by Liz Jensen
But when they arrive, the child doesn’t even seem to need it. His heart’s beating quite normally, and he’s breathing, though it’s laboured. So they take him back up to Emergency to identify the broken bones and assess the internal damage. They have to take his spleen out. One of the splintered ribs is threatening the left lung, so they have to manage that, while investigating the skull fractures and working out an intervention strategy. It’s looking pretty dismal. But he’s alive.
Philippe Meunier, who signed the death certificate, is hauled back in to assess the cranial injuries. I went to medical school with Philippe, where we began as friends. Later, when we both opted for neurology, a certain rivalry developed. He’s on the circuit, so we bump into each other once in a while at conferences, where we speak with a hearty brusqueness and mask our latent aggression by slapping one another on the back slightly too hard. We’ve had our clashes but I’ll say this for Philippe: he’s a good, thorough clinician. Time being of the essence, he acts quickly to reduce the oedemic process that’s started. The scan shows that the injury to the cerebrum is serious, but the brain-stem is intact. The real danger from head injuries comes from swelling, because the skull is a box that keeps the brain trapped. With ventilation and steroids, Philippe reduces the pressure swiftly enough. But the child’s still unconscious, hovering between four and five on the Glasgow Coma Scale.
You can’t call Louis’ return to life a miracle; we’re not supposed to talk about them in our profession. A medical screw-up is closer to the truth. But to be honest, my heart went out to Philippe Meunier. Drowning and hypothermia can resemble death, in very rare paediatric cases. Searching for some euphemistic phrase to paper over the cracks, one might perhaps call it an ‘unexpected event’, or ‘the result of a previous misdiagnosis’, or even ‘a rare phenomenon’. But the bottom line is that the boy came back to life, two hours after being pronounced officially dead. And no one on earth – to this day – knows exactly why. No need to go into how bad it’s going to be for the doctors involved – and Philippe wasn’t the only one – on the blame front. They’re all going crazy, of course. There’s a basic reservoir of paranoia in any hospital: that day in Vichy, it burst its banks.
Anyway, someone has to break the news to the mother. But they decide not to – at least, not right away. They don’t see any point in waking her, in case the boy dies a second time – a distinct possibility, given the extent of his cranial injuries. This case has ‘bad outcome’ written all over it. But when she wakes up, a few hours later, wanting to be with the body, he’s still in the land of the living – though only just – and they can’t delay it any longer. It seems, Madame, that your son is in fact alive. In rare cases, it’s not totally unheard of for ... We don’t completely understand how it ... She’s wild, overjoyed, tearful, confused – everything at once. Totally overloaded. She’s been to hell, thinking her son’s dead. The next thing she knows, the doctor’s telling her he’s a mini Lazarus. She’s woken from the worst nightmare of her life.
Or not. Because the son-coming-back-to-life part is the good news. The bad news is that he’s possibly going to be what in common parlance is termed ‘a vegetable’. At which point Natalie Drax goes very pale and very quiet. I can imagine her state of mind. She’d prayed for a miracle in the ambulance, prayed to a God she’d given up on long ago, never really believed in. And now here, as requested ...
It’s unthinkable. She shudders and blinks.
Despite the refunctioning of his lungs and vital organs, the patient did not regain consciousness, though his condition stabilised and improved. He remained in a comatose state in Dr Philippe Meunier’s neurological unit in Vichy for three months, until a sudden fit caused his condition to deteriorate considerably. At this point, according to the normal procedure, his transfer to the Clinique de l’Horizon in Provence was approved.
On 10 July, he arrived as my patient in deep coma ...
A Portuguese artist’s reworking of the Gall/Spurzheim phrenological map hangs on the wall of my office, above the table where I keep my bonsais. With deft brush strokes the artist has transmogrified the skull into a piece of natural architecture, a set of juxtaposed compartments all labelled according to phrenology’s vision of the mind’s contents: secretiveness, benevolence, hope, self-esteem, time, continuity, parental love, eventuality and so on. Nonsense, but so much more poetic, somehow, than the real structure of the brain, with its interlocking meat-chambers: the frontal, temporal, parietal, occipital lobes, the putamen, the pallidus, the thalamus, the fornix and the caudate. I remember glancing up at my phrenological map on the morning Louis Drax was due to arrive, as though it might hold a clue.
But look, before I plunge further into the story of Louis, let me tell you that I was a different man then. For all my professional success and for all the insight I believed I possessed, I was living on the surface of life. I thought I had seen its innards, taken its pulse, got an idea of its hidden workings. But I hadn’t really seen within. Had not yet marvelled. Put it this way: I was a man doing a job I loved – perhaps too much, too intensely – but I had my failings too, my tendencies and my traits and my blind spots or whatever a psychologist would call them. I won’t apologise for myself. The fact is that during the terrible summer when the world cracked open, I was who I was.
The day Louis Drax arrived at the clinic began on a bad note, domestically. It was a close, rain-starved July, one of the hottest on record in Provence; every day the temperature soared as high as the forties and the radio and TV blared fresh warnings of forest fires. It seemed that the arson season was starting early. As I sat out on the balcony finishing breakfast in the morning sunshine and skimming the previous day’s Le Monde, crashing noises came from the kitchen. When I’ve committed any kind of marital transgression, Sophie has the habit of unloading the dishwasher in a particularly cacophonous way. I knew better than to stir things up further, so at eight o’clock I prepared to leave for the clinic without giving her my usual kiss goodbye. But as I was closing the front door behind me, she flung open the kitchen window and stuck out her head like a cuckoo from a Swiss clock. She’d washed her hair and was dripping water.
—So, am I to expect you home for dinner at eight, or will I once again have the fun of cooking something only to sit on my own and watch it go cold for an hour?
Sophie was referring to the previous evening, when I had returned home to find her sprawled on the sofa, red-eyed, and flanked by greetings cards from the girls, her sister and her mother, wishing us both a happy twenty-third anniversary – an occasion I had totally forgotten, despite the fact that our eldest daughter, Oriane, had rung me the previous week to remind me to ‘do something romantic with Maman’. Not only had I failed to do anything romantic, but I had added insult to injury by coming home from work late – dismally, shockingly late, even by my own standards. I’d been recounting the content of an editorial in the United States Journal of Neurology to my patients and lost track of time.
—It’s just so humiliating! Can’t you show just a shred of romance? Sophie had wailed, as she cleared away the uneaten dinner she’d prepared. —I’m beginning to wonder why we don’t just go our separate ways, Pascal. You’d rather lecture comatose people about neurological theory than have a conversation with your own wife. Look at the two of us, rattling around in this big empty house like a couple of ... I don’t know. Pointless marbles.
Sophie never shies away from reality, and I recognised she had struck a note of truth. I felt bad, and said so – but my apologies fell on stony ground. It wasn’t an easy time in our marriage. Once upon a time we had been happy. We had children early, made a good family. Then ... well. A typical marriage perhaps: radiant moments, small losses of faith, nagging doubts, resurgences, complacency. For the last few months the public library in Layrac, which Sophie ran with characteristic zeal, had been threatened with cutbacks. With both our daughters now installed at the fac in Montpellier, Sophie was feeling frustrated and unfulfilled.
> I loved my wife, as far as I knew. But how far did I know? The empty nest had highlighted a lack, not just for her, but for me too. Emotional and physical. (Why is it so hard, I wondered, for a woman to grasp that a man needs the comfort of a female body from time to time? That it’s unfair to make a man sleep alone every time he rattles her cage?) That burning summer, even before the arrival of Louis Drax, things seemed to be spiralling downward.
My walk to work takes five minutes, door to door. A light morning mist hung in the bright air, with something feral in its scent, as when the hunting season is in full spate. Life, I thought. It smells of life. I love breathing in that mixture of pine resin and sea salt. It stirs the brain, puts the turbulences of marriage in perspective. Sophie was always mollified by flowers, especially if they came in the form of a highly expensive bouquet with cellophane and ribbons, so as I made my way to work through the olive groves, I resolved to drop in at the village florist’s on the way back from work and make us both feel better. As the clinic came into view up ahead, stark white and bright in the sun, bleached concrete and stainless steel grafted on to the nineteenth-century stone shell of the former Hôpital des Incurables, my heart lifted. By the time the automatic doors slid open to welcome me and I inhaled the first gush of chilled air, I was on a high.
Part of my excitement was about the new patient they were bringing me. It may sound strange to say this about somebody who appears to be irredeemably comatose, but I was looking forward to meeting the Drax boy. I don’t read the home pages of the paper closely, so I knew nothing about his accident at that stage, but I’d certainly heard about his bizarre return to life on the medical grapevine, though swift PR work in Vichy had ensured that part of the story never reached the papers. Hiccuping corpses don’t do a hospital’s image any favours. Given his medical history, I was intrigued about the state I’d find the boy in. Might I be the one to discover a sign of hope, where others – Philippe Meunier in particular – had failed? In my field, you can’t help fantasising about trouncing everyone’s expectations by producing an unexpected recovery. I spend much of my time doing just that.
I’m an optimist, when it comes to coma. These people are capable of more than it appears. Those who awake – often in an agonisingly slow, incomplete way – can occasionally recall intensely lucid dreams, almost like hallucinations: long, involved fantasies about people they could never have known or met in real life; scenarios so much more vividly alive and compelling than the dim, humdrum noises that filter through to them from the ward. There have even been cases – rare, I will admit, and much-disputed – of a comatose twin telepathically communicating with his identical sibling or a mother ‘hearing’ the voice of her unconscious child, clearly, in her head. Not all brain activity can be picked up by a machine. We fool ourselves if we think it can be.
So I had my usual optimism when it came to Louis Drax, though when I read his notes in more detail, I must admit that my heart sank a little. He’d had a fit the week before, which had led to his transfer here. According to the latest electroencephalograms, the episode had plunged him into a deeper coma than before, with a diagnosis of Persistent Vegetative State not far off on the horizon. What usually happens to PVS patients is that when they come down with something – it tends to be pneumonia – a doctor like me – in consultation with the relatives – lets nature take its course. It’s not unheard of for a patient to emerge from a coma that deep, but nobody holds their breath.
All morning, in my office, I listened out for the crunch of gravel on the driveway, while Noelle buzzed in and out with letters to sign, reminders of appointments, and a fresh memo from the directeur, Guy Vaudin, about evacuation procedures in case of a fire threat. Eric Masserot – the father of my anorexic, Isabelle – was arriving later, and I would need to make time for him. A detective with an odd surname had called and would ring back. If I wanted to order new equipment for the physio unit, I must liaise with the new physiotherapist by Thursday at the latest. Had I prepared my talk and my slides for the symposium in Lyon next week? I replied to Noelle’s various questions and signed her bits of paper, but my mind stayed on the Drax boy.
It was late morning when the ambulance rolled up the drive. By now the static weather had shifted into something more restless, with the air growing blustery beneath a cobalt sky, making the olive leaves shiver like shoals of fish, dizzy and capricious. There are times when the mistral can drive you mad. Times when it does not fan you, but merely churns the hot air. Today’s wind had menace in it, the same menace van Gogh painted over the cornfield the day before he took his life, the kind that starts outside but lodges in your head as soon as you feel its breath. They wheeled him in on a trolley. Age, nine. Condition, very poor. White-clad nurses on either side, one of them carrying a stuffed toy. And in his wake, the mother, who immediately impressed me with the way she held her small, upright body. Something about her carriage and the tilt of her head announced, ‘proud victim’. Madame Drax was petite, with pale hair that hovered somewhere between red and blonde. Her features – fine and delicately scattered with freckles – were too unremarkable to make her striking at first sight, but she had an allure. Something cat-like. As for the child–
The poor boy.
His hair and lashes were dark, but his face was deathly pale. He might have been cast from wax. There was something almost luminous about his skin, which brought to mind those stone carvings of the dead you see in churches, with their tiny, perfect hands and feet, their dreamily closed eyes. His breathing was so shallow that you could barely make out the influx and exhalation of air.
All I knew at that point was that back in April, Louis Drax had technically died as a result of a fall, but that somehow he’d returned from the dead – or at least from a shocking mis diagnosis. Either way, it was so bizarre that it bordered on the grotesque. A medically unusual case, then, with a dismal prognosis in the wake of his fit, according to the notes I’d just read. One to store in one’s mental scrapbook perhaps, not much more to me. But I was a different man then. I knew nothing.
And so the man who knew nothing introduced himself to Madame Drax and told her that his job was to do everything he could for her son. And that it was a pleasure to meet her. The first contact is important. I needed this woman’s trust if I was to help Louis.
She told me it was a great relief to be here. She had a Parisian accent, and a small catch in her voice. The smile she gave me in return was no more than a twitch. She was wearing a fragrance that I didn’t recognise. The hand she gave me to shake felt almost boneless, as though her skeleton had dissolved. What this woman must have suffered didn’t bear thinking about. Post-traumatic stress can take many forms. She bore the look of stunned dignity one so often sees on the faces of agonised relatives.
—The pleasure’s all mine, Madame. Louis is most welcome here. As you see, this is an open ward. Nine beds are filled at present ....
As I spoke, I watched her. I am used to studying faces. There is always the potential for both beauty and ugliness, depending on the emotional currents that swarm beneath. Beneath the mask Madame Drax presented to the world, I imagined the loneliness of unresolved and unresolvable grief – and yes, the shame, too, for pain is alienating – that so many parents suffer in such circumstances.
—He was in a stable coma for nearly three months, she tells me, as we look at the boy’s sleeping face, framed by white pillow, white linen, a pure white gown. Tucked beneath his armpit is a toy – a moose, its fur matted with ancient spit. —Then a week ago, he unexpectedly ... that’s why we–
She stops: it seems there is no ‘we’ any more. No ring on her finger, but a lighter band of skin where it once was.
—That’s why Louis and I came here. To you. Dr Meunier recommended you highly.
Our eyes meet. Hers are a pale greenish hazel, the colour of a Provenµal hillside after winter rain. Clear and young. It pains me that she seems to be facing this alone, and I feel an urgent need to know why.
&nbs
p; —And your husband, is he ...?
She looks at me in panic and alarm, and a nervous tic suddenly ratchets away at the corner of her mouth. —You mean you haven’t heard about Pierre? About how Louis came to be in a coma? she asks, flustered. —Didn’t they ...
—I’ve read the medical notes, Madame, of course. Rest assured.
My voice is calm, but I feel a little unsettled. Have I missed something?
—But how it happened, the full story ... you’re not aware? The police haven’t ...?
—I believe there was a call from a detective this morning, I said quickly, suddenly remembering something Noelle had mentioned. But I could sense something – was it anger? – boiling up in her. —A fall, I gather? Into a ravine?
But I have triggered an excruciating memory: her face tightens again, and more tears well up. She fumbles in her handbag for a tissue and turns away.
—Forgive me, Madame. I am assuming she will elaborate at this point, but she does not. Instead she smudges at her eyes with the tissue, then all of a sudden blinks, pulls herself together, and changes gear, telling me that she has rented a cottage in the village, on rue de l’Angelus, and wants to start participating in Louis’ treatment. What can she do? Can she spend as much time as she wants with him? The cleaning-woman, Fatima, begins to mop the floor by our feet; we shift a little. I explain that she needs to take it easy, and let her son settle. She, too, must settle. All too often, patients’ relatives neglect themselves – which doesn’t help anyone. She needs to feel as well and happy as she can.
—Is there any activity you particularly enjoy? Something you took pleasure in before the accident?
—I have lots of photographs of Louis. I’ve been meaning to sort them into albums for years.
—Perfect. And you can show them around. You’ll make friends here quickly, among the other relatives.