I depress the computer’s power button as stealthily as I can and swivel my chair and the phone away from its burst of startup noises. Google will be able to fill me in.
“Er, yes, I think I saw something….” I fudge as the home screen settles.
But he clearly sees through my delay tactics. “Ah, okay. I’m guessing you haven’t seen it. Let me give you the potted history. I’ll get the exact location details to you but he’s in England, it’s a coastal town, outside London. But diagnosis-wise, at this stage, it’s looking like retrograde amnesia or dissociative fugue.” He pauses to let that information sink in.
Retrograde amnesia or fugue. The loss of all stored biographical memory, through trauma—physical or psychological. Patients with either would retain all skill- and knowledge-based memory, as these types of memories are stored in different areas of the brain, but lose personal memory. A patient would know, for example, what the idea of home is, but he won’t remember his. He’d remember how to drive a car but not where he usually parked it. His past would be a blank slate, he’d remember nothing of his life before the physical or psychological trauma that caused the amnesia. Like walking into a room and forgetting why—except you also don’t know where the room is, or where you were before you walked into it.
Retrograde amnesia is caused by physical damage to the brain and it’s very, very rare. But fugue is even rarer and, unlike retrograde amnesia, fugue is caused solely by psychological trauma. I suddenly understand why Richard Groves is calling me in particular. In my thesis I argued Groves may have misdiagnosed certain fugue cases. I stuck my head out over the parapet of recent graduation and criticized the received wisdom, challenging the established method and arguing publicly that historically most fugue cases were likely misdiagnosed. He’s offering me a chance. A chance to prove it.
I take a deep breath. “I see.” There’s silence on the other end of the line. I realize he wants me to ask the most important question of all, the nub of the matter.
“Which do you think it is Richard? Retrograde or fugue?” I ask carefully. We both know how important the distinction is. If this is a genuine fugue case, it could give invaluable insight into an extremely rare condition. We’ve only really been able to test for it since the 1990s, which means study cases are few and far between.
“I haven’t seen any scans yet,” Richard answers cautiously, “but what they’re telling me sounds intriguing. It isn’t presenting as malingering, and it wouldn’t have got this far if it was, especially in light of the oversights on the Piano Man case. People are very keen to spot that kind of thing early. I have it on very cynical authority from Chorley that we’re dealing with something much more complex here. The powers that be over there seem pretty eager not to fuck the situation up. Yes, it’s definitely fair to say they don’t want another Piano Man situation.”
It suddenly occurs to me how big a deal this case could be. If I take it, I won’t just be treating an extremely rare RA/fugue patient, I’ll be responsible for averting another NHS diagnostic shit show. Because that’s exactly what the Piano Man case was.
Ten years ago, another man was found, this time in Sheppey—the Isle of Sheppey in Kent—in a seaside town during the off-season. He was soaking wet and wandering along a coastal road, in an evening suit. He had no identification on him; the labels had been cut from his shirt and suit. Admitted to the local hospital, he seemed unable to speak to the doctors and after neurological testing and psychiatric evaluation he was diagnosed as fugue.
Given a sketchpad, the man drew a detailed picture of a grand piano on a spot-lit stage. When the staff took him to the piano in the hospital’s chapel, he played the whole of Beethoven’s Moonlight Sonata from memory. And he was dubbed the Piano Man.
The Piano Man’s procedural memory was perfect, he remembered how to play, in spite of the fact that he’d lost all personal memory.
The hospital staff encouraged him to play daily, in the hopes that it would help his recovery and trigger memory recall. Staff and patients would gather at the back of the chapel to listen, enthralled as the music flowed out of him from who knew where. Inevitably, the press got hold of the story. A photo circulated of the lost-looking man, in the hospital’s garden, in his formal evening suit, a stack of chapel musical scores tucked under his arm, supplied by well-wishers. He looked every inch the lost musical genius that he swiftly became in the eyes of the world. The media went crazy for him, the public went crazy for him. And, overnight the world found out about the Piano Man. The name was almost too perfect, considering the other meaning of “fugue”: a piece of music made up of many voices repeating the same melody.
And the media storm that brewed became a fugue in itself. So many voices. People demanding to know who he was. Where he came from. But, most importantly, what had happened to him.
It played out loud and brash across the tabloids and for one summer the Piano Man caught the imagination of the world. The public wrote their own stories, projecting their hopes and fears on his blank expression.
Meanwhile, British neurologists, psychiatric nurses, and a host of other medical professionals fumbled and fudged different treatment plans and the police tried to track his family down. None of which came to anything. Until finally one day the Piano Man decided to speak. And what he said wasn’t what anyone had expected.
He wasn’t the man the world had been hoping for; he was simply an ordinary man, an imperfect broken person just trying to disappear. He’d been misdiagnosed. He wasn’t in a fugue state; and he didn’t have retrograde amnesia.
The National Health Service, police force, and government came under scrutiny for their complete and utter mismanagement of the whole case. The Piano Man was thrown out with the rubbish, a sad malingerer, a fraud who fooled everyone.
But I wouldn’t call what he did malingering, that seems too harsh a term. Malingerers tend to fake for financial gain or to avoid incarceration or military drafting. But the Piano Man just wanted to escape his everyday life for a while.
When Richard next speaks his tone is soft, parental. “I’d take the case myself if I wasn’t already neck-deep here at MIT. You know, I haven’t had a potential fugue for years now. There’s a lot I’d do different, a lot I know you’d do different.”
He’s right. I’ve never had a fugue patient. There aren’t that many around and men like Richard with years of clinical experience tend to scoop them up. Groves has treated cases similar to this one, although he had nothing to do with the Piano Man case—though he did work on a similar case, “Unknown Young Male” in 1999. It was the case where a twenty-year-old patient wandered into the Buffalo General Medical Center in upstate New York, soaking wet, with a shaved head, asking if anyone could help him find his way home, as he couldn’t remember where he lived or who he was.