Forget Me Not (14 page)

‘Yes, you’re right,’ she says. ‘I don’t know if Vivien told you, but we had a very difficult consultation some weeks ago. She was unhappy and angry with me when she left my office because I had advised against another round of IVF. So I suppose, when she missed her next appointment, I was more concerned than I ordinarily would have been, because she’d left our last appointment so distressed.’

I’ve known Mrs Murad for several years, and I know she can be a little brusque, somewhat blunt with her patients. She is not known for having the most comforting of bedside manners. But she is brilliant at what she does.

‘Maybe I should have contacted her earlier,’ Mrs Murad says, ‘in between appointments. But I thought it was better to let her cool down and reflect on what I’d said. I assumed we’d talk again in a few weeks. I took it as a positive sign she’d made another appointment.’

‘I think we all feel guilty,’ I say. ‘With hindsight everyone can think of something they should have said or done.’

‘That’s generous of you to say.’

I understand that she too must keep her distance: she deals every day with infertility, with the deepest of longings and the most painful of disappointments. We both know it would not do to cave in to the sadness or to absorb the emotions of our patients. If we did that, we could not go on.

‘May I ask why you’d advised Vivien against another round of IVF?’

Mrs Murad puts on her reading glasses, which hang from a beaded red cord around her neck, and she peers at the screen of her laptop. Then she closes the lid, takes off her glasses, and begins to speak.

‘The last time I saw Vivien was around eight weeks ago,’ she says. ‘She came back to see me, over the years, for more investigations of the fertility difficulties she was facing. We looked at different treatment options, and new treatments that became available. But we didn’t have as much success as I would have hoped after her first pregnancy.’

She pauses, and deliberates for a few moments, choosing her words carefully.

‘Vivien was young when we first started to look into her difficulties becoming pregnant. She was still in her twenties. She had polycystic ovaries, which I didn’t see as the main barrier to falling pregnant. But as time went on, my main concern wasn’t her fertility per se, but her weight.’

‘Her weight?’

‘Yes. It fluctuated. There were times when it dropped below levels of what was normal.’

She smiles regretfully at me, the smile of a professional about to deliver bad news. ‘Quite early on I suspected your daughter might have an eating disorder. Perhaps she didn’t fulfil all the criteria for a diagnosis, but she certainly had several of the features of anorexia.’

I feel her words as a blow to my stomach and I have to catch my breath. I had always admired my daughter’s self-control. I’d seen her ability to deny herself the pleasure of food as a virtue, not an illness. I saw her iron will as a strength. Now I have to wonder: exactly how blind have I been?

I am stunned. Then I feel a fool. And then I am angry.

‘But you’re not a psychiatrist,’ I say.

I regret this immediately. I hadn’t intended my words to come out sounding like an accusation, because the last thing I want is to put her on the offensive. My stomach tenses up. I expect she might clam up and ask me to leave; I know a bit about consultants’ egos. But Mrs Murad is confident enough, or perhaps pities me enough, that she doesn’t take offence.

‘No,’ she says patiently, ‘I’m not a psychiatrist. But my impression was that Vivien had become quite skilled at concealing the extent to which she controlled her food intake. As I said, her weight fluctuated, and there were times when it was so low it interrupted her menstrual cycle. There was a point at which I had to confront her with the fact that what she needed treatment for, first and foremost, was not her fertility problems, but her eating disorder. Unfortunately, as far as I know, Vivien never took up my recommendation that she see a psychiatrist. I don’t think she ever accepted she had an eating disorder.’

A voice in my head is demanding to know how I could have been so neglectful.

Mrs Murad weighs her words. ‘So,’ she says, ‘in answer to your question about why I advised against further fertility treatment – I thought a combination of factors made it unwise to go ahead. Unethical, even.’

I change the cross of my legs and run my hands along the creases in my trousers. ‘A combination of factors?’

‘As I’m sure you know,’ she says, ‘parents of IVF babies can carry a lot of anxiety. For some parents this can be very intense. In my experience, symptoms of eating disorders and anxiety and depression often go together. I thought it would have been the wrong decision to go ahead with fertility treatment under the circumstances. Given Vivien’s emotional state.’

‘I’ve been told,’ I say, ‘by the police, that Vivien was taking both antidepressants and slimming tablets when she died. But the slimming pills weren’t prescribed by her GP. Did you know she’d started taking these?’

I imagine a note of caution enters her voice. ‘Vivien never disclosed to me that she was taking slimming tablets.’

‘But did she tell you that she’d got hold of some of these tablets, or where she got them from?’

She shakes her head.

‘Did you ever tell Ben that you believed Vivien had an eating disorder, or that she should see a psychiatrist?’

‘I did.’

‘When?’

‘It was after she last came to see me.’

‘A few weeks before she died?’

‘Yes, Vivien had stopped bringing Ben to the consultations with her, and that worried me too. But I do believe I acted in her best interests – by referring her for psychiatric help.’

She is on the defensive now, I can see it in the pursing of her lips and I can hear it in her clipped sentences.

‘I did break confidentiality,’ she says. ‘I told Vivien I was going to talk to Ben and she wasn’t happy about it.’

‘If you broke confidentiality,’ I say, ‘then you must have been extremely worried. Did you believe Vivien was a danger to herself?’

‘No,’ she says, ‘I didn’t. I really had no reason to believe Vivien was suicidal.’

‘I don’t understand. In that case, why would you break patient confidentiality and talk to Ben?’

‘Because it wasn’t only Vivien I was worried about,’ she says. ‘It was her daughter. That’s partly why I wanted to talk to you.’

I don’t want her to see how fearful I am. I grip my hands together, clench them in my lap. ‘Why would you be worried about Lexi?’

‘I was concerned that Vivien was not only fixated on her own weight, but had developed distorted perceptions about her daughter’s weight. I suppose it was a displacement, or an extension of her own body-image problems. Of course, as you rightly say, I’m not a psychiatrist.’

She looks at me pointedly.

‘I apologize,’ I say. ‘I do understand that you acted in Vivien’s best interests. Please go on.’

‘Vivien told me her daughter was being bullied at school because she was overweight. She said she’d tried to encourage Lexi to eat more healthily but it wasn’t working. She asked me if there was any link between obesity and IVF, which I said was unlikely. And then Vivien told me she was thinking of medicating her daughter. She asked me a question about dosage. Of course I’m not a paediatrician and I told her I wasn’t the right person to advise her. But I was really concerned, because Alexandra is so young. I advised her to see a paediatric dietician about diet and so on, but Vivien had certain fixed ideas that worried me. I had the impression she wasn’t going to listen to proper medical advice. I must stress this was just an impression, but I’ve learnt to trust my gut instinct. The infertility treatment can be psychologically traumatic in itself – both the procedures and the repeated failure. In combination with her weight problems and some of her ideas around her child, I was worried about her mental state and I believed I needed to let Ben know about my concerns.’

I sit quietly while I try to digest everything she’s just told me. ‘So you told Ben about all of this?’

‘Yes. I telephoned him after our consultation. He said he would convince Vivien to see a psychiatrist. I’m only sorry I didn’t have a chance to talk to her myself, after that last appointment. And of course I’ve wondered about the timing, and why this happened right before she was due to see me. I’m only human. I’ll always wonder if there’s something more I could have done. But I like to think Vivien understood I had her best interests at heart. I hope so.’

‘I think she did,’ I say. ‘She was coming back to see you. She trusted you.’

Mrs Murad moves her laptop to the side of her desk. She gives me a rueful smile and I understand my time is up. There are patients lining up outside, I’m sure, anxious and expectant couples perched on the expensive sofa.

‘Come back and talk to me any time,’ she says. ‘If you let me know in advance, I’ll make more time for you.’

‘Thank you,’ I say. I stand up, and we shake hands across her desk.

As I reach the door, Mrs Murad calls out: ‘How is Alexandra doing?’

I place my hand on the doorknob but I don’t turn it and I don’t turn around to face her.

‘I’m keeping a close eye on her,’ I say.

This is not entirely a lie, I tell myself.

‘Ben loved your daughter very much,’ Mrs Murad says. Her voice is clear and strong. ‘Sometimes we can love people too much. So much that we don’t want to see what’s wrong. But your granddaughter is in safe hands.’

Alexandra is crying again. I lie still, as though I’m asleep, but my eyes are wide open. The cot is on Ben’s side of the bed. She has passed her one-year milestone, yet still sleeps in our bedroom.

Ben sits up, swings his legs over the side of the bed and scoops her up into his arms. He takes her out of the room, so as not to disturb me. Ben doesn’t mind getting up in the middle of the night, who knows how often. I’ve lost count of the times Alexandra wakes us. I hear him whispering to her, soothing her as he leaves our bedroom.
Lexi
, he calls her.

Ben never complains about these disturbances in the night. I’ve begun to suspect he might even welcome them; he says he doesn’t get to see his daughter enough during the day. I don’t understand how he manages the night-wakings and then the early-morning start and yet is more contented than I’ve ever known him to be. Ben really is a family man.

I pull the duvet up around my face. I’m cold, now that he’s left me.

Alexandra is no trouble during the day. She’s a quiet, contented sort of baby, and doesn’t cry much. She takes the bottle when I offer it to her, and she looks up at me, trying to fix on my eyes as she drinks. I try hard not to look away, but it’s a strange sensation, holding her and being stared at. I always feel as though my daughter is accusing me of something. I sometimes feel angry with her, for no reason. And sometimes, I have to force myself to pick her up. I have to remind myself to smile at her. Babies need those things: physical affection and smiley faces.

She is so needy and so small, and yet so powerful and all-consuming. Ben barely looks at me when he comes through the door. He wants me less often; what he really craves is the feel of his daughter against his chest. I don’t know any more whether the child is my saviour or my undoing. And yet I am Alexandra’s mother and that makes me queen of Ben’s kingdom. He will never leave me now.

My thoughts are always dark, paranoid and irrational in the early hours of the morning. I can’t get back to sleep. There is no sign of Ben or of the baby. I get up and walk, silently, out of the bedroom and down the stairs, towards the light in the nursery. Ben has his back to me as he stands at the changing table. Bare-chested and barefoot, he leans over her. Alexandra never cries when her father changes her.

‘That’s a wet nappy,’ he says. ‘What have you been drinking today?’ Alexandra gurgles.

‘What strong legs you have!’ Ben says. He holds her with one hand, slides the nappy out from under her, unfolds a new one, and parcels her up again. He and the baby don’t take their eyes off each other. It’s a love affair.

Ben picks Alexandra up and walks over to the window. He slides open the shutters, so she can see the lights of the street below. When she begins to niggle, Ben rocks her, placing his little finger to her lips.

I stay in the doorway, watching them. Alexandra, I’m sure, is asleep, but Ben does not put her down. He sways, rocking her. I have never seen him so contented. Or so compelling.

I creep back to our cold bed and I trace the contours of the empty space where Ben should be lying beside me.

We have three new admissions and all of the babies are on ventilators. The agency nurses on duty don’t have as much experience as they should, and so I have to keep an eye on them. The portable X-ray machine is perpetually in operation, as we clear the room and then return, over and over again.

By the end of the night shift I am worn out. My arms and legs ache and I’m ready to go back home and face my empty flat and my thoughts about what Mrs Murad has told me.

Instead of heading home, though, after handover, I find myself visiting little Yusuf. He’s awake in his cot, the yellow feeding tube still taped to his bulging cheek. As I reach over him to wind the mobile, he smiles up at me. He reminds me of Lexi sometimes, his temperament so settled and quiet. He is so uncomplaining in his solitude. I lift him up and carry him to the window, where I show him the same old sights.

There is a rustling behind us, a tentative sound, and I turn to find a young woman standing beside Yusuf’s empty cot. She is slight, with a magenta sari drawn up to cover her hair. In all the months Yusuf has been on the ward, I’ve glimpsed his mother only once before. On that visit she was trailing, submissive and head down, behind her husband, a loud and corpulent man.

She smiles at me but does not try to approach me, or to reach out to claim her son. She’s very young and she doesn’t speak English. She doesn’t understand any of it: the hospital, the incubators, the feeding tube, any of what’s happened to her and to her baby.