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You may find a great improvement on your next visit.’ The words were sympathetic but there was no warmth in her manner. ‘Mrs Valley-Brown probably explained to you that we’re dealing with a slow degenerative illness. It proceeds unevenly. Although we can’t halt the disease we can make life as comfortable as possible for Mrs Palmer until such time as she needs additional care.’
    ‘What would happen then?’ I asked. Out of the corner of my eye I saw Agnes freeze, the teacup halfway to her mouth.
    ‘Excellent care is provided at the psycho-geriatric unit at Kingsfield.’
    Agnes’ hand was shaking so badly that the cup clattered as she put it down. Everyone had heard of Kingsfield – one of the vast, old-style asylums.
    ‘I thought it was shut,’ I said. ‘I thought they were closing all those places down.’
    ‘Many wards did close and much of it has been put to other use but there’s a very successful psycho-geriatric unit.’ Mrs Knight seemed oblivious to Agnes’ distress. ‘The staff have a great deal of skill in dealing with confused and frail elderly
    people. We do recognise that community facilities aren’t appropriate for some patients, or they simply aren’t available. Kingsfield still has a role.’
    Agnes cleared her throat. ‘I was wondering whether Lily’s problems might be due to a physical upset. There’s something I’ve read about called acute confusional disorder.’
    Mrs Knight nodded. ‘The doctor ruled that out. The state you’re referring to is quite easy to identify because we can connect the confusion to a particular physical illness. In Mrs Palmer’s case there was no such link. She was given a complete medical on her arrival here. It’s something we offer all our residents – we even arrange X-rays at the hospital so we can be absolutely sure that people have no physical problems that have gone undetected.’
    ‘But it happened so swiftly,’ Agnes went on, ‘it wasn’t gradual.’
    ‘I know all the books talk about Alzheimer’s progressing very slowly,’ Mrs Knight clasped her hands on the table and leant forward as she spoke, ‘but quite often early symptoms go unnoticed. Mrs Palmer may well have been forgetful for some time without it causing anyone undue concern. In a new environment some of these symptoms stand out more clearly.’
    ‘She’s always had an excellent memory,’ insisted Agnes.
    ‘That was just an example,’ remarked Mrs Knight, unsmiling, ‘but I’ve been in nursing for twenty-five years, I’ve specialised in geriatric care and I’ve no reason to think Mrs Palmer has acute confusional disorder rather than progressive dementia.’ Subject closed.
    ‘Who’s her doctor?’ I asked.
    ‘Dr Goulden. He holds a regular surgery here every week. Mrs Palmer transferred when she moved in.’
    ‘So we could ask him about this?’ I ventured.
    ‘By all means. But Dr Goulden is only going to repeat what I’ve already told you.’ Her voice was icy.
    ‘Do you have his number?’
    ‘Certainly.’ She gave me it then rose from her chair. The interview was over. Then she made an effort to redeem the atmosphere. ‘I hope he’ll be able to set your minds at ease. We do feel it’s important that friends and relatives have all the information they can about each individual care plan here.’ Still no smile, though. It was unnerving. A missing bit of body language that made it feel that the whole conversation was askew. Well, the exchange had hardly been harmonious. Medical types sure don’t like their judgement questioning.
    Agnes wanted to sit with Lily for a while so we returned to the TV lounge. Lily didn’t resist when Agnes sat beside her and took her hand. They were like that for ten minutes or more. Lily staring at the box, Agnes, her eyes cast down, looking up at her friend every now and then.
    Lily was small, her feet barely reached the floor. Her neck craned forward and the top of her spine was curved with age. She had steel-grey hair,