LITMIR.BIZ

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The project was going full steam ahead, and I was to play a central role in it. I was to oversee the patient’s training.

      She looked at me for a long time, with a strange expression, then raised her eyes to the ceiling. ‘Let me see…’ she mused, tugging meditatively at her long earlobe, from which a heavy gold ring dangled. ‘The case came to me six years ago, when Dr Seaforth, the previous consultant, retired.’

      The history was as follows. Diane Levy collapsed the day after her twenty-first birthday, on the top floor of the maisonette that she shared with her husband, Adrian. She had married the young man a year earlier, having known him for only a few months. He worked for a newspaper; she kept house and dabbled in a little painting. Until her marriage Diane had always lived with her parents. She had suffered from diabetes since early childhood and her mother had, to some extent, wrapped her in cotton wool. True, she was prone to mild vascular problems, poor circulation, and once there was a scare over her eyesight, but it turned out to be a false alarm. In fact, the chances were that she had twenty-twenty vision. It was the brain behind the eyes whose state of health, or decay, was less certain.

      Soon after the Levys returned from their honeymoon in Florence, Adrian turned the top floor of their apartment into a studio for his wife. It was here that one afternoon, surrounded by her tubes of paint and brushes, her life took its sudden, tragic turn. To begin with, there was a suspicion of foul play. But the police found no evidence of a break-in and quickly ruled out the possibility that she had opened the door to her attacker. There was bruising on her neck and on the back of her head, which could have been caused by a blow, a fall, some internal, physiological process or a combination of all three. The police eventually called off their investigation. Most likely there was no third party involved, and she had merely suffered a thrombosis or clot related to her underlying diabetes. While she stood at her easel, dabbing at a canvas, it travelled through her blood vessels to the stem of her brain, where it became lodged, blocking the supply of oxygen to the cerebral organ higher up. She fell to the floor, unconscious, and was found there three hours later by her husband.

      At that point Levy called an ambulance and Diane was rushed to the nearest hospital, where she remained in a coma for several days. Then she woke up. That is to say, she opened her eyes and scalp recordings of her brain’s electrical activity indicated that she had recovered some form of sleep/wake cycle. It wasn’t obvious from looking at her, and in all other respects her condition stayed the same. After a couple of weeks, once it had stabilised, she was flown by helicopter to this hospital where she had remained ever since.

      Extending a smooth, bare arm from her voluminous green sleeve, Fleur now slid a thick dossier off the desk and, leaning forward, laid it in my lap. Lifting the cover with one finger, I took in the mass of poorly shuffled papers interleaved with glossy, grainy, black-and-white brain scans, and felt the familiar pulse of adrenalin at the prospect of a new case, a new challenge, and many different strands of evidence to marshal and make sense of. I let the cover drop, laid a protective hand over the top of it and paid attention once again to Fleur.

      From the beginning, she was saying, many doctors came to examine Diane. They filed past her bed ‘like cardinals at a pope’s funeral’. There were certain fundamentals they all agreed on. For instance, that she could breathe by herself, but not swallow; that she had no control over her muscles, except possibly for those that allowed her to blink, and others that controlled the direction of her gaze. For all practical purposes, she was paralysed. Some of the doctors had been inclined to write her off as a hopeless case even then, but scans of her brain brought them up short. Apart from a few isolated spots of nerve cell loss, the scans showed that most of her grey matter had been preserved. The grey matter is the seat of language, thought and memory. So the puzzle then was, if she was awake and listening, if she remembered who she was and recognised the people who came into her room, why didn’t she make use of her eyes to signal to them?

      She hadn’t. Not a sign in ten years. Only that disconcerting, mechanical smile and one or two other idiosyncratic facial tics. Over this incontrovertible fact the experts had fallen out. They simply could not agree on how much of Diane’s intellect and personality remained. Having failed to reach a consensus, they had split themselves into two camps. One camp considered her to have a primitive form of consciousness; that, at best, she could recognise a familiar voice and respond to it. Beyond that, they felt, her intellectual capacities were nil. This group believed that the scans that were carried out ten years ago, when Diane first came to the hospital, were not fine enough to reveal the critical lesion, the one that had erased her mind, her soul or whatever you liked to call it. Since then science had advanced in leaps and bounds, the technology had become far more sophisticated and some of them had petitioned to have her rescanned, believing that now they would certainly find that spot of dead tissue; the physical location of her extinguished life force. But her husband had steadfastly refused, arguing that it wouldn’t cure her, but it would cause her unnecessary distress. So the question remained unresolved, much to those doctors’ chagrin.

      The second group, by contrast, believed that there was no critical lesion. In their opinion, Diane was neurologically intact, conscious and aware of all that was going on around her, but had her own reasons for not communicating her status to the world. She was depressed, they suggested, and had retreated into herself. Perhaps, just prior to her injury, something had so shocked her that she had voluntarily turned mute. Her physical paralysis masked an emotional one. It must have been a very great shock to have silenced her for a decade. But since no psychiatrist could interview her, there was no drawing it out of her.

      Fleur fell silent and turned her big brown eyes on me, as if calmly anticipating my next question.

      ‘So,’ I said, after a moment’s reflection, ‘to go back to your cloud metaphor, either the clouds hide shoals of fish, coral, a shipwreck or two, that is, life as we know it goes on beneath the ocean wave. Or behind the clouds there are more clouds, and more clouds behind that.’

      She nodded, evidently pleased that I had been listening, and I asked her which camp she belonged to. She sighed and rolled her eyes. First, she said, she had allied herself with the optimists, those who claimed that Diane was ‘in there’, and all that was needed was the right incentive to lure her out. But with time, and no new evidence, she had shifted her ground. She had moved towards the pessimists, those who believed there was no hope, and that Diane’s consciousness was too fragmentary to afford her any meaningful interaction with the world; that she might indeed be better off dead. I looked at the floor, momentarily gripped by the futility of the exercise. Above my head, Fleur was still speaking. ‘But that didn’t feel right either…’

      I raised my eyes cautiously. She laughed, holding up the pale palms of her hands as if in surrender. ‘… so now I’ve set up a third camp. I call it wait-and-see camp…’ I slipped back into the recesses of my chair and gazed at her. Then I asked her one or two more questions. There were some technical details I wanted to clarify. After that Fleur walked me to the door, her fleshy hand resting affectionately on my shoulder. She asked me to come and see her again in a fortnight. I thanked her and said I would certainly keep her abreast of developments. But she tightened her grip on my shoulder and made me promise to return, in person, in two weeks’ time. By then I would have established a rapport with the patient, she said (even if that rapport existed only in my own mind), I would have met the family. Despite all my best intentions I would have been drawn into the case. She would like to make sure I didn’t lose sight of the facts; to act as my anchor in the real world.

      ‘You think she’s harmless because she doesn’t speak,’ she added. ‘But they’re the most dangerous kind.’

      And bending stiffly at the waist, rustling inside her silk sheath, she hugged me to her breast.

      I wandered slowly back along the corridor towards the lifts, clutching the bulging dossier, mulling over all Fleur had told me and smiling at her last piece of advice. Glancing absentmindedly into an empty room, I saw again that partially unravelled roll of bandage on the floor – the only evidence that the room had once functioned as an operating theatre – and felt the same stab of surprise as I had the first time I saw it, just half an hour earlier. I gazed at it for a moment, then walked on to where the lift doors stood open and waiting for me.

      7

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