Letters from Alice: A tale of hardship and hope. A search for the truth.

The man was still coughing when Alice joined him in the watching room. ‘She’s agitated ’cos I’m not earning what I-I used to on account of this cough,’ he told Alice in a thick Irish accent. ‘And what with the baby soon to join us –’

Alice opened a new file and jotted down some notes while Jimmy spoke. A thirty-five-year-old labourer, Jimmy had sailed for England from Ireland a year earlier looking for work. He managed to find employment on the Wembley Park site, where work was under way preparing the ground for a new restaurant to be built near the planned new sports stadium, but had not yet managed to save enough to cover the cost of a deposit on his own lodgings.

Alice managed to elicit that he had spent most nights sleeping with three other workmen in a small shed on site, while his pregnant wife camped out on her parents’ sofa. Waking in the same damp clothes he had worked in the previous day, his health had worsened through the winter. ‘’Tis a fine place here though,’ Jimmy said, when Alice confirmed that his meagre earnings and imminent dependant qualified him for entirely free treatment at the hospital. ‘And you’re a fine woman, so you are,’ he gasped, after she told him that he’d been booked into the chest clinic. A deep hacking cough issued from his lungs. He rubbed his red-rimmed eyes, watery with the strain of coughing, and said: ‘Too fine to be wasting your time helping a vagrant like me.’

As the almoner made her way back across the atrium, Hetty Woods nudged her husband with her elbow. When she neared, Ted signalled to her. ‘We was wondering, Miss Alice. Do you think you might have the opportunity to visit our daughter, Tilda? She’s expecting but her husband won’t let us near the place. He’s got some sort of hold over her, I think. We haven’t seen her for months. But my Hetty thinks that if anyone can sort them out, you can.’

Alice glanced over to the double doors, where another line of people were waiting to file inside. When temperatures plummeted, as they had in London in the last twenty-four hours, it was difficult to impose some order on the chaos reigning in outpatients. The doctors found the crowded conditions near impossible to work in, but the worsening storm and poor visibility at least provided her with an excuse to grant the most destitute a temporary reprieve.

‘I will see what I can do in the next few days,’ Alice told the couple, after noting down their daughter’s address.

‘Don’t go after six though, duck,’ Hetty said warningly. ‘That’s when our son-in-law gets home.’

The almoner nodded. ‘I cannot promise anything, but I will try.’

Ted and Hetty watched Alice as she headed off for her meeting with Dr Harland, their rheumy eyes watery with gratitude.

Chapter Three (#u71057930-510a-59d4-be5f-83948873ab46)

The almoner is a general practitioner in social healing. It is the almoner whose job it is to deal with the personal difficulties and troubles of the patient … the constructive side of the social work done by the almoner seems to know no limits.

(The Scotsman, 1937)

From its earliest days as an apothecary, doctors from the Royal Free went out into the community to treat patients who were too ill to leave their homes, or rose in the early hours to meet them at the hospital. ‘As there were no telephones,’ explained Dr Grace de Courcy, a medical student in 1894, ‘if an emergency arose at night and the resident required assistance he would go into the street and take a hansom cab or a growler to the house of the surgeon or physician in charge of the ward to bring him back.’

Dedicated to their patients and uncomfortable with the idea of their private lives being examined, medical staff at the Royal Free had initially been reluctant to share any information with the almoners. For some, the whole idea of conducting financial assessments on the sick was repugnant. Sir E. H. Currie complained to a reporter for the London Daily News in 1904 that vetting patients using ‘special detectives’ was ‘a scandal’. Currie ‘strongly condemned’ the use of inquisitorial methods to ‘denounce’ well-off patients. ‘What possible good can one woman investigator do?’ he argued. ‘It is ridiculous.’

Mr Rogers, a secretary from the London Hospital, defended the appointment of an almoner who was to ‘watch in the receiving rooms for cases of imposition’. The secretary stated that local doctors running private practices had accused the hospital of ‘robbing their profession’ by treating patients who ‘they had personally seen … driving to hospital in their own carriages’.

Like his predecessors, Dr Peter Harland was another of those people who subscribed to the view that any sort of surveillance of the private lives of others was a disagreeable pastime. He was waiting at the top of the stairs leading to the almoners’ basement office when Alice arrived. ‘I’m so sorry, doctor. Have you been waiting long?’

‘A minute or so.’ There was no reproof in his voice, but his features were strained.

Alice led the way down the dimly lit stairs, stopping before a sturdy-looking oak door inset at eye-level with a small barred window. Dr Harland waited silently as she opened the door to the office, where arrow-slit windows high up across one wall overlooked the sodden grey pavement of Gray’s Inn Road. The window sills provided neat cubby holes for reference books and medical journals, the heavy tomes blocking much of the natural light.

Before the fires were lit by the caretaker each morning, the almoners’ office lay silent, the stillness broken only by the rumble of underground trains beneath them. Now, the room was bustling with activity. Frank was seated at the nearest desk, taking ledgers one by one from a small pile and checking them against a list of the hospital’s assets. Alexander was kneeling on the floor beside a solid leather trunk and setting a trap for the mice that emerged at night to nibble the edges of his financial reports. He fumbled with the steel mechanism with a harried air, his handsome features twisted and pink with annoyance. In the far corner, Winnie sat behind her typewriter, her habitual anguished frown in place.

At the opposite end of the office, the Lady Almoner, Bess Campbell, was busy preparing lists for a post-New Year party; a get-together for those acquaintances who had missed out on the New Year’s celebration that had taken place in her considerable residence in Kensington. Miss Campbell, a woman with a flair for combining dynamic guests with those of a quieter nature so that everyone felt at ease, had a calendar packed with social events, dances and dinner parties.

She was a slim woman in her late forties, with greying shoulder-length hair and sharp but pleasant features. An accomplished and formidable character, she had a love of fine clothes and an air of authority, but she was also possessed of a natural humility, an essential quality in someone working so closely with the poor.

Like the majority of her colleagues, she had been selected from a class superior to those she served, the appointing committee believing that only someone gifted with eloquence could suitably advocate for the working class, who were generally less able to express themselves.

Each member of staff glanced up as Alice entered. At the appearance of Dr Harland, Alexander got to his feet and brushed down his trouser legs. Puffing absently on his pipe, Frank merely jutted out his chin. Miss Campbell beamed. ‘Peter, my dear, how are you?’

‘Too busy to be here. And you?’ The doctor’s expression settled as far into solicitousness as it ever went, though his face, all blunt lines and irregular angles, retained its slightly grumpy expression. About six inches taller than Alice, at just under five feet eleven, he was a tall man, sturdy and strong. In his mid-thirties, his square face was framed by a crop of thick curly black hair, his jaw displaying the hint of a beard.

‘Well, it’s most generous of you to spare some time for us, isn’t it, Alice? And I’m splendid, thank you.’ Miss Campbell ran the office with a regimen as strict as the fiercest sisters on the wards above her, but there were times when her staff caught a glimpse of the compassion she usually reserved for patients. When Alice had returned to the office after discovering the bodies of Molly and her infant son, Miss Campbell had been the first to her feet, steering Alice with tenderness towards her chair. Within minutes she had pressed a hot, disturbingly sweet cup of tea into one hand and a vinaigrette of smelling salts into the other. Alice was to take her final exam in social work the next day, but after what had happened, she told her boss that she was tempted to withdraw. ‘I’m not suited to this sort of work,’ she told Miss Campbell mournfully, after everyone else had gone home.

Miss Campbell had reached across the desk and taken Alice’s hand in her own. ‘If you’re not suited to it, my dear, I don’t think any of us are.’

‘If only I’d acted sooner,’ Alice had burst out, pulling her hands away to cover her cheeks. She shook her head. ‘I knew something wasn’t right. I should never have left Molly alone for so long.’

Miss Campbell scoffed gently. ‘Would not the world be a finer place if only we were all possessed with blessed foresight?’ She paused. Alice dropped her hands and looked at her. The Lady Almoner levelled her gaze. ‘Alice, you need to accept that we all have limitations, and that includes you. You’re not responsible for every vulnerable waif and stray in London, you know. But you have more empathy and intuition than almost anyone else I know. So you’ll go tomorrow and take your exam and then you’ll return here to carry on with your work.’

Alice’s eyes pooled with tears. ‘But I’ll fail, just like I failed Molly.’

‘Then you shall take it again,’ Miss Campbell had said with a note of finality and a short sharp squeeze of Alice’s hand.

At her desk, Alice removed her hat and gloves and tucked them into a drawer. ‘Would you like a cup of tea before we get started, doctor?’

Dr Harland nodded as he drew up a chair and sat at the end of her desk. From across the office, Frank began to cough theatrically. ‘I take it you would like one too, Frank,’ Alice said, moving towards the boiler with weary amusement.

‘I am parched, now you mention it.’

Winnie got to her feet and made efforts to convince Miss Campbell, who had declined Alice’s offer, that it would be wise to keep hydrated. She then hovered behind Alice and warned her of the perils inherent in carrying out any activity involving boiling water. ‘I have everything under control, Winnie, thank you,’ Alice said with impatience.

The almoner warmed the office teapot using the water bubbling away in a large pot on top of the boiler. After setting a few mismatched cups on top of an empty desk, she swirled the hot water around the pot and emptied the vestiges into the large porcelain sink in the corner of the room. She scooped a caddy spoon of tea leaves inside, the soothing simplicity of the act at odds with the concerns that had been swirling in her mind over the last couple of days, since visiting the Redbournes’ house.

Outside, there was a temporary reprieve from the rain. A shaft of winter sunlight shone through the grime-covered, half-blocked windows, temporarily transforming the gloomy office from dungeon to a bright, airy place. The fug of ink, damp paper and coal in the air lifted momentarily, returning less than a minute later when the sun disappeared behind a cloud.

‘What have I told you?’ Frank roared a minute later, jumping to his feet. ‘Milk in last, not first!’ He strode towards Alice, pipe in hand, his grizzled features screwed up in mock disgust. ‘If you were my wife I’d ask you to tip that away and start again.’

Alice lowered the teapot to the desk and grabbed one of the cups. ‘If we were married, Frank,’ she said, thrusting the steaming drink towards him, ‘it wouldn’t be me making the tea.’ Frank stared at her and took the proffered drink with his habitual hangdog expression. Seconds later, in a huff of smoke and quivering jowls, he bellowed with laughter. A few feet away, Alexander seated himself behind his desk with a look of distaste.

Alice rolled her eyes and passed another of the drinks, this time with more grace, to Dr Harland. After sliding her own cup onto the edge of her desk, she sat beside the doctor and switched on her desk lamp. Light pooled on the slew of beige folders that lay between them, the Redbourne file uppermost in the pile.

As Alice reached out and pulled the folder down in front of her, Winnie appeared. Her handbag was clasped in one arthritic hand, and she picked up Alice’s cup with the other. ‘Where would you like your tea, dear?’

Alice pushed her chair back and half stood up to retrieve it. ‘Where it was,’ she said tersely, replacing it on the edge of her desk. Winnie’s gaze flicked between Alice and the cup as if trying to communicate the folly of such action, but then she shuffled wordlessly back to her desk.

Before Alice opened the file in front of her, the doctor asked if any progress had been made in securing convalescence for one of his elderly tubercular patients who wasn’t well enough to go home.

‘Grove House in Eastbourne has reserved a place for the beginning of February. They’ve booked Mr Hobbs in for at least two weeks.’

Dr Harland grunted his approval, dipped his fountain pen in the inkwell of Alice’s desk and scribbled something in his notebook. ‘And Mrs Taylor?’

‘I saw her just after Christmas. I managed to convince her to apply for a crisis loan from the Samaritan Fund.’ Mrs Taylor’s husband, Simon, had recently been diagnosed with cancer of the lung, but was struggling to come to terms with the poor prognosis he’d been given. Medical staff had encouraged him to share the burden with his wife, but he continued to reassure her that he’d be back on his feet in a day or two. While it wasn’t up to Alice to break patient confidentiality, she had been able to visit Mrs Taylor to make sure that the practicalities of losing the family’s sole breadwinner were taken care of. A proud, respectable sort of woman, she had been reluctant to even discuss any form of assistance, but with two weeks’ rent arrears and only enough food left to last the week, she eventually conceded that she needed some help. By the time Alice left her, she had been tearfully grateful.

Alice and Peter Harland’s discussion turned to the family of a child who had died on the chest ward overnight. Nine-year-old Clara Stewart had been suffering from consumption complicated by pneumonia, and by the time she reached hospital it had been too late for doctors to save her. Clara’s parents had never been able to afford to have a family photograph taken and were desperate to take advantage of their one last opportunity to secure a memento mori, something that was certain to become a treasured keepsake, before their daughter’s body was buried. ‘The poor family,’ Alice said softly. ‘I’ll make an urgent application to the Samaritan Fund. I’m sure the panel won’t have any –’

Dr Harland waved his hand. ‘That will take time we don’t have,’ he said. ‘I’ll take care of the expenses. All I’m asking is that you make the necessary contact with a post-mortem photographer. Not all will take on such a task.’

Alice turned to face him, her expression soft. ‘That is very decent of you.’

‘It’s nothing,’ he mumbled gruffly. ‘Anything else? I need to get –’

‘Just a minute!’ Frank piped up from across the room. ‘Isn’t photography a hobby of yours, Alex? Perhaps you could help them out?’