No one else in the theatre knows the hopeless condition of this particular brain. The motor strip he's looking at now is already compromised by disease, most likely by deterioration in the caudate and putamen, deep in the centre of the brain. Henry places his finger on the surface of Baxter's cortex. He sometimes touches a brain at the beginning of a tumour operation, testing the consistency. What a wonderful fairy tale, how understandable and human it was, the dream of the healing touch. If it could simply be achieved with the caress of a forefinger, he'd do it now. But the limits of the art, of neurosurgery as it stands today, are plain enough: faced with these unknown codes, this dense and brilliant circuitry, he and his colleagues offer only brilliant plumbing.
Baxter's unmendable brain, exposed under the bright theatre lights, has remained stainless for several minutes - there's no sign of any bleeding from the arachnoid granulation.
Perowne nods at Rodney. 'It's looking fine. You can close up.'
Because he's pleased with him, and wants him to feel better about the evening, Perowne lets his registrar take the lead. Rodney sews up the dura with purple thread - 3-o Vicryl - and inserts the extradural drain. He replaces the bone flap, along with the two broken pieces from the depressed fracture. Then he drills the skull to screw in place the titanium plates that hold the bone secure. This part of Baxter's skull
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now resembles crazy paving, or a broken china doll's head clumsily repaired. Rodney inserts the subgaleal drain and then sets about sewing the skin of the scalp with 2-o Vicryl and punching in the skin staples. Perowne gets Gita to put on Barber's 'Adagio for Strings'. It's been played to death on the radio these past years, but Henry sometimes likes it in the final stages of an operation. This languorous, meditative music suggests a long labour coming to an end at last.
Rodney puts chlorhexadine on and around the wound and applies a small dressing. It's at this point that Henry takes over - he prefers to do the head dressing himself. He releases one by one the pins of the head clamp. He takes three opened out large gauze swabs and places them flat on Baxter's head. Around the head he lays two gauze swabs left long. Holding the five swabs in place with his left hand, he begins to wind a long crepe bandage around Baxter's head while supporting it against his waist. It's technically and physically difficult, avoiding the two drains and preventing the head from dropping down. When at last the head bandage is in place and secured, everyone in the theatre, the whole firm, converges on Baxter - this is the stage at which the patient's identity is restored, when a small area of violently revealed brain is returned to the possession of the entire person. This unwrapping of the patient marks a return to life, and if he hadn't seen it many hundred times before, Henry feels he could almost mistake it for tenderness. While Emily and Joan are carefully pulling away the surgical drapes from around Baxter's chest and legs, Rodney makes sure the tubes, leads and drains are not dislodged. Gita is removing the pads taped over the patient's eyes. Jay is detaching the inflatable warming blanket from around Baxter's legs. Henry stands at the end of the table, cradling the head in his hands. The helpless body is revealed in a hospital gown and looks small on the table. The meditative, falling line of the orchestral strings seems to be addressed to Baxter alone. Joan pulls a cover over him. Taking care not to tangle the extradural and subgaleal drains,
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they turn Baxter onto his back. Rodney slots a padded horseshoe into the end of the table and Henry rests Baxter's head on it.
Jay says, 'You want me to keep him sedated overnight?' 'No/ Henry says. 'Let's wake him up now.' The anaesthetist will ease Baxter - simply by the withdrawal of drugs - into taking over his own breathing from the ventilator. To monitor the transition, Strauss holds in the palm of his hand a little black sac, the reservoir bag, through which Baxter's breathing will pass. Jay prefers to trust to his sense of touch rather than the electronic array on the anaesthetic machine. Perowne pulls off his latex gloves and ritually pings them across the room towards the bin. They go in - always a good sign.
He takes off his gown and stuffs that into the bin too, then, still in his hat, goes down the corridor to find a form to do his op note on. At the desk, he finds the two policemen waiting, and tells them that Baxter will be transferred within ten minutes to the intensive care unit. By the time he gets back, there's a different atmosphere in the theatre. Country and Western music - Jay's taste - has replaced Samuel Barber. Emmylou Harris is singing 'Boulder to Birmingham'. Emily and Joan are discussing a friend's wedding as they clean up the theatre - on the night shift this dull task falls to the scrub nurses. The two anaesthetists and Rodney Browne are talking about offset mortgages and interest rates as they make the final preparations for the patient to be transferred to intensive care. Baxter lies peacefully on his back showing no signs of consciousness yet. Henry grabs a chair and starts his notes. In the name space he writes 'known as Baxter', and in the date of birth, 'est. age plus/minus 25'. All the other personal details he has to leave blank.
'You've got to shop around,' Jay is telling Gita and Rodney. 'You're in a buyer's market.'
'It's a spray-on tan,' Joan says to Emily. 'She's not allowed in the sun because she gets basal cell carcinomas. Now she's
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gone bright orange, face, hands, everything, and the wedding's on Saturday/
The chatter is soothing to Henry as he quickly writes, 'ext/subdural, sup sag sinus repair, pt prone, head elevated & in pins, wound extended/retracted, free bone flap turned . . .'
For the past two hours he's been in a dream of absorption that has dissolved all sense of time, and all awareness of the other parts of his life. Even his awareness of his own existence has vanished. He's been delivered into a pure present, free of the weight of the past or any anxieties about the future. In retrospect, though never at the time, it feels like profound happiness. It's a little like sex, in that he feels himself in another medium, but it's less obviously pleasurable, and clearly not sensual. This state of mind brings a contentment he never finds with any passive form of entertainment. Books, cinema, even music can't bring him to this. Working with others is one part of it, but it's not all. This benevolent dissociation seems to require difficulty, prolonged demands on concentration and skills, pressure, problems to be solved, even danger. He feels calm, and spacious, fully qualified to exist. It's a feeling of clarified emptiness, of deep, muted joy. Back at work and, lovemaking and Theo's song aside, he's happier than at any other point on his day off, his valuable Saturday. There must, he concludes as he stands to leave the theatre, be something wrong with him.
He takes the lift one floor down and goes along a polished, dim corridor to the neurological ward where he makes himself known to the nurse on duty. Then he walks in, and pauses outside a four-bed room to look through the glass. Seeing a reading light on above the nearest bed, he opens the door quietly and goes in. She's sitting up writing in a notebook with a pink plastic cover. As Henry sits down by her bed and before she has time to close her book, he notices that she's drawn for the dot of each 'i' a meticulous heart.
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She gives him a sleepy welcoming smile. His voice is barely above a whisper.
'Can't sleep?'
They gave me a pill, but I can't stop my mind.'
'I get that too. In fact, I had it last night. I was passing by, so - a good time to tell you myself. The operation went really well.'
With her fine dark skin, her round and lovely face, and the thick crepe bandage that he wound round her head yesterday afternoon, she has a dignified, sepulchral look. An African queen. She wriggles clown the bed and ptiMs the covers round her shoulders, like a child preparing to hear a familiar bedtime story. She hugs her notebook to her chest.
'Did you get it all out like you said?'
'It came out like a dream. It rolled out. Every last bit.'
'What's that word you said before, about how it's going to go?'
He's intrigued. Her change in manner, her communicative warmth, the abandonment of the hard street talk, can't simply be down to her medication, or tiredness. The area he was operating in, the vermis, has no bearing on emotional function.
'Prognosis,' he tells her.
'Right. So doctor, what's the prognosis?'
'Excellent. Your chances of a total recovery are 100 per cent.'
She shrugs herself deeper into the bed covers. The love hearing you say that. Do it again.'
He obliges, making his voice as sonorous and authoritative as he can. He's decided that whatever's changed in Andrea Chapman's life is written down in her notebook. He taps its cover with a finger.
'What do you like to write about?'
'It's a secret,' she says quickly. But her eyes are bright, and her lips part as if she's about to speak. Then she changes her mind and clamps them shut and with a mischievous look stares past him at the ceiling. She's dying to tell.
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He says, 'I'm very good at secrets. You have to be when you're a doctor.'
'You tell no one, right?'
'Right/
'You solemnly promise on the Bible?'
'I promise to tell no one.'
'It's this. Right? I've derided. I'm going to be a doctor.'
'Brilliant.'
'A surgeon. A brain surgeon.'
'Even better. But get used to calling yourself a neurosurgeon.' 'Right. A neurosurgeon. Everybody, stand back! I'm going to be a neurosurgeon.'
No one will ever know how many real or imagined medical careers are launched in childhood during a postoperative daze. Over the years, a few kids have divulged such an ambition to Henry Perowne on his rounds, but no one has quite burned with it the way Andrea Chapman does now. She's too excited to lie covered up. She struggles up the bed, plants her elbow on the mattress, and as best she can with her drain still in place, rests her head on her hand. Her gaze is lowered, and she's thinking carefully before asking her question.
'Have you just been doing an operation?'
'Yes. A man fell down stairs and whacked his head.'
But it's not the patient she's interested in. 'Was Dr Browne there?'
'Yes, he was.'
Finally. She looks up at Henry with an expression of pleading honesty. They are at the heart of her secret.
'Isn't he just a wonderful doctor?'
'Oh, he's very good. The best. You like him, do you?'
Unable to speak, she nods, and he waits a good while.
'You're in love with him.'
At the utterance of the sacred words she flinches, then quickly checks his face for mockery. She finds him impenetrably grave.
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He says delicately, 'You don't think he's a little old for you?'
'I'm fourteen,' she protests. 'Rodney's only thirty-one. And the thing is this . . .'
She's sitting up now, still pressing her pink book to her chest, joyous to be addressing at last the only true subject.
'. . . he comes and sits where you are, and says to me about how if 1 want to be a doctor I need to get serious about studying and that, and stop clubbing and that, and he doesn't even know what's happening between us. It's happening without him. He's got no idea! I mean, he's older than me, he's this important surgeon and everything, but he's so innocentV
She outlines her plans. As soon as she's qualified as a consultant - in twenty-five years' time, by Henry's private calculation - she'll be joining Rodney in Guyana to help him run his clinic. After a further five minutes of Rodney, Perowne rises to leave. When he reaches the door she says, 'Do you remember you said like you'd make a video of my operation?'
'Yes.'
'Can I see it?'
'I suppose so. But are you really sure you want to?'
'Oh my God. I'm going to be a neurosurgeon, remember? I really need to watch it. I want to see right inside my head. Then I'm going to have to show it to Rodney.'
On his way out, Perowne lets the nurse know that Andrea is awake and lively, then he takes the lift up to the third floor again and walks back down the long corridor that runs behind the neurosurgery suite and brings him by the main entrance to intensive care. In soothing gloom he goes along the broad avenue of beds with their watchful machines and winking coloured lights. He's reminded of neon signs in a deserted street - the big room has the ephemeral tranquillity of a city just before dawn. At the desk he finds the nurse in charge, Brian Reid, a Geordie, busy filling out forms, and learns that
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all Baxter's signs are good, that he's come round and is dozing. Reid nods significantly towards the two policemen sitting in the shadows near Baxter's bed. Perowne was intending to walk home as soon as he was satisfied his patient was stable, but as he comes away from the desk, he finds himself going across. At his approach the constables, bored or half asleep, get to their feet and politely explain that they'll wait outside in the corridor.
)
Baxter is lying on his back, arms straight at his sides, hooked up to all the systems, breathing easily though his nose. There's no tremor in the hands, Perowne notices. Sleej: is the only reprieve. Sleep and death. The head bandage doesn't ennoble Baxter the way it did Andrea. With his heavy stubble and dark swelling under the eyes he looks like a fighter laid out by a killer punch, or an exhausted chef, kipping in the storeroom between shifts. Sleep has relaxed his jaw and softened the simian effect of a muzzle. The forehead has loosened its habitual frown against the outrageous injustice of his condition, and gained him some clarity in repose.
Perowne brings a chair over and sits down. A patient at the far end of the room calls out, perhaps in her sleep, a sharp cry of astonishment repeated three times. Without turning, he's aware of the nurse going towards her. Perowne looks at his watch. Three thirty. He knows he should be going, that he must not fall asleep in the chair. But now he's here, almost by accident, he has to stay a while, and he won't doze off because he's feeling too many things, he's alive to too many contradictory impulses. His thoughts have assumed a sinuous, snaking quality, driven by the same undulating power that's making the space in the long room ripple, as well as the floor beneath his chair. Feelings have become in this respect like light itself - wavelike, as they used to say in his physics class. He needs to stay here and, in his usual manner, break them down into their components, the quanta, and find all the distal and proximal causes; only then will he know what to do, what's right. He slips his hand around Baxter's