Madness

‘Tell me what you would do at the moment of death,’ I said. ‘What is the first thing you would do?’

‘Do you know anything about the vascular and venous arrangements of the brain?’

‘No.’

‘Then listen. It’s not difficult. The blood supply to the brain is derived from two main sources, the internal carotid arteries and the vertebral arteries. There are two of each, making four arteries in all. Got that?’

‘Yes.’

‘And the return system is even simpler. The blood is drained away by only two large veins, the internal jugulars. So you have four arteries going up – they go up the neck, of course – and two veins coming down. Around the brain itself they naturally branch out into other channels, but those don’t concern us. We never touch them.’

‘All right,’ I said. ‘Imagine that I’ve just died. Now what would you do?’

‘I should immediately open your neck and locate the four arteries, the carotids and the vertebrals. I should then perfuse them, which means that I’d stick a large hollow needle into each. These four needles would be connected by tubes to the artificial heart.

‘Then, working quickly, I would dissect out both the left and right internal jugular veins and hitch these also to the heart machine to complete the circuit. Now switch on the machine, which is already primed with the right type of blood, and there you are. The circulation through your brain would be restored.’

‘I’d be like that Russian dog.’

‘I don’t think you would. For one thing, you’d certainly lose consciousness when you died, and I very much doubt whether you would come to again for quite a long time – if indeed you came to at all. But, conscious or not, you’d be in a rather interesting position, wouldn’t you? You’d have a cold dead body and a living brain.’

Landy paused to savour this delightful prospect. The man was so entranced and bemused by the whole idea that he evidently found it impossible to believe I might not be feeling the same way.

‘We could now afford to take our time,’ he said. ‘And believe me, we’d need it. The first thing we’d do would be to wheel you to the operating-room, accompanied of course by the machine, which must never stop pumping. The next problem …’

‘All right,’ I said. ‘That’s enough. I don’t have to hear the details.’

‘Oh but you must,’ he said. ‘It is important that you should know precisely what is going to happen to you all the way through. You see, afterwards, when you regain consciousness, it will be much more satisfactory from your point of view if you are able to remember exactly where you are and how you came to be there. If only for your own peace of mind you should know that. You agree?’

I lay still on the bed, watching him.

‘So the next problem would be to remove your brain, intact and undamaged, from your dead body. The body is useless. In fact it has already started to decay. The skull and the face are also useless. They are both encumbrances and I don’t want them around. All I want is the brain, the clean beautiful brain, alive and perfect. So when I get you on the table I will take a saw, a small oscillating saw, and with this I shall proceed to remove the whole vault of your skull. You’d still be unconscious at that point so I wouldn’t have to bother with anaesthetic.’

‘Like hell you wouldn’t,’ I said.

‘You’d be out cold, I promise you that, William. Don’t forget you died just a few minutes before.’

‘Nobody’s sawing off the top

of my skull without an anaesthetic,’ I said.

Landy shrugged his shoulders. ‘It makes no difference to me,’ he said. ‘I’ll be glad to give you a little procaine if you want it. If it will make you any happier I’ll infiltrate the whole scalp with procaine, the whole head, from the neck up.’

‘Thanks very much,’ I said.

‘You know,’ he went on, ‘it’s extraordinary what sometimes happens. Only last week a man was brought in unconscious, and I opened his head without any anaesthetic at all and removed a small blood clot. I was still working inside the skull when he woke up and began talking.

‘ “Where am I?” he asked.

‘ “You’re in hospital.”

‘ “Well,” he said. “Fancy that.”

‘ “Tell me,” I asked him, “is this bothering you, what I’m doing?”

‘ “No,” he answered. “Not at all. What are you doing?”

‘ “I’m just removing a blood clot from your brain.”