The Quick

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My own face was reflected against the night: a pale moon with two dark ovals for eyes, framed by short, thick, reddishgold hair. Beyond my reflection, or rather through it, were the lighted windows of the operating theatres. I knew that at this hour it could only be the cleaners at work up there, but the sight still had a soothing effect on me, for the reasons I’ve explained. Then suddenly it didn’t. The hospital seemed to crowd in on the axis of our two sets of windows, upsetting that precious symmetry. Three floors above me, Patient DL lay on her back as she had done for a decade, beyond the reach of medicine. Down in the basement, hundreds of obsolete hard disks harboured the records of patients who would never recover. In their midst, Nestor tinkered with his new toy, awaiting the hour when, if the rumour was true, he would set off on his nightly tour of the hospital. He would throw the switch on his way out, so that the only source of light in the room would be the greenish glow of the computer screen: that snakelike waveform I had managed at last to displace – though not, perhaps, in the way Mezzanotte had intended. Hurriedly I turned my back on my own reflection, crossed the room and locked the door behind me.

5

The next morning I returned to the hospital. As the lift rose past the second floor, then the third, I prepared myself mentally for the meeting to come. I had never yet dealt with a patient whose injuries were so severe, or whose diagnosis was as uncertain as that of Patient DL’s. I told myself that she was no different from the rest, only a little further along the spectrum, the scale of handicap, and that therefore I should treat her no differently. Even if she appeared not to respond to my attempts to communicate with her, I should continue to address her in the belief that she understood. I repeated the mantra over and over in my head: she’s no different, she’s no different. But I couldn’t quite drown out the small voice that said, there is something quite unusual about this patient and you know it. The upshot of this internal wrangling was that I was nervous, and several times as the lift rose, wiped the sweaty palms of my hands on the seat of my trousers.

When the doors opened at the fifth floor the first thing that struck me was the silence. It was thick, almost palpable, and when I glanced towards a window, and saw beyond it an overcast sky punctured by a few high-rise buildings, I realised with a shock that I had never set foot on this floor before. I had dealt with patients in hospitals on the other side of the world, but this was the first time I had ventured on to the fifth floor of my own. The fourth floor was where I had conducted most of my business, where the patients were, generally speaking, responsive. The silence was like a challenge to me: is there really anything you can do here? it seemed to say. Aren’t you out of your depth?

I presented myself at the charge nurse’s desk. She gave me a friendly smile and when she spoke her voice seemed to ring out too loudly, though in fact, I realised afterwards, she spoke at a normal volume. She checked her list and informed me that the patient had no visitors at the moment. It was still only eight thirty. Her first visitor of the day would arrive at nine. ‘And who will that be?’ I asked.

‘Her father,’ she replied. ‘He comes every morning and sits with her for an hour. A nice old gentleman. Quiet as a mouse.’

She pointed towards the mouth of a long corridor whose walls had been painted dark green up to waist height and cream above, with a long, narrow, black line separating the two. These were the colours that indicated the public areas of the hospital, though public and private lost their significance on this ward, where the patients were so ill they required round-the-clock care to keep them alive. In keeping with the hospital code, though, there was also blue linoleum underfoot, rather than carpet. The only thing that set this ostensibly public ward apart from the real public wards lower down was that each patient had his or her own room – on lower floors, and along with carpet, the exclusive privilege of private patients who paid for their care.

The corridor stretched off into the further reaches of the wing. I followed it and turned right where it formed a ninetydegree angle, and left where it formed a second. As I moved further away from the nurse’s station and, as it seemed to me, the living heart of the ward, the silence grew thicker still. I’ve never been to a morgue, but I suspect that if I had it would sound something like that. The notices occasionally taped up by the doors might not be worded so differently either. One read: ‘Do not enter without gloves or apron’, another: ‘Latex allergy’. Slowly my ear grew attuned, and I began to detect the sounds of frail, struggling life: the hum and occasional click of life-support machinery. The rhythmic expansion and contraction of twenty diaphragms. The faint, almost inaudible breathing of creatures trapped between life and death.

I found myself making efforts to walk soundlessly, not to let my shoes squeak on the linoleum. Eventually I came to the last room on the corridor. It had no notice pinned up outside it, but the door was open and glancing inside I was struck by the sight of a shiny balloon floating in a yellow haze. A child’s birthday balloon, filled with helium. Semi-deflated now, with the words ‘Happy Birthday!’ looping across it, it bobbed at half mast and a low voice seemed to emanate from it. As I stepped over the threshold, I realised that the voice actually came from a TV suspended on the wall above and behind me. I naturally turned to look at the woman lying in the bed, whose line of vision I had broken, and that’s when I got the fright of my life. Her brown eyes were fixed on me, and in them was a steady gleam of contempt, as if the liquid of her iris had crystallised that way. I froze, and in the instant that our eyes met I half expected her to rear up and point an imperious finger out into the corridor. But her gaze merely slid away from me and became liquid again.

Feeling like a clumsy intruder, my heart hammering against my ribs, I lifted the clipboard out of its slot at the foot of the bed and pretended to peruse the drug chart. My hands were trembling, but I forced myself to focus on the words printed before my eyes. Name: Diane Levy. Date of birth: so-and-so. I peeped over the board. Her head lay in the same place on the pillow, but her gaze was vacant now, and dull. A thread of saliva ran from the corner of her mouth, down over her slack jaw. Breathing a sigh of relief, I glanced quickly around the room.

My first impression had been of entering a shrine or grotto, and now I saw that I wasn’t far wrong. A ledge running at waist height down the side of the room facing the bed was crowded with small objects, ornaments and such like, while the wall above it was densely covered with fragments of drawings, letters and photographs. There were several vases arranged about the room, containing flowers at various stages of freshness. At the windows hung not the usual, pale, waxy hospital curtains, but ones with a flower pattern, white on blue, good cotton and properly lined. They were cheery, the sort you might find in a nursery, and obviously home-made. At the side of the bed nearest the window a rocking chair was covered with a pink, mohair rug that carried the impression of a large person’s shoulders and haunches. On the other side, nearest the door, stood a plain, straight-backed wooden chair that had been pulled up close to the bed, and on this I now sat down.

From her date of birth I calculated that Diane had recently passed her thirty-first birthday. Close up, she looked younger than that. Almost childlike, as if the injury to her brain had also knocked her body’s internal clock, causing it to stop. There were no blemishes on her sallow skin, not a single worry line or crease of laughter. Nothing had troubled that flawless complexion for a decade, except perhaps very fleetingly, and then only a surge in electrical activity, a bubbling over of the animal parts of her nervous system. Her hair, which had been cropped high on her neck, was tousled and shiny as a conker against the snowy-white pillowcase.

I introduced myself and explained why I was there. ‘Soon some men will bring a machine,’ I said, taking care to enunciate clearly. ‘It will arrive in parts. I’ll put them together and then I’ll show you how to use it. Before you know it, you’ll be able to ask for anything you want.’

Somebody was walking in the corridor outside, I heard their footfall and turned quickly. But there was no one there, and when I turned back my heart skipped a beat. Slowly, almost as slowly as Mezzanotte’s brainwave had risen to graze the foot of the letter A, Diane was arching her eyebrows. They fell at the same controlled rate, and her lips stretched horizontally beneath the feeding tube inserted into her nostril. At that moment a light came into her eyes, as if someone had shone a torch through the back of her skull, and her face lit up with a joyous smile. Her lips parted and I saw her small, wet tongue lolling inside. I sucked in my breath. At that moment, as if she had achieved the desired effect, the light went out, and once again her dull gaze slid past me.

It’s a reflex, I told myself, a simple reflex. But what if it wasn’t? On an impulse, I leaned forward and squeezed her bony fist where it lay, immobile on the sheet, to let her know I had seen. It was cool, a little rough to the touch. I saw myself do it; from a point on the ceiling I observed my own rather secretive gesture, and I immediately felt foolish. As I straightened up and let go of her hand, I caught a whiff of something. Not the usual smell of the chronically ill, but something sugary, cloyingly sweet. A wave of nausea rose to my stomach, so powerful it pushed me up to my feet and away from the bed. Mumbling something about another appointment, promising to return soon, I backed out of the room and sped away along the corridor.

6

What was that smell? At the first turn in the corridor I slowed to a walk and racked my brains to identify it. It was almost as if she were preserved in something, infused with a very weak syrup: a living cadaver. I shuddered and walked faster. Ahead of me I heard murmuring voices, two women, one of them I recognised as belonging to the charge nurse, the other deeper, more mellifluous. I emerged from the corridor, and the two women standing by the nurse’s desk turned to look at me: Sister and Fleur Bartholomew, a neurologist I had worked with in the past and knew well.

‘Well,’ Fleur said, ‘did she turn a nice somersault for you?’ The nurse laughed, a mocking laugh, and when I looked at her she lowered her eyes to her chart. Fleur was regarding me steadily, but in a good-humoured way. She wore an emeraldgreen tunic and a towering green turban. Heavy ropes of amber beads hung around her neck, and her teeth when she smiled were like a slash of white in her polished, black face.

‘She smiled at me,’ I said. ‘I mean, I know it wasn’t… but it really seemed as if she smiled.’

I felt the blood rush to my cheeks. Fleur laughed, a deep booming laugh like a train rumbling underground, and opened her eyes to show the yellowish whites. ‘Voodoo, is it?’

I glanced at the nurse, who was smirking under her blonde eyelashes, and I asked Fleur if I could talk to her privately.

We took the lift to the third floor. The hospital lifts were old and slow, we descended with rattles and jolts. I leaned in the corner and chewed my lip, watching Fleur as she adjusted her turban in front of the mirror that covered the back wall, but without, so to speak, really seeing her. My mind was still occupied with my recent encounter. I was surprised and annoyed at myself for having been put so easily off my stride. It was as if no time had passed since my immersion in the strange world of insomnia, as if I had learned nothing from that episode and all the patients who had passed through my consulting room since. This patient had plucked emotions from me as effortlessly as if she were picking daisies, and the nurse and Fleur had seen it written on my face.

The lift stopped at the fourth floor but the doors didn’t open. It remained stationary for a minute or two, as if confused. Fleur hummed a bit, and rustled inside her silk sheath as she swung her hips out to left and right. Then, as if she had been reading my mind, she threw me a sidelong glance and told me not to tie myself up in knots. As soon as she said it, I realised how tensely I had been holding myself. Her drawing attention to it seemed to release something inside me, and in the small, enclosed space of the lift, where nobody could hear us, I told her everything I had seen; my chaotic impressions of that first meeting. I explained that the two looks Diane had given me, the one of contempt and the other of joy, had seemed somehow directed at me. I had reminded myself that her facial expressions were nothing but muscular tics, I wasn’t as easily led as all that, nevertheless it was uncanny. Even though I had only been in the room a few minutes, I had felt very strongly the presence of another intelligence.

Fleur waited until I had finished, then smiled. It was natural to feel that way the first time one met Diane, she said, because as a human being one identified with the most meagre spark of humanity in another living creature. I mustn’t underestimate the power of wishful thinking, of willing her to understand. Even as a professional, it was hard not to be led astray, down the path of hope. As a professional, though, one also had to remember that there was a simpler explanation. There was almost always a simpler explanation. ‘I know, I know,’ I said, and slumped in the corner.

With a jolt the lift started to descend again. Fleur laughed and shook her head. Everyone went through the same storm of emotions the first time they met Diane, she said. After that, you had to come to terms with her in your own way. The way she had come to think of it was that looking at Diane was a bit like ‘looking at the sea’. Everybody had their own idea about what was lurking in the depths, but they all saw the same thing: clouds reflected in the surface. I thought about this. It was a nice idea, but it wasn’t enough. I wanted to say so, but Fleur had already turned back to the mirror, and raising a hand to the back of her magnificent turban, was twisting this way and that, smiling at her reflection. A moment later, the doors opened on the third floor.

A long corridor opened up before us, and I remembered that her office was at the end of it. That meant we had to walk past the operating suites on our right. One of the doors to these suites stood ajar, and when I looked through it I saw that the room was bare. All the equipment had been stripped out, including the operating table. There was just a solitary roll of bandage on the floor, partially unravelled. I stopped and stared at it. Fleur explained that the theatres were closed for repairs. All surgery had been moved to the paediatric wing on a temporary basis. Hadn’t I read the memo? No, I murmured in dismay. Somehow memos passed me by; I never found time to read them. We walked on and entered her office, which was similar to mine, except that where I had hung my framed certificates, she had photographs. In all of the pictures two children were laughing, a boy and a girl, and their smiles were identical to hers. I remarked how happy they looked and she smiled a proud, maternal smile.

We sat down in two stiff-backed armchairs covered in tartan plaid. Fleur crossed her legs and clasped her hands on her knee. Her red-lacquered nails stuck out in all directions, like the blades of a Swiss army knife. The conversation in the lift was forgotten. Now I could see from her erect posture, the way she held her head and the flash in her intelligent eyes, that she had assumed her professional hat. She explained in a matter-of-fact way that Diane’s smile was nothing more than a reflex triggered by stimulation of the retina: a shape flitting across the light-sensitive surface at the back of the eye. It might be that the shape had to be human, but no one could be sure about that. ‘A dog might get the same warm welcome,’ she said, and laughter welled up from deep in her thorax.

‘Yes, of course,’ I said, ashamed, and I asked her about the sickly smell. But that was easily explained too, she said. Diane’s mother assiduously massaged her with creams and lotions, to keep her skin from drying out and cracking. She was the bestoiled patient in the place; a glistening advertisement for royal jelly.

I laughed and settled back in my chair. I was feeling better now. I even said, ‘I don’t know what came over me,’ but Fleur waved her hand languidly in the air as if to say, ‘Don’t give it another thought.’ Then she continued to regard me with her smiling, questioning face, as if she were waiting to find out why I had come. Eventually I reminded her of what she must already know: that I was going to be working with the patient and Mezzanotte’s machine, so I needed to know everything there was to know about her; every detail of her medical history. At that, she arched a pencilled eyebrow. ‘He’s serious, then?’

I asked her why she should doubt it, and she looked at me thoughtfully. It was two months since the professor had paid her a visit, she said, and described how he proposed to help her patient. He had asked her opinion, and she had given it: the diagnosis was uncertain, the family was split. There were certainly more suitable candidates out there. But she agreed it was an interesting case, and that if she hadn’t been so busy herself, she would have liked to spend more time getting to the bottom of it. So she wouldn’t stand in his way.

Since then she had assumed that he had abandoned his plans, having come to the conclusion himself, perhaps, that they were too ambitious. The odds against it working, in the case of this particular patient, were high. I laughed. No, no, I assured her, the professor doesn’t give up so easily. 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

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.