There were not very many young people queuing up for the clinics Klein visited; mostly they were others of his age group in wheelchairs and on sticks, many of them limping and halting in sandals, slippers, trainers, and divers bandages and offbeat bespoke surgical-appliance footgear. He spent half-days waiting to see registrars and consultants while nurses of many ages, weights, and shapes marched, ambled, and frisked past him. He mentally undressed the good-looking ones down to their lissome and beautifully articulated skeletons as, like a greyhound in a walking-frame, he followed with his eyes the nimble rabbits of his desire.
When his name was called he popped as required. He popped himself on to and off tables; he popped on and off his tops and his bottoms, his shoes and his socks, always ‘for me’. ‘Just pop yourself on or off for me,’ said registrars and consultants. Nurses and house officers also required him to pop in one way and another for them. Eventually he popped into the street and made his way home to the word machine that silently asked what he had popped for it lately.
During that time he also reported to Charing Cross Hospital for his monthly visit in a drug trial for the use of bezafibrate in arterial disease of the lower extremities. The nursing sister counted the number of tablets remaining, took his blood pressure, and asked him whether he had experienced headaches, nausea, impotence, or ennui since taking the tablets which were either placebo or active. When she finished with him he was bled a little by the turbanned phlebotomist while they talked about world and local news and weather.
He had a thallium scan at Royal Brompton Hospital and a femoral angiogram at Chelsea & Westminster. He wrote a prescription request to his GP for more insulin, diltiazem, Imdur, captopril, frusemide, omeprazole, and aspirin. He bought a new bottle of glyceryl trinitrate tablets for angina and a new bottle of trisilicate of magnesium for oesophageal reflux. He stocked up on pine bark extract for his lower vascularities, green-lipped mussel extract for his knees, extract of gingko biloba for circulation in the brain and other extremities, and multivits just in case.
‘I have no inner voice and must speak my thoughts aloud,’ he said, ‘but I feel pretty good actually. I represent a triumph of the medical arts and the never-say-die spirit of the NHS. In clinical circles all the receptionists have a smile for me and I am known to consultants and other golfers as “he who declines to hop the twig”. In operating theatres I have more than once topped the bill; I am accomplished in nil by mouth and there is talk of getting me a permanent locker for my dentures. Life isn’t what it was but it’s a lot better than it’s going to be.
‘Now there comes to me a memory and I can smell the trees, feel the hot sun through the leaves. It was on the Appalachian Trail or it might have been somewhere else: my best friend Jim and I, hot and sweaty, pushing our bikes up a woodland road over a little mountain. At the top of the slope was a spring. I remember a stone trough and the clear cold water. There were leaves in the bottom of the trough and tiny crayfish. The water gushed from the pipe and it was a foreverness of itself, the endless quenching of all thirst. We drank it like an elixir and stuck our heads in the trough among the leaves and the crayfish and became new and strong and untired, for ever refreshed by the magic of that clear cold water that sparkled in the sunlight and the shadows on the mountain.’
5 Worth Writing Up?
‘Actually,’ said Professor Slope to Nathalie Lichtheim, ‘I haven’t come across anything like this inner-voice loss before — it might even be worth writing up.’ They were having coffee in Slope’s office where Escher’s carp lurked dimly on the wall.
‘You’re telling me this poor man has completely lost his mental privacy, his Selbstgesprach?’ said Mrs Lichtheim.
‘He whispers into his hand when he wants to be private. He presented like he was about to blow all his fuses and my first thought was hypomania and the usual bipolar thing. Then I began to wonder about his frontal lobes but I doubt that there’s anything organically wrong — his general irritability makes me think that his mental drains are blocked and he’s got a lot of sewage backing up on him.’
Mrs Lichtheim shook her head and sighed a little. ‘I’m surprised that it doesn’t happen more often. Year after year we don’t say all kinds of things that could get us into trouble, we keep an internal watch on the words about to come out of our mouths: we monitor the prearticulatory speech output code during speech production by means of an internal loop to the speech comprehension system. So here’s this guy of yours who’s been not saying things for about seventy years which is quite a long time, really. He hears these unsaid things in his head but they never come out of his mouth. Finally the monitor, the voice in his head, says, “The hell with this, I quit. You want to say something, say it out loud.” You think it could be something like that?’
‘I hope he survives long enough for us to find out,’ said Slope.
6 A Person, Another Person, A Tree
Nathalie Lichtheim M.Sc. AFBPsS. C. Psychol. was in her mid-forties, tall, with black hair, a luminous bespectacled face, and an abstractly motherly air. There was nothing in her office to lie down on but Klein whispered into his hand, ‘It would be nice to fall asleep with her sitting nearby.’
‘Can you tell me something about yourself,’ she said, ‘maybe something about how things are with you now?’ She spoke softly and with a slight accent, perhaps Viennese.
Klein told her about the loss of his inner voice.
‘Yes,’ she said, ‘but apart from that?’
‘I’m not in very good shape. I live about a mile away and I walked here. I had to stop four times and rest because of angina. Life seems more of a struggle than it used to be; often people coming towards me don’t give me room to pass, as if I’m invisible. When I take a bus the people who should be queuing behind me shove past me to get on — that sort of thing …’ He trailed off into whispers.
She asked him what medications he was on and he told her. ‘Now we’ll begin with the Bender Gestalt Test,’ she said. ‘I’ll show you nine cards and I’ll ask you to look at them and copy them.’
‘How does that bear on my inner-voice loss?’
‘This problem doesn’t come out of nowhere; we need to look at what’s underneath it.’ She showed him the cards and one by one he copied the various arrangements of lines, dots, and geometric shapes, whispering, muttering and singing into his left hand while his right hand was drawing. He sang ‘Stormy Weather’ and ‘Nobody’s Sweetheart Now’. ‘“Oh no,”’ he said, “‘it wasn’t the airplanes, it was Beauty killed the Beast.”’
‘“… Beauty killed the Beast”’, wrote Mrs Lichtheim. ‘Is that a quote?’
‘From the film King Kong,’ said Klein as he continued his copying, ‘when Kong’s lying dead in the street. I notice that I shorten everything. I wonder if tall men elongate.’
“‘… if tall men…?”’
‘Elongate.’ When he had copied the nine cards Mrs Lichtheim removed them, asked him to sign the sheet with his drawings, gave him a new sheet of paper, and asked him to draw the cards from memory. ‘“Far and few, far and few, are the lands where the Jumblies live …”’ he said as he set to work. ‘“The very thought of you makes my heart sing, like an April breeze on the wings of spring …”’ he sang, no longer hiding his mouth with his hand. He was able to recall seven of the cards more or less but not in the correct order; his attempts at the eighth and ninth were only guesswork. Again he signed his name and she collected that sheet and gave him a fresh one.