The young woman in my consulting-room tells me that she lost her hand in a childhood accident involving a lawnmower when she was three years old. No one in her family thought to preserve the hand, and it did not accompany her in a bag of ice to the Casualty Department in the usual way. The result: this sealed, blunt-ended flesh stump and this peachy prosthetic hand, lying in her lap with its straps and cuff abandoned beside it. She jabs her stump towards the paraphernalia.
‘I ask you,’ she says with a sniff. ‘As if that bloody thing would fool anyone.’
‘Quite’, I reply.
(I am not a soft-hearted man, thank God. You couldn’t do my job if you were.)
What she does have, this young woman, Emma, as do so many of my limbless patients, is a phantom hand.
I try not to show my excitement. She must know that she has been sent to me because it’s my area of expertise, that I’m the world’s leading authority on the phenomenon of patients who have vivid sensations, sometimes even severe pain, in a limb that no longer exists. Such patients being rare, I am always in need of them for my data. I have trained myself to hold very still when these people first begin to talk of their phantom limbs. I have become skilled at controlling the knocking in my knees, the breathlessness, the desire to rush to my computer, to add their details to my statistics. I’ve perfected a tone that sounds concerned, and encouraging.
The consulting-room smells odd today. There is a rather powerful, almost dizzying smell of some blue hyacinths that my assistant Anna brought in this morning ‘to make the patients feel more at home’. ‘That’s assuming they live in a wood,’ I mutter. Anna makes no reply. Now she has her back to us and is pretending to busy herself with some data analysis in one corner of the room. (Anna struck upon this ingenious device several years ago, when she suggested that a doctor as handsome as I might be in danger of false accusations of sexual molestation unless protected by her presence at all times. A ludicrous suggestion, in my view. But over the years, the lack of any such accusation seems to prove that her policy is working.)
‘How long have you experienced this phantom hand, Emma?’
‘Since I was three. Since the real one got cut off. It does things, you know. It’s tapping the chair beside me right now.’
‘Why is it doing that?’
‘It’s irritated, I suppose. It’s waiting for your pearls of wisdom.’
I ignore her tone.
‘It’s not at all rare,’ I tell her, ‘to experience a ghostly limb when one has been lost. It has actually been noted as far back as the 16th century, when such limbs were called “sensory ghosts”…’
Anna turns around, pushes her glasses further up her nose. She moves a little closer to my desk. (I must say her subterfuge of being busy is in danger of becoming unconvincing – but now is not the moment to mention it.)
‘It was once – ahem – Anna, do you have Emma’s notes on screen over there? – once believed by doctors that the curled-up nerve-endings in the stump…’ (Anna makes a little sound – a cross between a cough and a gasp – at the word ‘stump’, but I don’t see how using euphemisms ever helped anyone) ‘were inflamed and fooled higher brain centres into thinking the missing limb was still there. This theory is rather primitive. My research suggests that the part of the brain creating this illusion lies in the frontal lobe, particularly the strip of cortical tissue called the motor cortex.’
She has large eyes, this Emma, and she blinks more often than most people, or rather: she is blinking rapidly right now.
‘You’re the doc,’ she says. ‘When do I get to go in the space tube?’
I say that her appointment for the brain scan is fixed for next Tuesday evening. I smile, to cover up my pique. Space tube, indeed. Such a slip of a girl and so unimpressed by my 20 years of research. My consistent record of publication in The Lancet. My phantom-limb knowledge is second to none.
Emma arrives the following Tuesday. There has been an inconvenience and I am quite irritated as I explain it. ‘I’m afraid that Anna has had to rush home for some emergency involving Tommy, her seven-year-old… it’s unavoidable. She’s a single parent. So it’s just me today. I will operate the brain scanner and remain in the room for the 20 minutes or so it will take to do the scan…’
And where will we all be if this young woman takes it into her head to accuse me of sexual harassment? I must remember to put this to Anna later and to insist that she reverts to her policy of loyal support at all times.
‘Fine,’ Emma says, taking a piece of bubble gum from her mouth with her good hand and looking around for somewhere to put it.
I dive forward with a tissue.
As she takes her shoes off, she pushes a few strands of dark hair from in front of her eyes and says: ‘I had a funny dream last night.
It was about my brother – Dan. He was the one who caused the accident with the lawnmower. He lives in the States now, but in the dream, I sent him my ghost hand in an envelope. Dan opens it and it springs at him, you know?’
I feel another surge of anger at Anna’s absence. She is the one who is skilled at the soothing chitchat with patients.
‘Springs?’
‘Yeah. My hand can spring you know.’
‘Yes, yes,’ I say.
Why my patients imagine I’m interested in this kind of burbling, I’ve no idea…
‘And I said to him, to Dan, “Forget it. It’s OK. You were just a kid. You were what – five? You didn’t mean it. I’ve always known that.” And my fingers reached out, and there was all this green and yellow grass around, like a lawn that had sprung up, with little crocus shoots. And my hand sort of held his.’
‘Yes, fascinating I’m sure; I do have other appointments today…’ I gesture towards the brain scanner, indicating Emma is to lie down. She looks at me for a moment, and out of nowhere says: ‘She’s young, your assistant, to have a seven-year-old child, isn’t she?’
‘Hardly!’ I squeak. ‘She’s, well – I’m not sure how old Anna is, as a matter of fact.’
And I’d like to add: ‘And it’s no concern of yours, young lady!’ but before I can, Emma says: ‘Keep yer wig on. My hand is like – about to tickle you right now, you should loosen up. It’s really close to your ear.’
I spin around and Emma bursts out laughing.
‘Just kidding,’ she says.
I don’t know why but my palms are trickling with sweat. I am conscious that my heart is beating rather rapidly. This damn girl –and the absence of Anna – has made some troubling intrusion and I can’t seem to regain my professionalism.
I remind Emma that it will be noisy inside the brain scanner and she assures me she brought her iPod to listen to while in there, as suggested. I suppose it’s good that she’s talking about the hand, as I want her to think about her phantom limb while in the scanner. I’m hoping to record some changes in the frontal lobe whenever the hand is sent a message by the brain to move. I don’t know if she even hears this instruction: she barely acknowledges it. She is wriggling into the ‘space tube’, ears already plugged.
Once she’s inside, I sit on a chair beside her, and try to switch off from the metallic humming sound that fills the room.
It’s eerie in here with the blue light; Emma’s intergalactic analogy – predictable though it is – has some truth. I do indeed feel, in this airless room, separate from the rest of the world, exactly like an astronaut lost in space. The lack of distractions, the silence, the feeling of isolation – I wouldn’t call it loneliness, quite – but it’s true no one can reach me here, and my thoughts can float…
Unfortunately, rather than soothing me, my thoughts float now towards that earlier tense conversation with Anna. It was last night when she telephoned to say that Tommy was sick. ‘Couldn’t he go to school, don’t they have a Matron, some kind of sick bay he could lie in?’ I suggested. We had been getting on rather well; dinner, a film, talk of going to the theatre. ‘God, it’s hopeless,’ Anna suddenly said. ‘Years of this! You really have no idea about anything, do you?’
A remark that made no sense. The phone line went dead.
Musing on this, other troubling and inexplicable conversations drift into my mind. Patsy, a student doctor in med school. She called me – I remember it now with a stab in the chest, like a jabbing finger – the Coldest Bastard She’d Ever Met. I was fond of Patsy. I never understood what I’d done to provoke her but she clearly thought that whatever it was, I knew full well.
I sit up straighter in the chair next to the scanner. I hold my breath. I count to five. I breathe out. I glance around the room. I stare at Emma’s legs in their jeans; her top half obscured inside the scanner. Is she doing as I asked and thinking about her phantom limb?
I glance again towards Emma’s inscrutable legs. The room tightens, and the silver-blue light contracts. I almost dozed off there, the air being stuffy and the humming rather hypnotic. I suddenly feel swept by a huge wave of sadness. Another failure, the realisation that, after that bewildering conversation, I seem to have snapped off the shoots of yet another relationship.
Anna’s small dark head, her glasses resting on the perfectly shaped tips of her ears. The gentle way she puts my coffee down on my desk, never making the slightest sound that might disturb my concentration. Dear Anna. Could it be that… My throat is tight. I do at last understand that – once again – I’ve blown it.
And as I slump forward in my chair, the weirdest thing. My eyes are shut, my face is in my hands. I smell the salt smell of my sweating palms. But. There is something else. I feel it, forcefully. I feel something push my hands aside. Fingertips. Four small warm fingertips and a thumb – gentle but unmistakable pressure. The slight stickiness of warm, living skin. The hand of a child! A small hand. And it is trying to stroke my face.
I’m quivering. I dare not open my eyes. Without doubt, I feel a little hand touching my face. The fingers stumble, exploring. A pause. (How strange that when Emma spoke of it, I imagined a bigger hand; I’d forgotten that the hand would be so small.) The fingers wipe tenderly at my cheeks.
If I were a fanciful man, I’d say it was exactly as if a child, a small, supernaturally forgiving three-year-old child, was trying its best to stroke my cheek: to make me feel better.
However, I’m not. Fanciful, that is, or sentimental. I’m not prone to magical thinking, either. The humming stops. The blue light of the scanner fades; the room reappears as its regular clinical self. Emma emerges from the scanner, and after unplugging herself from her iPod, gives me another probing stare. The back of my neck tingles.
‘We all done, doc?’
‘Yes, thank you – that’s all for today.’ I fight a desire to glance around the room, to be sure that no one else is here with us. Emma puts her shoes on – she’s astonishingly adept at this; straps the watch onto her prosthetic wrist. She is grinning, almost giggling.
I can’t resist; I have to ask.
‘What is it doing now,’ I say, ‘your phantom limb?’ The skin under my collar is unbearably ticklish.
‘Oh, I think you know,’ Emma says, swinging her bag over her shoulder. She closes the door behind her.