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I took my sandwiches up on to the Heath for lunch and sat on the bench with the idiot. He went on ranting and rocking in a muted way, inhibited no doubt by my presence. I offered him a sandwich, which he accepted and then did hideous things to.

I looked over the city. The light pattern had been reversed as I was walking over from the hospital and now the vast ziggurat was bathed in bright light, while the bench where the idiot and I scrunged cheese through our teeth was in deep shadow. Tom had told me that he referred to the hospital, privately, as the Ministry of Love; and it was true that the sepulchral ship forging its way through the grid of streets had something of the future, the corporate about it, mixed in with the despotic past.

The wind whipped across the flight deck entrance to the hospital as I re-entered by the main gates. Well-heeled patients and visitors were being landed by taxis and minicabs, while their poorer fellows struggled against the up-draft that roared off the hospital’s oblique walls — air crewmen and women lacking enlarged ping-pong bats with which to semaphore.

On the ninth floor I met Jane Bowen. She was right outside the lift. Her hands fidgeted at her mouth as the doors rolled open.

‘Well, Misha, where have you been?’

‘I took my sandwiches up on the Heath. I like to get a little fresh air during the day.’

‘Well don’t make a habit of it.’

‘Why’s that?’

‘Zack prefers it if all the staff eat in the canteen on the ward …’

‘You can’t be serious …!’

‘Obviously it isn’t imposed on anyone. You’re free to do what you want. But Zack has good reasons for it and you need to witness lunch to understand them.’

The association area was thronged with patients, they eddied round the counter in the eating area — more of an enlarged serving hatch really — and then gravitated from there to the medication queue. Busner stood in the centre of it all, like some Lord of Misrule. He’d donned a shortie white coat which rode up over his rounded hips. The coat pockets were stuffed to overflowing, and because of the way he was standing it looked as if he was wearing a codpiece. Busner waved his arms around his head and turned circles on his heels, his face contorted, with pain? With hilarity? It was impossible to say.

I approached him through swirls of the committed.

‘Ah, Misha, I’ve tangled my spectacles cord up in my tie at the back. Can you see what’s going on?’ He turned his back on me and I fiddled with the two strands where they had become entwined. ‘Ah, that’s better.’ He clamped the spectacles on to the red grooved bridge of his nose. ‘Now I can see. We’d better sort out your materials for you.’ He led me over to a wall cupboard at the far end of the dining area from the serving hatch and opened the ceiling-high doors. Inside there was a mess of materials and half-finished attempts at something or other. ‘Gerry wasn’t great on ordering the materials,’ said Busner, stepping forward into the cupboard and crunching pieces of charcoal sticks beneath his heels, ‘but everything is here that you could need. I should take it easy, let them come to you and show you what they’re up to — try and build up some trust.’

Busner put a cloyingly affectionate arm around my shoulders, he didn’t register my wince. We stood side by side, facing a shelf full of streaked tins of powder paint.

‘Your father would have been proud of you, Misha. He would have understood what you’re doing. You know, in a way I feel as if you’re coming home to us here on the ward, that it’s the right place for you, don’t you agree?’ I muttered something negative. ‘I’m glad you feel the same way, come and see me when the session is over, tell me how it went.’ He wheeled away from me and tracked a series of charcoal arcs across the lino. I was left alone — but not for long.

* * *

Tom materialised. At his shoulder was a thirtyish man of medium height and build, unremarkable in lumberjack shirt and denims, remarkable for his arms and his countenance: arms which struggled to escape his body and pushed forward long, muscular, mechanical arms. His face was stretched tight away and zoomed towards his flaring brown hair. The whole impression was one of contained speed.

‘This is Jim,’ said Tom, ‘he can’t bear to wait, he wants to get started right away.’

‘Yeah. Hi. Jim.’ He thrust a tool at me, I shook it, he retracted it. ‘I really look forward to these sessions. I’d like to work on my thing all the time, but they won’t let me.’ I pulled the double doors open wider.

‘Which one is it?’

‘Here.’ He pulled down a sort of sculpture, made from clay, from one of the higher shelves, his long arms cradling the irregular shape protectively. He turned and set it down on one of the rectangular melamine tables.

It was a large piece, perhaps some three and a half feet long and half that wide. Jim had used a base board and built on it with clay. The work had the kind of naive realism I associated with children’s television programmes featuring animated figures moving around model villages. The work depicted a descending curve of elevated roadway which I immediately recognised as the Marylebone Flyover. Jim had neatly sculpted the point at which the two flyover lanes remerged with the Marylebone Road, there were tiny clay cars coming down off the flyover and one of them had knocked into a small Japanese fruiterer’s van which was coming in from the Edgware Road. Two miniature clay figures were positioned in the road gesticulating. The whole thing cut off at the point where the Lisson Grove intersection would be to the east and where the flyover reaches its apex to the west.

‘It’s nearly finished,’ said Jim. ‘Today I’m going to paint and glaze it and then I’d like you to arrange for it to be fired.’

‘Well, I can’t see any problem with that. Tell me, what’s the story behind this sculpture?’

‘It’s not a sculpture.’ He sucked in air through teeth, the weary sigh of a child. ‘It’s an altarpiece.’ He picked up the model flyover and went over to a table by the window with it. Tom giggled.

‘Jim’s got a messianic complex. He thinks that the Apocalypse isn’t coming.’

‘What does that mean?’

‘It’s a bit complicated. The Apocalypse will come when enough people have accepted that it isn’t coming.’

‘That just sounds stupid.’

‘Well it isn’t fucking stupid, it’s you who are fucking stupid, Mister Squeaky, get it!’ Tom’s voice switched from light mockery to the hair-trigger aggression of the subnormal thug. It was a startling transformation, as if he’d been possessed by a weird demon. He stalked away and joined his friend. I dismissed the insult. Busner had told me about him; it was clear that this was another act.

Over the next half-hour or so, most of the other patients on the ward trickled into the association area and came over to where their peers were already at work, mixing powder paint, working clay with fingers, cutting and pasting pictures from magazines. I was astonished by their quiet industry as a group. There seemed hardly anyone on the ward who was genuinely disruptive. Two or three of the patients stood like metronomes around the working area, swaying and rocking, marking the beat of the others’ labour.

Hilary sat at the window and worked on one of her tiny watercolours with hairline brushes. She had propped up the scrap of artboard on a little easel made from lolly sticks and she worked with deft strokes, each one pulling the mobile stand attached to the catheter in her arm, back and forth. The plastic bag that dangled from it contained a clear fluid and a particular sediment. As the stand moved back and forth this sediment puffed up in the bag, the motes occasionally catching and then gleaming in the afternoon sun that washed in through the huge windows.