‘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. ‘I 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 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.”
“Just lie still. Don’t move. I’m nearly finished.”
“So that’s the bastard who’s been giving me all those headaches,” the man said.’
Landy paused and smiled; remembering the occasion. ”That’s word. for word what the man said,’ he went on, ‘although the next day he couldn’t even recollect the incident. It’s a funny thing, the brain.’
‘I’ll have the procaine,’ I said.
‘As you wish, William. And now, as I say, I’d take a small oscillating saw and carefully remove your complete calvarium the whole vault of the skull. This would expose the top half of the brain, or rather the outer covering in which it is wrapped. You may or may not know that there are three separate coverings around the brain itself the outer one called the dura mater or dura, the middle one called the arachnoid, and the inner one called the pia mater or pia. Most laymen seem to have the idea that the brain is a naked thing floating around in fluid in your head. But it isn’t. It’s wrapped up neatly in these three strong coverings, and the cerebrospinal fluid actually flows within the little gap between the two coverings, known as the subarachnoid space. As I told you before, this fluid is manufactured by the brain and it drains off into the venous system by osmosis.
‘I myself would leave all three coverings – don’t they have lovely names; the dura, the arachnoid, and the pia? – I’d leave them all intact. There are many reasons for this, not least among them being the fact that within the dura run the venous channels that drain the blood from the brain into the jugular.
‘Now,’ he went on, we’ve got the upper half of your skull off so that the top of the brain, wrapped in its outer covering, is exposed. The next step is the really tricky one: to release the whole package so that it can be lifted cleanly away, leaving the stubs of the four supply arteries and the two veins hanging underneath ready to be reconnected to the machine. This is an immensely lengthy and complicated business involving the delicate chipping away of much bone, the severing of many nerves and the cutting and tying of numerous blood vessels. The only way I could do it with any hope of success would be by taking a rongeur and slowly biting off the rest of your skull, peeling it off downward like an orange until the sides and underneath of the brain covering are fully exposed. The problems involved are highly technical and I won’t go into them, but I feel fairly sure that the work can be done. It’s simply a question of surgical skill and patience. And don’t forget that I’d have plenty of time, as much as I wanted, because the artificial heart would be continually pumping away alongside the operating-table, keeping the brain alive.
‘Now, let’s assume that I’ve succeeded in peeling off your skull and removing everything else that surrounds the sides of the brain. That leaves it connected to the body only at the base, mainly by the spinal column and by the two large veins arid the four arteries that are supplying it with blood. So what next?
‘I would sever the spinal column just above the first cervical vertebra, taking great care not to harm the two vertebral arteries which are in that area. But you must remember that the dura or outer covering is open at this place to receive the spinal column, so I’d have to close this opening by sewing the edges of the dura together. There’d be no problem there.
‘At this point, I would be ready for the final move. To one side, on a table, I’d have a basin of a special shape, .and this would be filled with what we call Ringer’s Solution. That is. a special kind Of fluid we use for irrigation in neurosurgery. I would now cut the brain completely loose by severing. the supply arteries and the veins. Then I would simply pick it up in my hands and transfer ‘it to the basin: ‘This would be the only other time during the whole proceeding when the blood flow would be cut off; but once it was in the basin, it wouldn’t take a moment to reconnect the stubs of the arteries and veins to the artificial heart.
‘So there you are,’ Landy said. ‘Your brain is now in the basin, and still alive, and there isn’t any reason why it shouldn’t’ stay alive for a very long time, years and years perhaps, provided we looked after the blood and the machine.’
‘But would it function?’
‘My dear William, how should I know? I can’t even tell you whether it would regain consciousness.’
‘And if it did?’
‘There now! That would be fascinating!’
‘Would it?’ I said, and I must admit I had my doubts.
‘Of course it would! Lying there with all your thinking processes working beautifully, and your memory as well…’
‘And not being able to see or feel or smell or hear or talk.’ I said.
‘Ah!’ he cried. ‘I knew I’d forgotten something! I never told you about the eye. Listen. I am going to try to leave one of your optic nerves intact, as well as the eye itself. The optic nerve is a little thing about the thickness of a clinical thermometer and about two inches in length as it stretches between the brain and the eye. The beauty of it is that it’s not really a nerve at all. It’s an outpouching of the brain itself, and the dura or brain covering extends along it and is attached to the eyeball. The back of the eye is therefore in very close contact with the brain, and cerebrospinal fluid flows right up to it.
‘All this suits my purpose very well, and makes it reasonable to suppose that I could succeed in preserving one of your eyes: I’ve already constructed a small plastic case to contain the eyeball, instead of your own socket, and when the brain is in, the basin, submerged in Ringer’s Solution, the eyeball in its case will float on the surface of the liquid.’
‘I suppose so, yes. I’m afraid there wouldn’t be any muscles there to move it around. But it- might be sort of fun to lie there so quietly and comfortably peering out at the world from your basin.’
‘Hilarious;’ I said. ‘How about leaving me an ear as well?’
‘I’d rather not try an ear this time.’
‘I want an ear,’ I said. ‘I insist upon an ear.’
‘I want to listen to Bach.’
‘You don’t understand how difficult it would be.’ Landy said gently. ‘The hearing apparatus – the cochlea, as it’s called – is a far more delicate mechanism than the eye. What’s more, it is encased in bone. So is a part of the auditory nerve that connects it with the brain. I couldn’t possibly chisel the whole thing out intact.’
‘Couldn’t you leave it encased in the bone and bring the bone to the basin?’
‘No,’ he said firmly. ‘This thing is complicated enough already. And anyway, if the eye works, it doesn’t matter all that much about your hearing. We can always hold up messages for you to read. You really must leave me to decide what is possible and what isn’t.’
‘I haven’t yet said, that I’m going to do it.’
‘I know, William, I know.’
‘I’m not sure I fancy the idea very much.’
‘Would you rather be dead, altogether?’
‘Perhaps I would. I don’t know yet. I wouldn’t be able to talk, would I?’
‘Then how would I communicate with you? How would you know that I’m conscious?’
‘It would be easy for us to know whether or not you regain consciousness,’ Landy said: ‘The ordinary electro-encephalograph could tell us that. We’d attach the electrodes directly to the frontal lobes of your brain, there in the basin.’
‘Oh, definitely. Any hospital could do that part of it.’ ‘But I couldn’t communicate with you.’
‘As a matter of fact,’ Landy said, ‘I believe you could, There’s a man up in London called Wertheimer who’s doing some interesting work on the subject of thought communication, and I’ve been in touch with him. You know, don’t you, that the thinking brain throws off electrical and chemical discharges? And that these discharges go out in the form of waves, rather like radio waves?’
‘I know a bit about it;’ I said.
‘Well, Wertheimer has constructed an apparatus somewhat. similar to the encephalograph, though far more sensitive, and he maintains that within certain narrow limits it can help him to interpret the actual things .that a brain is thinking. It produces a kind of graph which is apparently decipherable into words or thoughts. Would you like me to ask Wertheimer to come and see you?’
‘No,’ I said. Landy was already taking it for granted that I was going to go through with this business, and I resented his attitude. ‘Go away now and leave me alone,’ I told him. ‘You won’t get anywhere by trying to rush me.’
He stood up at once and crossed to the door. ‘One question,’ I said.
He paused with a hand on the doorknob. ‘Yes, William?’
‘Simply this. Do you yourself honestly believe that when my brain is in that basin, my mind will be able to function exactly. as it is doing at present? Do you believe that I will be able -to think and reason as I can now? And will the power of memory remain?’