i drive across town to the infirmary. Jake is on one of the big orthopaedic wards. When I arrive his parents and girlfriend are by the bed. There is no talk between them-a bubble of silence. I get the impression there has been no conversation for some time.
He is the image of Christ on the cross. Matted curls of black hair drop over sunken cheeks. His forehead is bruised and scabbed where a crown of thorns might have been and a bed-sheet, crumpled at his hollow midriff, serves as a loincloth. His lean, pale, upper body bears other scars of the smash: broad purple grazes and yellowing contusions. But at the bottom of the bed there is nothing. The imploding metals of the car severed one leg at the moment of collision. The other, mangled beyond redemption, was surgically removed later. If he is a car thief (how ghastly the term "joyrider" seems right now) he has paid a high price for his misdemeanours.
When I pick up the medical file from the nursing station the charge nurse tells me of Jake's disturbed behaviour: yesterday he was trying to smear faeces into his wounds. I am not looking forward to this. I feel cowardly. I want to turn and go. But when we speak he is perfectly pleasant. He seems composed, even tranquil. He puts me at my ease. The pain is tolerable now, he tells me. Yesterday it drove him mad. Where does it hurt? I ask. Left foot, he says.
I run through some routine questions about levels of consciousness and recall of events in the hours following the accident. Jake can't remember. He was conscious, says his mother. How can you be sure? I ask. She knows because the dial-home function on his mobile phone had been activated, perhaps accidentally in the impact or by Jake himself in a moment of lucidity. There was no one home when the phone rang. The answering machine took the message and stored it until Jake's mother returned from her night shift. He was calling for her. Wailing like a baby.
I do my stuff and leave. I've had enough. I have a meeting later on, but I phone in with an excuse.
it is a summer's evening, still except for a tiny plane droning through low cloud, in and out of view. I can imagine people in the plane, but only with some effort. From this distance, who would care if it fell from the sky? I am sitting in the garden. I must have dozed off because the student dissertation I was reading has fallen to the ground.
I pick up the dissertation, which has opened at a page containing images of a series of brain scans. I know the person whose brain this is. MJ17, says the caption, but I know her as Maggie. She is one of my research patients. I recall the last time I saw her, a couple of months ago. She greeted me, as usual, like an old friend, taking both of my hands in hers and gripping them warmly for a good minute. She took my arm as we walked down the hallway and into her living room. Then, while I'm chatting with Don, her husband, she touches my cheek. She really has no idea who I am. Her memory is a void. This, and her lack of inhibition, are a result of the disfigurement of her brain.
There are blades of grass on the page from the freshly-mown lawn. I am looking inside Maggie's head. She was probably humming a tune to herself as these pictures were being taken. When she is not talking, she is humming or singing.
The pictures are mostly ghost-grey, but dense material, like bone, shows up white. Darker regions signify lower density: the black butterfly of the lateral ventricles, filled with fluid rather than brain tissue. Large areas of the anterior temporal lobes have been eaten away by the virus. She was unlucky. It was just a common cold sore virus, herpes simplex, but it found a way into her brain. Yet she's lucky, too. Lucky to be alive. Don thinks so. Who am I to say she isn't?
Little white arrows on either side of each picture identify the regions of dark space normally occupied by the amygdala and the hippocampus. They are vital components of the machineries of memory and emotion. Their loss is what makes Maggie interesting for science.
As a clinician, I have a duty to be scientifically informed and inquisitive. Someone sits before me in the clinic room. They have a fault with their neural machinery and I need to develop an appreciation of the characteristics of that fault. They speak of symptoms; I listen and look for signs. I hypothesise, I test and deduce. I refer, as needs be, to the scientific literature. But I fail if, as part of this process, I do not also engage with the person. After all, it is the person who is ill, not the neural machine.
This afternoon, with Jake, I found it hard to maintain the necessary balance between detachment and absorption. The mutilated young man with the torturous phantom limb, his calm civility, the devotion of his loved ones, the cutting desperation of the message on the answering machine: it was too potent a mix and I was caught off guard.
Now I find sanctuary in the solitude of my garden and a retreat into sleep, science and abstraction-the dissertation; the soothing icons of a bug-eaten brain. How comforting to lose sight of Maggie and see instead MJ17. It is getting dark. A crescent moon is visible. At the bottom of the garden there is an apple tree. It is an old tree, bearing fruit for the last time. I see not just the fading shape of the trunk, the twisting branches; I see the age of the tree and its weariness.
And how do I know it is bearing fruit for the last time? Because I realise it is not there at all. My brain has conspired with the failing light to conjure a fleeting illusion of the tree from memories of similar evenings a year ago, before it was felled by a February gale. It is a ghost tree, rooted only in thought. n
