LITMIR.BIZ

       For Richard

      1

      Patient DL had already been in the hospital ten years before I discovered her. She occupied a small room at the end of a corridor on the top floor, forgotten by all except her visitors and the staff who cared for her. There had been no change in her condition in a decade, no deterioration towards death nor stirring of life. It was a sad case, because she was quite a young woman, and it was the opinion of her doctors that she would remain that way until her natural death, or until someone put an end to her life – whichever happened first.

      I arrived at the hospital seven years after DL. I brought with me quite a reputation, and by the time I took up my post it was understood that I would see only the most difficult cases. It was therefore only a matter of time before I came across her, she who was to become my obsession, the most tantalising and elusive of my patients. She had already been there so long she was considered a part of the fabric of the place, as essential to it as the lift shafts, operating theatres and incinerators. It was as if Patient DL, or someone like her, had always occupied that small room at the end of the corridor on the fifth floor.

      Sooner or later, then, I would find my way to her. And yet for three long years I managed to avoid it. No whisper of her ever reached me, even though I must have passed people in the corridors, or nodded to them in the lifts, who had seen her with their own eyes. How could that be? I can’t explain, except to say that in some strange way, I feel it could only have happened in that place.

      After DL entered the hospital, the city underwent a period of rapid change. It was the first decade of a new millennium, some said the dawn of a new enlightenment, and the poli -t icians were in empire-building mood. They gave the architects free rein, and the architects played with the skyline like plasticine. Their techniques and materials had advanced to such a level that they could afford to have a little fun at last. I would glance upwards and laugh – I admired their playfulness. But the hospital was older, more earthbound. It wasn’t designed to draw attention to itself, but to shelter, or to hide, the most fragile of our brethren. It squatted at the heart of this giddy, gaudy construction site, like a trapdoor you might stumble through by chance.

      Everybody knew about that grand old hospital, with its historic reputation: backdrop to some of the greatest discoveries in medicine. But ask them to point to it on a map, and they would shrug their shoulders and grin. It was all but invisible to the untrained eye, and this invisibility was only partly an accident of town planning. The front of the hospital, the tip of the iceberg, occupied one side of a pretty Georgian square which was reached by several cobbled alleyways. These narrow openings – just wide enough to admit an ambulance – were easy to miss. If you peered into them from the busy street outside, they looked dark and uninviting. So people carried on walking into the brightly lit theatre district, or in the other direction, to the museums and restaurants. They rarely came to the square without an appointment, unless they arrived by ambulance, or fell in drunk. And so it was cut off from the city that encircled and pressed in on it, like an eddy in a fastflowing river.

      On passing through one of the narrow alleyways, and emerging into this peaceful backwater, the newcomer would be presented with a red-brick, rather austere building, with a gabled roof and regimented rows of small windows. In fact, that façade was deceptive, because grey, military-style blocks stretched back for some distance behind it, fanning out in all directions. There was a wide entrance with a flight of shallow steps leading up to it, a long ramp for wheelchair users and an ambulance bay on the street. Nowhere on the front of the building would you find the word ‘hospital’, something the reader might find hard to believe, until I explain that it had no emergency department, and the administration wished to discourage the scourge of every casualty room – the hospital tourist – from dropping in. Even the ambulances that served it lacked the usual characteristic markings. So it was only when you entered the building, and sometimes not even then, that you realised what kind of a place you had come to.

      What was that place? To those in the know, it was the country’s leading authority on the treatment of brain disease. That was its reputation at the time I’m writing about, the beginning of the new millennium, but originally its purpose was to treat psychiatric patients – those suffering from disorders of the mind. The distinction has now largely lost its signi ficance – the mind being considered a product of the brain, not able to exist separately from it – but the outdated ideas persisted in bricks and mortar, and many new visitors remarked, on gazing up at the façade, that the hospital had the look and feel of an asylum about it.

      The unhappy illusion persisted when you stepped inside. The architect had followed his instructions to the letter, and his instructions a century or more back were that patients were more likely to recover if they were only exposed to others with the same flavour of insanity as themselves. It gave their universe some coherence, the thinking went. So as soon as you passed through the grand portal you found yourself in a large, echoing hall, with the feel of a railway station about it. In the middle, a white-painted signpost pointed into the mouths of three wide corridors, exacerbating the feeling that you were embarking on a journey, destination unknown. The children were led off to the west wing, the elderly to the east; everyone else straight on, to the north.

      The north wing was much bigger than the other two. It consisted of a solid, five-storey block built around a rectangle of garden. The first three floors housed the administrative offices, consulting rooms and operating theatres; the top two, the wards. These were divided up again, according to whether the patients were surgical or non-surgical, public or private. A colour-coding system told you which sector you were in at any time. The top floor was reserved for the long-term, gravely ill.

      This north wing was the place I dreamed of graduating to during the years after I completed my training, years I spent in a series of provincial hospitals. Finally, the longed-for invitation came and I took up residence there. I was given a suite of rooms on the second floor, and a couple of assistants to deal with the run-of-the-mill cases – the dementias, common aphasias and so forth. Patients were brought down to my rooms from the wards, in wheelchairs or leaning on sticks, and my assistants would sit them down and, with smiles and encouraging nods, ask them to name a picture of a French horn or a microscope. If the patient was bedridden, or prone to lapses in consciousness, one of them would ride up in the lift and perform the tests at the bedside. Meanwhile, I devoted my attention to conditions so rare a specialist would be lucky to come across one in his lifetime. Often I never laid eyes on the patient. Doctors sent me meticulous descriptions from hospitals I hadn’t heard of, in countries I’d never visited. I would pass happy hours, my window open on to the garden, which smelt wonderfully of daffodils in spring, and roses in summer, devising new ways of probing their inner life. New tasks to set them, new games to play.

      The essential problem for me, always, was to get past the patient’s diminished ability to communicate, to see what was preserved behind – like tapping a wall until it gave back a hollow ring, then stripping away layers of wallpaper to reveal the panelled door beneath. To ask, ‘What seems to be the problem?’, but not in words. I used line drawings, flashes of light, music. I might ask the patient to press a button when a certain sequence of numbers appeared, or the face of a famous person. With my help, the doctors in La Paz showed that the bullet that had robbed an Indian boy of speech, had also liberated a prodigious talent for long division. An old woman living on the shores of Lake Garda, supposedly struck dumb by a stroke, discovered that it was only Italian she had lost: if someone addressed her in her mother tongue, the Veronese dialect she had learned as a child and long since abandoned, she responded fluently, if with a rather limited, infantile vocabulary.

      Those are well-known stories now, of course; the patients enjoy a certain notoriety, even make a modest living from their talents, or defects. They travel the world from laboratory to laboratory, willingly subjecting themselves to new and ever more elaborate attempts to probe the secrets of their brains. They have turned their idiosyncrasies to their advantage, and created a cottage industry. Meanwhile, new curiosities are born every day, in the pages

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