Night of Fire Page 10

  He had enjoyed, at first, the moment after surgery when he could convey good news to relatives, bathing in their gratitude and respect. But he guarded against this now. Sometimes he would speak to them almost harshly, reminding them of essential post-operative care, of the patient’s fragility.

  At about this time he took to winter sports. He could afford to holiday in Austria and France, and he skied fast. He relished the solitary mastery of it, the rhythmic turning of his body over a difficult piste, the soundless speed. Meanwhile, three successive girlfriends floundered on the nursery slopes below. They each accused him of heartless ambition, of an obliterating obsession with work. And they were right, of course. His practice – bordered always by the risky, the unknown – only goaded him on.

  The wind was dying round the chapel on St Adhelm’s Head. Out at sea, the racing cumulus of storm cloud was ebbing to the south, isolated in its own tumult. He pushed at the chapel door, assuming it locked, but it swung open on to a stony darkness. Its central pillar upheld a vaulted chamber, arched above a marble altar and a wooden cross. The rough-stoned walls were orientated out of true, and the pillars inscribed with half-decipherable initials and distant dates.

  By chance they stood together at the altar, as if at the marriage they had never discussed, and in this instant’s awkwardness Kate stepped away. This would have been his moment, he thought, but he did not want to ask her here, in this enclosure sombre with the carved names of others. And neither of them were Christian believers. Kate must have sensed some restless preoccupation in him, because she asked suddenly: ‘Was it a hard week?’

  ‘Yes.’ This was true (but not the reason for his silence). He was seeking the long-delayed moment for his question, and it was not now. He had imagined turning to her instead on the coast high above the sea: blue waves, alone, a hot sun.

  She said: ‘Did you have tough cases?’

  ‘Two.’ Yes, two. Not surgically tough, not really; but they had left an obscurely troubling aftermath.

  They walked on above the calming sea. Beyond the chapel headland they started round the long white curve of coast, pocked with caves and abandoned quarries, that stretched to the lighthouse on Anvil Point. The limestone cliffs yawned beneath them in tiers of champagne-coloured rock, which sometimes dropped their fragments two hundred feet into the waves. Beneath their path the ruins of a wartime radar station lay half invisible under ivy. The way was still too narrow to hold hands.

  The candidate for surgery had been a forty-two-year-old secondary school teacher with a mesial temporal lobe tumour. Her reports showed nothing unexpected. At the hospital’s multidisciplinary meeting two weeks before, the psychologist had painted the picture of a tense, rather enclosed woman, whose intelligence seemed unimpaired by four years of increasingly severe epileptic seizures. A raft of first-line drugs had failed to alleviate her. The epileptologist had expressed concern about aftercare in her family, but nobody questioned the case for operating.

  When he re-examined her file, the records showed an almost classic concordance. The video of the seizures she had suffered under surveillance agreed with the assessment of the normally cautious physiologist, and with the results of the MRI scans. Even her cognitive assessment – in which she performed near-perfectly – supported the diagnosis of hippocampal sclerosis and a low-grade tumour in the right temporal hemisphere. The operation would be delicate, but he had been performing it successfully for three years.

  She arrived for interview dressed with austere formality. Instead of sitting indulgently beside his patients, Walford preferred the distance and authority of his desk. It was important that a patient have confidence in him. Whether she liked him was irrelevant. Besides, the third chair was now taken by the woman’s husband, Richard Greene, a big man, running to fat, whose face was a mask of foreboding. Walford knew the value of consulting relatives, but Claudia Greene, according to the neuropsychologist’s report, was perfectly clear-headed. She said at once, in a quiet, metallic voice: ‘I don’t know if I want this operation.’

  ‘I’m not here to persuade you either way.’ Walford anticipated complications. ‘I can describe the procedure to you, and the risks involved. Then it will be your decision.’ There was silence. ‘I hope you understand me.’

  ‘She understands,’ her husband said. He wanted this over quickly, Walford could tell. His fingers were drumming on his knees.

  Walford said: ‘You need to think about the quality of your life now. How badly you want to change it, how much you want to risk.’

  Her husband said: ‘She wants to risk it.’

  ‘No two people feel alike about this,’ Walford said. ‘But your seizures have increased. Does this frighten you?’

  Her husband said: ‘Yes, she’s scared. She can’t teach any more.’

  ‘Mr Greene, your wife must answer the questions herself.’

  Walford thought he saw the ghost of a smile cross her face. She had once been pretty, he felt, but now looked much older than forty-two. Her face showed a papery dryness and was webbed by shallow lines. Her grey-blonde hair was pulled back to the nape in a spinsterly sheath.

  ‘The seizures frighten my husband,’ she said drily.

  ‘But you?’

  ‘They’re getting more violent. You’ve seen the videos.’ Her voice filled with distaste. ‘At first I feel air rising in my stomach, then I try to fix my eyes on something nearby, to steady myself, and I swallow to make the air go away, but it doesn’t work. Then I see my hands picking at my dress.’ She looked down at herself, her thin chest. ‘Then this fear comes. A kind of terror. I smell burning.’

  ‘Burning?’

  ‘Yes, burning. And I feel it’s all happened before, in a life I’ve forgotten, that’s the strange thing. It’s perfectly familiar, but I’m very frightened. There’s fire passing over my head, my skull. I can feel it searing in, and everything in my head is pouring away . . . I can’t describe it. I’m pouring away . . .’

  She stopped, as if she had said too much. It was odd. He had the impression of an intensely private woman, contemplating her own psyche. He said: ‘The feeling of déjà vu is common for your condition, and some olfactory sensations too.’ But he hadn’t heard of burning.

  The woman said: ‘My husband tells me that I then stare at him, just stare, before collapsing. I don’t remember this. Sometimes I wake up in the street with people round me.’ She gave a terse laugh. ‘I don’t wear dresses any more . . . I have an epileptic friend who remembers nothing about her seizures at all. I’d rather be her.’

  Her husband said: ‘You don’t want to be her. She’s going stupid.’ His mouth set. ‘So what happens now, Dr Walford? When can she go in?’

  ‘She must decide in her own time.’ He asked her: ‘How much do you know about the surgery?’

  ‘I know very little. Only that the tumour is very deep inside, and that it has low malignancy, at least for now.’ She added with clipped irony: ‘Can you really take off the top of my head, doctor, and peer in there?’

  ‘It’s not quite like that.’ For certain patients, he said, a more delicate approach was better suited than entering directly through the temporal lobe. He outlined this simply, as he always did with surgery candidates, while trying to assess her, to sense any impediment or loss in understanding. He needed to be sure of her capacity to decide. But he was aware too that she was assessing him, listening with some reservation that he could not identify; and once, of course, her attention went to his hands resting on the desktop, the hands that might recreate her. They were not the sensitised instruments that he would have liked, but wide and heavy-veined, with blunt fingertips.

  The process was like extracting tissue through a keyhole, he said. It should do minimal damage to surrounding areas of the brain, to speech or memory or eyesight. The operation itself was more fine-tuned than entry through the temporal lobe, more prone to error. She would go under total anaesthetic, of course. Yes, she would be held in a head clamp. He would cut in a curve a
bove the ear, deflecting the skin, then drill out the bone and fold back a little of the cranial membrane. This way he would have a window into the brain. He would intrude a surgical microscope, and from there the micro-instruments must find the ventricle leading to the hippocampus and the tumour. That was the crucial stage, with a small danger of inflicting haemorrhage.

  She asked: ‘But this way preserves memory?’

  ‘There will always be memory loss. In your case the surgery must excise not only the tumour, but the surrounding organs. They would be vaporised, then sucked out. You would lose most of the hippocampus, which might make for memory deficit, together with the nucleic cluster called the amygdala, where the tumour is pressing. This is the area that colours memory with emotions.’

  Claudia glanced at her husband, then away again. Her laugh was sudden, high and ugly. For the first time Walford wondered about her mental balance. He said: ‘The point is this. It will become harder to lay down memory in the future. It will affect your profession, I’m afraid.’

  She said in her quiet, tense voice: ‘My profession is over.’ For some reason she looked relieved.

  Walford was always rigorous in laying out the dangers. He knew colleagues who had minimised them, then suffered afterwards from furious relatives. Despite the sophisticated technology now in use – image guidance systems, volumetric sterotaxis – the end depended on the human hand. It must steer a way through a maze of fragile fibres and blood vessels. He cited the risk of impaired vision and of outcomes peculiar to the left hemisphere, even loss of language. She went on watching him intently. In her pinched face the eyes were curiously uptilted, and might have been beautiful in somebody less ravaged. He thought of Darwin’s awe at the exquisite perfection of the eye. But their glitter seemed incongruous in her, touched with obsession.

  At the end she asked matter-of-factly: ‘Could I die?’

  ‘There is a tiny risk. But if you leave this tumour untreated and your seizures worsen, you are more likely to die within the next three years than you ever would be from surgery.’ He thought: something private is troubling her. But it was not death, or anything he could trace. She was gazing at the floor.

  Her husband broke in: ‘What are the statistics, then?’

  Walford was expecting this. ‘After operating, the chances of being seizure-free are about seventy per cent. There’s a twenty per cent chance that the seizures will somewhat decrease, a ten per cent chance of no change at all, and a one per cent possibility that the operation will miscarry. But in the end this is not a statistical decision. It’s an emotional one.’

  Claudia smiled faintly, and asked: ‘What would you do?’

  He said: ‘It’s not me, it’s you. This is your body, your life. So it doesn’t matter what I’d do.’ She nodded. ‘If it wasn’t sensible to be entertaining surgery, you wouldn’t be sitting here. The question is: are you prepared to take the risk?’ Even to himself he sounded too brusque, too cold. He added: ‘You don’t have to decide now. And you can withdraw at any time, even at the last moment.’

  She turned away and stared out of the window. Across the street the plane trees were shining in the late sun. Her husband looked mystified by her indecision, and suddenly crestfallen. Then she stood up and shook her head, as if brushing off a trance, and said: ‘I need to think about it.’

  That night he dreamt perplexedly: a dream without incident, with nothing to account for the intensity it carried.

  He was a child again, crouching by the water tank in his parents’ garden: a rusted cylinder of rainwater, whose tap dribbled greenly at its base. His brother was standing beside it, older and taller than him, smiling. Somewhere nearby he sensed the orchard’s mellow tangle of pear and apple trees. And that was all. He remembered from boyhood how toads and a grass snake – the familiars of those years – had sometimes hunched or slithered beneath the water butt. But in this dream-instant there was only the sheen of smeared water, and the tap, and his brother saying something inaudible, and the resonance of forgotten days before and after.

  He woke with a maddening sense of loss, of something that had been almost in his grasp. He believed dreams to flow from agitated long-term memory, so this saturated fragment had been salvaged (he supposed) from a far longer story that had slipped away.

  The man looked like a startled hare. ‘What a wonder it is!’ His eyes jerked and dithered as if the nondescript surroundings – the styleless furniture, Walford’s desk, the clinic pictures – held alternate threat and fascination for him, and his coxcomb of chestnut hair wobbled above a face that seemed famished.

  ‘Nobody sees it, Doctor! There must be a fog in people’s heads. The glory is all around them and they’re blind! It’s burning in every moment of our lives, all around us, and . . .’

  This had been going on for twenty minutes now, and Walford could find no way of stopping it. He had been confronted by such epileptic personalities before, but in Roy Peters the prototype had arrived in troublesome force. God was pulsing through all human events, even the most trivial. Ordinary objects overflowed with mana, and certain places around them – hadn’t Walford noticed? – emanated a celestial power. You could feel it brush against your face. And God had spoken to Peters in confidences that others did not know, often before the onset of an epileptic fit. The joy of this was indescribable. Sometimes Peters noticed daylight stars which loosened from the sky to balloon into dazzling light. He had seen the face of Jesus. ‘Do you understand, Doc? Do you see what I’m saying? Do you realise how God is moving in the world?’

  ‘What I realise is irrelevant to this interview, Mr Peters.’ Walford was growing tired, irritable. He forced himself into a purposeful calm. ‘What is important is that you understand the implications of the operation. You say you want to have it, but I think you . . .’

  Peters broke in: ‘I’ll be in God’s hands!’

  You won’t, Walford thought; you’ll be in my hands. But he said: ‘If you’re to be free of seizures, I’ll need to extract part of an area called your limbic system. There is a structure there named the hippocampus, shaped like a sea horse . . .’ But he could see that Peters’s gaze – the eyes that had glistened over him a moment before – had detached itself to enter some dream of his own. The man was already suffering from some anterograde memory deficit, Walford knew. Four times in the past year he had split his head open in sudden falls. A lesion in his right temporal lobe had been spreading since puberty – Peters was now thirty-three – and his focal seizures had grown longer and more frequent, deteriorating into bouts of status epilepticus.

  The case for surgery was absolute. Walford would resect a part of the amygdala and the whole sclerotic right hippocampus, the ancient controllers of learning and emotion, and return Peters to something like normality. The strangeness was that Peters was not alarmed by his seizures. He even welcomed them. His pale eyes swivelled round to Walford again and glittered into his. ‘First I hear this music, Doc, this chanting, and I know He is calling me, He is breaking through, and then the curtain between us is torn aside, like the veil of the Temple at His crucifixion. But when I hear His voice, the Devil can’t bear it. The Devil knocks me unconscious. But I wake up in my rooms or on the street, because the Devil can’t kill me, and I will go on carrying Jesus’s message.’

  Walford said: ‘If we get the operation right, Mr Peters, these events will stop.’

  ‘Yes, yes. We will destroy Satan together. You will be the agent of God too.’

  Walford was jotting down notes for the rehabilitation therapist. ‘We can’t know for sure what the results will be. Every patient is different.’ He came from behind his desk and stood above Peters, who thought he had come to embrace him and stretched up his arms like a child. But Walford looked down dourly at the sprout of boyish hair and the trembling knees in their split jeans. ‘I want you to understand this. After the operation you will not feel the same. It may be that these visions and voices will disappear.’

  ‘They will never disap
pear . . .’

  ‘The brain is very complicated, Mr Peters. It is through the brain that we understand the world. Touch it, and the world changes.’

  Peters stared up at him. His voice came high and tense with angry alarm. Walford was trampling on holy ground. ‘Are you saying that you can cut God out of me with your knife?’

  ‘I am saying that you suffer from a lesion, a piece of your brain that is abnormally formed. It has been explained to you already that you run the risk of early death. But whether to operate or not is your decision, and first you must understand that the procedure will change you.’

  Peters’s cheeks flushed red. ‘You haven’t understood anything, Doctor. Nothing at all.’ He started to cross himself, again and again, with a smile of secret self-replenishment. ‘Do you think that God lives in the brain?’ His hands were clutched at his chest, shaking. ‘No, God is battering outside us, asking to be let in. Let Him in, Doc! How can you say the brain can change Him?’

  Walford answered with stony clarity: ‘Rational ideas of God evolve in the frontal cortex, Mr Peters. The occipital lobe may anthropomorphise God, and the limbic region supply emotional experience of Him. Suppressed activity in the parietal area can induce the conviction of unity with the divine.’ He pronounced this grim parody knowing it would not be understood or even heard, but he felt a cruel exoneration in the words. What troubled him was the question of informed consent. How could you perform an operation on a patient who did not understand what it might usher in? The person Peters would become might well forget or laugh at this whole discussion later. But he would be a person recreated by Walford.