Threnody: Closest to Heaven – Chapter 5

November 18, 2010 at 2:39 am (Threnody: Closest to Heaven)

– CHAPTER FIVE –

I wanted to decrease my dose of benzodiazepines again, come the next day, but despite having hinted to Dr Meisland I might do just that, I couldn’t quite ignore the fact that I had all but promised not to tamper with that little bottle. It was not easy passing the days in an empty room. I had spent a lot of time sleeping, previously, but after my night… I felt far less inclined to let my cheek meet my pillow.

There was spare paper under the books – I took some pages and the pen from my drug chart, and sat down with the paper propped on my knee, bolstered by a fat Danielle Steel hardcover for support. I put the pen to the paper, and almost started to apply ink to the page – but something stopped me, something silly.

I realised I had no idea what I was going to do. Was I about to write? Doodle?

Picking up a pen and putting it to paper had been so natural, so exactly what I needed, that I hadn’t given it any thought. I had no idea what to do with the pen I held ready, and after ten good minutes reflecting on this, I put the pen and paper away, and leaned back in my bed, looking out of the window.

The sky was cloud-laden today, as if to mimic the start of my dream. Unbidden, I stared up at it, as if I was back in that dream, back under a torrential downpour, walking on my way to somewhere, with a direction in what I was doing. Something in me yearned in a different way for the sky – as if I was a bird and longed to take to the sky again. Last time I checked, though, I was very much human – and anchored to benzodiazepines.

Dr Jonathan Meisland (whom my head persisted in calling the young registrar) must have been true to his word, because on the Thursday morning, as I sat in the bed with dark shadows under sleep-starved eyes, a nurse came to tell me I should get dressed so I could go to Professor Danielle Stroyd’s office. I repressed the strong urge to retort that I could present myself there in my hospital nightgown if I so wished, but I was not one to refuse looking like a regular person instead of a hospital patient.

There were only two outfits in my wardrobe, so I was not spoilt for choice. I dressed rapidly and happened to catch a glimpse of myself in the mirror – I looked different, older, more purposeful… and more contained. Somehow, the reflection currently in the mirror reminded me far more of myself.

I felt nervous. Of course I did. The benzodiazepine did little to that. In a few minutes, I would find out exactly why I was this way… and possibly what was going to happen in the immediate (and perhaps not-so-immediate) future.

There was something very frightening about associating the word ‘future’ with what I currently was.

It was strange, when the curly-haired blonde nurse, whose name tag said Katharine, led me through the hospital. I had been stuck in this place for so immeasurably long, by my standards, and yet had barely seen any of it. I was led down a corridor where there were other closed doors – whether they contained patients like myself, or were empty, was anybody’s guess. I then passed by a busy ward where nurses and doctors and patients all seemed to be overly active, nobody constrained to a bed. None of the doctors paid attention to me passing by; some of the nurses looked up, and I could recognise them – one of them was nurse Julia, who was carrying patient notes behind a man with a pink bow-tie. I presumed that this was a ward round.

I was then led down another corridor where things were much quieter. Every door was plastered with a little blue tag, and each tag had a name etched onto it. I kept walking until we arrived at the one on which was written Prof. D. Stroyd. The nurse knocked and opened the door, but I remained frozen on the threshold, as if by hesitating I could somehow avoid this moment altogether.

It was a deceptively square grey-papered room that contained a desk, bookshelves, four chairs and two people. One of the two was, unsurprisingly, Dr Jonathan Meisland, who I noticed was greeting me with a rather formal-looking smile, but my gaze glossed over him to land instead on the other being in the room. Professor Danielle Stroyd was, even sitting, a very tall and imposing woman. I would have placed her age to be in the mid-fifties, just beginning to go grey at the temples, the crow’s lines in the corners of her eyes making her look owlish. There was something of the steel about her – something implacable, unyielding, commanding. I wavered on the inside, and wished there was a convenient hole in the ground to accommodate me briefly while she scanned me with those piercing eyes.

‘Miss Auriel,’ she said, in faintly accented tones, ‘please have a seat.’

The nurse closed the door behind me as I stepped into the room, and stood in a corner. From experience, I knew that doctors wanted you in the special seat, so I took the chair closest to Professor Stroyd, although I would much have preferred placing a little more distance between her and myself. There was a desk between us, but it provided poor protection from that gaze.

‘Good morning, Miss Auriel,’ she said, once I was seated. There was a very officious but brisk, business-like tone to her voice. The formality with which the consultation was starting did not bode well. ‘I am told you wanted to speak to me as soon as possible – and quite frankly, hearing the reports at your remarkable progress, I felt rather inclined to see you as soon as I returned, too. How are you doing?’

Now that it was time for this, I wavered, unwilling to pit myself against the steel that I felt lined Professor Stroyd’s backbone. It was one thing to bully a registrar, but when it came to this woman, she was very much in charge. I looked across as Dr Meisland and noticed that his smile seemed forced and he looked distinctly intimidated. Even given that he was impressionable, it was something to be noted.

‘Physically speaking, I am in perfect health,’ I said, in a steadfast voice. ‘I am also very bored with this hospital and very annoyed by everybody’s inability to do anything more than produce soup or Jeffrey Archer novels for me.’

Was that a tiny twitch to the left corner of her mouth? I settled for my best blank expression and hoped it would convey to her I was very serious indeed.

‘Ah, the books. Jonathan mentioned that. We have no better, I am afraid. The alternative would be textbooks, and you did refuse that, too.’

We were in the realm of small talk, now. I took a deep breath, and met her gaze full-on. ‘Professor Stroyd, I have a question. What am I doing stuck on a ward, surrounded by boring novels and ugly painted furniture?’ I carefully omitted the word psychiatric.

Dr Meisland glanced her way and shifted in his chair. She, however, seemed undaunted by the direct question. ‘The best way to go about this, Miss Auriel, is to ask you: how much do you remember?’

The words hit like a slap. Of course, I had known that there was a problem here, that I should be remembering the answers to my own questions – but I had somehow thought, hoped, maybe, that Professor Stroyd was in control of how little I knew, and that she would be instantly aware of what path to steer me along to. With her question… she had abruptly turned the tables and left me floating in an open sea, with nothing to give me any direction.

‘If I had any idea,’ I said, through teeth clenched to rein in my terror, ‘I wouldn’t be asking you. I don’t know why I’m here.’ I did not voice it – with this woman, there was no need to bully my way along – but allowed an accusation to leak into my voice: And I know you’re to blame for me not remembering.

She did not so much as blink. ‘Let’s start at the very beginning, then, Miss Auriel. We have a stepwise approach for everything: a management plan usually begins with the least invasive – therapy. It then generally moves on to medication. And finally, it moves on to the more specialised, irreversible procedures. Electroconvulsive therapy – ECT – is one of those. We always start patients on the bottom of the ladder and move upwards. There is a procedure called Memory Altering Intervention – MAI. Are you familiar with the term?’

I was feeling strangely light-headed. Her words… made sense and yet did not seem to be reaching me anymore. I felt as if my little ship, already adrift in the sea, was spinning in the wind, and I could not pull in the sails.

‘MAI is a procedure similar to ECT, except that it is actual surgery and is precise – whereas ECT is generally recognised as brute trial-and-error. In MAI, small electrical impulses are first sent forwards to map out neuronal tracts pertaining to a certain event in a person’s memory. Sometimes it is possible to do this without the subject actively participating, and at other times, the sedated subject may be requested to focus on the topic in question. MAI is performed as a last resort because if somebody’s feelings on an event are weak, then the neuronal tracts will either be dispersed, or else hard to elicit correctly. If somebody’s event is so powerful that no therapy or medication can overcome it, then there is an excellent chance that we can map out a strong, distinct pathway for it. Unfortunately, though, the mind is never a clear thing, and information is not stored in only one set of tracts, hence MAI’s relative failure rate. Just as every therapy does not work with everybody – MAI is unhelpful for many people. They simply retain that information along other untouched tracts. The mind is wonderful for duplicating records of the same thing.’

I wanted it to stop here. At this stage, things were still… reversible. We hadn’t passed a point of no return, yet. I was terrified of that – I felt as if it would literally be like diving over the edge of a cliff, into a chasm – with as little possibility of a safe return to the cliff-top.

‘If things look promising, the procedure itself can then be undergone. An electro-conductive compound is used to map out the desired tracts and a stronger impulse is passed through those tracts – the electro-conductive compound, isothiomium, retains the impulse so that it only travels along connected tracts. The principle is similar to ECT: the strong impulse disrupts the interneuronal synapses, and effectively fragments that path into a collection of separate neurones no longer forming a tract of any kind.’

The room was dark, just like my dream – a strange smoky, dense sort of darkness, patchy around the periphery of my vision. The words fragments and no longer echoed in my head as if they were shouted in there and were bouncing off the surfaces of my skull.

I heard somebody speaking with my voice, distantly. ‘That’s what I had, right?’

I was vaguely aware of Professor Stroyd nodding and continuing, ‘That is indeed the case, Miss Auriel. You’ve had trials on various medications, none of which helped and in fact some of those backfired and caused rare side effects; and you have been on several therapy programs for years. Nothing worked, which is why we agreed to your request to try this. It was a rather desperate bid, but if it hadn’t been justified, we wouldn’t have offered the treatment.’

Justified? In what way? I realised I had voiced the words out when Professor Stroyd replied.

‘You, erm, had rather strong problems, Miss Auriel. We’re talking severe Post Traumatic Stress Disorder with ongoing anxiety and even psychotic symptoms at the worst of times. It was clear that everything was very much due to your past – you were otherwise a perfectly reasonable, practical and capable person. There were rather excellent grounds for MAI. No matter what else had been tried, you simply couldn’t overcome what had happened to you in the past.’

I was feeling so unwell at this point that I deeply wished every room came with a Provide hole in floor to allow rapid and total disappearance button.

‘We can continue this discussion later, if you wish,’ Professor Stroyd’s voice was saying, ‘maybe tomorrow or the day after. It’s a lot to take in one go.’

Maybe it was the unmistakeably note of kindness in her voice that brought me back to my senses. I was not used to kindness – it made me flinch, as if I had been slapped. People only offered kindness to me when they were about to crush me utterly – kindness was like a patronising pat on the head. I did not need kindness. I could stand on my feet.

I raised my chin and looked her squarely in the eyes. I was dimly aware of Dr Jonathan Meisland’s keen expression, next to her face. ‘No, please go on. I’d rather get this over and done with.’

She looked a bit surprised but obliged. ‘The rest is rather short and you’ve probably guessed most of it by now. The procedure didn’t quite… happen as planned. You react rather powerfully to even tiny doses of the regular inducing agent – propofol – got you unconscious very quickly; too quickly, given that we needed to map out the tracts we needed to pass the impulse through, and needed you to be still partially aware for this part of the procedure. So we used ketamine instead – which in hindsight, maybe wasn’t the best thing for a procedure on the brain, given that it is known to affect electrical activity in the brain. The long and short of it is, we gave you an initial dose of ketamine, and after some difficulty, managed to get you to concentrate sufficiently to give us a convincing neuronal tract pattern, that we mapped out, and then you were given a higher dose of the inducing agent to ease you out of mostly beta waves – monitored on EEG as anything between 8 to 30 hertz. That incidentally includes alpha waves as well, but we wanted to be on the safe side. Isothiomium, the electro-conductive compound we use to retain the neuronal pathway we want the impulse to follow, sets at that range of wave frequency. If we passed an impulse through it while you were still in beta cerebral activity, there’s a risk that it spreads to more tracts.’

She paused – probably not for dramatic effect, but that was cruelly what it felt like to me. I felt as if I was forcing myself to sit through a nightmare.

When she resumed the story, her tone of voice changed from the faintly didactic one she had used so far, to a much blunter one. ‘To be honest with you, I have no idea what happened during that procedure. You were in perfect delta waves. We waited for five minutes to be sure, then passed the impulse through the isothiomium. It couldn’t have been more textbook-perfect up to that point. When the impulse went through… I don’t know how to describe what happened. Your brain activity sparked and tract after tract lit up with active thought frequency… the isothiomium shifted through and so did the impulse before we managed to cut the power. We weren’t even certain, despite the isolating substances we use, that the activity had been limited to the frontal cortex. It was… that unexpected, that unexplainable.’ She paused again, sighed – a most unexpected sound from that stoic face – and went on, ‘So there you go, Miss Auriel. That is what happened, and we have about as much idea as you why it happened.’

I felt as if I was floundering in quicksand, that the more I panicked and thrashed, the deeper I sank – and yet I couldn’t stop that frantic, unreasonable terror deep inside of me that was threatening to take over everything. If they didn’t know what had gone wrong… then that likely meant that they also didn’t know what to do to… to correct what had happened.

‘You said you cut the power as quickly as you could,’ I said, clinging to what seemed the very last tendril of hope. ‘Does that mean that… even though you might have disrupted the synapses, the connection isn’t completely severed, and could potentially form again?’

‘Definitely something that can’t be ruled out,’ she replied, with a nod of the head. It was funny how such a simple gesture could flood me with so much hope. ‘We sometimes pass the impulse through the isothiomium up to three times to make sure that it has actually completely destroyed the tracts in question. Memory is resilient, and we still understand little of how neurones are bound to each other with memory tracts. It is the primary reason why MAI fails – even those three impulses aren’t sufficient to achieve what we want.’

‘So,’ I spoke wildly, pulse racing, ‘so I could recover all my memories, eventually – even the ones I’d wanted out? Or…’ My heart sank. ‘Or I might not remember anything. Is it usual for people to wake up not remembering things?’

‘It happens,’ she said. The more wary part of me noted that she didn’t confirm it being usual – but the rest of me was too desperate to find hope in this situation. Professor Stroyd must have realised, because she leant forward a little, one elbow on the desk, and said, seriously, ‘Miss Auriel, it will take a lot of hard work on your part. Intense therapy, cognitive exercises, and probably a lot of time – we’re talking years…’

I didn’t care. Years was much better than nothing.

I interrupted her. ‘When do I get discharged from the ward?’

Jonathan Meisland laughed, the first sound from him during the entire conversation. I shot him a look of annoyance, although I had to admit that the unexplained hilarity was much better than the fascination with which he had been previously watching me.

‘I win that bet, Professor,’ he said, still chuckling.

I struggled not to scowl. They had been betting on me? Of course I would want to get out of this hospital – that was no secret at all. It was hardly worth a bet! I couldn’t decide whether I felt more baffled or affronted.

I seemed to hear Professor Stroyd say discreetly, ‘Fairly won,’ before she cleared her throat and addressed me in louder tones. ‘Miss Auriel, I’m willing to discharge you as soon as we’ve tapered you off the benzodiazepine, which should take another two to three days, given that Jonathan already pulled your dose down slightly. But I hope that you’ll understand that we can’t discharge you completely from our department. Our community team will check in on you daily for probably a week – longer if they feel it necessary – then after that, somebody will check on you weekly, and you will be referred to a therapist. It will be quite unusual therapy, so it may take a while before we manage to get somebody qualified to see you.’

‘Two to three days?’ I repeated. ‘Why can’t I have it orally and at home?’

‘I’m told you don’t like being on it,’ she said, very diplomatically.

I had a moment of panic during which I wondered if the registrar had told her that I had decreased my dose – the two seemed to be more in cahoots than I’d thought – but noticed, from the corner of my eye, Dr Meisland very faintly giving his head a shake. Relief flooded me – then I realised I was supposed to look a little bit discomfited at Professor Stroyd’s sentence. I hastily tried to arrange my features into a suitably uncomfortable expression.

Unfortunately, I could see no way of winning this one. She was (quite rightly, too – I would have done the same in her place) not going to trust me with oral benzodiazepine when I was well-known for insisting to be taken off them at all points during my hospital stay.

‘With the community team checking on me daily, surely you shouldn’t worry about that?’ I suggested in my best helpful tone.

‘I like to err on the safe side,’ she said, dryly. ‘Do you have any more questions, Miss Auriel?’

‘Yes,’ I said, although I wasn’t sure this was a good idea. ‘The papers I signed, and the reasons why this procedure was agreed to in the first place. Can I see those?’

‘You can see the papers you signed, but nothing more than that. Everything prior to the procedure is now filed information, and only myself and the other consultants are allowed access to those files.’

Surely Dr Jonathan Meisland must be able to access them too. He’d mentioned being hugely interested in my case – surely such an interest would lead him to find out everything he could? Professor Stroyd was quite implacable, and I knew there was no way I could see more via her than the papers I had signed. I very deliberately did not glance his way – if either of them noticed at that point, they would realise what I was thinking and my chances would be completely ruined.

‘I understand this,’ I said, reluctantly. It was silly to do a procedure to take out some memories, and then feed those right back to your patient again. ‘Can I see the forms, please?’

‘Certainly.’ She must have come expecting just anything, because she reached to a shelf behind her and pulled out a thin beige folder, which she opened and then pushed across the desk for me to see.

I leaned forward, half eager, half frightened.

But I couldn’t have been less ready for this form. It hit me as strongly as the explanation of what had happened to me.

It was a standard procedure consent form, with the procedure name at the top, a short summary of what the procedure was, and a list of potential adverse effects ranging from ‘mild headache’ to ‘memory holes’ – all of which, except for the latter, were news to me.

That, however, was all right. The problem was what followed after that. There was Professor Stroyd’s name there… and then… I just stared. I don’t know how long I sat there staring. It felt as if I was in a void, somewhere far away, where only myself and this piece of paper existed… and I was floating in the wrong sort of gravity, my stomach falling one way and myself another.

‘Miss Auriel –’ It was Dr Meisland’s voice. ‘That is your signature.’

I exhaled slowly, forcing myself to swallow and breathe normally. ‘I – I know my signature! This – I’ve never seen it before. I know you’re going to say it’s the memory loss but for all I know, this could be a form you made up to cover yourselves!’ My voice was trembling, and I had no control at all over my expression, as I looked first at him then at Professor Stroyd. ‘And that bit in my name, that –’ I stopped abruptly as I realised that this part, they had not figured out yet. I had just given away that less of this form made sense to me than they’d thought.

It was that realisation that made me calm myself, in a supreme effort of control.

‘That’s not my name. I don’t have three names.’ Quiet, adamant – much better than the hysterical way I had been speaking just now.

Both their faces were carefully blank. I wondered idly if this was a clinical skill that psychiatrists were assessed on.

‘Miss Auriel, we don’t know the particulars behind your names, but I assure you, that is how we have you on record, too.’

‘Nonsense. It reads Auriel Denevier on my bedside notes,’ I said, flatly. It had taken me a shamefully long time to realise that those contained my name – if I had realised earlier, I could have given Dr Meisland my full name from that first day.

‘The form you filled out when registering with the NHS does say you only use those two, hence why these are the two we have on your notes,’ Professor Stroyd said, with placating gestures at the folder in front of me. The inside of the cover did indeed have only Auriel Denevier on it, neatly stickered there. ‘On record, we register patients with their full names, and that is the name we have you under.’

It is your name, Miss Auriel – I could hear those words going accusingly round and round my brain, echoing and sounding as if the voices were multiplying and becoming louder.

I closed the folder shut with a loud snap and eased it back towards Professor Stroyd, wishing I could also push those accusations back at her. Surely I would remember my full name, if I remembered part of it? Surely I would remember my signature if I remembered my postcode?

‘Would you like something to drink, Miss Auriel?’ Professor Stroyd had a concerned expression on her face. I must have gone pale.

‘I’m all right, thank you,’ I said, stiffly. ‘I don’t have any more questions right now.’ I sat up in my chair, as if preparing to stand up, hoping that this would be all I needed to do to hint that I wanted to get out of this room.

‘I’ll call a nurse to take you back to the ward, then,’ Professor Stroyd said affably. ‘I’ll see you tomorrow on my ward round, in any case, so we can always discuss any other questions you have by then.’

By the time a blue-clad nurse came to fetch me from the room, my thoughts were racing. In two or three days’ time – definitely two if I had anything to do with it – I would be home. My mind sped through all the possible discoveries I could make once home – every way in which I could recover my identity.

The hospital and Professor Danielle Stroyd had revealed as much to me now as I could get from them.

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