Past Lives (10 page)

'Maybe I’ll talk some more to Karen Bliss.’

Klinsman looked asked, 'What did she think of Jane?'

'She was thinking along the lines of Multiple Personality Disorder - or whatever the fancy new name is for it these days - but I haven't had a real chance to talk to her about it yet.' He looked at his watch. 'Too late now, maybe tomorrow.'

There was a message on his answering machine when Macandrew got back to his own office. Karen had called at four thirty. If he got back before six, he should ring her; if not, he should call in the morning. It was a quarter before seven. Macandrew looked at his diary for the following day; there was no operation scheduled till the day after but he did have to see the patient and familiarise himself with the case notes. There was a clinical meeting pencilled in for two in the afternoon and a seminar he wanted to go to at four thirty. He wondered if Karen would be free for lunch. He called her extension and left a message on her machine, just in case he should miss her in the morning. He suggested they meet at noon.

Macandrew got Karen's return message when he returned to his office next morning after examining his surgical case. Karen was free for lunch so he called an Italian restaurant down on the Plaza and made a reservation for twelve fifteen.

'Maybe our answering machines should be having lunch,' said Karen as they drove down to the Plaza.

'I think mine is going steady with the administration people,' said Macandrew. 'I get reminders every day about forms I should have completed and returned but didn't.'

'Thank God I'm not the only one.’

The restaurant was just over half full. They were shown to a table in a booth well away from the door and left to consider the menu beneath Italian travel posters on the walls and fishing nets suspended from the ceiling. The nets only served to remind Macandrew how depressingly far the mid-west was from the sea. The sea was what he missed most of all. Not being able to drive down to the coast was a big minus.

'Did you get permission to sedate Jane Francini?' asked Karen.

'Her husband gave it almost as soon as he saw her.’ Macandrew told her about his subsequent meeting with Weber and Francini's attorney.

Karen shook her head in sympathy and said, 'Heavy stuff. Sometimes the idea of being a country doctor seems very attractive.'

'It certainly was last night,' agreed Macandrew. He took a sip of iced water and asked, 'What did you think of the Francini tapes?'

'Complicated. Little Emma threw me; she seemed so real. I started out thinking multiple personality disorder but now I’m not so sure . . .’

‘There are lots of recorded instances of patients who’ve sustained head injuries in car accidents undergoing a personality change. They make what appears to be a good recovery as far as the nursing and medical staff are concerned, but once they’re home, their family and people who know them start complaining about big changes in the way they behave. The words, “different people” keep cropping up.’

‘That’s more or less what Tony Francini said,’ said Macandrew. ‘He said Janey was a different person. She looked like Janey but she wasn’t . . .’

Karen nodded. ‘Not too much is known about this but it’s been recorded in patients who’ve had strokes. It’s also been the basis of several lawsuits. Big insurance claims for changes of personality. Previous nice guy becomes selfish monster, that sort of thing.’

‘But this is more than a change of personality
trait
,’ said Macandrew. 'Jane Francini becomes an entirely different person - maybe several.’

‘But it is interesting that she’s always, Emma when she starts to come out of sedation, said Karen.

Macandrew nodded. ‘It’s only when she regains full consciousness that she becomes totally confused.’

'I tried working on the confused bits from the tapes I made but I'm really not sure what's going on. She's obviously suffering but the strange thing was that she didn't
look
deranged at any point.'

'That's exactly what I thought when I saw her like that for the first time,' said Macandrew. 'She
sounded
deranged but didn't look it. It was kind of spooky, almost as if she thought
I
was the one with the problem.'

‘I suppose that might fit with multiple personality disorder. Believe it or not, Carl Jung's own cousin suffered from it. She was in reality a shy fifteen-year-old girl of only mediocre intelligence, hesitant and unsophisticated. Quite suddenly and without warning, she would change into a smooth, assured, educated lady who spoke good, literary German instead of the rough Swiss dialect she normally spoke. This is often a feature in reports of this sort of case. The foreign personality is that of a much stronger character altogether than the patient.

'Jane Francini is normally a quiet, reserved lady,' said Macandrew.

'The character she becomes when she's not sedated is certainly not,' said Karen. ‘But there again, when she is under partial sedation, she’s a little girl from Moscow who doesn’t speak Russian . . .’

Macandrew shook his head. ‘If only one of her personalities could be Jane.’

'Mac, I know you'd like me to tell you that her condition might be treatable and, with time, she’ll get better but I can't. I'd dearly like to but I can't. I think she’ll have to be certified and sent out to Farley Ridge.

Two days later, Jane Francini was transferred to Farley Ridge Sanatorium: Macandrew was there to see her off. He knew there was a danger that his presence might be construed by some as an admission of guilt but despite this, he wanted to be there. He liked her as a person in their talks before the operation and, as she had pointed out, they were 'fellow Scots'.

Jane was lightly sedated and appeared comfortable in her Emma persona. Her eyes reflected bemusement at what was going on around her but nothing like the distress she showed when sedation was completely withdrawn. She continued to ask about her mother and the staff continued to assure her that she would be along presently as they wheeled her out of the Med Centre and lifted into the back of the waiting ambulance.

'Good bye, Emma,' said Macandrew as she passed by.

Jane turned her head towards him and Macandrew felt a hollow in his stomach. The look in Jane Francini's eyes was perfectly in tune with her Emma character. He was looking into the clear, intelligent, innocent eyes of an eight-year-old girl who wasn't at all sure what was going on. The attendants closed up the back of the ambulance and she was gone.

Things gradually returned to normal over the course of the following week although the Francini case was never far from Macandrew's mind. He had resolved to find out as much as he could about Hartman's tumours – something which involved him spending a good deal of time in the medical library and which proved easier said than done because of a dearth of published information. There was no text book material available on the subject: what information there was, had to be gleaned from medical journals and research papers.

Starting with a short list of references from Carl Lessing, Macandrew dug out what he could in the Med Centre library and made photocopies of relevant articles. There were a number of references to journals that the Med Centre did not take so he asked the librarian to put out an inter-library request for them. They arrived in due course and he was able to complete a file – albeit a painfully thin one - on the subject.

Most of the published material comprised straightforward case reports on patients who had been diagnosed as suffering from the condition: these did not tell him anything new. The condition was so rare that the reports had been published for that reason alone. There was no instance of anyone ever having made a full recovery but, as Carl Lessing had pointed out, none had died from the condition either. They had survived surgical removal of the tumour, only to be left confused and facing life in a mental institution for the remainder of their days.

There were however, a number of recent research papers which proved interesting. They originated from a laboratory in the medical school at the University of Edinburgh in Scotland. A Dr John Burnett emerged as principal investigator. He was sole author on the earlier work but appeared to have been joined later by, Drs Ashok Mukherjee and Simone Robin. Between them, these three had published several papers on the chemical changes in the brain associated with Hartman's tumours and had managed to identify an unusual acidic substance secreted by them – it was this substance that had been responsible for the colour change in the staining reaction of the tissue samples in the Path lab and which had alerted Carl Lessing to the possibility of a Hartman’s tumour.

As a medic rather than a scientist, Macandrew found the science hard going but the gist of the research approach seemed to be centred on finding a way to counteract the effects of the secretion on adjacent cerebral tissue. If this could be done then the damaging effects of the tumour might be limited. Using material obtained at autopsy, the researchers had identified a bank of cells in the normal brain that the Hartman's chemical appeared to affect and had subsequently gone on to describe a protein secreted by these cells that seemed to be its specific target.

By the time he had read the last of the papers, Macandrew was quite excited by their findings. If they had really identified the target protein in the normal brain then surely in this day and age it should be possible to synthesise the protein
in vitro
and replace it in brain-damaged patients.

Macandrew looked at the date on the last paper and was disappointed to find that it was over two and a half years old. He considered possible reasons for this - the most likely and most depressing being failure to synthesise the protein in the lab. But was the team still trying? Or had research on the subject stopped completely? There was also the very real possibility that funding had been withdrawn from the project. Competition for research funding was always fierce and Hartman’s tumours were such a rare condition that that might militate against support.

Macandrew considered contacting the university, but then it occurred to him that there might be a quicker way. He could use the Med Centre's computer to find out if anything at all had been published by any of the three named scientists in the last three years. To survive in research, it was essential to publish. Any researcher who had failed to publish anything in three years would be in serious career trouble.

It was a system that could be terribly unfair at times and also led to the scientific journals being inundated with less than compelling work, but its best defence was that there wasn't a better way. Peer review did much to screen out the dross but despite this, every scientific journal with perhaps the exception of the top two or three, carried a large proportion of
i
dotting and
t
crossing. Career fodder.

Macandrew tried entering John Burnett's name first and asked for a full list of his publications. This wasn't as straightforward as he’d hoped because there was more than one John Burnett in the database and he had to sort through them before establishing that it was the John Burnett who worked in cell biology at Edinburgh University that he was interested in.

The publication list came up on the screen and Macandrew read through an impressive record, finishing with the three-year old paper in Cell Biology he’d just read. John Burnett had not published anything at all in the interim, not even a review - the traditional stop-gap of senior scientists when times were tough and ideas scarce.

Macandrew stared at the screen and wondered if Burnett had retired. He didn't know anything about the man. It was conceivable that he had reached retirement age and was now growing roses by the sea. If that were the case, he might be able to confirm this by judging his age from his publication list. He looked back to the beginning of the list and found two papers that were cross-referenced to Burnett's doctoral thesis. He noted the date and made a mental calculation. Assuming Burnett had had a conventional academic background, with four years for an honours degree followed by three or four more for his doctorate, he reckoned that John Burnett would be in his mid to late thirties. A bit young for roses.

He drummed his fingers lightly on the desk while he tried to think of alternative possibilities. The librarian shot him a disapproving look and he stopped with a half apologetic smile. Librarians could be so intimidating. He instigated a new search and entered Ashok Mukherjee's name. This produced the work he’d published jointly with John Burnett and nothing else.

The only Simone Robin in the database was listed as being on the staff of the Institut Jacques Monod at the Seventh University of Paris, France but her publication list immediately told Macandrew that she was the lady he was looking for. He found the papers that she had published with John Burnett in Edinburgh and then four more, submitted from the French institute in the last three years but in a different area of research. He calculated that Simone Robin had left the University of Edinburgh around the time Burnett had stopped working on Hartman's tumours. She had obviously returned to France and was now working on something else entirely.

The depressing thing from Macandrew’s point of view was that, as far as he could tell, Burnett's team had been the only one in the world carrying out research on Hartman’s brain damage. If they had given up then no one was doing it. He copied down details of addresses and phone numbers from the on-screen information and logged off. He might not pursue things any further but then again, he just might. It would be interesting to find out why such promising work had suddenly stopped.