Bill recalled an experiment with decorticated cats. He told of how each cat's cortex was removed by cutting through the nerves and separating it from the lower brain, which remained functioning. Removing the cat's cortex guaranteed that there would be no neural impulses from its higher brain. The decorticated cat's body would just lie there living, immobile unless stimulated. And when they put a decorticated cat in a cage with other cats, it was as though the healthy cats thought of it as dead.
Bill's point was that overworked doctors and nurses might have similar reactions to James. We would have a new syndrome—the Decorticated-Cat Syndrome.
I remembered one locked-in case in which the neurosurgical team said that, unfortunately, prolonged survival was possible. Notice the word unfortunately. It was the Decorticated-Cat Syndrome in action.
Doctors talk about the “awesome” nature of a locked-in patient's inability to move or communicate and how the family and hospital staff begin to feel hopeless and incapacitated in the presence of the patient. As Bill and I spoke, we too slipped into the same behavior. We were talking beside James' apparently dead body instead of trying to communicate with him. Where were our emotions of grief and pain? They were inside us, but we couldn't be ruled by emotions when trying to save a life. Could we? But Bill and I were not emotionally dead.
So this was our plan: Bill and I would first try to protect James from the caregivers who might turn against him, as in the Decorticated-Cat Syndrome. Second, we would attempt to learn to think like James, to share his own thoughts with him even though he could not communicate them himself.
Breakthrough
Bill and I puttered about, setting up three stands, one on each side of James' bed and one directly in front of him.
I taped flash-card letters to a frame on the left stand; “James, if you look left, it will mean that you want one of the letters on this frame. Then we will point to each letter, and you will signal the correct one by fixing your eyes on it when we point to it. If you want a letter in the center group or the right group, just look that way.”
At that moment, a young therapist with dark, shining hair came in. He strode up to look at our work and tried to stifle a laugh. “How interesting,” he said. “Good morning. I see what you're trying to do. Actually, I have this small transparent plastic panel with six groups of letters set into it, which I can see through as I point to the letters. Much more efficient, don't you think?”
He took one elegant finger and pushed aside the frames I had set by James' bed. “I'll show you how we do it.”
An hour later, he rose to leave. “As I expected, there is no apparent cognitive functioning, certainly no linguistic capacity.”
Bill said, “Leave the plastic panel.”
“I've just demonstrated that there's no need for it.”
“I suggest you leave it.”
“Very well, Dr. Moore. I'll just report to the department head that it's in your care.”
Bill picked up the plastic panel. “It is a little neater than our system.”
Thirty minutes later, Bill and I (pretending to be James) had managed to decipher only three letters: Y, O and U. And we had misunderstandings of letters in between. We were hot, sweaty and irritated.
I stood up over James and took my coat off. “James, let's do it. Bill, you handle the board, and I'll write down the letters.”
James' eyes seemed to be focused on me, then they shifted way over to the left, away from the stands.
“Come on, James, look at the board. We can do it—do something anyway, even if the message is fragmentary.”
After a struggle we did get a word: T H E. Bill and I celebrated with a couple of Cokes.
For a moment I was overwhelmed with the reality of James' condition. Then, clearing my throat, I said, “Well, let's continue. I am expecting something breathtaking from your mind.”
The next letter was R.
The next, M. I thought, “Ah, the mind of James, the Jungian-world authority on dreams, has some fabulous insight on rapid-eye movements in sleep but has left out the E. He means REM.”
The next letter was O. The next, S. Then T.
“Bill, if you leave out the R as being a mistake, you have T H E (R) M O S T. Let's go for it.”
The next letter was A. The next, T.
“All right! THE MOST AT. The most at.... Where are the most at, James? Tell us.”
James' eyes rested on me for a moment, then slid off to the left.
“He can't finish the sentence, Bill. Maybe it never was a sentence, just nonsense. He's probably tired. I certainly am. I have to go, and I know you do, too.”
Bill said, “James, we'll hit it again tomorrow,” and left.
I noticed the sun would soon be down and stayed by the bed with my hand on James' forehead, thinking he might have some feeling there. I felt depressed and disheartened. We were running out of time before James was condemned to death.
Salvation
In the early-morning hours, the sound of a telephone ringing woke me. I groped for it.
Bill's voice was on the other end. “Not `the most at.' Remember the R we dropped? `Thermostat.' ”
“Thermostat! How obvious. How could I have been so stupid? Do you remember, Bill? There was a thermostat on the wall to James' left. When I stood up to take my coat off, I was right in front of his face. He would have seen how hot and sweaty I was. He sent thermostat—a clear, logical, impeccable message. He was concerned, first, about my comfort. How like him.”
