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mind she always feared for me. If I take tea with Aunt Mary I am indulging in gossip and gluttony but if I keep to my room it is because I wish to draw attention to myself. I think I need something to do. Some work, something real. I have too much time for self-reflection and self-questioning.’

And you believe, Alethea, that you should work not for the good of others but because it will be of benefit to you? For amusement, for diversion from the burdens of leisure? Think then of all those women laboured to exhaustion and looking only to death for release and say again that you want work as a rest from self-reflection.

It doesn’t matter, she thinks. It doesn’t matter why I work, if the work is in itself useful. It doesn’t really matter whether I take a walk out of boredom with the comfort of the fireside or because physical exercise is healthful; there is no recording angel, Mamma, noting each cup of tea not taken, each skirt patched and dragged out another season. Denying myself butter on my bread, even if I go out that very morning and give the butter to the nearest soup kitchen, will do nothing to alter the fate of all the children of this country born and yet to be born into grinding poverty. For that one would need a different kind of change, a revolution. For that one would need to turn the nation upside down, and perhaps that is what Mamma should be doing, if the hungry are to be fed, the children of the masses educated and the stain of poverty wiped from the land. But that is not what Mamma wants. As the nurses could not bear to see that the mad are just like us, only sadder, so Mamma cannot bear to see that the poor are just like us, only poorer.

‘Ally?’

Ally meets Annie’s eyes. Dear Annie, who is able to accept her manifest blessings without opening an existential account, and to do the work to which she is called without holding a running trial in her head.

‘I was thinking about Mamma, and my patients in the asylum. I was thinking that everything could be different.’

Annie reaches towards her again. ‘Many things could be different. But Ally, are you sure you want to stay in mad-doctoring? Forgive me, but it does not always seem perhaps the best line for you. To be so constantly exposed to such distress, to pass your days among those who—well—’

‘Those who hear voices?’ Ally asks. ‘Those who cannot tell their own minds, who cannot walk but cannot be still, cannot work and cannot bear idleness?’

Annie gasps. ‘No, Ally. Please. I did not say that. Dear Al. I did not.’

Ally looks up at her. ‘And you did not think it? Come, Annie. Do you think I have not questioned my own reason? I found myself hiding in the bushes in the park on Christmas Day for fear of my parents’ pursuit. I wept in the corridors of the asylum and shouted at the nurses that we are all more like the patients than we know. A mind can be aware of its own danger. I have perhaps not been mad but we cannot say that I have been without the symptoms of a deranged mind.’

And I hurt myself, she thinks, I remembered that only pain sings louder in my head than Mamma’s voice. I remembered that sometimes the pain I cause myself can eclipse the harm she does to me. But also that I hurt myself for her, because I do as she wishes and she wishes me harm.

This time Annie takes her hand. ‘Very few of us reach the ends of our lives without times of derangement. Through grief, or rage, or encounters with the spite or ill-will of others. I did visit the asylum, you know, last summer after you said it was every physician’s obligation to know what they are like. The saddest cases were not the most mad. There were those to whom delusion would be a blessed release, who were tormented by the knowledge of their own damaged intellects. But you did leave. You came here, and now you are better, I think? It was a breakdown of the sort to which fine minds are subject.’

Ally squeezes the hand.

If she were to be confined, she thinks, Annie would still visit her.

If she were to be discharged, Aunt Mary would still take her in.

There are people who like her whether she walks or reads, takes tea or stays upstairs. They do not love her for her work, or for her prize, but for herself. She cannot see why but she can see that it is true.

‘I dare say they didn’t show you the back wards?’ she asks.

‘I am ashamed to say I didn’t ask. I wanted to get out. The smell, and all those locks. I couldn’t work in such a place. I like to be with women having babies, and I’ll keep working in the lying-in hospitals but I like it when they have flowers in their rooms afterwards and a good fire and everyone happy that they are doing well.’

‘And when they don’t do well? Or the babies die?’

Annie looks down at their linked hands. ‘Then I do my best. I try to say the right words and I go home and tell Papa what happened. Sometimes he tells me his cases too.’ She looks up. ‘Papa and Henry have asked if I would join their practice. Henry says if they cannot beat women doctors they must join them.’

Henry is Annie’s brother-in-law, Ally remembers. He used to work at St Michael’s hospital and never liked the idea of women doctors.

‘You will accept?’

Annie nods. ‘I can keep on living at home. No worries about house-keeping or anything. I will be quite free to work. And of course to go to the theatre and see my friends. I have spent quite enough nights in boarding houses and

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