Authors: S. J. Bolton
‘When do you leave?’ asked the pale young woman in the wheelchair. Her eyes looked too large in her face and had grown dull since he’d last seen her. They didn’t look like violet pansies any more.
‘Today,’ said Harry. Then he looked up the hill to where his loaded car was parked. ‘Now,’ he added. He’d said his goodbyes over the previous few days. This one would be the last.
‘Are you OK?’ she asked.
‘Not really. You?’ He hadn’t meant to sound angry – she had problems of her own, he knew that. He just hadn’t been able to help it.
‘Harry, you should talk to someone. You need to—’
He couldn’t look at her again. If he looked at her he’d never be able to leave. ‘Evi,’ he managed, ‘I can’t talk to God any more, and you won’t let me talk to you. There really isn’t anyone else. Look after yourself.’
He turned from the grave and found the path. The other mourners had all disappeared. It was far too cold to be outside for long. As he strode up the hill, he heard the sexton begin to shovel earth on to the coffin. Thud, thud.
He thought perhaps he heard the squeak of Evi’s wheelchair, but he wasn’t looking back.
Thud, thud. Harry quickened his pace and the sound of earth falling on to wood seemed to follow him up the hill. The sexton was working fast. Before the hour was done the new grave would be complete, a soft mound of soil covered with flowers. They’d fade and die, of course, flowers always did, but people would bring others, they’d keep the grave neat. The people who hadn’t cared much for Gillian in life would look after her grave.
They honoured their dead in Heptonclough; some of them, at least.
Heptonclough
Heptonclough was inspired by, but not based upon, the village of Heptonstall (from the old English hep – wild rose, and tunstall – farmstead) on the Yorkshire Pennines, not far from the border with Lancashire. Like its fictional counterpart, Heptonstall owed its early wealth to the wool trade and today boasts two churches (one old, one very old), the White Lion pub, the old grammar school and numerous cobbled streets lined with tall stone houses. Visitors should not look for Wite Lane, the Abbot’s House or the Fletcher family’s shiny new home, but teenage boys can definitely be seen riding their bikes around the old church walls. I’ve watched them do it.
Congenital Hypothyroidism
‘I see a head of unusual form and size, a squat and bloated figure, a stupid look, bleared hollow and heavy eyes, thick projecting eyelids, and a flat nose. His face is of a leaden hue, his skin dirty, flabby, covered with tetters and his thick tongue hangs down over his moist livid lips. His mouth, always open and full of saliva, shows teeth going to decay. His chest is narrow, his back curved, his breath asthmatic, his limbs short, misshapen, without power. The knees are thick and inclined inward, the feet flat. The large head drops
listlessly on the breast; the abdomen is like a bag.’
Beaupre,
Dissertation sur les cretins, c.
1850
Congenital hypothyroidism, which can be genetic, sporadic or endemic, is a condition of severely stunted physical and mental development, caused by a deficiency of the hormone thyroxine. In the UK around one in every 3,500 to 4,000 children are born with congenital hypothyroidism. Similar rates are reported in the USA and continental Europe. It is more common in girls than in boys, but the reason for this is currently unknown.
Without treatment, adult stature is below average, ranging from 1 to 1.6 metres; bone maturation and puberty are severely delayed and infertility is common. Neurological impairment, of varying degrees of severity, is to be expected. Cognitive development, thought and reflexes are slower. Other signs of the condition may include thickened skin, enlarged tongue or a protruding abdomen.
Fortunately, genetic and sporadic congenital hypothyroidism, caused by abnormal development of the thyroid gland before birth, has been almost completely eliminated in developed countries by newborn-screening schemes and lifelong treatment.
The endemic condition arises from a diet deficient in iodine: the essential trace element that the body needs to produce thyroid hormones. The soils of many inland areas on all continents are iodine deficient and food produced there is correspondingly deficient. Iodine deficiency causes gradual enlargement of the thyroid gland, and the resulting growth is referred to as a goitre. The endemic form of the condition continues to be a major public-health problem in many undeveloped countries.
‘Cretin’, from an Alpine-French dialect spoken in a region where sufferers were especially common, became a medical term in the eighteenth century. It saw considerable medical use in the nineteenth and early twentieth centuries, and then spread more widely in popular English as a derogatory term for someone who behaves stupidly. Because of its pejorative connotations in popular speech, health-care workers have mostly now ceased use of the term.
One of the most rewarding aspects of writing is the opportunity to learn, and the following taught me a lot:
A History of Psychiatry
by Edward Shorter;
Basic Child Psychiatry
by Philip Barker;
Crime Scene to Court: the Essentials of Forensic Science
edited by P. C. White;
Postmortem: Establishing the Cause of Death
by Dr Steven A. Koehler and Dr Cyril H. Wecht; and
Practical Church Management
by James Behrens.
Avril Neal, Jacqui and Nick Socrates, Denise Stott and Adrian Summons continue to do sterling work, not only reading and correcting my early manuscripts but also patiently providing advice and information throughout the writing process. Dr Miraldine Rosser joined ‘the team’ this year, and her help in making Evi a credible psychiatrist was invaluable. Thank you, all of you, and as always, any remaining mistakes are mine.
The folk at Transworld continue to be supportive, encouraging, hardworking and wise. I’m particularly grateful to Sarah Turner, Laura Sherlock, Lynsey Dalladay, Nick Robinson and Kate Samano. In the US, my thanks as ever to Kelley Ragland and Matthew Martz of Minotaur Books.
As for Anne-Marie, Rosie, Jessica and Peter: it simply would not be the same without you.