I

I plunged into the swimming pool. The shock of the cold water revived me after the intense heat of the day. I put all my energy into swimming one length as fast as I could, then turned on my back to continue at a more relaxed pace and consider what I had learned from my first interview with Marilyn Jensen.

I had established many things, but for each thing I learned, ten more questions presented themselves. Marilyn’s boyfriend, Richard Berberich, had told Philippe Rohart that she had studied French when she was young and had recently been having private classes. But when they arrived in France, he had observed that she had problems understanding people when they spoke, and had difficulty answering them. That was not unusual.

When I first went to the USA, I quickly discovered that the English people spoke had little relation to the English I had learned at school. It had taken me a long time to decipher the various American accents and to respond fluently. Was it possible that this process had accelerated when Marilyn was unconscious? Had she lost the inhibitions which stopped her from accessing the French vocabulary in her possession?

During my interview with her, she chose the correct words easily. Any hesitancy on her part was not linguistic, but due to confusion about her condition. She was perturbed that people insisted she was an English speaker. Although some English words were familiar, she could not understand complete sentences, and she found it impossible to form the words to speak.

I got out of the pool, got dressed and took the elevator up to the studio I had rented for my stay. I opened my laptop computer and created a file for the notes about my new patient.

Aphasia can manifest itself in many ways: people can lose the ability to comprehend, but be fluent in speech; or they might be able to comprehend but unable to speak; or they might lose both speech and understanding; or indeed manifest any combinations of these symptoms in varying degrees, dependent upon the damage to the different areas of the brain.

It was important, therefore, to do more detailed investigations to discover which parts of her brain were affected.

II

“It would be nice if someone would keep me informed, is all I’m saying!” Richard Berberich’s raised voice echoed along the corridor as I approached. “I presume we’re going to be paying for this, yes?” Philippe looked even shorter than usual as the American towered over him.

Seeing me approach, Philippe seized his chance to escape: “Dr Lelong,” he said, addressing me formally, “apparently no-one told Mr Berberich that you had ordered an MRI scan…”

To Philippe’s relief, I led Berberich away down the corridor and into the cafeteria. I suspected that the last thing he needed was more caffeine, but at least we could talk in private there.

I explained that I had ordered an MRI scan to discover if there was any damage that had not shown on the CT scan. “The CT scan localises haemorrhaging or lesions, but the more sensitive detail in the MRI scan can show if there is axonal damage, which could occur without evidence of bleeding or trauma,” I told him.

“And what is… axonal damage?” he asked.

“Axons connect the white matter and the grey matter in the brain.” I tried to describe it in terms that would be easily understood. “The white and grey matters in the brain have different densities, and in a situation where the head suffers some kind of acceleration and deceleration, such as a car crash or a fall, they travel at different speeds back and forth within the skull, effectively tearing the axons.”

“So there can be damage without blood clots, or fractures, or other things that X-rays and CT scans would show you…”

“Exactly” I replied.

“And so this MRI scan will cost how much?” Berberich asked.

“A fraction of what it would cost in an American hospital. I suspect that Ms Jensen’s insurance company will be astonished at how reasonably priced our services are.”

I smiled. Berberich did not.

“Cheap treatment doesn’t impress me,” he said. “We have excellent insurance. Our insurance company will be happy to fly her back to the USA, if you’ll permit her to travel.”

I was surprised. “Have you discussed that with Ms Jensen? Does she want to return to the States?”

Berberich’s face reddened and his eyes fixed me menacingly. His jaw muscles clenched as he contained his anger. When he spoke, his tone was level and strangely soft. “Point A, Dr Lelong: I couldn’t discuss this with Ms Jensen as she was not here when I arrived this morning. Someone had taken her for an MRI scan without informing me. And Point B,” his control began to falter, “even if Ms Jensen had been here, she doesn’t understand me because apparently I’m speaking a foreign language!”

I nodded. “I apologise for Point A,” I said, trying to remain polite. But I couldn’t prevent myself from adding, “In France we normally take the course of action that’s best for the patient without discussing the cost of it with the patient’s friends first.”

Berberich’s eyes narrowed and he took a deep breath. Sensing an impending explosion, I continued quickly, “But concerning Point B, let me assure you that I’ll be happy to discuss the subject of travel to the USA with Ms Jensen as soon as we have established that there are no immediate medical problems. And you’ll be pleased to know that the results of the MRI scan will bring us one step closer to that.”

III

Marilyn was dressed and sitting in an armchair when I entered her room. Her long hair was loosely piled up on her head and held by a clasp. Her eyes sparkled, I thought, but on closer inspection I noticed that the effect could be attributed to mascara. She was making an effort to look attractive. Was it for me? The look she returned answered my question.

I turned my focus to her medical dossier and noted, on a professional level, that she was taking care of her appearance. The confusion and frustration of aphasia often causes patients to become depressed. If she was feeling optimistic and cared about her physical appearance, it was a positive sign.

“What news, Dr Lelong?” she asked. I detected again the slightly flat vowels in her colloquial French. Were these perhaps the sounds she heard from the Toulousain nurses while she was unconscious?

I placed the results of the MRI scan, my papers, and pen on a small coffee table between us. “Well, there are signs of injury but they are very minor and not in the area related to comprehension and speech. They probably explain your memory loss.”

“They’re minor. So that’s good news.”

“It’s good that any damage is not more severe, but it doesn’t mean that you’ll regain your memory. And it doesn’t help us to explain your linguistic…” I hesitated. I wanted to say 'difficulties' but it seemed absurd to describe her situation like that when she had no difficulty understanding and speaking French.

“Predicament?” she suggested.

I nodded. “I’d like you to do some tests so that we can check to see if any other brain functions are affected.” I pushed a questionnaire and my pen across the coffee table towards her.

She looked at the questionnaire. “What sort of tests?”

“Nothing too onerous. Just some questions – puzzles if you like – to test your organisational abilities, abstract reasoning, problem solving.”

“Like… how to solve the problem of an American woman turning French?” she laughed.

I couldn’t help but return the smile that lit up her face. She was displaying a sense of humour. It meant that there were parts of her character which were intact.

“Have you considered, Dr Lelong, that becoming 'French' may not be a problem for me?” she said.

“Are you sure about that?” I asked. “What about your job… your life in America?”

“They tell me I’m a lawyer. The loss of an American lawyer is probably a good thing for the world, wouldn’t you say?” she smiled again, and I found her eye contact disconcerting.

I looked down at my notepad. “That’s a very interesting thing to say. In other words, you haven’t forgotten what people think of lawyers?”

“Or what a litigious society America is?” She considered this for a moment. “No, doctor. It’s strange but I feel I know these things.”

“What else are you aware of knowing? Can you name the president, for example?”

“Sarkozy or Obama?” she asked. “It’s funny, because I’ve been thinking a lot about what I do know, rather than focusing on what I don’t know. And I feel much better as a result. I know things about the world, about history and so on. You know, I think if you were to ask me for a legal definition of 'Tort Law' I could give it to you.” She suddenly stopped. “Oh dear…” she grimaced, “I wasn’t a personal injury lawyer, was I?”

“I think you’d have to ask Mr Berberich. I believe he works for the same law firm.”

“Sadly, I can’t understand a word he says.”

I noted that she didn’t genuinely appear to be saddened by this fact. She turned away and looked out of the window. “Is he really my fiancé?”

“He says so, but you didn’t have a ring when you were admitted. An engagement ring is traditional in America, isn’t it?”

“Yes, and if he’s a lawyer, I’m sure he could have afforded a big one.” Marilyn continued to stare out of the window. “It makes you wonder, doesn’t it? Maybe he pushed me over the cliff. Maybe that’s why I can’t remember. Maybe I’ve blocked the memory from my mind because it’s too painful. Maybe he took the ring off my finger before he pushed me over. Or maybe we argued and I threw the ring at him, and it’s lost… and… and that’s why he pushed me…”

I wanted to say something reassuring to her but I thought about Berberich and his aggressive manner and hesitated.

Suddenly I became aware that she was looking at me and smiling, “Do you think I read too many mystery novels, Dr Lelong?”

“Do you think you do read mystery novels?”

“Do I?” She thought for a moment. “Well, yes. I think I do. So that’s something I know about myself! A piece in the jigsaw puzzle.”

IV

We searched that morning for any other pieces, no matter how unrelated. And a name came up.

“Elodie.” she said. “The name Elodie, seems to be so familiar.”

“You think you know someone called Elodie?”

Marilyn turned to me, frowning, “No, the thing is, when I first regained consciousness…” She couldn’t bring herself to finish. “This is going to sound too stupid.”

“Tell me, Marilyn.”

“Marilyn! That’s just it. Everyone was calling me Marilyn. The name signified nothing to me. If anyone had asked me what my name was, I would have said… Elodie.”

“Can you remember anything else from those first moments?”

“I was dreaming about the sea. I’m still having dreams about the sea. Waves crashing on a rocky coast. I don’t remember anything else.”

I took some notes. “When you wake in the mornings, try to remember any dreams you might have had. Keep a note of them.”

“Do they mean something?”

“They might.” I gestured to the questionnaire and pen on the table. “Now, you have some other puzzles to solve, remember?”

“Yes Doctor.” Her tone was like an obedient schoolgirl.

I picked up the results of the MRI scan and my papers and stood up.

“You’re not going, are you?”

“I promised to tell Mr Berberich the results of the scan.”

“He doesn’t have any rights over me, does he? He doesn’t have to sign anything for me. I mean, I know he’s listed as my next of kin but–”

“He has told the administrative staff here that, as far as he knows, you have no family.”

“That could mean either my parents are dead, or I just didn’t introduce him to them.” She shook her head. “I can’t picture parents. Maybe I was an abandoned baby, brought up in an orphanage with no-one to love me…” she raised her eyebrows, “like Oliver Twist! You see? Evidently I’ve read Dickens, too.”

“Evidently,” I said.

“All these books… what language do you think I read them in, Doctor?”

“English, I’m sure.”

She shook her head. “How is it possible? It’s just a jumble to me. It makes no sense at all. You’ve no idea how terrifying it is to have someone talking at you, making these alien sounds… how can it be that I don’t understand?”

“It can happen. Some people are worse off than you – they have no means of communicating. They open their mouths and make noises. They think they’re making sense but no-one can understand them. At least you have found French. At least we can communicate.”

She smiled at me. “Yes. I count myself lucky for that.”

The look in her eyes was intense and disconcerting. I forced myself not to respond and changed the subject. “Would you like me to try to search for information about you, to see if we can prompt any memories?”

“About me, Dr Lelong? Or about Marilyn Jensen?”

It was true. Marilyn Jensen tumbled down a rocky escarpment at Saint-Cirq Lapopie, and her fiancé, Richard Berberich accompanied her in the ambulance to the Toulouse hospital where she received treatment. But the young woman who opened her eyes 48 hours later, was not Marilyn Jensen.

I was fascinated by her. She was suffering memory loss, but seemed to have adopted an entire personality, a persona in which she was comfortable. On a professional level, her case was intriguing. On a personal level, I sensed that I was entering very dangerous territory indeed.