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Then is she an idiot savant, one of those people who don’t have sense enough to come out of the rain but can tell you what is 4,891 times 23,547 by reading off some computer inside their head? I did not know at the time, but I knew later. No, she was not.

I gaze down at her, my arms folded over the chart. What has happened to her? How can she be at once as innocent as a four-year-old and as blowsy as the Duchess of Alba? At the time I had no idea.

“Mickey, what about the dream?”

“Dream?”

“The dream of Vermont, your grandmother’s cellar, the smell of winter apples, the visitor who was coming.”

“The dream.” For a moment she seemed to become her old self, to go deep, search inward. She seemed to reach for something, almost find it. She frowned and shrugged. “Dream of Jeannie, Doc. That’s what Bobby calls me. Jean’s my real name. Jeannie with the light brown hair. You like?”

“Yes. Bobby?”

“Bob Comeaux. Doctor Comeaux, Doc.”

“I know.” I turn to leave.

“Doc.”

“Yes?”

“You call Bobby.”

“I will.”

“Bobby wants something.”

“All right.”

“And what Bobby wants—”

“All right,” I say quickly, suddenly needing to leave. “So I ask Dr. Comeaux and he’ll tell me?”

“Yes.” Her legs thrash enthusiastically.

I leave, knowing very little, not even who called me for a consultation or why. I will ask Dr. Comeaux.

2. A STRANGE CASE, yes, but nothing to write up for the JAMA. Indeed, I couldn’t make head or tail of it at the time, the bizarre business with the boy and the stallion, but mainly the change in Mickey LaFaye. But what physician has not had patients who don’t make any sense at all? To tell the truth, they’re our stock-in-trade. We talk and write about the ones we can make sense of.

Here’s another mini-case, not even a case but a fifteen-second encounter with an acquaintance even as I left Mickey’s room and started down the hall, musing over the change in Mickey. How much of the change, I was wondering, comes from my two years away and the change in me?

Here’s old Frank Macon, polishing the terrazzo floor. I saw him a week ago, just after I returned. Frank Macon is a seventy-five-year-old black janitor. I have known him for forty years. He used to train bird dogs when there were still quail around here. Then as now he was polishing the terrazzo with a heavy rotary brush. From long practice he was using the machine well, holding back on one handle to give it a centripetal swing until it caromed off the concave angle of the wall to propel itself back by the torque of the brush. I broke his rhythm. He switched off the motor and eyed me. He clapped his hands softly and gave me one of his, a large meaty warm slab, callused but inert.

“Look who’s back!” he cried, casting a muddy eye around and past me. He throws up an arm. “Whoa!”

“How you doing, Frank!”

“Fine! But look at you now! You looking good! You looking good in the face and slim, not poorly like you used to.”

“You’re looking good too, Frank.”

“You must have been doing some yard work,” says Frank, good eye gleaming slyly.

“Yes,” I say, smiling. He’s guying me. It’s an old joke between us.

“I knowed they couldn’t keep you! People talking about trouble. I say no way. No way Doc going to be in trouble. Ain’t no police going to hold Doc for long. People got too much respect for Doc! I mean.” Again he smote his hands together, not quite a clap but a horny brushing past, signifying polite amazement. He turned half away, but one eye still gleamed at me.

One would have to be a Southerner, white or black, to understand the complexities of this little exchange. Seemingly pleasant, it was not quite. Seemingly a friend in the old style, Frank was not quite. The glint of eye, seemingly a smile of greeting, was not. It was actually malignant. Frank was having a bit of fun with me, I knew, and he knew that I knew, using the old forms of civility to say what he pleased. What he was pleased to say was: So you got caught, didn’t you, and you got out sooner than I would have, didn’t you? Even his pronunciation of police as pó-lice was overdone and farcical, a parody of black speech, but a parody he calculated I would recognize. Actually he’s a deacon and uses a kind of churchy English: Doctor, what we’re gerng to do is soliciting contributions for a chicken-dinner benefit the ladies of the church gerng to have Sunday, and suchlike.

I value his honesty — even his jeering. He knew this and we parted amiably. We understand each other. He reminds me of the Russian serfs Tolstoy wrote about, who spoke bluntly to their masters, using the very infirmity of their serfdom as a warrant to scold: Stepan Stepanovitch, you’re a sinful man! Mend your ways!

“How Miss Ellen doing?” he asked, playing out the game of Southern good manners.

“Just fine, and your family?” I said, watching him closely. Am I mistaken or is there not a glint of irony in his muddy eye at the mention of my wife’s name?

That was my encounter with Frank Macon a week ago, a six-layered exchange beyond the compass of any known science of communication but plain as day to Frank and me.

This is my encounter with Frank this morning, in the same hospital, the same corridor, the same Frank swinging the same brush. He simply stepped aside, not switching off the machine, neither servile nor sullen, not ironical, not sly, not farcical, not in any way complex, but purely and simply perfunctory.

“How you doing, Frank?”

“Good morning, Doctor.”

“Still featherbedding—” I begin in our old chaffing style, but he cuts me off with, of all things, “Have a nice day, Doctor”— and back to his polishing without missing the swing of the machine. I could have been any doctor, anybody.

Here again, a small thing. Nothing startling. He might simply have decided to dispose of me with standard U.S. politeness, which is indeed the easiest way to get rid of people. Have a nice day—

Or he might have decided that the ultimate putdown is this same American civility. What better dismissal than to treat someone you’ve known for forty years like a drive-up customer at Big Mac’s?

Or: Feeling bad, tired, old, out of it, he might have drawn a blank.

Or: Something strange has happened to him.

3. THEN ALONG CAME MY second case, which gave me my first clue that something queer might be going on hereabouts, that Mickey LaFaye was not just a solitary nut.

Donna S—, a former patient, called to make an appointment.

It was last Wednesday afternoon. Downtown was deserted. The banks were closed. The other doctors were playing golf. They’ve mostly moved out to the malls and the hospital parks, where they’ve built pleasant plantation-style offices with white columns and roofs of cypress shakes.

Here I am, waiting for her, not exactly besieged by patients, sitting on the front porch of my office, my father’s old coroner’s building behind the courthouse, a pleasant little Cajun cottage of weathered board-and-batten and a rusty tin roof. It is October but it feels like late summer, the first hint of fall gentling the Louisiana heat, the gum leaves beginning to speckle. I am watching the sparrows who have taken over my father’s martin hotel. The cicadas start up in the high rooms of the live oaks, fuguing one upon the other.

I am the only poor physician in town, the only one who doesn’t drive a Mercedes or a BMW. I still drive the Chevrolet Caprice I owned before I went away. It is a bad time for psychiatrists. Old-fashioned shrinks are out of style and generally out of work. We, who like our mentor Dr. Freud believe there is a psyche, that it is born to trouble as the sparks fly up, that one gets at it, the root of trouble, the soul’s own secret, by venturing into the heart of darkness, which is to say, by talking and listening, mostly listening, to another troubled human for months, years — we have been mostly superseded by brain engineers, neuropharmacologists, chemists of the synapses. And why not? If one can prescribe a chemical and overnight turn a haunted soul into a bustling little body, why take on such a quixotic quest as pursuing the secret of one’s very self?