by Fiona Neill
As I lean in towards Jean I note that the kind lab technician has tried to remedy my botched dissection of her optic nerve and her left eye has been securely repositioned in its socket. But her lopsided glance reminds me of my limitations. I have talked to my tutor about my self-doubt and he says it’s not necessarily a bad quality in a doctor. Just as well, because I have a lot of it.
Carlo asks me to pass him a chisel so that he can remove the layer beneath the skull, holding out his hand without looking up, as if I’m his assistant. He correctly identifies it as the dura mater. Our anatomy teacher instructs him to use both the chisel and his fingers to remove it. It peels off like a swimming cap and there is a collective gasp as, magician-like, Carlo theatrically reveals Jean’s brain. For me this was always going to be the money shot. The embalming fluid might have changed the colour and texture so it has the pale colour and waxy texture of a pickled egg, but nevertheless it is a stunning moment.
‘Everything we are, every thought, every urge, is contained within this structure,’ says the anatomy teacher. ‘This was Jean’s identity. This is the essence of our being.’
We stand in awed silence.
The teacher points out a deep inky stain that we have all missed in the dura. ‘Note the middle meningeal artery. Anything out of the ordinary?’
‘It’s ruptured,’ Carlo says, leaning in. ‘You can see where the blood has leached into the dura.’
I envy his certainty.
‘Correct. What does this tell us?’
‘She probably died from a head injury,’ I suggest. ‘Epidural haematoma?’
‘Excellent, Mr Rankin,’ he says.
Aisha chips in, pointing out that the pattern in these kinds of injuries is that the patient at first can seem lucid and awake but this is often followed later by seizures, coma and even death as blood pools between the dura and skull. ‘Like Natasha Richardson,’ she says.
The anatomy teacher gets out a plastic model of the brain from his cupboard, puts it on the slab and starts taking it apart in layers. He asks us to identify each structure and describe its function. He leaves me till last, removing the final piece of the jigsaw, a small area lurking in the depths of the forebrain.
‘Max, your turn,’ he says. ‘Any ideas?’
So no reprieve from last week’s public humiliation.
‘I think this area is the basal ganglia,’ I say tentatively, wishing I could be more confident in my opinion. I pick up the section and turn it in my hands.
‘Correct,’ he says. ‘Anything more?’
‘It’s the deepest, most primitive area of the brain, one of the parts we share with birds and reptiles. It responds chemically rather than rationally to error and threat and goes into overdrive in patients with Obsessive Compulsive Disorder.’
‘Elaborate, please.’
‘OCD is an anxiety disorder. Sufferers have uncontrollable intrusive thoughts that cause intense distress and perform repetitive, rigid routines called compulsions to try to neutralize the anxiety and prevent the obsession from actually happening. On some level they know the thoughts and rituals are irrational but they can’t stop them. The more they do them, the worse the illness gets.’
Thank you, Daisy, I say to myself, staring at the basal ganglia in awe. Because if Daisy hadn’t been ill, the basal ganglia would never have featured in my life. How can such a tiny structure have so much power? I see Carlo making vomit gestures in the background. He can’t stand it when he’s not the centre of attention.
‘Okay, folks, that’s all for this week,’ says the teacher, looking up at the clock. ‘Good work, people.’ He covers up Jean with the green plastic sheet.
I will miss her when we are finished.
We all leave together. We’re a tight group. I switch on my phone and feel a surge of joy when Connie messages to say she is waiting for me outside my flat. Nothing’s ever planned with her. Everything is last minute. Until recently I assumed it had something to do with her job. All her talk of buying a flat, financial independence and long hours made me think she was involved in some white-collar slavery, like law or finance, and I have to say that when I finally got to ask her what she did last week I was completely taken aback to discover she works in an organic fruit shop. It forced me to re-calibrate several of my assumptions about her.
‘I manage an entire department,’ she volunteered, even though it wasn’t my turn to ask a question. ‘Tropical fruit and veg.’
Maybe she sensed my confusion at her lack of ambition. I didn’t press her for details. Sometimes the less you know about someone the easier it is to project on to them the idealized version of how you would like them to be. From what I’ve witnessed, most relationships are destined for disappointment.
And for the first time in my life I’m enjoying being obsessed by one person. Carlo says I’ve got it bad and he’s right. I’d like to be exclusive but Connie’s not interested. I guess everyone wants what they can’t have. Just look at Dad. He must have sweated bullets for Lisa years before they got it together. The difference with him is he always gets his own way in the end. Otherwise how can you explain that he’s ended up living in Mum’s childhood home in Norfolk with her best friend from secondary school?
‘Do you want to grab something to eat?’ Carlo asks.
It’s an ongoing joke in our anatomy group how full-body dissection not only makes us all ravenous but also makes us crave meat – apart from Aisha, who is veggie. Usually we all have steak and chips at a café round the corner after our weekly session. I make an excuse about needing to go shopping for a wedding present for my dad and then feel bad when the others look disappointed.
‘You didn’t tell me he was getting remarried,’ says Carlo.
I pull off my lab coat and stuff it in my rucksack even though it will make it stink of formaldehyde.
‘It’s pretty recent news,’ I say.
‘So is she hot?’
‘She’s pregnant, Carlo.’
‘Pregnant women can be hot.’
I don’t want to fuel his fantasies by getting into any detail.
‘Do you like her?’ asks Aisha.
I turn gratefully towards her. It’s weird but no one has ever asked me that before. ‘If she wasn’t with my dad, I might. I mean I used to like her before they got with each other.’
‘What’s she like?’
I think for a moment.
‘She’s one of those people who keeps her eyes open even when she’s swimming under water.’ I don’t know why I say this. It has nothing to do with what happened after the wedding.
‘You mean she never relaxes?’ questions Aisha.
I nod. ‘She’s always alert to the next opportunity.’
‘I actually slept with my stepmother,’ says Carlo, changing the tone completely. I’m relieved because I don’t like talking about my dad and Lisa. ‘It seemed like the best way to screw things up between her and my dad. She was closer in age to me than him anyhow.’
We all make suitable noises of disgust.
‘You are such a closet psycho,’ says Aisha.
‘Nothing closet about it,’ I say.
‘C’mon, guys, just jokes,’ says Carlo. ‘What kind of fuck-up do you think I am?’
I’m still not sure whether he was telling the truth. My phone beeps. There’s an email from Daisy. Subject: Yale-Brown Obsessive Compulsive Test. I’m knocked off balance, even though I am the one who suggested she check out her symptoms after the scene at the restaurant. 2* out of *0, says the email. I can tell from the date that she did it yesterday afternoon. I realize the missing number must be four or a multiple of four and the best-case scenario is that it’s 20 out of 40, which isn’t disastrous but is high enough to confirm that the illness is creeping back. My head starts to throb. I think about the clot we found in Jean’s brain today and imagine the blood pumping through my own middle meningeal artery and wonder if it could rupture from the pressure. I vigorously rub my scalp.
‘You okay, man
?’ asks Carlo.
My phone rings. I know it’s Daisy.
‘Sorry, got to take this. I’ll catch up later,’ I say, trying to sound relaxed.
I pick up the phone just before it goes to voicemail and Daisy does that thing where she starts speaking before I’ve even said hello. This is what happens when she has the thoughts. There are just too many words running like ticker tape through her head.
Her main headline is her certainty that something bad is going to happen to Mum. Or me. But mostly Mum. She’s worrying about burglars again and whether it’s possible for someone to get into the house without tampering with the windows. She read somewhere that people can put cellophane over the glass panes so that no one hears them shatter. In the bad old days, I would have tried to talk it through with her, to convince her that neither Mum nor I are in imminent danger, by running through all the evidence to the contrary and checking every window lock in the house. I would have pointed out that Mum is most likely at work seeing patients, I am in town having finished the best anatomy class of the year, and the window panes are too small for a burglar to climb through.
I zone out for a minute, wondering how much patience Connie has. Now I know it’s not work pulling her away from me, I wonder exactly what it is that she’s doing when we’re apart. That will be my one question for her this evening.
‘Ebola …’ I hear Daisy say.
My heart sinks.
‘… she does a clinic in that hospital where the nurse is being treated.’
‘So what,’ I say flatly, knowing full well where this is heading.
‘All it takes is one tiny cell.’
‘She’s not even on the same floor, let alone in direct contact,’ I say in exasperation. ‘And the infection control team will be in overdrive. It’s not an airborne virus.’
‘Are you sure? What happens if they change the bedding, it rests against the door of the lift and Mum touches it? One cell can survive on a surface for hours.’
‘Remember the therapist said you shouldn’t go on the Internet or read newspapers when you’re feeling fragile,’ I point out.
She doesn’t reply.
‘Daisy, just because you think something doesn’t make it true.’
Silence.
‘It’s anxiety. Nothing will happen. Focus on your breath.’ I immediately realize my mistake. This is what she wants me to say.
‘Say those three things again, Maxi,’ she pleads. ‘Please.’
‘I’ve told you I’m not getting into that again. Nothing bad will happen whether I say them or not.’
‘Please. Just this once. Until I’ve got the better of it again. If you say it three times I’ll be fine.’ It’s so tempting to give in but I know from previous experience that she’ll be back on the phone within hours. Three, to be precise.
‘Have you tried that thing where you recite a crap song in your head?’ I suggest. ‘How about that one about getting a house in Devon and drinking cider from a lemon?’
‘I’m in too deep. That doesn’t work. Please just say it three times.’
Her voice is so tight that she doesn’t sound like my sister any more. And in a way she isn’t because she’s being hijacked by the illness. But this time I don’t want to play the role of hostage negotiator or, worse, get taken prisoner with her.
‘The therapist told you not to do this,’ I say.
My phone beeps and I know it’s Connie, asking when I’ll be home. I imagine her sitting on the wall outside my flat with her skirt hiked up so that I can follow the curve of her leg from ankle to thigh. She will be getting impatient and then punish me with silence when I turn up late. I start to waver.
‘You’ll get back to your girl quicker,’ says Daisy, reading my thoughts.
‘Don’t involve me in your compulsions,’ I say, trying to stand my ground.
I remember something interesting that a psychology student in my flat once told me about a paper he had read on how the rituals performed by Nepalese Sherpas resemble OCD rituals.
‘Listen, Daisy. It’s really fascinating. They make one hundred miniature clay shrines, one hundred food cakes and one hundred butter lamps. It all has to be laid out completely symmetrically to placate and soothe their demons. Try to imagine it all in your head.’ I need to get her out of this loop.
‘Please, Max. Just say it three times. Then I’ll let you go.’
‘Have you told Kit what’s going on? Can’t he help you?’ Surely it’s someone else’s turn to pick up the slack with Daisy.
‘I don’t want to spook him. I should have explained before it came back. But if I tell him in the middle of a relapse he’ll think I’m a freak. I don’t want to mess it up with him, Max. He’s the only thing standing between me and the darkness.’
‘Believing something doesn’t make it real, Daisy,’ I say resolutely. I tell her I’m going to put down the phone in three seconds, forgetting her thing about the number three. ‘Try that thing where you ping an elastic band round your wrist.’
‘Three is a good and safe number,’ says Daisy.
Fuck this shit, I think. Fuck this shit. I resist the urge to say it a third time.
‘I’m going to put down the phone in four seconds.’ That was cruel but I can’t help myself.
‘Don’t! There’s something I need to tell you,’ Daisy shouts. ‘I wanted to keep you out of this but I can’t deal with it on my own. I’m sorry, Max.’ I assume she means the bad thoughts. My phone beeps. I don’t want to read her email because I can sense that however difficult things are right now, they are about to get a whole lot worse.
‘Open it up,’ she commands, going all bossy older sister. She can sense my reluctance.
I open the attachment. It’s difficult to read on an iPhone, especially because it’s a copy of a handwritten letter. I have to enlarge the image until the words are big enough and then the screen is so small that I have to tackle each sentence in halves. I hear Daisy doing her breathing exercises down the phone. I recognize Lisa’s loopy scrawl right away and for a moment am pleased that she is finally writing to Mum after all these years. But as I piece together the jigsaw of words on the first page I start to feel like a dirty voyeur. Lisa has cancer. She wants to apologize to Mum. There’s something she needs to tell her. I hear myself say the words under my breath until the initial shock has subsided.
‘She’s dying,’ I hear myself say, over and over again, as I try to digest the news. Every time I say ‘dying’, Daisy mutters ‘living’ under her breath. I feel sorry for Lisa and Dad because they are so happy together. I feel sorry for Mum because Lisa is asking too much of her. And I feel sorry for myself because I want nothing to do with any of this.
Also from a clinical perspective I can’t believe I got it so wrong. I mean what kind of dumb fuck mixes up the symptoms of cancer with the symptoms of pregnancy? It’s a lesson that stays with me for the rest of my career. Evidence always trumps instinct.
‘Where did you get this, Daisy?’ I’m halfway between angry and scared.
‘I intercepted the letter on Mum’s doormat when it arrived,’ she says, waiting for me to congratulate her.
‘Why did you open it?’
‘Because I don’t trust Lisa.’
I can’t argue with that.
‘Do you know what she wants to tell Mum, Maxi?’
‘No,’ I lie. Because of course I do – and of course now that I realize, it can’t be allowed to happen.
‘What do you think we should do?’ asks Daisy.
‘Has Mum read it?’
‘Yes. I think so. I kept it for a couple of weeks and then put it back.’
This must be what it’s like working in A&E. Trying to ask the right questions to reach the right conclusions as quickly as possible.
‘I thought she was pregnant,’ I say. ‘I saw the puncture marks on her arm and I thought that was why they were getting married.’
‘I think you need to brush up your diagnostic skills, Dr Rankin,’ says
Daisy.
Without realizing it she always hits the nerve. She’s right. I will make a crap doctor.
‘Where are you? I’ll come as soon as I can.’ Daisy’s relapse starts to make sense.
‘Meet me at Mum’s,’ she says. ‘I’m so sorry, Max. I didn’t want to involve you.’
Not as sorry as I am. I find a park bench and for the first time in years I sit down and bawl like a baby. I try to work out what I’m crying for and am besieged by different free-floating thoughts that I can’t anchor firmly enough to give them any productive analysis. Slow down, Max, I tell myself. I close my eyes and try to slice the thoughts into sections, as if I’m in my anatomy class.
First up, I don’t want to lose my sister to the plague of obsessions again. I realize she’s probably been downplaying the symptoms. My sense of self-preservation is overwhelming and I wonder if I could transfer to a medical school someplace like Spain, or even further afield, for the rest of my course so I can escape this time. I wipe my eyes and google European universities to see where you can do cadaveric dissection and then start to feel guilty that I am letting Jean down by disappearing halfway through the job. I start an email to my tutor but even before I have finished the first sentence I realize that the weight of my responsibility for Daisy’s illness means that I can’t turn my back on her: I am as trapped as she is. I am totally incriminated.
I get up from the bench and start walking to Mum’s house. I walk slowly because I never want to arrive. I am struck with guilt that I could even have considered leaving Mum alone to deal with all this. I get out my phone and start reading Lisa’s letter again, trying to gauge its effect on Mum. Because I sure as hell know what Lisa wants to tell her and the consequences will make an epidural haematoma seem like a head cold. How could Lisa do this, knowing how Mum struggled to keep everything together and get her life back on track after Dad left her? But it’s simple really: Lisa only ever cares about herself.
I press the doorbell three times so Daisy knows it’s me. I feel small and powerless, like the small boy who used to ring this bell every afternoon after school, unsure what he would find when his mum and sister answered the door. It’s the same sensation I had when I got caught in a rip tide in the sea in Norfolk the first weekend we went to stay there after Dad left. I remember being dragged out by a current so strong that I felt as if I was being sucked down the plughole of a bath. At first I tried to fight it, screaming and yelling in protest, raging at its force and my impotence. ‘If you want something badly enough, nothing can stand in your way,’ Dad used to say. That weekend what I wanted more than anything was Mum and Dad to stay together and as I struggled against the rip tide I realized Dad was full of shit. There was no point in struggle. Because some things are just stronger than we are.