Human Traces

by Sebastian Faulks

  It was a cold, blustery day and the snowdrops on the grassy graves in the churchyard bowed and swayed on the undulating waves of grass. A small grave had been dug next to those of Sonia’s parents.

  The mourners stood about the opened earth. Kitty gripped Thomas’s hand as hard as she could. Charlotte and Martha wept as they clung to one another. Denniston and Gregorio stared straight ahead, the muscles of their jaws occasionally seen to clamp or to release.

  Jacques closed his eyes and tried to imagine himself elsewhere, but could see only Daniel’s face.

  When he had been working late, he sometimes used to go into Daniel’s bedroom to say goodnight. As he bent over the sleeping child, he would lay his closed eyes, sore from reading, against his son’s forehead, so that the soft swell of the boy’s brow would fit into the sockets of his aching eyes and cool them.

  As Jacques stood in the wind, he remembered, too, the way that Daniel, normally so careless with possessions, would sometimes try to clean things; how he had knelt over his skis and carefully wiped each flake of snow from them with his handkerchief, lost in concentration, even though he was shortly to set off again through the powder.

  He had his arm tight round Sonia’s shoulder and felt he must somehow reach her. He leaned down and whispered in her ear, ‘I wonder what his moustache looked like’; but her face showed no answering smile.

  Little Herr Frage, thought Jacques: not a nail, not an eyelash left of him. It is as though he might never have been; it is as though he was not a human being, but just an idea of one after all.

  Sonia knelt on the grass and lowered the small wooden box into the hole in the ground while the vicar read a prayer.

  She stood up and held tight to Jacques, squeezing the rough serge of his coat in her hand. Her face was driven into a thin line of anguish; her eyes were dry and staring. The blood had drained from her skin, but she could feel it in her head, pounding at her temples, as though time itself were rising up inside and drowning her. She felt her lips part. ‘Hmm,’ she said in a dry, rough voice, and it was almost the first time she had spoken since he died. ‘Be my Valentine.’

  XXIII

  IT WAS A cold, dark morning in Zürich. Jacques took a cab from the railway station, past the restored guild houses, then watched the first sudden flakes of snow swirling in a light breeze across the stone façades of the palaces on the Bahnhofstrasse. It was more than two years since the Armistice, and while Paris still resembled an outsize field dressing station, its transports thronged with the maimed and limbless, the trams of Zürich were filled with whole people in plump coats; the cathedral tolled its twelve o’clock bell as it had each day since the Middle Ages, and the councillors of the Rathaus planned no monument to the dead.

  In the private clinic at which Jacques alighted from the cab, Herr Fischer gathered a small team together in the patient’s room. He sat down on the edge of the bed and gently took the hand of the woman who sat propped up on white pillows.

  ‘This’, he said, ‘is Maria. I am taking the trouble to introduce you because the operation we are about to perform is not like an appendectomy or even a straightforward cranial procedure in which the inhalation of ether renders the patient unconscious. On the contrary, in the course of the next few hours, Maria will be wide awake.’

  Although Fischer had been pleased to accommodate the request of a distinguished psychiatrist to be present at an operation, Jacques felt out of place in the small room. He had grown a beard and had been surprised to see it come out white; he felt old and shell-shocked in comparison to these Swiss people with their banal streets under silent snow.

  Fischer squeezed the woman’s hand; there was a charming benevolence in his manner, though Jacques could also see that the geniality served a purpose: Fischer needed the patient’s help.

  ‘Throughout the operation,’ he said, ‘Maria will be guiding us. That is why it is important for her to feel at ease with those of us who will be in the operating theatre.’

  Standing up, Fischer introduced the anaesthetist, the assistant, two students from the university and two nurses. ‘We also have a distinguished visitor from Paris, Dr Rebière.’

  Jacques shook hands with Maria, a plump woman of about forty whose head had been completely shaved. She looked anxious as she took his hand, but managed a faint smile. Jacques did his best to look reassuring and confident, though he had seldom been in an operating theatre.

  ‘To recapitulate for the benefit of Dr Rebière,’ said Fischer. ‘Since late adolescence, Maria has suffered focal epileptic seizures causing paralysis of the right arm and speech interruptions. We have therefore deduced that the site of the epileptic discharge is somewhere near the motor strip and the speech area in the left side of the brain.’ He pointed towards the area of Maria’s bald head with a long forefinger. ‘We shall be performing a craniotomy here. It is hoped that by administering a small electric current to the exposed area of the brain, the seizure can be reproduced and the site of the lesion can thus be located. It is envisaged that a small amount of damaged tissue can then be removed and that the patient will subsequently experience relief from her seizures. Is that not right, Maria?’

  ‘Yes, indeed.’ Her voice was small and uncertain, with a strong rural accent.

  ‘Do we have any questions?’ said Fischer.

  ‘Yes, sir,’ said one of the students. ‘Is this a new procedure?’

  ‘Yes and no,’ said Fischer genially. ‘The famous English neurosurgeon Sir Victor Horsley was prevailed on by John Hughlings Jackson to do something similar about twenty years ago. Sadly, Sir Victor died in Mesopotamia in the course of the War and was not able to build on his pioneering work. However, the celebrated American Dr Harvey Cushing has picked up the torch. Before the War, he had stimulated the motor cortex in more than fifty patients. Now perhaps Dr Artzmann will tell us about the anaesthesia.’

  The anaesthetist, a ruddy, sportive-looking man, stepped forward and coughed. ‘Well, the joy of it is,’ he said, ‘as I am sure you all know, that the brain has no sensory nerves. We could remove half the good lady’s brain with a spoon and she would not feel a thing. Though I imagine her behaviour might be somewhat affected!’ He gave a throaty laugh and the students smiled uncertainly. Jacques glanced at the patient.

  Artzmann coughed. ‘Anyway, I shall be injecting a local anaesthetic here and here and here,’ he said, pointing to spots round the base of the skull. ‘The scalp of course is innervated, so there we shall be most watchful, but once we are through the dura mater, which is a tough customer, it should be plain sailing. At any rate, I shall be doing all I can to minimise the discomfort.’

  ‘Thank you,’ said Fischer, evidently relieved that Artzmann had finished more tactfully than he had begun. ‘Now if there are no further questions, I suggest that we reconvene at two o’clock.’

  When Jacques returned in the overalls and mask provided by the hospital, he found the patient had been moved to a trolley, where she lay beneath a green surgical sheet. She looked like a convict about to be transported. On the left side of her shaved head there had been drawn the outline of a rectangle using iodine-soaked cotton wool wrapped round a wooden stick; it was the size of a picture postcard, though its shape, Jacques could not help noticing, was rather like a map of France.

  Two orderlies came into the small room, followed by Herr Fischer.

  ‘Are you ready, Maria? Your friends are all waiting for you.’

  ‘I am scared,’ said Maria.

  Fischer perched on the edge of the trolley. ‘I know. But listen. Your life has become very difficult, has it not? “Unbearable.” Was not that the word you used? When we have finished, I do believe you will have something like a normal life again. In return, all I ask is that you should be brave. A little courage for a couple of hours. I shall be with you all the time. If anything hurts or does not feel right, then you must tell me. I promise we shall take the best possible care of you. Is that not right, Dr Rebière?’

  ‘Of co
urse it is right. We shall all look after you.’

  ‘Are you agreed, Maria? Maria?’

  ‘Yes.’

  ‘Thank you. Take her through, please.’

  Artzmann was waiting in a small anteroom off the main theatre. Jacques could see his eyes crease into a grin of welcome, though his mouth was mercifully hidden beneath his white mask. He injected Maria at four points in the base of the skull and in the dotted lines of the planned incision; Jacques went through into the main room while they waited for the anaesthetic to take effect. He nodded to the assistant and the students, then took his place where Fischer instructed him.

  The trolley was pushed through the door feet first, then the orderlies swung it round so that the patient’s head was beneath a strong circular light.

  ‘I am going to keep talking to you all the time, Maria, and I want you to talk back,’ said Fischer, while the nurses secured the patient and draped sterilised towels about her head and body. A raised table, also draped with a towel, was placed above her abdomen. ‘I want you to tell me everything,’ said Fischer. ‘Is that clear? Sometimes I shall say something to the students, so if you hear some Latin word you don’t understand, please do not concern yourself. Are you with me? Good.’

  Fischer leaned forward and took a scalpel from the nurse. He held it with his right forefinger on top and steadied his wrist with his left hand. As he began to cut along the marked line, his assistant followed, applying steady pressure with his fingers until Fischer had clamped the incision at short intervals with arterial forceps, bundles of which, as they grew intrusive, were then taped and tied away from the opening. When the three sides of the incision were finally complete, Fischer painstakingly pulled down the flap of scalp with tweezers, so that it hung over Maria’s left ear. He stood back while the assistant then clamped the edges of the flap and wrapped it in soaked, sterilised gauze.

  ‘We are using all these clamps here’, said Fischer to the students, ‘to compress the blood vessels at the edge of the galea. Are you all right, Maria? Can you feel anything?’

  ‘No.’

  ‘Good. You are being brave. You are now going to feel an unpleasant vibration. Please do not feel alarmed. It is quite normal. We are going to make some holes, Maria, then I am going to cut between them and then we are going to turn back the section of bone. Do you remember I drew a picture of it for you yesterday? Here we go.’

  Jacques noticed that Fischer came in from out of Maria’s eyeline and wondered if it was to spare her the sight of the primitive brace and perforator attachment with which he set to work. In the skull he drilled seven holes about three centimetres apart whose positions on the notional map of France were roughly, going clockwise from the south-west, at Biarritz, La Rochelle, Brest, Caen, Calais, Mulhouse and Marseille. He enlarged the holes by attaching a burr to the brace and re-drilling each one; he then plugged the cavities with wax. Between the skull and the dura mater beneath it, he gingerly inserted a metal guide which, having gone under at Biarritz, emerged at La Rochelle. Through the groove of the guide he ran a thin flexible saw; when that too had re-emerged, he attached T-bars to its ends, so that it was like a serrated cheese wire. Standing squarely and locking his shoulders, he then sawed carefully upwards with gentle rocking movements on a slight outward angle, till Biarritz was joined to La Rochelle by a clean cut through the bone. All the holes at the edges of the map were thus joined except the southern line from Biarritz to Marseille, where although the bone was cut, the muscle was left attached, so that the flap of skull, like that of scalp, could be turned down while remaining attached to its blood supply.

  ‘Note’, said Fischer proudly, ‘the slightly bevelled edge of the reflected section which will make replacement more snug. This is a true osteoplastic flap. Maria, are you still all right? That grating is now over. Are you feeling pain? Maria?’

  ‘It’s all right.’

  ‘I am going to ask my colleague to give you a little more anaesthetic. The next part of the procedure can sting a little.’

  Fischer stood back with his hands held aloft like a priest making a blessing, while Artzmann injected the patient once more. The section of skull was protected by layers of soaked and sterilised gauze, like the attached flap of scalp at Maria’s ear.

  As they waited for the drug to take effect, Fischer encouraged Maria, telling her how well she was doing. ‘But you must speak to me, Maria. Tell me what you feel.’

  ‘I feel all right. It feels odd lying here with all of you staring at me, and I didn’t like the noise in my head. But I feel nothing strange. No pain.’

  ‘Good. We are now at the dura mater. This is the first and toughest of the meninges, the membranes that cover the brain. You have a splendid dura, Maria. Nice and thick and well supplied with healthy blood vessels. I am going to “reflect” it, by which I mean that I am going to cut it, then fold it gently back.’

  Fischer kept up his commentary, half-facetious, half-reassuring, as he explained his progress in ‘reflection’; while the dura was held back with silver clips inserted by his assistant, Fischer exclaimed at the health and beauty of the lower meninges – the arachnoid and the pia mater.

  He stepped back at last. ‘And now, my dear Maria, we can see your wonderful brain.’

  The students leaned forward and Fischer turned to the nurse, who wiped his forehead. The other nurse fitted a pair of magnifying glasses to his head, while the assistant tidied once more round the edges of the opening.

  The brain was exposed to the light. Jacques looked at the rippled organ, the colour of uncooked sweetbread, roped with black veins and delicate crimson capillaries, and then at the face of its owner, the skin of her cheeks quite pale, her brown eyes wide open.

  ‘I am looking for signs of gliosis,’ said Fischer, lowering his head to the brain. ‘Some shrivelling or yellowing of the grey matter, but I do not see anything yet. We have exposed part of the frontal lobe, here, the parietal here and the temporal down here. The appearance is normal. We shall now move on to the important part of our procedure.’

  Fischer’s assistant passed him two electrodes and went to a black faradic box on a trolley to which they were attached.

  ‘Are you comfortable, Maria? Are you ready? You must tell me everything you feel. Do you understand?’

  ‘Yes.’

  ‘One of the things we are doing with the electrical stimulus is to establish an exact map of the motor and sensory areas so that they can be protected during any excision of epileptogenic matter.’

  Fischer nodded to his assistant, who rotated a knob on the machine; then he touched the electrodes lightly to the surface of the naked brain. It had a shimmering lustre given to it by the cerebrospinal fluid, which gathered in small pools in the troughs of the sulci, like fresh dew.

  ‘Talk to me, Maria.’

  ‘My hand is shaking. Twitching.’

  ‘Yes. We can see.’

  ‘Now numb. Feel numb. My arm. It has gone to sleep.’

  ‘What about this?’

  ‘I . . .’ Maria’s voice stopped. Her jaw shuddered a little, but did not make the shape of words or syllables.

  ‘Keep talking, Maria.’

  No words came.

  ‘Broca’s area, we presume,’ said Fischer. He removed the electrodes. ‘Why did you stop talking, Maria?’

  ‘I . . . Tried. I . . . had no words . . . No words.’

  ‘Are you all right? Does it hurt?’

  ‘No. It is all right.’

  ‘What do you feel now?’

  ‘My tongue is tingling. Blue, very bright. Now I can. Field, you see gone. Match and something. Frank, frank. Tutupic. Tamia. Tamia. Avalli.’

  Fischer lifted the electrodes again. At each place that he touched the brain he afterwards stuck a small numbered ticket, designed to be photographed later, making sure one of the students had the number correlated in a notebook with the effect it produced. ‘Possibly Wernicke’s area,’ he said. ‘I am not finding what I want to find. I am going to
move to the other side of the Sylvian fissure. Keep talking to me, Maria.’

  ‘My leg now. It is kicking.’

  ‘Good. Anything else? I am going to move a little. Now?’

  Suddenly, for the first time, the grim and wary look vanished from Maria’s thick features; the skin flushed and the eyes filled. Her face became suffused with joy.

  ‘What is it?’

  ‘I am in the bedroom . . . It is home. My father is lifting me on his shoulders and showing me a star through the small window. I can smell . . . yes, gas from the lamp on the landing. Outside someone is singing. My mother is sitting at the end of the bed . . . Wait . . . I can hear the knock of the brass handle on my bedside locker. On the mantelpiece is a china giraffe. And my brother is asleep . . . And my father has me still, is leaning down so I can kiss my brother good-night . . . And the song in the street, I can sing it, I can hear it . . . Wait, wait . . . “The king sits in his castle, the maid is gone away. The raven . . . something . . . the farmer cuts the hay.” And I can see the star, my father pointing. And, and . . .’

  As Fischer lifted the electrodes, her voice tailed away. A look of puzzlement came across her face.

  ‘What happened?’

  ‘You are still here, Maria,’ said Fischer. ‘Everything is all right. I am going to move on now so I can find the source of your seizures, so—’

  ‘No, no. You have taken me away. I want to go back. Take me back to my room. Take me back. Take me back.’

  Jacques saw a look of concern in Fischer’s eyes above the rim of his mask. ‘I cannot do that. Even if I replaced the electrodes in the same place, some different images would occur. Something random.’

  ‘No,’ said Maria loudly, the vigour of her denial making the exposed brain tremble slightly. ‘That is exactly as it happened. I had not thought of it for all these years, but it was true and I was there again. It was real, Doctor. I was there.’