‘And so I would ask you,’ the doctor continued, ‘to consider who the ultimate beneficiaries might be. The type of brain injury your brother has suffered, the catastrophic shut down, is rare. Much more common, indeed the fate of most our brains, is that of slow decline. For the lucky, it will occur as nothing more than small lapses in memory, or occasional difficulties concentrating. But for millions, the process of ageing is less benign. I speak of the grandmother who no longer recognises her grandchildren. Of the man who has loved his wife faithfully for fifty years and now must watch her fade from the world, until all that is left is a shell to be ministered to. Quite apart from the massive burden of care, there is the tragedy of such a shabby farewell. We deserve better.
‘And now, at last, something better is on the horizon. Our early detection of degenerative disease is excellent. The challenge ahead is to develop the technology that allows us to harvest information from the still-functioning brain, transfer it to a transplant-ready laboratory substitute, and then complete the physical exchange. The patient would receive a new, disease-free brain, grown from their own cells, containing the old brain’s information, but not the structural weaknesses. Animal tests have been most encouraging. The impossible is within our grasp. This is the opportunity for medicine to bring the same dignity to the end of life we long ago mastered for its beginning. We don’t want to extend lifespan necessarily, despite what the protesters might say, we simply wish to allow every individual to flourish within their allotted span. If the measure of a civilisation is the way it treats its most vulnerable, then this research can be thought of as a most civilised act. Does that make sense to you?’
‘Of course.’
I knew there were protesters, I’d seen a group outside when I drove into the hospital. They were calling it the Immortality Project, accusing the researchers of crossing the line, of seeking to deny nature and turn themselves into little gods—the same accusations medical research had faced for hundreds of years.
‘Why Theo?’ I asked. ‘Why not start with a patient showing early signs of dementia?’
Doctor Huxley looked at me, as if trying to assess how much I could be expected to comprehend.
‘There is a saying in the brain sciences, that the easy problems turn out to be difficult, and the difficult problems turn out to be easy. Before the breakthrough with compression matrixes, it was always assumed that the transfer of brain data would prove impossible, while the physical transplant of brains seemed to be just around the corner. Now we are in the curious position of having managed the impossible task, while being stumped by the easy one. Animal trials continue to provide hurdles to the task of successful acceptance and interaction. So in the case of a dementia patient, even if the reading and transfer of information were successful, we would be left with a brain without a body, which would make it extremely difficult to verify the fidelity of the transfer. To get to the point where transplant is feasible, a great deal of funding is required, but funders are reluctant to back projects that remain so uncertain. You and Theo provide a unique opportunity for us to demonstrate a proof of concept.’
‘We could unlock the money you need.’
‘Quite so.’
‘And the second problem?’ I asked. ‘You said there was a second problem.’
‘Experiments on animals also suggest a risk, to the brain being read.’
‘What sort of risk?’ I asked.
I heard the tremor in my voice.
‘With animals, it is almost impossible to measure minor damage, specific memory loss, subtle alterations in personality. But in some cases, there were more extreme reactions.’
‘Did any of them die?’
‘Two, from a hundred trials. One of those was almost certainly attributable to an error with the anaesthetic.’
‘So there’s a one per cent chance this could kill me.’
‘No,’ the doctor answered. ‘With humans the procedure is markedly different.’
‘More complicated?’ I asked.
‘Of course.’
‘So more risky.’
‘Yes.’
The doctor’s hands were mottled, veins and ligaments clearly visible beneath the thinning skin. I wondered if this was the thing that kept him up at night, the fear of losing his mind.
‘I don’t expect the procedure will harm you in any way, but that is not something I can guarantee. Does that answer your question?’
‘Sure.’
More risky than one per cent, but not so risky that it wasn’t just a number, waiting for a story to be wrapped around it. The story I told myself was this: I would be all right. I could trust these people. If I decided to go through with it, no harm would come to me. I wanted it to be true, and I had no good reason to think it wasn’t. Sufficient for belief.
‘Which brings us,’ the doctor said, ‘to the details of the procedure. Tell me what you understand of this.’
‘I don’t know any more than what you told me earlier,’ I said.
‘That will do.’ He leaned slightly forward in his chair. ‘We need to assess your understanding.’
‘You will take a scan of my brain.’
I tried to mimic his cool detachment, but I’ve always been squeamish about brains. I only have to think about my own, squeezed beneath my skull, to experience an intense coolness at the base of my neck. If I visualise a particular spot, top centre, near the back, the simple thought of it being touched brings on a gag reflex. There was a time, when I was younger, when I would imagine my own death, and it always happened the same way: sudden and unexpected, a great focussed force on the top of my skull, pulverising everything I am. In a science class, the teacher told us the brain has the consistency of a firm custard, that you could scoop at it with a spoon. I felt so ill I had to leave the room. Later I tried to convince people Theo was the one who’d fled.
‘You will use the scan to reconstruct my connectome.’
‘And what is a connectome?’
I felt foolish. He was the world expert, alert to my every error. ‘Imagine you’re explaining it to a friend,’ he said.
I tried to be accurate and analytical, so that Maggie would consider me sane. Now I can see how easy it would have been for her to see through me.
‘The scan takes visual slices of the brain, each one no thicker than the width of an individual cell. The connectome is the pattern of connections between those cells. It defines the way the brain functions, the memories that are held, the dispositions of thought, the personality, the beliefs. It is…’ I struggled for the right expression. ‘The connectome is us, we are our connectome.’
He didn’t contradict me. ‘And then?’
‘In the case of Theo, his brain has been scrambled, vital connections have been lost. His connectome is…’
The fit of words was hopelessly loose, absurd even.
‘His connectome is dead. What you are hoping to do is equivalent to the first stage of the dementia experiment. Theo’s brain is the laboratory recipient. You have developed a method for reprogramming the brain, for taking my connectome, and re-establishing it in his head. Because his brain is intact, there’s no need for a transplant, onl
y the information has to be transferred. If the connectome embeds, then he will function normally. You will have the evidence you need, that this is a viable research path to cure dementia.’
‘Very impressive.’
That pleased me. I won’t pretend it didn’t.
‘So, I’m capable of giving informed consent?’ I asked.
‘It’s not for me to make that judgment. It is important that judging your competence and performing the operation remain separate functions.’
‘Rene.’ Maggie’s face gave nothing away. ‘Your description of the procedure isn’t complete yet, is it?’
‘I was hoping you wouldn’t notice.’
‘If the operation is a success,’ she chose her words carefully, ‘nothing will have changed for you.’
‘No.’
‘But for…’
‘Theo,’ I said. ‘For Theo, a successful procedure means he wakes up with my memories in place of his own. It means he wakes up from the operation thinking he’s me.’
‘And who will he think you are?’ Maggie asked, leading me towards the conclusion just as a nurse had led me to Theo’s body: gently, but insistent.
‘He’ll think he gave me his memories, to keep me alive.’
‘And is that why you’d be doing it?’ Maggie asked. ‘To keep him alive?’
She’d tricked me into saying it, and I couldn’t take it back. How could anyone think me sane, when my plan was so senseless? He, his connectome, was gone forever. My throat constricted. Two me’s. My head hurt.
‘No,’ I said, denial my only option. But they had noticed, surely, seen the truth break free.
‘That’s not why I would be doing it.’
And yet they didn’t challenge me. Perhaps Doctor Huxley’s allotted time with us had simply expired. Perhaps my lie was so clumsy there was nothing more for them to ask. Whatever his reason, the doctor stood and shook my hand.
I looked into his eyes. He had about him the measured calm of a man certain of his own importance, the sort that makes a handshake seem an act of generosity. I felt inexplicably lucky to have met him.
‘Rene, I wish you all the best.’
‘Thank you.’
5
It wasn’t until I was sitting again that I noticed the way Maggie was looking at me: as if she was expecting me to start crying.
‘Are you all right?’ she asked.
‘I already knew all that,’ I answered.
‘It can take a while, to sink in.’
‘It’s in,’ I said, but I had to look away.
‘You understand the risk this procedure poses to you?’
I nodded.
‘And the benefits are largely for the hospital.’
‘And for the people who might one day be cured.’
‘Do you feel you have a duty to do this?’
Now I looked at her. ‘No, it’s not like that. I want to help.’
I’m sure she knew I was lying. Still, I had no choice, I had to try.
‘Tell me how you came to be at drama school,’ she said.
‘I already told you.’
‘I didn’t believe you. Are you all right?’
My foot was pulsing, and my knee danced to an unreliable tune. My hands began to shake and then, weirdly, my jaw too. I clamped my mouth shut, pushed my foot into the floor, heard a noise something like gargling take hold of my throat. I looked down, embarrassed and frightened.
‘If you need to take a short—’
‘Sorry,’ I said. ‘It’s just, with the doctor, I…’
‘What?’
‘It doesn’t matter.’
‘You don’t get to decide that.’
She put her hand on mine, over my knee, and the trembling subsided.
‘Do you think I should do it?’ I asked her.
‘What I think isn’t important.’
‘You might help me understand.’
‘Understand what?’ Maggie asked.
‘Everything.’
‘The doctor asked if you had any more questions.’
‘It’s not a doctor question.’
I could feel myself on the edge of letting go: forgetting what the interview was for and allowing the words to take over. I suppose that was what she was counting on, fear getting the better of me. I could feel the sweat building up, between her hand and mine. She pulled back gently. Her gaze didn’t falter.
‘What do you need to know?’
‘Two people wake up, after an operation, and both of them think they’re me. Does that…does it make any sense to you?’
Safe territory, in a way. If I hadn’t asked her eventually, she would have wondered why not. No, she would have decided I was hiding it from her.
A long pause, as if she was trying to find me an answer. ‘That’s the question, isn’t it.’
‘I would say it is,’ I admitted.
Another pause. She watched me, the way a cat watches a bird. Only the bird flies away, when it realises.
‘I don’t think I can help you with that,’ she said.
‘You’re a psychologist, aren’t you?’
‘It’s not that sort of a question.’
‘What sort of a question is it?’
‘A question for philosophers, I would say.’
‘So how would a philosopher answer it?’ I asked her.
‘They’d ask you what you meant by making sense.’
That was a joke, I suppose, and an attempt to sidestep the question. But I had started now.
‘Is it going to do my head in?’
‘That’s closer to my area of expertise.’
‘And?’
‘I don’t know. There are no precedents.’
‘Your guess then.’
‘I don’t know enough about you,’ she said.
But the way she looked right through me, it felt like there was nothing she didn’t know. She was playing me, and she was so much better at the game than I could ever be. But Theo needed me. I had to try.
‘We have a little more time. Tell me about drama school.’
‘What would you do?’ I insisted. ‘If it was you. What would you do, to help you understand?’
I watched the slight inflation of her nostrils, and the slow flattening of her chest as she let the air go.
‘I suppose I would try to accept that it’s beyond understanding. I think I would try to make peace with my ignorance.’
‘Is that possible?’ I asked her.
‘We live with many mysteries.’
‘But this?’
She shrugged.
Tears stung my eyes.
‘Take me to Theo, please. I need to see him.’
6
Three people were in the room when we got t
here—doctors, researchers, scientists, I don’t know what to call them. We watched through the window. They were preparing him for the operation, getting ready in case.
‘Get them out of there.’
Maggie nodded and moved into the room. They listened quietly, made a few last adjustments and filed past me without making eye contact.
It was a great relief to cry the way I did: deep from the stomach, the sheet on his bed clumped in my fist, wet with my tears. I felt awful, but also, for the first time since I’d arrived in the hospital, human. I no longer saw an accident, a patient, a problem to be solved. Now I saw Theo. My brother. My other half.
I don’t know how long I stayed that way. At some stage I stood, stroked his hair, and kissed him—on the bridge of his nose, so its tip pressed against my chin.
Lips, chin, nose. Rare, medium, well done. Theo taught me that. I backed into the middle of the room, intending to leave, but unable to look away. As if that would be the final betrayal. I have never felt more hopeless.
Maggie stood three steps behind me. Giving me space, I suppose.
‘Would it fucking kill you?’ I asked.
‘Would what kill me?’
My shoulders were hunched, cramped into the crying position, as if they might never straighten. ‘To hold me. To help me.’
‘I’m not here to…There are people, if…’
For the first time I sensed discomfort in her voice.
‘Why aren’t you here to help me?’ Now I turned. Blazing and unguarded. ‘What’s wrong with you?’
‘I have job to do. I can’t do it if…’
‘How do you know you can’t?’
‘I don’t know,’ she said.
Her restraint repulsed me.
‘But it’s my profession’s best guess. It’s how we operate.’
My knees were buckling. Would she think it an act, if I fell? She didn’t move.
Lullaby Page 5
