Behringer no longer needed to confront the decline or mortality of the aging bands. Hendrix’s music didn’t decline and wasn’t mortal. Played in the surgery room, it made Behringer and the guitarist twins on a plane of pursuit that was esoteric to those at levels below. Did it cause certain of the older surgical nurses to vow never to work with him again? Fine, Behringer preferred younger ones. The music was something for the residents to roll their eyes over, while covertly digging it themselves. Standing in for his entire professional “personality”—Crazy Behringer with his Hendrix!—the music released him from the difficulty of formulating one.
Now Behringer’s attention refastened to the present situation. The German gambler’s face had been flapped downward, to lay on the tray mounted across his throat and chest. Like a baby’s bib! it appeared suddenly to Behringer. A resident named Charles Kai, skilled in vascular microsurgery, had diligently stemmed and redirected major arterial flow, working under the binocular microscope, like a diamond cutter or watchmaker with his loupe, to accomplish stitches half the width of a human hair.
The German, had he known, should consider himself fortunate the young and eager residents carried out the more prosaic tasks. After Behringer’s first bold violence, unlocking the patient’s nose from the axis of the orbital bones, it was the residents who had teased free the exposed flesh to form the flap that hung from the German’s chin like a beard of meat. Next the minor arteries had been individually cauterized, with a painstaking diligence Behringer could no longer be bothered to summon, he with his hundreds of entries behind him. A circular section of the bone comprising the upper sockets and lower brow had also been removed and set carefully aside, with bone chips from the saw blade conserved for eventual use in forming a reconstructive cement.
The cavern of the German’s inmost face was now prepared for Behringer’s spelunking. Copious irrigation on the part of the nurses had cleared his view, nerve bundles identified and tagged for preservation. The surrounding tissue appeared nicely relaxed. Before him now lay the entity the neurosurgeon had made this appointment to encounter. The meningioma, the flesh-crab that had squatted blackly in the scans, was revealed beneath the surgical lights as feeble-sickly pink. If was faintly veinous but, happily, not fed by any major branches of the sphenopalatine artery—not, in other words, a bag of hemorrhage-eager blood.
The tumor appeared soft, not especially firm. Behringer observed, even without magnification, some fibroid tissue, but not a troublesome extent. The central mass had undergone a measure of expansive deformation, relieved from containment behind the eyeballs and underneath the mask of bone. With mild probing it was evident that the tumor’s adherence to surrounding tissues was minimal. They’d biopsy a portion for frozen-section diagnosis and learn for certain before Behringer had gone far with his cutting, but he felt zero doubt of the diagnosis.
No meningeal tumor, outgrowth of the brain’s lining, could be one hundred percent removed. But the less sticky, the greater the percentage removed. Slow-growing, such an invader might reassert itself in ten or fifteen years. With vigilance, such a recurrence could be thwarted easily, with minimal invasiveness, by Gamma Knife. Such trite procedures interested Behringer not at all. Thousands were capable of them. Behringer’s present task, which he now guessed might top out at five or six hours of steady debulking work, was his alone to accomplish. In fact, thanks to dawning innovations like the Gamma Knife, gene therapy, and the like, the medical world might never cultivate another explorer like Behringer. The German drug dealer was lucky his surgeon existed.
“Mr. Gonzales,” he said without looking behind him.
“Yes.”
“‘Red House.’ The thirteen-minute version.” The iPod contained nothing but Hendrix. It might hold in the neighborhood of ten versions of the song. But Gonzales, though he groaned at the crudity of the joke, knew which the neurosurgeon meant. This crude joke was a ritual one.
Jimi Hendrix played another role in Behringer’s procedures, besides decorating the surgeon’s personality. The dead genius also stood in for Behringer’s patient. Delving hour after hour in the red interior, Behringer was prone to abstraction. Other surgeons learned some life facts to humanize their patient, to foreground those sweet stakes that dangled by a thread over the void, but this was not for Behringer. He had trouble recalling his patients’ names. Nor was he keen on meeting with families (useless, anyhow, in the case of the German, who apart from his phantom sponsor seemed alone in the world). Behringer would meet if they desired it, but the petitions of families made no special impression.
No, to keep himself in mind of the stakes, Behringer relied on a stock fantasy. In this daydream Behringer was a rock doc, but at a level far above that of the internists handing out electrolytes and sunblock from a tent. In each and every procedure, the flesh beneath Behringer’s Penfield was that of the epochal Negro guitarist, who’d been rushed in by paramedics, rather than left to expire in his bed of vomit, and required emergency resection of a neoplasm unapproachable by all but the most intrepid physician. Noah Behringer was, again and eternally, saving the life of Jimi Hendrix. The future of music depended on it.
III
Alexander Bruno’s face, having surpassed its eighth hour as an open door, now crawled into its ninth.
The face was the subject of vast ministrations. Residents monitored the flapped lips and cheeks, the philtrum and the skin surface of the nose, attending to blood flow and temperature. Care was lavished on the retracted eyeballs, so easy to damage irreparably, and the hood of bone and cartilage that had been set aside to permit the neurosurgeon’s entry.
The anesthesiologist, the Scottish woman McArdle, monitored the stabilized body. Alongside her was the surgical neurologist, who regularly tested and stimulated the patient’s inert extremities. The two, McArdle and the neurologist, existed at a remove from the drama of the exploded face, below its horizon, and yet were as necessary in support of the adventure of the face as the invisible root system is necessary to the drama of the flowering tree.
Gonzales and the other surgical nurses attended diligently, around the circumference of the face, to irrigation, to tagging nerve bundles and cauterizing seeping veins, as these were exposed by the neurosurgeon’s progress through the tumor’s irregular mass.
At the center, Behringer.
If the disassembled face could have somehow beheld what craned down into its core, the binocular microscope might have appeared as a pair of mad enlarged pupils, bled in every direction to the periphery, so as to make a sky of eyeball—a skyball.
For hours Behringer had borne down, into the paranasal and maxillary trenches, the nasopharynx, the orbital cavities, and into the tumor itself, the entrances he’d carved through its mass. His sense of scale was demolished. His tools and materials, the bipolar cautery and facial nerve stimulator, the tiny copper spoons and cup forceps and scissors, the neurosurgical Cottonoids, appeared like massive construction devices, excavators and steam shovels, brinked on shattered canyons of organ and tumor.
The Hendrix had played and played. Those in the room barely noticed it now apart from the transitions, the blips of silence between tracks, or at the start of a repeat—“Voodoo Child” or “Hear My Train A Comin’” for the fifth or twelfth time. Twice the neurosurgeon had startled them, calling out “Skip this one, Gonzales” for the “The Star-Spangled Banner” and “Room Full of Mirrors.” This, the only proof Behringer offered that the music still mattered to him. Otherwise he’d mutter out for irrigation or a cleansed instrument. Their own chatter was deferentially minimal, though speech was hardly forbidden. Nor did they seek his permission to rotate out on breaks for rest or nourishment. He’d be unlikely to care who, at a given moment, made up this room’s population.
In the tenth hour the neurosurgeon met a threshold; all sensed it. The air changed. Not a crisis (that being a thing for which his residents might subconsciously yearn, to bust into the tedium and test their untested courage), whatever shift ha
d occurred might not even entail a change in the surgical routine. They’d likely remain in these postures for hours yet.
But Behringer fell back, slightly. What remained of the tumor were tendrils, requiring cauterization, not removal. Tendrils, and a neoplastic layer adherent to the arachnoid tissue, more than could be safely approached. For the neurosurgeon, reaching this juncture aroused senses both of fulfilled ambition and of thwarted perfectionism, each so familiar that he no longer distinguished the two. For all purposes, they were one sensation.
The face now began its slow journey to reassembly. The displaced parts clamored for it, in their voiceless fashion. Cellular degeneration, shrinkage, nerve damage, these accelerated beyond a certain hour, no matter the quality of maintenance. That hour was past. The neurosurgeon, answerable to the whole of the face, knew the clock dictated priorities: Some shit had to be left inside. This outcome was a given.
The German (Behringer now abandoned his fantasy, Jimi Hendrix’s life had been saved, and he was also still dead, go figure) would or would not regrow his tumor incrementally, over decades; he’d die of something else before it mattered. What counted now was preservation of function—sight, skin sensitivity, swallowing, chewing. The patient would never know his face’s interior as it had now been known by Behringer, never even glimpse or dream of such knowledge, let alone judge the compromises inherent in such a procedure. It was in terms of function that the patient would measure success.
Of course the German would never be the same in any event. The face had been an opened door, yes. But behind lay a battlefield. The door, reclosed, would give testimony to what had occurred there. Behringer hoped he’d been clear enough on that point.
“Somebody begin an anecdote with uncomfortable sexual content,” commanded the neurosurgeon. “A compromising entanglement or position or proposal, something that once you hear it you can’t get it out of your head.”
He’d not lifted his face from the binocular microscope, allowing his staff to communicate behind his back—such that mute association of eyes over masks could communicate. Actually, you got good at this. The Behringer first-timers mimed helplessness to the Behringer veterans: Surely it couldn’t be their place to speak first? The veterans silently replied, to say either that they were outright resisters, so look elsewhere, or else that Behringer had strip-mined their private lives at times previous, so the newbies should step up and take their turn. Gonzales and McArdle, knowing the neurosurgeon best, said with their gazes that it didn’t matter who spoke, or whether anyone did. Behringer would find his way to turn the subject to himself, his own predilections, before long.
“Anyone been in an orgy?”
A rising scent of seared meat accompanied this query, as the cautery became Behringer’s predominant instrument.
“C’mon, a threesome? Or ever walk in on one? Ever walk in on anything, your parents even?”
This was a shy group. One nurse exited the room, but then that was always occurring, it was unclear whether there was any special reason why.
“You people disappoint me. Last time there was that nurse, Gonzales, what was her name? Remember, with the story about the staircase?”
“I think it was Park.”
“That’s right, Korean girl, Park. Probably from an upright family, insane math scores, piano lessons, never in a million years. Remember her staircase thing, Gonzales?”
“I think so, yeah.”
“Do I have to tell it myself?”
“Better you than me.”
“She’s in the stairwell of this sex party, I guess the whole scene was a disappointment, her girlfriend’s still inside but she’s ready to go, just having a cigarette on the staircase. But the guy she’s gotten the cigarette from is super-handsome, a super-nice guy she’d want to date in ordinary circumstances, right? So they’re talking, getting to know each other, soon they’re kissing. Tender, slow, nothing salacious at this point, maybe they’ll exchange phone numbers. I’m embellishing a little. At that point a guy comes out of the party and sees them on the stairs, this second guy’s not attractive at all, sort of short and toadlike, but figure there’s a perverse sexual charisma. Park didn’t say this exactly but I’d assume he’s one of those ugly-turn-on guys, women will admit to the existence of the category.”
“Castles Made of Sand” had just ended, so these last remarks fell in a gap accompanied only by the hum and whine of machines, and the thickening smolder and perfume of cooked flesh. Then “Tears of Rage” filled the silence.
“And he sees them and goes down below where she’s sitting—she’s wearing a skirt, I should have explained—and puts his head up her skirt and just begins to go to work down there, while she and the attractive guy are still making out in a very chaste and affectionate way. Needless to say, like a lot of ugly guys he’s pretty accomplished in certain techniques, a survival trait in his circumstances.”
No acknowledgment came, only the hiss of the cautery. For an interlude they worked wordlessly toward the goal.
“See, now that’s a story. But maybe we’re setting an impossible standard, you’re all intimidated.”
Nothing. Hendrix.
“McArdle, you’re from the United Kingdom, isn’t that right? Scotland didn’t vote itself out when it was given the chance.”
“That’s true so far as it goes, Doctor.”
“Well, then, right, so maybe you can clarify something for me. A friend sent me an amusing thing in an e-mail: Apparently some people in England held a protest recently, where some British porn stars went to Parliament and demonstrated for their right to sit on people’s faces. Have I got that right?”
“I couldn’t say.”
“I’m pretty sure of it. They were doing, like, a public sit-on-your-face-in. I just wondered if you knew what they were trying to establish, I mean, is it illegal in the United Kingdom to sit on someone’s face?”
“Possibly, I don’t myself know. I’ll look into it if you want me to. Not right at the moment, of course.”
“No, of course not. I just thought as the representative here you might have some angle on the whole deal.” His tone flattened. “We’re going to begin closing here, maybe as soon as half an hour.” With this incidental remark everything and nothing was changed, the whole room put on standby. The long voyage of the face now sighted a distant shoreline, the variously tagged nerves and arteries soon to be recleaved to their estranged counterparts. The painstaking reassembly was itself a voyage, of course, of many hours, requiring as much or more diligence than had the creation of the flap and opening.
“Here’s the thing that really nags at me. McArdle, are you listening?”
“Yes.” If anyone here understood that Behringer’s babble was the result of a comedown, his descent from the absolute promontory, it was the anesthesiologist.
“Do you think some of the appeal of having one’s face sat on, or should I say sat upon—that’s more properly British, isn’t it? That some of the appeal has to do with oxygen restriction? Just lack of air, I mean. If so, it would put the whole exotic area of autoerotic asphyxiation in a different light, wouldn’t it? Much closer to regular vanilla sex behavior, right? I mean, oral sex in general.”
“I’d never given it a thought.”
“Have you broken those particular laws yourself, McArdle? I mean, assuming we’re guessing right about the whole protest.”
“I’ve been known to in my time, Doctor.”
“Not just here, but in the UK.”
“Even there I’ve dared, yes, in fact.”
“Well, there you go. So these people, these protestors, though you probably wouldn’t be likely yourself to go down to Parliament and, you know, do it on the sidewalk, they were really speaking on your behalf, weren’t they, McArdle?”
“I suppose I should be grateful to them.”
“Yeah, you should, that’s exactly what I was thinking.”
“Would you like me to sit on your face, Doctor?”
The ro
om’s collective breath, held for nearly ten hours now, exploded in laughter, imperfectly suppressed beneath masks. Snorts through noses, subvocal hoots of incredulity, and so forth. McArdle was a sizable woman.
“I don’t mean just now,” she continued in her dry, even tone. “I can see you’re occupied.”
It silenced him, if only for the moment.
IV
After exiting the surgical room Behringer rested, on a gurney reserved for this purpose, in a disused office adjacent to the sixth-floor ICU. His residents concluded the closure regimen, disengagement of the patient’s body from the apparatus that had immobilized it for fifteen hours, and the dressing of the incision wounds. Much care would be given now to the limbs, at risk for pooling of lymph fluids, and to the risk of surgical phlebitis or hematomas. These were concerns beyond Behringer’s scope, were what specialization was for. The neurosurgeon slept.
More and more, lately, brain surgeons opted for swift awakening of the patient after craniotomy. Revival of function reassured the waiting family that the procedure had caused no neurological disasters, plus every hour shaved from anesthetic duration improved the pace of recovery. But Behringer still preferred, in his adventures into the face, to wait. Such patients were destined to be woken blind, with nothing to comfort them beyond a bedside voice. The German had no advocate present at the hospital. So Behringer had ordered six hours of instilled slumber, wanting to be present in person when his patient was revived. He’d instructed Kate to wake him after five.
She came in with a breakfast burrito and a tall coffee, his requirements, and a bottle of water, upon which she insisted. Behringer sat on the gurney’s edge and prodded himself very slowly in the direction of the light, while Kate described, droningly, the patient’s vital signs, and he ignored her. She’d placed the breakfast items on a Mayo stand, and Behringer began to reach for these, each in turn, while he let himself be soothed by her monotone recital. The room stank of Hibiclens, ChloraPrep, and furtive cigarettes.
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