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.

My intuition told me that this was one of those rare gems that had something important to teach me, something fundamental about the nature of consciousness, and I felt the stirrings of excitement. What switch had been thrown in the lawyer’s brain, that illusion had become reality and reality illusion for him? If fate hadn’t intervened, it might have been that lawyer, rather than Patient DL, with whom my destiny was to become entangled. But Mezzanotte decreed otherwise. As I sat at my desk on that winter afternoon, poring over my papers, oblivious to the approaching storm, one of my assistants came into my office and handed me a note. It was unsigned, but I recognised the handwriting immediately. Without a word to my assistant, I put aside the lawyer’s file and walked out of the room.

The first snowflake fell as I turned into one of the narrow tunnels that led to the outside world and, just as I emerged into the city traffic, the blizzard broke. I hurried through the swirling air, groping my way along the familiar route, until the snowstorm began to subside and I found myself standing in front of the new institute, which towered above me like a beacon against the purple sky, its giant windows ablaze. When I entered I found myself at the centre of a swarming, excited crowd. A symposium seemed to have just broken up and young men and women were flinging themselves through the sprung doors of the lecture theatre and dispersing in all directions, as if in a hurry to put what they had just learned into effect.

I stopped a young man with starry, bespectacled eyes who told me I would find the professor in his office. He had excused himself from the lecture on the grounds that he was tied up with an important experiment. I took the lift to the top floor, nodded at the two secretaries whose desks flanked his door, and knocked. Hearing no response, at a signal from the senior of the two ladies, I opened the door slightly, put my head around it and caught my breath. Across a large expanse of blue carpet, the professor was seated behind his desk, his back to a window beyond which the whole city was laid out, sparkling. The river kinked just there, beneath him, a black hole in the centre of the picture which drew to its edges the densest part of the galaxy of light. The disembodied dome of the cathedral gleamed beyond his left shoulder, and cranes loomed over the landscape like ponderous dinosaurs, lit up by Christmas lights. He was beckoning to me with a long, slender finger, then carrying it to his lips to indicate that I should not speak.

I approached his desk and stood there, waiting for him to finish. I took the opportunity to observe him. He was, by then, in his mid-sixties. His curls had turned white and fanned back from his noble forehead in a crenellated shock, lending him an air of distinction that was accentuated by the ivory cravat. Since I had seen him last, new creases had scored his forehead and lines ran down from the corners of his eyes like guy ropes. They seemed to lend his now rather gaunt face a new mobility, as if a mask had been peeled away or melted. The eyes were as dark and soulful as ever. A number of rubber pads were attached to his forehead and temples, and from these sprouted plastic-coated wires. Around him, on the desk, were arranged various grey metal boxes covered with knobs, dials and colourful, blinking lights. The professor was staring intently at a computer monitor whose greenish light threw into sharp relief the deep fissures in his face.

After a few minutes, with a sigh of expended effort, he pushed the monitor round so that I could read the words that were written there: ‘Good afternoon, Sarah. I, Mezzanotte, invite you humbly, and through the medium of my slow cortical potentials, to immerse yourself once again in your work.’

It hadn’t escaped my notice that there was no keyboard on the desk, and for a moment I was confused. How had he magicked the words on to the screen? He watched me, a little smile playing about his lips. And then he opened his arms as if to embrace the grey boxes scattered around him. These, he informed me, represented the culmination of three years’ work. He had been following a hunch, and if it turned out to be correct, it would draw all the other threads of his scientific enquiry together; it would make sense of his life’s work. He considered it the greatest idea of his career; more important than his sleep experiments, and far more audacious. He had proved it in principle (here he nodded towards the screen), and now the time had come to test it in the real world – the task for which he had summoned me.

‘Here I am,’ I said, my pulse quickening. ‘Give me my instructions.’

At a sign from him I dragged a chair to the desk, sat down and rested my elbows on top of it. He lowered his head towards mine. And for the next hour, perhaps two, I listened in mounting awe as he explained the conception, gestation and birth of a revolutionary device – one he had developed secretly, and whose potential, he hinted, could not even be dreamed at.

3

At the top of the screen was a cartoon apple; at the bottom a pear. In between, travelling from left to right, a thread-thin waveform. It was spiky in places and somewhat irregular, but the overall motion was of a sort of languid undulation – hypnotic, potentially, if one watched it for long enough. This, the professor explained, was a readout of his slow cortical potentials, a form of brain activity about which very little was known, except that it seemed to arise spontaneously within the grey matter in the instant preceding any thought or action. Normally, one wasn’t aware of it. But it was possible, with hard work, to gain control over it; to wield it as an extra limb and make it do your will.

He asked me which fruit I preferred and I told him. ‘Now watch,’ he said, and like a whip the wave leapt up out of its resting place and lashed the apple-shaped icon, causing it to disappear. I glanced at his hands, which had remained neatly and conspicuously folded in his lap, and laughed. I asked him how long he had been practising.

‘Oh, a couple of months,’ he said, his cheeks glowing with pleasure and the mental effort of executing that trivial action. As he spoke, his large, elegant hands on which the veins stood out proud and blue acted out what he was telling me. ‘To begin with, I had to conjure up certain mental images to get the wave to move the way I wanted. I remembered a circus that came one summer to my grandmother’s village. I was the ringmaster, wielding my whip, and those…’ he wagged a disapproving finger at the icons on the screen, ‘… those were a couple of bolshie lions. Or I thought about the local farmer raising his rifle, waiting for the she-wolf to move into his sights, squeezing the trigger, bullseye! It was hard work, every evening I’d go home with a headache. But slowly, slowly it got easier. Now I manipulate that wave as easily as lifting my arm, or breathing. I don’t think about it. And these days, I hardly make any errors.’

In place of the fruit the letters A and B now appeared on the screen. Again I chose and this time, to show off his neural dexterity, Mezzanotte persuaded the wave to rise slowly and steadily towards the A, until it glanced off the foot of it, nudging it gently into oblivion.

‘What you have here,’ he went on, unnecessarily, since I had already grasped its significance, ‘is a simple method of communication.’ He pressed a button so that two banks of letters now appeared at the top and bottom of the screen. Each bank contained half the alphabet. ‘Each time I select a bank it halves, until I’m left with the letter I want. Gradually, by this method, I can construct a word.’

He added that what I was seeing was actually an early prototype. He had a more advanced model, into which he had built sophisticated features such as a dictionary, a thesaurus and a mode for predicting the word from the first few letters typed. My mind raced ahead. ‘So someone who has lost the power of speech, due to a stroke, say, or a road accident… motor neurone disease –’

‘– someone whose output pathways are irreparably damaged,’ Mezzanotte interrupted me, ‘assuming of course they have something to say, could bypass the inert tongue or larynx and communicate via these brainwaves. All she would need would be the equipment. No dutiful secretary sitting by the bed, trying to make sense of her nods and grunts. Just willpower, a little mental application and a computer.’

‘But Professor, it’s brilliant. How did you –’ I broke off, having just noticed his use of the feminine pronoun, and glanced at him. ‘You already have a volunteer?’

Gripping a bunch of wires with one hand, he tore the suction pads off his forehead with a series of loud pops, stood up and strode out into that sea of carpet, where he began to stride up and down. I twisted in my chair to keep him in my sights.

‘Once I’d shown the system could work, the next step was to find a subject,’ he was saying. ‘So I sat down to write out a list of my requirements. I discounted at a stroke all those whose insult has left them with some residual motor function, who can mumble or blink or point. That type of patient can make their basic needs understood, and rather like a Spanish speaker in Italy, it makes them lazy. They don’t need to bother with my wires and waves and bolshie lions, the thought of which will quite literally make their heads ache. No, the patient who puts the Mind-Reading Device through its paces must be completely paralysed. She must be unable to nod, to signal yes or no, food or water, pleasure or pain. She is mute, and utterly dependent on those who care for her. Nurses dress her, machines feed her. In fact, you might say she has lost all dignity. She must be a quick learner, ideally young. Above all, she must understand my instructions and appreciate the rewards her efforts will bring.’

I thought for a moment. ‘Paralysed, but her intellect intact… a prisoner…’

He crossed the room rapidly towards me, resting one hand on the back of my chair and narrowing his eyes as he looked down at me. ‘I don’t need to tell you, Sarah, how many patients fit that bill.’

I completed the thought: ‘And how few of them we ever hear about.’ Mezzanotte nodded, smiled, and resumed his seat behind the desk.

I had seen some of those patients, shut away in back bedrooms or, if the families had money, in care homes in dismal seaside resorts. There were more and more of them, kept alive by modern technology. For the most part they led pathetic lives, cared for by relatives who saw them as nothing but a nuisance. Those whose families still held out hope of a cure were rare indeed. When you found one, they were usually against all experimentation. They were afraid it would be too taxing for the patient, or raise false hopes.

The professor continued. He had been searching for a suitable subject for months, in vain, when he had received a letter. The woman who wrote it said she was at her wits’ end. Her daughter had been lying in hospital for a decade, without lifting a finger or uttering a word. The doctors had so far been unable to do anything for her, but she and her husband continued to hope for a cure, or at least a partial recovery. They were prepared to wait for as long as it took, but matters had been taken out of their hands when, a few months earlier, the girl’s husband had announced his intention to draw the family’s ordeal to a close, and end her life. This outcome the mother would resist ‘with her last breath’. She had written to Mezzanotte in desperation, on the strength of his reputation alone, to beg him to find a way to help her daughter before it was too late.

The ground had been prepared for me, he went on. A technician in the department had offered his services. The doctors at the hospital had been briefed, the nursing staff was standing by. The team was assembled, all except for one member, in many ways the most important. He paused for effect. ‘As I see it, you will be the hub of the wheel, and the rest of us the spokes. It will be your responsibility to oversee the patient’s training, to observe her responses and adjust the schedule accordingly. You will relay her needs to us and we’ll tweak the device to accommodate them. That way, it will develop in parallel with her. If everything goes according to plan, I predict that this young woman, who has not spoken for ten years, will be chattering away in a matter of months. Weeks, even.’

My heart was racing. With a pretence of nonchalance I got up and strolled towards the bookshelves that lined one wall to confront a row of thick tomes: a medical dictionary, Gray’s Anatomy, a slimmer volume written by the professor, entitled simply, Perchance to Dream. A patient who had been shut off from the world for a decade and to whom we might now restore the power of speech, I said to myself with a little tremor of excitement. If we gave a voice to her, what was to stop us doing the same for hundreds, perhaps thousands of others? What insights she could offer us. What potential there was for learning about the effects of paralysis on the brain, the rearrangements in its structure and function, the compensation, recruitment of previously redundant areas, changes in sensory function, personality, consciousness… the possibilities were endless. And yet, it seemed already as if the opportunity were slipping through my fingers. There was too much work for me at the hospital, and my assistants were not yet experienced enough to deal with the harder cases. I would never get permission to manage an intensive training routine such as this patient would undoubtedly need, especially if she was far away. At best, I envisaged a long return trip each day; at worst, I would have to find accommodation close to her, and that would mean requesting several months’ leave. But I hadn’t been in my post long enough to have earned a sabbatical. Was I really to be offered the most interesting case of my career to date, just as my duties became so onerous as to rule it out?

I heard a drawer open and close, and looked back at the professor, whose hands were now resting on a piece of paper. I sauntered back towards him. Playing for time, I asked him again who the patient was. DL, he called her, using the convention in the medical literature of referring to patients in single case studies by their initials alone. And having delivered this tiny morsel of information, as if it should be enough to satisfy me, he settled back in his chair, pressed his fingertips together and brought his quizzical gaze to rest on me. I lowered my eyes. It had never occurred to me that I would have to choose between the professor and the job I had always dreamed of. I felt torn between my loyalty to him, my desire to help him and to be a party to the glorious climax of his career, and my love of the job he had, to a certain extent, groomed me for.

‘Is she far away?’ I asked, quietly.

I heard him pick up the paper he had been guarding from my sight, and push it across the desk towards me. I raised my eyes and saw that it was a typed, formal letter of consent. From the two short paragraphs of text printed there, the name of our hospital leapt out at me. I blinked at it, barely understanding what it meant.

‘She’s been under your nose all this time,’ he said, and laughed.

4

It was dark when I stepped out into the street, but this time with nightfall. It must only recently have stopped snowing, though, because the snow had settled in an even layer over the pavement and was almost undisturbed by footprints. The night was cold, and a three-quarter moon shone crisply over the city. The people in the streets were uniformly muffled in coats and scarves.

I made my way back to the hospital, deep in thought over the professor’s new project, and it was only when I stood in the large entrance hall that I became fully aware of my surroundings. It was deserted just then, though echoing footsteps receded down one of the long corridors. And it was dark; it occurred to me that a couple of light bulbs must have blown. The globe lamps on the walls had been switched on, but they seemed to shine rather weakly and hardly to penetrate the polished black slate floor. The gloom deepened towards the centre of the space, where the signpost stood. But the signpost itself was bathed in the moonlight whose shafts entered via glass panels in the ceiling. All in all, it was a ghostly scene.

The clock above the corridor that led to the north wing showed six o’clock. I had intended to go straight up to the fifth floor and introduce myself, if that’s the right expression, to Patient DL. I hesitated. They would soon be serving supper on the wards. DL wouldn’t be eating, of course, since she received her nutrients through a tube that fed through her nose, down her oesophagus and into her stomach. But there would be activity on the ward, and perhaps the general commotion would distract someone with a potentially tenuous grip on reality. Better to go in the morning, I decided, when it was quiet and she had a good night’s sleep behind her. After ten years, one more night wouldn’t make any difference.

At that moment, a figure stepped out from behind the signpost and moved in a wide semicircle towards me. It seemed to walk on the balls of its feet, in a strange sort of dance, and I recognised Nestor. He often loitered around the entrance hall. He was employed by the university as a technician, though most people still thought of him as a porter, because that had been his job for many years. He had the porter’s inside knowledge of the hospital, and more. He knew every cracked pipe, every broken window latch, as well as which nurses were sleeping together and who among the registrars had played angel of death on the wards. People who worked there were afraid of him. Everyone knew that he liked his drink. But sometimes he disappeared for days at a time, and although people whispered about his absences, and his rumoured forays on to the upper floors at night, nobody dared question him openly.

The latest rumour was that he had been barred from the paediatric wing. I had no idea if it was true, but here was Nestor in front of me, rocking back and forth on the balls of his feet, asking if I would like to accompany him down to his room. ‘Why would I want to do that?’ I asked, amused. He raised a hand to touch the rolled-up cigarette that was tucked behind his ear, smirked and said he was surprised Mezzanotte hadn’t explained. He had agreed to operate the Mind-Reading Device. The latest version of it was downstairs in his room, and he was under instructions to show it to me at my earliest convenience.

‘You?’ I asked, surprised. Puffing out his chest, he tapped it with a tar-stained forefinger. Perhaps I was still looking at him sceptically, because he glanced quickly over his shoulder, then brought his round, slightly greasy face close to mine and muttered that all the other technicians had refused. He wore his grey, wispy hair long on his neck. He was dressed neatly in grey flannels and a brown pullover, with a knitted green tie. It was hard to put an age on him, somewhere between forty and sixty, but there was something of the overgrown schoolboy about him. He wore a gold stud in his left ear, and around his right eye there were traces of a bruise. ‘Let’s go,’ I said.

He danced off with the same bizarre gait, his bony rump high in the air, as if he were walking on hot coals. I followed him through an unmarked door that opened off the entrance hall, just to the right of the corridor that led to the north wing. We descended a flight of concrete steps and passed along a corridor lit by a single neon tube.

It was the first time I had been down to the basement. Stacked up on the floor along both sides of the corridor were hundreds of derelict computers, models five or six years old, some covered in old sheets, others in a thick layer of dust. Their keyboards had been thrown down haphazardly between them, and fraying wires stuck out in places. Some of the screens were shattered, as if someone had deliberately put a boot through them. Nestor mumbled something about skeletons. When I asked him what he had said, he stopped, turned to face the phalanx of defunct hardware, and announced that I was walking through the graveyard of a computer system that had once been installed in the hospital.

The idea, apparently, had been to transfer all the patients’ records on to an electronic database. Ours was to be the first paperless hospital in the country, and if it worked, others would follow. But the computer hard disks turned out to have a flaw in them. Records were irretrievably lost, referrals sent to the wrong department. There were actually empty beds in the hospital for the first time, a fact that was trumpeted in the newspapers until it became clear that the sick were still waiting to fill them, their names had merely been wiped from the computer’s memory. There were stories of patients dying of treatable tumours that had been diagnosed twelve months earlier, because their notes had gone astray.

I listened to all this in amazement. I wanted to know why the scandal hadn’t come to light. Nestor snickered. There were many things he could tell me about this hospital, he said. Nothing was quite as it seemed. For instance, had I heard about the geriatric ward that had been closed off due to a superbug infection? Ten beds decommissioned because two of the ‘inmates’, as he called them, had died. One of them only after he had been discharged and welcomed back into the bosom of his family. The rest of the occupants had been put into quarantine, since the infection, once contracted, did not respond to antibiotics. Naturally the administration wanted to avoid a panic. Nestor had seen for himself the locked door and discreet notice barring entrance to the ward. He could show me if I liked. I told him that wouldn’t be necessary, and he turned down the corners of his mouth, as if to say, ‘Please yourself.’

We came to a door marked ‘W.E. Nestor. No Unauthorised Entry.’ He pulled a key from his pocket and unlocked it, switching on the light inside. More electronic and mechanical equipment was stacked around the walls of the small, windowless room, and directly ahead of me, as I stood in the doorway, was a wooden chair in front of a folding card table. Above the card table, which was covered in green baize, torn in places, a small wooden cross was tacked to the wall. Grey boxes identical to the ones I had seen in Mezzanotte’s office were arranged on the table around a computer monitor, and hanging over one corner of the chair was a sort of outsized, rose-coloured swimming cap with a tail of wires sprouting from it. A sinister-looking object, like some instrument of psychic torture.

Nestor was telling me that he had adapted and improved the device; put some ‘finishing touches’ to it. The electrodes were now woven into this soft, plastic helmet so that you no longer had to attach the pads one by one. He nodded in the direction of the table, indicating that I should sit down, and I did so. Then he picked up the helmet and without further ado, levered it first over the plates at the top of my skull, then the jutting bones at the base of it, sending a shudder down my spine. I gritted my teeth as he adjusted the cap on the forehead and tucked the hair deftly beneath it at the nape. Gathering the tail of wires he swept it over my shoulder so that it lay heavily against my back and didn’t impede my movements. Then he stepped back, folded his arms over his chest and said, ‘There!’

‘Can we get on with it?’ I said, crossly, and with an injured look he leaned forward to switch on the computer monitor. As the screen resolved itself, I saw that the layout was still the same. At the top was an apple, at the bottom a pear. Equidistant between the two undulated a horizontal line. He switched off the lights and melted into the darkness behind me. Closing my eyes I conjured up a ringmaster, faceless, resplendent in red, the polish high on his leather belt and boots. Idly twirling the whip at his hip, so that it stirred up flurries of sawdust, he waited for the lions to settle. Against my closed eyelids, one of the beasts yawned and looked round, as if preparing to climb down off its box. The ringmaster raised his whip arm high above his head and, ‘Yah!’, cracked it in the air… The lion stared at him, frozen in flesh and time. I opened my eyes. The line flowed on, unperturbed. I repeated the exercise three or four times and the same thing happened each time, until in exasperation I turned to Nestor.

‘It doesn’t work.’

He had been sitting quietly at the side of the room. I could just see him, his chair tipped back against the wall, lovingly fingering his rolled-up cigarette. Now he stuck it back behind his ear and brought his chair down with a clack. I had to remember that the machine had not been designed with me in mind, he said. It was supposed to be used by someone who was desperate to communicate, and for whom it provided the only means of doing so.

‘You mean I’m not trying hard enough?’

He shrugged. That was part of it, he said, and then there were the lions. ‘They don’t do it for me.’

I asked him how he had made it work, but he didn’t want to say. I cajoled him a bit and he hung his head coyly. I pleaded with him until at last, with some excited shifting in his seat, he came out with it. ‘I’m riding an old Enfield through a deserted city. I come to a red light where another bike is waiting. The rider revs his engine, he glances across at me. I recognise the head porter. Well, between you and me, I hate the head porter. I turn back to the lights, I watch them like a hawk. Red changes to red and amber, I tighten my grip. Green! I release the clutch, leap the junction and land on two wheels, leaving him trailing in the dust…’

He had been talking eagerly from the edge of his seat. But now he slid back into the shadows and I turned once again to face the computer monitor. It seemed to me that he had hit on a good device. There was a certain elastic tension in that sequence: red, red and amber, green. I frowned hard at the undulating line. But however hard I concentrated, I couldn’t interrupt it. Finally, I let out the breath I had been holding.

‘It’s no good,’ I said, ‘it won’t budge.’

For a moment there was silence, and then out of the darkness behind me came a voice.

‘It’s got to mean something to you,’ it said softly. ‘You’ve really got to want it.’

I sat staring disconsolately at the screen, raising a finger at one point to scratch an itch at my temple, just under the rim of the cap. But I had no ideas. And then I did have an idea. It came to me out of the blue. Thankfully it was dark in the room and my face was turned away from Nestor, so he couldn’t see how I blushed. Once again I pictured the ringmaster, dashing in jodhpurs and a red tunic pulled in at the waist by a thick leather belt. This time, however, he wore an ivory cravat and a shock of white hair rose from his high forehead. Taking a step towards the lions he planted the soles of his riding boots wide apart in the sawdust, cracked his whip and fixed them with his burning, soulful gaze. I stared at the undulating line and to my amazement it lurched drunkenly towards the pear, missing it by a hair’s breadth.

Suddenly the room was a blaze of electric light, and I spun round in time to see Nestor bring his hand down from the wall switch. His body was rigid in the chair against the wall. He was staring sulkily at his cigarette and a muscle was flickering in his cheek. What’s the matter with him? I thought. Is he annoyed that someone else besides him has made his precious machine work? I peeled off the pink swimming cap, draped it over a corner of the chair and stood up. Nestor remained sitting, his head bowed. Just as I reached the door, a thought struck me.

‘Have you seen the patient?’ I asked. He raised his head slowly and I noticed that the eye around which there were traces of bruising was also bloodshot.

‘Should I have?’

There was menace in his voice, and I was taken aback. I told him it was an innocent question. He slammed the two front legs of his chair against the floor, standing up as he did so and clenching his fists. He had no reason to go snooping around up on the fifth floor, he said, and he’d like to know who’d seen him there. Furiously he kicked at a screwed-up ball of paper, sending it flying into the corner. Then he seemed to calm down again, and scuffed the toe of his boot sheepishly against the floor. I asked him why the other technicians had refused to work with the professor. He shrugged. I pressed him and he told me that Mezzanotte was in the habit of ringing up at midnight to discuss a problem. Sometimes he wanted the technician to meet him straight away, at the lab, and the poor fellow might not get away before dawn. It was hard on a man. But it was no skin off his nose.

I raised an eyebrow. ‘You don’t need to sleep?’

He frowned, irritated. He needed to sleep as much as the next man, but he had to take pills to bring it on, and these days the pills didn’t seem to work as well as they used to. So he was often awake in the early hours. He didn’t approve of the professor’s working habits, but as it happened they suited him. He was the man for the job, and Mezzanotte would have saved a lot of time if he had come straight to him, rather than letting his mind be poisoned by ‘filthy lies’.

I looked at him. So he was an insomniac. That explained a few things, and yet it didn’t arouse any sympathy in me. ‘Good evening, Mr Nestor,’ I said, and stepped out into the corridor.

Back in my rooms everything was in order. My assistants had left for the night, and a note on my desk assured me that the afternoon had passed off well, and nothing out of the ordinary had happened. Two or three files had been placed over that of the Welsh lawyer’s: new cases awaiting my attention. I hesitated, wondering whether to sit down and make a start on them. Just then a wave of fatigue came over me and I raised my eyes to the window.

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.