Human Traces (33 page)

that it entailed, she suffered, in losing Herr P, a severe blow to her self-confidence as a woman and, in short, the conditions could not have been more disposed to the retention in her nervous system of large amounts of undischarged mental excitation. The irregularity of her menstrual periods, dating also from about this time, was evidently caused by her desire that she should in fact by now have been carrying Herr P's child. Masturbation to orgasm is also known to precipitate amenorrhoea, and it was indeed my suspicion that such a practice had taken place which led me to the heart of Fraulein Katharina's trauma, as we shall shortly see. The pains in her arms and fingers had initially been caused by the excessive amount of work demanded of her by her father; I had no doubt that this trouble had begun as little more than writers cramp, an organic, secretarial version of 'housemaid's knee' or some such trifling ailment. However, it had become complicated by two further factors. To begin with, she had been in competition with her mother for the attention of Herr P, and had tried to demonstrate to him how much more assiduous and reliable she was than the listless Frau von A; diligence in office work naturally occurred to her as the obvious way of impressing a serious young lawyer. I doubt whether even this aspect of the strain, however, would have survived the effective discontinuation of the manual work after her father's death, because Katharina was sufficiently conscious of the competition. No: the crucial development as far as suppression was concerned was the digito-manual nature of the pain and the fact that such activity had already become symbolically associated in her unconscious with the private habits that had disqualified her from becoming Herr P's wife. It was this unacknowledged guilt which enabled the symptoms to persist in her shoulders, elbows and finger joints; indeed as time went by and Herr P and her mother became overtly attached, then engaged to be married, the situation worsened: the painful region was extended by the addition of adjacent areas; every fresh event in her life which had a pathogenic effect cathected a new region in her arms. She had signalled desperately to herself, and to me, with her repeated phrases such as "I really must get to grips with this', or "I must take things into my own hands', but it was only now that the connection was established that the business of resolution could take place. I felt that, having laid out the groundwork of the resolution in the course of this consultation, I should leave the patient time to reflect on what we had discovered before I moved on to what one might call the denouement. I therefore concluded the session and arranged to see the patient the following day. April 26 [morning] Fraulein Katharina appeared in a subdued mood. The skin of her face was slightly flushed. She told me she had slept badly, though admitted to a complete absence of pain in the lower abdomen and a considerable improvement in the joints of the arms and fingers. One might describe her demeanour as chastened, though she continued to be as obliging as before in her dealings with me. I began by tidying up, as I put it, a few of the lesser symptoms with which she had presented me. Her low spirits, her insomnia and minor anxiety states were no more than the reaction of a young woman of unusual sensibility to the experiences she had gone through. The zoophobia, on the other hand, which I had at first been inclined to put into the same category, could now be seen in fact to be somewhat more significant. While it seems beyond dispute that Fraulein Katharina s heredity included a predisposition to hysteria, it would be unfair to describe her, as the diagnosis of that disease strictly requires, as degenerate. On the contrary, the moral seriousness with which she viewed her duties, the compassion and energy she displayed were the equal of a man's and in this respect her father's words to her were touchingly vindicated. Kitty's degree of education, regard for truth and tender feelings for others drove me to conclude that, despite what we have learned, a predisposition to hysteria may be compatible with a fine character and a well-governed mode of life. I tried to reassure Fraulein Katharina of this paradox, as I persuaded her to confront the central moment of her story: the moment at which the young lo cum tenens came into her room without knocking. I suggested that it was this incident, more even than the death of her father, which had been most difficult for her to deal with in conscious life. It was not, in fact, the young doctor who had surprised her. In her story, as in real life, he was a delegate or proxy standing in for someone more important: Herr P. It was the man she loved who had in fact entered her room without knocking and had caught her 'red-handed'. In the moment of her shame, when she felt that her 'hands were tied' she became aware that, having seen her engaged in this private act, he would never be able to view her as a future wife. It was not surprising that, with everything else going on in her life, this disappointment had proved too crushing for her to assimilate. We moved then to the question of how her aphonia, which I had wrongly thought at first to be connected to her anxiety about speaking a foreign language3 while temporarily removed from the company of the man she loved. I suggested that a more likely explanation was that at the moment she had been interrupted in her room she had in fact been fantasising about the act of fellatio with Herr P, and that it had been the pain of her absence from him while in Paris that caused this somatic representation of what she had lost. I did not doubt that the circumstances of the other instance of her aphonia, which she claimed not to remember, had also involved a separation. Fraulein Katharina was reluctant to concede the truth of my interpretation of events. She was adamant that it was the young doctor, the lo cum who had burst into her room without knocking and she had been engaged in no indecent action at the time. She admitted it was possible that she had become confused about the details and that there had certainly been more than one incident in which Herr P had himself knocked at her door. Although she would not concede that the incident I had interpolated into her story was necessarily true, she was not in a position to recognise it as something she had actually experienced: I believed it would have taken hypnosis to achieve that. 3 It will be remembered that the first instance came when she went to visit her brother Gustav in Paris. Having explained to Fraulein Katharina the genesis of all her symptoms, I warned her that it might be some time before she felt a full remission from them. Just as it took some time for the conversion of trauma to manifest itself in the production of hysterical phenomena (Charcot called this the 'period of working out', or 'elaboration', and one thinks of the case of the coachman Henri R), so the reverse was also true: some time was required for the catharsis to work through her system. In fact, Katharina reported a considerable improvement in her symptoms over the next few days, and when I last saw her appeared to be well on the way to making a full recovery. Thomas carefully replaced the papers on the desk. His astonished eyes were dry and stinging because he had barely allowed himself to blink in the time his gaze raked down the pages. "Jesus suffering God," he said, and steadied himself against the edge of Jacques's desk. He looked up to the sky outside the window, exhaled deeply, then set himself in motion. He ran into the hall and shouted, "Sonia! Sonia!" She appeared upstairs and looked down at him from the galleried landing. "What on earth is the matter? Why are you shouting like that?" "What room is Katharina in? That young fair-haired woman, a patient of Jacques's." "Eighteen, I think. Why? What is it?" "Tell Josef to get the trap ready at once. We may have to go to the surgeon in town." "Why? Why? What's the matter?" But Thomas was already gone, his running footsteps echoing in the cloister as he made for Katharina's room. He hammered at the door. "Fraulein, forgive me. May I take your temperature?" Ten minutes later, a startled and re-examined Katharina was ready in the hall of the main house, her scarlet overcoat belted at the waist, a hat pinned over her fair hair, her reading glasses folded away in her pocket, while Josef brought the covered trap to the front door. Sonia stood watching anxiously. "Where is Jacques?" said Thomas. "I think he is in the laboratory with Franz." "Please tell him nothing about this. I will not be back for dinner, so please tell him I was called away to see a patient at the hospital. Or some such thing. Come, Fraulein." In the hour or so it took them to reach the town, Thomas discovered that a great deal of what Jacques had written about Kitty was accurate. She was a young woman of composure and clear thinking who seemed embarrassed to have so disturbed the routine of the sanatorium and quizzical about the need for a further medical opinion; she also, to Thomas, appeared to be someone who was acutely ill and whose stoical self-control had not been in her own interest. To pass the time as the trap bounced along, Thomas talked to her about his life. This was not his normal conversational procedure, but he felt that the one thing Kitty had talked enough about was herself. He liked her shy, slightly sceptical response to his narrative ("Really?" she said. "Another brush with the authorities?"); it drove him to greater candour than he intended. They talked in English, which Kitty spoke as a native, though with a faint accent that Thomas could not place. It was dark by the time they reached the hospital lodge and descended from the trap. Thomas gave Josef some money to go and buy supper for himself and told him to return in two hours. In the hospital, he was able to find Herr Obmann, the surgeon, and to explain the situation to him. Obmann sent for an anaesthetist, Herr Aichwalder, who had to be fetched from his dinner at home. Kitty, by now candidly alarmed, was taken to a private room, undressed and given a sedative. Thomas told her that the operation was a minor one and that she must not worry herself. It was possible that he and Herr Obmann were in any case incorrect in their diagnosis, in which case they would make sure any scar was all but invisible. A nurse came in to shave her, and Thomas left the hospital. He went to a small tavern, but found that he was too agitated to eat. If his suspicions were correct, the consequences for him and Jacques were appalling; he was not sure the schloss could survive them. There was another factor in his anxiety that he could not yet identify, but it made him push back his plate and return to the hospital, where he paced up and down the dimly lit brick corridors, waiting for any word from the operating theatre. Towards eleven o'clock, a weary-looking Herr Obmann emerged from the theatre with traces of blood on his apron. He sighed as he approached Thomas. "Let us go outside," he said. In the hospital forecourt, Thomas gestured to the waiting Josef to be patient, while Obmann sat down heavily on a bench and lit a cigar. "Quite a battle," he said. "For God's sake, man," said Thomas. "Tell me!" Obmann looked at him curiously. "Calm yourself, Doctor. It was a straightforward procedure. I removed two cysts from the same ovary. One was the size of a hen's egg, the other about as large as a Seville orange. The larger one had twisted on its pedicle, cutting off its own blood supply, and had also twisted the fallopian tube. It was exerting considerable pressure on the neighbouring organs. I imagine it must have been extremely uncomfortable." "Nothing else?" "No... That was it. A nasty thing, but a straightforward one." "And will she be fertile still?" "I see no reason why not. The other ovary was healthy." "Thank God." "You were right to bring her to me." "How has she put up with the pain for so long?" "I imagine it was intermittent. It all depends on the degree of twisting. Sometimes by twisting they can free themselves. And the smaller one she would not have felt at all." "But there was no suggestion of cancer?" "I have taken a biopsy, but it is unlikely. Nine out of ten are harmless. We will keep her here for the time being." "Certainly," said Thomas. "I believe that she also has rheumatic fever." "It is no use asking a butcher like me about that." "I know. But I should like a second opinion from Maierbrugger." "He is coming the day after tomorrow." "Perfect. May I see her?" Obmann shrugged. "She's asleep, but you know where she is. You know your way around." "Thank you, Obmann." Thomas held out his hand. "Thank you very much." Back in the darkened hospital, he went up to Kitty's room on the first floor and knocked gently. The nurse opened the door and Thomas went in. By the light of the candle next to the bed, he could see Kitty's pale face, flushed with a slight fever, the hair a little damp at the temples where a strand of it lay over the tiny freckles on her forehead. "Look after her, won't you?" he said. "Yes, Doctor. Of course." "Don't leave her bedside. I will make sure you are... Rewarded." The nurse nodded. "I shall not move." Thomas leaned over the bed and stroked the hair back from Kitty's forehead. He felt his heart seethe behind his ribs.

Thirteen

"Good morning, Fraulein. I am Doctor Maierbrugger. How are you feeling?" "Much better, thank you." Kitty levered herself up on the pillows and tried to remember if she had seen this grey-haired gentleman in his silver spectacles before; the last two days had passed in a haze of morphia and men's faces bent over her bed. "The surgeon, Herr Obmann, is extremely pleased with the outcome of his operation. I believe he paid you a visit this morning." "Yes. He came when the nurse changed the dressing. He did seem pleased with..." She tailed off. "With himself?" Maierbrugger raised his eyebrows. "It is a characteristic of the profession." Kitty smiled. "And when may I go home?" "Not yet, alas. We need to observe you a little longer. To begin with, I would like to look at your throat, if I may. Open your mouth wide. Thank you. Now I am going to listen to your heart, if you would care to open your nightdress a little. There. I hope it is not too cold." Kitty looked down at the crown of Maierbrugger's head, red flaky scalp through a gash of grey hair, as he moved the diaphragm of his stethoscope over her skin. Free from pain, she felt happier than she had for some time and was beginning to be impatient with the exaggerated care to which she was being subject. "Are your parents alive, Fraulein?" "My mother is alive. My father died a few years ago. Of a heart complaint." Maierbrugger nodded. "Did you nurse him? Were you in proximity?" "Yes." "But you also have a history, I understand from Doctor Midwinter, of throat infections." Kitty pursed her lips. "Not a history exactly. I suppose I was sometimes sick as a child." "Did it cause you to miss school?" His voice was rasping. "On occasions, yes." Maierbrugger tapped a pen against the clipboard he had taken from the end of her bed. "I understand that at one point you had some involuntary movements of the shoulders and the face. Is that correct?" "Yes. At one time the muscles seemed to have a life of their own. This shoulder particularly. It was a little alarming. But it stopped. I have not been troubled by it for a considerable time." "Did you have movements in the hips as well?" "No." "Not the entire StVitus in that case. However, Fraulein, I have little doubt that you have been suffering from rheumatic fever. It is a distressingly common ailment, which varies a great deal in severity. Its early symptoms can include the spasms you have described, particularly in children and young people. The main symptoms, however, are pains in the joint, such as you have suffered in your fingers and wrists, and an intermittent fever, which I understand you have also had." Kitty said, "But I do not really feel unwell any more." "Good. I suspect you have had a number of attacks and that your most recent and most acute one is now receding. If you rest, you can expect to return to full health." "Is that all?" "Not quite," said Maierbrugger. "The disease can damage the heart valves. We have little way of knowing whether or not it has done so. Your throat problems suggest you may have contracted it as a child, and if in its various recurrences it has so far caused no problems then you are probably safe. If, however, you caught it from your father and the heart problem that killed him was caused by a weakness of the valves, then the outlook is somewhat less good. However, I must say that I could hear no irregularities when I listened to your heart just now." "And is there any treatment?" "Nothing yet, alas. We believe it to be caused by a bacterium, but we have no means of suppressing it." "So what do you recommend?" "Take precautions to avoid throat infections. And lead a well-governed life that does not place undue stress on the heart. That does not mean lying down all day; it means moderation in all things. And then we hope for the best." "I see." "You should rest for at least a fortnight, however, to recover from the operation as well as from the illness." Kitty inhaled. "So you do not believe that any of my illness has been caused by... By the circumstances of my life. By emotion or bereavement." "I think it extremely unlikely that a personal feeling might influence the activity of the microbe we believe to be responsible for streptococcal infection." "Thank you." When Dr. Maierbrugger had left the room, Kitty sank back onto the pillows and closed her eyes. She felt exhausted, yet dizzily relieved. Although she had been an active girl, a tomboy as she had told Dr. Rebière, the prospect of a quiet life without undue exertion seemed, in her weakened state, attractive; it would make her begin her life again, away from her family. She had no wish to return to her mother's house now that her irritating stepfather was resident there; her indifference to him had, after all Dr. Rebière suggested, turned to revulsion and distrust. Perhaps she would go to Paris, where her brother was working and, until she found employment of her own, she could be the housekeeper in his apartment near the Place des Vosges. She longed for normality again, to know that all the thoughts and hopes she had had, and all the private desires, were merely human and forgivable. She blushed when she remembered some of the confessions she had made to Dr. Rebière; the hot blood in her face made her eyes sting for a moment and she moved her head uneasily on the pillow. At the time, she had experienced remarkably little shame. His manner was so correct, so scientifically inquiring, that she had felt like a peculiarly fascinating and complex musical instrument, not like a woman at all. Her embarrassment subsided and gave way to a smile. She ought perhaps to feel angry with Dr. Rebière for misleading and exposing her; but her relief at the absence of pain in her womb and at the knowledge that her other ailments had a simple cause was now so overwhelming that there was no room for harsh emotion. In fact, she would probably return to the schloss for the two weeks' recommended rest. There was something powerfully attractive about the place, something she had loved even when in distress; and now that the causes of all her pain had been removed, there was nothing to prevent her from enjoying the scenery, the company, the sumptuous cooking and the play of sunlight on the bricks of the small, hidden south courtyard where she would read her book in peace. There was a knock on the door, and the nurse's head appeared. "Another visitor for you, Fraulein." It was Sonia. When he returned from the hospital, Thomas knew he would be unable to sleep, so went outside for a walk; he prowled the furthest reaches of the grounds, then walked all the way down to the lake itself and sat on the wooden jetty. He imagined Fraulein Katharina von A bringing a legal action against the schloss, though it would admittedly be hard for her to prove that she had suffered material harm as a result of their misdiagnosis. He pictured critical reports in the newspapers that would relate how a young woman of impeccable character had been subject to intense and lewd speculation which had transpired to have no basis in reality. Against these charges they could argue that they were not alone among neurologists and psychologists in making such psychosomatic connections; they could point to a small but growing literature in Vienna and Paris. No matter what defence they raised, however, the reputation of the sanatorium would be undermined; it would never again be looked upon as whatValade had called the city on a hill: it would be tainted for ever by a suspicion of bad science, credulity and a sort of brutal opportunism, a desire to supply a sensational cure for an ailment it had partially invented. He remembered something troubling that Faverill had once said to him about the snake-oil salesmen of Colorado whose potions met a crying need. Jacques and he had not been able to cure madness, so they had fabricated something that they could cure; and whatever happened now, the burnish of their great enterprise, its innocent lustre, was gone. In the morning, he took Sonia to one side after breakfast and asked her to cancel his first consultation, then come to his room. "Does Jacques know anything?" "No," said Sonia, closing the door behind her. He explained to her what had happened. "It is good news for the patient, whose pains have been cured by Obmann's knife, but for us..." He opened his hands wide. "It is ruin. Disaster." Sonia's thoughts were for Jacques, and what this reverse might mean to him, but she tried to see the consequences for them all. "Thomas, before you become too despondent, let us just think for a moment. It appears that Jacques has made a misdiagnosis. This often happens in difficult areas of medicine, does it not? It was made in good faith and no harm has resulted. On the contrary, a second opinion was promptly provided by a fellow-doctor you and it now appears that the patient is cured, or soon will be. She may not be so much angry with Jacques as grateful to you. Don't forget, she was simply a sick girl and now she is well." "It is possible." "I shall go and see her in the hospital. If she has been shamed by what has taken place, why should she seek to broadcast that shame? I suspect she may be so relieved to be well again that all other thoughts will be secondary." "And what shall we do about poor Jacques?" "We must break it to him slowly," said Sonia. "I suggest we use some slight subterfuge. We could say that Katharina developed sudden pains, nothing to do with what she had before... I don't know, but surely you could think of something." "I think we can delay the full impact, but eventually he will need to know because otherwise... Otherwise, he may persist in error. It could lead to worse things. Suppose he were to miss an instance of cancer. A doctor in Vienna recently diagnosed a patient suffering gastric pains with hysteria. Two months later, she died of cancer of the stomach and he merely commented that hysteria had used the symptoms of the cancer to disguise itself." Sonia's lip began to tremble because she knew how many thousand hours Jacques had worked and with what ardent philanthropic motive. "Don't worry, Queenie," said Thomas, seeing her distress. "We will manage. I think I must tell him about the cysts. I see no way out of that, and it is an easy mistake to make when you consider how much time he and I have both spent on the pains of hysterical women and the fact that most cysts give no symptoms at all. Hysteria was a fair deduction. I think we can deal with that. As for the rheumatic fever, perhaps we should keep that to ourselves for the time being." "All right," said Sonia quietly. "Tomorrow, you go into town to visit Katharina. Under no circumstances should she know that Jacques had written anything of her history down, let alone in a paper that he hoped to publish though I know he would have disguised her identity. She must not know that anyone else is privy to her story. Meanwhile, I shall talk to Jacques." "Very well. But Thomas, will you explain where he went wrong? Perhaps you could put it in a letter. I wouldn't show it to him, but I should like to understand." "I shall. It is easy for me to do with hindsight. But he was the adventurer. He was the pioneer. We must not forget that." Sonia squeezed his hand and went out. A week after the operation, Kitty returned to the schloss and resumed occupancy of her old room. In the afternoon, Thomas came to see her. He heard a scurrying when he knocked and wondered if she was taking off and concealing her reading glasses before calling out for him to enter. He discovered her sitting on a small balcony with a view down to the lake; she poured some iced lemon from a jug and invited him to join her in the unusually warm spring sunshine. "How are you feeling, Fraulein?" "Entirely well, thank you. I am very grateful for your intervention." "Thank you. What are your plans now?" "I am advised to rest for two weeks, and if you still have room for me, then ' "Of course. With pleasure. But I would prefer it if you would be our guest. In view of the time it took us to diagnose you correctly." "That is most generous." Thomas looked across at her arms, which were partly bare beneath a sleeveless blouse; the muscle was youthfully firm beneath the pale, teeming freckles. He wondered if she had them also on her legs and at what point they might fade out, because presumably the skin of... He remembered himself in time, and coughed; she was looking at him, a little quizzically. "I have spoken to Maierbrugger, and it seems that you will need no further treatment. However, you must nominally be under the care of a physician here. We should at least take your temperature twice daily. However, Dr. Rebière himself would perhaps no longer... I imagine I could ask the nurse, but in view of, in view of..." "Would you be able to take me on to your own books, Doctor?" "That is exactly what I was proposing," said Thomas in a rush of relief. "In view of what transpired with ' "Please do not concern yourself with what happened in my earlier treatment. Dr. Rebière was extremely civil and professional. I also found what he had to say extraordinarily interesting. I read a copy of his introductory lecture on the subject of resolution and found it fascinating." "Yes, indeed," said Thomas, feeling an unaccountable squeeze of jealousy, 'it is a fascinating subject." He heard his voice emollient, repetitive and felt ashamed of it. "What a wonderful life you have here," said Kitty, smiling. "A beautiful house, your sister to look after you and, as I understand it from Daisy, your best friend to work with. No man could ask for more." Thomas felt a drop of sweat at the top of his spine. This woman was a saint no, not a saint, there was nothing worthy or dull about her: she was a goddess. She had forgiven them, she had redeemed their life's work from destruction; the clarity of her thought was such that she had welcomed the surgeon's knife, bore no grudge and was able to make herself pleasant to him intimate almost with her bare arms and guileless blue eyes. Dear God. He breathed in. He had better start behaving like the man of science to whom she wanted to entrust herself. "Yes," he said. "I am very happy here. Happiness creeps up on you, does it not? You never see it arrive, but one day you hesitate and you are aware that there is something... Additional. I noticed it this morning when I came up from the lake. It was the smell of the hawthorn blossom along the path not really a beautiful scent in itself, not like a rose a faint something of the cat about it I always think, but it seems to me the smell of England, of childhood summers evenings in the woods, walking over dry lanes, when time was endless. To be transported back, you must be open to suggestion, you must already be a little happy, perhaps." Kitty laughed. "And when you were a child, was your sister there all the time?" "Yes. That was one reason I was so content, I
suppose. She was no angel, of course, Sonia. She did many spiteful, elder-sisterly things, but I must have been a profoundly irritating child and it was no more than I deserved. I was a boy running round in a small village and no one really took control of me. Sonia was my only confidante." "And she, too, is happy?" "Yes, indeed. Sublimely so, I think. She is expecting a child in the autumn. Please do not tell anyone. I should perhaps not have told you." Kitty laid her hand for a moment on his arm. "I promise. But what can have made a wild young boy from a remote English village into a man trying to establish cures for insanity? That is your aim, is it not?" "Yes, it is. One must say that for me to end up here is an unlikely story. But all men come from somewhere." "You had no personal interest, no members of your family who were afflicted in some way?" "No, not like Jacques, whose brother, as you probably know, is a patient here. And that has always been his driving force and ambition, to find a cure for Olivier's illness." "But you? You speak so well, if you will forgive me saying so, about feelings. Did you never experience anything unusual yourself?" Thomas thought. "Periodically, I have had spells of what psychiatrists call melancholy or depression, but not severe. Sometimes so slight in fact, that it was only when it left me that I recognised that I had been suffering from it. I noticed that the trivial aspects of a day the arrival of the postman, sunlight, food, the company of a friend were bringing me pleasure and for how long it had not been so when the sound of the letters on the mat was simply the start of more oppressive debt and toil." He wanted to ask Kitty about her own feelings, but did not wish to reveal how much he knew of her history, and felt sure that she would welcome a rest from questioning. "But you have never experienced any of the more remarkable symptoms of some of the poor people here?" said Kitty. "I have never believed that I am the King of Prussia, no." Kitty poured some more lemon. "And while Dr. Rebière pursues his theory of resolution, where is your work taking you?" "I think we are in the same room, but we are looking out of different windows." "Thank you, Doctor." Kitty laughed. "That is quite clear now. Are you plasterers or decorators?" Thomas turned his gaze on her the long, unsmiling, weighing-up scrutiny that Sonia had once found so intimidating. "A little of each. The room is where the mind and body meet. Jacques is working, as you know, on a particular affliction and on what of general application can be extracted from that. I am looking at other forms of illness, generally more severe, and seeing if they are like rheumatic fever a germ or like bereavement, an idea. Or perhaps they are both. I am particularly interested in the way in which one such severe illness, a psychosis as we people call it, may have entered the human animal how it came in, why it seems so unhelpfully prevalent, why there seems to be no equivalent in other animals, whether it is in fact related to a particularly significant moment of human development." "I see. Those are your two windows." "Yes. I suppose, for simplicity's sake, you might say that his guiding light is Charcot and mine is Darwin. For the rest we share a vast amount. I hope that our paths will fully converge again at the next stage." "Does Dr. Rebière not have the same reverence for Mr. Darwin?" "Respect, but not reverence. One of his reservations, I think, but you must please not repeat this, is that Darwin suffers from a fatal disability in Dr. Rebière s eyes." "What is that?" "He is not French." "Would that make a difference?" "It might. But it is better this way. If Jacques took on any more theories his head might explode." "Do you not think you have set yourself an impossible task? Can you really hope to discover all these things in your lifetime?" Thomas listened but could not hear any mocking edge to Kitty's voice. He ran his hand back swiftly through his hair. "Yes and no. In some ways, it does seem impossible. We need much better equipment in the laboratory, lenses a thousand times stronger, new inventions to help us look at microscopic matter. We do not yet even understand how heredity works. I imagine that your parents both had blue eyes, but the precise process by which you have inherited them is still a mystery. Mr. Darwin talked about pan genesis and gem mules but they don't really make sense; in fact his theory can be quite easily disproved. So we are in the foothills. Yet, I think we shall find answers. Never have we been closer. There are these sudden jumps and revelations in history. Take Shakespeare, for instance. He not only wrote the finest plays, but he described human motivation and behaviour in a way that had never been done before. You could say that his analysis did more than describe; it actually denned what humans were. From that moment on, the idea was born that each man and woman, instead of being a bundle of primitive desires and unreliable memories, had a consistently motivated psychology. They believed they might make something of themselves and change; they discovered a "self". Perhaps it was not until Shakespeare that humans really began to behave like humans." "Or like characters from Shakespeare, I suppose," said Kitty. "Well, it came to be the same thing. Of course, there are some drawbacks to this model. Some people do act inconsistently, they just do. And our brain cells die at such a rate, Franz Bernthaler assures me, that people do become literally someone else as they age, so in some ways it is not wise to expect them to preserve the same "character". But it was nevertheless a breakthrough in the sixteenth century, to imagine people to have a consistent and explicable responsibility for their actions. And I do believe that again, now, we stand on the edge of a full explanation of what it means to be human. It is a great moment." Kitty said nothing, but looked out towards the lake, which glimmered flatly in the late afternoon sun. A small village of white- and ochre-washed houses was beginning to grow on its far bank. She turned back to Thomas. "Will you be able to do all this without recourse to God? Is He not more likely to provide the answers than hereditary processes we cannot understand and instruments that have not been invented?" "That has traditionally been His role the guardian of mysteries. But He is a costive and niggardly keeper. He does not give up any secrets. Humans unriddle them all for themselves. When we have answered the last question, we will have no more need to dignify our ignorance with the name of "God"." "My word, you are a true scientist, are you not?" she said gently. "I have never previously met anyone who would give Mr. Darwin the time of day." "His reputation has fallen because there are some gaps in his theory. The machinery of heredity in particular. But I believe they will be filled. And the process of natural selection, which is the centre of his work that has been established beyond reasonable doubt." There was a silence, and Thomas thought he had perhaps offended or bored Kitty with the intimate detail of his speculations; but when he turned his head to look at her, he found that her eyes were fixed on him in a kind, almost indulgent gaze. "I have a favour to ask you," he said. "I shall tell Dr. Rebière that you are becoming my patient and I am certain that he will happily agree. However, if you should happen to run into him and he enquires about your health, as he is certain to do, could you perhaps not tell him about the rheumatic fever?" "If you say so." "I feel a little... Protective. We do share all our discoveries, but it is sometimes a question of timing." "I understand. May I ask you something in return?" said Kitty. "Of course." "Are you absolutely certain that you have never experienced any of the same symptoms as the patients that you treat? The more seriously ill ones, I mean." Thomas stood up and walked from the balcony into the room. Kitty's large brass bed was made up with a quilted cover and two large pillows trimmed with white broderie anglaise; it reminded him obliquely of his room in Torrington, of Sonia sitting on the edge of the bed many years ago, on the day when he feared that he had broken his arm. Something stirred in his mind; he felt the idea move from one part of his awareness into another, just as he himself had walked from the balcony into the bedroom. "Yes," he said. "I have never recognised it before, I have never allowed it out of the place where it lived. I used to hear a voice. But it was not real. I mean, it was real, but it was not attached to a body. It used to talk to me regularly in a slow, stuporific way. Then it stopped. It went away. I have not heard it for some years now and I feel sure that I never will again. It even said a kind of goodbye." Kitty had come into the room and stood beside him nodding her head gently. "And you have never told anyone about this?" "I have never even told myself about it," said Thomas. "I have never let it into my conscious mind. It just moved in at that moment, when you asked me." "But you were aware of it?" "I was aware of it very clearly, but only at a certain level of awareness, not at all levels." "And you did not question yourself about it?" "No. It felt like everything that happens to you: it felt like nothing. I discounted it because it had happened to me personally and was therefore valueless. Of no interest." Thomas put his face between his hands. He felt overcome by fatigue, as though some mortal weight, under which he had long been labouring, had been removed; now he barely knew how to stand. Kitty laid her fingers on his arm. "If you would like to," she said, 'you may put your head on my shoulder." He wrapped his arms round her waist, gently; and as he did so, she ran her fingers up through his hair. "I wanted to do that," she said, 'when I saw you doing it to yourself just now." Thomas lifted his head and looked at her. Kitty saw that there were tears on his cheeks. She said, "It is a hard life, Thomas." He felt himself in pieces before her. "Yes, Kitty. Yes it is. But it has its moments of transcendence." He took the bare freckled skin of her upper arms, feeling its softness beneath his large hands, and gazed into her eyes. The next day, after lunch, Valade approached Thomas in the hall and gave him a picture magazine. "I found this in town when I went in yesterday. It is a little out of date, but I think you'll find it interesting. It's about Mount Lowe in California. They have built a railway up into the Sierra Madre mountains near a little town called Pasadena. It runs to a height of about a thousand metres already and they are going to take it on further. Isn't that the height of the place you have your eye on?" "Mount Low," said Thomas, smiling. "That is a curious name for a mountain." "Lowe with an "e". It is named after the proprietor of the railway, a Professor Thaddeus Lowe. It was previously called Oak Mountain. Though perhaps you also find that amusing." "Less so," said Thomas. "In any case," said Valade,"you will see that they were able to build an electrical railway with an overhead trolley cable up the gentle incline, then when it comes to a steep lift, the passengers get out of the train and into a cable-car on an incline of roughly one in two." "Remarkable," said Thomas. "I shall read it this evening." "You should do so, Doctor," said Valade. "You will also find the details of the finance instructive. Perhaps we can talk about it further tomorrow." "Indeed. I am unusually busy at the moment and I need to talk to my colleague Dr. Rebière, but I shall make time for this. Perhaps you would care to come to our table for dinner tomorrow night." "Delighted. I shall speak to your cellar boy straight away." Thomas spent the afternoon with his patients and it was not until the evening that he finally saw Jacques, when they met in his consulting room to discuss the day. Thomas feared that Jacques would be humiliated and in despair, even though they had kept from him the diagnosis of Kitty's rheumatic fever. He tried not to meet his eye too directly when he went in, yet Jacques seemed strangely unruffled, Thomas thought, as he lit a cigar and looked out over the lawns of the schloss. After an exchange of minor news' Thomas said,"I saw your former patient yesterday. Katharina." "Yes," said Jacques. "So did I. She seemed well." "I have taken her on for the remainder of her stay. Merely a formality. Temperature, pulse and so on. I am not trying to ' "Yes, she told me." "Is that all right?" "It seems... Appropriate in the circumstances." There was a pause. Thomas coughed. "Jacques, I ' "Thomas, I am not going to be cast down by a single clinical error the failure to diagnose an asymptomatic condition. I am not going to abandon or alter the course of my work because one girl's womb had an impalpable cyst. And we are not going to lose face or lose heart as an enterprise because there was a slight delay in the treatment of a patient before the second opinion of such a highly astute doctor was able to set things right." Jacques's eyes were glowing, but his manner remained calm. Thomas found his mouth open, then close. This was not the response he had expected and he felt a clutch of panic. Was it possible that all along Jacques had been a fanatic? Perhaps when he was working all night in Paris, while Sonia looked on lonely and anxious, he had not been in a state of scholarly open-mindedness, but had really been driven by a desire to find a closed theory that would be the cornerstone of some personal church. Thomas said,"I think it is important that we do not panic. Naturally one case proves very little, and I am not suggesting we abandon all we learned at the Salpetriere in those great days. But we must understand what we can learn from this setback. If we do not examine it properly and ' "I do not see it as a setback. Fraulein Katharina presented a case of hysteria which has been cured by the techniques of psychophys-ical resolution. I told you at the outset that I believed it was not quite a classic case and that there were some complications. And so there were. You discovered them. Well done. But it takes more than two invisible sacs full of benign fluid to destroy the work of a decade. I dare say she had corns as well." Thomas found his anger rising, and held hard to the edge of Jacques's desk. "I am not trying to destroy anything. I want to build and progress. Before we can do that, you have to admit something. In the case of Fraulein Katharina, you were wrong, Jacques, and you were dangerously wrong." "I was not wrong. She suffered from hysteria, which ' "She does not suffer from hysteria, and she never has. Furthermore, I sincerely doubt that the disease entity of hysteria will continue to be recognised in ten years' time." "That is an absurd thing to say. It