“All these years and I’ve never seen him smile,” murmured Lucy.
The grocer propped an arm on a shelf. “Why should he?”
He was smiling but he said, “I couldn’t marry you, Ann.”
“Why not? Don’t you love me?”
“But you’re only twenty-two.”
“Is that bad?”
“I’m twice your age,” he said. “Someday you’d be pushing me around in a wheelchair.”
She jumped from her seat with that merry laugh and she sat on his lap and put her arms around him. “Oh, Vincent, I’ll keep you young.”
Amfortas heard shouts and the pounding of feet and he looked toward Prospect Street on his right and at the landing of the sheer, long flight of stone steps that plunged to M Street far below and, a little beyond it, the river and the boathouse; for years they had been known as “the Hitchcock Steps.” The Georgetown crew team was running up. It was part of their drill. Amfortas watched as they appeared at the landing and then jogged toward the campus and out of view. He stood until the vivid cries had dwindled, leaving him alone in the soundless corridor where the doings of men were blurred and all life had no purpose except to wait.
He felt the hot coffee on his palm through the bag. He turned from Prospect Street and walked slowly along Thirty-sixth until he came to his squeezed two-story frame house. It was just a few yards away from the grocery and was modest and very old. Across the street were a women’s dormitory and a foreign service school, and a block to the left was Holy Trinity Church. Amfortas sat down on the white, scrubbed stoop and then opened the bag and took out the bun. She used to fetch it for him on Sundays.
“After death we go back to God,” he told her. She’d been speaking of the father she had lost the year before and he wanted to comfort her. “We’ll be part of Him then,” he said.
“As ourselves?”
“Maybe not. We might lose our identity.”
He saw her eyes begin to fill with tears, the little face contorting as she tried not to cry.
“What’s wrong?” he asked her.
“Losing you forever.”
Until that day, he had never feared death.
Church bells rang and a slim line of starlings arced up from Holy Trinity, veering and circling in a wild dance. People were beginning to come out of the church. Amfortas checked his watch. It was seven fifteen. Somehow he’d missed his six thirty Mass. He’d been going to it daily for the last three years. How could he have missed it? He stared at the bun in his hand for a moment, then slowly he dropped it back into the bag. He lifted his hands and placed his left thumb on his right wrist and two left fingers on his right palm. He then applied pressure with all three digits and began to move the fingers around on his palm. The right hand, grasping in a reflex action, groped and followed the movement of the fingers.
Amfortas stopped the manipulation. He stared at his hands.
When he thought of the world again, Amfortas checked the time. It was seven twenty-five. He picked up the bag and the copy of the Sunday Washington Post that lay bulky and ink-smeared by the door. They never wrapped it. He went into the gloom of his empty house, set the bag and the paper on the small foyer table and then stepped outside again and locked up. He turned around on the landing and looked at the sky. It was turning overcast and gray. Across the river, black clouds scudded swiftly toward the west and a stinging wind sprang up, shaking branches of the elders lining the streets. They were bare at this season. Amfortas slowly buttoned up the neck of his sweater and, with no other baggage but his pain and his loneliness, began walking toward a far horizon. He was ninety-three million miles from the sun.
* * *
GEORGETOWN GENERAL Hospital was massive and fairly new. Its modern exterior sprawled between O Street and Reservoir Road and fronted on the western side of Thirty-seventh. Amfortas could walk there from his home in two minutes, and that morning he arrived at the fourth floor neurology wing at precisely half past seven. The resident was waiting for him at the charge desk, and together they began to make the rounds, moving from room to room among the patients, with the resident presenting each new case, while Amfortas asked questions of the patient. They discussed the diagnoses while moving through the hall.
402 was a thirty-six-year-old salesman manifesting symptoms of cerebral lesion; in particular, “unilateral neglect.” He would carefully dress one half of his body, the side ipselateral to the lesion, while completely ignoring the other side. He would shave only one side of his face.
407 was an economist, male, fifty-four. His problems had begun six months before when he’d undergone a brain operation for epilepsy. The surgeon, given no other choice, had removed certain portions of the temporal lobes.
A month before arriving at Georgetown General, the patient had walked into a Senate committee meeting and for nine straight, grueling hours devised a new plan for revising the tax code based upon the problems the committee had set him only that morning. His judgment and marshaling of facts was astonishing, no less than his acquaintance with the present code, and it took six hours just to organize the details of the plan and set them down in an orderly manner. At the end of the meeting the economist summarized the plan in half an hour without ever referring to the newly made notes. Afterward he went to an office and sat at his desk. He answered three letters; then he turned to his secretary and said, “I’ve got a feeling that I should have attended a Senate meeting today.” From minute to minute, he could not form memories that were new.
411 was a girl, aged twenty, with a probable case of Cocci meningitis. The resident was new and didn’t notice the flinch when Amfortas was given the name of the disease.
In 420 was a fifty-one-year-old carpenter complaining of a “phantom limb.” He’d lost an arm the year before and was continuing to suffer excruciating pain in a hand he did not have.
The disorder had evolved in the usual manner, with the carpenter at first having “tingling feelings” and a sense of a definite shape to the hand. It seemed to move through space like an ordinary limb when he walked or sat down or stretched out on a bed. He would even reach for objects with it unthinkingly. And then came the terrible pain as the hand clenched up and refused to relax.
He submitted to a reconstruction operation as well as the removal of small neuromas, nodules of regenerated tissues of nerve. And at first there was relief. The sense of having the hand remained, but now he felt that he could flex it and move his fingers.
Then the pain came back with the phantom hand in a very tight posture with the fingers pressed closely over the thumb and the wrist sharply flexed. No effort of will could move any part of it. At times the sense of tenseness in the hand was unbearable; at others, the carpenter had explained, it felt as though a scalpel were being repeatedly driven deep into the site of the original wound. There were complaints of a boring sensation in the bones of the index finger. The feeling seemed to start at the tip of the finger, but then it rose to the shoulder, and the stump would begin to have clonic contractions.
The carpenter reported he was frequently nauseated when the pain was at its extreme. As the pain at last faded, the tenseness in the hand seemed to ease a bit, but never enough to permit it to be moved.
Amfortas asked the carpenter a question. “Your greatest concern seems to be the tenseness in your hand. Would you tell me why?”
The carpenter asked him to clench his fingers over his thumb, flex his wrist, and then raise his arm into a hammerlock position and hold it there. The neurologist complied. But after some minutes the pain proved too severe, and Amfortas ended the experiment.
The carpenter nodded his head. He said, “Right. But you can take your hand down. I can’t.”
They left the room silently.
Walking down the hallway, the resident shrugged. “I don’t know. Can we help him?”
Amfortas recommended a novocaine injection in the upper thoracic sympathetic ganglia. “That should relieve it for a while. A few months.” But no lon
ger than that. He knew of no cure for the phantom limb.
Or the broken heart.
424 was a housewife. From the age of sixteen, she’d complained of abdominal pain so persistently that over the years she’d acquired a history of fourteen abdominal operations. After these came a minor head injury that had her complaining of pain in the head so severe that subtemporal decompression was performed. Now her complaint was of agonizing pain in her limbs and back. At first she had refused to give her history. And now she lay constantly on her left side and cried out when the resident made an effort to turn her over on her back. When Amfortas leaned over and gently stroked the region of her sacrum, she screamed and trembled violently.
When they left her, Amfortas agreed with the resident that she ought to be referred to Psychiatric with a finding of probable addiction to surgery.
And to pain.
425, another housewife, aged thirty, complained of chronic, throbbing headache, with attendant anorexia and vomiting. The worst possibility was a lesion, but the pain was confined to one side of the head, as was also teichopsia, a temporary blindness caused by the appearance in the visual field of a luminous area that was bounded by zigzag lines. Ordinarily, teichopsia symptomized migraine. Moreover, the patient came from a family that emphasized attainment and had rigid standards of behavior that denied or punished any expression of aggressive feelings. That was usually the history of a classic migraine patient. The repressed hostility gradually built to unconscious rage, and the rage attacked the patient in the form of the disorder.
Another referral to Psychiatric.
427 was the last, a man of thirty-eight, with a possible lesion of the temporal lobe. He was one of the janitors of the hospital, and only the day before had been discovered in a basement storage room where he had placed a dozen or so electric light bulbs in a bucket of water and was rapidly bobbing them up and down. Afterward, he couldn’t remember what he’d done. This was an automatism, a so-called “automatic action” characteristic of a psychomotor seizure. Such attacks could be seriously destructive, depending on the patient’s unconscious emotions, though most often they were harmless and simply inappropriate. Always bizarre, such fugues were normally brief in duration, although in rare cases they had lasted many hours and were considered to be totally inexplicable, like the baffling case of a man who had flown a light aircraft from an airport in Virginia to Chicago, yet had never learned how to fly a plane and had no recollection of the event. Sometimes, violent assaults took place. One man, later found to have a scarred temporal lobe in association with hemangioma, killed his wife while in a state of epileptic furor.
The janitor’s case was more the norm. His history was studded with uncinate seizures, auras of unpleasant tastes or smells; he gave descriptions of a chocolate bar tasting “metallic” and a smell of “rotten flesh” without apparent source. There were also fugues of déjà vu, as well as its opposite, jamais vu—a sense of strangeness in familiar surroundings. These episodes were often preceded by a peculiar smacking of the lips. The consumption of alcohol often triggered them.
Further, there were visual hallucinations, among them micropsia, in which objects seem smaller than they are; and levitation, a sensation of rising in the air, unsupported. The janitor had also had one brief episode of a phenomenon known as “the double.” He had seen his three-dimensional likeness mimicking his every word and action.
The EEG had been especially ominous. Tumors of this nature, if such it was, worked slowly and insidiously for many months, putting upward pressure on the brain stem; but at last it would gather a sudden momentum and in a matter of weeks, if left unattended, compress and crush the medulla.
The result was death.
“Willie, give me your hand,” said Amfortas gently.
“Which one?” asked the janitor.
“Either. The left.”
The janitor complied.
The resident was looking at Amfortas with an expression of mild pique. “I’ve done that already,” he said with an edge.
“I want to do it again,” said Amfortas quietly.
He put his first two left-hand fingers on the janitor’s palm and his right thumb on the janitor’s wrist, and then he pressed and began to move the fingers around. The janitor’s hand grasped reflexively and followed the movement of the fingers.
Amfortas stopped and released the hand. “Thanks, Willie.”
“All right, sir.”
“Don’t you worry.”
“I won’t, sir.”
By half past nine, Amfortas and the resident were standing by the coffee vending machine around the corner from the entrance to Psychiatric. They discussed their diagnoses, wrapping up the new cases. When they came to the janitor, the summing up was swift.
“I’ve already ordered up a CAT scan,” said the resident.
Amfortas nodded in agreement. Only then could they be certain that the lesion was there and probably close to its final stages. “You might want to book an operating room, just in case.” Even now, timely surgery would save Willie’s life.
When the resident came to the girl with suspected meningitis, Amfortas grew stiff and withdrawn, almost brusque. The resident noticed the sudden transition, but research neurologists, he knew, had a wide reputation for being introverted, uncommunicative and strange. He attributed the quirky manner to that, or perhaps to the girl’s youth and the possibility that nothing could be done to save her from serious crippling or even a hideously painful death.
“How’s your research coming, Vincent?”
The resident had finished his coffee and was crumpling up his cup before he tossed it into the trash. Outside the hearing of the patients, the formalities were dropped.
Amfortas shrugged. A nurse wheeled a drug cart past them and he watched her. His indifference was beginning to annoy the young resident. “How long have you been at it?” he doggedly persisted, determined now to crack the odd barrier between them.
“Three years,” said Amfortas.
“Any breakthroughs?”
“No.”
Amfortas asked for updates on the ward’s older cases.
The resident gave up.
At ten, Amfortas attended grand rounds, a full staff conference scheduled until noon. The Chief of Neurology delivered a lecture on multiple sclerosis. Like the interns and residents packed in the hallway, Amfortas couldn’t hear it, although he was sitting at the conference table. He simply wasn’t listening.
After the lecture came a discussion that soon was diverted into heated debate over interdepartmental politics, and when Amfortas said, “Excuse me just a minute,” and left, no one noticed that he never came back to the room. Grand rounds closed out with the Chief of Neurology shouting, “And I’m goddamn tired of the drunks on this service! Sober up or stay the hell off the ward, goddamnit!” This, all the interns and residents heard.
Amfortas had returned to Room 411. The girl with meningitis was sitting up, her gaze hypnotically glued to the television set that was mounted on the opposite wall. She was clicking through stations. When Amfortas entered, her eyes shifted down to him. She did not move her head. The disease had already caused her neck to be rigid. Moving it was painful.
“Hello, Doctor.”
Her finger pushed a button on the wireless control. The television picture sputtered out.
“No, that’s all right—don’t turn it off,” said Amfortas quickly.
She was looking at the empty screen. “There’s nothing on now. No good shows.”
He stood at the foot of the bed and observed her. She was pigtailed and freckled. “Are you comfortable?” he asked her.
She shrugged.
“What’s wrong?” asked Amfortas.
“Bored.” Her eyes came back to him. She smiled. But he saw the dark sacs beneath her eyes. “There’s never anything good on TV in the daytime.”
“Are you sleeping well?” he asked her.
“No.”
He picked up her chart. Chloral
hydrate had already been prescribed.
“They give me pills but they don’t work,” said the girl.
Amfortas replaced the chart. When he looked at her again she had painfully angled her body toward the window. She was staring out. “Can’t I keep the TV on at night? Without the sound?”
“I can get you some earphones,” said Amfortas. “No one else will be able to hear it.”
“All the stations go off at two o’clock,” she said dully.
He asked her what she did.
“I play tennis.”
“Professionally?”
“Yes.”
“You give lessons?”
She didn’t. She played on the tournament circuit.
“Are you ranked?”
She said, “Yes. Number nine.”
“In the country?”
“In the world.”
“Forgive my ignorance,” he said. He felt cold. He couldn’t tell if she had knowledge of what might be awaiting her.
She continued to stare out the window. “Well, I guess it’s all memories now,” she said softly.
Amfortas felt a tightness in his stomach. She knew.
He pulled a chair up to the side of her bed and asked her what tournaments she had won. She seemed to brighten at that, and he sat down. “Oh, well, the French and the Italian. And the Clay Courts. The year I won the French there was nobody in it.”
“What about the Italian?” he asked her. “Who did you beat in the finals?”
They talked about the game for another half hour.
When Amfortas checked the time and stood up to leave, the girl instantly withdrew and stared out through the window again. “Sure, that’s okay,” she murmured. He could hear the shields clanging down into place.
“Have you got any family in town?” he asked her.
“No.”
“Where are they?”
She angled her body away from the window and turned on the television set. “They’re all dead,” she said matter-of-factly. It was almost drowned out by the sound of the game show. As he left her, her eyes were still pinned to the set.
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