Far From The Madding Crowd

Three months passed.

True to her word Mother Fry rostered him on nights only, until one evening he found a note in his cubbyhole whilst making tea in the staff room.

It contained a single line etched in the rhythmic ink of a fountain pen.

You are to remain after your shift ends for your probationary review.

Unwin was not aware he had been working a probationary period, but then he hadn’t signed a contract either and learnt from the other nurses that no one had.

The wide spaced, florid writing undeniably belonged to Mother Fry. He had seen very little of her since his first day though her presence was moulded into every act of care that could be considered protocol. Some nights he spent marvelling at how Ward One could seem to run all by itself, such was the influence of Mother and her code. On those nights it seemed as though she had thought of everything. The nurses merely needed to follow her lead, imbibe the wisdom she passed unto them via policies and her clear authority.

Other nights were different. For no apparent reason a shift could begin loudly, bawdy even, with the promise of violence. The night shift would gather in the nursing office to rue their daytime colleagues for not keeping to the script. Nurses would be singled out for maverick behaviours. For not following the Rules. The Rules you were taught when you were inducted onto days. If you passed the tired scrutiny of the night staff.

“He’ll do”. Fry advised him. She had been informed by two or three of her trusted aides working the night shift that he had potential and should be retained.

And so Unwin would be inducted into the Rules of Ward One. The rules by which he had observed the night shift soothe a Ward simmering just beneath the point of riot, to one where the majority of patients filed slowly to their beds by the turn of midnight. The remaining one or two still excitable patients followed in the end through the strict deployment of non engagement, subsequent boredom, or the needle.

“That’s a complement”, Fry told him. “Some of them have been here even longer than me”.

“That’s how I will take it”.

“Now you are to work with me for two hours then finish your shift. You will be paid.” Fry stood up from her desk and motioned for him to follow her.

Mother Fry said she had rules. Not the rules printed in the hospital handbook. Those belonged to the administration. They concerned keys, medicines, timings, signatures, temperatures, meals, restraints, visitors, reports.

Fry’s rules were different. They were not written anywhere. They were learned.

A window was never opened fully during a storm, but it was never kept shut simply because the weather was bad.

A patient who had been silent all morning was not left alone merely because he appeared settled.

A nurse did not stand in the doorway of a sleeping patient’s room for longer than necessary.

A chair was never placed with its back to the corridor at night.

If someone began talking about the fen, you listened before telling them they were mistaken.

And if a patient said there was someone standing outside the window, you did not immediately look.

These seemed to Unwin like the habits of a staff that had been too long in one institution. Superstitions accumulated through repetition. He was beginning to understand that the hospital had its own folklore even before Fry had sat him down.

Fry insisted there was a difference.

“You don’t need to believe a thing,” she told him. They were standing in the treatment corridor while rain struck the high windows. “You need only know what happens when you ignore it.”

Unwin looked at her. “That’s a dangerous principle.”

“Why?”

“Because it makes every old wives’ tale into evidence.”

“No.” She adjusted the cuff of her uniform. “It makes experience worth remembering.”

She moved towards Ward One. Unwin followed.

Inside, Mr Haines was sitting beside the window. He had been quieter for several days. Too quiet, Fry had said.

Unwin had written improved. Fry had crossed the word out.

“What would you call it?” he asked.

“Withdrawn.”

“He isn’t distressed.”

“He isn’t speaking.”

“He doesn’t have to.”

“No.” She looked at Haines. “But if a man who usually speaks stops speaking, you don’t congratulate yourself because the ward has become quieter.”

Unwin said nothing.

Fry crossed to the window and opened it slightly. Cold damp air entered the room. Haines looked up. His shoulders loosened. Unwin noticed.

“You see?” Fry said.

“Coincidence.”

“Perhaps.” She closed the window again. “That word is useful.”

“For what?”

“For things we haven’t understood yet.”

The first rule, he realised, was to notice change. Not improvement. Not deterioration. Change. Fry called it the first duty of nursing.

“Patients rarely announce themselves before something happens,” she told him.

“They alter.” A change in appetite. A different way of folding a blanket. A refusal to look at a particular door. A new silence. A shoe left beneath the bed instead of beside it. A patient who usually complained suddenly becoming agreeable. “These are not diagnoses,” Fry said. “They are beginnings.”

Unwin wrote it down. He was beginning to see why the staff trusted her. She noticed what the charts missed.

But there were other rules.

The second was never to force a memory out of someone simply because they had begun speaking about it.

“Let it come,” Fry said.

“What if it’s delusional?”

“Then let it come carefully.”

“What does that mean?”

“Don’t wrestle it to the ground.” She had a way of saying things that made him feel both instructed and rebuked. “A frightened mind doesn’t become less frightened because you have proved it wrong.”

“So we agree with them?”

“No.”

“Then what?”

“We stay.” She said it simply. “That is the work.”

The third rule concerned the night. Fry believed that nights belonged to different forms of distress. People who were manageable by day could become frightened after midnight. Old memories returned. Rooms became unfamiliar. The sound of water in the pipes could become footsteps. A shadow could become a person. She did not mock this. Neither did she indulge it.

At two in the morning, if a patient said someone had called their name from the corridor, the nurse checked the corridor.

Once. Not five times. Not every time the patient asked.

“You acknowledge,” Fry said. “Then you close the door.”

“Why?”

“Because reassurance can become dependence.”

Unwin considered this.

“And if someone really is there?”

Fry looked at him.

“Then you will have to decide what kind of someone.”

He disliked answers like that.

“You’re deliberately being vague.”

“No.” She smiled. “I’m being precise.”

There was another rule.

The fourth.

Never let fear become contagious. This was harder. Fear moved through Ward One quickly. A raised voice at one end could alter the whole corridor. A slammed door could make three patients sit upright. A nurse frightened by a patient’s behaviour could frighten another nurse, who would then become brisker, louder, more controlling. The ward responded to them all.

Fry watched nurses as closely as she watched patients.

“You carry yourself differently when you’re afraid,” she told him. “Bed 3 – Mr McGuiness – he wasn’t shouting at you.”

Unwin looked at her puzzled. Mr McGuiness was always shouting.

“You hold your keys in your fist.” Unwin looked down. Fry gently opened his hand. “Don’t make a weapon of what is meant to open doors.”

Unwin remembered that.

Keys appeared frequently in Fry’s lessons. Keys should not be rattled. Doors should not be slammed. A lock should be turned once. Never twice.

“Why?” Unwin asked.

“The sound travels.”

“That can’t be the reason.”

“It is one of them.”

He waited.

She sighed.

“Patients hear keys before they hear nurses.” That made sense. Fry continued. “They hear the promise of being locked in. You don’t want to be associated with that”.

The fifth rule was about touch.

Never touch a patient from behind. Never touch someone who is asleep unless there is a reason. Never place a hand on a shoulder simply because you want to comfort them.

“Why?”

“Because comfort belongs to the person receiving it.” Unwin found this unexpectedly difficult. He had thought kindness was obvious. Fry seemed determined to make even kindness subject to discipline.

“You can’t impose comfort,” she said.

“Not everyone wants it?”

“Exactly.” She paused. “And some people have had too much imposed upon them already.” That silenced him.

The sixth rule concerned the building.

Fry insisted that nurses should know the sounds of their ward. Not merely the obvious ones. The ordinary noises. The pipe above the laundry room. The loose hinge on the fire door. The radiator that clicked three times before warming. The window that whistled in an east wind. The hum in the walls.

“Why?”

“So you’ll know when something changes.”

“Everything changes.”

“Yes.” She looked at him. “That’s why you listen.” He began to understand that listening, for Fry, was not passive. It was vigilance without panic.

The seventh rule was the one he objected to most.

If the marsh appeared in a patient’s speech, Fry said, do not dismiss it. The fen was part of the hospital. Patients saw it from the windows. Smelt it after rain. Heard birds and water beyond the grounds. Some had lived beside it all their lives. Others had been brought there from towns and cities and dreamed about it without ever having known it.

“You think the marsh affects them?”

“I know places affect people.”

“That’s not the same thing.”

“No.” She looked through the window. “Nothing is ever exactly the same thing.”

He followed her gaze. The land beyond the hospital was flat and grey. Reeds moved in the wind.

“What if a patient says the marsh is calling them?”

Fry was quiet for a moment.

“Ask what they think it wants.”

“Why?”

“Because sometimes the answer is more important than the question.”

“And if they say it wants them to die?”

“Then you stay with them.”

“And if they say it wants them to come outside?”

“Then you keep the door locked.” That, at least, sounded like medicine. Unwin smiled. Fry noticed.

“Don’t look so pleased.”

“Why?”

“Because you think you’ve caught me.” He didn’t answer. She turned back towards the ward.

“The marsh may be old,” she said, “but that doesn’t mean we have to obey it.” That sentence stayed with him. It was perhaps the most important thing she ever taught him.

Some rules were harder to accept.

Unwin first saw the knots in the nurses’ room. There were three of them. Small things. Almost nothing. Each had been made from thin green reeds, stripped clean and bent carefully before being tied. They had been placed along the edge of the windowsill, where the morning light caught the damp fibres. He assumed they were decorations.

“Who put those there?”

Mother Fry was making tea. She did not turn around.

“I did.”

“Why?”

“Because they needed tying.” Unwin looked again.

“They?”

She poured the water.

“The things people don’t say.”

He smiled.

“I see.”

“No, you don’t.” She handed him a cup. He took it. The knots remained on the sill.

He had seen reeds all his life. They grew everywhere around the fen, along drainage channels and ditches, beside footpaths that disappeared after rain. These were different. They had been deliberately chosen. Three reeds. Each knotted three times.

“How long have you been doing this?”

“Long enough.”

“Is it a local custom?”

“Perhaps.”

“Medical?”

“No.”

“Religious?”

“No.”

“Then what?” She sat down.

“Necessary.” Unwin looked at the knots again.

“Necessary for whom?”

“The nurses.” That interested him. Fry rarely spoke about nurses as though they were separate from the work. They were expected to endure. To witness. To clean. To restrain when required. To sit beside the dying. To listen to patients describe things no one else wanted to hear.

And then, at the end of a shift, they were expected to go home. As though nothing had happened.

Fry picked up one of the knots.

“When you’ve listened to enough people,” she said, “you begin to carry things that aren’t yours.”

Unwin said nothing.

“A patient’s grief.” She touched the first knot. “A mother’s voice.” The second. “Something you saw and couldn’t change.” The third. She put it down. “If you carry enough of it, you stop knowing what belongs to you.”

Unwin thought of his notebook.

“I write things down.”

“Yes.”

“That helps.”

“Sometimes.” She looked at him.

“Sometimes writing is another way of carrying.” He felt the small sting of the remark.

“You disapprove of my notes?”

“No.”

“Then what?”

“I think you are very good at keeping things.” The word remained between them. Keeping. Unwin glanced towards the ward.

“What should I do with them instead?”

“Give them somewhere else to go.” She stood. “Come.” He followed her out through the back entrance. The rain had stopped, though everything remained wet. The ground around the hospital was soft beneath their shoes. Beyond the last wall, the fen began. Reeds stood in dense ranks beside the drainage ditch, their heads moving together in the wind.

Fry walked to the water. She selected three stems. She did not cut them. She bent them gently until they came away at the root.

“Why three?”

“Because three gives the hands something to remember.”

She stripped away the damaged leaves.

“One for the mind.” She tied the first knot.

“One for the mouth.” The second.

“One for the heart.” The third.

Unwin watched.

“What does the knot do?”

“It doesn’t do anything.” He looked at her.

“You just said it was necessary.”

“It is.”

“But it doesn’t do anything.”

“No.” She smiled. “It teaches the breath where to settle.” He waited. She held the finished knot between finger and thumb. “When you have spent a night listening to someone else’s pain, your body doesn’t always understand that the shift is over.”

That was true. He knew it. He had carried patients home with him in small, unwanted ways. A voice repeating itself. A face. The smell of antiseptic. A hand reaching through bedclothes. A sentence spoken years ago that remained in the mind as though it had just been heard.

“You go home,” Fry continued, “but the ward comes with you.” She placed the knot in his hand. “It shouldn’t.” He looked down. The reeds were cool and slightly damp.

“What am I supposed to do with it?”

“Keep it until morning.”

“And then?”

“Let it go.”

“Where?”

“The ditch.”

“Why the ditch?”

“It runs to the fen.” He almost laughed.

“Of course it does.” Fry ignored him.

“Water carries things.”

“It also carries disease.”

“Yes.”

“And rubbish.”

“Yes.”

“And bodies.” She looked at him.

“Sometimes.” The word was so calmly spoken that he stopped smiling. She took the knot back. “That’s why you don’t put your sorrow in the water and expect it to disappear.” She walked along the bank. “You put it somewhere it can move.”

There was a difference. Unwin could feel it, though he did not yet understand it.

Fry crouched beside the ditch. She lowered the knot into the water. It floated for a moment. Then the current took it. The reeds turned slowly, caught against a blade of grass, freed themselves and moved on.

“That’s all?”

“That’s all.”

“No prayer?”

“No.”

“Words?”

“If you need them.”

“What do you say?” She looked at the water.

“Nothing stays where you put it.” She released the knot. They watched until it disappeared beneath the shadow of the reeds.

After that, Unwin began noticing the knots everywhere. Not many. Never enough to become a system. One beneath a windowsill. One beside the staff-room stove. A tiny bundle tucked behind the nurses’ noticeboard. Sometimes a knot appeared on the desk after a particularly difficult night.

No one claimed it. No one asked. They simply understood.

The practice became more important after a death. That was when Unwin began to understand why. The first was an old patient in Ward One. He had been there longer than most of the staff had worked at Manor House. He died quietly. There was no drama. No struggle. One moment he was breathing. Then he wasn’t.

The nurse on duty was young. Too young, Unwin thought. She stood beside the bed afterwards, staring at the man’s face.

“I don’t know what to do,” she said. Unwin had no answer.

Mother Fry came into the room.

She closed the patient’s eyes. Then she covered his hands. She did not immediately leave. Instead she stood beside the young nurse.

“Take three reeds.” The nurse looked at her.

“Now?”

“Now.” They went outside.

Unwin followed.

The nurse’s hands were shaking. She broke the first reed. It snapped. She began to cry.

Fry said nothing. The nurse tried again. Three stems. Three knots. Mind. Mouth. Heart. When they were finished, Fry took one knot. She gave one to the nurse. One to Unwin. He looked at it.

“I don’t need this.”

“I know.” She closed his fingers around it.

“Belief is not required.” He looked at her.

“Then what is?”

“Breath.” The word struck him more deeply than it should have. They stood beside the ditch. The nurse released hers first. It floated away.

Unwin held his. He could feel the tiny pressure of the reeds against his palm. He thought of the dead man. His name. His face. The sound he had made when he breathed. The things he had said during the weeks Unwin had cared for him. Unwin suddenly understood that he did not want to forget any of it. Not one detail.

Fry was watching him.

“Let it go.”

“I don’t want to.”

“I know.”

“It feels wrong.”

“Why?”

“Because if I let it go, it’s gone.”

“No.” She spoke quietly. “You are confusing release with erasure.” He looked at her.

“What’s the difference?”

“The thing you release no longer has to live inside you.” She pointed towards the water.

“But it has still happened.”

Unwin looked down at the knot.

“You remember.”

“Yes.”

“But you don’t keep.” He shook his head.

“I don’t understand.”

“You will.”

She said it without menace. There was no prophecy in her voice, no suggestion that she knew what would become of him. It was simply the confidence of someone who had spent longer than he had watching nurses mistake endurance for duty.

He dropped the knot into the ditch.

For several seconds it remained beside his hand, turning slowly in the brown water. Then the current caught it.

He watched it go. Something in him resisted. Something else loosened.

Fry turned back towards the hospital.

“Come.” He followed. Neither of them spoke.

Later that night, Unwin sat alone in the nurses’ room and opened his notebook. He wrote the dead man’s name. Then the date. Then everything he could remember. The shape of his hands. The way he had looked towards the window when it rained. The particular pause before he answered a question. The sentence he had repeated on his final evening.

Unwin stopped writing. He read the page again. For the first time, he wondered whether there were things a record could preserve too well.

Outside, the reeds moved in the dark. The hospital hummed. He closed the notebook. But he did not put it away. He placed his hand over the cover, as though keeping the pages still might keep the dead man still too.

Beyond the walls, the ditch carried its small bundle of reeds towards the fen.

The hospital kept its silence.

The water did not.