Remember To Scream

Roland Bell concluded that Las Vegas had advantages as a place for 850 neurologists to discuss pain, advantages beyond having more hotel rooms than any other city in America. For those devoting their careers to investigating pain and confronting its harrowing extremes, chronic urgency was an occupational hazard. By its nature, however, urgency could not be permanent; it was by definition an acceleration of life's norm. Still, raked by the cries, moans, screams—and the shattering pleas for surcease or death—the urgent threatened to become the new norm.

Bell wondered if that pace also accelerated the aging process. At 37, he had launched an a counter offensive against aging, propelling himself out of bed to work out—no excuses accepted on weekdays—and pushing away dessert at too many business luncheons. He had a few natural advantages—a tall frame that flared to wide shoulders, a tough-guy handsome face with blond hair kept unromantically short, and blue eyes to match the hair. Was he in the shape he was almost 17 years ago, when he passed on signing up for another U.S. Navy tour? Nope. Too fond of wine, too fond of waking up and saying, 'I'll sleep in and cook her breakfast...'

Here, in the world capital of frivolity and the monumentally unimportant, one might hope for refuge from urgency. What could demand less serious attention than a manmade lake with 1,000 computer-controlled jets that flung water 240 feet skyward to sway and spray in perfect time with a Frank Sinatra oldie or the London Symphony Orchestra playing Aaron Copeland? Arguably, it was beautiful; equally arguably, it was grotesque; but by no argument did it dictate a mindset of urgency or gravity.

Refreshed by such diversions, the neurologists could flock back to the meeting rooms for the next presentation on intractable cancer pain, opioid receptors, or cytokines. When it all drew to a close at day's end, there was the release of high-stakes Blackjack, topless bars (or bottomless, if you could take it without alcohol), excesses of magic and music on stage, or just the hypnotic incandescence of the Strip.

Dr. Bell's meditation on the pressures of pain as a career had begun that afternoon as he idled past the Bellagio's rows of meeting rooms, consulting his program of lectures, seminars, and panel discussions on neurology and this year's theme: pain. Most participants were in meetings that had begun at 3:00, but every sitting area had its knot of refuseniks doing their science outside the formal gatherings. Bell passed few groups without catching a phrase about pain in its manifold forms; only occasionally did he catch a phrase about the distractions of Las Vegas.

And then, abruptly, from behind closed double doors, came a scream, then another, and harsh sobs. A woman's voice shrieked 'no! no! God, no!' Bell had taken several quick strides toward the door. The screams had been joined by the murmured rise and fall of many voices. The doors flew open. As bystanders held them, a man with his arm around a woman's shoulders came out. The woman screamed again, protested in a language Bell did not recognize, and began to sob. Her body twisted away from the man's clasp, but only feebly. Her eyes were shut, her face streaked with tears. A crowd swirled in their wake.

As Bell watched, the man steered the woman to a sitting area. Grasping his intention, people on the couch quickly rose. He eased the woman down. She leaned back, but resisted his attempts to get her to lie down. Suddenly, as though seized anew, she cried out so shrilly that those nearby drew back. Bell himself felt his heart beat faster. Everywhere around him, he heard: 'What's wrong?' 'Who is it?' 'What happened?'

Without lifting his arm from the woman's shoulder, the man turned to the crowd. "I think it's all right," he said firmly. "I know her. I believe this is a bit of agoraphobia. I'll give her a sedative. She recovers quickly. This is very rare." He looked directly at those nearest him. "It's under control. I appreciate your concern," he said.

His confidence, and perhaps his appearance—tall and athletic, with distinguished grey hair—had their effect. The crowd began to unclot and flow back into the meeting room, where the abandoned speaker at the lectern seemed to be preparing to resume his remarks.

"Tamina," the man kept repeating, "Tamina. You're with Dr. Sturges. You're at a scientific meeting. You're in America. Do you understand?"

Bell had turned with the others to enter the meeting room, but had stopped just within earshot of the conversation. He had frowned. It was unusual reassurance for a woman experiencing an attack of agoraphobia. She was considerably younger than the man, with thick black hair brushed off her face in a heavy wave and beautiful dark skin. Her eyes were large and dark, with long, dramatic eyebrows, and her lips full. With her head thrown back and her chin thrust up, her broad face seemed shaped for resolve. She was an altogether beautiful young woman.

After another minute, Bell found himself in a small knot of remaining spectators who lingered, uncertain—or drawn by professional curiosity. The man turned again, looking directly at them, and said: "Please! We are all right. I'm a physician."

It had become rude to remain. But by then, Bell had lost interest in the sessions, which, in any case, would end in 20 minutes. He had decided to pay a visit to the famous fountains, then return to his room to email his office.

Much of the Bellagio resembles a fashionable block in Manhattan's East 50's, with 10 restaurants and lounges, ranging from Le Cirque to an old-fashioned soda fountain, and shops worthy of Madison Avenue. After half an hour on the telephone and a shower in the Roman baths that were a Bellagio standard, Bell had decided on a late lunch at the little coffee bar overlooking the gardens and pools. Dinner easily could be at 10:00 p.m. or later in this 24-hour city. Where else did the main business of a city operate 365 days a year, 24 hours a day, with never a holiday or a break to wax the floors?

As he entered and glanced around for a table, Bell saw the man who had helped the stricken woman that afternoon. He was alone at a table that overlooked the gardens and, although coffee and a pastry were in front of him, he sat staring ahead, elbows on the table, hands clasped; he was not smiling. Bell had intended to question him about the incident, but had not foreseen an opportunity this soon. He strolled over to the table and asked, "Everything under control now, I hope?"

"Oh!" The man looked up. "Oh, yes, yes it is. Thank you." He resumed his examination of the far wall, as though expecting Bell to move on.

"She's a colleague of yours? You indicated that you were familiar with her condition."

The man turned again. "Yes, she is." Bell waited. The man added, "I'm sure she will be fine."

"Her name is Tamina Khouri?" asked Bell. "I noticed on the agenda that she's presenting tomorrow. I suppose that's off, now?"

The man picked up his coffee. He said, "Actually, she's determined to go ahead," and bent his head to sip the coffee. For many moments, he did not look up at Bell.

"Good for her," said Bell warmly. "That's courage. Is she in your department?"

The man nodded, without looking at him. "Yes, yes she is."

"University of California? I noticed her affiliation in the conference program."

"We're a systemwide unit on problems in neuroscience. Quite new. Yes, she's with us." There was no help for it. He stood up and extended his hand. "I'm Alan Sturges."

"Roland Bell. Good to meet you."

"And you're with...?"

"Government, actually."

"NIMH? NSF?"

"No, not one of the scientific shops. I'm a

psychiatrist. Did my undergraduate and everything at St. Louis."

Now, Sturges would not be sidetracked. "Exactly where do you labor in the great bureaucracy on the Potomac?"

Bell said, "I'm in national security. I work with NIMH and NSF from time to time, though."

"CIA? FBI? National Security Agency?" Two could play at politely rude persistence.

"The CIA pays my salary."

"That's what counts." Surges looked ready to sit down. "Well, if you're at Tamina's presentation, I'll see you there."

"Listen," said Bell, "I wonder if the problem is agoraphobia, as you said. You know her, of course, but I'm familiar with the phobias and I can't make the signs fit."

Sturges said slowly, "Be assured, Dr. Bell, that we will do a complete work-up back at the University."

Bell's career had been built on ignoring polite hints to bug off. He pursed his lips. "You know, I'd have said it looked like Post-Traumatic Stress Disorder."

Sturges gave Bell a long, rueful look, sighed, and asked: "You wouldn't want to sit down would you, Dr. Bell?"

Yes, Bell would, and when Bell had ordered a sandwich and iced coffee, Sturges leaned forward over the table and said, in a low voice: "Listen, she's my postdoc and also happens to be the best postdoc in our unit. In terms of research readiness, she could go on her own right now. Obviously, these meetings are the academic bazaar—or the meat market as the young cynics put it. Tamina's going through with her presentation tomorrow because that's how you get job offers, right?"

Bell nodded. "Well," Sturges continued, "throwing hysterical screaming fits--which you and I know that that yesterday wasn't, but could be taken for—is not good self promotion. I wanted to minimize what happened." He glanced out the window, frowning, and said, "That thing about agoraphobia, well, it cast what occurred into a more benign light. But PTSD raises a slew of questions, none of which you want to explore while your new faculty member is beginning to teach students, apply for grants, and attend faculty meetings. Right?"

"That's how you discovered it?"

Sturges said, tonelessly, "You know, Dr. Bell, it makes me quite nervous to be discussing my postdoctoral student's mental health—or anything else, for that matter—with a CIA guy. Back when I was a grad student that would have ended your academic career quicker than getting picked up on a cocaine charge. Actually, much quicker."

"Okay," said Bell agreeably. "I remember that, too. But things have changed, as you imply. Didn't you? And not just since 9-11..."

"In the interests of frankness, I will add that just your being at this conference troubles me. Actually, it angers me. The CIA looking into the latest research on pain? Do you know where my imagination goes with that, Dr. Bell?"

"Sure." Bell took a big bite of his sandwich without shifting his eyes from Sturges's face.

"Before 9-11, I don't recall ever hearing anyone float the idea publicly that we might want to torture terrorists. In special circumstances, that is. Save Los Angeles sort of circumstances."

Sturges closed his eyes and slowly shook his head. "That is precisely why it disturbs me for you to be at this conference. And for me to be sitting here talking with you." He shoved back his chair and rose abruptly. "You know, right now, Dr. Bell, I feel compromised just having heard what you said."

Bell grinned up at him as though greeting an old familiar stage in making friends. He said, "I'm at liberty to attend virtually any scientific meeting I choose. No matter the field, I've discovered, some participants can project horrifying applications of the research."

Sturges seemed undecided about storming off. "I suppose so," he said, with a sigh, "but torture using scientific research on pain management and relief occupies a special place in my moral landscape."

"Mine, too," said Bell quietly. He looked down at the remains of his sandwich, and added, "Since none of our field agents can ignore the possibility that one day they will undergo it."

"All right," said Sturges, "I don't march on Washington, nowadays—except to apply for grants." He rapped the table with decision. "But listen, I have to go. See you tomorrow, maybe?"

"About Miss Khouri...," said Bell.

"Yes?"

"Had she had any earlier episodes of, let's say, for argument's sake, PTSD?" He added, with a laugh, "Sorry to throw this into the mix, Dr. Sturges, but I hire a certain number of postdocs myself. Could be why I'm here, you know."

"Oh boy," Sturges breathed fervently, "where do I come out on that one? No, I never knew her to have an episode. She's been with us just over two years."

"And presumably has studied every conceivable aspect of pain? Experimented with pain? The martyrdom of the white rats?"

"All that," said Sturges, "sure."

"Hard to see, then, how this afternoon's discussion set off an episode. I wasn't there. Nothing unusually awful?"

"Nothing she didn't know. She could have given that talk."

"No horrific slides? Blood?"

"No. And she's done autopsies, of course."

"So you see what I mean?"

Sturges shrugged. "I do. But PTSD is funny. When it comes, why it comes, what brings it on—we don't know so much. Two people have the same experience, one goes full-flown PTSD, one is born again. Why?"

Out of the window, Bell watched the last daylight on the Bellagio's oceanic pool. He cracked his knuckles, one by one. Then he looked up and smiled. "I know you have to go," he said.

"You're going to approach Tamina?"

"Like to. This evening, if she's able." He held out a card to Sturges. "Any serious moral qualms?"

"Mine are rather beside the point," he said. He laughed. "She has all of those she needs. You'll see. Sure, I'll pass along the card."

"Obliged," said Bell

Sturges shoved back the chair and rose. He looked down at Bell for a few moments. Then, he said, "She's gorgeous, of course. But I'm quite certain that in the two years she's been in our shop, no one has scored."

"Thank you," said Bell gravely. "Thank you, doctor."

Bell had told her on the telephone that he would recognize her. All she had to do was walk into the Bellagio bar and he would stand up. Still, he nearly blew it. The long black dress covered her from below her knees almost to her chin. Above it, her face looked pure and austere, the long black hair pulled back and knotted.

Although her arms were bare to the shoulders, she wore no jewelry but a watch. Her only ornament was the body covered but not quite concealed by the dress. The girl in the flowing hair and business suit that afternoon had vanished. Bell might have missed his cue had he not been rather impertinently examining her figure before he knew who it was. When she had noticed it, she smiled—and everything clicked and he shot to his feet.

She looked pleased. Perhaps it was the easy, athletic way he came forward. Bell still did some jujitsu because the agents with whom he worked, especially abroad, usually were exceptionally fit, and—hey, you never knew. Now, he exclaimed, "So beautiful!" and added, "And looking so evening-out-in-Las-Vegas. I love it!"

Smiling, she gave his hand a firm, efficient shake, and slid into a seat. She smacked her purse down on the table, straightened her shoulders, and said, "Well!"

Bell grinned. "No, I should be saying, 'well'!" Then, he realized that his admiration was ceasing to be a polite recognition and threatening to become a leer. He quickly said, "I mean, you've obviously put this afternoon behind you. It's impressive. And I'm glad."

"Dr. Sturges mentioned you were there."

"He handled it well." Bell didn't know if Sturges had mentioned agoraphobia to her. It wasn't a cover story that would hold up for long with neurologists. In the past hour, Bell had received an impressive initial package of information from Washington in response to his inquiries. Quite a few hot buttons had been hit: the Middle East, immigration, the Gulf War, the year 1991—all in addition to his professional interest in pain and in scientists with unusual vulnerabilities. "And this never happened before?" he asked.

She shook her head, holding his gaze. "I was stunned by it. Now, I'm embarrassed."

"I could say that there is no reason to be, but you may not mean that in a personal sense. In the neurology and psychiatry career game, yes, you have been slightly embarrassed."

"Oh," she said sighed, shaking her head, "personally, too. I looked like a nut case. Talk about alarming."

"I don't think I've seen that one in the DSM IV," said Bell.

She laughed. Her dark eyes had a way of catching the light. Like a gem, thought Bell. "It has to be in there," she said. "They just added the kitchen sink, didn't they? " It was a common criticism of the proliferation of psychiatric diagnoses in the Diagnostic and Statistical Manual, edition IV, revision A.

"Let's have a drink," suggested Bell.

"Canadian Club. On the rocks, please. Actually, a double?"

With the anesthesia on order, Bell reluctantly made his first decision. "I would say that it's in the DSM IV, yes. I'd check out Post Traumatic Stress Disorder, first. Don't you agree?"

Her smiled was gone, but she looked at him levelly. She said quietly, "PTSD: experiencing terror as though the trauma were happening again, nightmares, jumping out of your skin when startled, losing trust in people, rage, guilt, sleep problems. Yes, it's plausible." She left it there, a warning sign over the trail.

He said: "You grew up... Let's see how good I am. In the Middle East, of course. Perhaps the Levant. Ignoring the name 'Khouri'..."

"What do you mean, ignoring my name?"

"Americans change their names. It used to be an honorable tradition. In my business, you quickly realize that."

"What is your business?" It was a demand.

He held up his hand. "Wait. I'm making my guess."

"Turkey," she said. "Where are the drinks, I wonder?"

"College in Turkey, then medical school here?"

"That's right. North Carolina. Duke."

"Right after you arrived here, may I ask?"

"Not much more than a year. September 1992."

Bell waved to the waitress, who waved back and smiled. Tamina sat very straight in her chair, hands folded on the table, attending him. "I think I understand," said Bell. "Turkey can be trial by fire for a woman, especially a brilliant one. And if you happen to be a Kurd..." He was leaning on his elbows, hands folded, head bowed, as though contemplating a puzzle.

The waitress hurried over with the drinks. Tamina raised her glass in a perfunctory toast and took a long pull. Bell said to the waitress. "Assume that we'll have another round."

"I really shouldn't," said Tamina. "Usually, I don't."

"Las Vegas is for doing what you never do," said Bell. "I think that we're both old enough. So anyway, a young Kurdish woman growing up in Turkey—or Iraq—"

Tamina abruptly stood up, almost tipping over her chair. "All right, Dr. Bell. Perhaps I misunderstood why we were meeting." He noticed, for an instant, that he hands were shaking, but she quickly folded them. She was upset, but also angry, and perhaps more angry than upset. "Dr. Sturges told me that you are with intelligence, but I thought in America..." She added: "He said that you are connected with the NIH and NIMH."

"All true," said Bell mildly. "Intelligence and psychiatry—secrets squared." He said gently, "I hope you sit down. I promise that I have no interest whatsoever in your immigration issues." He added, "As sensitive as those can be, today."

"What are my immigration issues?" She did not sit down.

"I'm not interested in them."

"Except to get more information about them," she said, angrily. "Wherever you got it."

"Are you joking? Sturges told you what I am."

"Then tell me what you want. That's fair, don't you think?" She sat down.

"Yes, I think so, " he said, but he thought: I can't even explain to myself exactly what I want, can I? Have I become a snoop for the sake of snooping? What do I really need to know? If anything? Is it curiosity? Because she's so beautiful—and so hurt? But he said: "As bad as Turkey can be, Iraq is worse. That would apply especially in 1991, wouldn't it? The Gulf War over and Saddam turning on the Iraqi Kurds?"