The Best American Nonrequired Reading 2011

by Dave Eggers

  "That may be true, Irma—to a degree—"—but what was Lucas saying, did he believe this nonsense?—"but trepanation is not the solution. No reputable doctor would perform this 'sacred ritual' for you—I'm sure."

  He felt a tug of emotion for the agitated woman, as for himself. It was so—so many years! His childhood in Camden, Maine, belonged now to a boy he no longer recalled, on the far side of an abyss.

  "Doctor, if you, with your surgical skill, refuse me—I will have to turn to a stranger, on the Internet. I may have to fly to Geneva, alone—in secret since my family disapproves. Please say that you will help me, Dr. Brede!"

  "I can't 'help' you! The procedure is dangerous, and useless—it can't possibly be of 'help.' It's true, radical and once-discredited procedures like lobotomies and electroshock treatment have been reexamined lately—but in very rare instances, and when other methods have failed. There is no medical justification for 'trepanning'—drilling holes into a healthy human head."

  Whenever Lucas spoke, Irma Siegfried listened, or gave that impression, but in the way of a pilgrim whose fanatic faith can't be dampened by another's logic. "Dr. Brede, I would pay you, of course—twice the fee for a face-lift. This would be a 'spirit-lift'—it would save my life."

  "Irma, I don't think we should discuss this any longer..."

  Yet there was irresolution in Dr. Brede's voice—the faintest note, near-imperceptible. Like a dog sensing fear in a human voice however it's disguised, Irma Siegried leaned forward, baring her small, porcelain-white teeth in a ghastly seductive smile. "Doctor, I would tell no one—of course! This would be our utter secret! I will pay you in advance of the procedure—you would not even need to bill me. Here, I've brought—a drawing—the 'sacred triangle'—"

  Irma was smoothing out a sheet of paper. Here was a drawing of a triangle as a child might have drawn it, with a ruler. "Three very small holes, just above the hairline—here." Irma drew back her hair to suggest the positioning of the holes, in the area of what was called the frontal lobe—though she wouldn't have known this, still less what crucial functions the frontal lobe controlled. Sensing Lucas's reluctant interest, determined not to lose it, Irma was recounting how she'd dreamed the "sacred triangle"—which was, in fact, an ancient symbol predating even Egyptian history—out of the vast reservoir of the "collective unconscious" she'd dreamed this design which was fated for her.

  Somberly Dr. Brede listened. The tight, affable smile had clamped the lower part of his face.

  This is madness. You know the woman is mad.

  Yes, but she has money. She will pay you.

  Do I need money? How badly?

  Such yearning in the woman's eyes! Lucas had seen that look of yearning in the eyes of countless others, that filled him with both repugnance and something like exhilaration, pride—so a priest might feel presiding over sacred rites, ritual confession, absolution, and blessing.

  Or an execution, a sacrifice.

  Lucas was thinking—would it matter? If he drilled, or pretended to drill, a few very small holes in this woman's scalp, barely penetrating the hard bone of the skull? It would be a kind of cosmetic treatment, above the hairline; he would take care not to penetrate the dura mater. The smile clamped tighter about his jaws.

  "Dr. Brede? Will you—?"

  Lucas hesitated. His heart clanged like a metronome. Yet hearing himself say, with infinite relief: "Irma, no. I think—no. I'm sorry."

  Tears welled in the woman's eyes. Abruptly then the consultation ended.

  Lucas stumbled into the adjoining lavatory. He ran cold water and splashed it on his burning face. How close he'd come to a terrible danger!—but he'd drawn back in time.

  No. We can't. It would be a tragic mistake, we could never undo.

  In the photos—you can see the child is brain-damaged. Some sort of birth-injury. The eyes aren't in focus. There's a look of cretinism...

  We can't risk it. We can't get involved. We've been forewarned—the Russian "orphans"...

  No. No. No. Absolutely no..

  ***

  How was it his fault?—for years his wife had taken fertility drugs. A specialist had encouraged her, at enormous expense. Lucas had not been optimistic, though he'd wanted a child as badly as she did—of course. Soon he'd come to see that the powerful hormone supplements were adversely affecting her—her fixation upon a child, her emotional instability, mood swings. Her resentment of him, as a man. And when finally—almost unbelievably—she did become pregnant, at the age of thirty-nine, the sonogram had revealed serious heart and brain defects.

  Audrey, please understand—there is no choice.

  It is not infanticide! It is an act to prevent suffering. To put the fetus out of its misery before it is born.

  Then, the desperation. Internet adoption agencies to which without Lucas's knowledge Audrey gave their credit card number. In a weak moment he'd promised her Yes we can adopt we can try to adopt but afterward he'd realized his error. Never had the woman forgiven him his error.

  I. S.—these initials he penciled lightly on his personal appointment calendar. For Chloe wasn't to know.

  The procedure was so simple, he wouldn't need an assistant.

  She would be an outpatient, in his office. He would prep for the procedure himself.

  The plan was: the patient would arrive at Dr. Brede's office soon after 7:00 P.M.—when it was certain that Chloe would have left for the day. She would have taken a tranquillizer at 6:00 and when she arrived, Lucas would give her a more powerful sedative; if needed, he could administer chloroform in very small doses.

  Trepanation—so primitive a procedure, one would not have to practice beforehand.

  Very carefully Dr. Brede would drill into the woman's scalp—very shallowly, into her skull. He believed he could do this. The diagram called for three minuscule holes to be opened into an equilateral triangle measuring a quarter-inch on each side. Irma had been adamant about paying Lucas beforehand, a check for $12,600.

  Doctor, thank you, I am so grateful. Doctor, I will owe you my life—my new life.

  Irma's teeth chattered slightly, she was so excited. As she lay back on the table in Dr. Brede's examining room, her eyelids that were blue-tinged as if with cold were shut tight and her thin hands were tight-clasped below her small, soft bosom. Though her skin was sallow beneath the harsh fluorescent lighting, and fine white lines puckered at the corners of her eyes, Irma was an attractive woman and it was touching to see that she'd shampooed her hair just recently and had creamed and powdered her face. Coral lipstick darkened her lips. On a thin gold chain around her neck she wore a small gold cross that slipped behind her neck when she lay back.

  Doctor, thank you. I will adore you forever.

  Soon then the patient was asleep. Her mouth drooped open, like an infant's. Determined to be cautious—Lucas didn't want the patient to wake up suddenly—he soaked a cloth in chloroform and held it beneath her nostrils for a count of three.

  Lucas tugged on latex gloves. He was eager to begin. A sensation of elation, almost a kind of giddiness gripped him. New life! Owe you my life my new life! He parted the woman's fine, soft, sparrow-colored hair, clamped it aside. He dabbed her scalp with Betadine. The stinging sensation caused her to murmur faintly, querulously. With a small scalpel he made an incision in the skin—retracted the skin, less smoothly than he'd have wished—for his hands were shaky; he would have scraped the damp, exposed bone clean, but felt a wave of something like nausea sweep over him—he had to pause, to re-cover. Already the tiny wound was bleeding—this was distracting. And now—the drill!

  If he'd have had time to prepare more thoroughly for this unorthodox office procedure, Lucas would have purchased a small dental drill from a dental supply store; but he'd been rushed, he'd made his decision overnight, and so the drill he'd acquired—at a hardware store at the North Hills Mall—was an eight-inch stainless-steel PowerLux. A handyman's tool, there was no disguising the fact. The sharp whirring of the motor, the e
erie spin of the drill, the gleam of the stainless steel—Lucas's icy fingers trembled.

  "Irma? Are you—asleep?" The woman's blue-tinged eyelids fluttered, though it was evident that she was soundly unconscious. Her breathing was slow, deep. Her breath smelled of something sweet—mouthwash, mint—and beneath a more acrid, slightly sour smell of animal apprehension, fear. She knows!—her sleeping self knows. There is danger.

  Lightly he touched the drill against the woman's scalp—bright blood appeared at once, in a swift stream—this was more than he'd have expected, for such wounds don't commonly bleed quite so freely—he was prepared to sponge it away—yet, so rapidly the blood flowed, as the unconscious woman twitched and whimpered, immediately Lucas lifted the drill from her head. His heart was beating rapidly, the panic-chill rose into his throat. He waited until the woman quieted and resumed her deep breathing; he touched the drill to her scalp another time—again the bright blood startled him—and a smell of burning bone—distasteful, repugnant. This time the patient seemed on the verge of waking—her eyelids fluttered—her lips trembled—he could see the white of her eyeball, a glimpse of unfocused eyes that made him think of a zombie's eyes, or the eyes of one in a coma. Tape her eyes shut. Her mouth. Secure her. To prevent hysteria.

  This advice seemed to come to Lucas from a source outside himself. He tried to identify the voice—one of the supervisors at the Institute—but could not.

  These prudent steps he did. These precautions. This was not an emergency situation but you never knew—in an instant, in the OR, emergencies can erupt. This situation—the trepanning—seemed to be within control. The latex gloves were slippery with blood and the adhesive tape was slippery with blood, but he had no trouble taping the woman's eyes and her mouth and Lucas had no trouble strapping the patient to the table except the paper was badly torn already, and blood-stained—so quickly. And blood on the tile floor—the doctor's crepe-soled shoes would leave distinct footprints.

  Lucas lifted the drill. Now!—he drew a deep breath. His bloodslick rubber gloves caused the drill to slip, just slightly. It was a heavy, crude instrument that belonged in a handyman's workshop, not in a surgeon's hands.

  The trepanation would have gone far more smoothly except the doctor was nervous. He'd poured a shot glass of whiskey for himself after his nurse-receptionist left for the evening, and he'd swallowed two thirty-milligram tranquilizers of the kind he kept in his office for his skittish patients' short-term use. Immediately he'd felt better. Now in the stress of the moment he was considering a third tranquilizer but No. Clarity is required. Clear-headedness. Courage.

  Like one leaning over a steep drop, Lucas leaned over the woman who lay limply on the examination table, unconscious, or comatose—the torn scalp bleeding profusely and the faded-girl's face now deathly white, contorted by the adhesive tape he'd wrapped tightly around her head. He'd covered her eyes and her mouth—but remembered to leave her nostrils free for breathing. And quickly, shallowly, and erratically the woman was breathing. Lucas lifted the drill, positioning the razor-sharp spiral borer against the bloody scalp. He saw that bloody clumps of hair and skin were stuck to the borer that would shake off, or fly off, when he began drilling. The revelation came to him as if from a great distance This is not Lucas Brede, MD. This is another person who does trepanning.

  After several false starts he managed to finish the first of the tiny holes— trepanation was not so easy, as it was not quite so primitive, as the medical profession might think. Skill was involved here, in not penetrating the dura mater. The drill seemed steadier now in his hands—though still a clumsy, crude instrument—Lucas began the second hole, a quarter-inch from the first, as the whirring sound of the drill filled the room like an amplified scream. Still, the blood was a distraction—in the familiar quarters of his office he wasn't accustomed to such an excess—if a patienfs face bled, Dr. Brede or Chloe wiped it away easily with a sponge. Now there was so much blood from the patient's head wounds that he couldn't sponge it away quickly enough. He was having difficulty seeing where the sharp point of the drill pierced the scalp—a fine mist of blood coated the lenses of his glasses—how to clean his glasses, in the midst of this procedure?—no choice but to remove them. Now, too, Lucas regretted not having taken time to mark the patienfs scalp with orange ink—he'd reasoned that after all trepanation wasn't neurosurgery and didn't have to be so specifically directed. He wasn't "opening" the skull for brain surgery but only just perforating it, aerating it.

  Like a well that has been slowly poisoned.

  A new life.

  The skeptics in his profession—the notoriously conservative "medical community"—would have little sympathy for Lucas Brede if he suggested to them that trepanation might not be so bizarre after all, as a kind of alternative medical procedure; since childhood Lucas himself had felt the slow leakage of his "soul"—his personality trapped and disfigured by the confinement of the bone-armor of the skull.

  Of course Lucas had been skeptical also, and initially jeering—yet open-minded enough, after having sent Irma Seigfried away, to reconsider her request, and to summon her back.

  He'd spent much of a night—one of his insomniac nights, which lately he'd come to welcome as a respite from heavy, stuporous, sedative-sleep—researching trepanation on the Internet. To his surprise he'd come to concede that the ancient custom was either beneficial or harmless if executed by a skilled practitioner. Through the centuries holes had been drilled in the skulls of myriad individuals and these holes showed evidence of having healed; there were skulls with several holes, suggesting that among some primitive people trepanation may have been a routine procedure, like removing infected teeth.

  There was an ethical issue here, Lucas thought. As licensed surgeons are best equipped to perform abortions, so licensed surgeons are best equipped to perform trepanations. Refusing to serve desperate individuals for purely selfish reasons was as unconscionable in the one case as in the other.

  You could argue that tattoos were much more dangerous than a skilled trepanation since needles are easily infected, and "tattoo-artists" were hardly licensed surgeons.

  Maybe there was, as Internet testimonies suggested, a parallel world in counterpoise to Western medicine. It was just prejudice that valued Western medicine above all others.

  The whirring of the drill was fierce in his ears, the weight of the drill increasingly heavy as he was obliged to hold it at an awkward angle, uplifted. Lucas was beginning to feel light-headed, dazed. The smell of singed hair and flesh, and the excessive blood, was making him ill. He was stuffing strips of gauze into the bleeding wounds but these soaked with blood immediately and were of no use. How tired he felt, required to maintain such a high degree of concentration, with no one to assist him or even to offer to wipe his face, or polish the lenses of his glasses; a surgeon isn't accustomed to working alone. Lucas was thinking he might pause for a few minutes—he should pause—to examine the patienfs pulse—her heartbeat—for the patient no longer seemed to be breathing through her frantic widened nostrils—but a reckless sensation came over him, a sense of defiance—he would not turn back, now that he'd come so far.

  Not many minutes had passed since Lucas had switched on the power tool, but these minutes had flown by swiftly as in an accelerated film.

  He would clean out the wounds carefully, and dress them. He would caution the woman not to show anyone and not to speak of the trepanning. For this was a sacred ritual, and meant to remain private. When she woke the woman would feel some discomfort, he supposed—some pain—the brain didn't register pain but the scalp, the skull, and the dura mater registered pain—he would give her a prescription for Percodan—primarily she would feel an airiness, a strangeness—a floating sensation; almost, Lucas envied her; for it was enviable, to be so naive, and trusting; it was enviable to be a child once again; as he, Lucas Brede, had never entirely been a child, but always confined, held captive by his elders' expectations of him. Thinking these resentful thoughts
and holding the drill at a precarious angle, Lucas felt it begin to slip—the rubber fingers of his latex gloves were slippery with blood—or, what was more likely Lucas may have blacked out for a moment. And what happened, happened so fast he would have no clear comprehension of what it was—his hand slipped, the spinning borer must have penetrated the skull too deeply, and down, into the dura mater—in an instant this mishap had happened—the woman's body jerked, convulsed—her knees buckled, her legs flailed against the restraining straps—Lucas was grateful that her eyes were taped shut, he was spared locking his gaze with the gaze of the stricken woman—he heard a scream—a muffled scream—inside the adhesive gag.

  But no, this wasn't possible. The woman had not regained consciousness. This was not possible, the scream had to be Lucas's feverish imagination.

  Soon then the convulsing body lay limp. The struggle had ceased, the muffled screams had ceased. Dr. Brede staggered with exhaustion. He could not have been more drained if he'd performed an eight hour surgery before witnesses. His eyeglasses he groped for, couldn't remember where he'd dropped them, still the lenses were misted with blood and nearly opaque. The thought came to him as a consolation You have put this one out of her mercy. That is—misery.

  The patient's remains, the sprawled and befouled female body, Dr. Brede would have to dispose of.

  For he had no assistant. He was alone. It had always been so, Lucas Brede's soul.

  The shrewdest stratagem was to begin cleaning up the premises as he waited for Weirlands to darken. A few scattered lights remained, at 8:28 P.M.