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Pull Quote: Smith spends nearly all his time in a room on the third floor of St. Francis, reading books. Occasionally, he visits with the hospital's chaplain, the Rev. Wilbroad Mwape.
THEY call him Nigel Smith.
It is a name that carries a certain dignity, an implied sophistication; the kind of name that usually belongs to men of wealth and taste, men who know who they are and where they came from.
And when you meet Smith, the name fits.
He is slim and dark, with a clean-shaven head and a beard streaked with gray. He looks to be in his late 40s, speaks with a slight British accent, is highly intelligent and treats everyone with a cordiality that suggests a formal upbringing.
The only problem is Nigel Smith is no more his name than the hospital gowns he wears are his clothes. It is a name plucked from his subconscious and assigned by strangers, a name given to him because he does not know his own.
Smith suffers from an extremely rare form of psychogenic, or disassociative, amnesia, a psychological memory disorder often triggered by emotional trauma.
For most victims of this disorder, the absence of memory is localised to the specific traumatic event. For example, a woman attacked may block out the incident, while still maintaining the rest of her memories.
But for a handful of victims, the loss of personal history is complete. For these people, life becomes a series of question marks: Who am I? Where am I from? Do I have family? Am I missed?
The stress of dealing with such a wide-scale loss of identity often leads to depression and desperate acts.
Ten months ago, Smith awoke on the side of a road in Baltimore with no memories of his life prior to that moment. After receiving four months of treatment in a Maryland hospital, he headed south in a failed attempt to jumpstart his brain. He ended up in Charleston.
Three months ago, suffering from depression and at the end of his rope, Smith attempted suicide. He was taken to the emergency room at Roper Hospital.
Since then, doctors and therapists at Roper and its sister hospital, Bon Secours St. Francis, have worked to unravel a mystery unlike any they've ever experienced. They have had little success.
And with each passing day, it becomes more possible that this is one mystery that will never be solved.
Nigel Smith was born on June 16, facedown on the side of the road.
He awoke dazed, lying on top of a black leather duffle bag, his legs stretching out from the grass onto the blacktop.
"It took me awhile to realise anything at all," he says. "How do I explain awareness? I looked around and wondered where I was. There were trees around me. I was by a road. 'What am I doing here?' I wondered. Then slowly it dawned on me that I did not know who 'I' was."
Smith got off the ground and began checking himself. He was wearing a navy blue polo shirt, a pair of blue jeans and a nice pair of Italian shoes. Out of instinct he began searching his pockets.
There was a $10 bill, a $1 bill and some change in his left pants pocket. In his right pants pocket there was a pocket watch. He pressed the button. It was 6:05 a.m.
"I don't know why," he says. "Maybe I was coming around more, but that's when I really started to panic."
Smith turned his attention to the duffle bag. Inside there were two pairs of jeans, two shirts, four pairs of underwear, four pairs of socks, three T-shirts, some shaving cream, a razor, a nail file, some clippers, a toothbrush and toothpaste. Everything was arranged neatly.
"It's just stuff for a weekend," he said to himself.
"I don't know why I felt that or where it came from," Smith says. "It just popped into my head."
Finding no answers, Smith grabbed the duffle bag and began walking. He passed through a neighbourhood and came to a field where men where playing a game. It was lacrosse. He recognised it immediately. But how did he know that? Had he ever played the game?
Nothing came to him.
Across the field there was a building with a sign that read "Johns Hopkins University."
"I immediately knew I was in Baltimore and that the university had a graduate school of international studies," Smith says. "But that was all I knew. The words passed through my head like images on a screen. But there was no connection to anything personal."
Smith continued walking, going from one neighbourhood to the next. Eventually he ended up on the poor side of town.
He came to a 7-Eleven convenience store and went inside.
"I don't think I had ever been in one," he says. "It felt very unfamiliar. I did have the faint impression that I had heard comedians joke about all 7-Elevens being owned by Indians."
He left the convenience store and continued walking. He walked for hours with no idea of where he was going or why. And with each passing moment his panic grew stronger.
"I kept thinking that at any second my brain would snap out of it," he says. "But it never did. The last thing I remember is walking through a Jewish neighbourhood. There were Hasidic families outside. And then I remember falling down."
Smith awoke as emergency medical technicians were placing him inside an ambulance. A police officer stood over him.
"I don't think he's homeless," the officer said. "Look at his shoes. Those are expensive."
The EMT looked down at Smith.
"Sir, what is your name?" he asked.
"I don't know," Smith answered.
He was taken to the emergency room at Sinai Hospital of Baltimore, where doctors treated him for exhaustion and severe dehydration.
They took photos of him and ran them on the local TV news, asking for information as to his identity. The Baltimore police fingerprinted Smith to see if he had a record. He stayed at Sinai for five days, going through a battery of tests and meeting with psychologists.
In the end, doctors could find no obvious physical reason for his condition and the authorities had no luck identifying him.
"One day I was with the psychologist and I told him I had not been dreaming," Smith says. "I asked him, 'How does an amnesiac dream?' And he said, 'That's a good question.' That's not what I wanted to hear. I mean, they were the doctors. They're supposed to know these things."
Officials at Sinai transferred Smith to the Loving Care Home, an assisted-living facility in Randallstown, Md. The facility, owned and operated by Felicia Joseph, provides care for elderly and mentally handicapped patients.
"I don't think they knew what to do with him," Joseph says. "They paid for him to stay with us for a month. But he was out of place here. He really didn't need the help I was trained to provide."
On Smith's first day at Loving Care, Joseph asked him if she should call him `John’. He had been known as `John Doe’ at the hospital.
"I didn't like the sound of it,'" Smith says. "I don't know why, but the name of the PBS actor Nigel Hawthorne came to mind. So I told her to call me 'Nigel.'"
After a few days, Smith started helping out around Loving Care, helping care for the other patients. And after his month was up, he stayed on and continued to help Joseph.
"He was so intelligent," she says. "You could tell he was very well-educated. He would help me write letters to people, making sure I used correct grammar and everything."
In fact, Smith was so reliable, says Joseph, that she took a vacation for the first time in years, leaving him to care for the patients.
"He was real good with them," she says. "And he worked hard."
Once a week, Joseph drove Smith to Baltimore for therapy appointments. She says it became clear after a while that he was frustrated with his situation.
Smith frequently called the police and the TV station that ran the story on him. Neither source had uncovered any information. Smith felt lost and alone.
"He would be OK for a while, joking and having a good time, and then he would just break down and start crying," Joseph says.
After about four months at Loving Care, Smith announced he was leaving. Joseph couldn't stop him.
"He quit his therapy because he didn't like what they were asking," she says. "And when I asked him why he was leaving, he just said, 'I am not finding out who I am here.' One day he left and I never heard from him again."
Ticket to Charleston
Smith had saved about $300 working around Loving Care. He took a transit bus into Baltimore and bought a Greyhound ticket to Charleston.
"It was October and I didn't have a heavy coat, so I decided going north was out of the question," Smith says. "The ticket to Charleston left me enough money to eat for a few days. So that's where I decided to go."
Smith's ticket allowed him to get off at any stop between Baltimore and Charleston. He could board another bus bound for Charleston at a later date. So he made stops along the way, spending time in Washington, D.C., Richmond, Va., Fayetteville, N.C., and Columbia.
Each time he got off the bus, he hoped something in the town would spark a memory. But nothing did.
The day he arrived in Charleston it was raining. Smith started walking and made it as far as downtown. There, wet and exhausted, he passed out.
He was taken to Roper's emergency room, where he was asked the same questions he'd been asked in Baltimore. Smith simply handed them the medical records from Sinai.
Hospital officials transported him to Crisis Ministries, a homeless shelter on Meeting Street. His case was assigned to social worker Jeff Yungman, the shelter's mental health team leader.
Yungman, who has been with Crisis Ministries for four years, has worked with clients exhibiting nearly every type of mental illness, from schizophrenia to multiple personality disorder. Smith's case was something new.
"I first met Nigel on October 25," Yungman says. "And like everybody else, I was intrigued. It's not every day you hear a story like his."
In order to receive help from Crisis Ministries, clients must give a last name. Since Nigel did not have one, Yungman dubbed him `Smith.’
"It seemed to fit," he says.
Dr. Brad Sites, a consulting psychiatrist from the Medical University of South Carolina, worked with Yungman on the case. Sites began hypnotherapy on Smith, hoping to uncover memories hidden deep in his subconscious.
While Sites would not comment on Smith's case, citing doctor-patient confidentiality, Yungman says these therapy sessions yielded bits and pieces of information.
Under hypnosis Smith said he felt like he went to school in Bermuda; that he could see a blue blazer, khaki shorts and a yellow tie, similar to the ones worn by school boys there; and that he remembered a boy named Trevor Lowe.
The trouble with hypnotherapy is that images pulled from the subconscious are not necessarily memories. They could be fantasies or scenes from movies, or nearly anything for that matter.
Yungman contacted the Bermuda Sun, a newspaper on the island, and persuaded them to run a story on Smith. He also tried to locate Trevor Lowe and Ernest Batiste, another name that came up during sessions.
Nothing panned out.
Another image uncovered during Smith's therapy was a supposed daughter named `Stacey’, who Smith felt attended Princeton University.
Yungman contacted the university and tried to locate the daughter.
"We found no one," he says. "And really, for all we know, the truth may be that Nigel really wanted his daughter to go to Princeton. Not that she actually did."
Smith's spirits rose with each possible uncovered memory. But with each dead end, he fell further into depression. To make matters worse, life around the shelter was not agreeing with him.
He spent his days away from the shelter, reading books at the downtown library and at Millennium Music at Calhoun and King Streets.
This helped to pass the time in between sessions.
But at night, he was forced to sleep with the rest of the homeless inside the cramped shelter. And in truth, Smith slept very little. He sat on his bunk, wedged in on all sides by dozens of men, staring into the darkness.
"I would lie awake all night and think, 'Why is this happening to me?'" he says.
Sites prescribed sleeping pills to help him through the long nights, but Smith says he never took them. Instead he saved them.
Yungman last saw Smith on December 23, right before a Christmas break. "He was depressed," Yungman says. "We were all doing everything we could to help him, but up to that point we had found nothing, and Nigel was not very happy. It wasn't hard to see that Nigel had not spent much of his life on the streets and that this situation was tough on him."
On December 30, Smith left the shelter at 6 p.m. and walked to Millennium Music. He sat inside the store and finished two novels: `Dreamcatcher’ by Stephen King and `The Brothers Karamazov’ by Fyodor Dostoevsky.
He left Millennium just before closing and walked down King Street toward The Battery. There, looking out onto the Ashley River, Smith swallowed the sleeping pills he'd been saving for two months. There were more than 50 of them.
"I could not face a new year living like I was, not knowing who I am, not having an identity," he says. "I decided death was preferable."
Smith sat down on the sidewalk. His plan was to wait until he was dizzy and then dive in the water. That way no one could save him. But the pills worked faster than he thought. And by the time he felt dizzy it was too late.
Smith awoke in Roper's emergency room - again. Nearby a nurse was on the phone, talking about his case.
"I remember feeling very sad," he says. "Because I knew that I had not been successful."
Question of malingering
David Bethany had just returned from Christmas break when he was introduced to Smith's case. Officials with Roper transferred Smith to St. Francis' Behavioral Medicine Unit to be treated for both his depression and his amnesia.
Bethany, a clinical therapist with St. Francis, was charged with his care. In 14 years of working with patients, Bethany had seen some strange cases. He'd also seen his share of fakers, or "malingerers" as they are called in the medical profession.
"I was skeptical," he says. "Nigel's case is something out of a movie, so the first tendency is to doubt it. We get an awful lot of folks through here. We hear a lot of stories. And not all of them turn out to be true."
Bethany went over Smith's records as doctors at St. Francis gave the patient a complete physical work-up, including more detailed scans of his brain to search for hidden tumours.
According to Dr. Lawson Bernstein, a professor of forensic psychiatry at the University of Pittsburgh School of Medicine and one of the country's few experts on amnesia, treating the disorder is a process of elimination.
Bernstein says the most common form of amnesia is the result of a physical injury, such as a severe blow to the head or automobile accident. With this form of "organic amnesia" the cause is obvious.
A person also may have a pre-existing condition, a time bomb in the brain such as a tumour lodged in the hypothalamus or on the brainstem. Both are areas that play a huge part in memory. According to Bernstein, a victim of tumour could easily experience the total loss of personal memories, while still retaining general knowledge.
"Millimeters make a huge difference," he says. "You can press on a specific part of the brain and lose specific knowledge. The temporal lobes of the brain are like filing cabinets. Say you have a filing cabinet with four drawers. A tumour could apply pressure to one spot of the brain and obstruct your ability to retrieve information from just one of those drawers."
Doctors at St. Francis did not find any physical reason for Smith's illness, despite thorough scans of his brain.
Bernstein says that once physical possibilities are ruled out, doctors must move to the psychological possibilities.
Psychogenic amnesia is rare, occurring in only about .2 per cent of the population. Bernstein says a case such as Smith's is exceedingly rare because of the amnesia's duration. Smith has been without his memories for nearly a year. Usually, cases of psychogenic amnesia resolve themselves after just a few months.
Bernstein has practiced psychiatry for 12 years and in all that time he has treated only about 10 cases of psychogenic amnesia, none of them lasting as long as Smith's.
"And I have seen way more than most psychiatrists," he says. "So you have to ask yourself, is he genuine or is he malingering?"
RARE, BUT NOT UNHEARD OF
While Smith's case is rare, there have been others.
In 1996, Cheryl Ann Barnes, a teenage runaway from Florida, was found wandering the streets of New York City with no knowledge of her real identity. Barnes recovered her memories after seeing her father.
Others have not been so lucky.
In 1999, a man dubbed `Mr. Nobody’ by the Canadian press awoke on the streets of Toronto with no memories prior to that moment. He took the name Philip Staufen and has yet to recover any of his memories.
Perhaps the most famous case is that of Jody Roberts.
Roberts was a reporter with The News Tribune in Tacoma, Wash., in 1985 when one day she simply didn't show up for an interview. Weeks later, Roberts turned up at a Colorado mall, dazed and suffering from amnesia.
"She was walking in the parking lot, looking for her car," says Marilyn Roberts, her mother. "Then she realised that she didn't know what her car looked like, where it was or even who she was."
Roberts, who assumed the name Jane Dee, was treated for four months in a Denver hospital with no success. With the help of hospital officials, she obtained a new Social Security number and started a new life as Dee. She found a job, attended college and eventually moved to Alaska where she married and had two children.
Back in Washington, people assumed she had been killed. But a chance encounter in 1996 led to the discovery of her new life. She has since moved back to her home state of Oregon to be near her parents. And as of yet, she has no memories of her life prior to waking up outside of that mall.
Roberts did not want to comment for this article, but according to her mother, she has faced a continuous stream of questions over the truth of her illness.
"It has been tough on her," she says. "It's frustrating. The situation is so out there that it's hard to believe. The doctors in Denver originally thought she was faking. But after treating her for a while, they believed her. Can you imagine what she went through, what she is still going through?"
Physicians must ask this question. Malingering is a very real issue in the medical profession, especially when it comes to matters of psychology. Bernstein says this is because a variety of psychological conditions, such as Munchausen syndrome, a condition in which someone fakes an illness for attention, can lead to cases of malingering.
No one knows this better than Beth Bivens, clinical manager of St. Francis' Behavioral Med Unit. During the '80s, Bivens worked at Southern Pines Psychiatric Hospital, now Palmetto Behavioral Health. During her time there she came in contact with a man who claimed to have amnesia. Supposedly, it was the result of a horrific car crash that killed his wife and children.
"He was very convincing," she says. "But the case turned out to be fictitious."
When Smith was admitted to the Behavioral Med Unit, he was suffering from severe depression. He was placed on anti-depressants and scheduled for hypnotherapy sessions.
Smith's therapist, Bethany, approached these sessions cautiously. He did not want to implant memories, rather than uncover them. And he was wary of pushing too hard and asking questions that would cause Smith's subconscious to throw up defence mechanisms.
"Those memories are covered up for a reason," he says. "On the surface it may seem like he is having trouble remembering, but deep down he is struggling to forget something."
For this reason Bethany concentrated on helping Smith learn to cope with whatever he is covering up. But the sessions, which are ongoing, have yielded few answers.
Smith has related images of being thrown from a moving car. His limited medical records, however, do not show injuries that would result from such an incident.
Also under hypnosis, Smith has seen images of flying kites on Easter Monday. Later, he was able to sketch a very specific octagonal kite to show what he had seen.
Bethany did a search on the Internet and came up with several references to a kite-flying tradition on Easter Monday in the Caribbean Islands. And there were several pictures that matched Smith's sketch.
"I had never heard of the tradition, but it made sense," Bethany says. "With his accent, he certainly could be from there."
Bethany also contacted the local FBI office to have Smith's prints checked one more time. Again the results came back negative.
"Obviously, he is not wanted for anything," says FBI spokesman Tom O'Neill. "The problem on our end is that we are not set up for this kind of search. Usually, we start with the identity of someone and then try to find the person, not the other way around."
Bethany contacted `America's Most Wanted’ to see if they could help identify Smith. Producers say they're interested, but admit his case is not a top priority.
"We have lots of questions, but still no answers," he says.
He doesn't even have an answer to the question of whether Smith's case is genuine or faked.
"You can never know for sure," Bethany says. "But Nigel is so consistent and doesn't exhibit the other behaviours associated with someone who is malingering. He is not receiving a great secondary gain here. He is not living large, asking for drugs or cigarettes, he is not getting seconds on his meals. All I can say is he seems to be genuine. His behaviour is consistent with a person who is truly in need of help."
ALWAYS IN DARKNESS
Smith stays in a darkened room on St. Francis' third floor. It's always dark. He prefers it that way.
"I'm in the dark anyway," he says. "When it's dark, you can't see what you're missing."
The anti-depressants are working, but still Smith wrestles with his dilemma. His days are split between doctors' visits and therapy sessions, which leaves plenty of time for Smith to lose himself in thought.
He reads a lot. A box of books sits in the corner of the room. Each one represents a short diversion from the questions that haunt him.
Occasionally, the hospital's chaplain will visit. They talk about world events and religion. Smith is sure he is Roman Catholic. He can recall entire segments of Mass by heart, in Latin. And when he watches Mass on TV he feels the urge to participate. "I think I was an altar boy," he says.
But the nights are tough. He still sleeps very little.
"I lie awake and wonder if I will ever get my memory back," he says, his eyes reddening with tears. "It has been nearly a year since I've known the touch of a woman, the camaraderie of a friend. I don't even know how to hope. How do you hope, when you have no reference with which to tie it to?"
The ancient Greeks would have understood. Their mythology tells of two rivers in Hades, Mnemosyne and Lethe, memory and oblivion.
Mnemosyne is the daughter of heaven and earth. Lethe is the daughter of Strife. Mnemosyne gave birth to the muses. Lethe gave birth to nothingness, to a kind of death.
Smith says sometimes at night, when he feels sleep coming, he prays to not wake up.
"If this is all I have, then I would choose oblivion," he says.
Bethany says this may be a sign that Smith needs stimuli beyond the confines of the hospital.
"Being here is good for him, up to a point," he says. "Then it starts to work against him. He needs to be outside, to start living."
Bethany has started looking into getting Smith a new Social Security number and has contacted a number of facilities, looking for a place that can take him.
"This is a very difficult case," he says. "He may never regain a connection with his past. I'd like to think that won't happen. But we need to move him soon. Because if he can't get his old life back, he needs to start a new one. I'm still holding out hope, though, hope that we can help him solve his mystery."