Pain

by Adam Southward

  Alex didn’t try to hide his own disgust but kept reading.

  ‘15:00 Stabilising surgery took priority. Internal lower abdominal bleed fixed. Spinal rupture – cause of elevated pain, main focus. Dr T worked for three hours repairing. Nova kept rushing him, saying the treatment must start within a four-hour window.’

  ‘Dr Tau,’ said Laurie. ‘He saved her.’

  ‘Saved her for their purposes,’ said Alex. ‘It goes on like this – observations and Willis’s role assisting. He says he stitched up her abdomen then asked to leave. They refused.’ Alex flicked over to the next page.

  Laurie’s phone buzzed. She swore when she saw the screen. ‘Yes, ma’am,’ she said. ‘Yes, OK. I’ll be right up.’ She put her phone away. Alex saw the creases of concern on her face. She looked at Alex and managed a strained smile. ‘Hartley wants to see me.’

  Alex nodded. ‘Shall we . . .?’ He indicated the papers on the desk.

  ‘You continue,’ she said. ‘This is your world. Call me when you can – tell me what you think.’

  Laurie left the room, pulling the door closed behind her. Alex’s gaze lingered on the door for a few moments before turning back to Dr Willis’s log.

  Day 1, 18:00 We used the new batch on the female patient, Mia Anastos. Lot 19. She’d stabilised enough, so we brought her round. She was conscious with no painkillers. The levels of pain must have been astonishing. Her spine was still raw – the disc barely in place. She thrashed in her restraints. Her heart rate was elevated. The Nova rep pounced, administering the dose via IV. He stood back, watching her vitals, ordering our anaesthetist out of the way – Dr Robbie wasn’t too happy about it.

  Day 1, 18:30 A cruel half-hour, watching this girl in extreme pain, but it worked. Dr Robbie left the theatre in disgust. The endorphin catalyst – they’re calling it N5 – appears to be working. We woke her up enough to ask her subjective rating. She was confused, agitated, but gave a pain rating of zero. She didn’t have any pain at all, even after physical manipulation. Astonishing. She passed out shortly afterwards.

  Day 1, 20:30 In recovery. We’re all still here, minus Dr Robbie. There seem to be more of the Nova reps than before. Some are rather burly-looking. Mia seems pain free. The action of the endorphin catalyst should be to artificially generate natural endorphins . . . but of course they aren’t natural. I read the background material. It’s still artificial. When all is said and done, it’s still akin to an opiate. She’s generating her own heroin fix. Nobody wishes to hear my views. They just point at the girl. I’ve decided to keep my own records, separate, including this log. I must protect myself and my professional integrity, regardless of how this ends.

  Day 2, 10:30 I stayed the night. I’m not sure I had a choice, to be frank. Dr Robbie was back too. She looked scared. I must speak to her when I can. Mia, if that’s her name, is sitting up in bed. They’re stopping her from walking because of her spine injury, but she still has no pain. She’s displaying some confusion, staring at each of us, her eyes piercing. Nobody has told her about her parents, that her mother may still be alive. Should I?

  Day 5, 12:00 It’s been five days. I was allowed home, as were the others. I flicked through my contract. NDA and penalties spread throughout it. It’s quite threatening as a read. I wonder if it wasn’t a mistake . . . but the results are positive . . . I must remind myself of that. This young lady had life-threatening injuries causing pain on an objective scale of 10/10. This treatment has reduced it to zero. We’re winning?

  Day 6, 8:30 I’ve been back to my usual lists. We have a daily meeting with Nova at Mia’s bedside. I walked in this morning to find them arguing. Side effects. Oxytocin levels off the chart. Whose chart? I joked. Dr Tau asked about the long-term effects of elevated neurotransmitters such as oxytocin in the brain. The Nova rep refused to answer, obviously knew something.

  Day 7, 8:30 Refreshed my knowledge on oxytocin, ‘the moral molecule’. Posited to be at the heart of empathy in mammals. People with higher levels of oxytocin are more empathetic in all scenarios, able to put themselves in another person’s position, feeling another person’s suffering, wanting to help. We agreed to monitor levels. Talk of moving her to a specialist facility. I asked where and was told to read my contract. I guess that means I won’t be told.

  Day 9, 16:30 Called in for an unscheduled meeting. Mia left her bed in the night. She was found in one of the emergency wards, leaning over an elderly patient. Escorted back to her bed, she was displaying classic symptoms of opiate withdrawal. More arguments. Against the majority wishes, Nova administered more N5, claiming the dose hadn’t been high enough during surgery. Dr Tau looks stressed. He is running the show, so he says. I wonder how much control he really has over Nova. Is he bound by the same contract as me?

  Day 13, I had a few days off. I got emailed daily reports, as did the rest of the team. Mia responding well. Asked where she was. Another problem for the team – she appears to have amnesia. The psychological trauma must be hitting her. Nova have refused a psych consult at this point. Argued with Dr Tau. Nova won.

  Day 14, Complications. Amnesia is worsening. Oxytocin levels even higher than before, not sure if related. Continuing to monitor.

  Day 15, Opiate withdrawal symptoms continuing. Appears to come in waves every twelve hours or so. She suffered vomiting and diarrhoea this morning. I’m being distanced, as I question the efficacy of N5. Dr Tau seems to want me out. Does he not respect my experience and opinion? I thought we were professionals.

  Day 16, Mia found in the emergency room again. She was in a near-panic, sweating – symptoms of opiate withdrawal again. I questioned the whole underlying premise of artificial endorphin production – asked for access to the earlier trial data. Request refused.

  Day 17, Mia in emergency triage again. Being moved to another private room and restrained at night. Nova are placing a guard(!!) on the door. What do they think she’ll do??

  Day 18, Oxytocin higher than we’ve ever seen. Nova suggesting several unrelated tests. She seems alert but often disappears inside herself. Appears to study people in the room, watching them intently. She sniffs people. What is the oxytocin doing to her?

  Day 19, Called in by Dr Tau. He says the patient is being moved. We are to wrap up our own notes within the hour and submit them all to him. Nothing relating to the patient is to be stored anywhere else. This seems unorthodox, to say the least. We know we’re breaking the rules, but we’re assured these are phase 3 clinical trials. The dangerous early stages are over . . .

  Alex flicked the page over and found it empty. He scanned the desk, rifling through. Ten pages, ending abruptly with that final journal entry. He took a deep breath, re-reading the last few notes, grabbing his notebook and pen.

  It was here, Alex was sure of it. N5 was Nova’s drug. Purpose? To obliterate pain, so it seemed. It did so by artificially stimulating the creation of neurotransmitters – in this case endorphins – to interact with opiate receptors in the brain and thus reduce the perception of pain. Alex knew they acted similarly to drugs such as morphine and codeine. Endorphins were the body’s natural painkillers, created under all sorts of scenarios. Here, the N5 drug appeared to create a synthetic version, or perhaps the real version, but in an artificial way. Alex wished he had access to more information. Nova AG would be top of his list to question next.

  N5 created chemistry in the brain to eradicate pain. Was it permanent or temporary? And what about the underlying cause? Alex noted the questions, underlining them twice. This was no doubt a breakthrough, with potentially staggering implications – positive implications – if it worked.

  But Dr Willis’s notes were worrying. Elevated oxytocin levels was a puzzling side effect. Alex knew oxytocin was a powerful hormone, also acting as a neurotransmitter in the brain. He thought back to his post-grad study. Oxytocin regulated social interaction and sexual reproduction, playing a massive role in behaviour. It was involved in parent–infant bonding, release of milk for breastfeeding, thro
ugh to general empathy, generosity and ability to orgasm. It was often called the love hormone because of the stimulus for release – simply hugging a loved one caused oxytocin production. Having sex even more so. The hormone played an intricate part in one’s understanding of and interactions with other people. People with higher levels of oxytocin could empathise, understand. He scanned back in the journal entries . . . feeling another person’s suffering.

  Alex paused. Feeling when people were hurting.

  He picked up his pen. New line.

  N5 removes the pain. Leaves symptoms akin to acute opiate withdrawal. Check.

  Oxytocin elevates empathy to an astonishing, unheard-of level. Empathy, not sympathy. An ability to feel the pain of others, with no compassion for it.

  Feeling their pain.

  Alex placed his pen on the table. He stared at his notes. The evidence was here, and his theory was rational.

  Is that what drove Mia? What caused her to attack her victims? Is that what they had turned her into?

  A pain addict?

  CHAPTER TWENTY-SIX

  The hotel had been left behind, replaced by the dark corridors of a more familiar environment. Her expensive Valentino heels had been discarded in the hotel trash, replaced with black boots, the brief moment of extravagance over.

  The woman took a deep breath, leaning against the cold metal wall before turning the handle. She entered the small, windowless room, ignoring the shuffling of the two men already seated in front of the scuffed wooden desk as they sat upright and stared at her. She saw fear and reluctance. These men were scared of her and what she represented. The fear was necessary, and warranted. They didn’t know what she would do if they failed her, but the rumours were kept alive, fresh reports always available, most of them true.

  In the far corner of the room stood another man, large, with a bald head and an expensive pressed suit. He’d flown in on a separate flight, direct from Moscow. He gave a nod and she returned it.

  She turned to the two trembling men, raising her eyebrows.

  ‘We cleaned up as best we could,’ said one of them. His eyes darted to his colleague, who remained motionless.

  She nodded, waiting.

  ‘But we were disturbed,’ he said. ‘We can’t be sure we got everything.’

  She turned to the man in the corner. He gave a small shrug. She knew it was impossible to wipe clean all traces. What they were doing pervaded so much, involved so many people, that remnants were bound to exist. But some were more important than others.

  ‘Very well,’ she said. The two seated men appeared to sag with relief.

  ‘Go,’ she said. The men scrambled to their feet, almost falling over each other as they exited the room.

  She waited until the door clicked closed.

  ‘We need to prepare,’ said the bald man. ‘I can’t guarantee our safety.’

  ‘How much do you think he knows?’

  ‘Dr Madison?’

  She nodded.

  ‘Ah.’ The man risked a brief smile but wiped it quickly when he saw her stare. ‘Too much. We cannot take the risk.’

  She raised a finger. ‘That is for me to decide.’

  The man frowned, but nodded. ‘Of course.’

  They stood together in silence, their eyes meeting in mutual suspicion.

  The man broke first. ‘Then what do you suggest?’ he said.

  ‘We quieten down,’ she said decisively. ‘For now. Go dark. When it’s time to move, I’ll give the order.’

  The man continued to stare.

  ‘Understood?’ She squared up to him, stepping forward. His confident stance swiftly evaporated. He was not like her, not one of them. He might temporarily have forgotten his place, but it quickly came back to him under her gaze.

  ‘Da,’ he said, nodding, casting his eyes down in submission.

  ‘Nobody touches Alex Madison until I say so,’ she said, with more emotion than was appropriate.

  ‘As you wish,’ said the man, nodding again before leaving the room.

  The woman let out a long breath. The doubt rose again in her chest as her conviction wavered. Alternative courses of action crowded her thoughts. She considered the risk.

  The choice was hers alone.

  CHAPTER TWENTY-SEVEN

  Mia knew what she must do.

  The memory of the builder’s face burned into her vision. His fractured skull, caved in, the blood leaking from his ears and nose. Mia was out of the pit and climbing back into normality. She lay naked on the mattress, shivering but hot, tapping her splinted arm absently against the floor.

  She’d had her fix. Now she must use this brief clarity to continue her search. At London City Hospital, where it had all started. She needed more information, more memories to feel the triggers and find the truth.

  Her high was quick, the recovery quicker. She was poised at the top of a slide, teetering, struggling to stop herself descending into desire. The cycle was speeding up, and Mia plummeted into sorrow and grief. What would she become? Beyond the aberration she’d already achieved lay perhaps a deeper, darker Mia who knew no normality at all – one who would lurch from victim to victim without pause.

  How far away was she from such insanity?

  Mia washed, examining herself in the mirror, thinking, always thinking; delving into the blackness of her memories, searching for an answer. Her body was young, fit and damaged. Not from here. Who had seen it? Who had touched it? Mia clenched her fists and cried out, biting back the scream before it released, knowing it might never stop.

  Love. Mia yearned for the abstract emotion she witnessed daily among the people of the city. To love and be loved was surely beyond her reach. Even if she could find somebody, she couldn’t hide her grotesque desires and the murderous actions she was compelled to perform. No one would understand. No one would love her back. Mia knew she was destined to be a solitary animal, a predator and a hunter.

  Unless . . .

  Mia didn’t consider herself diseased so the thought of a cure was hard to process. But it played on her mind nonetheless. Would her search end in a cure, a solution, a remedy? Some way of breaking the possession she was cursed with? What had the doctor promised the old lady? To be free of pain, but ever seeking it. That couldn’t be the intention.

  Perhaps she needed a priest. At least they might forgive her.

  Mia sat at her desk: an ancient and dirty workbench with a stool. The wood of the bench was rough and splintered and the stool wobbled. Mia knocked her arm against the side a few times, listening to the dull clink of the metal rods.

  She placed her arm on the bench, palm down, the top of her hand exposed.

  Pain. Where was it?

  Pliers. Mia had a pair, lifted from the same hardware store she’d stolen the club hammer from. They were cheap, yellow-handled and small, but adequate. A pair of scissors would do.

  She chose her little finger this time. She found it useful to alternate – sometimes her toes, sometimes other parts of her body – careful not to inflict too much damage.

  One day, perhaps, it would hurt. Mia gripped the end of the fingernail on her little finger in the pliers. It was hard work keeping her finger on the table, but she managed it, as she held the pliers tight and twisted them, up and away. The nail tore with a crack and a brief sucking sound but snapped along the middle. Mia discarded the half-nail, watching her finger ooze with blood.

  It should have hurt. If Mia had been a normal person, it would have hurt.

  The pliers were needle-nose. Mia used one end, pushing it into the exposed flesh, trying to get hold of the rest of the nail. She managed to dig one point of the pliers in and grab it, the blood making the job difficult. Twice, the pliers slipped off. With a final tug the remaining nail came away, ripping the cuticle and the skin, a thin strip tearing towards the first joint.

  Mia stared at her bloodied and damaged finger. She focused on her body, the sensations and the reactions. Her mind registered the pressure and the scratch
ing; the throb of blood rushing to the damaged site was palpable. Her body was in trauma and reacting accordingly. No pain.

  Mia dropped the pliers and reached for the hammer and a blunt carpet tack. Pushing the tack on to the delicate exposed flesh, she lifted the hammer and slammed it down, careful not to hit too hard. A broken finger joint would be annoying and could restrict her movement even more.

  Her elbow began to throb. Mia guessed it was a result of blood rushing to the arm, her body screaming in alert. Closing her eyes, she looked inwards, searching. A faint haze tended to descend at this point, a mild clouding of her thoughts, nothing more. She observed it. She also observed a greater than usual feeling of calm. It draped itself over her like a warm blanket.

  Just for a moment, though. When she opened her eyes, the sensation disappeared, snapped off like a light.

  Useless. And pointless. Mia used the pliers again to retrieve the carpet tack from the end of her finger, poking around until it came loose in a puddle of blood and bits of skin and tissue. She could see the bone and frowned, thinking she’d gone too far.

  A liberal dousing of antiseptic lotion followed by a layer of gauze and a thick white bandage. Infection was the biggest risk from an open wound. Mia was good at cleaning and disinfecting. She’d change the bandage every night and keep the wound wrapped until it healed. The nail would grow back.

  They always did.

  CHAPTER TWENTY-EIGHT

  Alex wrestled with the handset as he weaved through the late-afternoon traffic.

  ‘Shall I give you a minute?’ said Laurie on the other end of the phone. ‘Give you a chance to learn how to use twentieth-century technology?’

  Alex managed to get his phone into the holder without hitting the kerb.

  ‘I’m fine, thanks.’ Alex would never admit he hated the way his car could automatically connect his calls. He preferred being in control, even if that meant pulling over.

  ‘You wanted to talk?’ said Laurie. ‘Three messages. I ignored them all, of course, but then you sent a fourth and I felt bad. Didn’t want you to think I didn’t care. Should I have sent an I’m very fucking busy emoji?’