The Echo Maker

  She couldn’t stop chuckling. “Not even in private?”

  “Private? What’s that?”

  He gave her his flight information. They traded a few more stalling phrases, reluctant to say goodbye. He was still talking to her in his head for several sentences, after they hung up. He showered, hanging the towel over the bar—Help save the earth. He retrieved his digital voice recorder from his briefcase, then slipped between the stiff, cool sheets, where he replayed the day’s taped conversation. He listened again to the twenty-seven-year-old boy, lost to himself, busy exposing impostors the world could not make out.

  Years ago, in Stony Brook, Weber had worked with a patient suffering from hemispatial neglect: the notorious “Neil,” from Weber’s first book, Wider Than the Sky. A stroke at fifty-five—the age Weber had now reached unscathed—left the office machine repairman with a lesion in his right hemisphere that overnight blotted out half his world. Everything to the left of Neil’s sight midline folded into nothing. When he shaved, Neil left the left side of his face untouched. When he sat down to breakfast, he failed to eat the left side of his omelette. He never acknowledged people who approached him from the left-hand side. Weber asked Neil to draw a baseball diamond. Neil’s third base trickled just off the edge of the pitcher’s mound. Even in Neil’s memory, recounting the day’s events, the left half of the world crumpled and collapsed. Closing his eyes and imagining himself in front of his house, Neil could see the garage on the right but not the sunroom on the left. When giving directions, he gave them all exclusively as a series of right turns.

  This deficit went beyond vision. Neil couldn’t see that he wasn’t seeing. Half the map where he stored space itself was gone. Weber tried a simple experiment, a scene he dramatized in Wider Than the Sky. He held a mirror perpendicular to Neil’s right shoulder and made Neil look at an angle into the mirror. The area to the left of Neil’s body now appeared to Neil’s right. Weber held a silver good luck charm above Neil’s left shoulder and told Neil to reach for the charm. He might as well have asked the man to sail to a bearing that had fallen off the compass. Neil hesitated, then stabbed out. His hand crashed into the mirror. He fumbled against the glass, even groping behind it. Weber asked what he was doing. Neil insisted that the charm was “inside the mirror.” He knew what mirrors were; the stroke had left that intact. He knew it was crazy to think that the charm could be in the glass. But in his new world, space extended only to the right. Inside the mirror was the more likely of two unreachable places.

  Cases such as Neil—thousands of them a year—suggested two truths about every normal brain, both of them shattering. First: what we took for a priori, absolute apprehension of real space in fact depended upon a fragile chain of perceptual processing. “Left” was as much in here as out there. Second: even a brain that thought it was measuring, orienting, and inhabiting plain-old given space might already, without the slightest notion, have lost as much as half a world.

  No brain, of course, could completely credit this. Weber had liked Neil. The man absorbed a crushing blow without bitterness or self-pity. He made his adjustments and pressed on—if not forward, then northeasterly. But after the last set of examinations, Weber never saw Neil again. He had no idea what became of the man. Some other neglect wiped him out, reduced him to story. The man Weber had met and interviewed at length passed into the man he described in the pages of his book. He’d left “Neil” behind in the prose looking glass, lost somewhere, off in an imperceivable direction, an unreachable place deep inside the narrative mirror…

  Weber woke early, from rough sleep. He showered to wick off the sluggishness, remembering, with a pang of conscience as the hot stream revived him, that he’d taken one just hours before. He made himself a packet of coffee in the complimentary coffeemaker, housed, for some reason, next to the bathroom sink. Then he sat at the writing desk, flipping through a rustic, hand-illustrated guidebook provided there.

  The name “Nebraska” comes from an Oto word meaning flat water. The French, too, called the river that ran through it “Platte.”

  Precisely how he’d pictured the place: a wide, flat hollow at the heart of the map, so level it would make Euclid blush. The real, rolling landscape surprised him. He sipped the grim coffee and examined the guidebook’s cartoon map. Towns dotted the blank space like so many circled wagons. He found Kearney—at 25,000, the fifth-biggest settlement in the state—in the southernmost oxbow of the Platte, cowering from too much openness.

  To the north and west, the Gangplank, a great swatch of eroded sediment, juts out across what was once, 100 million years ago, the floor of a vast ocean…

  Major Stephen Long’s 1820 expedition of Army Engineers called the area the Great American Desert. In his report to Washington, Major Long declared the crust of land “wholly unfit for cultivation and of course uninhabitable by a people depending upon agriculture.” The expedition’s botanist and geologist concurred, noting the “hopeless and irreclaimable sterility” of a country that should “forever remain the unmolested haunt of the native hunter, the bison and the jackal.”

  Herds of bison once scoured this basin. Brown rivers of meat flowed across the prairie, holding up wagon trains for days…

  Herds all done away with, the book said. The jackal and the native hunter, too: cleared off. Prairie dog cities, their underground streets stretching for miles, drowned in poison. River otters, all but eliminated. Pronghorn, gray wolves: all shot. Page 23 showed a color plate of two mounted, moth-eaten carcasses in the State Museum in Lincoln. Only two larger species now survived in the region in any quantities:

  For six weeks out of every year, cranes along the Platte outnumber humans several times over. They migrate over a quarter of the earth’s circumference, briefly stopping here for whatever scraps of waste grain they can scavenge.

  He finished the coffee and rinsed the cup. He donned his coat and tie, then, remembering his promise to Mark Schluter, removed them. In his shirtsleeves, he felt naked. Down at the front desk, he snatched a cosmetically perfect if tasteless apple and called it breakfast. He followed his directions to Good Samaritan Hospital and made his way up to Neurology. Dr. Hayes’s nurse showed Weber into the office at once, trying not to stare at the famous personality.

  The neurologist looked young enough to be Weber’s son. Gawky ectomorph with angry skin who steered his body like a legacy device. “I just want to tell you what an honor this is. I can’t believe I’m talking to you! I used to read your books like comics, back in med school.” Weber thanked him as graciously as he could. Dr. Hayes spoke deliberately, as if delivering a belated lifetime achievement award to a silent-film actor. “Incredible case, isn’t it? Like seeing Bigfoot stroll out of the Rockies and into your neighborhood supermarket. I actually thought of your stories when we worked him up.”

  Fresh copies of Weber’s last two books sat on Hayes’s desk. The young neurologist picked them up.

  “Before I forget, would you mind…?” He handed them to Weber, along with a heavy Waterman pen. “Could you make them out: ‘To Chris Hayes, my Watson in the strange case of The Man Who Doubled His Sister.’”

  Weber searched the neurologist’s face for irony but found only earnestness. “I…Could I just…?”

  “Or whatever you feel like writing,” Dr. Hayes said, crestfallen.

  Weber wrote: For Chris Hayes, with thanks. Nebraska, June 2002. Man was not only the commemorating animal; he was the animal who insisted on commemorating in advance. Weber handed the books back to Hayes, who read the inscription with a tight-lipped smile. “So you met him yesterday. Eerie, isn’t it? I’m still disconcerted, talking to him, and it’s been months. Of course, our group will be writing him up for the journals.”

  Bow shot. Weber held up his hands. “I don’t want to do anything to…”

  “No, of course not. You’re writing for a popular audience.” Broadside. “There’s no overlap.” Hayes rolled out the complete history, including the pages no one had shown Kar
in Schluter. He showed Weber the paramedics’ notes, three lines of green ballpoint on a form dated Feb. 20, 2002: ’84 Dodge Ram, rolled off south shoulder of North Line Road, between 3200 and 3400W. Driver pinned upside down in vehicle. Unbelted, unreachable, and unresponsive. The one accessible door was crumpled beyond opening. The paramedics couldn’t enter or move the truck, for fear of crushing the victim. They could only wait for support and watch the police take photographs. Weber studied one of the pictures. “Wrong way up,” Hayes said. Weber flipped the image. A long-haired Mark Schluter hunched on top of himself, a glaze of blood seeping up his face through his open collar. His head bowed against the roof of the cab, in inverted prayer.

  When the firemen arrived, they had to burn their way through a roof post with an acetylene torch. Weber pictured the scene: police lights strobing across frozen fields, flares circling the truck where it lay flipped in the roadside ditch. Uniformed people, their breath steaming, moving about in dreamlike, methodical activity. When the firemen at last torched through the roof post, the wreck shifted and the truck settled. The body crumpled on itself. The firemen scrambled under the wreck and drew the body clear. Mark Schluter briefly regained consciousness in the ambulance. The paramedics raced him to Kearney, the only hospital within six counties with any shot at keeping him alive.

  Hayes proceeded to the medical charts. White male, twenty-seven, five ten, 160 pounds. He had lost considerable blood, most of it from a gash between his right third and fourth ribs, where he’d impaled himself on the spike of a metal model Prussian helmet fastened to his truck’s gear shift. His front scalp and face were heavily abraded. His right arm was dislocated and his right femur fractured. The rest of his body was badly scratched and bruised, but he was otherwise astonishingly intact.

  “We use the word miracle a lot out here in the Plains States, Dr. Weber. But you don’t often hear the term thrown around a Level II trauma center.”

  Weber studied the images that Hayes clipped to the light box. “This one qualifies,” he agreed.

  “The closest thing to a Lazarus walk-away I’ve ever seen, even in my residency days in Chicago. Eighty miles an hour, on an icy country road in the dark. The man should have been dead, many times over.”

  “BAC?”

  “Funny you should ask. We see a lot of that, in the Kearney Emergency Room. But he came in at .07. Under the legal limit, even in the Cornhusker State. A few beers in the three hours before rolling his vehicle.”

  Weber nodded. “Was he on anything else?”

  “Not that we found. The ER attending logged him in at a Glasgow solid ten. E3-V3-M4. Eyes opening to speech. Withdrawing from pain. Some verbal response, although mostly inappropriate.”

  Eight was the magic number. After six hours, half of all patients with Glasgow Coma Scale numbers of eight or lower gave up and died. Ten was considered moderate injury. “Something happened to him after admission?”

  Weber was just playing professional detective. But Hayes grew defensive. “They stabilized him. All the protocols, even before determining whether he was insured. We have one of the highest rates of medical indigence in the country, out here.”

  Weber had seen higher. Half the country couldn’t afford insurance. But he murmured approval.

  “It took the paper-pushers an hour before they could locate his next of kin.”

  Weber studied the paperwork. The victim’s pockets contained only thirteen dollars, a knock-off Swiss Army knife, a receipt for a tank of gas at a place in Minden dated that afternoon, and a single cyan-colored condom in a transparent package. Probably his good-luck charm.

  “Apparently, his license flipped up under the dash when the truck rolled. The police found it while searching the vehicle for drugs. They located the sister up in Sioux City, and she gave phone consent for anything we needed. The trauma service got him going on mannitol, Dilantin…You can read everything. Pretty standard fare. Intracranial pressure steady at around 16 mm Hg. We got a little improvement right away. Motor response climbed. Some increase in verbal. Marked him up to a Glasgow twelve. Five hours after the admit, I would’ve told you that we were heading out of the woods.”

  He took the file back from Weber and searched it, as if he still had a chance to head off what happened next. He shook his head. “Here’s the note from the next morning. ICP up to twenty, then spiking even higher. He had a small seizure. Some delayed bleeding, as well. We went to a ventilator as soon as we could. We decided to drill. Tracheotomy clearly indicated. His sister was here by then. She approved everything.” Dr. Hayes scoured the papers, looking for some shred that refused to come forward. “If you’re asking me, I’d say we caught everything as it arose.”

  “It seems like it,” Weber said. Only, intracranial pressure had to be caught before it arose. Dr. Hayes blinked at him, perhaps resenting the national celebrity brought in to aid the poor locals. Weber stroked his beard. “I can’t imagine doing anything differently.” He glanced around Dr. Hayes’s office. All the right journals on the shelves, up to date and orderly. Framed diploma from Rush Medical and Nebraska Board Certification. On the desk, a picture of Hayes and a slim, honey-haired model, shoulder to shoulder on a ski lift. A world inconceivable to Mark Schluter, before or after his accident.

  “Would you say that Mark shows any tendency toward confabulation?”

  Hayes followed Weber’s glance, to the picture, the beautiful woman on the lift. “Not that I’ve noted.”

  “I tried him on a battery of the standard tests yesterday.”

  “Did you? I gave him everything, already. Here. Any scores you might need.”

  “Yes, of course. I didn’t mean to suggest…But some time has passed…”

  Dr. Hayes measured him. “He’s still under observation.” He offered Weber the folder again. “The data are all here, if you care for a look.”

  “I’d love to see the scans,” Weber said.

  Hayes produced a series of images and clipped them to his light box: Mark Schluter’s brain in cross section. The young neurologist saw only structure. Weber still saw the rarest of butterflies, fluttering mind, its paired wings pinned to the film in obscene detail. Hayes traced over the surreal art. Each shade of gray spoke of function or failure. This subsystem still chattered; this one had fallen silent. “You see what we’re dealing with, here.” Weber just listened to the younger man step through the disaster. “Something that looks like possible discrete injury near the anterior right fusiform gyrus, as well as the anterior middle and inferior temporal gyri.”

  Weber leaned toward the light box and cleared his throat. He didn’t quite see it.

  “If that’s what we’re looking at,” Hayes said, “it would fit the prevailing understanding. Both the amygdala and the inferotemporal cortex intact, but a possible interruption of connection between them.”

  Weber nodded. The current dominant hypothesis. Three parts needed to complete a recognition, and the oldest trumped all. “He gets an intact facial match, and that generates the appropriate associated memories. He knows his sister looks exactly like…his sister.”

  “But no emotional ratification. Getting all the associations for a face without that gut feeling of familiarity. Pushed to a choice, cortex has to defer to amygdala.”

  Weber smiled, despite himself. “So it’s not what you think you feel that wins out, it’s what you feel you think.” He fiddled with his wire frames, feeling out loud. “Call me archaic, but I still see some problems. For one, Mark doesn’t double every person that he cared for before the accident. He should still be able to draw upon auditory cues, behavioral patterns: all sorts of identification tools other than facial. Can flattened emotional response really defeat cognitive recognition? I’ve seen bilateral damage to the amygdala—patients with destroyed emotional responses. They don’t report that their loved ones have been replaced by impostors.” He sounded too effusive, even to himself.

  Hayes was ready. “Well, you’ve heard of the emerging ‘two-deficit’ theor
y? Perhaps insult to the right frontal cortex is impeding his consistency-testing…”

  Weber felt himself turning reactionary. The odds against multiple lesions, all exactly in the right place, had to be enormous. But the odds against recognition itself were even greater. “You know he thinks his dog is a double? That seems like more than just a rupture between the amygdala and the inferotemporal cortex. I don’t doubt the contribution of lesions. Right hemisphere damage is no doubt implicated in the process. I just think we need to look for a more comprehensive explanation.”

  Hayes’s tiniest facial muscles betrayed incredulity. “Something more than neurons, you mean?”

  “Not at all. But there’s a higher-order component to all this, too. Whatever lesions he has suffered, he’s also producing psychodynamic responses to trauma. Capgras may not be caused so much by the lesion per se as by large-scale psychological reactions to the disorientation. His sister represents the most complex combination of psychological vectors in his life. He stops recognizing his sister because some part of him has stopped recognizing himself. I have always found it worthwhile to consider a delusion as both the attempt to make sense—as well as the result—of a deeply upsetting development.”

  After a beat, Hayes nodded. “I’m…sure it’s all worth thinking about, if that interests you, Dr. Weber.”

  Fifteen years ago, Weber would have launched a counterstrike. Now he found it comical: two docs marking their territory, ready to rear up and batter at each other like bighorn sheep. Ram tough. Well-being coursed through Weber, the simple poise of self-reflection. He felt like mussing Dr. Hayes’s hair. “When I was your age, the prevailing psychoanalytic bias had Capgras resulting from taboo feelings toward a loved one. ‘I can’t be feeling lust for my sister, ergo she’s not my sister.’ The thermodynamic model of cognition. Very popular in its day.”

  Hayes rubbed his neck, embarrassed into silence.