfield. You’re not feeling well?’
Mrs. Elsfield turns her head, puts her hands over her face and opens her fingers to peek at Ally.
Mrs. Elsfield turns her face back into the mattress. Ally looks around to find Mrs. Middleton gazing over her shoulder.
‘Poor old dear,’ says Mrs. Middleton. ‘She shouldn’t be here, not at this last. And it’s the vicar she’s needing, not the doctor.’ Ally meets Mrs. Middleton’s eyes, perhaps for the first time.
The first part of her statement is true. ‘I’d like to examine her and find out about that,’ Ally says.
She glances around. There are no screens here, and it seems unlikely that Mrs. Elsfield will rise from her bed and accompany Ally to an office or to the sick ward. ‘Nurse, would you help me to undress her? Gently.’
Watched by Mrs. Middleton, the nurse takes hold of Mrs. Elsfield’s hand screening her face and tugs. ‘Come along now. Don’t make this difficult, Maria Soon be over and done with if you help us.’
Mrs. Elsfield curls herself smaller, tighter. Her thin grey plait, sewn at the end, moves on the pillow. The nurse yanks her hand and Mrs. Elsfield whimpers and tries to burrow away.
‘Leave it,’ says Ally. ‘It doesn’t matter.’
‘They have to do as they’re told or we’ll have no order. Last chance, Maria, or I’m sending for another nurse. Do you want her stripped, doctor, or is it just her chest?’
Mrs. Elsfield shrinks again. ‘Neither. Please, nurse, stop this.’ ‘Right. Excuse me.’ The nurse pushes in front of Ally and seizes both of Mrs. Elsfield’s hands, hauls on them. Mrs. Elsfield spits and the nurse slaps her.
‘Stop it,’ says Ally. ‘Nurse, stop it.’
She remembers the housekeeper Jenny slapping May, holding her down and slapping her while May fought and shouted and Ally stood, hands behind her back, waiting her turn.
‘Now you see what we have to put up with.’ The nurse drops Mrs. Elsfield, who curls up again like a released spring. She’ll never get out now, Ally thinks, but she was never going to get out anyway. ‘I’ll call another nurse and we’ll soon have her ready for you. Not that I couldn’t deal with her myself, but we have to keep the rules, don’t we?’
‘No,’ says Ally. ‘Leave it. It doesn’t matter.’
‘It’s no trouble. We do this kind of thing all the time. Have to, in this line of work. Stop that now, Maria, you’re only making things worse for yourself.’
The others watch while two nurses hold Mrs. Elsfield down and open her dress so that Ally, with trembling hands, can listen to her chest. NAD, Ally writes. Nothing abnormal diagnosed.
She’s on her way down the stairs to Ward Two when there are running feet along the corridor. The nurse from the sick ward.
She sees Ally. ‘Where’s Dr. Crosswyn?’ ‘Out,’ says Ally. ‘At the hospital.’ ‘You’d better come.’ The nurse opens the door of the sick ward and stands back.
There is shouting. Mary Vincent, with blood running down her face and a contusion on her forehead with the white gleam of bone behind it, is struggling with two nurses. Her closed dress is torn at the shoulder. Leave me alone, she shouts, get off me. Stop that, say the nurses, stop that at once. The nurse who came to find Dr. Crosswyn goes to their assistance and uses Mary’s hair to pull her to the bed. They put her facedown and fasten a strap around her bare white ankles. Mary arches her bound body and tries to fling herself off the bed but they seize her again.
‘You don’t get out of going upstairs like this, Mary. Thought you could get some more time down here, didn’t you? Stop that now.’
‘Always been sly, haven’t you? Rather be lounging in bed here than on the ward.’
‘She’s hurt,’ says Ally. ‘Her head is hurt.’
The corridor nurse looks up. ‘Some of them’ll try anything. She thinks if she hurts herself she can stay here. Ran herself into the wall.’
Mary howls. The sound makes Ally’s scalp crinkle. Stop, she thinks, stop, I can’t bear it. The doctor can’t bear it.
The other nurse puts her hands on Mary’s head, stubby fingers over her eyeballs. Silence. The nurse looks up. ‘Often works,’ she says to Ally. ‘Don’t have to press very hard, see, on the eyes.’
Ally bites her lip, closes her own eyes. Fingers pressing on the darkness, and one’s arms tied.
‘We’ll take her up, shall we?’ asks the first nurse. ‘You’ll probably find her more docile after a few hours on her own.’ They are going to put Mary ‘in seclusion’, in a windowless room on the top corridor where Dr. Crosswyn himself has authorised the use of restraints on patients experiencing episodes of unmanageable behaviour. It is therapeutic, he says, for those who have lost all control and find themselves quite at the mercy of destructive mania, to remove all sensory stimulus and all means of destruction. It is not unknown for patients entering such a phase of illness to ask for seclusion.
Mary drags her face around. There may be some traumatic deformity of the frontal bone and her eyes are already blackening. ‘No, please. I’ll stop, I promise. Please don’t send me up there.’
‘Pity she didn’t think of that earlier, isn’t it, doctor? Get the chair, Nurse Crawford. We won’t chance any tricks on the stairs.’
They are going to tie her to a chair and carry her up those stairs.
Mary’s eyes meet Ally’s. ‘Please, doctor.’ ‘Trying to put one over the doctor now, are we?’ So which are you, Alethea? A madwoman or a doctor? Did I not know, did I not warn you from childhood of your nervous weakness, of your propensity to hysteria and unreason? You chose the asylum, Alethea, because you indulge yourself in feeble-mindedness. Because despite all your training and all your socalled qualifications, you are still crazed.
‘No,’ says Ally. ‘No. Nurse, stop this. You are unkind.’ Her voice is too loud. All of them, even Mary, fall silent. ‘Tell me, nurse, how would you have to feel, to do as Mary does? How bad would it be, in your head, for you to run against the wall until your skull cracks, or to force a knife through your own flesh to the very bone? What would it take, Nurse?’
There are tears on her face. She swallows.
‘That is how it is for Mary. That is it. She is like you, and like me. Like all of us. Only more sad.’
She cries, there on the ward. She has not cried for years.
They do not let her go. They take her down to Dr. Crosswyn’s office, a nurse on each side, where one of them stays with her, watching her, until he comes.
Sarah Moss teaches at the University of Warwick’s Writing Programme. She is the author of five novels: The Tidal Zone (Granta, 2016), Signs for Lost Children (Granta, 2015), Bodies of Light (Granta, 2014), Night Waking (Granta, 2011) and Cold Earth (Granta, 2009). She is also the author of Names for the Sea: Strangers in Iceland (Granta, 2012) about living in Reykjavik in 2009-10, and academic books on Romantic-era British literature, food history and gender.