Charcot's Genius Read online

  CHARCOT’S

  GENIUS

  M.C. SOUTTER

  Copyright © 2011 M.C. Soutter

  For Lynne

  We are in strange waters here, where all the usual considerations may be reversed – where illness may be wellness, and normality illness, where excitement may be either bondage or release, and where reality may lie in ebriety, not sobriety.

  - Oliver Sacks

  The Man Who Mistook His Wife for a Hat

  Contents

  Chapter 1 – One Kind of Genius: Kline

  Chapter 2 – Another Kind: Melissa

  Chapter 3 – Kline’s Problems

  Chapter 4 – Melissa

  Chapter 5 – Kline’s Plans

  Chapter 6 – Melissa

  Chapter 7 – Students

  Chapter 8 – Kline’s First Kill

  Chapter 9 – Kline’s Escape

  Chapter 10 – Kline’s List

  Chapter 11 – Melissa’s Professor

  Chapter 12 – Modifications

  Chapter 13 – Complications

  Chapter 14 – Grim Research

  Chapter 15 – Meltdown

  Chapter 16 – Fathers

  Chapter 17 – The Other Teacher

  Chapter 18 – Together

  Chapter 19 – Begin Again

  Chapter 20 – Melissa

  Chapter 21 – Kline

  One Kind of Genius: Kline

  1

  They took hold of him, and they didn’t let him up. There were too many hands for him to break free, and he was weak from the treatments.

  “There won’t be any more of that,” said a voice somewhere behind him. The voice was stern. “Put him under.” A pause. “Don’t look him in the eye, you idiot. And check your nose plug – it’s slipping.”

  “Sorry.” Another voice, more hesitant. “But do you think he meant to – ”

  “I said put him under.” Real anger now. “Or would you like to be in charge?”

  Silence.

  There was a tug at his catheter line, and a few seconds later he felt his eyes grow heavy. He might have struggled, but he couldn’t think of a reason why he should bother. As his eyes closed, he hoped they had given him enough to kill him.

  All things considered, it probably would have been for the best.

  2

  The selections below are taken from Getting to Know Patient Nathan, by Dr. John Levoir. They are reprinted here, and in later chapters, with permission from the author.

  Dr. Levoir published his essays fully two years after the incidents at Dartmouth had already occurred, but these writings are still the only confirmed, first-hand accounts of Dr. Nathan Kline and his strange condition. Reliable testimony from other sources has proven difficult to obtain. Dozens of enthusiastic “witnesses,” all of whom claim to have encountered Kline in the weeks before his death, have given descriptions that are both logically inconsistent and medically implausible.

  The few players best suited to accurately describe Dr. Kline’s behavior are either unavailable or unwilling to comment.

  Most of them, of course, are dead.

  From Getting to Know Patient Nathan:

  Everything about Nathan Kline’s stay at our facility was irregular, even his arrival. A psychiatrist from the state ward in Concord, New Hampshire, brought his notes to our clinic personally. This surprised me. We are a small, privately run facility just outside of Boston, and we receive most of our transfer data by fax or mail. Sometimes we get nothing but the patient and a set of dirty linens. But the state psychiatrist was intent on making his delivery by hand. He caught me in the main hallway, where I was returning from my early morning rounds. He was very direct.

  “Are you Dr. Levoir?”

  I nodded.

  “These are for you.” He thrust a stack of folders at me. “From the N.H.S. facility.”

  “Thank you. And you are – ?”

  “What?” He stepped back, as if trying to put space between himself and that pile of notes. “Oh. Bjorn Larsen.” He looked up at me then, but only for a moment. His blue eyes were unsteady.

  “I think I saw your name in the papers,” I said, trying to make conversation. “From the trial, right? That must have been something.”

  “Why?” he said quickly. “What do you mean?”

  I shrugged. “Testifying in a murder case. I’ve never been called up for one.”

  “Waste of time,” he said.

  “How so?”

  Larsen sighed. “What does a jury know about psychiatry? Or neurology, for that matter? They don’t want to hear a real diagnosis. I start talking about behavioral disorders, treatment options, and they start falling asleep. No one can handle any big words. No actual terminology. It has to be either, ‘He’s perfectly normal,’ or ‘He’s completely crazy.’ ”

  I nodded and gave him my supportive face. I am the senior attending neurologist at Clancy Hall, and this face is one of my specialties. Yes, I understand, the supportive face says. And I want to hear more.

  It was a look I usually reserved for my patients.

  “You know what else kills me?” Larsen was saying. “Half of the jurors were probably taking one kind of drug or another – anxiety meds, some SSRIs – but none of them cared about Kline’s ’scripts. He was the defendant, for Christ’s sake. They should’ve wanted to know what he was taking. But everyone looked at me as if I was making excuses for him. He’s the one who killed a lab tech, not me.”

  I kept quiet for a minute. Larsen was agitated and defensive, as if someone had accused him of a crime. He struck me as jumpy, especially for someone in the business of treating psych patients. To change the subject, I said, “Speaking of medications, could you tell me what you’ve been prescribing for him?”

  Larsen nodded. “We started him with a standard antipsychotic. Risperidone. But it caused side effects I’ve never seen. Delusions, increased paranoia. Claimed we were poisoning him. So I tried haloperidol. But that was even worse. Strange reactions.”

  I stared at him. Larsen wasn’t making any sense. Risperidone didn’t create schizophrenic symptoms; it treated them. “So it didn’t work?”

  The psychiatrist smiled sourly. “Oh, it worked. For an hour after each dose, he was the model patient.”

  “And then what?”

  “Everything changed. Look.” Larsen put his hands up as though he were showing me how to hang a picture frame on the wall. “Let’s say he’s hearing voices in his head. So we start him with the risperidone. It kicks in fine, just like you’d expect. But an hour later, he’s fully manic. He’s chatting up the nurses like he’s looking for a date.”

  “Manic? So he’s bipolar?”

  Larsen pointed at me eagerly. “Right, that’s what I thought, too. Bipolar. So we hit him with divalproex, which was great. Worked like a charm, and he settled down. He left the nurses alone. But another hour goes by, and he’s totally incoherent, claiming his left leg doesn’t belong to him.”

  I blinked. “He said it didn’t belong?”

  “Yup. He called it a disgusting, dead piece of flesh. Accused me of attaching it to his body while he was sleeping.”

  “But what could be causing so many different – ?”

  “It didn’t stop there,” Larsen interrupted. “After a while, he came full circle. He was hearing voices again.”

  “He started over?”

  “Exactly. He was a regular schizophrenic again.”

  “What about the risperidone?”

  “It wore off.”

  I shook my head, wondering if I had misheard. A dose of risperidone doesn’t just wear off, like some over-the-counter cold medicine. It takes hours. “What are you talking about?”

  Larsen shrugged. “It was as if he never took
it. We tried upping the dosage a quarter milligram, which worked beautifully until his next round, when he was just as bad again.”

  “And the cycling from one symptom to another? Is that why…?”

  Larsen nodded, anticipating me. “That’s why he’s been on so many different kinds of medication. I can’t get him pinned down. He’s ten different psych patients wrapped into one.”

  I studied Larsen for a second. “He’d make an interesting case-study,” I said. “Don’t you want to keep him for yourself?”

  The doctor shifted his weight, suddenly nervous again. “Ordinarily, yes. All my interns want me to stick with him.”

  “It’s what I would do.”

  “I know – he’s a career-maker. I could be the first to describe the pathology. It’s just…” He hesitated.

  “Just what?”

  “Kline gives me the creeps.”

  I almost laughed out loud. The creeps? Larsen couldn’t be serious. State employees overseeing psychiatric prison wards didn’t get the creeps. You were cured of that sort of thing during your first semester at med school, in Gross Anatomy.

  I clamped my mouth shut and tried to show him the supportive face again. “Perfectly understandable,” I said mildly, when I had brought myself under control. “I have a number of patients who rub me the wrong way.”

  “That’s not it,” he said, shaking his head with dismay. “He catches me off-guard. His pathology is too unpredictable.”

  “Not surprising. Patients with severe schizophrenia can display dramatic – ”

  “Please, Dr. Levoir.” Larsen looked insulted. “Don’t give me a psych lecture. I know the pathology of a schizophrenic.”

  “Of course,” I said gently. “Of course you do.”

  “And Kline is not that simple.”

  “Apparently not.”

  Larsen ran a hand through his thinning blond hair and sighed. His face relaxed. “Anyway, now you have all my notes. Maybe someday you can write that case-study. Oh, and be sure to ask him about Charcot’s Postulate. He claims to have found a way to prove it, you know.”

  That got my attention. I knew a little about Kline from the stories in the paper, and he had been a respectable neurologist before his meltdown. Before the murder. But respectable was one thing, and proving Charcot’s so-called Genius Postulate was something else altogether. “No one’s made that claim in almost fifty years,” I said. “The last time I even heard Charcot’s name was in med school.”

  Larsen nodded. “I know, but you should hear him talk. He really believes in the thing.”

  I grinned. Maybe I had been too conservative before. Kline was starting to sound like the ultimate case study. The man would keep me busy for months, if not years. Imagine, someone who actually thought the Postulate was real.

  Larsen said, “Any other questions?” and began inching backwards as if I might grab him and have him locked in a room with one of my patients. “You can always reach me through the state institution if you think of anything later,” he said.

  “One more,” I said quickly. “After all that switching around, what’s he taking right now?”

  “Ah.” Larsen stopped and looked at the floor. He hitched up his belt and put his hands on his hips. I have been in the business of reading emotions for nearly half my life, and some are easier to spot than others. Larsen looked like a seven-year-old who had been caught in the act of taking money from his father’s wallet.

  “Actually,” he said, still fiddling with his belt, “he’s been on a course of thorazine and Xanax for the last several months.”

  I relaxed. “That sounds reasonable. If it’s effective, then by all means – ”

  “At two thousand mill and ten mill per day,” Larsen added quietly.

  I was too shocked to control my reaction. “A day? The Xanax is high, but the thorazine… two thousand every twenty-four hours… you could be inducing seizures with that dose. What were you thinking?”

  “Me?” Larsen was suddenly indignant. “Try taking him off it. You’ll see soon enough.” He looked up at me then, and there was something new in his eyes. Something that looked like desperation. “He’s not normal.”

  I was furious on behalf of my new patient, but I took a minute to slow my breathing. “I thought you testified that Kline wasn’t crazy.”

  “I did. But it’s always more complicated.” Larsen looked away. “Eventually you’ll agree with me.”

  “The doses you’ve prescribed are ludicrous. I’m surprised he’s still alive.”

  Larsen shook his head. He faced me again, and his expression was now strangely calm. Those blue eyes were finally steady, and the defensiveness I had seen before was gone. “Not this one,” he said. “You don’t understand the whole picture.”

  “Paint it for me.”

  His face went dark. “I don’t think so.”

  And that was it. Suddenly the conversation was over. He turned to go, this time with conviction. “I’ve given you everything I have,” he said over his shoulder. “If you want to change the medication I prescribed, go ahead. You’re his physician now.”

  I watched him hurry through the sign-out, property-return, and security search procedures at the exit. His step was already lighter. He moved like a high school senior leaving for summer vacation. The guard at the watch station unlocked the gate for him, and Larsen didn’t look back.

  3

  Kline’s former partner, Professor Frederick Carlisle, was having breakfast at Lou’s Bakery in Hanover when he saw the story in the Globe. It was on page two of the City/Region section. The bold print said that an orderly in the state ward down in Concord had been severely injured.

  The professor wiped the crumbs from his yellow cardigan, put his glazed doughnut to one side, and read the story line by line. Most of the article focused on the orderly’s injuries and expected recovery. There was an interview with the man’s mother, who related an endless anecdote about her son’s brave boyhood encounter with a rabid dog. Few details were included about the incident itself or the person who had caused it; the reporter mentioned only that the orderly “had been attacked by one of the patients in the ward, who was being transferred to another facility immediately.”

  What about the name, Carlisle thought angrily. Can’t you give me the name of the patient?

  No.

  No name. And there were no descriptions of the circumstances surrounding the incident, either. It was impossible to tell whether the orderly had simply made a mistake, or if the patient had been improperly medicated, or anything at all.

  Some patients, Carlisle thought, have reasons for wanting to hurt people. Or for wanting to escape.

  Carlisle put the paper down. The story had not been written very well, he decided. After staring out the restaurant window for a moment, he sighed and returned to his breakfast. Main Street in Hanover, New Hampshire, was so peaceful, so comfortingly ordinary with its white clapboard storefronts and Dartmouth students everywhere, that it was easy to feel safe.

  It doesn’t mean anything, he told himself. It’s probably not Kline.

  He would keep an eye on the papers, both here in New Hampshire and in Boston. But he wouldn’t let himself become overly distracted. There was no sense in getting worried.

  Another Kind: Melissa

  1

  From Growing Up Fast, by Melissa Hartman. Reprinted with permission.

  I never had a chance with my father. When I was older – much older – people who knew him well told me stories about what a “man’s man” he was. About how he would shout at women he didn’t think were dressed properly. About the way he would get after a night at the bar. That was when he would go looking for women he called the tramps. “Let’s go teach the tramps a thing or two,” he would say, tossing his empty beer bottle into an alley.

  On the quiet nights, when he couldn’t find anyone suitable, he would conveniently decide that my mother was one of those tramps. She often needed to be taught a thing or two, it seemed.
That she was his wife seemed to make no difference.

  These people who knew my father, they told me that when they found out Martin Hartman had had a baby girl, they thought it was the best thing they had ever heard. Maybe, these people said, Martin would be changing his mind about a few things.

  I told these people that maybe they didn’t know my father so well after all.

  2

  With his first baby on the way, Martin Hartman was in a good mood. He had not been to a bar in weeks, and on some days his wife, Janet, could see the man she had married three years ago. His short black hair seemed neat, rather than severe. The faded tattoos on his thick arms suggested protection, rather than abuse. He was home most evenings, spending his free time in the spare bedroom. “Setting up the little guy’s home plate,” was how he described it. He put up posters of Joe Montana and Wayne Gretzky. He lined the shelves with books about baseball and soccer. He went out and bought a set of NASCAR bed sheets.

  “Oh, Martin,” Janet said. “The baby won’t be sleeping in a bed for months.”

  “We want the whole room to be ready, don’t we?” He beamed at her. “Every detail should be right for him.”

  She smiled in spite of herself. “Martin,” she said softly, “what if it’s a girl? Are you going to go out and buy a few pink things, a dollhouse just in case? Not that girls don’t like sports,” she added quickly. “But still.”

  For Janet Hartman, asking such questions constituted a rare show of bravery.

  Martin looked up sharply at his wife, and he scowled. It was an expression Janet knew too well, and for a second she thought he was going to come at her. He would start shouting, and before she knew it, she would be pinned in a corner. She would cover her face with one arm, her breasts with the other…