Mr. Nobody(27)

The fire crackles to life, leaping from paper to lighter brick to kindling. I close the woodstove’s door, then go in search of Peter’s “Welcome” half-bottle of wine in the kitchen. Just to warm me. Just to settle those first-night nerves and send me off to sleep at a sensible hour. Because, God knows, tomorrow is going to be one hell of a first day at work.

I curl up on the Persian rug in front of the flames, glass in hand, and sip my wine, the patient’s medical records spread out all around me.

There’s a lot to go through, yet as I sit there surrounded by the sea of papers, the case feels more manageable somehow, like a puzzle that I might actually be able to solve, piece by piece, a thousand-piece jigsaw that just needs time and focus. My patient a tangled knot to be gently loosened. Peter was right, I do prefer working with hard copies. I like being able to see what I have.

I pore over the test results again, eyes flicking from the patient’s CT scans and the newer MRI scans on my laptop, to printouts of blood tests, cerebrospinal fluid analysis, virology reports, and hormone levels.

    A clearer medical picture is starting to form of my patient. Just the edges at the moment, but the tests and scans he’s already undergone show me the faintest outline of something already.

Here’s what I know. His brain is not physically damaged—that much is evident. The concussion he arrived with a week ago has left no lasting damage. There are other potential physiological causes that could be in some way responsible, which I can and will start testing for tomorrow. He may suffer from epilepsy or a nutritional deficiency; he may suffer from a non-related condition that requires medication, the side effects of which could somehow be responsible for his memory loss. Testing for outlying conditions would certainly be worthwhile. I jot down a quick list of possible tests in my notepad. Some screenings we’ll have to send away for results. Princess Margaret Hospital, where I’m heading tomorrow, isn’t big; its resources are acceptable, but they’re nowhere near London standards.

The tiny fleck I noticed when Peter first showed me the CT scan is clearer on these new MRI scans. Pituitary cysts aren’t uncommon. Most people can live and die without ever even knowing they have a cyst on their pituitary gland; these cysts only tend to get found accidentally when doctors are scanning for other things, and are rarely a cause for concern. However, if this cyst had recently fluctuated in size and exerted pressure on a neighboring area of the brain, it could be in some way responsible. But it’s unlikely. The area of the brain responsible for memory retrieval, the hippocampus, is nowhere near the pituitary, so I’m not sure exactly how the cyst could directly affect it. But it’s certainly strange that other fugue cases have had similar growths. Something to look into further. I note it down. The speck is something to monitor but, at this stage, I’m happy to put it on the reserve bench in terms of possible causes and instead consider it a potential symptom, or anomaly.

If I’m totally honest I’m already erring on the side of this not being a physiological condition. The scans show the patient’s hardware is intact. If he were a computer and you took him to the Apple Genius Bar, they’d tell you it’s a software problem.

    So, assuming the patient’s hardware isn’t broken, then we’re looking at a software problem. Psychological trauma.

And mental trauma isn’t that unusual a cause of memory loss. Post-traumatic stress disorder being the prime example; whether it’s soldiers back from war or children in the care system, PTSD is a lot more common than people think.

Up until fairly recently, in medical terms at least, the general wisdom was that psychosomatic illnesses were controlled by the sufferers. As if somehow the patient could just “pull themselves together” and then they’d miraculously recover and return to their normal lives. These days we know better. Psychosomatic illnesses are software errors, not user errors. If a patient’s memory loss is due to psychological trauma, he would have about as much control over his illness as you would have over a system failure on your laptop. No matter how much you wanted those wiped family photos back, they are locked in that old hard drive and you’re going to need a lot of patience and a pretty pricey specialist to help you get them out of it.

I take another sip of wine. The good news is that memory loss caused by psychological trauma is often only temporary. It tends to return over time once the real or perceived threat is removed. Patients slowly begin to regain memories—the trick is making sure the patient is in a safe and therapeutic environment when those memories, good and bad, do resurface. Or the consequences can be troubling.

A week ago, something very bad may have happened to this man. If he’s been through intense trauma, then hopefully, now that he has some distance from it, we should be in a position to help him remember what happened. Or, at the very least, help him move on from it.

I start to draw up my plan of action for tomorrow. I need to be prepared. This is important, for me and for him. We can’t afford to mess this up, not with the whole country watching. My pen glides fast in wide loops and curls across my yellow legal pad as I pour out my ideas.

    The low lights in the living room flicker.

I glance up at the lamp nearest me. It glows steadily. But there was a flicker before, I’m sure of it. A break in the electric current. I stare at the bulb. It flickers again, like a moth against glass, then all the lights in the room and through the hallway flicker back in response. Oh no. No, no, no. Not the lights…