by C. P. Snow
Sedgwick’s right arm moved up from his lap, hand shaking a few degrees in the first instants, then violently, not with slow weaving purposelessness like an amoeba’s tentacles, or an infant’s hand, but more as though it were gesturing in autonomous rage. It made darts at Pemberton’s hand, missed, went sideways, missed again. In the effort, Sedgwick’s fine serene forehead had become lined. There was sweat, maybe of embarrassment, at his temples.
‘That’s a pretty fair amount of tremor,’ said Pemberton as the arm dropped back. He hadn’t, as a layman would have, found the sight grotesque.
‘I’ve noticed that myself,’ said Sedgwick.
‘You ought to have had the operation before.’
‘That seems to be the general view,’ said Sedgwick.
‘Well,’ said Pemberton. ‘Now the left hand. Try to touch me.’
Just then Sedgwick’s poise was shaken.
‘No, that one’s all right.’
‘Never mind. I want to see.’
Sedgwick had a strained bright look which the other was inured to in men shrinking from a clinical test. Reluctantly the arm came up. Compared with the other, it was steady. It met Pemberton’s hand. Soon it touched fingertip to fingertip. There was perhaps as much shiver visible as in a moderately heavy drinker’s after a thick night.
Pemberton felt the fingers, bent the arm at the wrist. After he released it, he sat quiet for a moment, big face expressionless. Then he said: ‘Well. I’m not an expert, of course. But I’d guess that the operation on the right side ought to give you most of what you need. All being well, you’ll be able to walk decently, and you’ll have your working hand.’
‘That would be a distinct improvement,’ said Sedgwick, composed again.
‘That’s enough to be going on with. But I don’t know what your man has told you, but I’d also guess you’ll have to think of an operation on the other side in finite time.’
It was clear that Sedgwick had heard that before: and that was what he hadn’t wished to hear again. Pemberton administered his own kind of encouragement.
‘Anyway, you can cross that bridge when you come to it.’
‘I’m rather inclined to think the same myself.’
‘You’ll find out next week what the operation is like. It’s nothing very formidable. But it’s rather unusual. I suppose they’ve told you something about it.’
Some would have been fretted, or made more nervous, by Pemberton’s unembellished or unrelenting treatment. Sedgwick wasn’t. Perhaps it removed a veil of personalities.
He replied: ‘I’ve been doing a little research on my own. I’ve been through Cooper’s book.’ With his left hand, he indicated a volume on the chest of drawers. ‘Involuntary Movement Disorders. Extremely interesting, I might find it even more interesting if I didn’t happen to be somewhat concerned. In a passive sense.’
‘Do you know the man Cooper?’
‘Yes. Very impressive. I’ve always thought, he ought to have been an Englishman.’ (That could have seemed a singular remark to Sedgwick’s international colleagues, from that international un-chauvinistic dignitary. It sounded like the English soldiers talking about Joan of Arc.)
‘Why didn’t you get him to do the operation?’
‘Why?’ Suddenly that innocent question touched a nerve, where clinical probing hadn’t. ‘Isn’t Tompkin good? Is there anything wrong with him?’
Still unemollient, Pemberton thought it was time to give some reassurance. The operation was standard since the American perfected it: it was being done all over the world: Tompkin was first class, he had learned the technique at source: he was as good as anyone this side of the Atlantic. Pemberton had himself talked to him.
‘So have I, of course.’
‘What did you think?’
‘He went through the correct procedure, I take it. He produced the necessary warnings. He didn’t commit himself too much.’
‘Don’t you understand,’ said Pemberton, in his most overpowering style, ‘that he’s under great strain? Just as much as you are, perhaps more.’
‘Do you expect me to find that remarkably invigorating?’
‘For two reasons,’ Pemberton went on undisturbed. ‘In this operation, you’re having to be fully conscious all the time, I expect you know–’
‘Of course I know.’
‘That’s a strain on both of you. And he’s a young man and you’re a very distinguished old one. He’ll have to ask you questions right through the performance. It’s a hell of a responsibility for a man of thirty.’
‘No doubt,’ said Sedgwick, ‘I shall be able to take a technical interest in the process. After all, I’ve done some experiments in my time, myself.’
Pemberton let out an uningratiating laugh.
‘No one would like performing on someone like you. Because you’re what you are. And that takes in the other reason why he’s under strain. Imagine that something went badly wrong. Say the worst chance happened. If you were taken out of this place feet first, it wouldn’t do him any good, would it? After all, finishing you off wouldn’t pass completely unnoticed.’
‘I’m not sure that I find that remarkably invigorating either.’
‘That won’t happen. The chances are a hundred to one against, you must have gone into the statistics.’
Sedgwick had, which made the hectoring, sarcasm, antiphon get sharper. But Pemberton wore the other down.
‘Then you know the chances of coming out more incapacitated than you came in – they are about fifty to one against. We take that sort of odds plenty of times in our lives. It’s rather better than the chances against being seriously damaged if you drive a car for twenty years. That doesn’t prevent me getting my car out in the Fulham Road.’
‘Statistics are rather more convincing when they apply to other people. You are too young to remember some old mathematician saying that in an air raid he took refuge under the arch of probability. He may have done, but I confess I never could.’
‘The operation will be all right. I’m not worrying about it for a minute–’
‘Now that ought to be very invigorating.’ The sarcasm wasn’t unfriendly.
Pemberton continued: ‘The operation will be all right.’ He wanted to call the older man Adam, but at the last instant his toughness unaccountably failed him. Also unaccountably, what he had said about not worrying was not true. Reason was letting him down, as well as toughness. Still, he could fall back on his doctor’s drill.
‘It will be all right, I tell you.’
Drill was a help. He asked Sedgwick about his general health. Good for a man of his age. They’ve done all the routine tests, of course? Blood pressure? On the low side. Weight? A hundred and fifty pounds.
‘You’ll live more years than I shall.’ (Pemberton weighed nearly half as much again, though he carried no fat.) ‘Large men don’t last. Statistically, that is.’
He said: ‘You’ll sail through that operation, I’m telling you. By the way, I’d better tell you also that I shall be there.’
‘Where do you mean, you’ll be?’
‘There. In the operating room. It’s all in order. I have Tompkin’s permission. I’ve never seen one of these operations. I should like to. I might be able to take some notes for him. Or be another pair of hands with the X-ray plates.’
Sedgwick said: ‘This is rather unusual, isn’t it?’
‘Oh, it’s often done.’ (Pemberton didn’t reveal that he had insinuated himself by pulling rank, that is by using his title.)
‘I said I had Tompkin’s permission. But I haven’t asked yours. I’d better do so, now hadn’t I?’
Sedgwick looked unforthcoming, stern, but slowly his expression changed from the austere into a curiously urchin-like smile: ‘I have an idea that you’d be there whatever I said, wouldn’t you? And I shouldn’t be in a very strong position to resist, I take it.’
The conversation didn’t end there. Pemberton had come with a dual purpose. One discharged, now
he wanted something for himself. He wanted advice, he told Sedgwick. He had always hoped to do medical research, he said, not just ordinary practice. What were the prospects? He duly got advice: and, though it was polite, it was as acerb, as candid, as that which he had been bestowing himself. The prospects were negligible, said Sedgwick. No money? That wasn’t the prime difficulty. The trouble was his age. How old was he? Forty-seven. Too old to do anything first-rate, or even decent second-rate. Possibly, if he had started at the right age, he might have done good work. Too late now. Perhaps he could manage some clinical observations. Nothing of first-class interest would emerge, except by sheer blind luck. It might be better than nothing.
Pemberton knew when he was hearing the truth. With his obstinacy and persistence, he would try to hack out a way somehow, but he would need an adviser with lower standards than Sedgwick’s. Before he left that room, Pemberton said that he would raise the topic, later the following week, as soon as Sedgwick was fit after the operation. That was another bit of his doctor’s drill, implying that the future was safe. It was intended to pacify Sedgwick. It was also intended to pacify Pemberton himself.
To his own puzzlement, he was not objective about this piece of surgery. Not that he preserved any hope, or really had ever had any, that Sedgwick would help his old scientific ambitions (it would have enraged Pemberton to know that, to the other, they had a touch of pathos). If that had been true, it would have been a good, sound, selfish, egotistic reason for being concerned about Sedgwick’s condition. Pemberton would have understood himself for that, and have approved. But he had no such reason, and was still concerned. He respected Sedgwick. Surely that wasn’t enough? After all, he was an old man, all he had done in science was already done. His effective life was over. In the nature of things, his physical life couldn’t last very long. Pemberton had no use for people who got maudlin about mortality. Pemberton didn’t like symptoms of maudlin sentiment in himself. Yet he was still concerned.
Eight forty-five a.m. on Tuesday, 2 January, 1973. Sedgwick’s head, shaved and polished, shone under the spotlights in the operating room. Miniature pointed clamps, also shining out under the lights, gleamed at the sides of the head, held it immobile, so that he looked only upwards, at the X-ray box in the ceiling. He was as helpless as a sentient being could be.
It was a fine head, if anyone in the room had been disengaged enough to study it. He had always worn his thick grey hair, with its casual quiff, as carelessly as an undergraduate of the twenties. That had concealed the vault, not specially large, smooth-curved, which now pointed behind him towards Tompkin. Tompkin had just taken up his place after another ritual washing of his hands and arms, between a nurse on his right, an assistant surgeon on his left.
On the table, Sedgwick was covered up to the neck by green blankets. The room was large, immaculately tiled underfoot, packed with apparatus. No one present needed instruction in what the apparatus was: Tompkin had learned the technical lessons from his master, this had become standard form. Gleaming console, dials set and clear against the unyielding white, controlling the flow of liquid nitrogen: X-ray beamers, one in the ceiling, the other in the walls aligned at right angles to the patient’s head. It could have been a scientific laboratory, with one function, all purposes or intakes analysed away, except the single one. It could also have been a torture chamber, to which the same definition would apply.
As usual with any functional process, technological, official, there were more people in the room than an outsider expected. That was true of legal conferences at David March’s, or Cabinet committees, or police investigations: there were always people, more or less anonymous, whom no one counted. It was true that morning. They were all dressed in long coats, caps, mouth-and-chin masks, slacks, all in uniform green, the same colour as the blankets which covered the patient – rather like a football team parading in their track suits. There was the chief surgeon himself, his assistant, an X-ray technician, another technician in charge of the liquid nitrogen apparatus, an operating nurse, another nurse at general disposal, an anaesthetist (as an insurance, not for use). There was also Dr Pemberton.
On one wall stood a bold notice: SILENCE PLEASE THE PATIENT IS AWAKE. In fact, no one but Tompkin and the patient had spoken for the last quarter of an hour. Underneath the caps and masks, the faces round the table were barely identifiable, but Pemberton’s massive shape took more disguising.
Sedgwick had said: ‘So you have come, have you? Good morning.’
Tompkin had heard that, knew that Sedgwick was trying to sound detached, and immediately tried to sound detached himself, explaining to Sedgwick another detail of the operation, as though the two of them were surveying an interesting piece of experimentation. Tompkin was an impressionable and sensitive man: at least he was certainly impressionable, and wished to be sensitive. He had learned more from his master than the surgical techniques, and would have liked to feel as deeply.
Of course he was tense before the operation. He had a touch of what cricketers called the needle. They said you couldn’t be a first-class performer without it. He could understand one of the Cooper lessons: after hundreds of these operations, one knew at last when the anxiety and responsibility would have evanesced and the profession taken over: and the answer was never.
That was certain, for a man like himself. But perhaps he was cooler than he thought. Certainly he tried to appear cool up to the limit, that was right, that was the professional imperative. But perhaps that came easier than he imagined, and some of the lessons not so easy. He had to remember that this man, helpless, an object on the table, was knowing the meaning of loneliness: ultimate loneliness, not too far from the loneliness of dying. You could remember that only if you had a depth of feeling. He had to remember something not so desolating but much uglier, more a kind of moral impotence in all of us. Human sympathy cuts off sharp, he had been taught. Our instinct for superiority is so harsh that we don’t admit it: but the living feel superior to the dead, the well feel superior to the ill. Just walk with your nerves alive through a hospital. If this had been a torture chamber instead of an operating room, the torturer would be feeling superior to his victim: morally superior, which helps men to commit horrors. The surgeon feels superior to the object on the table. That has to be transcended, Tompkin had been taught, if we are going to stay human at all.
It was a difficult, alien lesson for a young man like Tompkin. Humility didn’t come naturally to him, though duty did. He had been making an attempt, punctilious or comic according to taste, to find a way to cope. For this operation in particular, he had for days past been thinking of the formalities. Sedgwick was an eminent man, and he himself wasn’t: he must preserve the right deference when he talked to Sedgwick on the operating table. What was the best form? ‘Lord Sedgwick’ would be unwieldy: ‘Sir’ might do: no, he recalled that in his own undergraduate days at Cambridge, Sedgwick, at the height of his fame, just awarded the Nobel, had a Royal Society Professorship and, in the English fashion, was always called Professor. That would put them both at the right distance.
So at nine a.m. precisely by the operating room clock, Tompkin said, in a light-toned but clearly articulated voice: ‘Professor, I am just going to begin.’
Tompkin was concentrating on the operation, and on nothing else. Dr Pemberton, standing on Sedgwick’s left side, would have assumed, and approved of, that. To him, there were no moral concerns. There was a job to be done. A good deal less prepotent or assertive than usual, he was eager to see it through. He had one small regret, that he hadn’t found a piece of work to help with. It wouldn’t have mattered how mechanical it was.
‘Professor, I’m ready with the local anaesthetic. You’ll feel a prick, not much more.’
In a moment, Tompkin added:
‘That’s all you’ll feel. The brain is insensitive to pain.’
‘I know that.’ Sedgwick’s reply struck strong and terse.
Pemberton was engrossed in the mechanics of the operation,
and wished to follow them, step by step, but from where he stood, the first he could not see. Tompkin was making an incision on the left side of the scalp. Pemberton watched the nurse, practised, on her cue, handing him a small and shiny object. Must be to keep the cut open. Now the surgeon – it was all concealed from Pemberton – was looking at the bone beneath the scalp: ‘We’re going to drill a hole,’ he said. ‘Very little. It’ll only take a few seconds. It makes a bit of a noise.’
Sedgwick had learned the procedure off by heart. His voice came up: ‘I must say, this is getting rather near the bone.’
Sedgwick, who had thought about gallows jokes after his visit to Hillmorton’s bedside, was vain about that one. Had it been prepared? No one there knew, or attended, or perhaps even listened. The whirr of the drill took over. Silence.
‘Good,’ said Tompkin.
Nine fourteen a.m. The hands of Tompkin and the nurse were moving steadily, and nothing else. No sound. Pemberton was recalling the anatomy of the outer brain. Hook in Tompkin’s left hand; then a scalpel in his right. Nerveless movements of the hand. Must be through the cortex surface. Tweezers. More work with the scalpel.
‘All right,’ said Tompkin. ‘How are you, Professor?’
‘Still here.’
Nine nineteen a.m. Pemberton understood the next stage. As a mechanically-minded man, he got fascination from it. A rubber tube was being inserted through the puncture on the brain surface, fluid withdrawn, replaced by air. Air formed a shadow when they took X-rays, and that would give Tompkin his map inside the brain.
Meanwhile the other surgeon attached an instrument to the head of the table. To Pemberton this was a beautiful device, working in three dimensions, driving the probe to the target. The cannula probe, more shining metal, was already in place, aiming, waiting. Now they were all waiting.
Tompkin said:‘This is where we have to stop for the X-rays. The remaining X-rays will be quick. This takes a few minutes.’