A clearer medical picture is starting to form of my patient. Just the edges at the moment, but the tests and scans he’s already undergone show me the faintest outline of something already.
Here’s what I know. His brain is not physically damaged—that much is evident. The concussion he arrived with a week ago has left no lasting damage. There are other potential physiological causes that could be in some way responsible, which I can and will start testing for tomorrow. He may suffer from epilepsy or a nutritional deficiency; he may suffer from a non-related condition that requires medication, the side effects of which could somehow be responsible for his memory loss. Testing for outlying conditions would certainly be worthwhile. I jot down a quick list of possible tests in my notepad. Some screenings we’ll have to send away for results. Princess Margaret Hospital, where I’m heading tomorrow, isn’t big; its resources are acceptable, but they’re nowhere near London standards.
The tiny fleck I noticed when Peter first showed me the CT scan is clearer on these new MRI scans. Pituitary cysts aren’t uncommon. Most people can live and die without ever even knowing they have a cyst on their pituitary gland; these cysts only tend to get found accidentally when doctors are scanning for other things, and are rarely a cause for concern. However, if this cyst had recently fluctuated in size and exerted pressure on a neighboring area of the brain, it could be in some way responsible. But it’s unlikely. The area of the brain responsible for memory retrieval, the hippocampus, is nowhere near the pituitary, so I’m not sure exactly how the cyst could directly affect it. But it’s certainly strange that other fugue cases have had similar growths. Something to look into further. I note it down. The speck is something to monitor but, at this stage, I’m happy to put it on the reserve bench in terms of possible causes and instead consider it a potential symptom, or anomaly.
If I’m totally honest I’m already erring on the side of this not being a physiological condition. The scans show the patient’s hardware is intact. If he were a computer and you took him to the Apple Genius Bar, they’d tell you it’s a software problem.
So, assuming the patient’s hardware isn’t broken, then we’re looking at a software problem. Psychological trauma.
And mental trauma isn’t that unusual a cause of memory loss. Post-traumatic stress disorder being the prime example; whether it’s soldiers back from war or children in the care system, PTSD is a lot more common than people think.
Up until fairly recently, in medical terms at least, the general wisdom was that psychosomatic illnesses were controlled by the sufferers. As if somehow the patient could just “pull themselves together” and then they’d miraculously recover and return to their normal lives. These days we know better. Psychosomatic illnesses are software errors, not user errors. If a patient’s memory loss is due to psychological trauma, he would have about as much control over his illness as you would have over a system failure on your laptop. No matter how much you wanted those wiped family photos back, they are locked in that old hard drive and you’re going to need a lot of patience and a pretty pricey specialist to help you get them out of it.
I take another sip of wine. The good news is that memory loss caused by psychological trauma is often only temporary. It tends to return over time once the real or perceived threat is removed. Patients slowly begin to regain memories—the trick is making sure the patient is in a safe and therapeutic environment when those memories, good and bad, do resurface. Or the consequences can be troubling.
A week ago, something very bad may have happened to this man. If he’s been through intense trauma, then hopefully, now that he has some distance from it, we should be in a position to help him remember what happened. Or, at the very least, help him move on from it.
I start to draw up my plan of action for tomorrow. I need to be prepared. This is important, for me and for him. We can’t afford to mess this up, not with the whole country watching. My pen glides fast in wide loops and curls across my yellow legal pad as I pour out my ideas.
The low lights in the living room flicker.
I glance up at the lamp nearest me. It glows steadily. But there was a flicker before, I’m sure of it. A break in the electric current. I stare at the bulb. It flickers again, like a moth against glass, then all the lights in the room and through the hallway flicker back in response. Oh no. No, no, no. Not the lights…
And as if the thought were a wish, the whole house plunges into darkness.
* * *
—
It’s just the fuse box, I tell myself. Houses aren’t haunted, people are.
The edges of the room are no longer visible; armchairs, bookcases, and cushions have been swallowed up into the darkness. The kitchen is nothing more than a black void beyond the archway. Only the firelight remains, carving deep shadows into the space.
My pulse is racing high and fast in my chest. Jesus. There is only darkness all around me.
These things happen all the time in the countryside, I tell myself. These things happen all the time in remote cottages deep in the woods.
It takes my eyes a fraction of a second to adjust to the light of the fire.
I hear a noise outside, low and animalistic, a creature, a fox perhaps. I look to the patio doors, suddenly keenly aware of all the life outside this cottage. I realize that up until this moment I’ve been lit up like a Christmas tree in here, exposed for all to see. But in the dark glass I see only myself. My own ghostly face looking back at me, reflected, flickering in firelight. I quiet my breath and listen again for noises outside; I listen so hard the room buzzes with silence and the popping fire.
It’s just a power failure. Grow up, Em.
I’d better find a flashlight and the fuse box and hope it’s just that. If it’s not, then it looks like I’ll be heading to bed. I know from experience that you can’t do anything useful after dark during a power outage.
I find a flashlight under the sink in the kitchen and head for the basement.
My mind creeps back to Holt again, to our old house. The staircase downstairs into the dark, the glow of a light from the study, the sound of dripping. I shake the memory away, shuddering.
It’s colder in the basement, the air damper. Shadows leap and dance at the corners of my vision. I remember the thick pooling of dark arterial blood, from long ago, the sound of breath rasping behind me.
Stop it, Em. Stop it.
I throw the switch on the electric panel and the house leaps back to life. The darkness vanishes and I’m standing in a basement laundry room. No spiderwebs and rot here, just appliances and laundry detergent.
I guess I overloaded the circuit turning on all those lights. Lesson learned.
13
THE MAN