It's Katrina, my trainee, on the phone, asking if I would come and see Mr Barrington. I'm forming a picture as I make my way down the corridor to the out-patient clinic. Mid-fifties, light grey suit, wet blue eyes, sandy hair, moist handshake, hint of a stammer. I saw him a couple of weeks ago. There before me, as I enter the clinic room, is a middle-aged man, the same suit, the same eyes. But this man is completely hairless. His head glistens under the strip lighting. There are tears filling his eyes and he is sweating profusely. He looks globular, dripping wet to his bones. It's a feature of his medical condition. Katrina explains that they started their assessments, but Mr Barrington quickly became distressed and felt unable to continue. She tells me this in just those terms, as if reading from a set of notes. I make a pretence of jotting down some notes of my own, but what I have written and am now tilting towards Katrina is, "what happened to his hair?"
Mr Barrington is ahead of me. "You're probably wondering what happened to my hair," he says, then gives me the story. Apparently it fell out at the weekend, mostly during Saturday night while he was lying in bed trying, unsuccessfully, to sleep. It came out in clumps as his head tossed and turned on the pillow, diffusing under the bed covers and sticking to his perspiring skin. He tried to brush it away, but the sheets were damp and he was afraid of waking his wife. Several times he got up to go to the bathroom to dispose of the hair he had gathered, each time noticing in the mirror, without particular dismay, the virgin patches of skin advancing across his head. "You weren't concerned?" I ask. "No." He says it's the least of his worries. Anyway, he had lost a few clumps over the week, so it wasn't that much of a shock when the whole lot fell out. He's been under a terrible strain, he explains, and things seem to have come to a head. I note the unintended pun. Language has a life of its own. He's had these things playing on his mind, he says, this thing in particular. "Would you like to tell us about it?" I ask. "Are you able to?" But he just drops his face in his hands and sobs.
Between bubbling sniffs and quivering exhalations, he asks permission to remove his jacket. He also removes his tie. His cream shirt is marked with a bib of sweat down to the fourth button and there are large ovals of dampness beneath the armpits. He regains his composure and is steeling himself to say something, but is not quite ready. "Why don't you take a break," I say, "get a breath of fresh air. Then, if you like, you can come back and we'll chat. We'll leave the tests for now." He just stares at the floor between us. No, he says, he must talk. It's driving him mad. But he remains hesitant. His gaze retreats to his feet. Then, looking in Katrina's direction, he says if we don't mind he thinks he'd find it easier if...
Katrina reads the signals and leaves. Mr Barrington looks out of the window, across the suburbs towards the distant hills, his wet blue eyes unblinking. But he is not admiring the view. He is adrift somewhere in a vast, inner space, exhausted prey to a relentless emotional predator. Guilt. I shake his soggy hand at the end of the session. He is very grateful. I'd listened, I'd advised. Outside it had started to rain.
While Katrina fills the kettle, I think back to Mr Barrington. I hear the sustained, oscillating groan like a child exhausted by a bout of crying. Then the confession: a single, weedy act of marital infidelity, a long time ago. His wife never knew. He'd almost forgotten.
Yet this was not a wasp at a picnic, it was a skewering torment. His hair had fallen out. The storm troopers of his super-ego were doing their worst, commanding him to put the record straight with his wife. But it would break her heart, wouldn't it? What was he to do? "Tell me what to do," he said. "Please."
Can we disentangle the dilemma from the disease, I wonder? The provisional diagnosis is multisystem atrophy, a degenerative condition. It carries a poor prognosis. Perhaps he's clearing the decks. But the disease is affecting his brain, so the urge to come clean and the inability to decide what to do about it might also be understood in neurological terms. I once made a home visit to see a head-injured patient. He greeted me at the door, but as he put his hand forward he noticed a milk bottle on the doorstep. Before his hand connected with mine he was bending to pick up the bottle. He had almost reached it when he began to straighten again and turn towards me, only to change tack and bend to the doorstep. He straightened again. He bent. He straightened. He bent. He shifted his weight and shuffled, struggling to execute one or other of the action plans hopelessly misfiring in the mutilated circuitry of his frontal lobes: motor dysexecutive syndrome. Finally, I picked up the bottle and put it in his hand. We would have been there all day. Is Mr Barrington displaying moral dysexecutive syndrome?
Katrina returns with mugs of tea. I feel inclined to keep Mr Barrington's secret. He was naked enough. I won't tell her, not yet anyway. Perhaps not at all. Perhaps I'll take charge of the case, and then she need never know.
