The Quick

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

Back in my office I set Patient DL’s notes aside and turned my attention to the files already there. Opening one I settled down to read it, but I kept seeing that partially unravelled roll of bandage in my mind’s eye. I glanced over my shoulder at the lights on the third floor opposite, knowing now that those rooms were empty and the light came from the corridor beyond. It didn’t help to tell myself that the operations were going on as usual, in another part of the hospital, because the fact was that they were no longer there, where they should have been. Knowing that ruined my concentration.

I gave up trying to read, got up from my desk and walked out of my office. Seeing one of my assistants helping a young man on a crutch limp into his room, I told him I had been called to see a patient in the geriatric wing and that I would be back as soon as possible.

The entrance hall was busy. Porters were crossing it in different directions, briskly pushing patients in wheelchairs. A family stood near the signpost looking lost and a female guide was giving a tour to a group of men in suits, who with their heads tipped back, were politely inspecting the stained-glass window above the great door, which depicted various ancient and obsolete forms of healing. I walked past them, heading in the direction of the geriatric wing.

As I’ve explained, the paediatric and geriatric wings were smaller than the north wing and had no gardens of their own. However, the geriatric wing did have one distinguishing feature: a small, circular chapel built just beyond the end of it, which was reached by a gravel path that extended from a door in the wall of the building. This chapel was of a rather unusual design. Inside, it was arranged on a hexagonal plan, with six recesses facing a central pulpit. In the days when the hospital was an asylum, each alcove would accommodate a different category of patient, who were prevented from seeing the others but had a full view of the priest at the centre. At the time, the prevailing wisdom was that the different varieties of insanity mixed badly, so it was thought that the drunks should be separated from the suicides who should not be allowed to mingle with the prostitutes.

This chapel was where I now headed. There was no one else there, and I sat down in one of the empty recesses, breathing in the odour of warm stone and wood polish. I am not religious, but I believe that churches are the last corners of our cities that are conducive to quiet reflection. Perhaps because no one goes there any more. And for that very reason, perversely, people might come back to God.

A chapel in the geriatric wing of a hospital is quieter than most, and this was where I went when I wanted to think through a knotty problem. After a few minutes I heard the heavy door of the chapel open and then the slow shuffling of feet and the rhythmic tap of a cane. It sounded, from their muffled voices, like two old men. They sat down in the recess next to mine, close to the wall against which I leaned, and continued their conversation in hushed tones. Their quavering, feeble voices, issuing no doubt through false teeth, rose up to the vaulted ceiling and echoed round the walls. I let the soft, insipid sound wash over me, but at one point one of them said something that made me prick up my ears.

‘Latimer is off-limits,’ he said, and I recognised the name of one of the geriatric wards. I didn’t catch the other’s reply, something about a sore throat. Then the first said that was how it started, with a ticklish throat. He for one didn’t intend to hang about, he had a good mind to discharge himself that afternoon, even though he didn’t know how he’d manage by himself, especially when it came to his dressings. I waited to hear what else they would say. But the conversation turned into a dispute over a card game and I lost interest. The volume of the old men’s voices gradually increased until it became intrusive, and I was obliged to clear my throat. They broke off their argument in a surprised silence. A few minutes later I heard the tap of a stick and more shuffling, and then the heavy oak door open and close.

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