Hughes says. “He must have been mad.”
Munin and Hughes stroll along an Italianate promenade of faux columns and kitsch fountains littered with coins too small to toss in a slot. At the corner Mexicans are handing out hooker postcards, gift certificates, coupons for free pulls. An interstate bus huffs out in a diesel fog and turns onto the Strip, heading south.
The glare makes the street surreal. Each of the casinos is a fantasy — ancient Egypt, the Arabian nights, the imagined desert — each as elaborate as a fuck dream. Just background noise to Hughes; he’s reading a flyer advertising blond college grads delivered direct to your hotel room.
They enter the stream of tourists crowding the boulevard.
“No one walks anymore,” Munin says, the pace too slow for his taste and he’s a little testy in the heat. “They lumber along.”
“Why stay put?” says Hughes. “Family ties? They hold you back. Ex-wife? Kids? Leave them behind. If you hate the east, go west. Hate the cold, go south. It has a certain charm, believing that life will be different somewhere else.”
At the corner they are recognized by two men wearing convention badges. “Dr. Munin, isn’t it? I’m Dr. Raffie, Nashville. I’m the director of the outpatient access prog —”
“Yes, of course.”
“I heard your lecture in Miami last year. Will you be speaking here?”
“Thursday,” Munin says. “Just a case I’m presenting at one of the satellites.”
“Yes, I seem to remember reading that in the program. I’m not sure if I can make it, may have to go back early — busy, so many people to see. This isn’t my favourite venue. Crass, don’t you think? My wife absolutely refused to come. If you’ve got a few minutes now, I’d appreciate your opinion on a difficult patient of mine.”
“Call me in a week or two. Or send an email.”
They cross the boulevard, Hughes intent on traipsing about a shopping mall modelled on a Roman forum to scrounge for souvenirs. “I’ll leave you here,” Munin says. “I’m going back to my room. I’ve still got a bit of work to do on my presentation.”
“That fellow didn’t ask about my case,” Hughes says, a bit peevish. He’s presenting at the same symposium. “You’d think he would have noticed. A case of gambling addiction — what could be more bang on in a place like Las Vegas?”
“Eating disorders for one,” says Munin.
“I expect so. It is a buffet-and-bulimia sort of town.”
“Did you see our waitress? The one at the coffee shop?”
“You barely glanced at her,” Hughes says.
“You didn’t notice anything?”
Too thin, that was the first clue. Pale complexion, muscle wasting, the drawn look on her face. Index and middle fingers were shiny as if etched by stomach acid. Teeth were a mess, the enamel worn away when she brushed to get rid of the taste in her mouth. There are always signs.
“Do you think we should go back and talk to her?”
“I don’t think so, no.”
“Curious that she’d work in a restaurant.”
“Is it?” Munin studies him for a moment, Hughes’s face naked in bright sunlight.
“Perhaps not,” says Hughes. “No, I expect it isn’t.”
On Thursday Munin will lay out the facts of the matter. The case of Penelope. He has been allotted twenty minutes to discuss the signs and symptoms, what occurred, how he has intervened. It will be enough: to review the obsessions she reported, the compulsions he observed, what he has done. There’s no need to capitulate and recapitulate her life. He will present only the small part bisected by treatment. He will not talk about the things that came before, or after.
The mall is an agora with marble columns, galleries of designer shops, the inevitable slot machines. The dim lighting heightens the glow of the storefronts, scads of people fluttering like moths but no one settling on anything. Puts Hughes in mind of a medication he once used in his patients with gambling addiction: it controlled their impulse to wager but also killed the urge to shop. There was a neurological link there, shopping and gambling, one of those clinical curiosities the British journals were keen to publish. He should really write it up. Nothing prudish, no rant against the false economies of consumerism and the gaming industry. Shopping was hard-wired so it must be essential, the soul equivalent of breathing or reproduction. That would get him a spot on the lecture circuit.
The air is chilled and ozone-rich. Hughes coughs; it’s hard to breathe. He blames the ceiling in this place, painted an oppressive sky blue with puffs of cloud looming overhead. It makes him anxious. Wherever he turns he is aware of that crypt of ceiling, as he is not aware of other ceilings, or of the sky itself. He can feel himself starting to hyperventilate.
In an hour the show will start, the fake Roman statues will come to life, or so a sign says. Hughes doesn’t wait. He hurriedly buys a few T-shirts, a coffee mug, a deck of cards, then flees to the adjoining casino where the air feels more breathable. Kills a few hours at a blackjack table. The environment entirely artificial but soothing somehow; it isn’t pretending to be real. A casino is a self-enclosed world, mad in a way but conforming to its own logic. It succeeds, like all delusions, as long as the doors remain shut and reality isn’t allowed to intrude.
Flick of cards, whir of the automatic shuffler. Hughes hits and busts, hits and busts. Stands and is beaten by the dealer’s two face cards. Surely there’s a pattern to it all. Hughes tries to visualize it, the rhythm, the flow that makes up a run of luck. Something mysterious, hidden from the weekend punters. Munin would see it, Hughes is quite sure of that. His colleague has the rare ability to understand the play of physical symptoms, the behaviours, the random thoughts that aren’t so random, after all. A diagnosis is simply an attempt to wrest some sort of meaning from the human chaos. All that messy business of a patient’s life: the false starts, dead ends, and the path that’s left in front of you becoming ever more constricted. You are tired and freighted with baggage. Who wouldn’t want a guide, someone with a map, a way of categorizing and organizing everything? Who wouldn’t welcome someone with a fresh way of looking at things? Who doesn’t desire to have a system? Nothing predetermined. Nothing judgmental. Nothing so procrustean that it couldn’t accept every conceivable complaint, every mad thought, any unsettling act. Munin’s world could even accommodate those absurd “six aspects of love.”
There’s a woman at the slots counting coins in the metal tray. A man at the craps table is rubbing his fingertips on the felt; he touches his heart, he touches his temple, he blows on the dice before rolling them. Hughes would like to believe that these gestures, the small rituals and superstitions, mean something. But he’s a skeptic. He lacks faith. When he’s with his patients, he listens carefully to what is said, and what isn’t. He understands just enough of what they tell him to make a diagnosis, prescribe something, have them come back in a few weeks. But still, after ten years of trying — after what has been said, after what has been done — he knows he’s missing something. He hasn’t grasped the heart of it.
He pretends, of course. He dutifully conducts the examination, completes questionnaires, checks items on a checklist. He fills uncounted files with his painfully acquired observations. He tries to break things down to their essential elements, their six aspects, or nine, or twelve. He records gestures, counts physical symptoms. He shines a light in his patients’ eyes. He sees all that can be seen. But there is a shadow, always.
Munin dials his home number. Out on the Strip, a stream of early-evening traffic, river of people looking up at signs as though they meant something, bright neon bleaching out the heavens. The phone rings. Munin realizes he’s no longer staring at Vegas but at the glass.
He turns away, phone still ringing, and shuts off the television. On the fourth ring the phone clicks over to voice mail and he hears her: “I’m