How could I refuse? Emma thought. “Yes, I’d be happy to see him. Do you have his notes?”
The SHO showed Emma the notes and she made a double take when she saw the name Brian Spencer on the front of them. The last time Emma saw him was 13 years ago, when she’d just been appointed as a consultant and he’d made an impression because of his newly found love of cooking. But Emma was astonished that he was still alive at the ripe old age of 86 with advanced prostate cancer diagnosed way back then.
She went over to his bed and briefly looked at him. Reading his notes hadn’t prepared her for the change she saw in him: a tiny wizened man who looked as if the wind could blow him away at any moment. He looked up at her and there was that instant recognition that sometimes happens even after many years of being apart.
Emma sat down on the chair by his bed.
“It’s Dr Jones, isn’t it?” he said in a soft, barely modulated voice.
“Yes, it’s me, Brian, and after all these years,” said Emma. “I hope you don’t mind me saying this but I can’t believe you’re still with us. You had pretty advanced prostate cancer back then, didn’t you?”
“Yes, doctor, but I think it was something about how you talked to me that gave me some hope and I sort of got back on my feet after that. Also, they had some new medication that they wanted to try and that seemed to help, too.”
“What about now, though, Brian?” asked Emma.
“Look, doctor, I’m not going to beat about the bush; it’s really gone beyond pain now. I’ve asked them here for something to help, but they say there’s nothing they can do and it’s just a matter of waiting, but I just can’t stand the thought of that… and I do miss Lucy so much.”
He cried softly to himself.
“Lucy was your cat, wasn’t she?”
“Yes, she died just last year, and that was the final straw.”
“Gosh, she must have been almost as old as you in cat years.”
“Yes, she was 85.”
“Brian, I think I can help you, but you have to understand that I can’t do anything which will actually end your life. All I can do is help you to find the way you want to go. Do you understand that?”
“Yes, doctor, I trust you.”
Emma pulled the curtain around his bed.
“Now, Brian, what I’m going to do will be like before all those years ago. I’m going to look into your eyes and try to feel what you’re going through and then help you to turn that into something that might help you. Do you understand that?”
“Yes, doctor.”
“Firstly, I need to prop you up in the bed so that I can look at you on the same level.”
Emma helped him sit up against the pillows until the two of them were able to look at each other on the same level.
“Okay, are you ready, Brian? Do you have any second thoughts or questions?”
“I’m ready.”
“Right, Brian, I want you to keep your eyes open as wide as you can.”
Emma looked directly into his eyes from about four feet away, letting her cortex absorb his emotions. She could feel his profound love for his cat and she imagined her limbic system glowing in intensity on the scan. She moved closer until she was about two feet away and let his pain and despair engulf her brain. She remembered the location of her prefrontal, insula and anterior cingulate and imagined them glowing ever brighter as they responded to his pain. Then using all her ability, she imagined cutting the blood flow to the activated centres and then sent that back to Brian’s cortex through his optic nerve. The effect for her was like suddenly shutting off a torrent of water, leaving nothing but silence and tranquillity.
Feeling exhausted, she looked down at Brian, who now appeared to be sleeping peacefully.
Emma found the trainee and said that they’d talked about his interest in cooking and his cat. She added that there wasn’t any active intervention she could offer, but thought the time would come very soon.
Emma wrote up her notes and returned to her office, thinking that she’d finally proven something to herself.
An hour later, just before going home, Emma had a call from the SHO on the ward where she saw Mr Spencer.
“Oh, hi, is that Dr Jones?”
“Yes, how can I help you?”
“It’s David Simpson, the SHO looking after Mr Spencer. I just wanted you to know that he passed away a few minutes ago. I think you must have helped, as he looked so peaceful.”
“Thanks for letting me know. I’m glad that he didn’t suffer anymore and I hope he’ll be stroking his cat wherever he ends up.”
“Dr Jones, I’m interested to understand - you know, from a learning perspective - what you did.”
“Well, David, it’s a long story, and it’s not exactly evidence-based, but I think it was his pain that was keeping him alive, and that by removing his pain, I allowed him to make the decision to move on to where he really wanted to be.”
“I thought it was something like that. I guess it’s not something I should really discuss at supervision.”
“I think probably not, David.”
“Oh, and another thing, Dr Jones?”
“Yes, David?”
“I learnt a lot from that seminar and I wanted to thank you for that.”
“Thank you, David. I thought you had. I think you’ll make an excellent doctor.”
She heard him crying softly as he put down the phone.
June 2005, one day later
The following morning, Emma contacted two colleagues who had been very helpful in the past: Dr Michael Moore and Dr Jim Lawrence. She suggested that they meet to discuss something very important. Their interest was obviously piqued and they agreed to come to Emma’s house the following Saturday.
“Thanks, Jim and Mike, for coming at such short notice. I’ve got a proposal to put to you but first I need to fill you in with some background because it’s some time since we last met. So, where do I start? I think right at the beginning:
“When I was baptised a few months after birth, I’m told that I glared at the vicar on being lifted out of the font. He died from a heart attack two weeks later. Five months postnatally, my mother was admitted to a psychiatric ward in a psychotic state and she told my father and those treating her that I was evil and that she saw something in my eyes. Then when I was at kindergarten, I glared at a boy and he fell out of a tree and broke her arm. One day at school, I was humiliated by a girl in front of the class and she had a seizure. When I was a volunteer in a nursing home in my last ‘A’ level year, I spent some time talking to an elderly woman who took an overdose of insulin the same day. At my Oxford interview, I glared at a rather obnoxious Dean and I learnt years later that he died from a heart attack a couple of weeks later.
“During my years as a house officer and SHO there were a number of unexpected deaths that occurred after I’d spent time with patients. As a higher trainee, I became more aware that I had some sort of ability, but I was generally wary about using it. Things came to a head after I saw the two of you, when I became convinced that I’d turned into some sort of latter-day Medusa and very nearly jumped off the top of a six-storey car park. That was the turning point for me, and I think I’ve established some sort of control over this ability and I believe I can now use it reliably and therapeutically.
“I’ve also gained some information about this ability from elsewhere. I was contacted after my mother’s death by a former consultant whom I’m sure has a similar, although more limited, ability. She told me that she had been contacted by someone called Brimstone who had asked her to mentor me and she thinks he was part of some organisation that has a particular interest in people like me. She also warned me that I might be at risk. A short time after this, I was lured to my grandparent’s house and I think they had the intention of gouging out my eyes, although I suspect this is because they blamed me for my mother’s death and have some rather extreme religious beliefs.”
“Christ, that sounds horrendous,” said Jim. “Did you report that to the police?”
“I just don’t think they’d have believed me,” said Emma. “And by the time I left with my father, they were just cowering in the corner holding their crucifixes.”
“Do you think that someone put them up to it?” asked Mike.
“No idea,” said Emma. “I somehow doubt it as they were pretty much loners. Anyhow, I also did a literature search and discovered that there’s a widespread tradition of the evil eye that crosses many centuries and cultures, and almost invariably involves a female with heterochromia; in other words, someone like me. I found out that there’s a certain Scottish clan where the belief in the evil eye is particularly prevalent and I think that they may have been somehow involved in transferring a cadaver to the dissecting room in Oxford in order to send me a warning sign, as the body had both eyes removed and dead butterflies put in their place. Whilst I was at Oxford, my old kindergarten school teacher died and left me her butterfly collecting equipment plus a single butterfly, and it wouldn’t surprise me if that was another warning.”
“That’s a lot to take in,” said Jim, “but there’s certainly an internal consistency to it all and we already know that your functional MRI scans are unusual, to put it mildly. And it won’t be the first time that a superstition turns out to have some basis in reality. In fact, some believe superstition is a sort of adaptive learning that’s useful from an evolutionary perspective and designed to protect rather than being ridiculous and a waste of time.”
“So, where do we come in, Emma?” asked Mike.
“Well, this is where I hope it gets exciting. When Daniel died, he left me a large sum to set up an organisation to be called the Daniel Armstrong Foundation and named me as the trustee. What I’d like to propose to you is that we dedicate the foundation to putting the clinical work I’ve done using my ability firmly on the map, which I hope will also keep religious fanatics like my grandparents off my back.”
“And you want us to come up with the science to back this up, I guess,” said Jim.
“Basically, yes,” said Emma. “And this is how I think we should do it. First off, I think in an ideal world we’d need to be scanning both the patient and myself to see how well my areas of activation match those of the patient who’s actually experiencing the pain. If it turns out that my brain response is accurate, then we shouldn’t need to scan the patient at all. It may be that you’ll still need to scan me for some more atypical patients whose pain doesn’t match the usual pattern and where other areas of the brain might get activated. Second, I think we need to see whether there are other people around who could be trained up to do a lower level of therapy, possibly with some sort of biofeedback to enhance any basic ability they have. I’m thinking here of psychologists who’ve been trained in CBT and have demonstrated good empathic skills. The sort of biofeedback I’m envisaging is EEG, and probably with some sort of high-resolution enhancement.”
“That all sounds quite do-able from my point of view,” said Mike. “It’d certainly be difficult to get enough time on the functional MRI scanner to puts lots of patients through it.”
“I guess the difficulty we still have is trying to explain what’s going on from a neurocognitive point of view,” said Jim. “I can just about get how you might be sufficiently attuned to pick up the emotional state of the patient, but actually influencing their cortical structures through your own cognitive processes is stretching things rather far. Do you have any ideas on that?”
“Well, apart from suggesting that it’s something to do with quantum mechanics – which I suppose it could be – I was wondering whether it was something to do with refraction of ambient light with some sort of modulation created by heterochromic eyes that then gets assimilated by the patients’ eyes. Sorry, if that sounds a little far-fetched,” said Emma.
“No, that’s an interesting hypothesis and it’s certainly something to go on with,” said Jim.
“So, gentlemen, do we have a ’go’ for the project?” asked Emma.
“It’s a ‘yes’ from me,” said Jim.
“Same here,” said Mike.
And so the Daniel Armstrong Foundation was born.
July 2005
A month in to the project and good progress was being made. Jim and Michael had come up with a way of simulating pain using cold or hot pads. Trials with subjects experiencing this simulated pain had shown that Emma’s functional MRI scans closely matched the activation shown by the subjects, so putting patients through the scanner wouldn’t be necessary for the pilot at least. However given that Emma’s ability was probably at the upper end of the evil eye spectrum, the team also had to think about how less able therapists might be trained up.
Michael had come across some technology being developed in the Los Alamos National Laboratory with SQUIDs (not the cephalopod variety but superconducting quantum interference devices) which allowed MRI scanning at very low magnetic fields, but this was too early on in development for it to be something the Foundation might use in the near future. A more positive approach seemed to be enhanced electroencephalography, similar to that used on Emma’s mother, but designed to be more portable and with resolution sufficient to allow the sort of patient-specific mapping of activation that they’d need in a clinical setting. Jim contacted a manufacturer in the USA who agreed to send him a prototype of what they were describing as a ‘neuroheadset’ for evaluation.
Recruitment of would-be therapists was the next issue. Jim recalled some research carried out in Australia looking at the qualities in psychologists that determine whether patients being treated for a problem like depression get better or not. Rather surprisingly, nothing obvious emerged from the research data and the paper’s somewhat ironic conclusion was that patients may improve simply because of the therapeutic relationship rather than the therapy itself. So adverts were put to recruit therapists from the surfeit of cognitive-behavioural therapists being trained for various NHS programmes. It was also quite difficult to tell the applicants exactly what sort of therapy they’d be doing, so they’d used some vague description of augmented empathic therapy which wasn’t too far from the truth. And in order to ensure that the right therapists were selected, Emma used her ability on interview panels to select those who seemed to have the best empathic skills.