He paused at the front door. “Don’t get any of that crap on the rug,” he growled.
Two-year-old Melissa sat back from her work and smiled. The look on her face could have charmed a marble statue. “Daddy?”
Martin was unaffected. “Jesus,” he muttered, and walked out. He slammed the door behind him.
Melissa’s lips pouted forward. Daddy was having one of his “grumpy times,” as her mother would say. Daddy was a strange and unpredictable character. Seldom available for quiet time. Often distracted.
She returned to her coloring.
Martin came home late that night. It took him a while to locate his own bedroom, and it confused him to find his wife not there.
“Janet?”
“In here.”
He stumbled into the children’s bedroom, where he found both his wife and daughter standing at Jimmy’s crib. Janet held Melissa’s hand in her own.
Melissa looked up at her Daddy with an expression of infinite sorrow.
Martin blew air through his lips like a man who has just discovered a parking ticket on his Jeep. “Fuck,” he said. He reached into the crib and gave Jimmy a little shake. When Jimmy did not respond, Martin began poking him roughly, as one might poke a raccoon carcass on the highway.
“Martin, please,” said Janet.
“Oh, shut up.”
All four of them were silent.
“I’m going out,” Martin said finally.
“Martin, what about Jimmy – ?”
“Shut up.” He turned to go. Conveniently, he had not yet removed his coat.
When he was gone, Janet and Melissa walked into the living room and sat down on the couch. Melissa’s bare feet did not reach the edge of the cushions. She held onto her mother’s hand and waited.
Eventually, Janet began to cry. The tears came down in thick, steady streams, and her body shook. It was a behavior Melissa was used to, and she was not distressed. She gripped her mother’s hand as tightly as she could manage with her toddler’s forearm muscles, and she breathed in the familiar scent of sweat and tears.
“It’s okay, Mommy,” she said quietly. “It’s okay.”
Kline’s Problems
1
From Getting to Know Patient Nathan, by Dr. John Levoir:
When I saw the patient for the first time, he was strapped to a gurney. He seemed even taller than his listed height of 6’4”, probably because he was remarkably thin. “Gangly” is the word Nurse Bailer always liked to use. Considering the quantity of thorazine and Xanax Dr. Bjorn had prescribed, I expected to find a man lost in a deep, sedative swamp. Physically, this was true.
“Nathan?”
He turned his head towards me with an agonizing slowness. I was surprised that he was able to move at all.
“Nathan, I’m Dr. Levoir. I’ll be your doctor from now on.”
His eyes found mine, and they locked into place with an unsettling intensity. It was as though I were a spot of firm ground, and he was using me to steady himself.
“Nathan, I understand you have been placed on a high dose of tranquilizers. The first thing we are going to do here at Clancy Hall is take you off of them. Start fresh, okay?” I put one hand on his arm. I’m not sure he felt it. “Going off the Xanax will create some significant withdrawal issues. But we’ll help you though the process.”
He blinked once. It may have been my imagination, but I think he was thanking me.
Detox was a struggle, as it always is. The details are not relevant, though I will say that Nathan endured his period of deprivation with more than the usual stoicism. Towards the end, I visited his room to discuss treatment options.
“Good morning, Nathan.”
He turned his head and nodded silently, his face set in concentration. Beads of sweat stood out on his forehead.
“You’ve been doing very well, and it’s almost over.”
“Thank you,” he whispered.
“I have an idea about how we are going to proceed from here. I wanted to ask you about it first.”
He waited.
“I’d like to give you a few days – perhaps a week – with no medication whatsoever. I know this has not been tried with you, but at this facility, we have the luxury of – ”
“Yes,” he said. “Yes, please.”
“Keep in mind that this will probably be only temporary. We need to get a better understanding of your symptoms.”
He nodded, keeping his eyes fixed on me. “I understand,” he said. “I won’t let you down.”
I smiled. “There’s nothing to accomplish here, Nathan. It’s not a test. No matter how you behave, we will find a way to help.”
“I won’t let you down,” he said again. His face was gray.
“All right, Nathan. That’s good. I believe in you.”
He continued looking at me for a beat, then turned away, apparently satisfied that he had made his point. His breathing returned to its slow, regular rhythm, and his eyes went blank.
The next few days were some of the worst for him. The nurses and I repeatedly offered to turn on the television; most patients suffering from chemical dependency withdrawal enjoy the distraction that T.V. provides. But Nathan was never interested. He preferred to use the window in his room as a point of focus. The view was nothing spectacular – just a small yard with a tree and a few patches of grass – but he looked out at that little green yard for days at a time.
Later he told me that he was usually thinking about his daughter, Alexandra, during these difficult days. “Her face,” he explained. “Just remembering her face always made me feel better.”
I now know that Nathan was only using Alexandra as a cover-up. He may well have been thinking about his daughter, but she was not all he was thinking about. I had forgotten, you see, about what Bjorn had told me: that Nathan believed he had found a proof to the Genius Postulate.
But Nathan had not forgotten. The Postulate was always on his mind. In retrospect, I suppose those were the days when he started to make his plans.
2
We have visitors occasionally here at Clancy Hall, most of them family members. Dr. Kline’s file listed a wife and daughter living in Hanover, New Hampshire, but neither one had contacted me or anyone at the clinic about coming to see him. I had read in the news that they were moving to another state. I didn’t blame them. Even his beloved daughter, Alexandra, whom he always talked about with such affection, never sent a letter or called even once.
I don’t think he ever saw her again.
Still, Nathan never wanted for company. He always had plenty of attention from other visitors, even though none of them were relatives. When people saw him, they naturally wanted to know more. They found him fascinating. I can remember one woman in particular coming up to me – she wasn’t even on the right floor, I don’t think – to ask about him.
“Why is he walking like that?” she said.
I had been contemplating Nathan on my own for several minutes, and I was caught by surprise. I stood back and faced the woman, who was the sort of earnest, weary-looking aunty type who could often be found visiting our ward. Her hair was a gigantic, badly-dyed tangle of unkempt curls and rogue barrettes.
“Miss?”
She pointed to Nathan, who was in the process of navigating one of our long, banister-lined hallways. He was trying to move without touching the railing, and having a hard time of it.
“He looks like a human bowl of Jell-O,” the woman said quietly. I was grateful to her for keeping her voice down. “What’s wrong with him?” she said.
I took a moment before answering. There were so many things wrong with Nathan, it was difficult to know where to start. “At the moment, he’s going through what I’ve been calling his scarecrow phase.”
The aunty lady gave me a disapproving glance. “That’s a charming term, I’m sure,” she said. “But I was actually wondering about the pathology.”
Ah, I thought. An aspiring clinician.
“Well
,” I said, “he’s lost his proprioception. The condition is transient, but until his parietal lobes resume normal function he’ll have to rely entirely on external visual cues for skeletal orientation.”
The woman’s eyes clouded over. Apparently the term proprioception didn’t show up in any of the standard waiting-room pamphlets. I started over. “You know what it’s like to be dizzy, right?”
She nodded.
“Okay. Proprioception is one of the things that helps you keep your balance.”
“No,” she said, shaking her head. “I thought balance was controlled from the inner ear. The vestibule-something.”
“The vestibular system, exactly,” I said with a grin. The lady was in over her head, but she was still game for the conversation. I liked her spirit. “You’re on the right track. The inner ear does account for most of your sense of equilibrium. But proprioception is essential, too. It’s an internal sense, a sort of ‘joint-to-joint’ monitor that helps your brain keep track of where your limbs are. For example, proprioception is what lets you touch your nose even when your eyes are closed. Or catch a ball without actually watching it hit your hand.”
She looked towards Nathan, who had fallen to the floor again. “He doesn’t know where his hands are?”
“Hands, arms, legs, feet – he can’t tell where any of his body parts are going. Not unless he actually looks at them. And in his case it’s a system-wide deficit. There have been plenty of documented cases of proprioceptive impairment over the years, but that’s not what we’re dealing with here. His proprioception is gone.”
She nodded slowly, sympathetically. “So how do you help him?”
I shrugged. “Actually, I don’t. I wait, and it goes away after an hour or so.”
“Goes away?” Her eyes grew wide, and she opened her hands in a gesture of confusion. “Then what’s he doing stumbling around? Wouldn’t it be easier for him to sit it out? Wait until he’s normal again?”
“Yes,” I said. “It would. Controlled movement without the benefit of proprioception is incredibly difficult, and walking without it is almost impossible.” I let out a long breath. “I don’t know what he’s trying to accomplish, but if I understood what made him tick, he wouldn’t be in here.”
The woman shook her head and turned to go. “Guy looks like he’s on a mission,” she said.
That’s true, I thought, watching the aunty lady waddle away. But in an asylum? Nathan can barely stand up on his own. What kind of mission could he possibly have in mind?
Unfortunately, not all of Nathan’s problems were so benign as the scarecrow phase, which was, after all, not much more than an advanced case of the wobbles. There was the “half-blind” phase, for instance, which was actually first identified – quite by accident – by Nurse Bailer. She had me paged one evening near the end of Nathan’s second week. It was dinner time, and I had been hoping to have a minute to myself and my cold ham sandwich. But then I heard my name announced over the PA system, and I knew the meal would have to wait. When I arrived in Nathan’s room, Nurse Bailer was standing at the foot of his bed with her arms crossed. “He’s making trouble again,” she said, her mouth drawn tight over her teeth.
Nathan didn’t seem to notice me, though he had looked up briefly at the sound of my footsteps at the door.
“What’s the matter, Nathan?”
“Doctor?” His head moved as if he were searching the room, but there was something strange about the way his eyes darted about. He never actually looked in my direction.
I glanced at his dinner tray, which was still half-full. “No appetite this evening, Nathan?”
“Dr. Levoir, I’m not trying to be difficult – ”
“He’s a liar,” Nurse Bailer cut in coldly. “He’s trying to get me to bring him a new tray.”
“I’d like to hear his side,” I said, doing my best to sound impartial. Bailer huffed loudly to emphasize her contempt for the patient, but I knew she wouldn’t interrupt again. “Nathan?” I prompted him.
“I… I don’t understand,” he said haltingly. He sounded apologetic.
“What, Nathan? What don’t you understand? It’s okay.”
“It just seemed like… like there wasn’t very much tonight,” he said finally.
“But you only ate half your dinner.”
Nathan’s brow furrowed, and he stared down at his supper tray as though it contained a complicated mathematical formula. “That’s what she said,” he said under his breath. “And I know you’re only trying to help, but…”
I watched him carefully, letting him work it out. Meanwhile, I was doing some serious thinking of my own. I saw him reach out and grasp at the empty half of his plate, and something occurred to me.
“The rest of the meal is on your left,” I said slowly. “Your left, Nathan. Do you understand me?”
He froze. “Left… I know the word, yes. But it’s nothing to me now. It has no color.”
I nodded and came towards the bed. I had never witnessed this particular form of hemi-inattentive deficit before – and certainly not with a presentation so extreme as this – but by now I was beginning to expect remarkable things from Nathan. Moving very slowly, I reached out and gave his plate a careful, 180-degree turn. The untouched portion of food now lay in his right field of vision.
His eyes lit up immediately. “There it is,” he said, and he breathed out a huge sigh of relief.
“Oh, give me a break,” Nurse Bailer growled, and she went stomping out of the room. I didn’t call after her, or even try to explain. She wouldn’t have understood anyway. The condition Nathan was suffering, as I had suspected, was due to a severe, recurring deficit in his right temporal lobe. It was one of his most difficult phases. I referred to it, as I mentioned before, as his “half-blind” phase, but the word “blind” is misleading here. Blind people can be told what they are missing, and can understand the scenes described to them; Nathan’s experience was nothing like this. During these episodes, any object not in his right field of vision would simply cease to exist in his mind. Not only that, but he could never remember that turning his head to the left would help his situation. Nathan was blind not only to objects on his left, but to the very idea of a left side. There was a hole there; a nothingness. It was a void in his mind.
So yes, it would be accurate to say that Dr. Nathan Kline was fascinating, both to me and to others. The visitors never stopped asking questions about him. About why he moved in that strange way. About why he refused to speak in anything but a whisper. “What is he doing sticking his head out the window?” they would ask, as Nathan tried to escape the stench of the asylum during one of his dog phases. “What’s wrong with him, Dr. Levoir?” Then, invariably, they would ask me about his prognosis, and at this I could only smile and shake my head. The word “prognosis” is a statistical term, referring to a probability for survival. A patient’s prognosis is based on data that have been collected from similar cases over the years. The problem, of course, was that no one had ever seen anyone – or anything – like Dr. Nathan Kline. Looking at his chart was like looking at the map of an undiscovered country.
There never was any prognosis. Not in the traditional sense. Because the only person at Clancy Hall with a clear vision of Nathan’s future was Nathan himself. Not that this slowed him down; his vision was clear, even if mine wasn’t.
A vision of revenge is, by all accounts, a vision of finely focused clarity.
3
Eventually I convinced Nathan to sit through a formal interview with me. He was becoming more trusting every day, and I considered it significant that he was willing to submit to such a thing. I told him so.
“My pleasure,” he whispered, easing himself down into the chair across from me.
“How are you feeling right now?”
“Terrible.”
“Why?”
“This table, this chair, this whole room.”
“What about them?”
“They all smell very, very
bad.” He grinned. “But not nearly as bad as you do.”
I smiled back at him. This condition, which we had been calling Nathan’s “dog” phase, was one of the easy ones for him. Having a hyperactive sense of smell was obviously unpleasant, but it didn’t require medication.
“And what’s coming?”
“Fear,” he said.
“Of what?”
“You. Anyone. Everything.”
“How soon?”
“Soon. Maybe ten minutes.”
“And it will last an hour, like the others?”
“About that.”
“Can I get you something?”
He glanced up at the window behind me, where we both knew security personnel would be watching. “I’d like to try it clean, if you don’t mind. Alexandra’s not going to want a father who’s always hopped up on anti-psychotics.”
I nodded. “Good point. You can do it. I believe in you.”
These interviews became a ritual for us. Sometimes we would just talk. Nathan would describe what he was feeling, always in that tight whisper of his. On other days he would pass the session by struggling through one delusional state after another: the room would spin on its head, or my face would become inhuman and ghoulish. His memory would desert him. He would lose the ability to speak.
The right-brain deficits were the most difficult, as they are for all who suffer them. The right hemisphere of the brain carries out the most basic cognitive functions; there is no “thought” in the sense that most people would recognize. Patients with tumors or seizures in the right hemisphere go through experiences that are unfathomable to the rest of us. Can you imagine, for example, what it would be like if you couldn’t recognize your own face in a mirror? Or remember the word “hello”?
Charcot's Genius Page 3
