Remembrance Sunday, page 1
Epigraph
How much of him is in me, and how much of me is in him?
Brian Keenan, An Evil Cradling
Contents
Cover
Title Page
Epigraph
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Author’s Note
About the Author
Praise
Copyright
About the Publisher
1
I have a book opened on the desk in front of me: Van Gogh in Auvers. It documents the two months that Van Gogh spent in the village of Auvers-sur-Oise in 1890, after his release from an asylum in Saint-Rémy in Provence. By the time of his arrival, he was still fragile but rested, optimistic, ready for work, entranced by the cool, muted light of the north. During his visit, he lodged with the Ravoux family in their auberge. They gave him a small room and a warm welcome. In gratitude for their hospitality, he painted a portrait of Adeline Ravoux, the eldest daughter, who was ten years old at the time.
It’s a strange, disconcerting painting. It doesn’t become any less strange with repeated viewings. Adeline is dressed in blue, and Van Gogh chose to paint the background in the same colour, which gives it an hallucinogenic aura, the girl’s face and hair and hands seem to float outwards, towards the viewer. This effect – although effect seems too slight a word – was entirely intentional. On arrival in Auvers, Van Gogh wrote to his sister, saying: I would like to do portraits which would look like apparitions to people a century later. But the style of the painting isn’t what unnerves me. It’s Adeline’s face that’s disturbing. It’s not the face of a child.
On the opposite page, there’s a black-and-white photograph of Adeline as an elderly woman. She sits in a chair and gazes at a reproduction of her portrait. The likeness between the old face in the photograph and the prematurely old face in the painting is so accurate it’s deeply unsettling. Underneath the photograph, she’s quoted as saying: The painting frightened me in its violence. I didn’t see its resemblance to me. It was only much later that I realized, when looking at a reproduction, that he had been able to perceive the woman I would become in the girl that I was at the time.
Recently I’ve been overcome by seizures. They happen daily now. Some force, internal or external, overcomes my body and causes me to thrash and flail on the floor. Usually I come to on my back: groggy, disoriented, flushed out, sometimes with blood in my mouth, sometimes with my trousers soaked with urine. My seizures first came upon me when I was fifteen years old, living in Northern Ireland, at the height of the Troubles. They passed quickly then, with only a few occurrences, lying dormant until they returned to me several months ago, at the age of forty-nine.
To try to explain all this, I’ve been reading, looking for justifications, but nothing in the textbooks on my desk can bring me any kind of clarity. Modern science is no closer to identifying the source of consciousness than the Ancient Greeks were. We all feel that we’re located within our bodies, and yet we don’t feel that we’re made of the kind of stuff we see when we look inside a human being – organs, tissue, sinew. If we didn’t know that human beings experience the world, we couldn’t deduce it from neuroscience. There’s nothing about the behaviour of neurons to suggest they’re any more special than, say, red blood cells. They’re cells, doing what cells do – generating flows of ions, sodium, potassium, chloride, calcium – and releasing neurotransmitters as a consequence.
When speaking of consciousness, we still don’t know where to even begin looking. It could be that it isn’t even located in the brain, that it’s something outside of ourselves, and that the organ in our head is merely a processing machine. This isn’t a new idea. Aristotle thought that the soul is – briefly – identical with the objects of our experience. According to his thinking, when you see an apple, your consciousness and the apple are made of the same stuff, which he called the form of the apple.
All the science I read seems so cold, so removed from the sensation of a seizure, from the having of it. They talk about it, but can’t communicate what it’s like to be in it, to inhabit a fallible body that is susceptible to these electrical storms. So instead, for solace, I turn to Dostoyevsky, the great chronicler of the condition.
In The Idiot, Dostoyevsky describes the moment before his seizures – via his character, Prince Myshkin – as the highest degree of harmony, beauty, measure, reconciliation, and an ecstatic, prayerful merging with the highest synthesis of life. I recognize the nature of the condition in these words. There’s a moment of supreme clarity that often arrives before my body twists into convulsions, where past and present intermingle, where time and memory become physical and spatial entities, released from the vaults of the brain to flow out through my body, flooding whatever room I happen to be in. Perhaps a seizure is the price you pay for experiencing a world without categories, for stripping away the fabrications we each create for ourselves just to get through the day.
I’m saying all of this as an explanation, a kind of confession maybe: I have my own personal apparition. A man who lives with me. A companion. An enemy.
I can’t see him, I can’t reach out and touch him, but I know he’s there. This isn’t a ghost that appears, it’s a visitor from my past, a memory made incarnate. He – or, more accurately, his shadow – arrives from behind me, whispers into my limbs and speaks a sentence inside my skull, inflected in a Fermanagh accent, those soft vowels. He’s a figment of my imagination. And yet not. He’s a part of me. And yet not. He is present and yet not. He floats somewhere in that nether region between objective reality and perceptual insight.
Form. The word feels accurate. Every afternoon, a form comes to me or I become form, and am laid bare, time and time again.
2
My desk, this desk, this room, is in Chinatown, New York. Tonight is a Friday, the first Friday in June. I live on the fifth floor of a building that sits adjacent to the Manhattan Bridge. The room is triangular. I’m sitting at my desk in the cupola at its apex. There’s a window in front of me and on each side of me. The central window overlooks a plaza. To my right is the bridge; to the left I can see along Division Street all the way through to the trees of Seward Park.
My seizures re-emerged just before I moved here, but I don’t attribute this to the space. I think of it as a refuge, a shelter. I don’t pay rent – a miracle in New York. A neighbour of mine, a friend of a friend, offered it to me. In the city permits it’s listed as a commercial space, so she’s waiting for the paperwork to come through to turn it into a residential apartment. For now, it’s mine, a sanctuary, a quiet room in which I can be still and remember.
I can’t sleep. I don’t want to sleep. Instead I sit here and look out into the night. The city moves differently in these hours: it loses its intensity, becomes more individualized, more contained. People stepping across the plaza ward off attention by keeping their gaze downwards, rarely lingering. Around midnight a flurry of recycling collectors arrives, each pushing a shopping trolley and filling it with plastic bottles or sheets of cardboard. When I first moved here, I thought that they worked together, but then I noticed that they never interact. After taking possession of a single side of the street or plaza, they then work their way along the piles that have been left out for the garbage trucks. There’s one man who, every night, takes his break in front of the video-rental store. He leans against his trolley and watches Asian war movies for twenty minutes, even in the rain.
I can see people walking from the bus depots on East Broadway, arriving from Philadelphia and D.C., pulling trolley cases or hefting rucksacks on their backs, impatient to bed down for the night. I can see a limousine make its way towards the small casino on Pike Street, weaving deftly through the narrow alleyways, its gleaming white patina so at odds with everything around it.
Above the plaza, down towards the East River, are the Vladeck Houses, a vast development of mid-rise buildings from the 1940s. I spend a lot of hours just following the movements of the lives that are stacked up inside them. Many of the windows pulse blue in the TV-screen light. I watch figures rising to go to the bathroom, or bedroom, moving through the window frames. New York, I’ve come to realize, is mostly a city of internal light. Its charm comes from the fact that there’s an endless array of individual lives on display. I lived in Paris for a while and, looking back, I realize that the night there was arranged around its monuments, lit by hidden sources. It gave the city a more public feel; it imposed characteristics on the buildings themselves.
Here, I’ve developed an affinity for water towers. I like their air of uncomplicated sturdiness. I can see more than a dozen of them from where I sit – tucked on to unobtrusive platforms, or standing exposed, solitary, on rooftops, their silhouettes identical in the reflected glare.
To my right, just a few yards from my window, subway trains clack unhurriedly through the underbelly of the bridge. As the night deepens, when the bars are long closed and the partygoers are in their beds, the trains are usually so empty that I can count the number of passengers. I g
I find the constancy of the trains to be reassuring. I can feel them rumbling up from the ground at Canal Street, then they trundle along past my right shoulder, a length of bright silver bulldozing into the night. Again and again, I find myself following them as they slide out over the river, traffic streaming above them, an unceasing flow.
Tonight, I’ve been watching a video on my laptop. It documents a hospital procedure that I went through this morning. My neuropsychologist, Dr Ptacek, sent it over to me. I’m lying on a gurney in an angiography suite. The camera is directly above me. I’m staring straight into it. A green surgical sheet covers me up to my neck. I’ve been shaven bald, and a nest of electrodes is glued to my scalp, the head of a Medusa.
It’s strange to see yourself in such a vulnerable state. I recognize myself of course, but mostly I just see a patient, a prone body in an indistinguishable hospital gown. It’s interesting to watch my reactions: they don’t necessarily fit with my recollection of events.
People lean into the shot and speak to me. They’re indistinguishable: the camera shows only the tops of their heads, which are covered in scrub caps. They look as though they’re about to step into a communal shower. Around my groin, a square patch is cut out of the sheet. I’m being readied to undergo a Wada test to check for damage to my right hemisphere.
My seizures have become frequent enough and serious enough to warrant an operation. Dr Ptacek has charted my brain scans and logged my clinical record. He and his team have identified some scar tissue in my left hemisphere. In the absence of any other answers, they suspect that this might be the source of my ills. The operation carries a grandiose title: amygdalohippocampectomy – so called because it involves the removal of my amygdala (the Greek for ‘almond’) and part of the adjacent hippocampus (‘seahorse’). The hippocampus is a vital component of the brain’s memory circuitry, essential for laying down new traces. If we’re the sum of our memories, the hippocampus is the means by which we assemble ourselves. Everything I can recall flows through it. The amygdala houses my means of accessing emotion. It links the higher cortical areas of the brain – language, perception, rational thought – to the deeper structures that manage the regulation of emotion and motivation.
I can see my face on the screen so clearly, see right into my eyes. They emanate terror, which – although understandable – is odd, because I don’t remember being scared. I felt calm this morning, lying on that gurney. I allowed myself to take solace in the constancy of my breath. I trusted those around me. Then again, our internal state often doesn’t correlate with our public selves. We prepare a face to meet the faces that we meet.
The purpose of the Wada test was to clear a path for the operation, to check that the right side of my brain was functioning properly, that there were no silent lesions lurking in its folds. If I became inhibited on both sides, I would be cut adrift, unable to form new memories, be devoid of emotional colour. Despite the precariousness of my position, I find a kind of delicate beauty in the fact that the gatekeepers to our lives come in such simple forms.
Last Monday, Dr Ptacek talked me through the procedure in his consulting suite. The Wada test involves pumping a course of Amytal into my left hemisphere to anaesthetize it (although the word is apparently incorrect in this instance: the brain has no sensory receptors; it’s forever in a state of anaesthesia, another mystery I fail to understand). We rehearsed what would happen. He had me lie on a gurney and raise both my arms in the air. As I counted to twenty, he had me imagine – after ten – that my left arm had become limp and that I allowed it drop to my side. Then he went through the motions of the test, asking me to perform simple actions, do some basic maths and name images on a flipchart.
We’ve come to know each other a little. Over multiple sessions of what he calls his obstacle course – an EEG, an MRI, video telemetry, neuropsychological profiling, various courses of medication – he’s told me some details of his life. He comes from the Czech Republic. He confessed to me that he still thinks of it as Czechoslovakia, which it was still called when he left. He grew up under Soviet rule in a village in the Carpathians. His father was a mechanic. He arrived in New York on a scholarship after his undergrad degree. His voice still carries the inflections of his homeland. It sounds so rich, so measured and authoritative. I find it calming.
He’s told me to call him Karl, but I can’t. It’s a question of trust, I suppose. I need to believe in his capabilities, his ability to tackle any problem that faces him. I need the professional signifier.
On the screen, the anaesthetist approaches and injects a local anaesthetic into my groin. I keep my gaze upwards, straight into the lens. It’s strange but I don’t remember the camera above me. I think I was concentrating on all of the activity within the room. It was cramped, filled with X-ray equipment and control panels. The cameraman sat in the corner viewing his video feed, headphones on, checking the sound levels. Above my head was an arrangement of monitors, all showing cross-sections of my brain. In the video, you can hear people milling about in the background: EEG technicians in white scrubs, radiologists in blue, like two teams competing for something. The technicians were keeping track of my brain’s activity levels, which snaked across the monitors in different colours. The blue lines were dominant and undulated only slightly, which I knew was a good sign, meaning that my brain was idling in a languid alpha rhythm.
I can see myself closing my eyes. I turn my head from side to side. I think I was trying to get comfortable on the pillow. I remember the electrodes were itchy on my scalp – I wanted to reach up and yank a few of them out.
Dr Ptacek enters the shot. He leans over to greet me. I turn towards him, opening my eyes again. He’s carrying a clipboard, a stopwatch and a black ring binder. He hands the clipboard to a colleague.
‘How are you doing, Simon?’ He touches my shoulder.
‘Fine. Nervous.’
‘You’ll be out of here in no time. Keep taking those nice calm breaths.’ He looks up towards the EEG monitors. ‘Everything will happen just as we rehearsed it. I promise.’ I remember once again finding his voice so relieving, that assured accent.
A nurse approaches from the left of the frame and holds my hand. They’re ready to begin.
The radiologist makes an incision in my groin. I can tell when this is happening on the video because at that same moment the nurse brushes a strand of hair away from my forehead and I flinch with distress, fear washing over me. The radiologist slips a catheter into my femoral artery and slides it, expertly, through my body.
‘Just the junction with the internal carotid,’ she says. I couldn’t tell if she was saying this to herself or to me or to one of the technicians.
I could feel the sensation of the catheter sliding up through my chest, from heart to brain: a stranger winding its way through me. On screen, I make a chewing motion, as the catheter scratches the inside of my neck.
The radiologist sits back, relieved. She has arrived at her destination. She clips the other end of the tube into a machine and then leans in towards me.
‘Okay, Simon,’ she says, ‘I’m going to pump through some dye, to make sure that we’ve reached the right area of your brain. It’ll feel a bit weird, like something has burst. Just relax, you’re doing great.’
I can see myself clenching my jaw determinedly, ready for action. My face flushes. The liquid, I remember, felt disconcertingly warm. It flashed underneath my skull, an orgasm, a brainwave, an abandon.
Dr Ptacek approaches again and stations himself on the other side of my midriff, across from the nurse. The nurse places her hands on either side of my face. It was so good to feel her cool touch. The nurse, now that I see her on-screen, seems to have no specific medical function; she’s merely there to reassure me. As I watch these three people gather around me, I think how each of them is attending to a particular strand of myself. The body. The mind. The human being.
Dr Ptacek speaks. ‘Simon, I’m going to ask you to raise your hands just as we practised. Once we begin to pump the Amytal through, you can start to count to twenty.’
