Chapter 4

4

The room is saturated in a pale blue fluorescent glow. Machines blink and bleep. Behind a glass screen at one end there is a bank of computers and, in the middle, a large hollow cylinder with a motorized bed poised to glide inside it.

"Please, do sit down," he says as I glance anxiously at the MRI scanner.

One of the researchers hovers at his elbow, brisk and efficient, and asks me to roll my sleeve up, smears some gel on my arm. Dr. Reid sits on a chair next to me. There's an acuity in his gaze, a focused energy about him that unnerves me. I'm experienced, I remind myself, prepared to the very last detail. Yet, for once, my preparation rituals haven't quite worked their magic.

"Okay, so I hope I can give you a little insight today into what we're doing here at the Rosen."

"Right," I say crisply, trying to avoid looking at the gleaming instruments neatly lined up on the trolley next to him. There are fine needles of varying sizes, tweezers, pincers, forceps, tubes of gel and a metal box attached to two electrodes. As a couple of other researchers flit in and out of the lab room, his hand hovers over the tools, as if unsure which to select first. My instinct is to keep him talking.

"And what exactly are you trying to find out?"

"For us neuroscientists, pain always presents an intractable problem. It's a universal experience, one that creates misery for millions of sufferers. It's also utterly private, in that only you're going through it. A bit like dying," he muses. "Nearly all people feel pain. Yet we still struggle to describe it, words often run out, as you'll discover."

I grimace. He smiles.

"So," he continues. "How can we treat a patient who's unable to define what they're feeling? What we need is measurable data. When I inflict a unit of pain on you, I can see exactly how your brain reacts and I can give that a measurement. This creates data. And data is hope." He pauses for effect. "The hope of easier diagnosis and more effective treatments."

"Sure," I nod, wondering when the longest needle is going to come into play.

Nate hesitates, grins briefly as he sits back. "Sorry, you've got me on my favorite subject and we should be focusing on you. I'd like to ask a few questions too before we start. You do bruise quite easily, don't you?"

His gaze shifts as it travels down my bare legs, settling on the mauve crescent rising above my left knee, and I swallow, reflexively tugging at the edge of my skirt.

"Corner of the kitchen table yesterday. Yes. Very easily."

"Tell me about the last time you were in real pain. The symptoms, how it felt."

"Well, I suppose last year..."

"Describe it to me."

"How to describe the pain." I sigh, finding myself strangely inarticulate. All his assumptions coming true. "I guess my mind goes blank when I try to think of the right words. I cut my finger. Badly. I was slicing garlic."

He waits for me to carry on. I take a deep breath, wincing at the memory, particularly the phone call last year that preceded it. Where do I start? If Dr. Reid really wants to hear about pain, we could be here all day.

It was a silly argument with my brother. Tony had wanted to meet my new boyfriend, Dan, and I had been putting it off, pretending I was busy. He had even suggested a double-date with whoever his newest girlfriend happened to be. I had refused, instantly hurting his feelings. "But why not? We always have fun together," he had reproached me gently. "And it's what Mom would've wanted. I'm here to protect you. It'll be fun."

After the call I had felt distracted by the usual cocktail of emotions Tony provoked in me, irritation, guilt, regret over hurting him. I peeled off the pink papery skin of the garlic, tipped back a glass of wine, angling an oversized knife through the small kernel. Why can't I be a more decent sister? Another gulp of wine. Another slice. Then the slip, a cut that was deeper than a usual knick. I think about that exquisite hiatus, less than a second or so, between the act of harm and its effect. How do you tell a pain expert that on this particular occasion the sensation was weirdly satisfying, clean and uncomplicated, obliterating everything that came before?

"It was agonizing," I say instead, because it's the straightforward answer, the one he expects. "I felt sick, frightened too."

"Of?"

"Of what would happen next." I shrug. "It was all fine in the end. A&E. Four stitches, acetaminophen." I hold up my hand and he touches the ivory ridge of scar tissue at the top of my finger.

"Well, I promise you that nothing here today will feel as bad as your contretemps with a sharp knife. These are simulations, acute but brief. Shout and I'll stop." He pauses, his expression growing intensely serious. "So, we're going to stick some electrodes on you to monitor each region of your brain and they'll flash up on those screens over there in different colors, depending on how you react."

"I think I can guess."

"Doubtful. No one knows how they'll respond to pain until they're up against it..."

"Can we just get on with it?" I interrupt.

He looks at me quizzically. "You look worried, why?"

I see all sorts of assumptions flicker in his eyes. Female. Red-haired. Oversensitive. Likely correlation with low-pain threshold, higher-complaint score.

Nate's directness unnerves me, a clinical candor. It's not that I'm afraid of pain. But the idea of being studied as I'm experiencing it is unsettling. The last person I want gazing into my brain and drawing conclusions, I realize, is Dr. Reid. I'm not sure he'd like what he found there.

"No, not all." I try to sound bright. "I'm fine. Let's go."

"Okay. What I'm going to do is rub some capsaicin here, a chemical that you find in the hottest chili. It's the part of the pepper that gives you the deepest heat." After outlining a circle on the inside of my arm, he lathers it on, scrutinizing me as the gel starts to tingle. "You're okay?"

I grip the chair as a burning sensation ripples through me, aware that he's noting my reaction.

"It's intense, right? Capsaicin is one of our most efficient conductors, it reacts with the nerve endings really well."

He presses what looks like a metallic circuit board, the size of a SIM card, onto the gel.

"This will help to kick it up a bit and give us more control, like a volume button. I want you to rate what you feel out of ten. So zero is nothing, five unpleasant and ten pure agony. We'll try not to go further than five."

"Try?" I echo, as a flash of pain shoots along the inside of my arm.

"Too much?" He turns it down instantly, but the volt of his smile disconcerts me. "Okay, now? Out of ten?"

"Er, four?"

He increases the power and I flinch, terrified now that he'll ramp it up further. I want to tell him to stop.

"You're sure you're okay?"

I nod, gritting my teeth.

"Score?"

"Eight." Mercifully the pain begins to recede and I compose myself, determined to steel it out in front of him. "Out of interest," I ask cooly, reaching for a glass of water, "has anyone tried this experiment and not responded at all?"

We both know there's only one person who was oblivious to these simulations, however agonizing. I remember reading in one profile how he'd brought Eva here soon after she agreed to take part in his research. He probably couldn't wait to entomb her in the scanner so he could peer into her brain, all those neurons firing up for him to see.

"You're referring to my work with CIP patients?"

I continue looking at him until he breaks eye contact.

"Believe me, watching someone unable to respond to these tests makes one profoundly grateful to experience any sort of pain," he says, with maybe more feeling than I'd anticipated. He glances down at his tray of implements, briefly lost in thought.

"But finding a cure for pain, rather than helping those who can't feel it, has that always been your aim?"

"I guess the answer to one lies in the other. Pain is more complex than other senses because unlike, say, taste, hearing, smell, vision or touch, it's a warning sign—a distressing sensation with real or potential damage involved. Someone once described it to me as the white-hot core of human experience, and I think that's accurate." He pauses, checks his watch. "Okay, let's try the next test."

"Needles?"

He nods. "They're superfine, more like acupuncture," he says neutrally, selecting a couple from the trolley that look anything but superfine to me. "Now I'll need you to raise your left leg slightly. We want to get to the fleshy part of your calf."

I roll up the side of my skirt, grit my teeth and look away. The sensation feels like a hot knife, as if my nerves are fizzing. "Eleven!" I cry. "You said you wouldn't hurt me."

"That was unexpected." He hands me a small circular ice pack, holds it to my calf, and the relief is almost tear-inducing. A wave of nausea rises in my stomach and my back arches.

"It was more than unexpected. You promised," I say, shaking. My breath feels uneven, as if all the air has vanished from the room.

"Some people barely notice this test but it really depends on the lateral peroneal nerve. Unusual that you had such a strong reaction," he says, evidently pleased. "You see, the peroneal nerve winds around the outside of the fibula and it can be exquisitely painful if you catch it. It's an easy one to stimulate. In fact, yours appears to be particularly sensitive. I told you, it's all subjective."

Nate notices my teeth still chattering and looks as if he wants to say something, but then he shakes his head. "Right, so Kate, our researcher, will pop you in the scanner and I'll be checking your reactions on-screen over in the corner."

He walks away while she takes me through a list of instructions. Slowly I slip into the machine and a small screen above me flashes READY in green lettering before each sensation is administered. Yet again I picture Eva, trapped like me in this rattling metal tube, blissfully safe from whatever agony was about to be inflicted.

A series of red flashes and I feel an acute burning like a blowtorch deep within the muscle of my arm. Another needle slips into the skin around my ankle close to the bone. I think of all those useful adjectives the pain specialists devised back in the '60s. Throbbing, shooting, drilling, lacerating, crushing, sickening.

The problem is that these are only lame explanations. Once pain strikes, language shatters. Memory makes it difficult to describe precisely since we try to block it out, but so does the sensation itself. I see and feel it in colors more than words. Shutting my eyes, I focus on the orange patterns at the back of my eyelids, morphing into silver shards.

The scanner vibrates and an alarm sounds. My bed moves slowly into the light and I open my eyes. I try to stand up but my legs are unsteady. He walks briskly back over to me, checks my pulse, the tips of his fingers pressing into my wrist.

"So how did I do? Do redheads really perceive pain that differently?"

"They appear to," he says, his head tilting as he studies my scans. "But in conflicting ways. Their pain tolerance can be higher and yet they can also require more anesthetic to be sedated. So I'm not surprised you're a complex respondent," he reflects. "Resilient at points I wouldn't expect, but then over-responsive at others. On the whole, unpredictable as far as the data is concerned."

He flips through a series of images where regions of my brain glow orange and red like a forest fire. "It's a fascinating start and, if we had longer, I could talk you through all your results, your pain profile, but I'm afraid we're out of time. Is there anything else Kate can help you with for your article?"

I realize I am being dispatched. The interview is over.

"Is that it?" I say, still jittery from the tests. "What happened to my interview?"

He shrugs, polishing his reading glasses.

"No." The pitch of my laugh takes me by surprise, and I touch the tender skin inside my arm. "It's been great hanging out in Room 101, being poked and burned and prodded. So you get what you want and I get nothing?"

"Not exactly nothing. It will add to your profile, surely?"

"Amazing," I say. "But you haven't really kept to your side of the deal."

"I disagree. As I said before, you're the first journalist to set foot in here. You've had a unique opportunity to see my work, to experience it firsthand for yourself. Anything else, background, facts, more quotes, I'd be happy to follow up by email."

"That doesn't work for me." I stand up, aware that my face is hot, my hand trembles as I grab my bag off the floor. "It's a cover story. Readers will want to know more about you, a bit of background. We can talk about your work, but there needs to be a personal element to my article too, for color and context."

I inhale sharply, instantly regretting my show of impatience. This was meant to be a charm offensive but now I've sabotaged all that. I've let my emotions surface, disaster for an interviewer, let alone a prospective ghostwriter. "Look, I'm sorry. I think those tests may have thrown me slightly." I massage my arm, laugh awkwardly.

"No, you're right." His tone softens too. "The truth is I don't do interviews, but Rhik is very persuasive, and there is The Pain Matrix to promote, so I gave in. But I value my privacy above all else and, as I think we both know, there are good reasons for that."

"Okay, well, how about I send you a list of questions first so you know exactly what I'm going to ask you? Could that work?" He considers this for a moment and I press on, "You don't have to answer anything that makes you feel remotely uncomfortable, I promise. Completely up to you. I trusted you and now—"

"It's my turn?" He looks faintly amused. "Okay, fine. But I may as well say now that I won't answer the really personal stuff, particularly what happened in the past. I'm not keen on raking through all that, not yet." He picks up his phone and scrolls through the diary. "I'm away for a while from next week so I can do...this Friday?"

"Fine. Do you have a home office?" I suggest, as casually as I can.

He hesitates. I see a small pulse in his jaw line. "Yes, but—"

"Well, that sounds ideal," I say, jumping in before he can change his mind about the prize that's being dangled in front of me, an open invite to Algos House that has always been very much off-limits to journalists.

"Just to clarify, Anna, my home office, not an at-home interview. You do understand? I don't want to disappoint you on that one."

"Of course. Absolutely." But we both know it's a compromise, an unpredicted win.

"I'll get Rhik to email you and confirm the details and address. My niece is staying there at the moment while she's on a research placement and she'll be around if I'm delayed here for any reason," he says and then he's on the move again. I follow him back along the acres of beige corridor until we reach the elevator, facing each other. "Thank you for coming along today, Anna, for being so game. There's something about seeing an authentic response to my work that is always such a privilege."

He gives me a small, secret sort of smile as the doors close.