Unlocking the Enigma of a Lifelong Patient: A Doctor's Quest to Save a Soul

“'It's no use going back to yesterday. I was a different person then.'”
-Lewis Carroll, "Alice's Adventures in Wonderland"

***

"I know people are afraid of me," Lily said. "And I understand why. So I won't take it personally if you prefer not to work with me directly."

Ashe's pen scratched across her notebook. She looked up only occasionally. The room was blank, white, antiseptic, marked only by the dull sheen of the one-way mirror. Lily wore a hospital gown; it was the smallest size the clinic had but it hung off her like a sail. She had electric blue eyes and shiny copper hair and freckles and looked exactly like a ragdoll. She toyed with a loose thread while she talked.

"I'm just saying that if you want to talk with me through the glass partition or even through my cell window, that's all right," Lily continued. "You won't hurt my feelings. Most of the doctors don't like being in the same room with me. Some of them don't even like to look at me on the monitors."

"How does that make you feel?" Ashe said.

"It's okay," Lily said. Her voice brimmed with geniality. "I wouldn't want to be around someone like me either."

"What do you mean 'someone like you'?" The pen scratched some more.

"Don't you know?" Lily said. "You must know, since you read my file, and anyway, everyone knows." She smiled; it was a tiny, beautiful, completely sincere gesture.

"I'm a monster," she said.

***

Ashe rewound the video and played it a second time. The director of medicine sat at her desk on the other side of the office and the assistant director (who, like Ashe, was new, having arrived that very morning) hovered over her.

"My God," he said, "she's as bad of a mess as everyone says."

Ashe ignored him, focusing on the recording.

"Who was the first person to use that word with you: 'monster'?" she heard herself say.

"My mother," Lily's voice said. "Or maybe my father? It had to be one of them. I'm sure it's in the file."

"Where are your parents now?"

"Papa hung himself. That's when I was…" On the video she furrowed her brow, tugging one ruby-red lip in thought. "Five. Yes, five years old. And then Mama brought me here. She's dead now too."

"Lily, do you think you're dangerous?"

"Oh yes."

"Have you ever killed anyone?"

"Goodness gracious, no!"

"Ever hurt anyone?"

"Of course not. And I never would. Oh no. The very thought!"

"But you still say you're dangerous?"

"Terribly dangerous. Nobody should even come near me." She sounded somehow pleased. Ashe turned the tape off. She finished making notes before turning to the director.

"How long has she been like this?" Ashe said.

"All her life. All her life here, anyway, which is all the life she really ever had," the director said. "Her parents were terrified of her. I really think they might have killed her if we hadn't agreed to commit her here full-time. It was that bad."

"What were they frightened of?"

"They never would say. They just called her a monster."

"Did anyone ever suggest treating them instead of her?" asked the AD.

"Of course. We had spectacular arguments over it and they were under investigation from the child welfare services. Then they died and settled the matter."

Ashe fanned herself with Lily's file. It was almost too thick to hold. "And in fifteen years she's had how many primary physicians?"

"At least a dozen," the director said. "Most of them don't last a year. It's a troubling case. It takes a heavy toll."

"I've talked to the clinic staff and what she says is true," the AD chimed in. "Most of them don't even like being around her. She makes them…uncomfortable."

"And how does she make you feel?" Ashe asked.

The AD squirmed.

"That's why you're here," the director said. She moved to the window and her view of clinic's western wing, where Lily lived. "I've spent my entire career looking for someone who can get through to her. If you can do that…well, I suppose that would just about be a miracle."

She closed the blinds.

"And for a miracle worker, a lot of doors can open up. A lot of things that, under normal circumstances, couldn't be done, would suddenly become quite a bit more…" She hesitated. The AD chimed in:

"Plausible."

Ashe felt a little thrill. She gathered up her notes, and the file, and the tapes.

"Our facilities are entirely at your disposal," the director said. "You're here as an outside specialist, which means you report to me and no one else. The only things we can't give you access to are the notes left by Lily's previous primaries. We had an agreement with each of them."

"But how will I treat her without knowing her full case history?"

"If we see you pursuing a dead end we'll notify you. Lily's case is sensitive. Every treating physician needs to feel they have complete freedom to try unorthodox methods. A privilege you'll enjoy now, too."

"I…understand," Ashe said. "And I want to say--"

"Save it," said the director. Then, perhaps seeing how startled Ashe was, her voice softened a bit. "I meant, save it for later. After you've worked with her for a while you might find that you don’t want to thank me." And she ushered Ashe out with a handshake and an oddly solemn "Thank you."

Ashe and the AD shared an awkward elevator ride down together. He tried to make small talk. It wasn't much of an effort. The clinic couldn't set Ashe up with quarters on the grounds, so instead they found her an apartment on the outskirts of the city, a 45-minute drive. Everything was still in boxes but she didn't bother to unpack, or even to eat (although she was famished) before playing the tapes again. This time she read back her notes from the interview as the tape ran, to assess her own reactions.

"Have you had a lot of doctors?" Ashe said on the tape.

"How many is a lot?" Lily said.

"Did you like your other doctors?"

"I liked Dr. Benway. He was very kind," Lily said. "But he's not here anymore."

Here Ashe had put her notebook away. "Lily, there's something I want you to know, and I'm telling you because I think we should both be completely honest with one another."

Lily folded her hands in her lap and looked attentive.

"You should know that I'm not a real doctor. I've had all the schooling but I could never pass the final examinations. The clinic brought me in to work with you because some of my university work made them think I might be able to help. It's a special arrangement."

"That's kind of you," Lily said. "And if you help me, will they let you become a real doctor?"

Ashe paused. "Yes," she said. "But that's not the reason I'm here. I'm here because I really care about your case."

"You're very sweet," Lily said, and she gave a full smile now, a bright, dazzling, 50-watt movie star-style smile. "Can I still call you Dr. Ashe?"

"If you want to. As long as you know it's not true."

Lily leaned in a little. "It'll be our little secret," she said. And she giggled.

***

Lily's Diary, Day 1:

Dr. Ashe asked me to write things in this book every day. She says that she will not read it, and that neither will anyone else, but I do not understand why you would ever write words that no one was going to read. I think if you leave words around someone is bound to read them sooner or later. But I will do what Dr. Ashe asks. I do not think my doctor would ever tell me to do something that was not good for me.

I do not know what to write in a message to no one. Dr. Ashe said I should think of it as a message to myself, but what can I write that I do not already know? Dr. Ashe does not seem like the other doctors I have had. She says that she cannot help me, but she can teach me to help myself. She said that, with things like this book, she can teach me how to know everything about myself.

I do not think it would be good to know everything about myself. I think the idea is scary.

Dr. Ashe said that I should write my dreams. I do not have dreams. But I know that a dream can also mean a wish, so I wish that Dr. Ashe will find a way to help me before she has to stop being my doctor, like all the others.

***

Another awkward elevator ride with the AD. He had walked her to her car the previous night and asked her to dinner, and Ashe had said no. Now he said nothing except a polite "Good morning." He checked his phone twice in the time it took to pass four floors.

"Is she waiting for me?" Ashe said.

"Everything is the way you wanted," the AD said.

"Thank you," Ashe said, and was surprised to see him blush.

Lily was in the same interview room they'd met in yesterday. A guard was posted at the door, and she knew two others would observe from behind the mirror. Lily always had three guards at all times, though Ashe did not know why. It was related to one of her previous doctors, and therefore the details were off-limits. The clinic staff considered guarding Lily the least desirable assignment, even worse than toilet duty.

Lily sat with hands folded, waiting. When she saw Ashe she lit up with another movie-star smile. She never blinks, Ashe realized. She suspected that if she watched the previous day's tapes very closely she would find that Lily blinked only once every two minutes, maybe less. Ashe sat. It was impossible to get comfortable in these chairs, but they didn't seem to give Lily any trouble. Maybe after a lifetime you can get used to anything, she thought.

"We're going to have a little talk," she said. "You can think of it as a kind of game." Lily was attentive. "I'm going to ask you some questions about what you think you might do in the situation I describe, and you should answer honestly and as fast as you can. Do you understand?"

Lily nodded; her bangs bounced.

'All right: If you saw a homeless person on the street--"

"Oh, I wouldn’t be on the street," Lily said.

"But if you were?"

"I wouldn't be."

"Why not?"

"It's too dangerous. For everyone else."

Ashe pondered for a moment. "Pretend that it wasn't. Pretend that everyone else in the world was like you."

"You mean…everyone would be a monster?"

Ashe flinched at the word but let it slide, "Yes. Imagine that's true for all of these."

Lily looked as if this were a lot for her to take in, but she nodded again.

"Imagine someone on the street asks you for money because he can't eat. Would you give it to him?"

"Why would he have to eat?"

"People get hungry."

"I don't. And you said everyone was like me in these questions."

"You would get hungry if the clinic ever forgot to feed you."

"I don't eat. Ever."

Ashe paused. She leafed through the file. There was a section at

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THE END