Mr. Nobody

by Catherine Steadman

  27

  DR. EMMA LEWIS

  DAY 9—FMRI

  It starts to snow on my morning run. Great soft clumps drifting down through the gaps in the forest canopy as I follow the track that leads away from the lodge.

  I only got back from the hospital at around 4 A.M. this morning so I decided to give myself at least five hours’ sleep. I’ll go in later. Matthew needs time to rest before we do his fMRI scan anyway. I’ll head in after my run but right now I need time to process exactly what happened earlier.

  After bolting from his room, I managed to pull myself together in the staff locker room, thankfully before anyone saw me. Back in my office I shot off an email to Nick Dunning, asking him to move around some appointments and fit us into radiology for an fMRI today. When I woke, Nick had replied, telling me he’d booked the fMRI in for this afternoon, which is ideal. It gives me enough time to source some prompt images and questions for the test.

  I let ideas flash through my brain as I run, my sneakers crunching over frozen leaves and hardened mud while the snow floats sleepily down around me and settles. Today I need to distance myself from the patient, I need to put my messy life to one side to diagnose him. While he may remind me of someone long gone, I do not know this man. And I must remember that no matter what he says, he does not know me. I need to keep that foremost in my mind, whatever happens today. God knows how he knows the things he’s been saying, but there will be a logical explanation, and I need to stay far enough away from the subject matter to find that reason.

  Back at the lodge, I knock the snow off my shoes and plonk them down by the still-glowing fire. I slept on the living room sofa when I got back this morning, rumpled blankets and pillows evidence of my stay. Order slowly breaking down.

  When I get to the hospital I tell the nursing team to prep Matthew and have him sent up to Radiology. I head to my office and email the questions and photos I’ll need for the test over to the Radiology Department as well. Only then do I pick up the phone and call Peter.

  “He’s talking, Peter.”

  “Emma.” There’s a pause on his end before he speaks again. “Well, that’s fantastic. And what’s he saying exactly? Anything helpful?”

  I think carefully before I speak; how much should I tell Peter? “He doesn’t know his name or who he is. At least that seems to be the impression. You were right, the symptoms seem real. I’ve ordered an fMRI scan to verify the amnesia and the extent if there is any.”

  “Good. And he consented to that?”

  “Yes, instantly. It was…unusual.”

  “Humph, interesting.” He hesitates. “Look, Emma, I think in this particular case it might be worth conducting the scan on your own. Just in case anything sensitive should come up…that we aren’t expecting. Perhaps once you’re set up, best to have anyone else leave the room.” He lets the idea hang there for a moment.

  My stomach tightens. Is he worried Matthew might reveal who I am?

  “Sorry, in case what comes up, Peter?”

  He chooses his words carefully. “I know you’ve signed an NDA, but, of course, we can’t have everyone at Princess Margaret’s signing one. I mentioned before, there are…concerns relating to the patient’s identity.”

  His evasiveness annoys me. “Tell me what the concerns are, Peter. If I’m going to lock myself in a room with him, I think I deserve to know.”

  “Uh, well…yes, I suppose if you put it like that. There is a concern from the Ministry of Defense that the patient may be military, a missing person. Obviously, it’s not ideal that this is only coming to light now—but there we go. There are some conversations going on re jurisdiction—nothing to be concerned about just yet.”

  What the hell does the Ministry of Defense know about Matthew? “Peter, what makes them think he’s military? What’s informed that conclusion?” I hear the sharpness of my tone.

  “I’m afraid I’m not privy to that just yet, Emma. If it becomes…relevant then I’m sure we’ll be informed.”

  “Peter, come on, am I at any risk here? From my patient? I need to know. Do the MOD think he’s dangerous?”

  There’s a silence on the line. Which isn’t comforting at all. I suddenly feel so far outside my comfort zone that I almost consider hanging up. But Peter’s voice cuts in just in time. “No. No, I don’t think it’s that sort of situation, Emma. I certainly don’t believe so, that hasn’t been mentioned by anyone at this stage. I’m confident we would have been forewarned if it was anything like that. But of course, I would say use your own best judgment on this, Dr. Lewis.”

  Wow. Thanks, Peter.

  * * *

  —

  When I reach radiology, Matthew is already safely in position on the MRI tray bed, his head strapped inside the plastic head frame, his face hidden from sight. Rhoda is leaning over him explaining the procedure. She looks up when I enter and rests Matthew’s hand back down onto the bed.

  “Rhoda, I’m going to need the room to myself once we get started. No other staff members present. Are you okay with that?”

  She looks surprised but eager to assist. “If that’s what you need, then I can definitely do that, yes, doctor.”

  “Great. I’ve already spoken with the radiologist so it will just be Matthew and me. I think the more straightforward we keep this for him, the better.”

  “Of course.” She nods and turns back toward the man on the bed. “I’ll get him in and ready and then just let me know and I’ll slip out.”

  * * *

  —

  Once Matthew is safely inside the machine Rhoda makes her way out of the room with a smile. I seal the ward doors behind her and slip into the control room, engaging the magnetic shield door behind me, sealing Matthew in the MRI room. I find my seat at the control-room console and, through the thick glass that separates me from Matthew, I watch the MRI bed’s smooth motion into the machine. I lean forward and turn on the mic in front of me.

  “Matthew, it’s Dr. Lewis. Can you hear me?”

  I watch his face spring to life on the video screen next to me as my voice comes through his headphones. He opens his mouth to answer.

  “I won’t be able to hear you, Matthew, so try not to speak, just use the keyboard Rhoda gave you to answer. Press either yes or no. You’ll see the questions on the screen above you and you just need to answer yes or no. Rhoda should have given you an emergency squeeze ball as well. I want you to squeeze that as hard as you can if you start to feel concerned in any way or if you need us to stop, okay?”

  I watch the screen. He taps Yes.

  “Good, that’s great, Matthew. Now basically, this is how it works. The fMRI will show me the areas of your brain that receive the most oxygenated blood when you perform a task or when you respond to any stimuli. Those will be the areas you’re using to perform whatever function we’re testing. We’re going to start by taking a basic structural scan, so just relax and try not to move. The banging noises are the pictures being taken, so don’t worry when you hear them. Now, it’s very important you don’t move during the scan or the image will be blurry.”

  He taps Yes.

  “Excellent. You won’t hear my voice for about eight minutes while the scan is under way, okay?”

  He squeezes his eyes shut briefly. Yes.

  “Okay, here we go.” I turn off my mic and initiate the structural scan. I watch his face on the screen as the fMRI pounds noisily to life and the first images of his brain begin to take shape on the next monitor.

  He looks calm in spite of the overwhelming intensity of the machine thundering around him and I wonder if what Peter hinted at could be true, if he has some kind of military training. I’ve known the sounds and confinement inside those fMRI units to make the manliest of men uneasy, but not Matthew, he looks perfectly at ease. I lean forward and quickly jot down a final question for the scan. It can’t hu
rt.

  The screen flashes. I turn on the mic again.

  “That was great, Matthew. Nice clear images. Now we’re going to dive right into the next couple of tests, if that’s okay?”

  I watch his face on the screen. He smiles and taps Yes.

  “I need you to perform an action in this test. I want you to tap each finger in turn on your thumb of your right hand and just keep doing that until the screen above you says stop.”

  Yes.

  We steam through the basic brain activation tests: motor function, sound processing, visual processing, and then we get to the meat of the scan.

  “Okay, Matthew. Now I’m going to show you some images on the screen. I just want you to think about what you see, how the images make you feel and what they remind you of. You don’t need to direct your thoughts in any particular way. It will all just happen naturally, so just relax.”

  Yes.

  “Then if you’re okay with that, we’ll go straight into the question portion of the scan. A question will show on your screen. All you will need to do is choose a simple yes or no answer.”

  He pauses a second before tapping Yes.

  “You’re doing great, Matthew. Don’t worry about a thing.”

  He smiles and I click off the mic.

  * * *

  —

  I set up the photo sequence and press start.

  A photograph of an empty beach.

  His eyes flick fast over the image, pupils dilating fractionally, he inhales sharply.

  I watch the fMRI light up. His cortex now aglow, pulsing, as it processes the image. Then his amygdala, the fight-or-flight center, blazes, processing his emotional response to the stimuli. Immediately followed by a flare in his hippocampus—relevant memories are being sourced. Memory Retrieval 101.

  Matthew remembers being on the beach. But then, we knew that, didn’t we?

  I check the video link; he’s very pale. I check his vital signs: his pulse is slightly raised. To be expected; the last time he was on a beach must have been absolutely terrifying.

  Now to test whether his memories go any further back than that day on the beach.

  I flick to the next photo in the sequence.

  A stock family photo—a young couple, each holding a child in their arms.

  I watch the fMRI images as they register. Cortex firing, only a dim glow from the amygdala, and nothing from the hippocampus. Interesting. Either Matthew can’t remember having a wife and child or he’s never had either.

  I flick to the next picture.

  Another family photo this time from the 1980s—a couple in their forties with a seven-year-old son; it’s more formal in style.

  I’ve chosen a stock image from the eighties so it will resonate more with Matthew’s memories of being a boy, and potential memories of his own parents, if he can access them.

  I watch the fMRI screen. Visual cortex glows, and then the amygdala leaps to life, a burst of brain activity blazing on the screen. An extremely strong emotional reaction to the idea of parents or childhood. But as I study the dark mass of the hippocampus, there is nothing. Nothing. He has no memories of a family. I realize I’m holding my breath. I double-check the screen. No, there is no activation.

  He really can’t remember.

  A fizz of excitement thrills through me. Matthew might be the first fully verifiable case of fugue.

  In spite of everything that’s happened over the last two days, I feel a bright burst of joy inside. I can’t help but smile to myself. Buoyed, I flick to the final image.

  A thick green forest fills the screen.

  I watch his face on the screen, his pupils widening as he makes sense of it. Last night Matthew mentioned having one clear memory, of being in a wood.

  I look to the fMRI screen. His visual cortex activates, but his amygdala is strangely subdued, given how he spoke about the memory. I study the screen and then a sudden flash, an intense burst of activation in the hippocampus. A flash of memory. I jolt forward, leaning into the screen, and a constellation of areas in the cerebral cortex glow in answer to the initial flash. I’ve never seen anything like it, such a localized and specific reaction. I glance at his amygdala again. There’s hardly any emotional engagement. No emotional connection to these memories. My focus is pulled by a sudden low beeping below the screen.

  The lower screen is flashing—Matthew’s heart rate has soared well above the recommended level. I hover my hand above the fMRI’s emergency stop button and turn to check on his face on the video screen. Then I pull back my hand in surprise. Matthew’s face is utterly calm. His breathing is normal. I check the readouts again. His heart is pounding. He should be hyperventilating, but none of it is visible. The bright areas of his brain’s center for self-control, the dorsolateral prefrontal cortex, are glowing with vivid intensity. Somehow he’s masking it, suppressing it, he’s using self-control.

  Incredible self-control.

  I click off the last photo and reset the system, taking a second to shake off the oddness of what just occurred. I let his heart rate settle.

  We need clear readings for the next portion of the test. The most important portion.

  After a moment I turn on my mic again. “Matthew, are you okay to continue?”

  Yes.

  I check his vitals and everything has made its way back to the appropriate levels. I guess we’re safe to move on.

  I bring up the Q&A intro screen, explaining that I will not speak but he should respond to the text on the screen by pushing either Yes or No on his keypad.

  Yes.

  I start the sequence.

  WERE YOU FOUND ON A BEACH?

  Yes. His hippocampus activates briefly, the same as before.

  DO YOU KNOW YOUR NAME?

  Matthew pauses for a microsecond, then taps No. His hippocampus does not activate although his amygdala flares and his heart rate spikes.

  DO YOU KNOW WHAT HAPPENED TO YOU BEFORE YOU FOUND YOURSELF ON THE BEACH?

  Matthew closes his eyes. No. No activation in the hippocampus, only amygdala and dorsolateral. That’s fascinating—self-control again.

  I pause, finger poised over the final question in the sequence. His pulse is high but not above recommended levels. I click the next question. There’s no simpler way to find out if we’re dealing with a dangerous man, someone who the military might be concerned about misplacing.

  HAVE YOU KILLED?

  He looks directly up at the screen, his pupils constricting as if he can see right through the camera to me. He seems to hold my gaze, unflinching and steady. On the fMRI his dorsolateral glows white-hot, overshadowing everything else. There’s that self-control again. The beeping starts once more on the screen below, and I tear my eyes away from his.

  His heart rate is way too high: tachycardic.

  I hit the emergency stop button on the fMRI machine and jump up to release the control room shield door. I heave the door open and race into the scanning room, slamming my palm into the bed release mechanism on the side of the machine. The hydraulic system kicks in and the bed glides out achingly slowly from the bulk of the fMRI. I see him now, he’s gasping for breath, head still lodged in the head brace, hands fumbling at its clasps. I run to him and swiftly unhook the fastenings.

  “Matthew, are you all right? Can you hear me?”

  He clutches at his chest now, desperate, deep in the throes of a panic attack. He can’t breathe. My eyes swing to the readout next to him, his blood oxygen is lethally low at fifty. I look around the room but there is no one here to assist me. Damn it. I smash my hand on the emergency call buzzer and grab an fMRI safe oxygen tank, wheeling it quickly to the bed. I push the head brace away, and twisting the tank valve I slide the mask safely over his face, before I kick off my shoes and scramble up behind Matthew on the bed. I pull him back toward me, cradli
ng him, his head and shoulders resting against my chest. It’s not flattering but I’ve got him. I slide one arm under his shoulder and brace him. I need to calm him, to get him to slow his breathing. I need to lower his ludicrously high heart rate. He needs to breathe.

  I hold him tight. “Shh, shh, Matthew. It’s okay,” I soothe, but he struggles against me, wheezing and fighting for breath. “It’s okay, Matthew, you just need to calm down, breathe slow. Everything is fine. Just breathe.” He loosens back into me, his breath still snatching noisily in his throat. But at least he’s listening to my voice. “That’s it, Matthew. Good. Now nice and slow. In through your nose, out through your mouth. Good. That’s perfect. Everything is going to be okay, Matthew.” He takes a noisy breath in through his nose, and lets it out audibly through his mouth.

  “Good. That’s good. I’m right here. Everything is fine. I promise you.” I feel the weight of him against me, his fear, his trust, his vulnerability.

  There wasn’t time to get an fMRI reading on that final question, Have you killed? But, in a way, what just happened might be answer enough.

  28

  DR. EMMA LEWIS

  DAY 10—A VISIT FROM JOE

  Matthew is recovering on the ward. It’s Friday and I’m taking the day off, to the extent that a doctor on call can ever really have a day off.

  When I open the front door of the lodge, I find that everything is smothered in thick white. There must have been another flurry of snow overnight. The forest branches bend low with sparkling weight, while the garden, bench, and long lane all the way to the road glitter brilliantly in the winter sunlight.

  I zip up my down jacket to my chin, pat my pocket to feel for the lump of my hospital pager, and scrunch briskly out across the snow to my car. I’m heading to pick up Joe from the train station.