Meaning Out of Madness

This story was written for the MSc Science Communication course at Imperial College London, for assessment as part of the Narrative module.

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By Sarah Lim
Posted April 2022

An impish breeze slips in through the open window and rushes across the small room— Emily slaps her hand down, barely catching the half-written sheet between her palm and the time-worn mahogany table. Irritation bubbles up within her, recedes before it grazes the surface of awareness. She’s too fatigued to be irritated. Months of research, experimental design, clinical trials, data collection. And before that, years of accumulating experience, expertise. She is an expert. This is supposed to be the easy part. One report, hardly distinguishable from the dozens she’s churned out during her long career. Yet this feels different. 

There’s a quiet, persistent knocking at the door. Certainly a familiar, maddening characteristic of her assistant— Karen? Kathy? It’s on the tip of her tongue— incomplete activation of the memory retrieval pathway unfortunately manifested in the intangible sensation of something missing. Regardless, her hypothesis proves accurate— a short, dark-haired woman stands in the doorway. Some might describe her assistant as pretty, perhaps even beautiful. Though privately, Emily thinks that her perpetually peeved expression may act as somewhat of a deterrent. Her brows seem utterly unable to escape from the constraints of a permanent frown, her thin lips similarly affixed in a tight, unamused line. Even upon finding the answers to a particularly difficult problem, her expression always remains curiously dissatisfied, as if teetering on the edge of raising an objection. In those moments, Emily can sometimes recognise the youthful tenacity of her younger self.

The ever-present frown relaxes slightly. ‘Ready to go?’

‘More than ready,’ Emily replies.

She gets in the car. In the driver’s seat, her assistant’s frown is back and deeper than ever. A familiar bitterness creeps into Emily’s mind, a lamentation for her declining independence. It has seemed unshakeable lately. Emily turns to face her and raises an eyebrow. An averted gaze, a terse nod. They pull out of the drive. In the rearview mirror, she sees a man at the window of her study, dressed in white from head to toe. She closes her eyes for a moment. When she opens them, he’s gone.

They are on their way to see a woman of seventy-five, a retired gardener, near the northern edge of the city. The mews house is stout and entirely covered in overgrown ivy, blending into its surroundings like something left and forgotten. Its owner sits them down in the living room with a mug of tea each, and seems surprised when Emily asks about her symptoms.

‘Surely you already know. Aren’t you a doctor?’ she says, with a wry smile.

‘Scientist. I know all about it in theory. But I’ve recently become… invested in the truth. The things that diagnosis can’t get quite right. It’s difficult to explain.’

‘You don’t say,’ the woman says, amusement wrinkling her eyes. ‘We don’t tend to last this long. I suppose you must be searching for my secret. Well, here it is— never trust a doctor.’

Emily takes a sip of her tea. Her assistant looks taken aback at the woman’s candour. She wonders if it was the right choice, making this journey. If it will help or hinder her work.

‘What do you mean?’ Emily asks.

‘What do you think I mean? What do they know about my own mind that I don’t? All their technical jargon and Latin nonsense. It never made sense to me.’

For a second, she finds herself in a nightmarish vision of the past. Where it all began. The walls and floor are so white they almost appear to merge into one featureless plane. Every surface gleams; she feels slovenly in comparison. The doctor seems a reflection of his habitat, garbed in white, his face carefully compassionate in a way that suggests hours spent in front of a mirror practicing and polishing the expression to perfection. The words tumble interminably out of his mouth and into her stomach like a deluge of cold oil. She almost laughs at the irony of it. Perhaps this is her punishment for a lifetime of atheism— the wrath of a god she never believed in.

When she regains her senses, they are in a different house. The young girl— second on the list— speaks calmly, though Emily detects a weariness in her voice.

‘—It’s something to believe in,’ the girl is saying, ‘It’s comforting, knowing that things are happening for a reason.’

‘But, there isn’t a reason. Risk factors, underlying processes maybe. Nothing to do with fate or a divine plan of any kind. How could that possibly help?’

‘Sometimes I see things that aren’t real. The science doesn’t solve anything, but it makes it easier knowing there’s an explanation, like any other illness. That it’s just chemicals and electricity.’

‘How can you tell if something is real or not?’

The girl picks at her nails as she speaks. Two scuffs on the left, cuticle pushed up with the base of the thumb, two scuffs on the right, then a sweep under the nail. Then the next nail. Left, push, right, sweep. Clearly a systematic process, muscle memory trained into an endless, repetitive series of motions.

‘How can you tell if something is real or not?’ Emily asks.

Her assistant has an odd look on her face.

Her assistant is pestering her to stay, but Emily is resolute and unyielding. Theory is not enough any more, she needs to speak to the people behind the numbers, know what it really means to lose your grip on reality while the doctors give you countless ways to comprehend it.

‘The report is almost done, and you are definitely not driving—’

‘Why are you still here?’ she snaps. Her assistant quietens.

Why is she here at all? Emily feels a headache coming on, a wraith-like premonition of discomfort at her left temple. She can’t quite recall the precise circumstances in which she came to acquire an assistant. Tip of her tongue.

Her pace picks up, weaving haphazardly through the crowd, eyes on the pavement, a landscape of dress shoes and winter boots. Somewhere along the way, she loses sight of her assistant. Clutched tight in her gloved hand, a small scrap of paper containing three addresses. The next patient is a man in his forties, a former journalist. The final stop on her pilgrimage for truth. She raises her right hand to knock—

Then, nothing. A dark chasm where her memories have withered, irretrievable.

A frigid week in February, she loses an entire day. One moment she’s waiting for the espresso machine to heat up, the next she is sitting in the study at dusk, the very last tendrils of sunlight lending a weak glow to the room. She finds the empty mug in the sink afterwards, grieves the loss of more than just the taste of coffee.

An impish breeze slips in through the open window and rushes across the small room— Emily slaps her hand down. It meets the bare mahogany with a dull thud. The page has somehow evaded her. The wind sweeps it off the table, her eyes following its smooth, languid path. Paper sheets blanket the floor from wall to wall like a field of snow. Some are empty, others half-filled with neatly inscribed notations, still others marred by blotchy ink stains, words crossed out and rewritten and crossed out again. They obscure the carpet completely, and crinkle under her feet as she stands. There’s a pale man near the window, watching her. His expression is one of understanding— or is it pity?

Pale walls, pale tiled floors, a pale man in a pale coat. The doctor is talking, but his voice sounds warped, garbled, as if underwater, ‘—can include recurrent visual hallucinations, delusions, fluctuating cognitive impairments and sleep disruption. And as the condition progresses, you may develop some aspects of Parkinsonism, which means—’

‘Please, doctor,’ Emily interjects bitterly, ‘I said you could skip the minutia. Of all people, I think I should know what it means.’

A knock at the door. No, not just one knock, a persistent knocking—  who knows how long they’ve been knocking? Emily nods a greeting to the man at the window as she shuffles past.

There is a pale man near the window in her study. She freezes, pen hovering an inch above the paper. He meets her eyes, and his face looks familiar, although she cannot remember ever meeting him. She doesn’t move. Neither does he. When she finally breaks the tableau, it feels as if they have established a truce. After that, he comes and goes, like a stray cat. Sometimes weeks go by without a glimpse of him, and Emily starts to question if she’s going mad. Sometimes he stays— always by the window, with his sharp, discerning gaze— and she knows she is. ‘Persistent visual hallucinations’— a term that strikes her as both impressively succinct and overwhelmingly inadequate. 

The knocking continues. Steady and unrelenting. Emily never knocks like this herself, it simply isn’t effective. Surely they know that it’s much easier to filter out consistent noise. Sensory receptors adapt, firing rate declines, eventually the noise diminishes until it’s entirely imperceptible. Then again, maybe not. Regardless, she’s too fatigued to be irritated.

There is a well-dressed brunette on her doorstep, thin lips pursed in displeasure, or potentially concern, almost certainly one of the two. 

‘That took awhile. I’ve been worried.’

Both it is, then. Emily stares at the woman dispassionately. ‘I suppose we must know each other. You’ll need to introduce yourself, I have a condition.’

Five hours after the diagnosis, her eyes are red. Not from crying— that will come later— but from five hours spent staring at her laptop screen. Early-onset dementia with Lewy bodies. Quite a common condition, nothing special. She’s read every paper on it, at least those published in English, and knows what to expect in vivid detail— too much detail. Not exactly her area of expertise, but close enough. 

The woman goes quiet for a long moment. A very long moment. Long enough that Emily has serious thoughts about leaving her on the doorstep.

She finds her voice. ‘It’s Kate. The doctor sent me. You refused to attend your check-ups, so I’ve been coming here to help while you finish your work.’

‘It isn’t happening.’

‘You say that every time. What’s happened?’

‘Parkinsonism,’ she says abruptly. ‘Tremor, muscle stiffness— the lot.’

Another tedious moment of silence.

Then, ‘You speak, I’ll write.’

The papers float gently to the ground. Outside, the leaves are falling in sympathy. Emily grips the edge of the table. It doesn’t make sense. All these reviews, studies, conclusions. She understands the neuropathology of it in morbid specificity— yet the anxiety persists. An ache begins behind her left temple, an ill-fitting, head-numbing sensation that something is missing. She prides herself on being thorough. There must be something else.

Her assistant— or rather, the doctor’s assistant— is perched on the desk. Emily considers how her careful hypotheses, meticulously-collected data, robust statistical analyses, have amounted to nothing but a futile attempt to capture an indeterminable phenomenon. The revelations of recent days—or weeks? Months? It is increasingly difficult to tell— have waged a war of attrition on her prized methodology, slowly eroding the pedestal on which it once sat comfortably. She considers the gardener’s cynicism, the young girl’s faith. Her own inner turmoil, an awkward, uncomfortable creature that has commandeered a crevice of her mind for itself and built its thorny nest there. The revered scientist, suddenly thrust into the role of the subject. In some ways, she feels like more of an expert now than ever before— theory and experience working in symbiosis.

‘Remember,’ her assistant says, ‘tell me everything, anything, even if it seems inconsequential. You’ve already wrung the science dry, so try something else.’

Something else.

Emily leans back in her chair, her mind clear. She stretches her legs out, feet stirring the paper field, and begins to speak.

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Sarah Lim is currently enrolled on the MSc Science Communication course at Imperial College London. She completed her undergraduate degree in Neuroscience at the University of Bristol with a focus on ASD and neurodegenerative disease, and writes whenever she has time to spare.