Lucia

by Alex Pheby

  And what does the patient think while immersed?

  It is possible, perhaps likely, that the cause of the disturbances that are seen on the ward – the throwing of chairs, the setting of fires, the surly and dismissive attitude when presented with figures of authority, the withdrawn and reluctant persona, the refusal to eat sufficient to maintain a minimum healthy weight, the attention seeking behaviour, the unhappiness, the poor hygiene – have, as their source, a psychological cause rather than a somatic one. Possibly there is a psychosomatic cause, or a purely psychogenic cause.

  Under immersion, the patient brings to the fore all those things they have purposefully forgotten or have repressed.

  Like a child left locked in a school gymnasium as a form of punishment, detained after the end of classes and then forgotten either purposefully or by accident (and then the caretaker has left and locked up and no staff will return until the following morning) these forgotten experiences run around and make difficulties. They scream the building down, which echoes through the corridors. So loud is the tumult in the locked and empty school of the mind that these experiences disturb the behaviours, even without the patient sensing the sound. As the neighbours to the school building are disturbed without knowing the reason for the child’s detention (she threw a board rubber toward a teacher) or the name of the child, or even whether she was a child, or instead some kind of spectre, or trapped animal, or something unidentified but terrifying, so is the patient disturbed.

  So, the patient might profitably think to open the doors on the pains which they have forgotten and remember them in the knowledge that the disturbances themselves are lessened when suffered directly. They cause fewer aberrations of behaviour than those which the noisy screamed echoes of the pain cause. So pain, during hydrotherapy, might be an appropriate subject to turn the mind to.

  If the logic of this suggestion does not find hold in the patient (because, most likely, they are mad) then a willingness to turn the mind in toward a subject suggested by the physician can be provided using certain drugs. The painful experience can then be iterated repeatedly by an attendant while the immersion in water is taking place, immersing the patient in her pain simultaneously, and thereby providing short term relief from the symptoms of her overheated nerves, while addressing the longer term tendency for the patient to shriek her pain silently in the locked and empty school gymnasium of her mind.

  The attendant might repeat ‘do you remember the time when…’ and here would be inserted a painful experience revealed by members of the immediate family, or culled from previous interviews with the patient when she was less unstable, or taken from the police records. Failing the above, plausible and likely painful experiences can be selected from a list that can be provided by any reputable psychiatrist.

  While wrapped in cold bandages, or whilst restrained on a stretcher, or while crouched in a tiled room and doused with a hose, the patient might think of those things she wishes not to think of. They are too many to name individually, but there are classes of such experience into which these ones will fall: the class of experiences had whilst left alone for prolonged periods as a child; the class of experiences had while harshly punished for minor misdemeanours; the class of experiences had whilst serious misdemeanours are punished by the induction of pain in a helpless loved one (a pet rabbit, or chinchilla, for example) up to and including the point of its death, and for which the patient is made to feel guilt; the class of experiences had while the father indulges himself sexually, and for which the patient is made to feel guilt; the class of experiences had where the mother punishes the daughter’s primary and secondary sexual characteristics for being more beautiful than the mother’s currently are, and for which the patient is made to feel guilt; the class of experiences had when induced to do one thing in the expectation of praise, but for which punishment is then given; being laughed at, cruelly, for those things that the patient was previously induced to feel pride in; being mocked in front of third parties for matters told in expectation of strict confidentiality; being beaten whilst pleasure is ostentatiously displayed by he that delivers the beating; being burned with a cigar; being pricked with needles to the tune of a favourite nursery rhyme; being shaken very hard; miscellaneous.

  Whilst dwelling on difficult and traumatic experiences is in itself difficult and traumatic, if the experiences themselves, or the experience of them, or the memory of the experience, or the sensations and feelings induced by the memories as they are experienced in the present can be integrated with the self as it exists in the present, this is the key to resolving the painful effect of the inducing incident. It is in the repression of this material that the flaws in her behaviour exhibited by the patient in the present are amplified. So, let her scream, let her suffer, let her shiver – all these are demonstrations that the self in the present is developing methods of dealing with what should have been dealt with satisfactorily in the past. Once the melodrama is over, there will be a person more able to cope with themselves and their history than she was before. Just as the attendant dries her body and rubs into the skin a glow of health with a new white towel, so will the physician at subsequent interviews bring a blush to the mood of the patient, by pointing out to her how much stronger she now is in the face of thoughts and preoccupations that would previously have seen her crouched in the corner of the room, or tipping over the side table, or refusing her soup.

  Once emptied, we scour the bath with Vim powder and a hard brush. The enamel is pitted from long use, especially around the plughole, so no elbow grease is spared. We circle the brush whilst pushing hard enough to bow the bristles, keeping a firm grip on the wood. For this job, plastic gloves – yellow or pink – are used (if there are none in the store cupboard we make a request on the inventory sheet) to protect the skin of the hands. If bleach splashes onto our lips, or eyes, or mucous membranes during the process, we immediately rinse them in an adjacent sink.

  When the bath is clean to our satisfaction we begin again and repeat the process – the debris left by the patient is often not visible to the naked eye, and consequently we are not best placed to understand when it has been removed. Even if our effort is probably redundant, we make it regardless: better that we expend ourselves uselessly than germs and micro-organisms are left to flourish in areas used for medical purposes.

  We rinse the bath and gloves after use, and place the gloves in the store cupboard.

  Once the patient is returned to her ward, we put the observation record in her file and reestablish her usual routine as soon as is practically possible. Regardless of the efficacy or otherwise of the treatment, the conditions in the ward as they were prior to the treatment must be maintained – this allows for a continuity of routine for staff and patient, and also allows any improvement/degradation of behaviour to be observed against the baseline control established by day to day life in the ward. In the event of any unusual reaction to the procedure, we note this and add the note to the file – the doctor attends to the matter at the next available opportunity.

  They had sealed the deceased’s mouth so she could not speak, and so could not proclaim her innocence of any sin.

  May your god be gracious to you

  The tomb is sealed and the deceased begins her journey to the afterlife.

  THE DENTIST CHARGED WITH REMOVING LUCIA JOYCE’S TEETH

  NORTHAMPTON, DATE UNKNOWN

  He is called out to an appointment, ushered through to the room, introduced to the patient, and the nurse opens the mouth.

  It is a right mess at the back: abscesses, crumbling away, significant degradation to the bone structure, x-ray like a bath sponge, vacuoles on a cell diagram. A strong breeze and this lot would be out like tiles slipping from the roof and smashing in the drive. Like slate pieces chipping his paint work. He’d sand it back, prime it. New layer of enamel and several hand coats of wax, buffed to a shine.

  They’re virtually out by their own accord, as if the teeth want to flee this tube of flesh,
and make a life for themselves alone, outside. These hard objects are disgusted by the softness they find themselves surrounded by. Couldn’t a canine make a better go of it alone? It couldn’t do worse.

  He gets the nurse to open her up wider and inserts a dental prop.

  Show him a strong tooth. Show him a structure that will take the teeth of a pair of workman’s pliers. He’d have it done before lunch. His knee on her chest, brute force, one at a time, and ride back to the saloon to play poker and drink fingers of whisky in the company of petticoated whores from the rooms upstairs.

  Painless Parker.

  This is more like archaeology. He’ll have to pick out the tesserae from which this corrupt mosaic is figured, unpick them from the shattered superstructure. Tease them out from the glue. It’ll take much longer.

  If only he could chisel away the maxilla, grind into the mandible and get it all away. Start again with new stone, cement it into place and slip the flap of skin over to cover the evidence. A sculptor would do it that way. Unhappy with the results of his apprentice, he’d show him how it was done. Let the master see the fox, let the hounds watch the hunt. One heavy hammer and one sturdy blade and the whole skull would be gone from the vomer down, ready to accept a perfect replacement, carved in the workshop in awed silence.

  No.

  She won’t wear the nosepiece: too jittery, too nervous, too barking like a dog. She writhes in the chair, keening and whining like he is going to torture her. Even with the wrist restraints she manages to get the mask off, whipping her neck round and thrashing. No need for hands, no need for thumbs. Opposable digits are not required for her mischief. It could be achieved by a fish, thrashing about in a net, hook in her mouth. She’ll tear the cartilage to pieces and die slowly in the shaded deeps beneath a weeping willow. She’ll drift into stagnancy where the river bank is weak, damaged. Out of the current, out of eyeline and earshot. Working against her own better interests.

  —I’m not going to torture you.

  One and half grains of pentobarbitone and he’ll see her in an hour.

  He arranges the bone curette, rongeurs, root tip elevators, probes, mirrors, and explorers. Unless she takes the nitrous it will be intravenous thiopentone. He can’t work on a woman like this, not safe with all the movement, all the incoherency. His tendency to slap must be resisted, the urge strong though it might be to undercut her hysteria with a blow to the cheek, a cuff to the side of her head. A punch directly to her eye socket. An elbowing. A kneeing. He could cut through all the nonsense and let her see the lay of the land. Done hard enough he’d provoke the same effect that several quid of analgesia could achieve.

  He does it through the vein instead: chemical cosh, fast acting and legal. No bruises except one so tiny there’s no noticing it. No need to account for it. No talking it off, no living it down. He smacks her with the syringe.

  Spare the, spoil the.

  Now she’s out, the nurse can put the nosepiece back on. The elastic is tight against her hair like a laurel wreath. It’s like a permanent wave; it’s like a crimp.

  She breathes slowly, eyelash unresponsive and docile. If it was up to him then all life would be like this – quiet and peaceful and dreamless while what was best for them, but painful, was carried out in their absence. He’d strap them into a chair and get about the business of fixing what their inadequacies had brought about in their bodies. He’d anaesthetise the lot of them and do what needed to be done. Then, when they awoke, numbed and blinking, it would be to a world in which things were better than they are, where things were manageable and correct, where the damp roots had been removed from the earth where too much water had caused them to rot. He’d prune the dead wood back, pinch the yellow leaves between fingertips, compost the death and decay in the darkness, out of sight: piles of detritus transformed beneath a blanket into good productive loam ready for the fork, ready for the shovel, integrated with the land to make new growth to the proscribed plan.

  He finds it necessary to cut a semicircle in the gingiva, so the lip is drawn up in an emotionless snarl. The assistant holds it in place with instruments, suctioning the saliva and then the blood, so that the scalpel can slice above the incisors. He makes an inverted arch which can be folded up and held. It is reflected into an aqueduct, black and red in the gloom of her mouth. The nurse brings forward the lamp and it all glistens like berries gathered in the autumn and washed.

  He swabs, she suctions, he melon-balls the bone away.

  In Kew Gardens there are plants that bear seed pods that, when held between finger and thumb, explode pepper corns all over. He sees a tooth like that stuck near the throat. It is difficult to deal with that tooth and not run the risk of choking her.

  Despite the injection, despite the constant flow of gas and air, she moves as if she is unwilling still. She gives a long [no(o-o-o-)] shouted from the bottom of a well. Her muted echoes of dissent can be ignored.

  He uses iodine swabs, suctioning. Black thread stitches the wounds where necessary. The body has an amazing ability to regenerate some areas; the mouth being one of them. Why, he wonders, not the rest? Why do we not regenerate as a skink does? New arms, new legs, new organs? The history of medicine might be subsumed into that of horticulture, relieving the physician of the jeopardy of his trade. Snip it out and let it regrow. Open wounds and let the body regenerate them. Pull out teeth and, rather than taking casts and making new sets, wait for a week and see the buds of them appear. Watch them grow in situ until the new are as good as the old.

  Not the will of God.

  And what does the patient think while her teeth are removed?

  That the mouth is like a vulva, the throat the vagina, the valves of the oesophagus the cervix, the dentist the gynaecologist, and drills and needles and clamps, and shafts for which multi-faceted interchangeable heads are available are themselves interchangeable. Needles in the gums, needles in the soft palate, needles in the hard palate, in the gingiva, in the interdental spaces. Iodine swabs and powder sprinkles into the wound like salt, seasoning. Pump and clamp. The curette, curettage, applicable at both ends. The scraping out, the removal. Adenoids intact here, but the process is the same – things which must be removed. The teeth wish to be born, so here it is the reverse: the child too long where it is no longer required, these teeth requiring a life of their own. To be out of a mouth from which nothing listened to emerges, which consumes nothing to fulfil them, whose guardian takes insufficient care of them. She is incompetent in that way. Scars across the back of the throat and the sides of the mouth. Splinters in the flesh. Loci for infection.

  To the dentist, all mouths are the same. The mouth of Napoleon would have seemed the same to his dentist as the mouth of one of his soldiers, no doubt. The mouth of a film star the same as the mouth of a lunatic to her dentist. Still, there adheres a certain quality to the work he does for the rich that is not present in the work he does for the forsaken. Perhaps it is the glamour of the environs in which his work takes place. Certain places in central London have a subliminal influence over the mood, the mood over the thoughts, and the thoughts over the mouth as it appears and is experienced. One opening into the flesh, while biologically and anatomically identical in its type is felt to be a ‘better’ mouth than another one for which one is paid to minister to in Northampton, in a home for the diminished.

  The mouth itself seems to be diminished.

  Or perhaps the dentist to the wealthy is himself filled with a sense of his own value that comes from the status of his patients, whereas the dentist to mad old bitches feels himself, for the period in which he is obliged to work on their mouths, a mad old bitch himself. Has he failed in his life to have to attend to them? He’s not fucking Christ, after all, to wash the filthy feet of every piece of human scum that crosses his path.

  Is he Christ?

  No. That honour belongs only to Jesus Christ, and, in a lesser way, to his priesthood, to the church. A dentist is not a priest, so perhaps then he resents this work,
thinking of the class of person his colleagues tend to. The men with whom he shared digs during his education, men he sees occasionally at reunions and festive times of the year, men who drive cars that are larger than his, have wives that are prettier than his, have wives who are more attentive than his, have wives who are not found placing their lips on the generative members of men who are not their husband, by mutual friends who say this only since it is a burden on them to have to keep the secret, and who, if not gleefully, then with a certain self-righteousness, do not claim he should have performed his own marital duties with more vigour if he wished to prevent his wife from taking the semen of other men into her mouth and then spitting it into her handkerchief before placing the lot of it in her new handbag and clipping together the clasp.

  The rongeur, the rat chewing through bone, gnawing on it, required when there are immoveable roots. When the tooth and the bone are reluctant to be parted, mother and daughter, too close a relationship, too similar, they must be separated from each other for both of their goods. The whole situation must function. The world must go on as it needs to, even if the two of them are trapped by their attachment into a formation that cannot be allowed to continue.

  When both are in opposition to the needs of their environment, in opposition to each other, there is only one route that can be taken through – forced removal of one from the other, for all our sakes. She cannot go on living here, when the two of you fight like dogs. You are driving her mad, and she will kill you in the end.

  What does the rational man do? He removes his emotions from the matter and applies a utilitarian argument. He creates an equation, makes of the real an algebraic representation. He assigns values to the terms, and by following logic comes to the correct solution – remove the teeth, separate mother from daughter, create new teeth, and come to terms with the new regime dentures require – sterilisation, a change in the manner of moving the mouth, the avoidance of certain types of food.