The Quick

LAURA SPINNEY

The Quick

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 of obscure journals, from where a select few of them will rise to neurological stardom.

My name would often be included among the authors of such a paper. My long list of publications, all of them in prestigious journals, earned me the right to organise my time as I saw fit, and not to have to venture too often above the second floor. On the rare occasions that I did, I was accompanied by a consultant, various other specialists and, of course, my two assistants. With this retinue making constant demands on my attention, asking my opinion on this or that, I had little opportunity to look to left or right. Blinkered as I was, I failed to notice the patient who lay three floors above my office, unable to move or speak, whose doctors considered beyond my help. In hindsight, it seems only right that Mezzanotte should have been the one to draw her to my attention, he who always knew where to look for the most interesting question, and then how to go about answering it.

2

That hospital, detached though it was from the city it served, represented my ideal of modern medicine. The people who ran it, the director and her deputies, didn’t parade through the corridors inspecting the work in progress. They were discreet, in fact we never saw them, but their competence was evident in its smooth running. Patients always left better off than when they had entered, unless there was nothing that could be done for them, or unless they left via the cremator -ium chimney, which was the only other possible exit. Everything that happened happened for a reason, and being able to count myself among its several hundred employees, I admit, only added to my sense of its rightness.

I preferred to be in my office than in the small flat that had been provided for me nearby. I went home to sleep, to change my clothes and pick up my post. If I was obliged to wait around there in the day, to receive a delivery, say, or because it was Sunday, I quickly began to feel restless. I preferred to walk the short distance to the theatres, pick one at random and lose myself in a fictional world for a few hours. But above all, I longed to be back in my office. It was a source of great pleasure to me to turn my chair to face the window, to see beyond it the facing side of the north wing, which enclosed our little garden.

My office was small, but comfortable. It was painted white, and there was room for the desk, a couple of armchairs and some bookshelves. On the wall by the door, in two symmetrical rows, were arranged the framed certificates which, with ribbons and seals, announced my membership of various professional organisations. I would have to step right up to the window to look down on the garden, on the mosaic of lawn, flower beds and paths lined with benches and ornamental fruit trees. But it was enough for me to know it was there. The paediatric and geriatric wings were too small to have gardens. But the north wing did, and that lent it a certain grandeur. It made it the spiritual heart of the hospital; its soul. More than that, the lighted windows on the third floor of the other side appealed to my liking for symmetry.

The reason was that those squares of frosted glass belonged to the operating theatres. Behind them, under the bright theatre lights, faceless surgeons in green overalls, caps and masks drilled through cranium, lifted flaps of bone and scooped out tumours. They inserted grafts, or probes, applied pulses of electricity, then retreated through tough, transparent curtains of membrane, stitching them up behind them as they went. They repaired the hardware, and after the patient had spent a little time recuperating on the wards, I would start the slow process of reprogramming it. I made good on their promises. Our efforts complemented each other entirely.

And so it went on. For three long years, between us, we sculpted the material at our disposal and sent it back into the world, to use the frightful jargon, in a more highly functioning state. There was no let-up in the work. As the recognised authority on every kind of brain disease, we were supplied by hospitals all over the country – those hospitals I had worked in previously, at earlier stages of my career – and even hospitals in Europe and further afield.

If there was ever a pause in my daily schedule, perhaps because a patient had failed to turn up for an appointment, or died in the night, I would lean back in my chair, close my eyes and let my mind wander. Often, in those rare, peaceful moments, I would think of Mezzanotte. We hadn’t spoken since I had taken up my post (it was he who tipped me off, by telephone, before I received the official letter of invitation), but I felt his exacting, enquiring presence all around me. He was, in fact, less than a kilometre away as the crow flies, in a large, light office at the top of one of the architects’ new follies – a rhomboid in glass and steel. From there, he commanded six hundred square metres of state-of-the-art laboratory and all those who laboured in it.

My debt to Mezzanotte was so great that it could never be repaid. I first went to work for him almost by chance. I simply answered an advertisement in one of our professional journals, not knowing who had placed it. At the time he was interested in the question of why we sleep, and hunting for clues among the human sleep anomalies: insomnia, narcolepsy, incubi or night terrors. But mainly insomnia. Even then, he ran a large group and I forget who it was who interviewed me. But I was accepted and my duties were explained to me. I was to interview the patients, note their symptoms and perform the various psychological tests. Last but not least, I had to make sure they understood they weren’t being offered a cure.

For this task I was allocated one of the old teaching rooms in the university’s Department of Anatomy, a few streets away from the hospital. It was lonely work, and back then I was still inexperienced. In my field, in the medical profession as a whole, you have to develop an immunity to human suffering or the first hard-luck story will pierce you through. But my outer casing hadn’t sealed over yet and I quickly discovered what a lack of sleep could do to people. In the most extreme cases, it turned them into monsters. A procession of unravelled men and women trooped through my room, red-eyed and raw, and told me such tales of woe that at the end of every day I would break down in tears.

My contract lasted three months, and during that time I never once spoke to Mezzanotte or even stood in the same room as him. I saw him occasionally, from a distance, striding across a street, his head turned away from me. He wore an ivory silk scarf wound tightly round his neck, and his left hand was always tucked into his jacket pocket, as if he were concealing something there. I had seen his picture, of course, many times, though he was still some way off the height of his fame – not yet a household name. He was forty-five years old. A tall man, slightly stooped, he wore beautifully cut tweed jackets a little too long beyond their natural lifetime. In the olive-skinned oval of his face burned two dark, soulful eyes. He had a high brow framed by thick brown curls, and soft, full lips. A passionate-looking Mediterranean, but reserved – some would say, cold as ice. The passion lay in the features he had been given, not in the way he used them. His face was curiously expressionless, and the general view in scientific circles, though it was only whispered, was that his brilliance hid a lack of human feeling – something I later found to be not quite accurate.

What I knew about the professor at that time necessarily came to me second-hand. He was born of mixed stock, of an aristocratic Italian father and a mother of unknown origin, possibly Hungarian. Mezzanotte spoke five languages, but understood or read several more; he was knowledgeable about sixteenth-century Italian art, and had built up his own collection of paintings which circulated on permanent loan, since he himself was of no fixed abode. By that I mean that he moved around the world, led by the latest question that obsessed him and the location of the tools and people he needed to answer it. He was at home anywhere in Europe and had lived happily in the Arizona desert too. He had left behind laboratories in Trieste, Copenhagen, Tucson and Tokyo, all of which continued to thrive, and his name had been mentioned in the same breath as the Nobel Prize – though back then, he had yet to win it.

He had what you might call the Midas touch when it came to his science, and though there was certainly a ruthlessness to his pursuit of the truth, most of the rumours about him – that he manipulated his data, that he harassed his female students, then fired them for his own mistakes – had not stood up to scrutiny. There were stories of women who had come close to him, of men too, but even if they were true the affairs can’t have lasted long because I never heard the same name repeated twice. He was the object of great admiration, but also, inevitably, of envy. The head of the anatomy department explained to me, not unkindly, that my part in the sleep project mattered very little to the maestro. He was far more deeply involved in another series of experiments, the brainchild of a brilliant young student from East Germany, which involved tweaking the circadian rhythms of mice, sending them to sleep and waking them up again with the wave of a chemical wand.

Later he moved on to other questions. How much of the world do our waking brains perceive? Do we log every new detail, every change in our environment, or are we more slapdash? Do we sample it crudely and fill in the gaps from memory, from imagination? But those experiments, the ones with the sleeping mice, were the ones for which he would be remembered. They won him the prize and secured him the directorship of the new brain sciences institute. A certain type of patient came to see him as their hero and saviour. People in the street, even the healthy ones, knew his name – but only long after his work had already changed their lives in subtle ways they could never imagine.

What happened to the East German prodigy, Franz Kalb, I don’t know. I never heard of him again. My insomniacs fell by the wayside, but perhaps my hard work was noticed, or perhaps (as I prefer to think) I unwittingly offered Mezzanotte some small insight that prodded him along the road to fame, because I was handsomely rewarded for my efforts. Once a year, sometimes less often, sometimes more, he would invite me back to work for him, to census and survey a certain patient population, or even just to observe and describe a single, unusual case. Even after I had left the city, the summons would find me, whichever town I happened to be working in at the time. I accepted without a second thought, working overtime so as not to annoy my boss. I could always count on the work being interesting, and even if I was kept in the dark as to where it was leading, I felt myself a part of something grand and momentous; a universal movement towards the light. Because I knew in a general sense what the adventure held for me, the day the summons arrived was always a day of great joy. I would walk around the hospital with a smile on my lips and a feeling that I had been singled out for some special purpose.

The professor and I never spoke more than was necessary, we met only to discuss the work, but I remember every detail of those meetings: how he reclined in his chair and pressed his clasped hands down on his springy brown curls when meditating on a problem; the greedy look that came into his eye when he thought he had found the solution; his habit, when the solution eluded him, of standing up suddenly, circling the desk and coming to a halt somewhere behind me. There he would linger for a few minutes, quite still and without making a sound – like one of those hawks you see hovering over the motorway verge, waiting for a small woodland creature to stray into the space beneath its talons. I don’t know if he was looking at me, or if he was even aware of my presence, but the hairs on the back of my neck would stand up anyway. I came to recognise those moments as the calm before the storm, the brief interlude during which he dismantled his conscious mind and waited for some insight to well up from the depths. I would sit perfectly still, not daring to move in case I broke the spell. It was rare that an idea didn’t occur to him, but on the few occasions that happened I would be summarily dismissed, without explanation or platitudes. In the early days I used to wonder why he asked me there at all, so little did I contribute. But it seems that in some strange way I was necessary to him, if only as a sounding board, a witness.

Over the years I thought I discerned a subtle change in his attitude towards me: an increase in warmth. At some point he started to call me by my first name, Sarah, but even then it didn’t occur to me to call him by anything other than his proper title. Our relationship was rooted firmly in the old-fashioned, continental tradition of respect for your elders; of maintaining a formal distance between master and pupil. Only once did I venture too close. During one of our meetings I was distracted, and when he asked me where my mind was I blurted out news of a tragic event that had happened to me, the loss of someone I had loved. He merely turned to gaze out of the window, and when he spoke again, it was to continue the scientific discussion where we had left it off.

That was early on, when I was still soft in places. I didn’t know what I had done to offend him, I was in turmoil for days, and he never enlightened me. I had the impression that he was a very private, if ambitious man. My admiration for him anyway verged on the unconditional, not only because he provided me with a lifeline during those dull years in the sticks, but also because I had seen him at work, and known myself to be in the presence of a great mind. Some time later, after I had taken the decision to throw myself into my work, to make that the focus of my life, things changed. Rather, my view of him changed. It came to me out of the blue one day: without knowing anything about him, I was probably the person closest to him in the world, and vice versa.

But I’m getting ahead of myself. I had been at the hospital three years, and in that time I hadn’t heard a whisper from him. It was a longer silence than usual, but that didn’t worry me. I felt sure, though he had never explicitly told me, that he followed my work closely through the journals, perhaps also through word of mouth. He never neglected to congratulate me on a paper that had received polite reviews, and his praise was a source of great pride to me. I ran over it in my mind for days afterwards, savouring every word. He watched my star steadily rise, and I strove not to disappoint him. I knew also that as sure as summer follows spring, I would one day receive a note from him, asking me to return to what he called my ‘real’ work.

At last it came. It was a cold afternoon towards the end of January, the last in a week of freezing fogs and snowstorms. The sky beyond the window was darkening, the lights across the way burned more brightly than usual. I was working on a difficult case, a lawyer from Cardiff who, following a car accident and a mild concussion, had reported seeing things: ants filing across his pillow, bears crouching in corners. He suffered from hallucinations, all right, but since his accident he had become immune to the common-or-garden visual illusions – the Necker cube, Escher’s reversible staircase or some of the other ambiguous images.