by David Ellis
“Yes, I suppose so, but I don’t want any more tests. I just want this pain to go away.”
“So where exactly is the pain?” asked Emma.
And so Emma’s questioning proceeded. It was clear that the pain wasn’t consistently localised and did indeed move around like a will-o’-the-wisp. And although she emphasised how painful it was - “At least 11 out of 10 on the pain thermometer, doctor” – it was also notable that when she moved around in the bed there wasn’t a flicker of a grimace on her face. Emma examined her physically which confirmed that any indication of pain she showed didn’t match any underlying anatomical structures. It puzzled Emma that so many doctors had done so many things to her over so many years. This is the real power of the patient, Emma thought.
Although Emma wasn’t convinced that it would help, she decided to use her ability to see through the veneer for what was underneath; which could, of course, be real pain, but pain that had obviously defeated conventional medicine and where pain management might be helpful.
“Now, I’m almost finished, but I just want to do one final examination. It’s really a type of eye examination and it just involves me looking at your eyes. You’ll see me firstly looking at your eyes from a distance, with these special glasses on, and then I’ll come closer and look at your eyes with the glasses off. Is that okay?”
“Yes, I suppose so. As long as it doesn’t hurt,” she said.
“No,” said Emma, “I promise you won’t feel a thing. But it’s very important that you keep your eyes wide open the whole time.”
So, with the patient sitting up in the bed and looking toward her, Emma leant back in the chair so that she was about six feet away from Naomi’s face. She put her glasses on and started staring at her eyes. Keeping her eyes focused on Naomi’s eyes, Emma gradually moved closer and closer until she was about four feet away. So far, with the glasses on, the feeling she was getting could best be described as a general, rather bland discomfort, which she often found with patients in hospital. Maintaining the distance, Emma took off her glasses. Suddenly, Emma felt overwhelmed by a wave of the most intense anger she could ever imagine: a surge of rage that threatened to totally engulf her. She quickly put the glasses back on and the anger was cut off almost as abruptly as it started.
“What happened there?” asked Naomi. “I saw something in your eyes and it really freaked me.”
“You know, I’m not really sure,” said Emma, “but I think I’ve got a better idea of what you’ve been going through.”
And Emma was sure that horrible things had been done to her in the past by people other than doctors.
Emma also thought that she’d disrupted what could have become a very nasty feedback loop just in the nick of time. This was the price she paid for this strange ability of hers.
Emma decided that the approach she’d use with Naomi would be a softly-softly one so as to avoid the anger breaking free again. It was also a somewhat unconventional one that she’d learnt from a psychiatrist colleague: writing something down on paper in the form of a journal. In fact, this sort of written homework is basic to doing cognitive-behavioural therapy, which is how Emma would try to sell it to her.
So, Emma told Naomi that she wanted her to start writing something with the title ‘Me’, and that she could set this at any time in the past, present or future. And Emma told her that she’d be back to check on her progress.
November 2001
Given that scanning could only show how her brain reacted to looking at patients rather than how she might be able to affect them, Emma decided to do a literature search to see what she could find.
Emma’s starting point was a book entitled ‘The Evil Eye: A Folklore Casebook’, published in 1981. This included case histories from many countries and cultures and showed a remarkable conformity in the folklore of what was described as “the malevolent glance”, which was said to be able to bring misfortune, ill health, and even death to its victims.
The book described the evil eye as a channel through which malicious powers can harm certain vulnerable people. Babies, young children, brides, pregnant women, the elderly and the ill were all thought to be vulnerable to the ‘eye’, together with those who are “envious, proud and puffed up with self-esteem”. Emma started to see similarities in her own case histories. Countermeasures were said to include spitting and a bride wearing a veil. Verbal protection was also described being used; for instance ‘in shalah’ in Arabic speech.
The possessor of the ‘eye’ was said to be usually female and heterochromia of the irises was also thought to be common. Emma recalled that she had been told that she had that otherwise totally benign ocular anomaly, so a number of boxes were being ticked already. She also recalled that heterochromia was usually inherited, so she wondered whether mentions of the ‘eye’ might run in certain families. Another reference mentioned a particular Celtic interest in the evil eye - called ‘droch-shùil’ - in the Scottish borders with the Armstrong clan figuring prominently.
In another text, Emma came across a reference to how those thought to have the evil eye should be buried: ideally, with both eyes removed and dead white butterflies inserted in the empty sockets. Emma immediately remembered the cadaver in the dissecting room. This is getting very weird, she thought: another connection with the cadaver transferred to the Oxford dissecting room from Scotland. And why do butterflies keep on cropping up in her life?
December 2001, Christmas Eve
Two middle-aged men sat in a comfortable, book-lined room enjoying single malt whiskies in front of a log fire. They had copies of a brown, foolscap file on their laps.
“Some developments, I believe?” asked the first man.
“Yes, a rather close shave, as one might say,” said the second.
“And it wouldn’t have been a happy landing,” said the first.
“Indeed, potentially very messy,” said the second.
“Should one point a digit?” asked the first.
“Our friends at CNU?” asked the second.
“A little too fast too soon, I suspect,” said the first.
“Yes, more caution needed,” said the second.
“And maturity,” said the first.
“And no more precipitation of precipitousness, one would hope,” said the second.
“I couldn’t have put it better,” said the first.
They topped up their whiskies and moved on to the next file.
August 2002
One weekend evening, Emma was walking through the park on my way home after a night out with a friend. She’d had a bit to drink but not enough to reduce the apprehension she felt walking through an irregularly illuminated section of the park where the lights cast ominous shadows. Out of the corner of her eye, she thought she saw a movement and then heard rustling that could only have been made by a human being. Moments later, she had someone’s hands on her breasts and a very erect penis pressing into her backside through the thin summer dress she was wearing. She smelt stale beer on his breath and felt the roughness of his unshaven chin on her neck. She was also aware that he had an accomplice who now moved furtively out of the shadows with his zip open and semi-erect penis dangling. At that moment, a sudden desire for self-preservation must have engaged her fight or flight response and she spun around.
“Alright, then, if that’s what you want, you can have it from the front.” he said.
Emma glared at him with her eyes wide open whilst mouthing “you bastard”. For the briefest moment, she felt his seething rage, malignant hate and sexual aggression, but the next thing she registered was him grasping his head in pain and then he fell flat on his back. His accomplice ran off, zip still open.
Emma wasn’t sure how she gathered the wherewithal to do it, but she managed to dial 999 on her mobile phone and shortly thereafter ambulances and police cars turned up with blue lights flashing and sirens wailing. It must have seemed a bizarre crime scene: a distressed female in her summer dress with no sign of any i
njury and a black male lying flat on his back with his detumescing penis lolling to one side. The paramedics seemed to approach the body with caution, almost as if they expected the penis to rise up like a spitting cobra, and then they went through their paces to establish that he was beyond their help. They put a plastic bag over the penis, presumably to help with forensic evidence, and manoeuvred him onto a stretcher. Emma was led into the back of an ambulance with a blanket over her shoulders and a female police officer by her side. In A&E, she was thankfully fast-tracked through into minors where everyone concluded that she was fine and could go home in a police car.
Emma wasn’t fine, of course. She took a few days off work and told her secretary the bare bones of the story. She sat indoors waiting for someone to contact her.
A few hours later, she found herself for the second time in her life in a police station being interviewed by two male detectives. They had no forensic evidence and the crime scene had revealed nothing. Emma wouldn’t have described them as actually hostile, but they certainly found it difficult to believe her story. Emma thought their masculinity was affronted by the idea that a woman could defeat the mighty membrum without even raising a finger. But she remained very calm and repeated the story as often as they wanted. She also gave a good description of the other would-be rapist.
After a week, Emma returned to work, which was actually the worst bit. By the end of the first day, she felt like putting up her account of the incident on the hospital noticeboard for the entire world to read.
A week later, Emma received a phone call at work from a female police officer who told her what she needed to know. It transpired that the dead male had ‘form’ and was known for his predatory behaviour towards vulnerable females but had never attempted rape before. Forensic evidence obtained from his body showed that he had been in a state of arousal before his death. Post mortem examination revealed that he’d died from a massive intracerebral bleed and that he had an aneurysm that could have burst at any moment. The CPS wasn’t going to press charges and Emma was commended for her defensive action. However, Emma was advised to use the more conventional technique of kneeing the assailant in the balls next time. The police hadn’t managed to track down his accomplice.
Emma wanted to think that it was her gaze that pricked the bubble in his brain, but it was probably just fate for him and luck for her.
Emma decided that she would take an alternative route home in the future in case his accomplish decided to return for a second attempt.
February 2003
Feeling just a little apprehensive and somewhat furtive, Emma decided to attend a conference in Utrecht, Holland, organised by the International Palliative Medicine Society. The title of the conference was the cosy sounding ‘Comfort Care’, which was sufficiently broad to cover a multitude of therapeutic virtues or sins. However, the location of the conference, in what had almost become the epicentre for assisted death, suggested that a more local agenda might be included. From a personal perspective, Emma believed that there was a case for assisted death right from the moment it was discussed in medical school.
Recently, Emma had started to think about getting more actively involved in the pro-assisted death movement in the UK. But her views were still in the minority, hence her slight secrecy about attending the conference. And in terms of her current practice, she’d more or less concluded that the best that she could aim for is enabling her sickest patients to get more involved in considering how and when they might die. She was also doing her best to keep her ability out of the way with such patients.
It was bitterly cold when Emma arrived at the vast conference centre and she decided to get a coffee in a nearby cafe before registration started. She walked in and noticed a pleasant looking, and similarly chilled, woman standing in the queue who resembled someone she’d met a year ago at another conference.
“Excuse me, you’re not Janna Roit, are you?” asked Emma.
“Well, yes,” said Janna. “And you are… I don’t believe it... Emma!”
“Yes, that’s me. It’s so good to see you. Are you here for the conference?”
“Yup. I’m trying to get my head around certain things and I’d hoped the conference would help.”
“Same thing here.”
“Are you still doing the same pain medicine job?”
“Yes. And you’re still in palliative care?”
“Yup, but we’re told the new term is ‘comfort care’.”
“So I see.”
They laughed and agreed to meet up again in the break for lunch.
The first session of the day was a debate entitled ‘Comfort Care or Cautious Care?’ and included a variety of pro-life and pro-assisted death speakers from across the spectrum of palliative and terminal care, and from different countries with vastly different legislation. Emma found the sanctimonious pro-lifers difficult to endure and almost walked out before the end. But just before the session concluded, a rather unprepossessing woman went up to the dais and started speaking. She calmly explained that she was the carer of a son with a thirty-year history of bipolar affective disorder. She went through a long list of all his hospitalisations, treatments, arrests, assaults, suicide attempts and side effects, and then put up a slide showing him how he was at the end of all this: a bloated, filthy balloon of a man with despair and frustration etched into his face. The stunned shock that went through the audience was palpable. She described the journey the two of them had taken to seek assisted suicide, which proved to be an endless succession of visits to different doctors in different clinics who all maintained that his condition was treatable. Finally, she made the decision to move the two of them to a tiny flat in Utrecht simply to facilitate his death. The two of them had finally met the residence requirements in November and her son had received the two independent assessments required. He now had a date for what the two of them had sought for so many years. The smile of relief that appeared on her face when describing this said it all.
Janna and Emma sat down in the café to have their lunch.
“That carer was quite something, wasn’t she?” said Janna.
“Amazing, absolutely amazing,” said Emma.
They sat in silence, eating their lunch and looking out across the city.
“You know, Janna, I think I’ve got my take home message.”
“Me, too,” said Janna.
December 2003
It was time for Emma’s annual appraisal and she was meeting up with the Witherington Hospital’s Medical Director, Dr Michael Martin. Appraisal was something introduced in the early 2000s in the wake of the Harold Shipman case. Emma never knew him personally, so she couldn’t vouch for his character or professionalism, but she had met other doctors who did know him and they had nothing but respect for him. So, apparently, did some of his patients. Unfortunately, at least 250 of them weren’t available for comment. Nonetheless, Emma thought that he’d probably have done rather well at his annual appraisal.
“Come in, Emma,” said Dr Martin, gently avuncular, with a pipe ready to smoke as soon as he was given a chance.
“Good to see you, Michael,” said Emma, “how’s the family?”
“Fine really,” said Michael, “apart from the usual angst with the kids and the pregnant gerbil.” They laughed. “Now, your appraisal. I’d imagine that there’s not much different from last year, but let’s go through it anyway. Where do you want to start?”
“Okay, starting with my personal details – you’ve got your copy in front of you – I’ve put where I work – that hasn’t changed of course – and the date of my full registration with the GMC – there’s a letter confirming that in my portfolio – and when I was appointed to this post, which was August 1994. Revalidation hasn’t come in yet of course, so I’ve left that bit blank, and I haven’t started moonlighting elsewhere.”
And so it went on: an hour of going through the form in quasi-forensic detail with variable seriousness. The marginally tricky bit that they came to
45 minutes in was ‘Probity and Health’. Probity is meant to be about moral principles of honesty, decency, integrity and so on. As far as Emma was concerned, she was honest with herself and with her patients, but often felt bogged down by the moral maze of stopping and starting treatment for her chronically ill patients. Health-wise, Emma had what one helpful cognitive neuroscientist called “emotionally unstable traits”, which she wouldn’t have any qualms about admitting. She might also have had a sub-clinical eating disorder, but she was hardly going to disclose that at her appraisal to someone she saw so infrequently. And there‘d been no overnight visits to Oxford in the last year either.
So, that was Emma’s appraisal. Year in, year out, she guided the discussion and omitted anything too sensitive. Bad doctors may be found out if there are complaints or bad audits; good doctors who occasionally transgress remain off the radar unless they are really stupid.
Dr Martin wouldn’t quite have reached the same conclusion. On the contrary, Dr Jones was very much on his radar.
December 2003, a few days later
A few days after Emma’s appraisal, and not long before Christmas, her mother was admitted to the local hospital in Guildford. Her father was spending much of the day by her bedside as he’d just retired. Although Emma and her mother rarely spoke these days, she drove down to visit her. This would prove to be one of the most difficult clinical situations she would have to deal with in her entire medical career.
Guildford General Hospital is a hotchpotch of new buildings, portacabins and a Victorian ex-sanatorium where patients with tuberculosis were incarcerated whether they liked it or not. During World War One, it generously took the sick and wounded. Emma’s mother was on one of the older wards, whose economical, Victorian design is pretty much standard wherever you go in the modern NHS unless the magic of private finance initiative has stepped in. She was, at least, in a single sex bay which was some small comfort.
