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  When they emerge, his arm around her against the dankness, the noon sunlight is refracting from the rocks in a warm brilliance. They lie down in a patch of sheltered grass. His hand finds her cheek and touches her mouth to his. They look up at the sky and the stone beauty of the cliff. Her body is supple and alive beside him. When he loosens her jeans at the waist, she helps him. He is fierce in his longing for her, in his imminent proposal, and hears her low laughter, and feels at last the bloom of the full, athletic body that furls nakedly into his. A Tortoiseshell butterfly flutters from the grass and settles on her shoulder. He brushes it away. In the long intensity of his desire, of his lips smothered in her neck, of her own whispering orgasm, his words of marriage are momentarily forgotten. As they drift into calm, he wonders how she will greet this irony, then falls asleep on her breast.

  Later she murmurs teasingly, waking him: ‘Why did we make love here? Did you plan this all along?’

  But his mind goes perfectly blank. ‘I don’t know why.’

  ‘But you know everything!’ She often says that, with a mocking complaint that he explains everything through the brain. Now she announces that it was not they who were making love, of course, but only his amygdala and her anterior cingulate, and she bends over to kiss his forehead, and playfully massages his heart.

  It was an easy walk from the flat to the hospital. You went through a public park and a small cemetery, and in the early morning it was so tranquil that you heard little but the pipe of waking birds. This interlude between breakfast and the surgery gave him a cleansing momentum. He enjoyed his own energy while others were barely stirring. His footsteps fell sharp and purposeful on the gravel paths. The near-silence, the brightening sky and the sea air concentrated him for the day ahead.

  In the churchyard the faded flowers and repeated epitaphs passed by, today, with a faint dissonance: ‘in loving memory’, ‘forever remembered’. This morning’s patient would be Claudia Greene, whose memory’s fragility obsessed her. In the afternoon he would operate on a pensioner whose memory would be impaired with the excision of his astrocytoma. He thought: there are things we cannot afford to dwell on, and the sacrificed past is among them.

  He construed ‘forever remembered’ not as reality, but as an extravagance of grief. The remembering brain was as corruptible as any other flesh. By the time he reached the hospital, all thought of these delusive consolations had vanished. The receptionists were as sleepy as usual, and the passageways empty. Familiar antiseptic smells hung in the air. He put on his loose-fitting scrubs and disposable gown in a darkened locker room.

  At this early hour, before the clamour and fussing of others intruded, he liked to take ownership of the operating theatre. It was a reassuring ritual: the checking of instruments and screens. He wanted nothing superfluous here. He needed the surgeon’s stool precisely calibrated beforehand, its arms adjusted. He checked that the guidance system was loaded (this morning it wasn’t) and that the patient’s scans were up on the screen. The marking pen for incision and the tapes and razor for the hair should be in place.

  At 7.30, he went up to Mrs Greene’s ward. She was awake, with her husband beside her, and an anxious teenage son whom she’d never mentioned. She looked newly taut and pale. The metallic control of her questions jarred on the silence. Her husband shifted in his seat and kept clearing his throat as if to say something, but did not. How soon would her anaesthetic fade, she asked, would she wake with a headache, how long afterwards would he see her? A few minutes later his anaesthetist arrived and explained her procedure with chatty assurance. Then Walford left them.

  He was conscious of Claudia wanting to say things that she could not. He disliked such irregularities, but he waited in the doorway of the anaesthetic room beside the theatre, until the porter wheeled her close. Then he gave her the encouragement that sounded so stereotyped to him, but which often elicited in patients a pleading gratitude, and sometimes a shaky hand would rise to grasp his.

  But Claudia Greene only licked her dry lips for a moment. Her slanted eyes stared up at him from the trolley. Then she pulled out the same packet of letters – she had smuggled it beneath her gown – and pressed it against his chest. Forced to accept it, he expected to be struck by anger, but instead felt a mixture of pity and curiosity, as if her forgetting or recollection might, after all, have some clinical value.

  His team was in the theatre. It was almost a routine morning. He had a reputation for punctiliousness, he knew, and they were waiting a little edgily: his registrar, Salim Gupta, talented but young, together with an experienced scrub nurse and her runner. The patient’s MRI scans were up on screen, showing sections of the diseased left hemisphere. He and Salim studied these cursorily, already familiar with them. There were two linked sites of operation: the amygdala and beside it the sclerotic hippocampus. Just on the basal nucleus of the amygdala hung the cloudy blister of a low-grade tumour. There was no immediate telling how deeply and invisibly this penetrated. The attached hippocampus showed sclerosis over half its body – in the enhanced images it shone brilliant white, then faded towards the structure’s tail – and it was twenty-two per cent smaller than that in the right hemisphere.

  Claudia Greene was wheeled in unconscious, accompanied by the anaesthetist with her registrar and operating assistant. Although the patient’s eyes were taped over, and her mouth stopped with oxygen and gas tubes, her face, to Walford, seemed younger, smoothed out, and her hands were interlaced like a child’s on her stomach. He undertook himself the shaving of hair from the area of operation, and marked with a surgical pen the line of cranial incision. It circled out in a wide question mark above the ear. He gave to Salim the task of pivoting the patient’s head in the clamp, holding it rigid for the computer guidance system, and supervised the placement of its pins into the skull cosmetically, just behind the hairline. The fiducial markers on the patient’s head were correlated with the navigation system on screen. Then the scrub nurse veiled off Claudia’s face.

  Now, with the operative site isolated, he felt his focus sharpen. It was a familiar moment. His attention converged on a single depersonalised segment of the head. The patient became a surgical field. He felt the tight exhilaration of his own control. His murmur and lifted hand would automatically receive the right grade of scalpel or retractor. And he regulated the tension purposefully, like ventilation, with a pressure never dropping to casualness or rising to panic.

  He started to open up the cranium with customary swiftness, slicing the muscle over it, folding back the facial nerve. The bleeding was minimal. Then came the drilling of the burr holes into the skull and the circling incision of the craniotomy saw. For long minutes its shrill whine filled the silence, and there was a stench of singed bone. Then he cauterised the flap of loosened cranium, and lifted it off. Around the cavity, and the sheltering membrane of the dura below, he and Salim packed in oxidised cellulose until the operational field was defined in a bright circle.

  Less than thirty minutes had elapsed, and there might be four hours to go. But his sense of time would disappear now. These operations happened in a temporal vacuum, insulated under the artificial day of the surgical lights. After he had perforated and sliced it, the dura began almost of its own accord to ease away from the white folds of the brain itself, and so much bleeding followed that he sutured the site swiftly, stitching back and weighting the clips around it.

  Now, with quickened concentration, he lowered the theatre microscope and began the long, deep probe into the inner brain. Experience lent him a familiar calm, almost elation: the practised delicacy that guided his retractor and forceps to the sylvian fissure and opened his way at last to the threshold of the amygdala, the anciently formed organ whose removal could destroy emotional recollection. Its detection was the most challenging part of the procedure. The jagged navigation lines, superimposed on his microscope field, warned him off the optical regions, and highlighted his target. From screens around the theatre his team could scrutinise his progr
ess, but to his naked eye the amygdala and hippocampus were still invisible. Probe too far back and you might damage the patient’s language strip. Go too high and you would cut the optical radiation fibres, wrecking the right-side vision. All the while, he and Salim were cauterising the surrounding vessels: vessels whose precise function nobody knew. He said to Salim beside him: ‘Watch closely.’

  He was discreetly proud of his abilities in this hardest of regions. Now, after only twenty minutes probing a path through the temporal lobe, his aspirator entered the ventricle itself, betrayed by a flood of cerebrospinal fluid, and he knew he was on track. On the MRI scan the tumour showed in a solid nucleus, ringed by magnified light. As he began to debulk it, the cancer came hard and fibrous against the instrument’s tip. He could not yet know how deeply it had intruded. For a long time the lesion’s resistance continued – he could sense it through his fingertips – then its texture loosened, and the pure amygdala’s tiny arteries splashed against the aspirator’s head and rose through the tube in a soft flow, the consistency of redcurrant jelly.

  Meticulously now he started to disconnect the amygdala from surrounding organs. He needed to sever it, in particular, from the sclerotic hippocampus – the channel and storehouse of memory itself – which lay half exposed beyond it. During this rigorous process his hands continued to do what they had been trained to do, but his mind started strangely to detach, as if inured to what he was performing. The amygdala, the seat of primal feeling, was deeply embedded. As he started to separate it from the hippocampus – as if from the bedrock of memory – he was struck by the irreversibility of what he was doing. He even imagined his hands hesitating – but they were not – because he had become aware of this woman’s past, and the years he might be gutting of their meaning. He was doing what he had trained himself never to do: identify with a patient; and he was glad that his vision was confined within the microscope and that he could not see on the surrounding screens, as the others could, the crimson exodus of Claudia’s memories.

  For a moment he paused, adjusting his mask, and glanced at his team in case they had noticed something. But the anaesthetist was scrutinising the monitor on her machine, and Salim was glancing at him for more instructions as they prepared to shave down the hippocampus. He drew up the surgical chair. After three hours his arms were aching. For a minute he waited, settling his elbows on the armrests, until his hands hung free above the patient’s head. He focused his gaze on neutral objects – the newly installed humidifier, the gleaming scrub basin, the endoscopy ceiling pendant.

  It was clear what must be done to render the patient seizure-free. He had performed this operation often. The MRI scan and the oncologist’s report showed sclerosis over half the hippocampus. This organ looked less like its sea horse namesake than a long white tadpole, netted in red veins. When he ran the mouth of the aspirator over it, its surface barely shivered. It seemed like ancient skin. Even when he maximised the tissue selector, nothing crumbled; so he turned the vibrating tip to dissect the tissue from the brain’s lining, and cut it into segments, lifting them out piecemeal. At first the residue massed and coagulated round the aspirator’s head; then it started to lurch up the tube in a thick, resistant waste that quivered through his fingers. He was easing it away from the brainstem, which loomed below, and at last reached an area where on the scan the sclerosis faded away.

  As his aspirator touched Claudia’s living tissue, his mind flinched. Every fragment that he removed now might be abrading her memory. His breath inside his mask felt stifled and heavy. Again he imagined his hands shaking above the rasp of the aspirator, though in fact they were perfectly assured. There was no way to know precisely what he was doing. Every human brain was different. Perhaps years ago her right hemisphere had begun to compensate for the other; or maybe even now he was severing the bridge between her consciousness and memories. He could not know. Only the feeling persisted – almost the knowledge – that with every second, as his aspirator went on ingesting, he was no longer sucking up flesh, as he sometimes told himself, but the memory of a woman’s self-esteem, the man’s voice returning to her. The incarnate flow of her past was vanishing up the aspirator’s tube to end in the hospital incinerator.

  Perhaps he left her with a millimetre more of the hippocampus than he had intended, he did not know. His working hands and brain had performed unerringly. He irrigated the cavity, watching for blood leaking into the water, then staunched more vessels with diathermy. At last he returned the dura to its sheltering place, and allowed Salim to close up the skull and stitch the temporal muscle. When they unclamped Claudia’s head, he peeled the tapes from her eyes and checked their pupils for dilation; then he and a nurse bandaged her tightly against haemorrhage.

  Only Salim, who normally regarded him with spaniel hero-worship, had sensed that anything was wrong. While the anaesthetists and porters were wheeling the patient out to the adjacent recovery ward, he asked quizzically: ‘It went all right, Steven, didn’t it?’

  * * *

  In the muted light of the recovery room, an hour later, the only other patient was awake, staring through his oxygen mask. Four staff nurses were moving about softly, adjusting equipment. It was almost silent. These were the anxious moments after operation, waiting for patients’ responses. Nothing was quite predictable. Several of Walford’s colleagues had been confronted by paralysis of limbs, speech, sight. He walked down an avenue of empty beds. Claudia was at the end. Her head looked white and shrunken under its turban of bandages, but he saw that she was already testing herself, curling her fingers, feeling her thighs. A nurse was seated at the monitor behind her. Claudia turned on her pillows at his approach and her eyes opened. He asked her how she felt, and her words seemed to surface from a great distance, but they were clear and careful. ‘I’m all right. But my head is numb.’ Her free hand lifted, dragging the cuff of her pressure gauge with it, and touched her bandaged forehead.

  ‘You’ve had local anaesthetic. It will fade in a couple of hours.’

  Above her head the screen showed normal ECG and respiration, and lowered blood pressure. He asked her to move her right leg, her right arm – the control side of the left hemisphere – and she did so without trouble.

  Faintly smiling, she asked: ‘What did you find inside my head?’

  He laughed. It was a good sign. Weakness and anaesthesia normally eliminated humour. He said: ‘The operation went to plan. I don’t expect you to have more seizures. And we excised the tumour.’

  ‘Good.’ A pause, then: ‘I know they can come back.’

  Strange, he thought, how he had delved into the private depths of this woman’s brain, yet how impersonal that seemed, as if human character and consciousness lay somewhere else. These were returned to him instead by her thin-lipped mouth and the pale slant of her eyes. She asked about her tumour again, its extent and prognosis. He was able to reassure her. She enquired about time in intensive care, and her referral to a new neurologist.

  Perhaps it was the anaesthesia, he thought, or a deepened sense of privacy, that prevented her from asking after the packet of letters. But he pulled them from the pocket under his gown. He was clinically curious about her response. ‘You asked me to show you these.’

  She looked momentarily, drowsily, surprised, then said: ‘Oh yes. I do remember.’ Her free hand emerged from the blankets to take them. She stared at the photo for a long time.

  He asked: ‘Do you remember?’

  ‘Yes. That’s Joaquim Gonzales.’ But she said this without colour, as if she were identifying an unfamiliar object. ‘He died three years ago.’ Again, no tone at all. Just a fact. ‘Poor fellow.’

  The staff nurse hovered a moment longer by Claudia’s monitor, then moved away, sensing a plea for privacy. Walford said: ‘Can you read those letters?’

  She fumbled a sheet from its envelope, and examined it. He wondered if she had forgotten Spanish. But she took out another and read that too, her face knotted with a slight frown, like brack
ets gathered between her eyes. She said: ‘They’re very sweet.’ The words held a baffled distance, tinged with condescension.

  He insisted softly: ‘Mrs Greene, you asked me to show you these letters so you would be reminded of somebody you still loved.’

  She looked down at them again, and shuffled them in her hands, like playing-cards. He regretted his words, too insistent for a weakened patient. He said: ‘I didn’t mean to intrude.’

  ‘You didn’t intrude, Doctor.’

  ‘You said that after his death you used to listen to him.’

  ‘Did I?’ She stared at the foot of the bed as if baffled. He thought: why would she bother to access a voice that she has forgotten to love?

  He wondered now, with his own chill of puzzlement, why he demanded so strenuously that she remember. Professional pride, of course: he wanted an operation unmarred by any deficit. But he was thinking too of the frailness of memory itself, and of Claudia’s affair – the love of strangers – surviving somewhere, even as an inaccessible memory trace. He began thinking involuntarily of Kate.

  He drew back from Claudia’s bedside. He realised that he had been craning over her. It was a medically interesting case, after all. But it was more important, he knew, that her capacities survive. Patients like her would notice, above all, the failure of short-term memory in the future: the frustration of small things forgotten, the compensating accumulation of lists and memoranda. Her rehabilitation therapist would not care about an affair buried in her past.

  He envisaged her living a restricted but competent life. But as he looked at her, he felt a reluctant disquiet at what he had created. She smiled at him wanly as he started to leave. The letters lay under her inert hand, beside the cannulae that snaked out of her forearm.

  He found himself clasping her shoulders in farewell.