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 ABOUT THE BOOK

Natalie King may be a psychiatrist, but that doesn’t mean she can
persuade her baby to go to sleep. Sienna wants to party through the
night—and lack of sleep is a major trigger for Natalie’s bipolar
disorder.

Sleep school at Southside private psych unit, however, turns out to

have its own hazards. It’s bad enough that Natalie doesn’t really want
to be there, that she wants to keep her professional status quiet and that
she’s seen enough group therapy to be quite sure it’s not her thing. But
then someone arrives who Natalie knows very well indeed—and not in
a good way.

Luckily she’s out of Southside by the time the murder happens.

Unluckily, she knows everyone who’s involved, including the cops.
They think they have an open-and-shut case. Natalie’s pretty sure
they’ve locked the door on the wrong person.

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CONTENTS
Cover Page
About the Book
Title Page
Dedication
Map
Patient Register
Before the Murder
A Straightforward Case
The Sisterhood
If Things Can Go Badly, They Probably Will
Acknowledgments
About the Author
Copyright Page

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 For all the perinatal mental health staff I have had the privilege of
working with over the last thirty-five years, in acknowledgment of their
dedication to making a real change for women, babies and their
families. This story would never have happened on their watch.

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SOUTHSIDE MOTHER–BABY UNIT

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PATIENT REGISTER
Robbie (partner K.C., child Damon): admitted 22 Jan.
Phoebe (husband Graydon, child Chabon): admitted 24 Jan.
Nicki (partner Rocky, child Sam): admitted 25 Jan.
Yu (partner Chang, child Mei): admitted 28 Jan.
Jamillah (no partner, child Shamso): admitted 28 Jan.
Natalie (partner Liam, child Sienna): admitted 1 Feb.
Angelica (partner Tim, child Lincoln): admitted 1 Feb.
Maddison (partner Miles, child Amelia): admitted 1 Feb.

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Four days after the murder

The day started badly, but a pretty standard type of badly for a Monday. By
8 a.m. Sienna had more or less told me she hated me, and spat broccoli over
the shirt Liam had put out to iron (don’t get me started on broccoli for
breakfast). By 9 a.m. Sienna’s father Damian had offered his colourfully
expressed thoughts about my parenting—on speaker—and at ten I was at
work, listening to my boss’s less colourful but pointed critique of my time
management.
The day didn’t get any better from there. By 2 p.m. I was up to my neck
in murder.
That wasn’t as unusual for me as it might be for most people: as a
forensic psychiatrist I routinely perform psychiatric assessments of accused
murderers. In this case, though, I recognised the woman who’d done the
murdering.
I don’t usually see people until after the crime. Unlike a cop, I’m
interested less in the crime scene and more in the person who made it
happen: who this person is; how and why they got to the point where they
eliminated another human being. There’s rarely any question of whether
they did it or not. It’s usually down to psychosis, and psychosis isn’t
conducive to master-planning. My task, aside from treating their illness, is
to help the court decide whether they knew what they were doing at the
time.
The most likely scenario here would be that she’d killed her baby. We get
those.
Postpartum psychosis isn’t that common, but with schizophrenia, drug
abuse and personality disorder to worry about, too—not to mention
scumbag partners—it sometimes seems like being a baby is a risky
endeavour.
 Since Sienna’s birth last year I’d seen only one case of infanticide, and it
had been hard. My daughter just had to smile at me and I was putty. The
thought of anyone harming her, or any child, made me want to throw up.
Feelings that get in the way of being objective and compassionate, which is
essential as an assessing or treating doctor.
In the case of this new admission…well, I knew this woman’s baby.
I’d spent the last week with her.

Everyone tells you that having a baby isn’t easy, but until you have one, you
don’t truly get it. Little things add up—the need for breakfast in silence
(anything in silence), a Saturday sleep-in, a spontaneous meal out or a
weekend away—and bigger things pile on to the tally. Self-doubt;
wondering whatever made you think you could look after another human
being for the next eighteen years; no time to do the talking you need to keep
your relationship on-track, let alone enhance it; vengeful exes hovering and
hoping for you to fail. And the main problem that brings everyone unstuck:
lack of sleep.
Back before everyone started getting old, I used to sing in a band. I dealt
with 4 a.m. finishes and going to work next morning with a hangover, and I
was self-medicating the bipolar disorder that sleep deprivation triggered.
Things could get a little crazy. But since Sienna was born I had been
scrupulous about taking my meds. I knew I had a high chance of
postpartum relapse anyway; without the drugs it was pretty much
inevitable. And I didn’t want to go there.
I was not, under any circumstance, going to go into hospital.
Until I was.

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Before the Murder

Monday: three days before the murder

‘If we’re still here in five days, shoot me,’ I said to Sienna when the Uber
dropped us off at Southside Private Hospital. I had to be back at work next
week anyway—work being Yarra Bend, the forensic psych hospital.
There was a common waiting area where sleep-school clients and
psychiatric admissions were processed together, and we sat there while the
paperwork was completed. The admin staff seemed put out that I didn’t
want my surname anywhere except on the bill but that was a non-negotiable
for me. You don’t need social media when you’ve got access to the
hospital-system rumour mill, and I was able to raise eyebrows in my
professional capacity without any juicy additions. As far as these people
were concerned I was a mother, not a psychiatrist.
‘No fucking way.’ A voice floated down the corridor: someone was
reading my mind.
I peered past the nurses’ station and saw a woman in her early twenties
with her arms crossed defiantly. Pixie face, messy blonde hair falling out of
a ponytail, an inch of brown roots. She looked like me when I got out of
bed first thing for the daily stand-off with Sienna.
The chirpy nurse who’d welcomed me took a step backwards. ‘The unit
manager has asked…’
‘It’s an infringement of our rights.’ There was another patient there—this
one slight, older, pretty in a pale, nondescript way. Her prim voice wavered
from under the kind of neat bob everyone wore in The Great Gatsby.
 ‘My father’s a lawyer,’ bad-hair pixie added. ‘I know what I’m talking
about.’
‘Maybe—’
The nurse was interrupted by the arrival of a motherly figure with grey
streaked through dark hair who I assumed was the unit manager.
‘Nicki.’ She smiled at bad-hair pixie with the air of someone not to be
fucked with. ‘What seems to be the issue?’
‘She wants to search my room,’ Nicki pouted.
‘This looks like it’s going to be entertaining.’ A woman had sat down
next to me to get a better view of the fracas. Late thirties, solid build, gold
bangles and wide gold diamond-encrusted rings. They looked like the real
thing. ‘I’m Angelica,’ she said. ‘What do you reckon Nicki’s up to? Drugs
or porn?’
‘Who has time for sex?’ I asked. ‘Could be sharp objects.’
Angelica raised an eyebrow—the sort you paid a lot for in a South Yarra
salon. I restrained Sienna from poking her baby, who had to be less than a
month old, and we both turned back to watch how the unit manager was
going to convince Nicki to let them search her room.
‘Nicki, I believe you signed the contract with your psychiatrist.’
‘I don’t fricking care about any contract.’ Nicki turned to Gatsby-bob
woman. ‘Phoebe, can they hold me to that?’
‘Perhaps you should call your father?’ Phoebe was looking flushed.
There was an air of fragility about her—good chance she had an anxiety
disorder, I thought, and being involved in Nicki’s crisis was unlikely to
help. I reminded myself I wasn’t here to treat anyone other than myself.
‘Let’s talk about this in your room, Nicki,’ said the unit manager with a
glance in our direction. She wasn’t taking any argument from either Nicki
or Phoebe, as the nurse gently encouraged the latter into the TV room. The
manager smiled at us as she came past, leading Nicki to a room at the far
end. I felt like applauding.
‘Thank god I’m only here until Friday,’ said Angelica.
‘Sleep school?’
Angelica nodded. There were eight beds here, two of them reserved for
sleep-deprived women looking for some magic, in this case Angelica and
me. The other six beds were for women—including fragile Phoebe and
Nicki the bad-hair pixie—with postpartum psychiatric issues. All voluntary
—but it didn’t mean some of the women weren’t really unwell.
 I’d suggested Damian come, but of course he said no way. For a cop, he’s
soft and fuzzy. But he is a cop. Anyway, lack of sleep was more my
problem than his. My mentor, Declan, had said I needed a live-in nanny or
I’d relapse, no matter how much lithium I was taking. Sleep deficit and
circadian-rhythm disruption are like timebombs for me. And I need the
sleep between midnight and 6 a.m.: any other time just doesn’t work in the
same protective way. The biology of my trigger is something I picture as a
molecule careering around my brain like Gazoo in the Flintstones, only
with Jack Nicholson’s face from The Shining.
A live-in nanny would have been great. But there was no room for
anyone extra in my warehouse, which was where we were living since
Liam’s ex, Lauren, had taken their kids to Sydney. Liam and I had yet to
talk about how that situation was going to play out. Needless to say, making
things easier for us wasn’t on Lauren’s agenda; but there was no way Liam
was giving up on his kids.
And Damian and I had yet to talk about the problem of Sienna doing
overnights with him and his mother.
Neither were topics that helped me sleep.

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‘That’s personal!’ Nicki’s voice came through the wall. I was hiding away
in my room, which was next to hers. I told myself it was worth staying for
the aircon; there had been a run of very hot days and my warehouse was
stuffy at best.
The nurse, whose name was Dilani, said something I didn’t hear through
the banging on the adjoining wall. Nicki’s fist, I imagined.
I peeked out. Dilani was walking towards the nurses’ station carrying a
plastic bag. Looked like weed.
When she returned, she came in to take my admission history.
‘Short version,’ I told her, ‘I need to sleep to stay sane. Sienna likes to
party between one and five in the morning.’
Dilani took a detailed history about the partying, then we moved on to
the staying sane.
‘Past history?’ She pointed at the heading on her form.
‘Admitted once for mania and once for depression. I’m on lithium.’
Dilani dutifully recorded this. ‘Can you sleep when Sienna isn’t
disturbing you?’
A good question. ‘Mostly.’ Except when my brain started firing up of its
own accord—which sleep deprivation could bring on. ‘I take quetiapine if I
can’t.’
Dilani finished the history. I gave her eight out of ten. Only thing she
missed was that Liam was not Sienna’s father. I’d written Damian’s name
on the form but otherwise referred only to Liam; I doubted she’d notice the
discrepancy.
‘Okay, we’re done,’ she said brightly. ‘Just in time for you to get to dance
therapy.’ So much for hiding.
I reluctantly let her lead me and Sienna to the group room, where a
slightly spaced-out new-ager was handing out brightly coloured scarves.
‘I have metal plates in my hip,’ I told her. Courtesy of a motorbike
accident.
 ‘Okay, well, just move in whatever way you feel comfortable.’
Nicki bad-hair-pixie and her mate Phoebe of the Great-Gatsby look were
already there, moving around in a way that presumably felt comfortable.
For Nicki, that was a rhythmless shuffle from foot to foot, but Phoebe
looked like she was doing an aerobics routine. Presumably they’d been here
for the previous week’s class.
Phoebe stopped dancing and raised a hand. ‘I’m Phoebe Hunt and my
baby is Chabon.’ She gestured towards a pram parked in the corner.
‘As in Michael?’
Phoebe masked her surprise. ‘I’ve always thought he’s the finest writer in
the world.’ She gave a self-conscious little laugh.
I didn’t have an opinion since I hadn’t read anything of his, just an article
about him which, to be fair, probably had said he was a fine writer.
‘You seem to have this dance thing in hand. Have you done ballet?’ She
had the anorectic look; but maybe that was the anxiety.
‘No, I’ve never studied dance,’ said Phoebe. ‘I’m a black belt in
taekwondo, though.’
Okay: looks could be deceptive. If I got bored I could ask her for a few
new moves to add to my limited repertoire.
Nicki ignored me. Still sulking.
A few other women and their kids sidled in, including—with a nod to me
—Angelica. The new-ager led the scarf-waving into nursery-rhyme-singing,
then started blowing bubbles—huge ones that fascinated even the smaller
children. Sienna was keen to try it herself.
In the doorway a young woman of Chinese appearance stood watching us
blankly. She put her child down on the floor and left, and the little girl
crawled over to me. Soon I was managing both children, as well as their
scarves and bubbles, until Dilani looked in and frowned. ‘Where’s you?’
‘Me?’
‘No, you. Y-u.’ She gestured. ‘And her daughter is spelt M-e-i—
pronounced May.’
I wondered if the play on words was deliberate, and started to
contemplate what it said about their attachment before I could stop myself. I
was relieved of Mei as Dilani went in search of the mother.

‘What other classes do we have to look forward to?’ Angelica asked over
lunch.
 ‘Mindfulness,’ said Nicki. She sat down again. She’d already been up
and down more times than I could count. I couldn’t exclude sharp objects as
a motive for the room search but I thought the smart money was on drugs,
and more than just weed. ‘Where you get to pretend you’re a sultana.’
‘I think we were meant to concentrate on the sultana,’ said Phoebe as she
waved some mushed vegetables in Chabon’s direction. ‘Not be it.’
Yu had come in as we were talking, turned her nose up at lunch—which
for hospital food was half-reasonable—and walked out again. She left the
baby strapped in her highchair.
Phoebe barely suppressed a look of fury. ‘Yu!’ she yelled. ‘Come back
and get your child.’ Her face was flushed.
In a conspiratorial tone, Nicki said to me, ‘Only child, like in China.’
No sign of Yu.
When one of the afternoon staff—a short sturdy woman of Southern
Asian appearance—looked in, Phoebe seemed relieved. ‘Parveen, can you
get Yu? Or take Mei to her?’
Parveen hesitated.
‘We shouldn’t be expected to have to look after any children other than
our own,’ said Angelica. ‘And even then, quite frankly, I thought we’d get a
bit more help.’ She looked at the nurse pointedly.
Yu appeared in the doorway. Phoebe, perhaps without thinking, grabbed
her arm and Yu wailed as if it had been sliced off, which prompted Mei to
start screaming, setting off most of the other children.
Parveen took charge. ‘Stop this noise! Phoebe? Time out,’ she snapped
over Phoebe and Yu’s combined protests, and carted Yu and Mei off to their
room. Phoebe was shaking as she left; I had the impression she wanted to
let rip but was held back by a lifetime of ‘good girl’ training. Probably what
the taekwondo was an outlet for.
When the remaining babies had been settled, I was gripped by a deep
desire to collect Sienna and leave. Tensions in inpatient units were
inevitable and maybe I was being oversensitive—lack of sleep wouldn’t be
helping. And I knew health professionals made bad patients, me especially
since I hated being told what to do. But I didn’t need any extra stress. It was
only because Dilani had said the nurses would try to settle Sienna overnight
that I decided I’d just return to my room instead.
As I got up, another woman came in. The first thing I noticed was that
she was tall—taller than Angelica who was maybe one-seventy-four—and
her skin was the deep black I had seen in a number of my private patients
from the Horn of Africa. She was dressed in a long, dark patterned skirt and
a scarf that covered her head and shoulders, but if her face and hands were
anything to go by, she was painfully thin.
The second thing I noticed was that she did her best to avoid any eye
contact at all. When I did, briefly, catch her eyes as she looked for the water
jug, they were completely blank, as though she had pulled a shutter down
behind them.
The third thing was that she was being watched. In the doorway, a stout
woman in blue trousers and shirt was keeping a close eye on her.
‘That’s Jamillah,’ Nicki whispered to me. ‘Comes with a security guard
as part of the package from Nauru.’
I had heard about immigration detainees—deemed ‘illegal arrivals’ by
the conservative government—being sent to the mainland for medical
treatment. Melbourne was usually not the first port of call, but it was no
further from Nauru than Perth, the other city with ample mother–baby beds.
Presumably the immigration department had struck a deal with the private
company that ran Southside. The presence of the guard didn’t mean
Jamillah was dangerous—just that the government couldn’t afford to lose
her.
But still. A place with an angry taekwondo literary snob, a bad-tempered
gossip and a security guard—let’s not even mention the scarves—felt a lot
like somewhere I needed to get out of sooner rather than later.

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The first lesson followed lunch: Settling 101. Sienna was not a fan of the
afternoon nap but she was usually tired enough to collapse. This morning’s
dancing, and the chance to entertain a new set of people, meant today was
no exception: she dropped off like a champ.
Dilani’s smile suggested that this was how it went—you applied the
correct technique and achieved the desired result—but she didn’t know my
daughter. Our problems started at 8 p.m., not in the afternoon.
The group session that came next, run by a maternal child health nurse,
was about feeding which was not Sienna’s problem exactly, though she had
become weirdly fond of broccoli. I sat back to check out the other mothers.
They were all there, apart from a new admission who, Nicki informed us,
was having her history taken. Yu was muttering about not understanding
why she needed to be there—it was unclear whether she meant the session
or the admission in general. Phoebe was wearing her anxiety—maybe also
anger—like it was a familiar companion she was back to managing. Nicki’s
lunchtime meds must have calmed her because she was not just sitting still
but close to nodding off. Jamillah said nothing, still avoiding eye contact.
Angelica was on her phone, pretty much: she ducked out twice without
apology.
‘Christ,’ she said as she came back the second time. ‘I’ve got World War
One relics arriving in St Kilda and Bombay Sapphire cocktail glasses in
Warrandyte when it should be the other way around.’ She laughed at my
expression. ‘I run an Antiques and Collectables business. Derek’s usually
across the deliveries but it seems to have gone pear-shaped today, and I
don’t have anyone else to take it over.’
‘Oooh,’ said Nicki. ‘Can you get me an Elvis shot glass?’
‘Sure. You have the bucks, I can get anything.’
The nurse gave her a glare and asked her to put the phone away.
‘I read something about brain food?’ said Phoebe, deflecting, and the
nurse gave her a grateful look before launching into a long spiel about eggs
and kale.
The woman across from me was the only one I hadn’t met. Robbie. Short
cropped brown hair with a fringe that looked in dim light like a do-it-
yourself-job, a plain collared shirt and shapeless trousers. Her smile was
hesitant, suggesting a depression that might be lifting, but was taking its
time to do it.
Nicki raised her head long enough to bring me up to speed. ‘She’s being
zapped. Shock treatment, like in One Flew Over the Cuckoo’s Nest.’ She
mimicked Jack Nicholson in the final scene, which was actually after a
lobotomy. It had nothing to do with ECT, which was what Robbie was
getting—presumably to treat either severe depression or postpartum
psychosis. I watched her with her child. Every time she looked at the tiny
bundle in white, it was with a sense of bewilderment bordering on terror. ‘I
don’t know anything about babies,’ she piped up suddenly. ‘It hasn’t been
anything like we expected.’
Fair enough. Not many expectant mothers factored in a psychosis.

The group ended and we had an hour gap before yoga relaxation—strongly
advised at the end of each working day. Phoebe said she was going for a
coffee and looked tentatively around for takers to join her. Nicki and
Robbie declined in favour of a nap, and Yu was having a one-on-one
session on bottle-making with the afternoon-shift nurse, Parveen.
‘This,’ the nurse told Yu in a manner that transcended her diminutive
size, ‘is not an acceptable way to do things.’ She brandished the
substandard bottle.
‘Do it however you want then,’ said Yu, face impassive; fire in her eyes.
‘No, it is necessary for me to see you do this.’
‘That’s what you’re paid for.’
The nursing staff here had their work cut out for them. I sent Parveen a
look of sympathy.
Angelica followed Phoebe. ‘Please tell me they do a latte.’
As I picked Sienna up so I could join them, I remembered we’d left out
Jamillah. I had seen her escape into the garden, guard hovering. It had to be
extraordinarily difficult for her, isolated from family and friends, with
possible limited language and probable culture shock—to say nothing of
whatever traumas she’d endured along the way. No matter how much better
it might be at Southside than Nauru, she would know she had to go back.
There would be little relief in the reprieve.
‘Is she allowed to go to the coffee shop?’ I asked the guard.
‘If it’s on hospital premises.’ The woman looked bored—she could
probably have done with a caffeine hit herself.
‘Jamillah?’ I called from the door.
She looked up, her dark eyes meeting mine for only a second.
‘Want to come for a coffee? It’s not good to be alone all the time.’
She responded as if to a command rather than an invitation. I led her out
of the unit and along an empty corridor past the labour ward and theatre,
then the obstetric ward, guard close behind. The doors were all open; we
only needed our key cards after hours to get in and out.
Phoebe and Angelica had already found a table in the corner. Both their
children, younger than Sienna, were in prams. They looked surprised to see
Jamillah, whose baby was strapped to her in a papoose, bright eyes looking
out but struggling to see.
I pulled an extra couple of chairs over. The guard ordered herself a soy
latte and took a seat in the far corner.
‘How long have you guys been here?’ I asked, addressing the question to
Phoebe and Jamillah.
‘This is my second week,’ said Phoebe, smile timid but tension evident in
the taut sinews of her neck. I had thought, from her manner and her size,
she must be in her twenties. I saw now she was probably older than me—
maybe late thirties. ‘I came initially for Chabon’s sleep, but Graydon
wanted me to take more time out.’ Phoebe sounded at best ambivalent about
this. ‘We want what’s best for Chabon.’
‘And you, Jamillah?’
The African woman just looked at me.
‘You came here on the weekend? From Nauru, right?’
After a moment, Jamillah nodded.
‘Was it bad?’
Phoebe looked at me anxiously.
‘Detention,’ I said. ‘And before.’
‘Don’t think we support what our government is doing,’ gabbled Phoebe,
before Jamillah could answer. ‘I mean real people think it’s totally barbaric.
It’s a complete violation of our international treaty obligations and, er,
human rights…’
 ‘What she’s trying to say,’ Angelica took a sip of the latte that had just
arrived, ‘is that you are among friends here.’
Jamillah smiled; brief, but with warmth. ‘It is very hard. Mainly because
I have no family. Few are left in Sudan anyway. This is especially hard.’
Her English was better than I’d expected. Many refugees had had to learn
on the boats and in the camps, I knew, and Jamillah’s fluency suggested she
had been at it longer. Or maybe she’d just spent a long time in camps.
‘You don’t have to tell us anything,’ I said. Phoebe looked to be winding
up to go again. ‘But it’s okay if you want to.’
Jamillah nodded, her eyes briefly checking out her guard. Understandable
if you were being monitored; I saw no suggestion of psychosis, but
depression, anxiety and PTSD were all live possibilities.
But before Jamillah could answer, Angelica stood up abruptly and
walked out without a word, abandoning her half-drunk coffee. If she’d been
clutching her phone it wouldn’t have been a surprise, but the phone was
silent and her hand hadn’t gone to her pocket. She’d simply gone pale; I
couldn’t pin down her expression. Phoebe shrugged. She knew her no better
than I did.
Jamillah took no notice of Angelica’s departure. ‘It is good to be here,’
she said finally, the smile lasting longer this time. She spooned several
sugars into her coffee and then added all of the milk from the jug that had
arrived with Phoebe’s tea.
We sat for a moment in silence. I didn’t know about the others, but good
wasn’t how I’d have described being at Southside. It made me feel
somewhat protective of the Sudanese woman. Unlike her, I knew when I
was leaving, and that I’d be going somewhere better.
Phoebe and I returned to the ward with Jamillah, the guard trailing
behind us. As we left the obstetric section a new mother, post-caesarian,
baby on her chest, was being wheeled out of the theatre. Jamillah and I had
to step aside, crowded into each other by a temporarily parked theatre
trolley with surgical instruments in a kidney dish half-covered by a sheet. I
glanced briefly at the trolley, which was presumably on the way to the
steriliser, unaware how important that second would later become.

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At the afternoon shift change Dilani handed me over to Maggie, an old-
school nurse in her fifties who’d seen it all, both in midwifery and psych
nursing. They were the type I loved working with. You could rely on their
judgment—most of the time they knew more than the doctors—and they
usually had a life, which meant they also had perspective, not to mention a
sense of humour. Nobody survived that long in the job without one. Maggie
and Dilani both had an easy confidence with Sienna that was soothing for
her—and me.
In the nurse stakes, I had clearly been the winner. When we had returned
to the unit kitchen after coffee, it was to find Parveen getting into it, first
with Yu—who had allowed Mei to go nappyless and consequently wee on
the floor—and then with Angelica.
We could all hear Angelica yelling at her as we came in. ‘Just do your
job!’
‘You should learn respect,’ said Parveen from Angelica’s room. ‘My
mother, even with dementia, treats the staff at her home better than you.’
A woman I didn’t know looked in, said, ‘Fuck’s sake,’ and started taping
a nappy onto little Mei, as Phoebe registered the situation and ducked back
to her room—clearly this was too confronting for her—and Angelica
stormed out past the kitchen. Nicki was engaged on her phone and didn’t
take any notice.
So much for relaxing. I went in search of the yoga group.
The therapist, a solidly built physio with a no pain, no gain philosophy,
was certainly up to the task of rallying the troops. There was no sign of the
new admission, but the other seven of us were there no more than five
minutes after the starting time—including Angelica. Whatever had caused
her sudden departure from the coffee shop and the verbal assault on
Parveen, which I had no doubt she’d won, there was no trace of it now.
But Parveen wasn’t giving up easily. She interrupted the group just as the
physio was about to start.
 ‘You,’ she said, pointing to Angelica, ‘left soiled clothing on your floor.
You might think fancy jewellery makes you better than me, but this I would
not expect in an Indian slum,’ she laughed.
Rather than returning fire as I’d have expected, Angelica stiffened,
looked down at her hands and rubbed one of the massive rocks; she
appeared to be shaking as she stood and walked out. I caught her eye to
convey my sympathy. I figured she was finding, like the rest of us, that
things weren’t working as they once had in the waste-disposal department. I
was still doing pelvic-floor exercises nearly a year after having Sienna, and
wouldn’t want to trust myself on a trampoline. But she looked right through
me as she left, and didn’t return to yoga. I guessed she’d gone to wash her
clothes.
‘Bloody Godzilla,’ mumbled Nicki, glaring at Parveen. ‘Someone needs
to teach her a lesson.’

Dinner was at 6 p.m. Hospital timetable. The difference from lunch was that
some of the women’s partners joined us, before, during or after.
The woman I’d met changing Mei’s nappy turned out to be Robbie’s
partner, K.C. She ducked in to get a tray for the two of them. They were
eating in their room, as was the new admission I had yet to meet. K.C.—
Nicki informed me with a knowing look that her full name was Kaye
Charlene; she was mid-thirties, like Robbie, and had a guarded look.
Shoulder-length brown hair and basic jewellery, not obviously corporate,
not obviously motherly. She seemed as bemused by their child as Robbie,
with a tired ‘how am I meant to do all this after a hard day’s work’ air about
her that I recognised from the new fathers I’d met when I worked in a
mother–baby unit. Didn’t seem it was necessarily gender related. Trying to
juggle work and a baby, I got that.
Angelica’s husband Tim was younger than her, and good looking in a
corporate way. He played with their son, in the way men traditionally do,
with a lot of enthusiastic movement—probably too much for an infant so
tiny. Nicki’s parents, a comfortable middle-aged, middle-class couple,
visited briefly. Her father the lawyer looked more suburban solicitor than
criminal defence barrister. No sign of Nicki’s partner.
 Phoebe’s husband disappeared into their room and I only saw him as he
passed—a lot older than her, I thought. Slightly shambolic, like a
cartoonist’s idea of an academic.
Yu and her husband spent most of the rest of the night arguing, either
with each other or Parveen. Even in my room I could hear them. Chang—
shorter than his wife and twice as wide—turned out to be a doctor Yu had
met in pre-med. She hadn’t made it into the medical course. Maybe she’d
failed the interview, which looks for empathy and people skills; but then her
husband showed very little evidence of them either.
‘I’m working long hours and studying for my physician’s exams. It’s her
job. She’s the mother.’
‘And what do you think a father’s and husband’s role is?’ Parveen asked.
I didn’t hear Chang’s response, but Yu yelled, ‘He’s threatening to send
me back to China.’ Maybe she was on a student visa. Chang had an
Australian accent—he was a local. Even so, I doubted he could do anything
to have her sent back, even if they separated.
Not my problem, I reminded myself. I had enough of my own.
Four days left.

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Tuesday: two days before the murder

The first night on the unit established that Sienna really didn’t want to sleep
when she needed to. And that Maggie wasn’t going to be doing the sort of
magic baby-whispering I’d been praying for because Sienna was absolutely
not up for a quiet life.
Liam had summarised the issue a few nights earlier. ‘She’d be taking
after her mother, would she?’ Sienna was a lot like I used to be. But scarier.
Like she’d absorbed some of my later acquired knowledge, too, and was
using it against me.
The sleep-school method, as Maggie conveyed it, was simple: calm
mother delivers consistent message; calm baby receives message. Sleep
ensues. The crucial part was staying on-message despite all the frustration
and derangement of lack of sleep. And the message in this case was that bed
was a safe, comfortable place to be and that I trusted Sienna to sleep. The
message needed to radiate from my pores, and be delivered in the same
way, at the same time each night. As it turned out, I radiate energy and
attitude instead of calm. Which Sienna picked up. Maggie suggested I put
on a relaxation tape through ear buds and listen to it as I tried to settle her.
I did manage some sleep; the nursing staff dealt with the 6 a.m. call to
arms and let me sleep in. By the time I’d had a blessed couple of hours,
then breakfast and a shower, I was fit to face the world. And the world did
like it usually did—served a backhand underarm swerve ball that hit me in
the face.
I recognised the new admission.
I heard her first. Then, if there had been any doubt, I heard her husband.
Worst possible person to have to spend the next four days with—excepting
a couple of psychopaths I’d help put away.
My half-sister.
She was the one who’d told me Southside had a sleep school.
 There were many complicated reasons why this was not going to end
well. Mostly my fault, and mostly starting from when she was born. It was
going to take more than four days to make up for, even if I’d had the
inclination or the stamina.
The trouble with Maddison was that she liked things to go according to
plan. The chaos that followed me around was anathema to her. It frightened
her. As a child she’d turned to our mother for protection, then learned to
ignore me, and finally to write me off as an unfortunate reality of biology
that she could mostly avoid. She had a nice organised life; she worked in
PR and was very good at it. She’d married a stable (boring) public servant
called Miles, in a wedding with the lot, and timed her pregnancy
successfully so she could have baby one when she was thirty.
I thought about discharging myself. Sneak out so she would never know I
knew. But I was too damn tired. I needed help. She was just going to have
to get over it. And who knew, maybe it would give us something in
common.
Maddison’s expression, when I knocked and entered her room later that
morning, suggested that this wasn’t likely to happen in the short term. She
looked like she’d had about as much—or as little—sleep as I had been
having. Only it looked worse on her because my hair and clothes were
always a mess, and my dark-toned clothes hid a multitude of stains. Pale
pink and white did not. Maddison was usually immaculate, but now…I
hadn’t even known she owned a tracksuit. Designer, but still: a tracksuit.
With splodges of pumpkin puree.
She just stared.
‘Okay,’ I said, ‘neither of us thinks this is ideal, but I’m leaving Friday.
We don’t have to tell anyone we’re related.’
Maddison opened her mouth but nothing came out.
‘Does Mum know you’re here? I was just sneaking in and out myself.’
Hopefully I still could.
‘No one except Miles knows I’m here.’ Maddison’s glare told me she’d
like it to stay that way. Before I could tell her I was right behind her on this
plan, she added, ‘Did you stop taking your medication?’
Vintage Maddison. I was tempted to launch into a manic rant—they
scared the shit out of her—but I didn’t have the energy. Besides, I knew
how she was feeling.
 ‘Just exhausted,’ I said. ‘If I had spare meds I’d be tempted to dose
Sienna up. What is it with these kids that they want to party instead of
sleep?’
Maddison forced a smile. Her blonde hair—normally in some type of
French twist—was hanging loose. She looked young, and very vulnerable.
Like she had twenty-five years ago, when I’d locked her in the back shed so
I could escape with my friends without her tagging along.
‘Amelia’s okay.’ A big admission from Maddison. I had expected her,
like Phoebe, to use her child as the excuse for the psychiatric admission.
‘So will you be, sis,’ I said. ‘I won’t bug you, okay?’
Just me being around was going to bug her—and there was the risk that
now I knew she was here, so would Mum, and Maddison would lose her
treasured perfect-child status. I wanted to tell her that there was a lot more
she’d have to do to be ousted from the top spot, but it would have just
drawn it to her attention that she was failing in her own eyes.

The therapists were out in force to get us to ‘be involved’, ‘take charge’ and
to ‘not give in to those negative feelings’. I managed to avoid art therapy
while, with dubious success, I settled Sienna to sleep, and missed half of
self care. By the time I got there, Maddison and Yu seemed to have formed
an unlikely friendship, Maddison nodding along as Yu talked about wanting
her husband to do a lot more than he was, and how could she care for
herself if she never had any time of her own?
Maggie was again my afternoon nurse, but it was Parveen that came to
herd me into mindfulness. ‘It is important you go.’
‘I know all about mindfulness.’ I knew I was being difficult but I just
wasn’t a group type of person. And I was here for Sienna’s sleep—not my
mental health.
Parveen crossed her arms. ‘This is not something we argue about.’
‘I’ll get the app and do it in my room.’
‘You must go. Even if you…’ She stopped herself. Squinted. I saw her
make the connection. I thought she’d looked familiar. Shit. ‘Even
psychiatrists need refresher sessions.’
There was no getting out of it.
And to be honest, the mindfulness session was probably good for me. But
all Maddison was mindful of was that her big bad sister was there, seeing
her at her most vulnerable.
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My dinner plan was to grab my tray before Maddison had appeared in the
kitchen and make a dash to my room. But in the tradition of anything that
can go wrong going completely tits-up, I ran—literally—into Miles, and the
fruit salad that had been balanced on top of my lasagne ended up on his suit
trousers.
‘What the fuck?’ Then he saw me. ‘Oh. Maddison wasn’t kidding. You
are here.’
Miles and I had a chequered history. Before I met him he sent Maddison
a giant Valentine’s card—pink, heavy with hearts and teddy bears—that
prompted me to suggest to Maddison that her new beau mightn’t be a
hundred per cent heterosexual. It was just before I had my first admission
and I was manic, though none of us knew it. When I finally did meet him, I
was hovering at the depressive end of the rollercoaster and saw nothing in
him but a pompous, tubby little blusterer. I didn’t voice my opinion that
time, but I suspect it was obvious. Miles, to be fair, had been unfailingly
polite, at least to my face. But I had no doubt we had each other’s measure.
Some things don’t need words.
‘Sadly, no, she wasn’t kidding.’ I offered him the napkin, and stopped
myself smirking as I pictured myself mopping up his trousers and Maddison
stepping out of her room to see the spectacle. I needed to get a grip. ‘I’m
leaving Friday.’
Miles ran his hand through prematurely thinning pale long strands. ‘She
really doesn’t need any extra grief, Natalie.’
‘I don’t intend to give her any.’
Although I’d be prepared to give him grief if he deserved it.
‘What’s going on, Miles?’
As soon as I’d spoken, I was kicking myself. It wasn’t any of my
business. Until that point, I had assumed she was a classic postnatal
depression with anxiety—high expectations not fulfilled. Personality
fighting reality. But she had clearly connected with Yu over marital issues
—and now it only took me a second to realise that Miles was not himself.
He looked drained and had possibly even lost weight. He was used to a
Superwoman wife; having a baby might have been quite a shock to them
both.
‘What do you mean?’ He saw my expression and backed off. Forced a
smile. ‘Maddison just needs some sleep.’
‘Great.’ I smiled back and retreated to my room.

There was more drama after dinner. I was returning my tray to the trolley in
the kitchen and caught the end of a conversation.
‘Parveen has lost the plot,’ said Nicki. ‘Maybe it was someone in her
family that got beheaded.’
‘Beheaded?’ asked Phoebe, eyes wide.
Nicki pushed the newspaper across the table. The main headlines were
about an international paedophile ring but Nicki was referring to the article
further down. ‘In Pakistan. Some prominent Pakistani-American beheaded
a child…’
Phoebe wasn’t sticking around to listen to that.
I picked up the paper. ‘It was his childhood friend,’ I amended. ‘Because
she’d refused to marry him.’
Angelica raised her eyebrow at me. To Nicki she said mildly, ‘Parveen
may have many faults but I doubt she has any connection—’
At that moment Parveen stormed into the dining room, herding Phoebe
back in with her.
‘Which of you made the call about my mother?’
She looked pointedly around the room. Maddison and Miles weren’t
there; they were eating in their room and presumably Jamillah was too. But
everyone else looked at Parveen except Robbie and K.C., the only couple,
who looked at each other.
No one spoke. I had no idea what Parveen was talking about, but behind
the veneer of professionalism, I could see that she was absolutely—
incandescently—furious. It wouldn’t take much for it to break through.
‘Today I was late for work because someone rings here and asks for a
message to be given to me.’ She looked at each one of us, as if I did it
would be written on the culprit’s forehead. The glance at me was cursory.
‘I’m not referring to you, Natalie.’ Parveen turned her attention to the
others. I guessed that since I was a doctor, I got a pass. Angelica flashed me
a look of hostility that seemed to say You’ve been greasing up to the enemy.
‘What message?’ said Phoebe, looking flustered.
‘That my mother was in hospital. All while she was sleeping comfortably
where she always is!’ Parveen clearly hadn’t taken comfort from the fact
that her mother was in no danger. ‘I spent an hour at the Royal Melbourne
trying to find her before I rang the home, to find they never made the call.’
‘What makes you think it was one of us?’ I asked, keen to gloss over my
preferential status.
‘The switchboard has told me it was an internal call. From a phone in this
unit.’
Phoebe continued to look anxious. Robbie looked spaced out and K.C.
was trying to contain her own anger. Yu finished her lunch and left without
saying a word. Parveen, arms crossed, glared at us one last time before
chasing after Yu.
Angelica winked; she seemed to have forgiven me. ‘That was
entertaining.’
‘Hope she gets docked an hour’s pay,’ Phoebe mumbled. Her hand was
shaking. It wasn’t the type of interaction that was going to help an anxiety
disorder.
‘I wonder if she’s deliberately trying to get at some of us?’ mused
Angelica.
Phoebe slipped out, but I had the sense she’d not only heard Angelica’s
comment but taken it to heart.
‘Nice to see Parveen get a bit of her own medicine,’ Angelica continued.
She lowered her voice and said to me, ‘I think the message she got might
have been a little more graphic about the mess her mother was in.’
Angelica laughed, and the sound took me straight back to the days after I
was asked to leave school in year eight: there had been quite a few crank
calls. Among other things.
I raised an eyebrow; Angelica winked again. ‘One for those who can’t
fight back.’
K.C. smiled.
We really were back at school.
By 9 p.m. I thought I might wear out the carpet in my room from pacing.
I’d realised too late that we weren’t meant to leave the ward after 8 p.m.
and now I felt like a big cat in a small cage. I suspected no one would miss
me if I slipped out for a while, but my key card wouldn’t get me back in the
main hospital doors. And I’d have had to ask someone to listen out for
Sienna who, for the moment at least, was quiet—I wasn’t prepared to say
sleeping, given past experience.
To escape the confines of my room without leaving the unit I had the
option of the courtyard garden or the group room; last night the TV had
been blaring in the group room with Nicki glued to it until well after
midnight. I stuck my head in and she was there now, in prime position.
Angelica was there too, in the corner with an iPad; and Phoebe and her
disorganised-looking husband in the living area.
‘I tell you, I’ve seen her before,’ I heard Phoebe say. From the tone, she
wasn’t trying to recall an old schoolfriend; more like a school bully.
Her husband looked almost as anxious as she did. So did Chabon.
‘There’s nothing you need to be concerned about,’ he said. ‘I’ve had
Jackson go over the house from top to bottom so there’ll be nothing to
worry about when you come home either.’
OCD? I had looked after a woman with OCD who insisted her husband
shower and change his clothes before he was allowed inside, so they’d had
to get a shower installed in the garage.
They saw me and fell silent; Phoebe quickly looked away. Maybe it was
me she thought she recognised, worried I might know about her psych
history. She could have been a colleague’s patient from my days in private
practice, but if I’d ever seen her in the waiting room, I had no recollection
of it.
Her husband seemed aware of the awkward pause. He stuck out his hand
then withdrew it awkwardly, either concerned about hygiene himself, or
remembering he wasn’t in a professional setting. ‘Good evening. I’m
Graydon Bruce.’ He had to be over fifty, with a weathered charm.
‘Professor Bruce,’ Nicki called out. ‘He’s famous.’
Not to me, and it must have been obvious. Phoebe clarified: ‘He’s on TV
sometimes. His field is the effects of colonisation on the Indigenous
culture.’
I introduced myself, wondering if he was Indigenous himself, or whether
his specialist viewpoint was white male privilege, and kept going, leaving
them to talk about whether there was anything worth worrying about. Or
anyone.
It was still light outside and the weather was warm so I opted for fresh
air, and found I wasn’t the only person to have that thought. A security
guard—same outfit, different woman—was hovering around the door
reading Who Weekly; in the garden Jamillah had claimed the closest bench
and was staring up at the first stars. The garden was surrounded by a high
wall with a gate—locked, and not keyed to our swipe cards. Only the nurses
or the fire alarm could open it; I’d ascertained that early on. Our key cards
were effectively redundant, in fact. They only worked on the main ward
door, which wasn’t locked until 8 p.m., and we weren’t meant to go out
after that anyway.
It was a decent-sized garden, maybe thirty square metres, and a huge tree
in the far corner suggested the garden had either been designed around it, or
it had been fast growing. There was a barely visible seat tucked on the far
side of the tree, near the gate. I headed towards it.
‘You can sit here if you like,’ said Jamillah. I could only just make out
her words, and her face was lost in the shadow, but the white of her eyes
and her teeth shone in the dusk light.
I didn’t really feel like talking, but I felt for Jamillah’s isolation. She was
reaching out, perhaps because I had invited her to coffee. I joined her.
‘How are you?’
She gave a small shrug. ‘The same. I have many worries that being here
cannot help.’
I nodded. ‘Have you been…do you have family you are in contact with?’
I wondered if they were on Nauru or if she had set out to Australia alone
and pregnant.
‘I have a brother and an aunt in Sydney,’ she said.
Too far to visit, but they might have been able to help her get a visa had
she arrived earlier. Now the government was refusing to budge.
‘My father was killed in the war,’ she said. ‘My sister died in the camp in
Kenya. Having a baby.’
There was no emotion in her voice, just facts reeled off. It didn’t surprise
me. It’s too hard to speak of traumatic experiences without building a wall
to block the emotions.
‘Did your sister’s child…?’
‘No. They gave her to me to care for, but there was no milk.’
 ‘I’m so sorry.’ It sounded so ridiculously inadequate. ‘Does that make it
harder now that you have a baby of your own?’
‘Shamso.’ There was the smallest of real smiles; the first I’d seen.
I tried to imagine what it might be like; having lost or been separated
from her family, trying to get to Australia to be with those she had left, the
camps, the boat; then Nauru, which by all accounts had no redeeming
features. I couldn’t even begin to place myself in her shoes.
‘She’s seems a very…healthy baby,’ I said, fighting to find words that
might have meaning.
‘Shamso means sunshine,’ said Jamillah. She looked back up to the stars.
‘That and the sky are all that has stayed the same.’
‘It’s a lovely name. Does she bring light into your life?’
Jamillah simply looked at me. I suspected light and happiness were
foreign to her. ‘I hope she has sunshine in her life,’ she said eventually.
‘Where is…Shamso’s father?’
‘He is back home. He was my second husband, the brother of my first
husband who was killed. He already had a wife who did not want me there.’
She shrugged. ‘When I found I was pregnant I knew I had to find a new life
for us both.’
I decided silence had a lot going for it. I took her hand and held it,
attempting to feel a little of her grief even if I could never fully understand
it.
A few moments later, when Parveen stuck her head out into the courtyard
and called Jamillah in to care for Shamso, I felt a flash of her anger, too.
Anger at Shamso, Parveen, or all that I had stirred up? I couldn’t be sure.

I stayed out a little longer, and Parveen reappeared at the end of her shift,
taking the shortcut out through the garden gate.
She stopped as she passed me. ‘Your little one sleeping better?’
‘Hope so.’ I thought about how upset Parveen had been earlier. ‘Is your
mother okay?’
I couldn’t see her face in the shadows but she nodded. ‘It is hard for her
here. She misses Karachi but there was no one there to care for her. My
brothers are not…’ She shrugged to indicate the universal shortcomings of
male relatives.
She said goodnight, and swiped the garden gate with her pass key to let
herself out.
Less than three days to go.

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Wednesday: the day before the murder

On Tuesday night with Sienna we tried again with the radiation of calm and
low-stimulus activities, adding in low light and a warm, calming bath. One
simple toy.
The bath was more like an episode of Flipper with Sienna guest-starring
as Skippy the kangaroo. When I got her into bed she kept demanding extra
toys—no mean feat for a largely preverbal child, but somehow I knew what
she meant. Then she immediately threw the toys out, before demanding
them back.
I started googling the television nanny program which the mothers here
raved about. Maybe Maddison and I could go halves on a nanny? Although
as far as I could tell—and I was up for more of the night than anyone else—
her daughter Amelia was fine. Slept through. Maddison one; me nil.
Of course I could always fall back on my meds…Maybe just a little
quetiapine? For Sienna, not me.
Eventually I admitted defeat and went off to my own bed, leaving Sienna
with Dilani, who told me that she had finally slept. Of course she had—just
not when she needed to.
Dilani also asked me straight out if it was true that I was a psychiatrist.
Damn Parveen. Unless it was Phoebe who’d worked it out…
‘Do I look like a psychiatrist to you?’ I said, and Dilani laughed. I wasn’t
sure whether it had been a winning argument or not.

At lunchtime we were all there, Robbie—post ECT, and Jamillah included.

Maddison was uncharacteristically quiet, and I didn’t think it was just
because of me. She looked miserable.
But even if she’d been on form she’d have struggled to get in a word. She
wasn’t the only unhappy person.
 ‘I will refuse to have Parveen this afternoon. Private insurance costs a lot
of money and we deserve better.’ Yu looked at the rest of us from under her
thick black fringe, daring us to disagree.
‘What did she do this time?’ asked Nicki, jiggling a toothpick between
her front teeth as she spoke. ‘I know someone who could sort her out for
you.’
Yu looked startled, then for a moment seemed to consider taking up the
offer.
‘She does not wish to help, only criticise.’
‘I think she’s an agency nurse,’ said Angelica. ‘So I doubt she knows
much at all about babies; she certainly doesn’t seem to like them.’
‘So why is she here?’ mumbled Phoebe.
‘You had problems with her, yes, Angelica?’ Yu was looking for support
that didn’t involve knuckledusters.
In an accent that was clearly meant to approximate Parveen’s, Angelica
said, ‘I wouldn’t let this Nurse Ratshit worry me if I was you.’
‘Better not to descend to her level,’ I said, keeping it mild. Last time I’d
called someone out on racism I’d ended up in front of my boss on bullying
charges; I was learning to glare less and not look like I was going to take
the culprit out when the topic was aired.
‘I will complain,’ said Yu. ‘She is rude.’
‘Did I hear her telling you that you have no aptitude as a mother?’ asked
Angelica, patting Yu’s hand. ‘I guess it’s not for everyone.’ Then she
whispered to me: ‘Poor Mei.’
I tried not to react, but I thought Yu might have heard. There was a hint—
slight—that she’d been at least briefly shocked out of the bubble of
entitlement she existed in.
‘She was pretty shitty to Jamillah,’ Nicki said, through a mouthful of
beef curry. Jamillah didn’t look up. Nicki soundlessly mouthed: called her a
dirty Muslim.
‘Parveen’s from Pakistan,’ I said. ‘She’s probably Muslim herself.’ My
smile and tone made it very clear that I thought Nicki had made this up.
Maddison said quietly, ‘Parveen was very nice to me yesterday.’
‘That’s because you’re blonde and blue-eyed and have a male husband,’
said Robbie. It was a surprise to hear from her; she rarely spoke. She didn’t
meet our eyes, looking back down at the food she had barely touched.
 Maddison looked flustered, so I stepped in. ‘I’m sure Maddison was just
trying to say there are two sides to every story.’ Our mother would be
glowing with pride that I was backing up my sister; Maddison looked more
like she wanted to swing a cricket bat at me. I sympathised: according to
family tradition, she was the one who had it together, not me.
‘Jamillah, will you come and see Nola, the unit manager, with Yu and
me?’ Phoebe pressed on.
Jamillah looked up blankly.
‘She. Wants. To. Know. If. You. Will. Complain. About. Parveen,’ said
Nicki loudly.
Jamillah mumbled something and shook her head. Then she pushed her
lunch away and disappeared to her room, security guard following.
Two and a half days.
Nola came to see me during the afternoon, looking serious. My first
thought was Maddison had asked her to discharge me, which goes to show
how family leaves you in a constant state of paranoia. My alarm must have
been obvious.
‘I am seeing everyone,’ Nola said. ‘There have been a number of
complaints about one of our agency nurses.’
‘Parveen.’
Nola nodded.
Could I complain about her telling Dilani I was a shrink? But Nola might
not know—and she certainly would if I brought it up…
I shrugged. ‘I haven’t had much to do with her—heard the last part of an
argument with Angelica and another with Yu.’
‘Please know we take complaints seriously, but there is absolutely
nothing to worry about regarding safety.’
Safe? I wondered where—or rather who—that had come from. I wasn’t
feeling unsafe. Unless you counted the dangerous thoughts I was having
towards Sienna’s father for putting my name down on the waiting list at
Southside instead of his own. I’d had enough time to focus on what I was
doing to cause Sienna’s problem. Damian had to cop some of the blame.

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In retrospect, the unit had become a tinderbox.
It wasn’t surprising. I remembered from working in a mother–baby unit
myself that tensions could easily escalate, not just because of the issues the
patients were grappling with, but because the attachment issues were
universal: they affected staff as well. I just hadn’t been on the patient side of
the tension.
Still, I was pretty sure the tension here was higher than usual. We were
eight new mothers, at various stages of fragility, in a situation where facing
reality meant facing our own failures—and we’d been handed a scapegoat.
Or maybe it was just that Parveen really was an appalling racist whose
self-righteous obsessionality should have disqualified her from caring for
women with perinatal mental health issues. Agency nurses often didn’t have
the training and experience for this work—they either had the psychiatric
qualifications or the maternity ones but not both, and they tended to bring a
whole stack of unexamined assumptions about dealing with babies.
Sprinkled in among other ideology you could find beliefs about controlled
crying (‘never did my children any harm’) or that no one should be
breastfeeding while on medication or that women with mental illness
shouldn’t even have children. Nurses without psych qualifications tended to
panic if someone expressed suicidal thoughts—and might well overlook
someone who was keeping quiet because she actually did have a plan to
implement such thoughts.

The evening started well. I took Sienna out for a long walk and when we
got back, just before the door was locked, she was tired but not so-
hysterically-tired-I’m-going-to-party-all-night tired.
Parveen was looking after me now, following a trade in which Yu had
scored Maggie, but the advice remained the same. I did exactly what the
nurses had all been reinforcing, and gave a solid impression of a serene and
confident mother. Warm bath; quiet time with story. There had also been
some stern advice around maintaining routine by not moving the child
around between houses, which was going to mean a difficult conversation
with Damian—not to mention his mother—but that was something I could
put off for a while.
For now, I calmly put one toy in Sienna’s cot and kissed her goodnight,
ignoring the gesticulations for other (stuffed) inmates to be added, and
steeling myself not to give in under any circumstance.
Sienna looked up at me, gave me an angelic smile—and went straight to
sleep.
‘Fuck me. It worked.’
‘Do not swear,’ said Parveen, glaring at me. I gave her the finger—in my
mind—and smiled.
Eight-thirty and the night was mine. It was liberating. I spent half an hour
chatting to Liam on the phone, then wandered out looking for company.
Nicki was in the garden talking to someone through the bars of the gate—
long hair, but I was pretty sure male. Her son Sam’s father? When they saw
me, he disappeared and Nicki gave a brash smile—fear and guilt more than
true bravado—as she walked inside.
Jamillah came into the garden almost as soon as Nicki left. She didn’t
look like she wanted conversation, so I smiled and left her to the stars. After
checking there was no sign of Maddison, I headed into the group room.
Robbie, looking brighter, was cuddled in the corner of the sofa with K.C.,
deep in conversation. Nicki had parked herself in front of the TV but it was
on mute and she was talking on her phone; probably continuing the
conversation I had interrupted at the gate. Phoebe was with her husband.
Yu walked in with Mei, deposited her on the floor and disappeared.
Angelica looked at me. ‘I know about how postnatal depression can stop
you bonding with your baby—but that’s pretty extreme.’
Mei was entertaining herself. Used to being left already.
‘Only one more night after this,’ said Angelica, with the naked relief we
shared. ‘I now know exactly what to wish upon my worst enemies.’
‘Children, or an admission to Southside?’
‘Both. This will be my one and only. Thank god Lincoln was a boy; shut
my father up.’
‘No brothers?’
‘Sadly, no. The old bastard is a full-on misogynist—Eastern European
stock. Gave my mother hell.’
 And Angelica too, I figured; probably what was behind her drive to
succeed. She’d definitely paid for her own bling.
‘Has Lincoln’s sleep improved?’ She’d named her son after his
grandfather—no American presidential connection there.
‘If it hasn’t, Tim’s going to have to deal with it.’
‘He’s going to stop work?’
‘We have a nanny for the day shift. I need to get home,’ said Angelica
with a yawn. ‘Business aside, someone needs to give our architect a kick up
the arse. He’s creating some ecosexual fuck-up around a tree instead of the
alpha-female building I specified.’
I started giggling, picturing a vagina-shaped building with a phallic tree
at the centre. Angelica grinned and started laughing too. ‘I know, right? I’ve
got wood where I wanted it least.’ She elaborated on the tree situation with
some graphic actions. Phoebe looked as if she might faint and I was
laughing too hard to get another word out.
Everyone else had stopped talking to turn and stare at us—bar Nicki, who
just looked annoyed because she couldn’t hear her boyfriend on the other
end of the phone.
‘What is going on here?’ Parveen stood in the doorway frowning.
I sobered. More quetiapine tonight, I thought. Or else it wouldn’t be just
Maddison that I’d scare the crap out of.
Parveen glared at us but saved most of her energy for Nicki. She strode
over to the girl, grabbed her phone, hit end call and put it in her pocket.
‘Hey, give that back!’ Nicki protested.
She put her hand into Parveen’s pocket, but the nurse’s hand gripped her
wrist and pulled her along after her. ‘Your baby is crying. This is not the
time for social activity.’
Nicki dug her heels in, leaning back to prevent them moving. ‘Let go of
me you evil bitch!’
However middle class her parents looked, Nicki came across as street
smart and a survivor: if it came to a fight I didn’t fancy Parveen’s chances. I
underestimated her. They were both short—around my height—but Parveen
had more weight on her. She let go at exactly the right moment and Nicki
shrieked as she fell onto her backside.
‘You,’ said Parveen, waving her finger, ‘need to look after your baby.
Don’t think I don’t know you are taking drugs, and don’t think for a
moment I won’t report you to child protection.’
Another random document with
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day hung on his wall or brought to his bedside will be more
appreciated.
The Queen of Nurses combats the frequently accepted idea that
cut flowers and growing plants are unhealthy in a sick-room, even at
night. “The carbonic acid they give off at nights,” she writes, “would
not poison a fly. Nay, in overcrowded rooms they actually absorb
carbonic acid and give off oxygen. Cut flowers also decompose
water and produce oxygen gas.” The nurse should observe what
colours are most pleasing to her patient. “Some sick persons feel
stimulus from looking at scarlet flowers, others exhaustion from
looking at deep blue.”
This reminds me of an incident which occurred while the present
writer was going over Netley Hospital when it was filled with
wounded from the battlefields of South Africa. The convalescent
soldiers were doing fancy woolwork, and a sister came into a ward
bearing a parcel of wool sent by a benevolent lady. When opened,
the wool was found to be all in khaki colour. The men turned their
heads in disgust. “Didn’t we see enough of khaki in South Africa,
sister?” they exclaimed. “Why don’t these kind ladies send us bright
colours which will drive the thought of khaki out of our minds.” A
moment’s intelligent reflection on the colours most likely to please
the brave fellows at Netley would have prevented such a foolish
mistake. Miss Nightingale’s words of wisdom, written forty years ago,
are not obsolete yet.
The subject of “Taking Food” is next dealt with, and Miss
Nightingale vigorously attacks the accepted traditions. It is a
common error “that beef tea is the most nutritious of all articles. Now
just try and boil down a pound of beef into beef tea, evaporate your
beef tea, and see what is left of your beef—barely a tablespoonful of
solid nourishment to half a pint of water in beef tea.” Still, Miss
Nightingale admits that there is a certain reparative quality in beef
tea, as in ordinary tea. She denounces that favourite article with the
friends of the sick, jelly, which usually contains no nourishment at all.
Miss Nightingale is constantly called the “soldier’s friend” and
one may add that she is above all the patient’s friend. “Attend,” she
writes, “to the intelligent cravings of the sick. Patients crave for
things laid down in no sick dietary. It often happens that the patient’s
stomach is right and the book wrong. You can’t diet a patient from a
book.”
How many weary invalids will thank the Queen of Nurses for
granting them the too often condemned cup of tea. “A great deal too
much against tea is said by wise people,” she writes. “When you see
the natural and almost universal craving in English sick for their ‘tea,’
you cannot but feel that Nature knows what she is about. I should be
very glad if any of the abusers of tea would point out what to give to
an English patient after a sleepless night, instead of tea. It is the
almost universal testimony of English men and women who have
undergone great fatigue, such as riding long journeys without
stopping, or sitting up for several nights in succession, that they
could do it best upon an occasional cup of tea—and nothing else.
Let experience, not theory, decide upon this as upon all other
things.” Cocoa increases fat, but has no restorative power, and it is
“pure mockery to offer it as a substitute for tea—you might,” adds
Miss Nightingale, “as well offer patients chestnuts instead of tea.”
She gives the warning, however, that too much tea is given to the
sick by foolish people, and that as a rule neither tea nor coffee
should be given to invalids after five o’clock.
The remarks on “Beds and Bedding” are not as relevant now as
when they were written in the days of the much be-curtained four-
post bedstead and luxurious feather beds. Most people now
acknowledge the superiority of the iron bedstead with spring
mattress. The bed coverings should be light as well as warm and “a
true nurse,” says Miss Nightingale, “always makes her patient’s bed
and does not leave it to the housemaid.” She recommends that the
bed should always be in the lightest place in the room, and the
patient able to see out of window. “A fashionable physician,” she
writes, “has been saying that he turns his patients’ faces from the
light. Yes, but Nature is stronger than fashionable physicians, and
depend upon it, she turns the faces back and towards such light as
she can get.” Observation of the sick shows that patients do not turn
their faces to the wall.
 Miss Nightingale, in illustration of the craving of the sick to see
out of window, relates a beautiful story of a nurse’s self-sacrifice. A
poor man in one of the hospitals was suffering from spinal accident
and expressed an intense longing just to have one look out of the
window. The nurse, moved with compassion for the poor fellow’s
craving, raised him on her back so that he might take his coveted
look at the outside world once again. His joy was great, but the effort
cost the nurse a long and serious illness.
Under the heading of “Chattering Hopes and Advices,” Miss
Nightingale evidently speaks out of the fulness of her own
experience. “‘Chattering Hopes,’” she says, “may seem an odd
heading. But I really believe there is scarcely a greater worry which
invalids have to endure than the incurable hopes of their friends.
There is no one practice against which I can speak more strongly
from actual experience, wide and long, of its effects during sickness,
observed both upon others and upon myself. I would appeal most
seriously to all friends, visitors, and attendants of the sick to leave off
this practice of attempting to ‘cheer’ the sick by making light of their
danger and by exaggerating their probabilities of recovery.... The fact
is that the patient is not ‘cheered’ at all by these well-meaning, most
tiresome friends.” The advice or opinion of the experienced does not
of course come under the head of “Chattering Hopes,” but it is the
advice of “inexperience to bitter experience” which Miss Nightingale
condemns, and which amounts to nothing more than this, “that you
think I shall recover from consumption, because somebody knows
somebody, somewhere, who has recovered from fever.” Nurses
should protect their patients from visitors of the class indicated.
The “Observation of the Sick” is a quality which needs
cultivation. “The most important practical lesson that can be given to
nurses is to teach them what to observe,” writes Miss Nightingale,
also “how to observe,” and to accurately state the result of
observation. It is a more difficult thing to speak the truth than people
commonly imagine. “Courts of justice seem to think that anybody can
speak ‘the whole truth and nothing but the truth,’ if he does but
intend it.” It requires many faculties combined of observation and
memory to do that. She quotes a little incident to illustrate the point.
“I know I fibs dreadful; but believe me, miss, I never finds out I have
fibbed until they tells me so,” was a remark once made to her, which
is, as she says, “one of more extended application than most people
have the least idea of.”
Needless to say, unintentional “fibbing,” or in other words lack of
observation, which leads a nurse to wrongly inform the doctor
regarding the patient, often leads to disastrous results. “I knew,” says
Miss Nightingale, “a very clever physician of large dispensary and
hospital practice, who invariably began his examination of a patient
with ‘Put your finger where you be bad.’ That man would never
waste his time with collecting inaccurate information from nurse or
patient.” Nothing leads to inaccurate information more than putting
“leading questions” to sick people. “How do you sleep?” “How is your
appetite?” A tactful and observant nurse will be better able to answer
such questions than the patient himself.
Miss Nightingale thinks that Englishwomen are not naturally
good observers, though capable of attaining to it by training. The
French or Irish woman is much quicker. She records a homely little
example of want of observation. “I remember when a child,” she
writes, “hearing the story of an accident related by some one who
sent two nieces to fetch a ‘bottle of sal-volatile from her room.’ ‘Mary
could not stir,’ she said; ‘Fanny ran and fetched a bottle that was not
sal-volatile, and that was not in my room.’ If Fanny had observed the
bottle of sal-volatile in the aunt’s room every day she was there, she
would have found it when it was suddenly wanted. This habit of
inattention generally pursues a person through life, a woman is
asked to fetch a large new-bound red book lying on the table by the
window, and she fetches five small old boarded brown books lying
on the shelf by the fire.”
In contrast to this type of careless person, Miss Nightingale
instances the trained observations of a famous actress. “I was once
taken,” she writes, “to see a great actress in Lady Macbeth. To me it
appeared the mere transference upon the stage of a death-bed,
such as I had often witnessed. So, just before death, have I seen a
patient get out of bed and feebly re-enact some scene of long ago,
exactly as if walking in sleep.” The actress played her part so well
because she had actually observed life.
 PARTHENOPE, LADY VERNEY.
(From the painting at Claydon by Sir William Richmond, R.A.)
[To face p. 283.
 “The very alphabet of a nurse,” says Miss Nightingale, “is to
observe so well that she is able to interpret every change which
comes over a patient’s countenance, without causing him the
exertion of saying what he feels.... A patient is not merely a piece of
furniture, to be kept clean and arranged against the wall, and saved
from injury or breakage—though to judge from what many a nurse
does and does not do, you would say he was.” Then comes a
caution that all sick people dislike being watched, and the nurse
must observe without appearing to do so. Miss Nightingale relates
that the best observer she ever knew was a distinguished doctor for
lunacy. “He leans back in his chair, with half-shut eyes,” she relates,
“and, meanwhile, he sees everything, observes everything, and you
feel he knows you better than many who have lived with you twenty
years. I believe it is this singular capacity of observation and of
understanding what observed appearances imply which gives him
his singular influence over lunatics.”
In a concluding chapter, Miss Nightingale refers to the dangers
of “reckless physicking by amateur females,” and tells of the lady
who, having procured a prescription for a blue pill which suited her
during one indisposition, proceeded to dose not only herself but her
family too, “for all complaints upon all occasions.” Then there are the
women who have no ideas beyond calomel and aperients, and the
Lady Bountifuls who dose their poorer neighbours with a favourite
prescription when it would be doing more good if they persuaded the
people to “remove the dung-hill from before the door, to put in a
window which opens, or an Arnott’s ventilator, or to cleanse and
lime-wash their cottages.”
She has some last words to say on nursing as a profession, and
gives a humorous little thrust at “the commonly received idea among
men, and even among women themselves, that it requires nothing
but a disappointment in love, the want of an object, a general
disgust, or incapacity for other things, to turn a woman into a good
nurse.” “This reminds one of the parish where a stupid old man was
set to be school-master because he was ‘past keeping the pigs.’”
Miss Nightingale sums up the matter with some condensed
wisdom on the question as to whether women are fitted for the
medical and other professions. She urges them to keep clear of “the
jargon” which impels a woman on the one hand to do things simply
to imitate men, and on the other to refrain from doing what she has
the power to accomplish simply because it has hitherto been
considered man’s work. “Surely woman,” she writes, “should bring
the best she has, whatever that is, to the work of God’s world,
without attending to either of these cries. For what are they, but
listening to the ‘what people will say’ opinion, to the voices from
without? No one has ever done anything great or useful by listening
to the voices from without. You want to do the thing that is good,
whether people call it ‘suitable for a woman’ or not. Oh, leave these
jargons, and go your way straight to God’s work, in simplicity and
singleness of heart.”
A year after the publication of Notes on Nursing, Miss
Nightingale issued (1861) a modified edition of the work, under the
title of Notes on Nursing for the Labouring Classes, adding a chapter
on “Minding Baby,” which is specially addressed to young girls in
working families, who have a great deal to do with minding mother’s
baby. It is delightfully written and reveals how conversant the author
was with the homes of the poor. It would do more good than many
tracts if distributed by the district visitor, and would be a useful
addition to the textbooks of our elementary schools. With her usual
quick insight the Queen of Nurses recognises the importance of the
working-girl nurse. “One-half of all the nurses in service,” she writes,
“are girls of from five to twenty years old. You see you are very
important little people. Then there are all the girls who are nursing
mother’s baby at home; and in all these cases it seems pretty nearly
to come to this, that baby’s health for its whole life depends upon
you, girls, more than upon anything else.” Simple rules such as a girl
of six could understand are given for the feeding, washing, dressing,
nursing, and even amusement of that important person, “baby.”
“The healthiest, happiest, liveliest, most beautiful baby I ever
saw was the only child of a busy laundress,” writes Miss Nightingale;
“she washed all day in a room with the door open upon a larger
room, where she put the child. It sat or crawled upon the floor all day
with no other play-fellow than a kitten, which it used to hug. Its
mother kept it beautifully clean, and fed it with perfect regularity. The
child was never frightened at anything. The room where it sat was
the house-place; and it always gave notice to its mother when
anybody came in, not by a cry, but by a crow. I lived for many
months within hearing of that child, and never heard it cry day or
night. I think there is a great deal too much of amusing children now;
and not enough of letting them amuse themselves.”
The versatility of Miss Nightingale’s pen is shown by her next
publication, The Sanitary State of the Army in India, which came out
in 1863. The hand which could write with such tender womanly
concern about baby could deal vigorous blows at the insanitary
condition of the soldiers in India. She had been keenly interested in
Lord Herbert’s scheme for uniting the Indian with the Home army,
and followed it up by a thorough investigation of the causes affecting
the health of the army in India. An elaborate series of written
evidence procured from all the principal stations of India by the
Royal Commission appointed for the purpose, was laid before Miss
Nightingale in 1861, and at the request of the Commission she wrote
a valuable paper of comments on the reports. Lord Stanley
succeeded Lord Herbert as President of the Commission, and to him
Miss Nightingale addressed her observations, which form a book of
some hundred pages. She points out in her usual concise style the
evils arising from the defective sanitation of the camps, the bad
water, lack of drainage, and the imperfections of the hospitals, and
deals with the preventable causes which lead to drunkenness and a
low tone of morality amongst the Indian troops.
The state of the army in India continued to be a matter of great
concern to Miss Nightingale, and at the request of the National
Social Science Congress she prepared a paper on the subject, to
which she gave the arresting title “How People may Live and not Die
in India.” This was read at the Edinburgh meeting in 1863, and
published in pamphlet form the following year. In a prefatory note
Miss Nightingale refers with pleasure to the improvement in the
condition of the soldiers which had taken place in many respects.
The introduction of soldiers’ gardens, trades, and workshops
enabled the men to realise that it was better to work than to sleep
and to drink, even during hot weather.
She gives an interesting instance of how these reforms had
worked. “One regiment marching into a station,” she writes, “where
cholera had been raging for two years, were ‘chaffed’ by the
regiments marching out, and told they would never come out of it
alive.
“The men of the entering battalion answered, They would see;
we won’t have cholera. And they made gardens with such good
effect that they had the pleasure not only of eating their own
vegetables, but of being paid for them too by the commissariat. And
this in a soil which no regiment had been able to cultivate before.
And not a man had cholera. These good soldiers fought against
disease, too, by workshops and gymnasia, and at a few hill stations
the men have covered the whole hill-sides with their gardens.”
She goes on to tell of the good results taking place from the
introduction of gymnastics for the men and cricket and other outdoor
sports. “In short,” she adds in a pithy sentence, “work and all kinds of
exercise cause sickly men to flourish.” Soldiers’ libraries were being
established by Government, better cook-houses built, and the
soldiers taught to cook. And so far she is glad to record that the
soldiers’ habits had improved. “But the main causes of diseases in
India—want of drainage, want of water supply for stations and towns
—remain as before,” she ironically remarks, “in all their primitive
perfection.” The death-rate of troops serving in India was the
alarming one of sixty-nine per thousand per annum. “It takes
something more than climate to account for this,” she writes. “All that
the climate requires is that men shall adapt their social habits and
customs to it, as, indeed, they must do to the requirements of every
other climate under heaven. There is not a shadow of proof that
India was created to be the grave of the British race.”
Miss Nightingale then enumerates the simple rules for dress,
diet, and exercise to be observed by soldiers serving in India. But
though a man can regulate his personal habits, “he cannot,” she
adds, “drain and sewer his own city, nor lay a water supply on to his
own station, nor build his own barracks,” and she proceeds to urge
that sanitary reform in India is still one of the most pressing
questions for the Government. By wise measures the enormous
death-rate of sixty-nine per thousand might be reduced to ten per
thousand. “What a work, what a noble task for a Government—no
‘inglorious period of our dominion’ that,” she writes, “but a most
glorious one!”
Ten years later Miss Nightingale again returned to the “charge”
and prepared a paper on “Life or Death in India,” which was read at
the meeting of the National Association for the promotion of Social
Science at Norwich in 1873, and afterwards published as a pamphlet
with an appendix on “Life or Death by Irrigation.”
In this paper Miss Nightingale pointed out the cheering fact that
during the past ten years in which sanitary reforms had been
progressing the death-rate of the army in India had been reduced
from sixty-nine per thousand to eighteen per thousand—that is,
eighteen men died where sixty-nine had died before. Still, she
considered that this only sufficed to show the work that yet remained
to be done, especially with regard to the drainage, water supply, and
the irrigation of the country for commercial purposes, on account not
only of the soldier, but to promote the health of the teeming millions
of our fellow-subjects in India and their general prosperity.
Miss Nightingale disposes of the “caste” difficulty with an
amusing incident. When the Government’s new water supply “was
first introduced into Calcutta, the high-caste Hindoos still desired
their water-carriers to bring them their sacred water from the river;
but these functionaries, finding it much easier to take the water from
the new taps, just rubbed in a little (vulgar not sacred) mud, and
presented it as Ganges water.
“When at last the filthy fraud was discovered, public opinion,
founded on experience, had already gone too far to return to dirty
water. And the new water supply was, at public meetings, adjudged
to be theologically as well as physically safe.”
Miss Nightingale urges that irrigation schemes should be set on
foot by the Government as a preventive against the ever-recurring
famines which afflict our fellow Indian subjects so severely. “Is not
the Government of India,” she asks, “too much like a dispensary,
which does all that man can do to cure when too late to do anything
to prevent?”
While Miss Nightingale’s pen was pleading so eloquently and
practically during this period for the good of the great Empire in the
East, she was not unmindful of the people at home. Her writings and
work in connection with the sick poor must form the subject of a
separate chapter.
 CHAPTER XXIII
THE NURSING OF THE SICK POOR

Origin of the Liverpool Home and Training School—Interest

in the Sick Paupers—“Una and the Lion” a Tribute to
Sister Agnes Jones—Letter to Miss Florence Lees—
Plea for a Home for Nurses—On the Question of Paid
Nurses—Queen Victoria’s Jubilee Nursing Institute—
Rules for Probationers.

Nursing is an Art; and if it is to be made an art, requires as exclusive

a devotion, as hard a preparation, as any painter’s or sculptor’s work; for
what is the having to do with dead canvas, or cold marble, compared
with having to do with the living body—the temple of God’s spirit....It is
one of the Fine Arts; I had almost said, the finest of the Fine Arts.—
Florence Nightingale.

T HERE is no branch of sick nursing which appeals more

strongly to Miss Nightingale than the care of the sick poor. It
was as a visitor in the homes of her poorer neighbours at Lea Hurst
and Embley that she began her philanthropic work, and though the
outbreak of the Crimean War drew her into the public arena and
concentrated her attention on the army, she had not ceased to feel
the importance of attending to the needs of the sick poor, and
repeatedly drew attention to the fact that England was behind other
nations in providing for the sick poor at home, and in infirmaries.
She recognised also that for this work a special training was
needed. A nurse who had received a course of instruction in a
hospital was not necessarily competent to nurse the poor in their
own homes. Special knowledge and special experience were
needed before a woman, however skilled in the technical side of
nursing, could become a good district nurse.
About the same period that Miss Nightingale was establishing
and organising her Training School for Nurses at St. Thomas’s
Hospital, she was also working in conjunction with Mr. William
Rathbone, M.P., and other philanthropic people to found a special
training school for nurses for the poor. It was at her suggestion that
this branch of pioneer work was started in connection with the
Liverpool Infirmary, which had already made some provision on
similar lines. The prospectus for the Liverpool Training Home for
Nurses was made public in 1861–2, and a commodious building was
subsequently erected in the grounds of the infirmary.
In 1865 Miss Nightingale wrote an introduction to a work
describing the “Origin and Organisation of the Liverpool School and
Home for Nurses.” “It is the old story, often told!” she writes, “but this
book opens a new chapter of it. It gives us hope for a better state of
things. An institution for training nurses in connection with the
infirmary has been built and organised. This is a matter of necessity,
because all who wish to nurse efficiently must learn how to nurse in
a hospital.
“Nursing, especially that most important of all its branches—
nursing of the sick poor at home—is no amateur work. To do it as it
ought to be done requires knowledge, practice, self-abnegation, and
as is so well said here, direct obedience to and activity under the
highest of all Masters and from the highest of all motives. It is an
essential part of the daily service of the Christian Church. It has
never been otherwise. It has proved itself superior to all religious
divisions, and is destined, by God’s blessing, to supply an opening
the great value of which, in our densely peopled towns, has been
unaccountably overlooked until within these few years.”
With such noble words did Florence Nightingale usher in a
movement which has now spread to all parts of the kingdom. There
is not now a workhouse infirmary which has not its trained nurses in
place of the rough-handed and unskilled inmate, nor any town and
few villages which have not some provision for nursing the sick poor
in their own homes, and our beloved Queen Victoria found it the
worthiest object to which she could devote the people’s offering in
commemoration of her Jubilee.
The main objects of the pioneer Training Home at Liverpool
were:—
1. To provide thoroughly educated professional nurses for the
poor.
2. To provide district nurses for the poor.
3. To provide sick nurses for private families.
Miss Nightingale watched the progress of the home with keen
interest and gave her advice from time to time. She was also actively
engaged in promoting workhouse reform. A sick pauper was to her a
human being, not a “chattel” to be handed over to the tender mercies
of the Mr. Bumbles and Mrs. Corneys. It afforded her great
satisfaction that two out of the first lot of nurses which left her St.
Thomas’s Training School went as matrons to workhouse infirmaries.
A reform in workhouse hospitals had been brought about by Mr.
Gathorne-Hardy’s Metropolitan Poor Act of 1867. But the introduction
of trained nurses on the Nightingale system grew directly out of the
experience and information which followed the founding of the
Liverpool Training Home.
Hitherto the workhouse nurses were the pauper women,
untrustworthy and unskilled. At Brownlow Hill, Liverpool, Infirmary
Mr. Rathbone relates that there were twelve hundred beds occupied
by people in all stages of every kind of disease, and the only
assistants of the two women officers who superintended the nursing
were pauper women who were as untrustworthy as they were
unskilful. This was a fair example of workhouse infirmaries all over
the country.
The Select Vestry of Liverpool, having received an anonymous
offer to defray the cost of the experiment for three years, consented
to try Miss Nightingale’s plan. With her assistance, Miss Agnes
Jones, a lady who had been trained at Kaiserswerth like Miss
Nightingale, and also at the Nightingale School at St. Thomas’s, was
appointed Lady Superintendent, and she brought with her a staff of
twelve nurses from St. Thomas’s. At first Miss Jones tried to get
extra help by training the able-bodied pauper women as nurses, but
out of fifty-six not one proved able to pass the necessary
examination and, worse still, the greater number used their first
salary to get drunk. The painful fact was established that not a single
respectable and trustworthy nurse could be found amongst the
workhouse inmates, and the infirmary nursing had to be taken
entirely out of their hands.
After a two years’ trial Miss Jones’s experiment with her trained
and educated nurses proved so satisfactory that the guardians
determined never to return to the old system, and to charge the rates
with the permanent establishment of the new one. To the deep regret
of every one, however, Miss Agnes Jones sank under the labours
which she had undertaken, and died in February, 1868.
Miss Nightingale contributed a beautiful tribute to the memory of
her friend and fellow worker in Good Words for June, 1868, under
the title “Una and the Lion,” which subsequently formed the
“Introduction” to The Memorials of Agnes Elizabeth Jones, by her
sister.
“One woman has died,” writes Miss Nightingale, “a woman,
attractive and rich, and young and witty; yet a veiled and silent
woman, distinguished by no other genius but the divine genius—
working hard to train herself in order to train others to walk in the
footsteps of Him who went about doing good.... She died, as she had
lived, at her post in one of the largest workhouse infirmaries in this
kingdom—the first in which trained nursing has been introduced....
When her whole life and image rise before me, so far from thinking
the story of Una and her lion a myth, I say here is Una in real flesh
and blood—Una and her paupers far more untamable than lions. In
less than three years she had reduced one of the most disorderly
hospital populations in the world to something like Christian
discipline, and had converted a vestry to the conviction of the
economy as well as humanity of nursing pauper sick by trained
nurses.”
 We must refrain from quoting more of this singularly fine tribute
of the Chief to one of her ablest generals in the army of nursing
reform, with the exception of the beautiful closing words: “Let us add
living flowers to her grave, ‘lilies with full hands,’ not fleeting
primroses, not dying flowers. Let us bring the work of our hands and
our heads and our hearts to finish her work which God has so
blessed. Let us not merely rest in peace, but let hers be the life
which stirs up to fight the good fight against vice and sin and misery
and wretchedness, as she did—the call to arms which she was ever
obeying:—

The Son of God goes forth to war,

Who follows in His train?

Oh, daughters of God, are there so few to answer?”

MRS. DACRE CRAVEN (NÉE FLORENCE LEES).
 (From a drawing by the Crown Princess of Germany
(the late Empress Frederick), when Miss Lees had
charge of the Crown Princess’s Lazaretto at
Homburg during the Franco-German War.)

[To face p. 304.

One cannot leave the subject without a reference to the

influence which Miss Nightingale’s own early example had had on
the gifted woman whose memory she extolled. On the eve of going
into training at St. Thomas’s Miss Agnes Jones wrote: “It is well that I
shall, at my first outset in hospital work, bear the name of
‘Nightingale Probationer,’ for that honoured name is associated with
my first thought of hospital life. In the winter of ’54, when I had those
first earnest longings for work, and had for months so little to satisfy
them, how I wished I were competent to join the Nightingale band
when they started for the Crimea! I listened to the animadversions of
many, but I almost worshipped her who braved all, and I felt she
must succeed.”
The system inaugurated by Miss Agnes Jones at Liverpool
Infirmary spread over the country, and Miss Nightingale had the
satisfaction of seeing in a comparatively short time a great
improvement in the nursing and treatment of the sick in workhouses.
Gaols had long been visited and reformed, lunatic asylums opened
to inspection, and it seemed unaccountable that the misery of sick
B
workhouse paupers should have been so long overlooked.

B
Miss Louisa Twining in 1854 began her
pioneer efforts in workhouse reform, which
resulted in 1874 in the establishment of the
Workhouse Nursing Association.
 The success of the introduction of trained nurses into
workhouses gave an impulse to sick poor nursing generally, and in
1868 the East London Nursing Society was founded by the Hon.
Mrs. Stuart Wortley and Mr. Robert Wigram. In 1874 the movement
received a further important impulse from the formation of the
National Nursing Association, to provide skilled nurses for the sick
poor in their own homes, to establish district organisations in London
and in the country, and to establish a training school for district
nurses in connection with one of the London hospitals.
This work appealed most strongly to Miss Nightingale, and she
expressed her sympathy in the following letter to that devoted
C
pioneer of district nursing, Miss Florence Lees, now Mrs. Dacre
Craven, who was the indefatigable honorary secretary of the newly
founded National Nursing Association.

C
Miss Lees was described by Kinglake as “the
gifted and radiant pupil” of Florence Nightingale.
She was a probationer at the St. Thomas’s
Training School when it was temporarily located
in the old Surrey Gardens.

“As to your success,” writes Miss Nightingale, “what is not your

success? To raise the homes of your patients so that they never fall
back again to dirt and disorder: such is your nurses’ influence. To
pull through life and death cases—cases which it would be an
honour to pull through with all the appurtenances of hospitals, or of
the richest in the land, and this without any sick-room appurtenances
at all. To keep whole families out of pauperism by preventing the
home from being broken up, and nursing the bread-winner back to
health.”
The next point in Miss Nightingale’s letter was one which was at
the root of the movement and which she invariably emphasised: “To
drag the noble art of nursing out of the sink of relief doles.” It was