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Underground fugue, p.5

Underground Fugue, page 5


Underground Fugue

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  Years ago, in New York, from her first apartment near Gramercy Park, she’d also walked, taking long excursions south along the paved path by the East River—passing the immigrant families gathered for their Sunday picnics, the children chasing each other across the dusty grass; turning at the Williamsburg Bridge toward the old tenement blocks of the Lower East Side; crossing onto Orchard Street and Hester and Canal, with their Jewish schmatte shops and synagogues and delis turned bodegas and Chinese laundromats.

  Everyone came from elsewhere in New York. They came from the Dominican Republic, from Jamaica, Russia, Taiwan, Sri Lanka, New Jersey, the Midwest. Layer by layer, they made the city theirs. But London was different, or at least it was back when she was a child here. You couldn’t become English; it was something you inherited, part of your genetic code. London was full of foreigners, now more than ever, but somehow the boundaries seemed fixed. You could assimilate—perfect your accent, make a fortune, change your name—but the real England remained as inaccessible as the city’s private clubs and gardens, locked away behind wrought iron gates.

  She remembers once, as a child, going over to a classmate’s house to play. She must have been seven or eight. A grandmother or great-aunt was visiting, and the adults had gathered in the dim, upholstered sitting room, the children called in to be introduced. Little bowls of sweets had been set out on all the tables: foil-wrapped toffees and Bendicks mints. Esther took a toffee and hid it in her fist.

  “Fagin,” the old woman said, peering at Esther over her spectacles’ rim. “An Irish name, is it?”

  Esther shrugged. Not Irish, she didn’t think.

  “Are you Catholic?”

  She shook her head.

  “Protestant, then?”

  Another shake.


  The classmate’s mother spoke up with an embarrassed smile, her lips tight.

  “Your family’s Jewish, isn’t that right, darling?”

  Esther looked down at her feet, her brown Oxfords, scuffed at the toes. She clenched the toffee in her hand. When she tried to unwrap it later, the foil would not come off.


  She wakes in the middle of the night to the muffled sound of running water. It rises, faintly, above the other night noises: the creaking floor joists, the whine of a distant motorcycle, the ticking of the bedside clock. It’s 1:57 a.m. The noise must be coming from somewhere in the walls. It’s just the faintest trickle, like the runoff from light rain. Is it raining? Or is there some kind of leak? She can hear it, then she can’t. The minutes click by. She shuts her eyes. Through the darkness the sound of the water rises, mingling with the whooshing of the blood inside her veins. It pulls at her like a strange sea, the calm surface a deception, the current tugging underneath. She jerks awake, squints at the clock. It’s 3:16 a.m. The house is silent. She turns over, pulls the pillow over her head.

  In the morning, she checks the bathrooms, but the toilets are not running and none of the taps appear to have a leak. She crouches down and feels inside the kitchen cabinet beneath the sink, but it is dry as well. She goes down the creaky stairs to the cellar, dank and dim and crammed with boxes and oddly shaped objects draped in sheets, and shines a flashlight around the pipes, furred with a century of dust and grime. There’s no sign of moisture anywhere. She pictures the pipes stretching through the walls like organic matter, twining around the joists, winding tendrils into cracks: lead intestines, copper arteries, polyvinylchloride veins. She knows nothing of plumbing beyond the strangely anthropomorphic language: couplings, elbows, waste arms, slip joints, traps.

  She eases open the door to her mother’s room. Her mother is propped up in bed, leafing through a magazine. Esther wonders how long she’s been awake. The windowpanes are rattling from the thudding roar of the excavation machinery across the street.

  “You haven’t noticed any leaky taps, have you?” Esther says. “I could have sworn I heard something—the faintest drip.”

  “A what?”

  She clears her throat. “I thought maybe I heard something dripping?”

  Her mother’s mouth turns down. “I don’t know how you can hear anything whatsoever with that infernal racket across the street. You should ring the police. This shouldn’t be permitted in a neighborhood like this.”

  Esther sighs. “You’re probably right.”

  “I know I’m right. What was it you said you heard?”

  “Forget it, Mum. Just something dripping. I’m sure it was nothing. I checked all of the toilets and sinks.”

  “It was probably coming from the Arab’s house next door.”

  “You really need to stop calling him that.”

  “Go over there, Esther, and tell him to ring the plumber.” Her mother shakes her head. “With neighbors, there’s always trouble, believe me.”


  Esther steps out the front door. The sky is raw and white, the pavement damp. Probably the rain was all she heard last night. She shakes a cigarette out of the pack and lights it. Across the street, workers are maneuvering a fat hose that appears to be sucking dirt from beneath the foundation and spewing it into an idling dump truck. She wonders what they’ll find down there, beneath the ground. London’s marshy soil was always giving up its relics: potsherds, Roman coins, marble statuary, medieval paving stones, bones from Anglo-Saxon mass graves.

  She thinks of Noah as a toddler, running to her along the beach on Fire Island, palms extended and filled with shiny pebbles, bits of driftwood, broken shells. She remembers showing him how to tunnel through a sandcastle, scraping away at the cool, wet sand from both sides of the mound until her fingers poked through and met. There was something uncanny about the feeling of her sandy fingertips touching one another deep inside the tunnel, as if the other hand belonged to someone else.

  She can see him so clearly, lying on his back on the beach at Fire Island, tracing sand angels. Overhead, clouds fled across the taut blue sky, chased by the salt wind off the dunes. She sees the three of them as if from an enormous distance, her and Gil and their little boy, three tiny figures on that tiny spit of sand.

  The dump truck is bleeping now, backing up, a new dump truck behind it waiting to pull in. Traffic is backed up down the street. The giant machine is roaring. Everything is vibrating with the noise. She can feel it in her teeth. It wouldn’t be surprising if all that excavation had caused a pipe to break.

  She steps down to the pavement and turns around to look back at the house. The twin blue front doors, the two rows of mirror-image windows, the symmetrical white trim. On the doctor’s side, the blinds are halfway up in one of the upstairs windows. She moves a little closer and squints, but she cannot see in.

  She turns their names over on her tongue: Amir, Javad, Javad, Amir. The other day she’d walked over to the public library in Swiss Cottage and clicked through websites on the computer until she finally found him: Dr. Javad Asghari, University College London Institute of Neurology, Alexandra House, 17 Queen Square. The thumbnail photo was rather blurry, and the biographical details revealed little, but the official confirmation pleased her, as if without it he didn’t really exist. On a whim, she typed Amir Asghari into the search bar too, but turned up only references to some mathematician in Birmingham and an Iranian civil engineer.

  Across the street, a workman yells; the dump truck belches smoke. It is too early in the morning to knock on anyone’s door. She can hardly ask Javad to call a plumber, anyway; she should just call one herself. Again she sees his not-quite smile, feels that odd sense of déjà vu. Again the lie she told gives off a little twinge.


  The clamor of construction noise wakes him before the alarm, the roaring and banging jolting him out of some annoyingly overcomplicated dream. Bloody hell. He swings his feet out of bed and groans. His lower back is stiff. He shuffles to the bathroom and splashes water on his face.

  Today he’s due in Kent by ten. He’s been called in to consult on a patient down at Little Brook—so
me fellow who turned up lost in April, out on the Isle of Sheppey—amnesic, aphasic, a possible case of dissociative fugue.

  Trousers on, shirtless, towel around his neck, he steps into his study and jiggles the mouse on his computer. He checks his email, sends one off to his secretary saying he should be back at the Institute by two, clicks on the news. Polls are open today for the general election; Labour are expected to win a majority again. Another roadside bombing in Iraq. Weather chilly and unsettled, showers lingering with sunny patches later in the afternoon.

  He could really do with a holiday someplace warm. Malta, maybe, or Greece. Perhaps he’ll take Amir when he’s finished his exams. They haven’t gone away together in god knows how many years.

  Behind the closed door of his bedroom, Amir is still asleep. Some days they hardly see each other, as if they lived in different time zones. Downstairs, he grabs an overripe banana from the kitchen counter, snaps shut his briefcase, switches off the lights, turns back to refill the cat’s bowls with food and water, and then he’s out and down the steps. He’s on his way.

  The sky is white, the pavement damp. His glasses blur with mist. That blasted digging machine is spewing dirt all over the street. He skirts the workmen in their orange vests and heads toward Finchley Road. He’ll catch the Underground and then the overground south to Kent.

  It would not be so difficult, he thinks as he walks, simply to keep on going, to give up all intention, all conscious will, and hop onto the first train, any train, and let it take you wherever it might go. That’s what happened to people in a fugue state. They forgot themselves. Took off. Jumped tracks.

  There was an outbreak of so-called “fuguers” in late nineteenth-century Europe—young men, mostly, who wandered away on strange, compulsive journeys that took them hundreds or even thousands of miles away from home, from bourgeois villages in France and Germany to Constantinople, Moscow, Sevastopol, Algiers. Les aliénés voyageurs, the French called them. Mad travelers. They’d scrape for money, get arrested for vagrancy, dragged off to hospital, shipped back home. When they finally “awoke” they could not say why or how they’d gotten where they’d been. “Yet another escapade,” one fuguer noted in his diary. “What a calamity.”

  Dissociative fugues were rare but not unheard of these days as well. Fuguers turned up from time to time in railway stations or wandering, disorientated, on nearby streets, unable to give a coherent account of who they were or where they were going or where they’d been. Some were autistic, others suffered from dementia or epilepsy or posttraumatic stress.

  Javad was intrigued by the phenomenon of neurological symptoms that seemed to lack any organic pathology in the brain. Hysteria was the word used by Charcot and Freud. Their patients were mostly women, of course, in whom hysteria tended to present as paralysis rather than as flight.

  It’s all in your head, people always said about conversion disorders, and of course that was exactly right. It was all in the anterior cingulate cortex, in the dorsolateral prefrontal cortex, in the hippocampus, in the medial temporal lobe. It was uncharted territory. They were just beginning to explore it now with functional imaging studies. Slowly, a new map was starting to emerge.

  He crosses Finchley Road and joins the commuters funneling into the entrance to the Tube, a bustle of damp umbrellas and swinging briefcases. He swipes his Oyster card over the pad, pushes through the ticket barrier, and he is on his way.


  The patient is tall and thin, with short, light hair and pasty skin. A twitchy, agitated affect. He cowers on the examination table, bare legs very white beneath the gown, arms crossed tightly over his chest, as if he were trying to fold himself away. He might be Northern European—a Pole or Finn. Early to mid-twenties? Difficult to tell. Javad checks the chart. Normal body weight, normal blood pressure, normal temperature, slightly elevated pulse. He notes the odd, fixed stare. Mild catatonia, perhaps.

  Javad manipulates the patient’s head toward his chest, from side to side. The patient flinches at the touch but gives no sign of pain. Javad shines a penlight in his eyes. The pupils dilate and contract. He moves the light from side to side and the eyes follow. Normal. By miming the action that he requires, he gets the patient to open his mouth and stick out his tongue—soft palate, uvula, pharynx—nothing unusual there. Gag reflex is fine. Taps the tendons of the elbows and knees. All normal. He sets down the reflex hammer and again tries asking a few questions, but the patient does not seem to understand. He demonstrates the Luria sequence with his fist, also to no avail. There is not much else he can do. There is no way to administer a diagnostic questionnaire to a patient who will not speak. He’d be keen to get an MRI. He wonders if he can make a case for that.

  “There we are,” he says out loud. “That wasn’t so bad, was it?” The man’s eyes flick toward him and away, quicksilver as fish. He thinks he catches the tiniest inclination of the head, the faintest intimation of a sign.

  Fuguer or feigner? The difference was a matter of whether or not his symptoms were under his conscious control—and it was nearly impossible to tell. What might the man stand to gain by malingering? Either way, it seemed clear that he was trying to run away from something. Some kind of trauma, presumably. But what? What had caused this break?


  The Little Brook hospital staff have gathered round the conference room table. Motivational posters hang on the walls: a sculler on a lake lit orange by the sun (“Achievement!”), a ring of skydivers holding hands (“Teamwork!”). The room smells of cleaning fluid and cheap cologne. He takes a sip of coffee, vending machine fare in a flimsy plastic cup, which, as always, manages to be simultaneously bitter and weak. Through the sealed windows, he can hear the faint hum of traffic along the motorway. The taxi from the railway station drove him along streets of tidy redbrick cottages, lanes flanked with hedgerows and rosebushes in bloom. Far in the distance, he could see the tops of the high white stanchions of the Queen Elizabeth II Bridge. The white sky was as open as a dome. As always when he left the city, he felt the lightness of escape.

  “I’m afraid that at this stage I can only confirm what I presume you already know,” he tells the assembled group. “We can quite confidently rule out the major organic pathologies—head injury, dementia, encephalitis, Korsakoff’s, and so forth. Epilepsy also seems unlikely given a normal EEG. So we are most likely looking at a psychogenic etiology. And it is well established that nearly all individuals with dissociative symptomology have significant comorbid psychiatric diagnoses, frequently including personality disorders. But I’m afraid it’s impossible to say much more than that without a thorough clinical history and exam.”

  The NHS manager folds his arms. “Which, of course, is precisely what we cannot get, since he will not speak.”

  “The mutism is a bit of a puzzle,” Javad admits. “Aphasia is atypical in dissociative disorders, although it does sometimes present with severe anxiety or posttraumatic stress—rather more commonly in children than adults. There’s no apparent evidence of vocal cord damage or paralysis. Of course, one would need to do a scope to see if his voice box has been damaged, and a scan would be necessary to rule out lesions or a tumor in the brain.” Without permission, he knows, they could run neither of those tests.

  “What about autism?” one of the social workers says.

  “It’s a possibility, certainly,” Javad says. “As I’m sure you know, the resistance to close contact and that sort of flat affect are quite common in individuals on the spectrum.”

  “But what about the piano playing?” another of the social workers says. “How is that possible if he can’t even remember who he is?”

  “Musical ability is often preserved in both organic and dissociative forms of amnesia,” Javad says.

  One of the consultants, a turbaned Sikh, frowns and says, “Quite right.”

  All they could do was speculate. Perhaps he was yet another illegal immigrant—an asylum seeker who’d jumped off a passing ship. Perhaps he’d be
en pushed into the sea by ruthless smugglers or the Russian mob. Or perhaps he really was a brilliant pianist who had fled a disastrous performance or some other personal calamity and tried to drown himself in grief.

  Javad says, “Are there no reports of anyone fitting his description gone missing?”

  The unit manager shakes his head. “Not as of yet.”

  He had to belong to someone, Javad thinks. Everyone belonged to someone; nobody was truly singular, alone. Eventually someone—a mother, father, sibling, neighbor, lover—would have to notice that he had disappeared.

  Around the table, people begin closing their files, gathering cups and papers. The unit manager stands and extends his hand. “This has been quite helpful, Dr. Asghari. Thank you very much indeed.”


  At home, Amir is hunched over his laptop at the kitchen table, earphones in. Javad touches his shoulder and Amir pulls out one earpiece, tilting his head.

  “Grub’s on, mate.” Javad sets the carrier bag of Chinese takeaway onto the counter. “Clear away your things. Let’s eat.”

  Amir pulls out the earphones and shuts the laptop. There’s a sticker of the high-voltage warning sign on the laptop’s cover, a yellow triangle outlined in black enclosing a jagged arrow pointing down: DANGER. KEEP OUT. What secrets did he hide in there? Javad thinks of the patient down in Little Brook and what his parents knew, or didn’t know, before he disappeared.

  “Are you ready for your exams?” Javad pries the lids off the containers and pokes spoons into the food and sets them on the table.

  Amir shrugs. “I guess.”

  “This one’s prawns, the other’s beef.” He spoons some of the prawn lo mein onto his plate and pushes the container over to Amir. “So. I was thinking.”

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