"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.'
"You are?'
"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 re-connected 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 and 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 re-connect 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."
"Staring at the ceiling," I said.
"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."
"No.,'
"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?"
"Of course not."
"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."
"And you could actually tell?"
"Oh, definitely. Any hospital could do that pan of it."