Requiem

by Clare Francis

  ‘But chemicals don’t always show up in tests, do they?’ Nick said.

  The toxicologist blinked into life. ‘It depends on the type of chemical, the dosage and how soon after the event you can run a test. And of course it helps to know what you’re looking for. Then you know which tests to run.’

  ‘And we’ve run all the obvious tests,’ Plumb said in his plodding delivery. ‘Several times. But with no trace of chemicals or chemical damage.’

  Arguing technical points with this man was like playing tennis without a racquet: it was difficult to return even the most basic shot. Like all specialists, he was paid to have an opinion, and he wasn’t about to admit that there might be the occasional yawning chasm in his knowledge, that, just possibly, he might simply be wrong. Nick rubbed a hand over his eyes. He felt dreadfully tired.

  Aware that he was repeating himself for perhaps the twentieth time, he said wearily: ‘My wife was overcome by fumes. She inhaled a large quantity of dangerous chemicals. You can’t possibly say they had no effect.’

  Plumb put on a serious but kindly face. ‘Mr Mackenzie, your worries are very understandable, but this particular chemical that your wife inhaled, the wood preservative …’

  ‘Reldane.’

  ‘… Yes – Reldane – has no known harmful effects. Isn’t that so, Blair?’

  The toxicologist tore his eyes away from his hands. ‘As wood preservers go, it’s pretty benign really.’

  Nick tried to remember what the people from Catch had told him over the phone. ‘But that’s not absolutely certain, is it?’ he said. ‘I understand that the research is fairly thin.’

  Plumb frowned at that. ‘But Reldane’s been passed for use by the safety people. It must have been. It wouldn’t be allowed on the market otherwise, would it, Blair?’ He flung a glance at the toxicologist.

  ‘But I’m told that means very little,’ Nick said before Blair had a chance to come in. ‘The testing was done years ago. It could well be out of date.’

  Plumb drew a deep breath. ‘But there’s no scientific basis for saying it’s dangerous. No hard evidence to suggest it has any long-term effects. Quite the contrary. Isn’t that correct, Blair?’

  Given his cue, the toxicologist spouted facts. ‘When ingested by mouth in any significant quantity, more than a millilitre, Reldane can cause nausea and dizziness, but it has no other known toxic effects. It’s not carcinogenic or tetrogenic. And it doesn’t affect the nervous system, not like the cholinesterase inhibitors.’

  ‘What’re they when they’re at home?’ Nick asked, beginning to lose patience.

  ‘Substances that cause damage to the nervous system by inhibiting nerve transmitters. You find them in powerful pesticides. But not Reldane.’

  ‘But when it’s breathed in? That must be damaging, surely?’

  ‘The Reldane was definitely inhaled, was it?’

  ‘Yes. It was spilt on the ground, next to my wife’s head. She was breathing it all the time she lay unconscious.’

  ‘In that case, I have to say that it’s even more unlikely that Reldane was to blame. You see, the effects of inhalation are invariably less severe than those of direct ingestion.’

  If it was a trap, it had been neatly laid. Nick heard his voice rise: ‘So you’re saying it’s harmless?’

  Blair looked to Plumb for help.

  ‘Not harmless exactly,’ Plumb said. ‘But not harmful either. One has to accept that if Reldane had had any serious long-term effects in the population they would have come to light by now.’

  Something in Nick died a little every time he heard a statement like that. Every answer was so plausible, every explanation so utterly reasonable, that gradually but relentlessly they wore you down and swamped your own instincts. He was weary of text-book solutions and standard assurances, weary of beating his head against the wall of scientific fact.

  Plumb added: ‘And the amount your wife inhaled was really quite small. After all, she was discovered in a reasonably short time, wasn’t she?’

  Nick didn’t reply.

  ‘Don’t misunderstand me,’ Plumb said. ‘The chemical incident – contamination, if you prefer – might well have contributed to the trauma and the miscarriage. I’m not discounting that possibility, far from it.’

  Nick looked away to the window, reaching for his breath. Even now he couldn’t hear mention of the lost pregnancy without experiencing a mixture of conflicting emotions, all strong, all painful. He dimly recognized that there was a large dose of guilt in there somewhere, guilt at not having been there to prevent the accident, guilt at not being able to share or alleviate Alusha’s anguish, misery that was all the worse for her attempts to hide it.

  He forced himself back to Plumb’s words. ‘So you’re saying it was trauma?’

  Plumb settled back in the chair, a gleam of relief in his eyes now that that he was on the safer ground of his own expertise. ‘I do indeed. The bump on the head, the inhalation, the miscarriage – I don’t think they can be separated. One alone probably wouldn’t have caused too much bother, but all three together – well, they’d be sufficient to cause significant trauma. And trauma – shock – whatever you want to call it, has profound physical effects.’

  He paused for a moment to ensure that he had been understood. Nick understood all right; he was saying there was nothing wrong with Alusha. Overcome by the now familiar sense of helplessness, he was silent, not trusting himself to speak.

  ‘There’s no doubt your wife has endured a very testing experience,’ Plumb continued in a voice tinged with sympathy. ‘But what has to be understood, Mr Mackenzie, is that all this was a long time ago. Three months ago, to be precise. After such a time there’s absolutely no reason why your wife shouldn’t have recovered. At least, be well on the way – ’

  ‘Then why in hell hasn’t she recovered?’ Nick said in sudden exasperation.

  ‘Ah. Now, the best person to talk to you about that is my colleague, Dr Carter. He’s the expert. He should be here any moment – ’

  ‘But I want you to explain.’

  ‘I assure you – Carter’s the best person.’

  Something shifted in Nick, a final thread broke in the thin web of his control and his anger rose into his throat like sickness. ‘No. You.’ His voice wavered and he fought to control it. ‘I want you to tell me.’

  Plumb blinked at this unexpected show of emotion. Finally he said awkwardly: ‘Very well,’ and, muttering thanks to Blair, waited for him to leave.

  ‘Please understand,’ Plumb said when they were alone, ‘there’s no suggestion that your wife doesn’t have physical symptoms. Not for a moment. Her illness is very – real.’

  ‘But you just said there was nothing wrong with her.’

  ‘Well – ’ Plumb glanced to the door as if for assistance but it remained stubbornly closed. Looking back, he began to feel his way slowly into his argument. ‘Often, after some physical trauma or disease, the brain remembers the symptoms of the disease and keeps producing them in the body, even after the illness itself has gone. It’s a well-known syndrome. Pain is a common manifestation. Pain from injury, pain from an accident. The brain gets so used to receiving pain signals that it continues to manufacture them long after the injury has healed.’ He attempted a heartening smile which didn’t quite come off. ‘The good news is that this sort of syndrome usually responds well to treatment.’

  Nick felt an icy calm, an absolute clarity. ‘What you’re saying is that it’s all in her mind.’

  Plumb gave a short bray of a laugh. ‘Well – not in the way you mean, not in the sense that she’s imagining it. Not at all, no, no. No, what happens is that the brain gets wrongly programmed and keeps sending out inappropriate signals – it’s as simple as that.’

  All Nick’s instincts rebelled against this idea. This, surely, was nothing more than hot air wrapped up in elegant theory, intellectual verbiage invented to fill an inconvenient gap in the text books. But he resisted the impulse to say so
. Instead, haunted by his responsibilities to Alusha and the need to consider every possibility, he tried to make sense of what Plumb was saying, to consider the idea rationally. Was it possible? Was there really no reason why Alusha shouldn’t get well?

  He thought back over the months, to the accident itself, to her fuddled brain, her streaming eyes and grey skin. There could be no doubting that. Nor the fact that her weight loss had started immediately, even before the miscarriage. All the other things – the sweating, the diarrhoea, the memory problems, the jumpiness – they too had started straight away. Since then little had changed. If anything she’d got worse.

  How could such awful symptoms come out of nothing? How could there be no real cause? These people kept forgetting one vital thing – that apart from the few days after the miscarriage Alusha had never given in to her illness, never stopped trying to get better, making the effort to walk even when she was exhausted which was nearly all the time, forcing herself to eat when it sickened her, putting on a bright smile when she must have longed to scream in despair.

  No, he couldn’t buy the idea that Alusha’s brain was in some devious way blocking the way to a miraculous recovery. Quite apart from anything else, such a belief would be a betrayal.

  Anyway, there was something about Plumb’s little speech that made him wary; it had been too assertive, too facile, almost as if Plumb were convincing himself of his own argument.

  And what was he really saying? What did the diagnosis actually boil down to?

  Nick came full circle. ‘So you do think it’s in her mind.’

  The other man’s face reflected disappointment, but also lack of surprise. ‘A lot of people have the same reaction,’ he said. ‘They think that any suggestion of, well, a mental component to a disease is some kind of a slur. But all illnesses have a mental component. Even a dose of flu. Really – all illness.’

  If he hadn’t been so close to despair, Nick would have laughed. He’d last had flu two years before, caught after crossing too many time zones. The only mental component he’d felt at the time was a desire to stop travelling in badly ventilated aircraft.

  ‘Would you mind explaining that?’ Nick asked with exaggerated courtesy. ‘About the flu.’

  ‘Well – people who have a positive attitude, their immune systems function better.’

  ‘Ah, I get the idea. You mean people who are feeling good recover quicker?’

  ‘Something like that.’ Plumb nodded unsuspectingly.

  ‘You mean people who are in good health, with no worries, no emotional problems and good strong bodies recover faster than other people?’

  Seeing the way things were going, Plumb began to look cautious. He didn’t reply.

  ‘My wife was all those things, doctor. Strong in mind and body. So why isn’t she better?’

  Plumb drew a deep breath and began to wade through the morass of arguments again. Now, however, his tone was brisker, more uncompromising.

  The sound of muffled female laughter floated in from the nursing station outside, then rose sharply as the door swung open and someone came in. Even before the new arrival had exchanged nods with Plumb, Nick knew this would be Carter. The man moved with the curious mixture of confidence and animal caution peculiar to specialists in private clinics, like a cat on a thick-pile carpet.

  Nick shook the proffered hand but did not attempt to return the smile.

  Plumb hurried into a rapid explanation of the conversation so far.

  Seating himself elegantly in a chair, Carter nodded sagely, rubbing a finger across his upper lip in a practised gesture of concentration.

  Carter turned to him. ‘I’m sure we can help your wife, Mr Mackenzie.’ His voice was beautifully modulated, like an actor’s. For no apparent reason Nick took an instant dislike to him

  ‘And what exactly is your angle, Dr Carter?’

  ‘I’m a psychiatrist.’ Carter watched for a reaction and, finding one, added smoothly: ‘But from what you might call the new school. Not exclusively drug-based, you understand. We favour a multi-faceted approach. I deal with diseases with a mental component,’ Carter continued. ‘That is to say, all disease. Though sadly I don’t have the opportunity to deal with half the cases I’d like to.’ He gave a modest little shrug, as if he was in such demand that he had difficulty in allocating his time. ‘Nowadays my sort of medicine gets called holistic. It approaches disease from the point of view of the whole person: mind, body and spirit. You really can’t separate those three things, you see, though I have to admit modern medicine is slow to absorb the fact.’

  ‘So what do you think caused my wife’s illness?’

  He went through the motions of considering the question. ‘In a word – trauma.’ The voice was low-pitched for reassurance. ‘The fall, the knock on the head. The lost pregnancy. And I understand your wife suffered an assault some years ago. These events – all serious shocks – were bound to take their toll. It’s been established that these things can have long-term repercussions – ’

  Nick was so incredulous it took him a moment to interrupt. ‘You’re saying that something that happened six years ago could be making her ill now?’

  ‘Not directly, not perhaps in the way you think. I’m suggesting a cumulative effect. It’s been shown that shock can have profound physiological effects for many years after the event.’

  Nick felt the beginnings of a quiet but total despair. ‘So … how exactly would you treat my wife?’

  It was a moment before Carter replied. ‘Our main approach would be cognitive therapy,’ he said.

  ‘Which is?’

  ‘Basically, we’d concentrate on getting your wife up and about again. We’d draw up a programme of measured exercise involving a variety of activities.’

  ‘What sort of activities?’

  ‘Oh – things she enjoys. You know. Swimming. Walking. Getting out and about.’ He sounded like a seedy salesman pushing two weeks at a holiday camp. ‘And some physiotherapy, of course. As I’m sure you’re aware, there’s a danger that too much inactivity can lead to muscle wastage and fatigue, and then the patient gets caught in a downward spiral which is twice as difficult to break out of.’

  A picture of Alusha pushed to exhaustion on a relentless exercise machine came into Nick’s mind. He murmured: ‘She doesn’t like swimming.’

  ‘Really? We’d take her to a lovely warm pool. It’s really very pleasant.’

  Now Nick saw Alusha out of her depth, foundering. Shaking himself free, he asked, ‘And drugs. Would you use drugs?’

  ‘Some. But the minimum possible.’

  ‘Which? What kind?’

  ‘Well – antidepressants mainly.’

  ‘But my wife’s not depressed.’

  ‘No, of course not,’ he agreed hastily. ‘It’s an unfortunate name, a misleading name. You see, alleviating depression is only one function of this type of drug. They have many other uses. Sometimes the hormones and neuro-transmitters in the brain get out of balance and block the pathways …’

  He elaborated at some length. The scientific terms came in a steady flow, the words at once impressive and chilling. Nick made the effort to listen with great care so that he should miss no detail.

  Eventually he cut Carter short by standing up. ‘I think I’ve got the picture.’

  Plumb, who’d been fidgeting with his hands for some time, got thankfully to his feet. Carter, too, stood up, and stretched out his hand. They both looked relieved because Nick had finally understood.

  Nick stared down at Alusha. She was asleep, her breathing shallow, her face thin and pale. She lay with one arm over the covers, her fingers clutching the edge of the sheet, as if for support. Her hair, which had lost its distinctive shine, looked tangled and unwashed. The nurse must have overlooked it; he would mention it when he saw them.

  He longed for her to wake up so they could talk. He wanted to know what she thought of Carter’s ideas, though he was pretty sure what her reaction would be; she would give a
small snort of disbelief, a derisive smile and say the madmen were loose again. She called most medics madmen, often to their faces. He knew what she would say, but he needed to be sure.

  He stared down at her as if the very act of examining her face might make her wake up. Her skin, taut, translucent and devoid of lines, was like a mask; her features, smooth and expressionless, were curiously inanimate as if she had slipped away somewhere.

  After a time the strangeness of the mask-like face began to frighten him, and he went across to the window and looked out. Even four storeys up he could smell the stench of the traffic fumes. He allowed himself a brief moment of longing for Ashard.

  He waited another ten minutes in case Alusha should wake, then went in search of the staff. Leona, a plump Jamaican staff nurse, was behind the desk. Seeing him, she grinned and called a cheerful hullo. He told her about Alusha’s hair.

  ‘I know. And I’m sorry. It doesn’t look very good, does it? But she didn’t want bothering,’ Leona explained.

  ‘But she’s usually awake by now.’

  ‘She wanted to go back to sleep.’ Leona tutted in friendly remonstration: ‘We’re not meant to let her, of course, but you know …’

  Nick was instantly alert. ‘Not meant to? What do you mean?’

  ‘She needs to get up and about a bit. Sleeping’s no good, is it? Not if you have too much of it.’

  ‘You’ve been told she mustn’t sleep?’

  Leona’s normally open expression clouded slightly. She said solemnly: ‘She’s meant to keep active, Mr Mackenzie. Get the circulation going and that sort of thing. All patients are, unless there are medical reasons against it.’

  What had the staff been told? Nick wondered. Had the doctors already labelled Alusha a neurotic? Was Leona secretly planning to put Alusha on an exercise machine?

  He pulled himself up short. He was getting paranoid. Leona was a perfectly nice straightforward girl who wouldn’t force anyone to do anything. He managed a smile. ‘Tell my wife I’ll be in this afternoon, will you, Leona?’