“It’s to do with this shirt, isn’t it?”
“That’s right. It’s from a film, Alex. It’s called The Big Lebowski. That man on your shirt, he’s Lebowski. But he prefers to be called the Dude. He’s very, uh, informal.”
“Lebowski.” Of course the surgeon had recognized the visage, one beard speaking to another.
“Yes. What were you thinking it meant?”
“The shirt? I liked the colors. And—‘abide.’ ”
“It’s a good word, a terrific word, in fact. Is there more I can help you with?”
“No,” said Bruno. “I think that’s fine. That’s all for now.”
•
Moving to the streetcar stop through a salt-tinged breeze, Bruno felt overtaken by a relief like jubilation. A sensation of beams of light squeezing through the chinks of his soul. He might be shedding beatitude. Once Noah Behringer opened his face and set it aside and then back into place Bruno would grow a beard, be like Behringer and Lebowski, whoever Lebowski was. He’d inhabit this dawning fate. He’d abide, not merely wear the shirt.
It might only be Bruno’s face that had always set him apart. So his face had to be wrecked for him to be saved. His face was as much a burden as the blot behind it. This attitude was sudden and absurd and he embraced it. He’d become the Saint Francis of San Francisco—how had he never noticed the one hiding in the other until this moment? Saint Francisco, Saint Bay Area, he’d love all creatures, those wearing Google Glass and equally those booted to the curb and sorting deposit bottles from trash bins. The jocks and skate punks of Telegraph, the tattooed tribes of lower Haight, their lobes deformed with piercings. The BART or Muni riders slumped in bondage, lowly analog workers, handlers of waste and foodstuffs. Those he’d fled to Europe, fled into history, to avoid becoming, he’d embrace one and all. He’d even go to People’s Park and seek June’s traces. Maybe find June herself still alive, it wasn’t impossible. In his beard, in the devastation to be wrought on his aging face, Bruno would resemble his own lost and unknown father, his unnamed father. June would gasp at this apparition, then Bruno would explain and they’d be reunited. The love he felt was boundless, idiotic.
As the N-Judah streetcar pulled in again to roll him down to Market Street, back to BART, Bruno’s mobile rang. The surgeon’s assistant, already? No, it wasn’t possible. He glanced at the phone.
It was the prostitute from Berlin, from the Kladow ferry. Masked Madchen. Her fourth attempt, her calls were stacking up. No one else had rung his phone, which only made sense, since the instrument was a vestige of Falk’s will, of Falk’s purposes, and Falk seemed to be done with him. Yet Madchen’s string of calls were like a pulse in an otherwise dead body. Europe hadn’t forgotten him.
BOOK TWO
Eight
I
The resection of Alexander Bruno’s meningioma began for Noah Behringer on a Monday in April, at four thirty in the morning, with a wake-up call from Kate, the surgical coordinator he’d corrupted into his own personal assistant, hobbling her career in the process.
“Hi, darling,” he rasped when he lifted the phone, his land line, from the bedside table. Behringer had left a desk lamp on to make it possible to find the instrument, and prided himself on catching it before a third ring.
“Are you awake?” Kate asked. When he said, “Yes, I’ve been thinking about you all night,” she hung up.
Behringer no longer troubled to set his own alarm clock, in fact no longer owned one. Kate had once surprised Behringer by saying the cell phone he carried could be used to set an alarm, but she hadn’t meant he should try to do so. She was only teasing.
Behringer had been asleep, of course, but it was true that he had also been thinking of Kate. He’d masturbated to thoughts of his assistant in order to put himself to sleep. It was the only way he knew—masturbation, that was, not to Kate in particular—to divert his mind from the vast, scarab-shaped neoplasm behind the face of the gambler from Germany. Behringer had failed to grasp Bruno’s nationality, and the question of his patient’s unplaceable accent and odd manner had resolved, in this deficit, into an association with the notes and scans from Berlin. These lay strewn, with newer materials generated from the tests Kate had scheduled for Bruno over the past weeks, in heaps around Behringer’s apartment, for study. Behringer didn’t want to dream all night of the anatomy he’d be addressing in the surgical suite. Worse yet, lie awake all night visualizing it. A sixteen-hour surgery was itself a waking dream. He’d have enough time to contemplate the backgammon hustler’s tumor.
At Ninth and Judah he stopped at Donut World. The all-night shop was at this hour reliably bringing out trays of fresh, piping crullers. Behringer took a bag of them and a tall Styrofoam cup of black coffee. He ate a single cruller hurriedly in his parked car, then recrimped the bag and drove to the hospital. When he stowed his car behind the hospital’s steam vents, at the base of the steep, pine- and mulch-smelling hill, his special spot, he carried only the coffee and the bag of crullers. All paperwork, all transparencies, all notes in preparation for the day’s procedure were duplicated on the hospital’s computers and in a sheaf of material printed out for him by Kate. She trusted, rightly, that Behringer’s apartment was a black hole, from which nothing useful could be expected to return except the neurosurgeon himself.
A chief of neurosurgery at a major medical center such as this one—the career Noah Behringer had been on track for, had sacrificed everything for, had progressed diligently toward, until developing his fascination with untreatable tumors of the olfactory groove, intractable invasions of the paranasal and orbital region, patients more thoroughly doomed even than those his training had destined him to encounter—a chief of neurosurgery wouldn’t be up at this hour, munching doughnuts in the dark. A chief of neurosurgery would be at home while the anesthesiologist put his patient out. He’d be asleep, or enjoying a long shower, a slow breakfast, while his residents cracked and drilled and flapped the skull, while they cauterized and clipped and retracted, those first hours of painstaking tedious craniotomy that made the interior arena of the skull ready for the big man to sweep in and do his work. The brain surgeons were cleanup hitters who sat in the clubhouse while the singles hitters and bunters made their occasions ready for them.
Behringer could have been one. A cleanup hitter, a star making cameo turns. Show up for a few hours in the middle, resect a tumor, clip a thorny multiple aneurism, reorganize a major draining artery. Or fuck up, slice through the major artery, explode the aneurism, maul the language and motor-control quadrants in overly robust pursuit of a fundamentally untreatable glioblastoma or astrocytoma. Casey hitting it out of the park or striking out. Either way, his day was finished. The interns closed up the skull and flap for you, whether the skull of a triumph, a solid bragging point, or that of a new-made human vegetable never again to breathe without a tube, or the skull of a bled-out corpse.
Kate met Behringer at the elevator. Riding with him, she freed his hands of the coffee and the paper bag containing the remnants—not many—of his crullers. For these, she exchanged a folder containing the scans and transparencies, as well as notations he’d dictated briefly to her on the phone. The stuff was redundant: not only were the best images to be readily called up on the in-surgery monitor but he’d barely glance at these once he’d plunged inside, by means of the binocular microscope. The map was not the territory, etc. The monitor was for the residents, so they could study Behringer’s approach without crowding him, and to magnify artery and nerve bundles for more adept support work. Paperwork was afterthought now. From the first incision the matter was between Behringer and the flesh beneath his instruments.
For if all this was what Behringer could have spared himself—waking in the dark to be scrubbed and in among the residents for the very first incision—it was also where the distinction lay. In Behringer’s procedures, nothing was routine. Entry to the domain of the tumor was itself the adventure, whose intricacies were personal to him each ti
me. Not that he didn’t have residents to assist. The younger men viewed their sporadic call to Behringer’s procedures—well, who knew how they viewed it? The residents were themselves on track to become top-dog neurosurgeons, they featured all the characteristic monomaniacal disposition, and though they might indulge a fascination with Behringer’s eccentric method, his reckless path through the face, they couldn’t afford to sustain it.
In the passage to the lockers and washroom, in the windows lining the corridor, Behringer glimpsed the sunlight dawning now. The last he’d see until the following day. Not unless on some break he wandered into the corridor, but the cost of such wandering was to disinfect, change gowns, scrub in again. He rarely bothered. There was no sunlight in the surgical room, of course, nor in the lockers or washroom. It was enough to scrub in after the two or three bathroom voyages he’d need—he’d exaggerated during his consultant visit with Alexander Bruno—and after the meatball parmigiana sub Kate was deputized to retrieve from Molinari’s in North Beach. By Behringer’s dinner hour Alexander Bruno’s nose and eye sockets and upper lip might hope to be in the early stages of a reunion with his head. As to this matter of eating during surgeries, Behringer had been entirely dishonest with his patient. He always was.
In terms of sheer imperial arrogance, Noah Behringer was actually typical of the neurosurgical caste. Yet many of his colleagues hated Behringer, not only for his eccentricities but for his audacity. These mostly short and Jewish men were meant to be the cowboys, the Clint Eastwoods in this landscape. The brain surgeons stood atop the heap, sneered and sighed and rolled their eyes at internists, at oncologists, at phlebotomists, at the neurologists. All other specialties lay beneath them in sheer balls—even the cardiac surgeons. Pop a heart out, put it on a plane, stick it in another body. Make a dozen mistakes—hell, you could drop a heart. Whereas one nick, one wrong turn, the brain died. A heart surgeon was Scotty in the engine room, sweating, up to his elbows in greasy parts. The brain surgeons were the Vulcans.
His comparisons, Behringer was aware, were forty years out-of-date. Scotty no longer ran the engine room. Most of those actors were probably dead. (It was a miracle he’d been able to identify the Big Lebowski T-shirt, entirely due to a girlfriend, whose favorite film it had been.) To be woefully out of touch with everything except medicine since the day you entered the machine was the price of doing business, of rising to this place, and Behringer’s compensations were as pathetic as the next guy’s, despite attempts to read the latest best seller, or to do more than trot his weekly New Yorkers from mailbox to recycling bin, having grasped nothing but the occasional article by Oliver Sacks or Atul Gawande, the rest an opaque hash of fashionable names, communiqués from a world that had left him behind. One morning The New Yorker had informed Behringer, while on the shitter, that Jerry Brown was governor again. Imagine! Which other bewilderments might be lost on him, who knew?
Behringer scrubbed now, honoring the ancient regimen, each arm treated elbow to fingertip, not the reverse, each finger to be treated as a four-sided object, scaled and buffed individually, fingernails a minimum of twenty-five times, contaminated soap sluiced downward yet while keeping elbows lower than fingertips, etc.
Behringer, who liked to speak of his “writing,” had actually passed through his Oliver Sacks delusion long since. He was compassionate, sure, but a ponytail and beard didn’t make him Sacks. Nerdy spectacles didn’t make him A. R. Luria. Nor did his eccentricities render him a humanist, a soul surgeon; he’d abandoned the pretense. Behringer’s minor flirtation with the brain-mind perplex had been satisfied by reading a few articles. Confronted with a book on the topic (there was a new one on a monthly basis), Behringer drifted. His interest in the fabulation known as human consciousness was bounded neatly inside its traditional container. He was interested in his own surgeries. He recognized himself in the word solipsist.
Behringer stepped inside the surgical room, no longer referred to as a theater. His anesthesiologist, McArdle, a jolly raffish Scottish lady he was always glad to see, had done her work; the German was out. She’d given way to the scrub nurses and technologist working to drape the man, to shave his eyebrows and position his limbs to endure the procedure. As usual for Behringer’s marathons, a neurological technician would monitor the risk of “positioning effect,” preventing nerve or tissue damage a body’s length from the surgical area. Behringer couldn’t recall the technician’s title or name: another watcher-participant, another minor actor. Yet the surgical stage still wasn’t a theater because there was no audience. The only non-player at Behringer’s performance was guaranteed to miss it entirely: the German with his head now bolted in place, his body draped and insensate on the table. Breath flowed to the patient’s lungs through a hose in his throat; Behringer needed to assault the oropharynx and the posterior nares and the sphenoidal sinuses with impunity, not be forced to work around tracheal intubation.
First, however, and feeling real excitement at the thought, the good burst of adrenaline at last, Behringer wanted to dismantle the sockets and loosen his patient’s eyes.
Behringer didn’t need it to be a theater, not for playing Hamlet or Macbeth or Godot or any other figure riddled with hesitation and remorse. He needed no witness, nor sidekick or foil, no Sancho Panza here. Thanks to the power of the binocular microscope, for Behringer the incision into the patient became a planetary landscape, cavernous, labyrinthine, enveloping. In that zone, everything was between Behringer and his fascination, between his hands and the meat. A hundred watchers couldn’t drag him back to the human realm here, if he was honest.
His sole tether was the music. Now was the time. He nodded to Gonzales, the surgical technologist who knew him best. Gonzales tapped the iPod, mounted in a small speaker bay, and it started playing “Night Bird Flying” from First Rays of the New Rising Sun, as always. It was set at a volume that permitted work to be done, the instructions and observations to pass among the members of the team, but loud enough to cover the drone and whine of the motors driving the suction and drill, loud enough to matter.
With this, and after one last impatient glance at the 3-D scans on the screen and his own brisk notations, Behringer asked for the first instruments he’d need to carve his German’s face apart.
If he was hated by the brain surgeons the real reason was here, in this ripple of disturbance—ambient, denied, intangible, but unmistakable—that Behringer triggered as he laid the honed blade to the backgammon player’s forehead, along the line where eyebrows had been, and worked the incision down, around each eye socket, to the underside of the temple. Behringer was a heretic, an outlier. Nobody was supposed to delve farther for a tumor than into the braincase. That some other secret place resided so close, “hidden in plain sight,” yet even more inaccessible to traditional treatments, freaked everyone out. The Bermuda Triangle of self. The brain surgeons were top dogs, Behringer a coyote. Specifically a coyote eating frontally, into the face. Nobody liked someone who came at the face. In surgeon’s terms, the face was for the plastic guys, the sleazy, go-for-the-buck tit-lifters, who congregated down in the Southland. Behringer stunk of this impurity, he knew. It gave the neurosurgeons a way of feeling superior to him.
Really, they were afraid. The neurosurgeons draped the face, dehumanized it for their convenience, before cutting. They taped off a bald cranium to appear like an orb, a science-fiction egg. The unity of face and skull, if encountered suddenly, sickened even the most hardened among them. They defended themselves from this awareness. Snobs for depth, they slighted the surface and those who engaged with it.
In Behringer’s view it was all meat, the surface and depth alike. Physicians were, each and every one of them, mechanics of the meat. The stuff of which dreams were made, sure. But not itself dreams, not ectoplasm or soul or spirit. Those eluded the knife. Instead, gum and glue, nerves and fat. Animals made in evocative and stirring shapes, out of a meat that sometimes tried to wreck itself with mutation. The brain surgeons were plastic su
rgeons; plastic surgeons were all there were.
II
Though he wasn’t quite old enough to have seen Jimi Hendrix play live, in his younger days Noah Behringer had been a “rock doc,” working the medical stations at festivals and backstage at Winterland and the Warfield, in exchange for free entrance. There, he’d dispense prescription medicine to touring musicians and roadies, while doling out ibuprofen and Gatorade to sunburned LSD overdoses and dehydration cases among those in the audience. Most who manned the tents were nurse practitioners or stoner family-practice types; Behringer was the only neurosurgeon among them. He’d begun during his internship, on a colleague’s suggestion, at a string of Hot Tuna shows in the late ’80s.
The music fans seemed to Behringer a population worthy of curious study, full of childlike adults presenting simple problems he could usually solve. The musicians? Strangely, they reminded him of surgeons. Professionally aloof and unreachable, until that moment when the lights went on and they became exacting technicians. They were interested only in the cleanest and most efficient amphetamine doses in Behringer’s supply, and in B-vitamin shots. All of this seemed precisely arranged to say to Behringer: What are you doing here? Go back to what you’re best at. To where you’re the star. The music itself, for which he’d been hopeful, barely interested him. He got more from retracing, on headphones, Dave Gilmour’s guitar solo on “Dogs” for the thousandth time than he did from anything in the events he now attended, with all the indignities of the rock-doc’s role, his button shirts infused with clove, cannabis, and vomit.
Behringer’s last show was at the Oakland Coliseum. The Who, or what survived of them. The venue had ordered up an excess of doctors, so Behringer snuck into the general-admission area on the Oakland A’s ballpark grass, and during a rote rendition of “Pinball Wizard” filtered his way through the blankets and folding chairs of the infield until he found the mound, which sat bandaged in tight-pinned canvas. He stood on top, facing the stage, and pitched a no-hitter in an imaginary ball game. Behringer wasn’t needed in this place. He left before the band’s encores.
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