Thin Places

Where do I start and stop, is what I want to know.

Enrique Martínez Celaya, The Secret. 2012, Oil and wax on canvas, 44 x 60”. Private collection, Los Angeles, California.

The electrode is the width of angel-hair pasta. A surgeon has threaded it through one of the four dime-size holes in the patient’s skull, and it is advancing into her one millimeter at a time, controlled by a small knob that another surgeon is turning and turning with great concentration.

This morning a nurse shaved off the patient’s hair, and the surgeon drilled these holes around the crown of her head, two in her temples and two in the back. Then he fastened a metal brace the size of a dog cage around her head to hold the wires steady as they enter her brain. Surrounding the patient, the brace, and the doctor is a giant O-shaped machine the color of tangerine sherbet, which is taking live images inside her head. The patient is awake.

First, the electrode passes through the part of the brain closest to the bone, the part of her that knows the names of things and left from right. Then it bores down through the part of her that knows how to draw, the part that recognizes her mother’s face and remembers what she said to the nurse when he asked about the birthmark on her temple. Down through the part of her that likes sex and the part that knows how to talk. Down almost to the deepest part of the brain, the stem, which is responsible for her breath and her heart. This movement, from outside the patient’s body through the opening in her skull and into the core of her brain, is called transversal.

The transversal has been plotted carefully. The path of the needle is precise to the millimeter, avoiding important veins and arteries as well as nerve clusters better left untouched. The destination is Area 24, also known as the ventral anterior cingulate. Hers is suffering from either underdevelopment or hyperactivity, depending on which doctor is explaining it. The electrode will stay inside her to deliver electric currents to Area 24 for the next several years, or possibly forever.

The patient finds herself strapped to a gurney with wide belts, naked under her paper gown, because this morning, like every morning, she thought, 117 times, “I am going to kill a stranger.” A pacifist by nature and in her politics, she finds this thought sickening and goes to great lengths to ensure that it doesn’t come true. An elaborate protocol has arisen: every time the thought “I am going to kill a stranger” pops into her mind she jerks her head hard and declares silently, “I am a peaceful person, I am a peaceful person, I am a peaceful person.” This quells the panic that rises — is she peaceful? What if she killed someone by accident? What if she flew into a sudden rage? What if she is, at heart, monstrous? — and works like penance: three peaceful thoughts for every murderous one keeps the balance tipped in the right direction. This becomes more difficult when the thoughts come quickly. The number of times she thinks “I am going to kill a stranger” has to be prime or the thought’s power increases, so she’ll restart the cycle as many times as necessary to bring the count to a prime number. A twenty-minute reprieve is as much as she hopes for in a day.

She has thrown out all her knives, scissors, heavy blunt objects, needles, and sharp pens. She stopped driving a long time ago. She never stands near train tracks or close to people on the sidewalk, just in case something were to come over her and she were to push someone into traffic. Despite being shy, she feels compelled to introduce herself to almost everyone she sees. Once she meets them, they are no longer strangers and therefore no longer in danger of her. This became exhausting — and alarming to the strangers — so a few years ago she stopped leaving her house altogether. Now she lives in terror of what she might do to deliverymen.

Over the years, doctors have prescribed nine medications in various combinations, as well as talk therapy, exposure therapy, cognitive behavioral therapy, and electroconvulsive shock therapy, all with meager results. Her case is, to use their terminology, “intractable.” She had to sign all manner of paperwork formally acknowledging this, attesting, for example, that she knows what the word intractable means, before she could find herself in this room with Frankensteinian screws in her temples, counting the ceiling tiles. She consented to everything without hesitation.

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