by David Ellis
“Okay, Emma, I think I can do that if you were shown the right images. I’ll give you a ring back in a few minutes.”
“Thanks, Michael, I’d appreciate that.”
Ten minutes later, Michael rang back.
“Emma, it’s strange, the activation was off the scale for old people whose photos showed them lying down; as if they were ill in other words. And there was something else too: certain photos we showed you could have been perceived as images of people in pain, and those scans showed activation in the prefrontal, insula and anterior cingulate. It’s weird but it’s almost as if you were experiencing their pain just by looking at the photos.”
“Michael, I think I need to see you again.”
And so, for the second day in a row, Emma visited the imaging department, but this time she chose to talk in his room rather than anywhere more public.
“You look worried, Emma,” said Michael.
“I am, Michael. Now, I know what I’m going to tell you is going to sound screwy, but it’s something I’ve got to say someone, or else I’ll go completely out of my mind. So please hear me out.”
Emma pulled out the piece of paper with her jottings on it and started going through the associations that she’d been making.
“But the difficulty is that any temporal connection seems to be all over the place – sometimes virtually immediate in the cases of Carlisle and Simmonds, but sometimes weeks later in the case of Bascombe - and then there are the emotions I get, which can range from just a feeling in the case of Bascombe to a huge wave that left me drained in the case of Simmonds. It’s very confusing. What do you think, Michael?”
He leant back in his chair to think and then sat forward, looking in her eyes. “Have you considered seeing a psychiatrist, Emma?”
“Oh god, I thought you’d say something like that! Look, Michael, I’m sure something is happening and that I’m connected with it and I need to understand what it is.”
“Okay, okay. Look, Emma, this is really out of my area, I’m just a bog-standard radiologist really. What about if I give you the details of a guy who works in cognitive neuroscience? He’s into complicated things like consciousness and the soul, and he might be able to help you. He’s also a psychiatrist, which might just be useful.”
“Thanks, Michael. But please keep an open mind about this and don’t tell anyone what we’ve been talking about.”
“Okay, agreed.” He turned to his desk and found a card with a name and phone number on it. “And here are the details of the guy I was telling you about; his name is Jim Lawrence.”
Emma spent a few days mulling over what she’d discussed with Michael Moore. She tried to recall whether there were any other cases that she could add into the equation. She suddenly thought of the Dean at her interview for St Helena’s. He’d made some pointed comment which annoyed her and she remembered looking at him. Emma couldn’t recall feeling anything emotionally, but there was definitely a look of surprise on his face. Emma decided that it would be worth checking with St Helena’s to find out what happened to him.
Emma phoned director enquiries and obtained the number for switchboard at St Helena’s.
“Oh, hello, this is Dr Emma Jones. I was up at St Helena’s from 1981 to 1986. I wonder whether I could speak with someone about one of your fellows, the Rev Bryant; I think he was a Dean back then.”
“I’ll put you through to the bursary, doctor,” said the porter.
“Bursary here, how may I assist you?”
“Yes, hello, it’s Dr Emma Jones. I was an undergraduate from 1981 until 1986. This is probably a long shot, but I’m trying to track down a Rev Bryant, who I think was your Dean back then.”
“Oh yes, I recall the name. He’s not one of current fellows, though. Let me check for you.”
Emma waited for a few minutes before the person came back on the line.
“Yes, I’ve found it. Well, I’m sorry to say that he passed away; a heart attack I believe.”
“When would that have been?” asked Emma, her pulse rate climbing.
“Let me see. Ah yes, it was just before Christmas 1980.”
Emma studied the business card in front of her: ‘Dr Jim Lawrence MB BS, MRCPsych, DPhil, Reader in Cognitive Neuroscience’. Well, she thought, there was no harm in trying.
Emma got through to Dr Lawrence’s secretary on the first ring and was put through to his extension. He sounded pleasant and said he’d be happy to see her when Emma mentioned Michael Moore’s name. They arranged a time and date for an appointment.
October 2001
Dr Lawrence had his office and lab in the Cognitive Neuroscience Unit in King Square which Emma gathered had received a hefty donation from some wealthy benefactor in the USA. His office looked as if it was inhabited by a compulsive hoarder and his appearance could be best described as wholesome but dishevelled.
“You must be Emma. Michael mentioned that you might be ringing me, but he said it was all confidential, so I’m very intrigued.”
“Thanks for agreeing to see me, Dr Lawrence,” said Emma.
“Please call me Jim.”
“Okay, Jim, I’ll give you the whole, unexpurgated story. I guess it should start with my birth. My father was a newly-qualified GP. My mother got pregnant on her wedding night, hated pregnancy and gave birth to me four weeks prematurely at home. All that seems to have been unplanned and I sometimes wonder whether she hoped I’d simply just disappear. She breast-fed me and that was fine until I was about five months, when she developed post-natal depression, thought I was evil, and tried to harm herself. That resulted in the police and ambulance being called to our home and she was detained at a local psychiatric hospital and treated with psychotropic drugs. She told the psychiatrist that she saw something in my eyes. My mother was very distant when she came home and seemed to avoid me.
“I was a bit spiteful as a child but things improved when I went to kindergarten and primary school. I liked school but didn’t mix much with other children and was really a bit stuck in my books. It was when I was 13 that I realised that I could cause things to happen just be looking at people. There was this girl in a biology class who teased me and somehow I made her have a fit. That’s when I started cutting myself which was really because of feeling out of control. I think I was also on the verge of developing an eating disorder. I tried to keep a low profile in secondary school and I was good at sciences, so I applied to read medicine. I had an interview for St Helena’s and remember giving a member of the interview panel - the Dean - a particular look because of something he said; I gathered recently that he died from a MI a few days later. Another strange thing happened when I was visiting an elderly lady in a nursing home in my last year at school. She was surrounded by medication and was obviously chronically unwell. I spent some time talking to her and looking at her, and I remember feeling all her pain and suffering almost as if it was my own; she took an overdose of insulin the same night. Medical school was okay; there were a few occasions when I self-harmed but usually because I’d felt very exposed in a public situation and couldn’t cope.
“Strange things started happening when I did my house jobs: a few deaths occurred after I’d spent time with patients and sometimes after I’d felt a similar wave of emotion as with the woman in the nursing home. Those coincidences continued when I did my SHO rotation but less so when I became a registrar. I did a course in CBT which in retrospect was probably more to understand myself. I got appointed as a consultant in pain medicine six years ago and I guess I’ve been careful not to look too carefully at patients in case something happens. Then, just out of the blue, I contacted Michael to talk about a piece of research I was interested in doing and he suggested my being a subject in one of his functional MRI projects. This involved looking at lots of different photos of people and seeing which parts of the brain got activated. He seemed very surprised by the results which showed a hyper-activation in certain parts of the brain – mainly the visual cortex and limbic syste
m, I think – when I looked at older people, and particularly older people appearing to be sick.
“That’s it really, and I’m desperately trying to understand what’s wrong with me.” Emma started crying.
“That’s some story,” said Jim. He leaned back in his chair, clasped his hands behind his head, and said: “Okay. Well, for a start, I don’t think you’re psychotic. You have emotionally unstable traits – and you probably know that – but that’s not psychosis. Next, it sounds as if your parents and grandparents have a lot to answer for, but that’s for some sort of therapy – if and when you feel ready for it.”
Emma nodded, listening intently.
“Now, the strange stuff you describe. It’s funny, but when you were describing those incidents, it reminded me of various consultants I’ve worked with in the past. There was one who had this extraordinary effect of promoting calmness and tranquillity no matter where he was and whom he was talking to; another was exactly the opposite and he’d only have to walk into a room and shouting and violence would ensue. Now, I’m sure that if you put him in a functional MRI scanner you’d see activation of his amygdala, but that hardly explains the malignant effect he had on people. As you probably know, there’s a term called ‘countertransference’ that’s bandied about a lot in psychotherapy. Most of the time, I suspect that there’s no such thing happening, but I just wonder whether this really is happening with you, but at a magnified level and with emotions rather than feelings.”
“That’s interesting; a previous consultant of mine did suggest something similar,” said Emma. “Could you try and explain that a bit more – my psychiatry is very rusty.”
“Okay, Freud had this idea that when a therapist is with a patient, feelings that the patient has towards others get transferred onto the therapist. So, if the patient is angry with his father, the therapist gets the anger transferred onto him; that’s transference. With countertransference, it’s the therapist’s feelings that get transferred onto the patient.”
“So, where does this take me and my countertransference – if that’s what it is?”
“Probably not very far, I’m afraid. The difficulty is that things operating at the unconscious level are, by definition, not modifiable at the conscious level. I suppose some sort of biofeedback approach could help – a bit like modifying heart rate, for instance - but that would rest with identifying something that could be measured. We could also try medication – an antipsychotic, for instance – but that would be more for sedation and I don’t think you’d thank me for that. At the end of the day, I think my best recommendation is for you to learn to live with it.”
“Okay, thanks, Jim. I appreciate your honesty and I think I’ve got a better understanding of what’s going on. But I’m not sure where I’ll go with it.”
“It’s been a pleasure meeting you, Emma. I’d be happy to see you again, but if you’d prefer not, then best of luck with your journey.”
October 2001, one week later
Emma drove down to Oxford after work in order to kill herself. Following that meeting with Jim Lawrence, she’d realised that there was no way she could continue living with the time bomb her brain had turned into. The final straw had been seeing her reflection in the mirror this morning with snakes sprouting from her head,
Emma had booked a one-person table in the window at ‘The Elizabeth’, a tiny, well-renowned restaurant, opposite Christ Church College, that had switched from serving traditional French food to something lighter and healthier. She didn’t want to feel bloated with calories on her final night. Having parked the car near the restaurant for a quick escape, she walked into Christ Church Meadow to savour the last of the autumn sun. Walking along the river bank, she spotted a number of her old friends darting from one herb plant to another: Brimstone, Brown Argus, Common Blue, Red Admiral, White Lady… And she was surprised to see that they actually seemed to be following her.
After an hour or so, she walked back and took her place in the relatively empty and peaceful restaurant. She had an excellent starter of beetroot and feta on rocket with a tangy citrus dressing, followed by Dover sole with pommes puree and spinach, and accompanied by a half bottle of Sancerre. She felt she needed a bit of Dutch courage but didn’t want to affect her co-ordination. She didn’t have a dessert. She paid with cash as she’d destroyed her credit and debit cards.
After dinner, Emma drove down Cowley Road to the rather ugly six-storey car park. She chose the car park because one side of it abutted the far boundary of St Helena’s grounds, and she thought that it was fitting that her final landing place would be where she started her career. That was assuming she could judge her trajectory accurately enough to fall inside rather than outside the boundary. Cowley Road is also where she first disclosed her story to a very pleasant counsellor called Robert, but she certainly didn’t want her body to be discovered by him.
Emma parked in a space on the ground floor as she’d decided that walking up to the top floor would befit her having reaching some sort of pinnacle in her career. She did this slowly as she didn’t want to be too breathless arriving at the top. Arriving at the top floor, she was relieved to see that it was deserted with no cars parked and no-one around. She felt that she had Oxford to herself. Crossing the parking area, she stepped over the barrier and stood on the edge, her toes just poking over, and glanced down at the grounds of St Helena’s still glowing with autumnal colours in the light from nearby buildings. She looked across the grounds to the main quad and could see the spire of Christ Church cathedral, the dome of the Sheldonian Theatre and much more that she could no longer remember. Emma decided that it was time. She took a deep breath, constructed her trajectory and…
October 2001, a few hours later
….she didn’t jump.
Emma wouldn’t have been able to explain exactly why she changed her mind, but it’s probably significant that as she stood on the ledge, taking her last breath, she was aware of butterflies fluttering around her head rather as if she was some exotic, brightly coloured flower.
She walked back down to her car, and with each floor that she descended, she could feel a weight being taken off her shoulders and a certainty that she did actually deserve something better. She got into her car and noticed that a solitary White Lady was fluttering by the side window as if checking that she was safe from harm. She lowered the window to say “Thank you” and the butterfly flew off into the night. She found a local hotel in which to stay before she returned home in the morning. She wished she hadn’t destroyed her cards.
Emma decided to buy some sunglasses.
October 2001, three days later
Back at work after a very eventful (or thankfully, uneventful) weekend, Emma felt surprisingly rejuvenated. She did go out and buy a pair of sunglasses at the weekend after borrowing some money from a friend, and decided on some light adaptive sunglasses so that it wouldn’t appear that she was hiding behind the lenses. Importantly, she’d moved on from viewing herself as a Medusa-like creature to something more like a sunglasses-wearing avenger with the mission statement of defeating pain and suffering. Captain Countertransference, perhaps.
Emma thought her team noticed the renewed bounce in her step. They were amused by the addition of sunglasses to her fashion accessories, which Emma said was because her contact lenses had given her corneal irritation.
Emma put her new found confidence to work immediately.
The morning clinic proved to be fairly run of the mill, and she used some typical chronic pain cases to discuss pain management with a trio of medical students who unfortunately gave her and the patients the impression that they preferred the less soft end of the medical spectrum.
In the afternoon, Emma had a couple of new patients to see on the wards and she anticipated that both would take at least an hour to go through the notes, see them and then formulate some sort of plan. It turned out that she’d miscalculated and just one patient kept her occupied most of the afternoon.
Thi
s patient met all the requirements of the unfortunate sobriquet of ‘thick note syndrome’. She actually had four sets of notes, each three inches thick, stuffed with admission notes, outpatient notes, investigations, operation notes, letters from all grades of doctors, letters from solicitors, and so on. On this occasion, she’d been admitted with pelvic pain under a gynaecologist who’d never met her before and didn’t have access to her multiple notes. The urgent referral had come from a GP who also had never met her and didn’t have access to her notes. In other words: the blind leading the blind.
Now, generally, when Emma saw a new patient on a ward, she’d spend a good fifteen minutes just going through the notes to work out what has been done to them and she’d also try to get a good chronology for their symptoms. With this new referral, Emma had to use the fast forward button to get to the highlights. She also looked for any sort of summary that would have pulled her history together but this didn’t exist.
The long and the short if it was that the patient was a woman in her early 40s who’d seen more than twenty specialists in ten different hospitals – NHS and private – and had had umpteen scans, a mixture of invasive and non-invasive tests and had endured at least ten operations by various surgeons and gynaecologists in order to find the source of pain that moved around her body like some malignant will-o’-the-wisp, which was clearly proving utterly elusive and infuriating for all concerned.
So, Emma approached with caution, but with her best professional manner in place.
“Hello, I’m Dr Jones. I’m a pain specialist and I’ve been asked to see you,” said Emma.
“No-one told me you were coming,” said Naomi.
“Sorry,” said Emma. “Sometimes doctors are so busy that they don’t inform their patients. Is it alright if I ask you some questions nonetheless?”
