Patient X and Patient Y by John O’Donoghue


A Case Study by  John O’Donoghue


“Ere a whim?”

These were the words that announced Patient X’s unusual condition to the world. He had been admitted to the neurological ward with concussion, where I am the Consultant Physician.  The manner of his concussion was rather ironic. Patient X had been working in the library of the local university. As he stooped down to check a book on the bottom shelf of the Reference Section, the first volume of the Shorter Oxford English Dictionary fell on his head and knocked him out. The librarian called for an ambulance and Patient X was taken to the hospital where I first encountered him.

“Ere a whim?”

It sounds like nonsense, like gibberish, and at first I did not understand what he was trying to say. He had been unconscious for the best part of four hours, by the time his girlfriend and his supervisor – Patient X was then a PhD candidate in Linguistics – had arrived at his bedside. I had made a preliminary examination, and Patient X seemed to be in relatively good health. I estimated that he was in his late twenties, about six feet tall, weight and height in proportion. His pulse was steady, his temperature normal, his breathing regular. I was alerted to him regaining consciousness by his girlfriend, who found me in the Nurses’ Station, looking through his medical records.

I’d discovered that Patient X had had no significant illnesses before his admission. He had been treated for a stammer by a speech therapist when he was a child, but he no longer stammered, and his academic career to date had shown steady progress. He was now in the third year of his doctoral studies, an investigation of twin languages. I was aware of this area of research – the supposed private languages twins invent when small – and kept an open mind on the matter. There had been some papers published in Patient X’s field of study, but no clear evidence, and I supposed he was conducting surveys and gathering data.

I came rapidly to his bedside on hearing he’d regained consciousness.

“Ere a whim?” he kept repeating, his manner becoming rather more agitated as we could not understand him. We looked from one to another and back to him, but all of us were puzzled.

“Ere a whim?”

It was his supervisor who was able to decode Patient X’s urgent question.

“My God!” he said. “It’s an anagram: ‘Where am I?’”

I felt Patient X needed reassurance, so I told him that he was on the neurological ward of the local hospital.

“I hog hole whenever bean?”

It was now his girlfriend’s turn to show signs of agitation. She asked me what was happening, why he was talking like this, what was going on.

Meanwhile, his supervisor had taken out his mobile phone.

“He’s asking ‘How long have I been here?’”

His supervisor had accessed a website that generated anagrams, and had fed Patient X’s very strange, disconnected words into the site’s scrambler. Except it had now become an unscrambler for it soon became apparent that Patient X was now only able to communicate by mixing up his words. Thanks to his supervisor and his mobile phone we were starting to understand him.

“Whatnot peeped ham?”

As I became used to Patient X’s strange way of expressing himself, his bizarre sentences yielded their meaning in an instinctive flash. I saw immediately that “Whatnot peeped ham?” meant “What happened to me?” Likewise “Gingko emit a boo?” This was Patient X’s version of “Am I going to be OK?” Perhaps some of my intuition came from long experience of treating people in his situation. Concussion can often prove to be disorientating, and the questions he was asking I had heard many times before.

But of course, Patient X’s situation differed radically from any of the patients I had treated in my career. This was not a case of aphasia, where speech and/or comprehension is affected, usually following a stroke. Rather, Patient X seemed to be experiencing an extreme form of paraphasia, where letters, syllables, or words can be muddled, so that patients will refer to ‘papples’, or ‘gingerjed’’, or ‘deks’ (‘apples’, ‘gingerbread’, ‘desk’). However, his own unique form of paraphasia was far more complex. Patient X spoke in whole sentences, his syntax more or less correct, even if his sentences were rather surreal. I noticed that there was a kind of instinctive ‘anagrammar’ to his utterances, as if underneath the paraphasia there was still a preservation of the rules of language.

But this observation came much later in my treatment of him. For now, there was the more pressing problem of how to manage his care in a world where he was finding it very hard to make himself understood, at least in the usual spontaneous way that most of us do.

While I was pondering this question his girlfriend received a phone call. It was Patient X’s mother with some disturbing news. Apparently, his brother – let’s call him Patient Y – had sustained an uncannily similar injury. I learned that Patient X was himself an identical twin, and that his brother was also working as a PhD student, and was also – remarkably – in his third year. He was researching the flip side, as it were, of his brother’s field of enquiry, that’s to say the way twins acquire language in the first place, whether or not they go at the same pace in terms of their linguistic development, whether they show differing rates of acquisition, and indeed whether one twin may show a bias towards particularly metaphorical or plain discourse. When Patient X’s girlfriend told me what had happened to his brother, his supervisor and I both did a double-take. For he too had been looking for a book on the bottom shelf of the Reference Section of his university library when the second volume of the Shorter Oxford English Dictionary had fallen on his head and knocked him out. And now he had come to in hospital and was talking gibberish: like his brother, his first words on coming to consciousness were “Ere a whim?”

I asked Patient X’s girlfriend to hand me her phone. I spoke to the twins’ mother, who told me she was by her son’s bedside. I asked her what hospital she was calling from, and then asked her to hand her phone to the Ward Sister. I was able to explain to the Ward Sister what had happened to Patient X, and to speculate that it sounded like Patient Y, as I called him, had been affected in exactly same way as his twin.

Within the hour I had arranged for Patient Y to be transferred to the ward the following day, where his brother was recovering and so bring the two of them together. The Consultant responsible for Patient Y was an old colleague and friend, and I think he was rather relieved to hand such an unusual case on to me.

I saw immediately that I was faced with several problems: 1) How to enable Patient X and Patient Y to communicate with those around them in a fluent and spontaneous manner 2) How to account for what had happened 3) How to treat them. It was Patient X’s supervisor who offered us a way forward. He said he would consult with his own colleagues at the university and that he thought it would be possible to bring together specialists in the Linguistics and Computer Science departments, to develop software that could immediately decode the twins’ unusual locutions. He indicated the likelihood of splicing together a speech recognition programme with the kind of anagram generator he had been accessing on his phone. We said goodbye and I gave him my number. He promised to be in touch as soon as he had news, and that this project was now his top priority. Patient X’s girlfriend made her own farewell shortly after, and I was left alone with my thoughts, as Patient X had fallen asleep.

I saw that by a curious coincidence I was now in a rather similar position to the twins themselves before they had had their accidents. That is to say, I too would be able to conduct something of a twin study, and that I might be able to ascertain certain aspects of language acquisition that the twins had both been investigating. I might then be able to check what part of their brains had been affected to bring on such extreme paraphasia. I left Patient X and went back to my office.


The next day I witnessed a rather uncanny encounter between the brothers. Patient X’s brother was admitted around 10.30am. It was strange to witness the two identical male patients lying next to each other in the private room I’d been able to arrange for them, despite some misgivings from my colleagues. But I thought it essential that they were together and as disturbing as it was at first to see these mirror images of each other in close proximity, I was glad to have them both under observation. It was when they started talking to one another that I was taken aback.

“Hothead thee I been?” asked Patient X.

“She berets fry orthodoxy,” said Patient Y.

I quickly scribbled down what they said, which sounded like absolute nonsense. What amazed me, however, was that both patients seemed to automatically understand what the other was saying, each able to decipher the scramble of letters they now used to communicate. It seemed that the knocks to the head they had sustained had not only affected speech, but – mercifully for both of them – understanding also.

As for this opening chain of lexis, it was quite quickly deciphered by me using the app on my phone: ‘Been hit on the head?’ ‘Yes, by the Shorter Oxford.’ Here was a truly remarkable development. Instead of each twin being isolated through the idiolect of their anagrammatese, they now understood one another perfectly and could communicate without difficulty. However, until Patient X’s supervisor returned from the university, their communication with the rest of humanity would be inevitably slow and laboured as we took time to unscramble their speech.

It was at this point that Patient X’s supervisor returned with some good news: his research students at the university, along with their peers in Computer Science, had been able to rig up some software that would hopefully be able to translate what the twins were saying.

Once we’d explained to them what we had done we got an unexpected reaction. Patient X’s supervisor turned on his laptop and asked them to say something.

“Beefers mock weave!” said Patient X.

A metallic sounding voice came out of his supervisor’s laptop: “We’ve become freaks!”

“Bitter whooper fee trims cash!” said his brother.

Like an electronic echo the laptop said, “I hope we’re better for Christmas!”

I suddenly felt immense pity for them both. Their essential isolation, instead of being ameliorated by the software, seemed to have been brought into sharp relief by the tinny, metallic voice of the unscrambler, eroding any individuality or trace of personality they had once possessed.

There has to be a better way, I thought. But for now I kept my reflections to myself while I tried to work out what to do.


It was decided by both of their supervisors and their universities that the twins should be allowed to continue with their research while they were patients at the hospital. We all had no way of knowing how long their treatment would take, nor even if a cure could be effected. So before long the twins’ laptops, their files of data, recordings of the children they had studied, all were brought into their room at the hospital.

And so the twins worked away as I conducted tests, consulted with colleagues in the weekly Multi-Disciplinary Team meeting, and time after time drew a blank. Their brain scans seemed normal, their EEG readings were what would be expected for patients with their health profile, and – given the confines of their hospitalisation – the twins seemed to be in remarkably good spirits.  I reasoned that their anxieties about being perceived as ‘freaks’ had been dissipated as they resumed their doctoral research, work that had given their lives meaning and relevance up to their accidents. But as much as it was heartening to see them progress with their studies, I started to grow increasingly frustrated with our inability to find an effective cure.

I kept having a recurring dream from this time. I dreamt that I met the twins in a pub not far from the hospital. We started conversing normally enough, talking about the weather, the usual banal pleasantries Englishmen indulge in whenever they meet strangers, or acquaintances they haven’t encountered for a while. All was going well. But then the twins lapsed into their strange anagrammatese. To my horror I found I was talking to them in anagrams also. What was worse was that we all understood each other. It was then that I would wake up, covered in cold sweat, no nearer curing my patients, and with the unsettling feeling that what they had was catching.


The twins made good progress on their theses. Within three months of their accidents they were ready to submit. I suppose without distractions, with only their work to occupy them and the institutional life of the hospital to support them – meals prepared, a modicum of care given by the staff, a social life that had to be fitted in around visiting times – it was perhaps no surprise that they should have made such swift progress. However, I want to pay tribute to the twins’ strength of mind, the way they encouraged one another to race towards the finishing lines of their PhDs. They were remarkable patients.

Except of course, as their supervisors were at pains to explain to me, the PhD was not the finishing line for them but the starting gate. Once they had taken part in their viva voce examinations and published their theses a career in academe awaited them. But how would they be able to teach, give lectures, attend meetings? They would be back to being freaks, anagram spouting freaks. A cure was now of vital importance to their future prospects and well-being.

I’m not sure where I was when I came up with a possible solution to this impasse. But I do know that I phoned both of their supervisors to tell of them of my hypothesis and to seek their support. Both were dubious at first but I eventually won them over, mainly by dint of there being nothing else. We were all getting desperate and desperate measures were called for.


The twins submitted their theses shortly after I’d spoken to their supervisors, and a special double viva voce convened. I asked to attend as this was the first occasion the twins had left the ward in nearly six months. And so I made my way to Patient X’s university, as this was nearest to the hospital.

The panel comprised six in total: two Internal Examiners, two External Examiners, and two independent Chairs. I sat behind the panel, ostensibly to observe the twins, but also to offer support if needed.

The viva voce proceeded, the Examiners posing questions, the twins weird locutions preceding the tinny echoes of the unscrambler as they gave their answers. Neither betrayed much sign of nerves, but were – as much as their condition allowed – fluent and informed. I don’t think they really stumbled nor were lost for words once. After an hour and half of being quizzed by this double panel, the twins were asked to leave the room and wait outside while the panel deliberated on the outcome. PhDs in this country – once they’ve got to the viva voce stage – usually result in four outcomes: Pass, Pass Minor Corrections, Pass Major Corrections, Fail. The first outcome – basically, the recognition that the thesis is perfect in every way – is very rare, as is the last outcome, Fail. Minor Corrections and Major Corrections are rather more common. At this point I thought the twins had both carried out some brilliant research and presented their findings in a striking and persuasive manner.

They were called in after about ten minutes. Patient X’s Chair spoke first.

“We’ve reached our conclusion,” he said. This was the cue for Patient Y’s Chair to chip in. “I’m afraid you’ve both failed.”

There was a moment of silence as the shock set in. Then both twins let fly.

“What the f –?!”

“You cannot be serious!”

They immediately turned to each other.

“What did you say?” said Patient X.

“I think we’re cured!” cried Patient Y.

My ruse had worked. For I had reasoned that although it looked as if physical trauma had been the cause of their strange affliction, none of the tests we’d run would confirm this. I therefore deduced that the trauma was in fact psychological, that the shame of being knocked unconscious by the Shorter Oxford English Dictionary had affected their speech. Perhaps, I thought, a similar psychological trauma might reverse what had occurred.

And so it turned out. I had asked for the dual viva voce panels mainly in order to intensify the twins’ stress levels. I had also asked the panels to ‘fail’ the twins. In actual fact, the panel was of one accord that the twins’ theses were works of exemplary research and scholarship.

I am pleased to say that both have gone on to have brilliant academic careers. The only concession to their curious malady? They set up their own scholarly press. It’s a little obscure, and virtually unknown outside of the ivory tower. You’ve probably not heard of it – the Anagram Press?


I thought not.


jod-photoJohn O’Donoghue is the author of the poetry collections Brunch Poems (Waterloo Press, 2009); and Fools & Mad (Waterloo Press, 2014); and the memoir Sectioned: A Life Interrupted (John Murray, 2009). Sectioned was awarded Mind Book of The Year 2010 by judges Fay Weldon, Michele Roberts, and Blake Morrison. He holds a PhD in Creative Writing from Bath Spa University, and teaches Creative Writing at West Dean College, Chichester.

28 September 2018