The silent patient by alex michaelides

To my surprise, she reached into her bag and pulled out a thick slice of cake wrapped in cling film. She thrust it into my hand. “Take it. Walnut cake. I made it last night. For you.” 

“Oh, thank you, I—” 

“I know it’s unorthodox, but I always get better results with difficult patients if I give them a slice of cake in the session.” 

I laughed. “I bet you do. Am I a difficult patient?” 

Indira laughed. “No, although I find it works just as well on difficult members of staff too—which you’re not either, by the way. A little bit of sugar is a great mood enhancer. I used to make cakes for the canteen, but then Stephanie made such a fuss, all this health-and-safety nonsense about food being brought in from the outside. You’d think I was smuggling in a file. But I still bake a little on the sly. My rebellion against the dictator state. Try it.”

This was not a question but a command. I took a bite. It was good. Chewy, nutty, sweet. My mouth was full, so I covered it with my hand as I spoke. 

“I think this will definitely put your patients in a good mood.” 

Indira laughed and looked pleased. I realized why I liked her—she radiated a kind of maternal calm. She reminded me of my old therapist, Ruth. It was hard to imagine her ruffled, or upset. 

I glanced around the room as she made the tea. The nurses’ station is always the hub of a psychiatric unit, its heart: staff flow to and from it, and it is where the ward is run from day to day; at least where all the practical decisions are made. The goldfish bowl was the nurses’ nickname for the station, as its walls were made of reinforced glass—meaning staff could keep an eye on the patients in the recreation room, in theory at least. In practice, the patients hovered restlessly outside, staring in, watching us, so we were the ones under constant observation. The small space did not have enough chairs, and the ones that were there were generally occupied by nurses typing up notes. So you mostly stood in the middle of the room or leaned awkwardly against a desk, which gave the space a crowded feel, no matter how many people were in it. 

“Here you are, love.” Indira handed me a mug of tea. “Thanks.” 

Christian ambled in and nodded at me. He smelled strongly of the peppermint gum he was always chewing. I remembered he used to smoke heavily when we were at Broadmoor together; it was one of the few things we had in common. Since then Christian had quit, got married, and had a baby daughter. I wondered what kind of father he made. He didn’t strike me as particularly compassionate. 

He gave me a cold smile. “Funny seeing you again like this, Theo.”

“Small world.” 

“In mental health terms, it is—yes.” Christian said this as if to imply he might be found in other, larger worlds. I tried to imagine what they might be. I could only imagine him in the gym or in a scrum on the rugby field. 

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