Dr Brown
Early in his career, Dr Brown had given up trying to cure any of his patients. The more he observed them, the more he doubted that they even wanted to be cured. Eventually he came to wonder whether they even knew that there was anything wrong with them.
He couldn’t deny that there were moments of distress. As his patients paced the room or sat and stared at the window, it would have been easy to describe them as living in worlds of their own. But in truth they did not have that luxury, and the real world impinged continuously upon them. Even small perturbations in the routine of their lives — the movement of favourite object out of its place, a loud and sudden noise, or an unexpected touch — could leave them in a state of obvious anguish. But there were also moments of joy, behaviours which brought them evident happiness, and the clear satisfaction they got from doing their own thing with diligence, whenever the world would let them.
Dr Brown couldn’t change the intrusive world that his patients were forced to live in, but within his small clinic he could provide them with a measure of respite from it. His eleven years of training had taught him a little about how to handle such patients, but most of what he knew came from simple observation. Most patients produced very few comprehensible words, and their grasp of signs and body language was similarly limited, but there was a certain understanding, a degree of unspoken communication, between Dr Brown and those in his care. By watching his patients for long enough he could work out exactly what upset them, and what they seemed to enjoy. He was careful never to raise his voice, for example, instead watching his patients in silence or simply muttering in a low murmur, much like his patients themselves did.
Dr Brown’s clinic had beds for up to a dozen, but was typically home to only five or six inpatients at any one time. There were also regular visits from outpatients who were cared for at home. Younger patients were dropped off at the clinic by their carers; older ones often turned up on their own. Appointments were never made in advance, but his patients’ love of routine allowed Dr Brown to predict a good number of their visits.
Christmas and other holidays were particularly busy times. Socialising in the normal way at these times was impossible for such patients, and in spite of their mental isolation, they didn’t like to be alone. So they would turn up at the clinic, sometimes at night, unsuitably dressed and shivering in the cold. Occasionally they came clutching bottles in their hands. Dr Brown had wondered at first at the wisdom of whoever had allowed these vulnerable people access to alcohol, but it seemed to cause them little harm. The drink did nothing to improve his patients’ communication skills, but it made them a little less withdrawn around the other patients, and in any case, once a patient had got hold of a bottle it would have been difficult to take it away again. Dr Brown knew how much it upset the patients if he tried to prise things from their hands. If a patient chose to pick an object up, however random or dangerous the object, in the patient’s mind it was a prop in a careful routine, and it would have been negligent not to allow the routine to be acted out to completion.
In his consulting room, Dr Brown would sit in his old chair, his head propped thoughtfully on one hand, appearing to be looking in another direction while remaining precisely aware of what the patient on the couch opposite was doing. Some would stare downwards and babble to themselves, often holding their hands to their faces. Others would sit in silence and stare out of the window. The tiny window in the corner of the consulting room had particularly good views, and some patients would look out of it for hours, as if relishing the opportunity to access the outside world in a safely packaged form.
Sometimes a patient would pick up one of the things in the consulting room and turn it over in his hands, examining it thoughtfully. Shiny or intricately-patterned objects attracted a particular fascination, and patients could contemplate them for a long time. Anything with an incomplete or irregular pattern seemed to bother them, and they would glare at the offending design as if sketching in their heads how the perfect pattern would go. Sometimes Dr Brown would even catch them tracing the missing pattern with their fingers. After suitable contemplation, the patient would put the object down again, usually in the precise spot where it had been found. Dr Brown had no need to tidy his consulting room: his patients did it for him, and indeed if he tried to rearrange the room, the patients would notice and indignantly try to move each ornament and piece of furniture back into its original and proper position.
Clocks were an obsession. Those patients who didn’t have wristwatches would pay continuous attention to the big clock in the reception area, visibly agitated if they looked away too long and found its big hands in an unexpected position. Inpatients also had clocks in their rooms, and synchronised them very precisely with the reception clock. All but the most incapacitated patients knew how to adjust a clock, and they did so with more care than almost any other task of which they were capable. Having set their clocks, patients would follow them with religious fervour, refusing to perform even simple tasks unless the position of the clock was suitably auspicious.
Hygiene was another concern. Food had to come wrapped in sterile layers of plastic and foil — patients would not touch it otherwise — and once unwrapped it could be touched only with the very cleanest of implements, and handled only by the patient whose food it was. Hands were washed endlessly. Dr Brown kept his distance from his patients when they were eating. They would glare at him suspiciously if he came too close, seemingly concerned that he might break one of their careful rules and thus contaminate their dinner. Dr Brown had been well trained in hygiene, of course, but this was one of a number of points on which even his most long-standing patients had never quite seemed to trust him. At first this lack of trust had upset him — winning complete and absolute trust had been his goal. Yet he eventually came to realise that his patients would trust only what was predictable and unchanging, an impossible standard for him to meet. Although he may not have been able to cure them, Dr Brown did aspire to make his patients’ lives better, and this in itself amounted to a change. Only by sacrificing his patients’ trust, to a carefully measured degree, could he ever have helped them.
Most of all, Dr Brown’s patients did not like to be touched. At least, that was the received wisdom. However, Dr Brown had spent enough time among them to appreciate that they did have a desire for warmth and contact, but simply lacked the mechanism, and shied away from exposing themselves closely to something so unpredictable as another being. Certainly, Dr Brown would never have touched a patient without warning. Yet there were times when patients themselves reached out for contact — a hand on the shoulder, perhaps, or a tap on the back, a stereotyped movement, one simultaneously forced and yet deeply felt. Patients groped for contact with the air of those pulling a lever that they had seen others pull, hoping the machine would produce the same entertainment for them but always ready to withdraw in a jump if it did otherwise. Having tapped Dr Brown once on the shoulder or back, and found no unpleasant reaction, a patient might do it repeatedly. Occasionally these experimental, groping touches would land on other parts of Dr Brown’s body, including delicate parts such as his face. He tried not to shy away from this, unwilling to discourage any attempt at contact, but they noticed the involuntary flinch, and never did it again. Despite their usual difficulties with body language, his patients could recognise behaviours that mirrored their own. Whether this constituted a capacity for empathy was something Dr Brown had thought about at length. He feared that it might be merely another manifestation of their endless ability for reflection and repetition, but he wanted to believe that on some level, deep beneath the stereotyped aversions, his patients had the ability to care.
As Dr Brown grew older and the tufts of hair on his chin turned grey, only one thing truly concerned him: what would become of his patients after he retired. Another doctor could be found to look after the clinic, but it would be hard to find anyone with such experience, or such dedication to the patients’ care. And of course, his patients did not react well to change.
As the date of Dr Brown’s retirement approached, he felt sure that his patients were thinking about this too. There was a sense of it in their eyes when they looked at him, a subtle expression of something they could never have put together the words to express. It wasn’t fear, nor foreboding, and it took Dr Brown a while to realise what the emotion was: his patients felt sorry for him. As far as these self-absorbed individuals were concerned, they were the only meaningful things in the entire world, and for Dr Brown to lose them was to lose everything. Yet the very fact that his patients now seemed capable of showing concern for another being struck Dr Brown as a remarkable sign of progress. Thus was a shadow in his patients’ eyes transformed in Dr Brown’s mind into a profound vindication of his work, an endorsement of his care. So pleased was he that he never stopped to reflect that when his patients assumed that they were his entire life, this was nothing but the truth.
Dr Brown had devoted everything to his patients’ care, and his only reward from them was a sympathetic look. Which was more than he had ever hoped for.
When Dr Brown retired, his patients buried him under a tree at the end of the garden. They carved his name onto the bark of the tree, and spoke fine words about what a caring and loyal companion he had been. They laid him in the hole with his head resting on one paw and his tail curled to one side, the same way he had sat when watching them from his favourite spot on the old chair in the sitting room. It comforted them to see him that way.