Richard Powers - The Echo Maker

Weber could think of nothing. He’d worked his entire life to efface his past, no biography except what would fit on the flaps of a book. He looked at Mark, trying to think of some story. “I liked to adore girls from a distance, without telling them.”

Mark curled his lip and shook his head. “Done that. Very little ROI. How’d you ever get married, Romeo?”

“My friends mounted an intervention. They set me up on a blind date. I was supposed to go to a coffee shop on a Sunday afternoon and find a woman who looked exactly like Leslie Caron. I got there, and nobody in the place even remotely fit the description. It turns out the woman got cold feet. But I didn’t know, so I just stood there in a haze, analyzing every female in the place, thinking: Well, could be, maybe …You know: brown hair, bilateral symmetry…A waitress asked if she could help me. I told her I was hoping to find a woman who looked like Leslie Caron. She mistook me for a brash young man with a sense of humor. Three years later we were married.”

“You’re shitting me. You married a total accident? You’re a maniac.”

“I was pretty young.”

“And did she look anything like…Lindsay Whozit?”

“Nothing at all. Maybe a tiny Natalie Wood thing. But more like…the woman I was going to marry.”

Mark looked out through the wraparound waterfall, his glee collapsing. “You’re saying fate? Two inches to the left, and your life is somebody else’s. She’s just standing there, making a living, and bang: your lifelong companion. I’d say somebody was looking out for you.” Weber started the engine. Mark stayed his arm. “Only — we don’t believe in that angel shit, do we? Guys like us?”

Weber now saw how badly he’d failed the man and his sister. He wouldn’t do so again. He made calls, tapping his network of colleagues. To a person, they were discomfited to hear from him, assuming he’d gone off somewhere to die of public disgrace. But Mark’s story fascinated them. None had ever worked with anything like it. And no two of them proposed the same course of action, except the pair who suggested leaving a nonthreatening condition alone. Most sounded grateful when Weber said goodbye.

He worked the broadband connection in his hotel lobby, late into the night. He logged into all the medical indexes, exploring every clinical reference in the literature. He’d done as much before, but cursorily. The patient had been Dr. Hayes’s; Weber was just a visiting interviewer. He’d looked at the literature, enough to conclude that no real literature existed. What few cases he had found bore no direct bearing.

On a second trip through the most current databases, a single abstract jumped out at him. Butler, P. V. Seventeen-year-old man with Capgras delusions following traumatic brain injury. Treatment and outcome: Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily.

He checked the date: August 2000. Two years old, in the Australian and New Zealand Journal of Psychiatry . No excuse for having missed it on first look, not with electronic search. But he hadn’t really been looking, the first time. The sister had begged him for some treatment, but Weber hadn’t wanted Capgras to be treatable with yet one more newly marketed miracle pill. Psychopharmacology: hit or miss, hard to tune, ripe with side effects, symptom-masking, and once begun, difficult to tail off of. Medicine’s next generation would surely remember Weber’s as sadly as Weber remembered his father’s. The general level of barbarism receded, but never as quickly or completely as thought. Or maybe he was the last barbarian. Months of unnecessary suffering, because of Weber’s eyes-averted Puritanism. Because he’d never considered Mark anything but a good story.

Karin came to meet him at the hotel. She even came up to his room, bringing her boyfriend for protection. For no reason, Daniel Riegel, a perfectly decent man, made Weber acutely uncomfortable. Spontaneous unease, hidden in some association: the goatee, the loose-fitting collarless shirt, the aura of calm self-acceptance. Karin was understandably anxious. He’d hurt her with his quick departure the first time, and baffled her by agreeing to a second. Her lips moved as Weber spoke, struggling against the hope that he might still help. How she’d gone on hoping that, Weber could only dimly imagine. How hope itself got selected for, over the eons, Weber had no clue.

He had straightened his room before their arrival, squirreling his possessions away in closets and drawers. He’d missed a pair of socks, a milkshake cup, and his bedside reading— The Seven Pillars of Wisdom —and couldn’t now retrieve them without calling attention. The room gave no real place to sit, and he lost the rhythm of a real office visit. For their part, Karin and her Daniel walked into the meeting as if dragging into court. And Weber hadn’t even presented them with options yet.

He described his follow-up visit with Mark. Mark’s condition definitely had grown more pronounced. Spontaneous improvement no longer seemed likely. Behavioral therapy had failed. “I do still believe that Mark is in no danger of harming anyone,” he pronounced. Karin gasped, which irked him. “I think it’s time to try something more aggressive. I recommend that Mark be started on a low-dosage regimen of olanzapine.”

Karin sat blinking at the word. “Is this something new?” New since June?

Daniel challenged him. “What kind of drug is that, exactly?”

Weber felt like pulling rank. Instead, he just raised his eyebrows.

“I mean…is it a…what category? Is it an antidepressant?”

“It’s an antipsychotic.” Weber found the exact tone of professional assurance. But reflex fear struck both listeners. Karin reddened. “Mark isn’t psychotic. He’s not even…”

Weber was ready with the necessary reassurances. “Mark isn’t schizophrenic, but he’s developed complicated symptoms. This drug is effective in countering those symptoms. It was very successful in a similar case…elsewhere.”

Daniel bridled. “We wouldn’t want to dope him or put him in some kind of chemical straitjacket.” He checked with Karin, who did not back him up.

“He wouldn’t be in a chemical straitjacket.” No more than everyone, always. “A small number of people experience lethargy, and some put on some weight. Olanzapine adjusts levels of various neurotransmitters, including serotonin and dopamine. If it works for Mark, it will reduce his agitation and confusion. With luck, there’s a chance it could leave him more lucid, less susceptible to extraordinary explanations.”

“Luck?” Karin asked.

Weber smiled and spread his hands. “It’s medicine’s great ally.”

“He would recognize me again?” Ready to try anything.

“No guarantees. But there does seem to be a precedent.”

Daniel geared up for moral battle. “Don’t these drugs lead to dependency?”

“Olanzapine is not addictive.” Weber didn’t say how long Mark would have to take it, for the simple reason that he didn’t know.

Daniel persisted. He’d heard stories. Antipsychotics producing social withdrawal, flattened affect. Weber gently pointed out the obvious: Mark was already worse. Daniel began a list of every side effect known to medication. Weber nodded, fighting his irritation. He wanted to see the man in distress, repenting. “This is a newer drug, one of the so-called atypical antipsychotics. It has notably fewer side effects than most.”

Karin sat on the lip of the purple hotel chair, her leg pumping. Postural hypotension and akathisia: two of olanzapine’s side effects. Sympathetic suffering, in advance. “Daniel means…we’re just afraid the medicine might turn Mark into someone else.”