Elie was fifty-eight years old when she began to lose language. She told Hiroji that the first occurrence was in St. Michael's Church in Montreal, when the words of the Lord's Prayer, words she had known almost from the time she had learned to speak, failed to materialize on her lips. For a brief moment, while the congregation around her prayed, the whole notion of language diminished inside her mind. Instead, the priest's green robes struck her as infinitely complicated, the winter coats of the faithful shifted like a collage, a pointillist work, a Seurat: precision, definition and a rending, rending beauty. The Lord's Prayer touched her in the same bodily way that the wind might, it was the sensation of sound but not meaning. She felt elevated and alone, near to God and yet cast out.
And then the moment passed. She came back and so did the words. A mild hallucination, Elie thought. Champagne in the brain.
She went home and did what she always did. She closed the glass doors of her studio, unlatched the windows, lifted them high, and she painted. It was winter so she wore her coat over two shirts and fleece sweatpants, thick socks, and a woollen hat on her head. A decade ago she had been a professor at McGill University, but at the age of forty-six, she had abandoned that life. Now, experience unfolded in a different pitch and tone, when she closed her eyes she saw how the corners of improbable things touched―a bird and a person and a pencil rolling off a child's table―entwined and became the same substance. Painting was everything. She painted until she couldn't feel her arms anymore, ten, twelve hours at a time, every single day, and even then it wasn't enough. Her husband grew accustomed to the smell of oil paint on her skin, the way she gestured with her hands in place of words, the way she gazed out with a newfound passion and righteousness. "I can see," he heard her calling to him one day. "Look what I can see."
"I thought," Elie told Hiroji, when he had been treating her for many years, "that my entire past was fantasy. Only my present was real."
The champagne in the brain began reoccurring, blotting out people's names, song lyrics, street names, book titles. She felt sometimes asif the words themselves had vanished, in her thoughts, her speech, and even her handwriting. There was a stopper in her throat and a hole in her thoughts. In her paintings, she turned music into images, the musical phrases playing out like words, the words breaking into geometric shapes, her paintings grasping all the broken, brilliant fragments. When she worked, there were no more barriers between herself and reality, the image could say everything that she could not. Increasingly, she could not speak much. But she could live with losing language, if that was the price. This seemed, back then, a small price.
She was painting when she noticed the tremors in her right arm.
The first time she had met Hiroji, he had asked her if she found speaking effortful. The word had seemed to her like the priest's green robe that day in St. Michael's Church, an image blocking out all other ideas. Yes, how effortful it was. "I'm decaying," she told Hiroji, surprising even herself.
"What do you mean?" he asked her.
"I can't... with the..." She put her hands together, straining to find the words. "There's too much."
Hiroji sent her for diagnostic testing. Those MRI films are conclusive. The first thing that strikes the viewer is the white line, the fragile outline of the skull, surprisingly thin. And then, within the skull, the grey matter folded around the hub of white matter. What has happened is that her left brain, the dominant side (she is right-handed), has atrophied—it is wasting away in the same manner that a flower left too long in the vase withers. Throughout Elie's left brain this disintegration is happening. Language is only the first thing that she will lose. It may come to pass that, one day soon, she will not be able to move the entire right side of her body.
The images show something else too. While one side of her has begun to atrophy, the other side is burgeoning. Elie's right brain has been creating grey matter ― neurons ― and all that extra tissue is collecting in the back of her brain, inthe places where visual images are processed.
"It's a kind of asymmetry," Hiroji had told her, "a kind of imbalance in your mind, between words and pictures."
"So what is it, all this, that I'm making? Where is it coming from?" She waved her hands at the bare walls, as if to pull her own paintings into the room, to trail them behind her like an army.
"It comes from the inner world," Hiroji said, "but isn't that where all painting comes from?"
"My diseased inner world," she said. "I'm at war. I'm dwindling, aren't I?" She picked up the MRI scans from his desk. "Do you paint, Doctor?"
He shook his head.
"Have you ever thought about it?"
He thought for a moment. "My mother always encouraged us to use our minds and not our hands. She was a Buddhist and, I suppose, she always felt more at ease with the ephemeral side of things."
"The ephemeral," she said, doubtfully. "Like dancing?"
He laughed. "Yes, like dancing."
Hiroji kept Elie under what is known as surveillance MR imaging. Scan after scan, year after year, the films show the imbalance widening. Three years after her diagnosis, Elie's paintings, too, began to change. Where once she had delighted in turning music into complex mathematical and abstract paintings, intense with colour and the representation of rhythm, now she painted precise cityscapes, detailed, almost photographic. "I see differently," she told us. "It comes to me less holy than before." He wanted her to go further, to explain this holiness, but she just shook her head and poured the tea, her right hand trembling.
"The conceptual and the abstract," Hiroji told her, "are no longer as accessible. Your interior world has changed."
Hiroji and I co-authored a paper on Elie's condition. He described to me how, in Elie's home, her paintings graced the walls. He had the sense that they pleased her because they brought the interior world into the world that we live in, the one that we hold and touch, that we breathe and smell. "Soon," she had told him, tapping her fingers against her chest, "there will be no inside."
Elie is almost completely mute now. When she telephoned Hiroji, she wouldn't speak. She would hit the keypad two or three times, making a kind of morse code, before hanging up again. Her disease is degenerative, a quickening loss of neurons and glia in the other parts of her brain, impeding speech, movement, and finally respiration. Unable to paint, she and Gregor spend long days at the riverside, where things move, she once told Hiroji, ephemeral, and nothing stays the same.
Two years ago, delivering a lecture in Montreal, Hiroji spoke briefly about consciousness. He said that he imagined the brain as a hundred billion pinballs, where the ringing of sound, in all its amplitude and velocity, contained every thought and impulse, all our desires spoken and unspoken, self-serving, survivalist, and contradictory. The number of possible brain states exceeds the number of elementary particles in the universe. Maybe what exists beneath (tissue and bone and cells) and what exists above (ourselves, memory, love) can be reconciled and understood as one thing, maybe it is all the same, the mind is the brain, the mind is the soul, the soul is the brain, etc. But it's like watching a hand cut open another hand, remove the skin, and examine the tissue and bone. All it wants is to understand itself. The hand might become self-aware, but won't itbe limited still?
A few days after the lecture, Hiroji received a letter from a man recently diagnosed with Alzheimer's. I have been wondering, the man wrote, how to measure what I will lose. How much circuitry, how many cells have to become damaged before I, before the person my children know, is gone? Is there a self buried in the amygdala or the hippocampus? Is there one burst of electricity that stays constant all my life? I would like to know which part of the mind remains untouched, barricaded, if there is any part of me that lasts, that is incorruptible, the absolute centre of who I am.
Madeleine Thien is the author of the story collection, Simple Recipes (2001), and the novels Certainty (2006) and Dogs at the Perimeter (2011), which takes place in the long aftermath of the Cambodian civil war and genocide. Dogs at the Perimeter was shortlisted for Berlin’s 2014 International Literature Award and won the Frankfurt Book Fair’s 2015 Liberaturpreis, celebrating avant-garde literature by women writers.. Her work has been translated into 24 languages. Madeleine’s essays have appeared in Granta, The Guardian, The Financial Times, Five Dials and Brick, and her story 'The Wedding Cake' was shortlisted for the 2015 Sunday Times EFG Short Story Award. Her latest novel, Do Not Say We Have Nothing (Granta Books, 2016), has been short-listed for the 2016 Booker Prize. In 2017, Norton will publish in the U.S. her novel Dogs at the Perimeter.