The Syndrome

by John Case

  “What’s in an ‘intake interview’?” Adrienne asked.

  “Oh, well—” Shaw rolled his hand through the air.

  “It’s a basic medical history” Duran explained. “Operations, dizzy spells, allergies—”

  “And a bit of testing,” Shaw added. “Routine stuff: the TAT, the MMSE—”

  “Which are what?” Adrienne asked.

  Shaw shrugged. “Well, the names don’t tell you a lot more than the acronyms. But they’re tools we use to ascertain the patient’s psychopathological status, identify cognitive impairment and thematic perception curves—that sort of thing.”

  Adrienne nodded, even as Duran frowned. What was he actually agreeing to by coming here? Was he going to be this man’s guinea pig?

  Shaw winked at him. “I’m sure Mr. Duran knows as much about the tests as I do—not so?”

  Duran shrugged. “I know what they are,” he said, “but I’ve never really had much use for them in my own practice.”

  “Well, I’m a great believer in testing,” Shaw told them, “and if we have time, I think we’ll take a shot at the Beck Depression Inventory.” He saw the wariness in Duran’s eye, and rushed to reassure him. “Just to get a take on things.”

  “I understand,” Duran said, “but… what we’re talking about is memory—not my sanity. My memory.”

  Shaw rolled his head from side to side, as if the distinction was unimportant. “Well,” he said, “if everything you’ve been telling me is true, there’s clearly a dysfunction of some kind. The tests are just investigative tools. And the first thing we need to find out is whether your amnesia is organic or adaptive, the result of trauma or… something else.” He clapped his hands together. “We need to get some idea of the kind of thing we’re dealing with.”

  “Which is what?” Adrienne asked.

  Shaw turned his palms toward the ceiling. “There’s no way to say, at this point. Amnesia can have any number of causes, from a knock on the head to epilepsy, extreme stress or—I don’t want to frighten you, but—a brain tumor. It could be a form of hysteria.”

  “‘Hysteria’?”

  Shaw winced. “It’s an outdated term. Basically, we’re talking about adaptive amnesia, the kind of amnesia that results from psychological—as opposed to physiological—causes.” Shaw steepled his hands and peered over his fingertips: “Of course, the lines can be blurred. But, generally speaking, hysterical amnesia is amenable to talk therapies. These days, we tend to classify it as a dissociative disorder.” He glanced at his watch, then bounced to his feet. “In any case, the tests will give us a leg up on things.”

  He shook hands, then shepherded them toward the door. “See you at three.”

  They checked the car (no ticket), fed the meter, and found a deli a few blocks from Shaw’s office, where they ate pastrami sandwiches with a side of half-sour pickles and cans of Dr. Brown’s Cel-Ray soda. Duran was in a funk, uncomfortable with being someone else’s patient, Shaw’s litany ringing in his head: cognitive impairment, dysfunction, hysteria.

  “What’s the matter?” Adrienne asked, as she speared a slice of pickle on her fork.

  Duran shook his head. “If he tries to throw me in the bin,” he said, “I’m outta here.”

  “‘The bin’?”

  “It’s a clinical term,” he explained.

  With more than an hour to kill, they decided to check out the offices of Mutual General Assurance. “They’ll probably give us copies of Nikki’s tapes, if you’re the one to ask for them,” she said. “I mean, you’re their client, right?”

  A subway ride and a five block walk got them where they were going, though it was anything but obvious when they arrived.

  The address on Avenue of the Americas turned out to be a branch of Box ‘n Mail, one of those places that sell bubblewrap and cardboard boxes, while packaging and sending items via UPS, FedEx and the postal service. As a sideline, this particular Box ‘n Mail was also a mail drop, renting boxes to people who found it problematic to receive mail at home.

  Mutual General Assurance’s offices in “Suite 1119” was in fact a 4- by 6- by- 12-inch tray. A pressed metal door obscured whatever contents it might have held.

  Adrienne and Duran waited in line behind a woman sending a care package to her son at Cornell. When it became their turn, Adrienne asked how she could get in touch with Mutual General Assurance.

  The clerk was an energetic slob with long blond hair. “Only one way,” he said. “You write them a letter.”

  “But there’s a list, right? I mean, there must be some kind of contract—between you and them.”

  The clerk shook his head, turned his attention back to the package on the counter in front of him, expertly affixing a length of sealing tape to a seam.

  “Couldn’t you just give me a phone number?” Adrienne cajoled. “It’s important—I mean, I really need to talk to these people.”

  “Lady,” said the clerk, “why do you think people rent these things?” He swept a hand toward the ranks of cubbyholes. It was a rhetorical question but Adrienne answered anyway.

  “As a place to receive mail.”

  The clerk looked at her, then flipped the package in his hands, examining every side. Finally, he dropped it into a white plastic crate on which someone had scrawled UPS.

  “They rent them because it’s a discreet way to receive mail. Discreet,” he repeated. “You want a phone number for one of these outfits, you can call 411.”

  “This place is unlisted,” Adrienne told him. “I already tried that.”

  The man gave her a regretful grin. “Yeah, well, that’s why I say you oughta write ‘em a letter. They want to talk to somebody, they’re probably not gonna rent a box from us.”

  They stopped at the car to feed coins into the meter and when they returned to Dr. Shaw’s office, Adrienne was given the option of cooling her heels in the reception or—“I think I’ll go for a run,” she said. “The park’s only a few blocks away.” Retrieving her running clothes from the car, she changed in the ladies’ room outside Shaw’s office, then took the elevator down to the first floor, leaving the psychiatrist and Duran to themselves.

  She loved running in Central Park. The distance around was almost perfect, about six miles, and there was something wonderful about jogging beneath a canopy of skyscrapers and trees.

  She ran for an hour and, once or twice, got turned around, emerging from the park on the wrong side. Each time, she went back the way she came, crossing the park, thinking, You idiot. What if you’d sprained your ankle? You should have brought money—enough, at least, to make a phone call. And anyway, you should have been paying attention.

  The receptionist—a punky young woman with blue fingernails and henna colored hair—left at six. When she’d gone, Adrienne went to her desk and used the telephone to make a reservation at one of the hotels whose numbers she’d taken off the computer the night before. Then she changed back into her regular clothes, and began to read Newsweek. By 7:30, she’d read New York, People, and was halfway through the New Yorker, and beginning to worry that something was wrong. Twice, she got up from the couch and stood, listening, outside the door to Shaw’s office. But the door was solid, and all she could hear was a low mumble.

  It was 8:45 when they finally emerged, and the sound of their voices startled her so that she jumped up, as anxious and eager as a relative in a hospital’s waiting area.

  Shaw smiled at her and she could see that he was excited. For his part, Duran was exhausted, looking pale and tired, a shadow of stubble covering his jaw.

  “It’s a pain in the ass,” Shaw was saying, “but nothing that hurts.” Turning to Adrienne, he lifted his palms toward the ceiling, and apologized for keeping her waiting so long. “I’m completely baffled,” he told her, “but more intrigued than ever. I’ve never seen anything like it! And as I was saying to Jeff, I’d like to run some tests in the morning. Nothing too strenuous—”

  Adrienne frowned. “But, surely y
ou have some idea. I mean, you’ve been in there for hours.”

  Shaw sighed, entwined his hands and stretched his arms above his head. He closed his eyes, and rolled his head in a circle. Then he lowered his arms and rotated his shoulders. Finally, he said, “Why don’t we sit down?”

  They did.

  “It’s a very odd business,” Shaw began. “What interested me at first was the duration of what I was led to believe was an amnesic fugue, but—”

  “You changed your mind,” Adrienne suggested.

  Shaw nodded.

  “And now what do you think?”

  “I think—that I don’t know what I think. I can honestly say I’ve never encountered anything like Jeffrey’s mind. He knows almost nothing about his past and what he does know is less remembered than learned. It’s as if he read about himself, and memorized the details.”

  Adrienne looked at Duran.

  “I’m a fascinating case,” Duran told her, his voice thick with sarcasm. “Ray’s gonna name a disease after me. Call it Duran’s Syndrome.”

  Shaw smiled. “If I ask Jeffrey about an incident in his past, one that he recalls, he’ll relate the story in the same way each time, bringing up the same details in the same sequence.”

  “So?”

  “They’re anecdotes—remembered stories, rather than memories per se. It’s not uncommon, really. All of us do it to some extent, embellishing our recollections to conform to one agenda or another, making ourselves look more attractive, our parents more loving—whatever it may be. But in Jeffrey’s case, his memories aren’t just polished, they’re set in stone.” Seeing Adrienne frown, Shaw went on to explain that “I asked Jeff to recall certain incidents from his past—the kinds of things no one would embellish.”

  “Like what?” Adrienne asked.

  “Ohhhh… “ He rolled his hand in the air. “The time you lost your first tooth.” He paused, and nodded encouragingly. “How was that handled in your family?”

  Adrienne blushed. “I don’t know—”

  “Of course you do. Think about it. When you lost your baby teeth—was it handled matter-of-factly? Or was it a big deal?” The psychiatrist pressed his hands together and put them in front of his face, so that his fingertips touched his lips.

  Adrienne thought about it. “Well,” she said, a little nervously, “in my family—that’s kind of a loose construct, just for openers. I did a lot of moving around between ‘families’ when I was a kid.”

  “That’s not what we’re talking about,” he objected, impatient for an answer. “Wherever you were, whoever you were with, you lost your first baby tooth. Take it from there. What happened?”

  She shut her eyes, squeezed her face tight, made a show of having to remember although why she was doing this she didn’t know—because she did remember, she remembered quite clearly. Finally, she said, “I lived with my grandmother, and she made a big deal about it—which wasn’t really like her.”

  “Go on.”

  “Well, she had a little ceramic case. A special case that was shaped like a tooth.”

  Duran laughed.

  “Really! And it had a hinge that you opened, and ‘Tooth Fairy’ was engraved on the top. I thought it was wonderful,” Adrienne told them, “though now that I think about it… well… it seems a little strange.”

  She giggled nervously.

  “Go on.”

  “Well, the tooth went in the box and the box went under my pillow and, when I woke up in the morning, there was always a dollar bill—all folded up in a tiny little wad—instead of the tooth. Gram didn’t understand how mercenary I was—I was ready to pull out the rest of them.”

  “You see,” Shaw said, gesturing toward Adrienne with an open palm, “you recall it perfectly. As you should. Losing a tooth is a rite of passage—and almost everyone has some recollection of it. But not Jeffrey. Jeffrey doesn’t remember anything about it at all.”

  He glanced at Duran, who shrugged.

  “Anyway, as I was telling Jeff—I have a catalog of unimportant incidents of that kind. Things we all did—like eating lunch in elementary school, going out for a haircut, going to the dentist. I could give you dozens of examples of what amount to collective memories, memories that you might say are common to the human condition—or at least to the American condition. But—” Shaw turned to Duran with an apologetic smile. “Our friend, here, might as well be from Mars. Of all the events I suggested—and there were a dozen of them—Jeffrey responded to exactly two.” He held up his fingers, like a peace sign. “He remembers going to the beach—Bethany Beach—with his parents. And he remembers blowing out the candles on a birthday cake. Everything else is a blank—and that’s not what I expected.”

  Adrienne looked puzzled. “Why not? We know he has amnesia.”

  Shaw tilted his head from side to side. “Yes, but we also know he’s a confabulator. And that’s what makes the case so interesting: he’s a twofer. And not just any twofer. Mr. Duran is convinced that his recollections are true—that’s why he passed the lie detector test that you mentioned, and that’s why he naively took you to a beach cottage that didn’t exist. All of which is consistent with what I learned this afternoon. When I asked Jeff about these insignificant events that we’ve been talking about, he made no effort whatsoever at invention. Either he remembered them, or he didn’t. Mostly, he didn’t.”

  “But what does that mean?” Adrienne asked.

  “That he’s not a conman.”

  “And?”

  “That he’s delusional as well as amnesic.” Shaw turned to Duran. “Are you sure you’re comfortable with me discussing you in this way?”

  Duran rolled his eyes. “Yeah. Adrienne and I are old friends. Ever since she stopped suing me.”

  Shaw looked surprised. “You’re suing him?”

  Adrienne shook her head. “No. I was. But I’m not.”

  The psychiatrist took this in stride. “At any rate, we went through some of the clinical tests I mentioned earlier.”

  “And?”

  “Everything’s normal—except the patient.” He smiled. “So I hypnotized him.”

  Adrienne frowned. “But… I thought you were opposed to hypnosis.”

  “On the contrary. It’s a useful tool—and I thought it might relax him. Loosen his inhibitions.”

  “And did it?” Adrienne asked.

  “No—even under hypnosis, he was still drawing blanks. But the incidents he did recall—going to the beach, his first birthday cake (and first birthday party)—well that was even more interesting.”

  “How so?”

  “He told me the same stories. And I mean, exactly the same stories. Almost word for word. As if he were reciting a poem, or a speech.”

  “Which means what?” Adrienne asked.

  Doctor Shaw shook his head. “Too soon to say. But there are a couple of tests I’d like him to take—just so we can rule a few things out.”

  “Like what?”

  “Hippocampal damage.”

  “And these tests… what are they?” Adrienne asked.

  “CAT scan. PET scan. MRI.”

  It was Adrienne’s turn to roll her eyes. “I don’t think Mr. Duran has the money—”

  “He’s insured,” Shaw told her. “We checked.”

  “Is he?” she asked. “With Mutual General?”

  “No,” Duran told her. “I’ve got Traveler’s. The other was malpractice insurance—for the tapes.”

  Shaw got to his feet, and went to the receptionist’s desk. Opening one drawer after another, he finally produced a map and some papers, which he handed to Duran.

  “What’s that?” Adrienne said, looking over Duran’s shoulder.

  “A map of the hospital, shows you where the lab is. Consent forms.” Shaw glanced at his watch, and made a helpless gesture. “Oh, Jesus,” he said, “I’m going to catch hell.”

  “Sorry,” Adrienne told him, pulling together her little bundle of shoes and sweaty running clothes.

>   The psychiatrist waved away her concern. “Won’t be the first time.” He led them out the door to the elevator. “You the nervous type, Jeffrey? Claustrophobic?”

  Duran shrugged. “How would I know?”

  Shaw chuckled. “Well, if you think you’ll have a problem with the MRI, tell the technician. He’ll give you something that will help you chill out.”

  The car had a ticket tucked under its windshield. “God damn it!” Adrienne wailed. She rushed to pluck it free, as if it might replicate if she didn’t remove it in a hurry. “It’s a hundred bucks!” She looked at it and saw that the ticket had been written hours ago, during the time she’d been running. Getting lost in Central Park—she’d been worried about getting back late to Shaw’s office and had forgotten about the meter. It wasn’t fair but she turned toward Duran as if it was his fault: “Why did you have to take so long?”

  He could sense her frustration, and knew better than to test it. So rather than making a wisecrack, or replying that the trip was her idea, he said, “I don’t know. I’m sorry you had to wait.”

  Two minutes later, they were in the car, heading toward lower Manhattan, and she was apologizing. “It’s my fault,” she said, her tone emphatic and remorseful. “I parked there. I forgot to feed the meter. I don’t know why I’m yelling at you.” She sighed. “Sometimes, when I get stressed out—”

  “Forget it.”

  “No, that was bad. I know it wasn’t your idea to spend all that time in his office, being grilled from A to Z. I’m just a jerk.” She seemed so disconsolate that he wanted to put his arm around her.

  Instead, he said, “I know you’re worried about money. You didn’t even want to spend the night here.”

  “Yeah, but don’t try to talk me out of it,” she told him, beginning to laugh. “I like to wallow.” She let out an exaggerated moan. “A hundred dollars… shit!” The windshield fogged up and she rubbed at it with the heel of her hand.

  “Where are we going?”