Black Water

CHAPTER EIGHTEEN

Dr. John Stebbins welcomed them into a small office in an old building behind the UCI Medical Center. A floor fan worked diligently from one corner but it couldn't break the heat. The floors were old and wooden and Merci could hear footsteps and voices from the hallway outside.

Stebbins wore a white doctor's coat like the last time Merci had seen him, but a considerably more relaxed expression.

"I apologize for last time," he said. "I… when you have a bad day in my profession, it's, ah…"

"People die," said Merci.

"Yes. Thank you. Same as yours, in some ways."

"I haven't cured anybody recently," Merci said. "And we're sorry that Deputy Wildcraft decided to check himself out. He didn't consult us and we can't keep him here or anywhere else for more than forty-eight hours unless we arrest him."

"I'm concerned. The edema could easily increase. Infection is possible. If a cranial vein leaks or breaks, the resulting hematoma would be fatal. And besides this organic damage he's sustained, well, I'm not sure if he's capable of taking care of himself. Whether he can remember to take care of himself."

"I'm not either," said Merci.

"Have you seen him?"

"Three hours ago. He seemed a little slower, mentally. Said he was tired, not thinking straight. He said he'd check himself back in this afternoon."

"He hasn't."

"What's going on inside that mind of his, Doctor?"

Stebbins shook his head and sighed. He leaned back from a desk cluttered with papers. The fan oscillated his way and the corners lifted like spectators watching a home run.

"It's easiest to show you."

He rolled back on his chair and stood. Behind his desk was a wall mounted x-ray screen that he flicked on with a toggle. Archie Wildcraft's x rays were already in. Dr. Stebbins darted a red laser pointer across the image, stopping it suddenly on the outside of the skull.

Merci was startled by the dark chaos that the bullet had brought to Archie's brain. A shadow the shape of a tornado issued from high on the right side, with the narrow funnel touching ground near the bottom of the skull. Around the tornado was a border of pale gray.

"This is Archie's right hemisphere. The bullet entered here, resulting in the darker hematoma you see. You can see the bone fissure, and the way the blood vessels of the pia mater have hemorrhaged. It's hard to say whether the bullet's path was altered by the skull, or if it was fired from the corresponding angle, but you can see that it traveled downward and lodged here, beside the foramen magnum-that's the opening in the skull where the spinal cord exits. It missed the vein of Galen, which lie in this large triangular fold in the pia mater known as the velum interpositum. It missed the major cranial nerves-the vagas, optic, trigeminal, etcetera. It missed the internal capsule of the brain itself, which controls motor function."

Dr. Stebbins frowned at the x ray. Then he looked at Merci and Zamorra. "Unfortunately, it did not miss the right amygdala. You can see the largest part of the bullet right here, about two inches in from the ear."

"What's it do?" asked Merci.

"In a male, the right amygdala processes the emotion of memory. Not the memory itself, but the feeling surrounding the memory. In women, it's the left."

"He has no emotions attached to his memories?"

"His recent memories. And to memories that he's now attempting to construct-every waking moment-with the fragment lodged in his amygdala. His long-term memories will begin to lose their emotional content, also. They're stored elsewhere in the brain, but when the links connecting present and past emotion are destroyed, recognition fails along with reproduction and retrieval."

"Meaning what?" asked Merci.

"His recent memories will be fragmented and incomplete, and he'll have little emotion attached. His long-term memory will weaken, in terms of clarity and emotional content."

Stebbins circled his red dot, then it vanished.

"So, if he can't form emotions as he experiences things, he'll be detached from what those things mean to him," said Zamorra.

"Yes."

"Like a zombie?" asked Merci.

Stebbins smiled.

Rayborn smiled back, lifting her eyebrows. "Look, I'm a cop, not a brain surgeon."

"No, your idea was workable. Just the language was amusing. But to answer your question, he's going to be detached from the emotional components of his recent past. Confused, too, because the emotional weight of memory is what we use to form our ideas of right and wrong, good and bad. Of what is threatening or loving. Dangerous or benign."

"He's got no emotional rudder," said Zamorra.

"No recent emotional rudder," said Stebbins, circling the x ray of Archie's amygdala once again. "He's only got his past to go on."

"But that's going away, too," said Rayborn. "Because there's nothing new for it to connect with, to keep it… living."

Stebbins nodded. "Of course, a certain amount of healing is possible. If the edema subsides and the pressure is lowered, we can expect some of his short-term memory to return. Whether or not the damaged amygdala will still be able to supply him with appropriate emotions again, I can't say."

"Will some parts of his brain be ruined forever?" asked Merci.

"Changed forever," said Stebbins. "He's lucky to be alive."

Merci wondered at the angle, the way the bullet went down through Wildcraft's brain, rather than across it. She wondered how tall Size Sixteen was, and thought about the light that Archie had remember just that morning, and how he said it came from above him.

"That's just the amygdala," said Merci. "What other physical damage does he have?"

"Impossible to say without more tests and observation. Certain the swelling here, near the optic nerve, might give him focus and depth-perception problems. Maybe his colors are dulled or transposed or exaggerated. Seizures are possible-mostly the smaller, focal seizures, but also some general convulsions. Seizures are caused by pressure and pressure is caused by swelling. The skull has very little give in it. There's also a chance that he won't feel crude pain or light touch as quickly and specifically as before, because of a small fragment against his thalamus."

"He seems to have forgotten a lot of what happened that night said Zamorra. "Not just emotions, but whole… scenes, segments."

"That's traumatic amnesia and it's common. Even a mild concussion can leave someone with no memory of the injury. Full retrograde amnesia, where he loses large portions of older memory, is certain possible here. It would take a great deal of observation to even diagnose him. Personally, I'd very much like to have that time to spend with him."

He looked at them with disappointment and an air of blame,

"There's also the difficult area of psychogenesis memory disorders."

"Psychogenic memory disorders," said Merci.

"Yes. That means disorders of the memory that are not tied organic damage or disease."

"Psychological."

"Basically, yes. See, Mr. Wildcraft knows what happened. He remembers some of it. And the more time goes by, if the edema and bleeding subside, he will remember more. But the more he remembered the better chance he has of developing various forms of hysterical amnesia. Hysterical amnesia is brought about by psychological stress and trauma, as opposed to strictly organic damage. Its range is wide and unpredictable."

Merci thought about this. "So, the part of his brain that forgot will start to remember. And the part that remembered will start to forget."

He smiled. "That's roughly true."

"Sounds tiring," she said.

"My patients undergoing that kind of retention-loss pattern tell me it's exhausting."

Stebbins sat back down and swiveled his chair around to face them. Merci watched the fan lift the paper corners, heard the quiet hiss of moving air, saw the collar of Dr. Stebbins's lab coat flutter briefly.

She tried to imagine what it would be like to be remembering and forgetting at the same time. Remembering and forgetting the same event at the same time. What, she wondered: you remembered the coat collar fluttering but you forgot there was a fan in the room? How did you explain things?

"Dr. Stebbins," she asked, "will he make things up?"

Stebbins started to answer, then caught himself. He looked at Merci, then Zamorra, then back to Merci again. "I'd hate to find myself on a witness stand against a patient. I'm not sure I would do that."

"You would if the court ordered you to."

"Is that how it works?"

"That's how it works. But we're not asking you to," she said. "We're trying to understand this man. We don't think he killed his wife, but some people do. What you tell me here might keep you off the stand, Doctor. And keep Archie out of jail."

Stebbins sighed quietly and shifted some papers. "We call it confabulation," he said. "Invention, exaggeration, chronological transposition. Some amnesic patients can invent perfectly logical and believable events that never took place. Some, when you ask them what they did the day before, will tell you in great detail-but it was what they did on a day twelve years ago. Some get fanciful and the inventions are very easy to identify as spurious."

"So which is Archie?"

"I didn't have time to find out," he said quietly. "And it may change-as the edema comes and goes, and as the psychological trauma runs its course. Confabulation is unpredictable. Generally, we see that patients with damage to the right temporal lobe are prone to feelings of deja vu, which we consider a form of confabulation. Generally, we find that the more a patient is aware of his own amnesia, the less he will confabulate. Those who most strongly deny having amnesia are most likely to invent. But these are generalizations, they won't turn out to be true in every case."

"Archie recognizes that he's lost memory," said Zamorra. "He ADmits it. He seems to remember things a little at a time, like he's retrieving the pieces of a puzzle."

"That's exactly what he's doing."

"Is it selective?"

"He's not consciously controlling the amount and quality of his recall, no. But Archie's memory is being filtered through, and certainly guided by, his general emotional state. Absolutely. He's gone through a profoundly traumatic experience. It's possible that he'll never fully recall some of what happened, that he'll remember in painful detail other aspects of that night. When all is said and done, we have difficulty differentiating organic from psychogenic amnesia. When you factor in the damage to the amygdala, it gets almost impossibly complex to make a sound prognosis."

"When will he be healed?" asked Merci. "I mean, physically? If nothing more goes wrong?"

Stebbins shook his head and exhaled. "Probably never if you don't get him proper medical care."

"And if we can do that?"

"It's impossible for me to say. I'm sorry."

"Two weeks? Two months? Two years?"

He looked at her. "If he develops no infection, and if the edema controlled by the steroids, he'll likely have recovered what memory he's going to recover within a year. But you have to understand that he's had tissue damage. Some of his memory has been lost. It's not retrievable. It's gone. The same can be said of the psychogenic amnesia-if the psychological trauma was severe enough, he may never recover certain memories."

"But they're in there," said Zamorra. "Those memories are inside him."

"Yes."

"How do you get them out?"

"Hypnosis."

Merci thought of Dr. Joan Cash and the terrific results she'd gotten from a witness using hypnosis. She wrote J. Cash?

"Understand," said Dr. Stebbins, "that using hypnosis on a subject like Mr. Wildcraft could be damaging to him. You would be bringing forth memories that he is not presently able to process, emotionally. You'd be overriding his mechanisms of self-defense and self-preservation. It would be tantamount to trying to remove that bullet from his brain surgically. It would be ill-advised, destructive, possibly catastrophic."

In the quiet that followed, Merci listened to the fan-blown air tapping at the surfaces of the room, heard the footsteps and the echoes of footsteps in the hall outside. She wondered how many tough decisions had been made by people sitting right here where she was. How many people had looked down at the same floor, heard the same sounds, prayed to their gods for guidance.

"We couldn't use him in court if he'd been hypnotized," she said. "California law."

"Well," said Stebbins, "as I've said, that's getting ahead of what's really feasible now."

"Can you get us exact measurements on the bullet fragments?"

"I can get you measurements accurate to one millimeter, which would be acceptably accurate if the bullet was in one perfectly shaped piece. But there are three fragments visible on the spiral CT, and there are probably more that are too small for us to see. So there's no way to tell which dimension we're measuring-diameter, length? A combination of the two? I can't get an accurate caliber for the bullet-I assume that's what you're after. After talking to Sheriff Abelera I did some measurements. All I can say with reasonable certainty is that the caliber of the bullet is probably between a twenty-two and a thirty-eight."

"You're not even sure of that?"

"No. It's possible that the bullet fragmented on entry and part of it never penetrated. It's even possible that a fragment left his skull and came to rest somewhere else in his body. We only had time to take pictures of his head before he so foolishly checked himself out."

"If we got him back, could you try an MRI?"

"We can't do an MRI because of the metal in the bullet."

"What about positron emission tomography?" asked Zamorra.

"Wonderful for the biochemical activities in the brain, but not for space and volume measurements that precise. I'm sorry."

"I just exhausted my medical scan knowledge," said Rayborn.

"I did, too," said Zamorra.

"Believe me, I'd get you a caliber on the bullet if I could. An autopsy would be the only way. We'd literally have to put the pieces back together."

A moment of acknowledged possibility passed between them- three blinks and a small stretch of silence.

"Thanks for your help on everything else," said Merci. "And for your honesty."

"I don't know any other way to practice medicine."

Dr. Stebbins met her stare for a moment and neither looked away. Then he swiveled his chair and looked again at the x ray of Archie Wildcraft. "The human brain weighs about three pounds. It's small. You can hold one in your hands. But it's hugely complex. The hard you look the bigger it gets. It's like looking at the night sky through a telescope. The more you see the more there is to see. The more you learn the more there is to learn. It goes on forever, and there's so much we don't know."

He turned back to Merci. "But, Sergeant Rayborn and Sergeant Zamorra, I do know that Archie belongs under medical care. Too much can go wrong. I strongly advise you to get him back into this hospital.