My Brother's Keeper

by Charles Sheffield

  I sweated in the hospital bed, tossing and turning, peering into the past until the night nurse, looking in, gave me an injection to bring the relief of a deeper sleep.

  The next morning I couldn't avoid trying again, the way we tend to pick at a half-healed scab once we realize that it's there. Memories came easier after Leo and I had our first real meeting—which is to say, the first meeting where we were able to understand our relationship to each other.

  It happened when we were nearly twelve. A big medical conference took place in Edinburgh, and one of its key sessions had as a theme the psychology and physiology of identical twins who had been reared apart. Uncle Fred had the brain-wave of his life. At his suggestion, the conference committee arranged for Leo and me to attend together and to submit to a couple of days of tests and questions. All our expenses were covered.

  My inferiority complex probably began with that meeting. Raised in a house with no other children, I had become used to spending time alone and I was shy with strangers. My public recitals somehow didn't count; they were encounters with an anonymous and faceless audience. Leo had the advantage of me. Tom and Ellen Foss already had one child, a girl, before they took Leo, and a year later they had another daughter. Leo grew up in what sounded to me like a rowdy, active household, full of visiting California nymphets who came to see his sisters. At the conference in Edinburgh I met a relaxed, tanned version of myself, already a bit taller and heavier (blame those American meals and vitamins), far more self-confident, and with a developed line of small talk that allowed him to meet and impress any girl he happened to fancy. I watched and imitated, but there was no doubt who was the expert.

  We had a great time in Edinburgh in spite of all that. Even the tests were fun. We came out with the same IQ's, rather differently distributed as to skills.

  Our memories were about equally good, but I knew more English words. Thank crossword puzzles for that—the only Sunday newspaper that Uncle Fred would allow in the house was the Observer, and I cut my teeth on the "Everyman" crossword puzzles.

  In spite of that evidence of wordpower, it was Leo who showed more aptitude for and interest in languages. Concert travels eventually have brought me to the point where I can ask my way to the airport in half a dozen foreign tongues (and sometimes even understand the answers). But Leo was really interested, and by the time he was twenty-five he was fluent in five languages, and had a passing acquaintance with three or four more.

  When the Edinburgh conference was over we had a few hours to ourselves before we had to take the train back to Middlesbrough. There was no need to sit and talk any more—we already knew that we got on better together than anyone else in the world. So we hit the fleshpots. I introduced Leo to skate and chips with salt and vinegar, and then to knickerbockerglories, with five flavors of ice cream, pineapple crush, whipped cream, strawberry sauce, chocolate flakes and grated nuts. He insisted he could eat another one. So did I.

  On the train back to Middlesbrough I was sick out of the window on one side and Leo was sick out of one on the other. Two days later we watched a shuttle lift-off together on the television in Aunt Dora's bedroom. That same afternoon we had our first fight.

  I was trying to bring back some details of that when I fell asleep again, and woke to find Sir Westcott Shaw sitting in his favorite place at the end of the bed.

  He was holding two apples in one paw (did the man live on them?) and nodded amiably to me when he saw my eyes were open.

  "How are you feeling?"

  "Terrible." My ribs were killing me, and so was my right leg.

  "Right. I thought you might be. I dropped your dose of painkillers in half."

  "You're very kind."

  "I thought you ought to be as alert as possible for this session."

  "How's Leo?"

  "If you'll give me a minute, I'll tell you. But first off I want to ask you just a few questions. All right?"

  "Whatever you like." I didn't try and hide my impatience.

  He reached down and picked up a pad from the floor next to his feet, then fished out a stub of pencil from his inside jacket pocket. I looked again at the heavy boots, and the fat, banana-bunch fingers.

  "Are you sure you're a doctor and not a policeman?

  He looked at me sympathetically. "Pain's pretty bad, eh? I'll keep this as short as I can, then we'll give you a jab. I'll start with the easy stuff. What's your name?"

  "It's still Lionel Salkind."

  "Good. You're saying that a sight better than you could this time last week. How old are you?"

  "Thirty-seven—unless you've had me unconscious for a few more months and not told me about it."

  "Not this time. Now, I want you to think for a minute before you answer this one. I know your head hurts like hell, and I know we've bunged you full up with drugs. Try and allow for all that, and tell me, does your head feel normal?"

  I tried. It didn't. My thoughts ran in swooping, random patterns, dipping away from the question and back again. I had to concentrate on every word he said, and for the first time I realized I had been like this ever since I woke up after the accident.

  "No," I said at last. "My head feels funny."

  "I'm not surprised. Do you think you can describe it better—give it something more than saying it feels `funny'?"

  "It reminds me of the way I feel when I speak French or German after a long time without using it. I have to grope around for what I want to say, looking for words. And when you speak to me I have to listen very hard to grasp what you're getting at."

  "Good way of putting it." He scowled down at the page, then stuck the pencil up behind his ear. "One more question, then I'll talk for a while. What can you remember about your accident? Take your time, and tell it in any order you like."

  I had to work hard at answering that. So long as I didn't try to pin events down closely, my memory seemed to be clear about what happened. But when I thought hard, events became confused and wandering. It was like trying to look at a very faint star. So long as you look a little away from it, your sensitive peripheral vision lets you see it. When you turn your attention to it directly, it just winks out of existence.

  He showed no impatience as I went through my mental struggles, but when at last I spoke he leaned forward intently, nodding now and again. He said nothing until I described the two men who had entered the wreck and searched me and Leo for something, then he frowned and shook his head unhappily.

  "That worries me. It sounds like pure hallucination from start to finish, I was hoping we wouldn't run into any of that."

  "It's not hallucination. I remember it clearly, and that's just how it happened."

  He shrugged. "I'm sure that's the way you remember it. The records say otherwise. The first people at the crash were a carload of farmers who saw the helicopter come down from a few fields away. They didn't search you, and they brought you straight here. Just as well that they did. Half an hour later, and we'd have been able to do nothing for you. You had a close call."

  "But I'm telling you, it happened the way I said. We were searched."

  "I don't want to beat that point to death—we can talk about it more later. I promised you some explanations today, and I think you're well enough to take them. But it will take a few minutes. Stop me if this gets to be too much, or if you have trouble following what I'm saying, Otherwise, let me talk."

  He took a manila folder—he had been sitting on it—opened it, and started to read from it in a flat, toneless voice. The beginning was simple and unpleasant enough: my list of injuries when they logged me into the Emergency Room at Queen's Hospital Annex in Reading.

  Lionel Salkind, British subject.

  Crushed right leg below the knee; broken tibia and fibula, compound fracture; broken patella; crushed talus, crushed navicular, broken metatarsals.

  Broken right femur, compound fracture, with severed sartorius muscle. Crushed right testicle and epididymis.

  Fractured eight, ninth, tenth, and elevent
h ribs, penetrating the costal pleura and piercing the right lung.

  Ruptured spleen.

  Damaged right kidney, and severed renal artery.

  If I had been feeling sick when Sir Westcott began his catalog, I grew sicker as he went on with it.

  "Don't just keep reading that," I said to him, when be showed no signs of stopping. "Tell me what you can do about it."

  He waved his hand at me without looking up. "I'm keeping this as short as I can. There's a lot of messy detail for all these that don't help us at all. Let me get to the bad part. Here we are. Head injuries."

  Crushed right middle and inner ear and severed pharyngo-tympanic tube.

  Crushed right mastoid, sphenoid, temporal and occipital bones, with fragment penetration of right frontal, temporal, and parietal brain lobes. Crushed cuneus and precuneus. Right cerebral cortex shows numerous lesions and approximately fifty percent tissue destruction.

  He coughed. "Prognosis: terminal."

  Then he looked at me to see my reaction. I couldn't speak, but the punch line of an old tall story would have been the thing to offer. "So what happened to you then, Bill?" "What happened to me? Why, I died, of course."

  Prognosis: terminal.

  If you want a phrase guaranteed to send you over the edge into lunacy, there's my candidate.

  I gave a sort of hysterical titter. "What are you telling me? That I died and now I'm in Hell?"

  "Nothing so sensational. Let me finish." He pulled another sheet of paper from his folder. "Your brother."

  Leo Foss, United States subject. Broken pelvis.

  Broken lower mandible, broken humerus.

  Damaged and crushed liver, lacerated pancreas, lacerated stomach.

  Shattered spinal column, crushed lumbar, thoracic, and cervical vertebrae, crushed medulla, severed spinal cord in cervical region.

  He looked up at me. "There's more, but it all tells the same story. Prognosis: terminal. For ten different reasons."

  At that point he laid down his folder, pulled an apple out of his pocket, and fished about for his clasp knife. I couldn't believe my eyes. Was he going to settle in and munch one now, leaving Leo and me with our terminal prognoses while he had a mid-afternoon snack?

  "You see," he said—now he was deliberately opening the knife. "I knew I had a problem within five minutes of you being brought into the hospital. I could fix your broken leg, after a fashion. You'd not walk on that ankle, but I'd have taken it off at the knee, anyway. And I could have done a halfway decent job on your ribs and lung, too. You'd have had to manage on one kidney and one ear, but there's plenty of people who do that, an' get along very well with it. Only your very close friends would ever get to know that you only had one testicle, so that didn't worry me, either. You see the problem? It was that smashed skull, and the damaged brain lobes. The right-hand side, in by the ear, that was a mess. It was all bubble-an'-squeak, no good to anybody. I might have been able to keep you alive for a couple of weeks, and that would have been it."

  "It's been a month since the accident, and I'm still alive."

  "Alive, and doing very well. You were in good physical shape before the crash, too, or you'd never be as far along as you are. But my other problem was your brother, Leo. He was in worse shape even than you were. With his spinal injuries and internal bleeding, he was sinking before we could even get him into the theater. I had to make a decision."

  He paused, and suddenly I knew what was coming. It made me feel sick inside.

  "You killed Leo."

  "No." He sighed. "The crash killed Leo. I saved you."

  "Leo is dead. You never told me that." I was trembling.

  "Because it's not true. Shut up, and listen to me." He glowered down at me. "Your brother was a hopeless case, absolutely hopeless. And you were terribly injured. I had to make a decision, but it was an easy one. Save one, or save none."

  I closed my eyes. "So you killed Leo to save me."

  "I did not, you jackass. Will you shut up and listen to me? You know as well as I do that you and Leo were perfect donors for each other. There's no tissue rejection problem with identical twins. And since Madrill's work in '03, the success rate for nerve tissue regeneration has been going up every year. I did the easy work first. You have Leo's right leg, right kidney, right testicle, right inner ear, and a bone graft from his ribs. That was straightforward, and we know it will work. Once the nerve regeneration therapy is complete, you'll have full use of all those. The tricky part came later."

  He took the knife he was holding and cut the apple in his hand cleanly down the middle. "If I were to put the problem in your half-baked terms, you died as much as Leo did."

  "I'm here, and he isn't."

  "Don't be too sure of that. Look, imagine this apple is the whole brain, and now the two halves are the left and right hemispheres. At first, I had the idea that we might be able to put all Leo's brain into your skull—a full transplant. But no one ever made one work yet, and I didn't like the odds. It was easier to be less ambitious. You lost partial segments from three main brain lobes, but you had the brain stem and the midbrain completely intact. This was what your right hemisphere looked like, if we forget the part that was damaged."

  He made a few swift crosscuts with his knife, and segments of apple fell clear into the palm of his hand. He looked at them vaguely for a couple of seconds, then popped them into his mouth and ate them.

  "See?" he said with his mouth full. "You lost a good part of one hemisphere, but what you had left was well-connected. People have survived head injuries in which they lost nearly this much, and had nobody around to give transplant material to them. You'd have died, but not, so to speak, by very much. And if I took parts of Leo's brain, and used them to replace the lobe segments you lost, the chances became very good. I could use undamaged parts of his skull, too, and have that as bone grafts for the smashed parts of your skull. That's what I did."

  He looked pleased with himself. "And it worked—worked damned well. You're getting better all the time."

  "But Leo's dead. I don't feel half like Leo, and half like myself. I'm Lionel Salkind."

  "That's what you tell me—I asked you that when you first became conscious. But all it proves is that you have the verbal part of the brain under control. That's all in your hemisphere, we know that's a left hemisphere function. You feel just the way you ought to, at this stage in the recovery. Do you know what the corpus callosum is?"

  "No. "

  "Well, you will, for the rest of your life." He pushed the two apple segments together, then drew them apart again. "The corpus callosum is the part that sits between the two brain hemispheres. It acts as a sort of a bridge between them, and pons would be the natural Latin name for it, 'cause that means a bridge. But we got smart too late, so another bit of the brain is called the pons. But it's the corpus callosum that's the real bridge, and handles all the information transfer directly between the hemispheres. There's lots of other communication goes on, of course, through a bit called the anterior commissure, but that's mainly indirect and chemical. To make the story short, just now you're missing a corpus callosum between your brain segments and Leo's. But it'll regenerate, thanks to Madrill's treatments."

  "When?"

  "Ah, now there you have me. It could take three months, or it could be a couple of years. Just to complicate things a bit more, the left side of your body is mainly controlled from the right side of your brain. That's why I wanted to know if you were getting any information through that left eye. That'd give us some idea how fast regeneration of nerve tissue is going. Nothing yet?"

  I closed my right eye. "Nothing. Look, are you saying that Leo's sort of alive still? I mean, if you transplanted his kidney into me you wouldn't say he was alive, would you?"

  "I wouldn't; but then not many people think with their kidneys. If you want my honest opinion, yes, I think that Leo Foss is still alive, in some sense, and he's inhabiting part of your skull. At some time—don't ask me when and where,
or even how—I would expect the two halves of the brain to integrate again. You'll become a single individual. And beyond that, I can't go."

  He pressed a button at the end of the bed. "Now, I think you've had all the excitement that's good for you for one day. Miss Thomson will be here in a minute or two and give you an injection. If you don't mind, I'd like to sit here and watch as that takes effect."

  He handed the carved-up apple to the nurse when she appeared and took the second one from his pocket. While she checked my blood pressure, pulse, and temperature (I suspect I tested worse than I had that morning) I looked at Sir Westcott and had terrible visions of those uncouth, pork-butcher hands meddling with the delicate couplings of my brain, cutting and tying and stitching.

  While I watched, Sir Westcott took his open clasp knife and started absentmindedly to peel the apple. He didn't seem to look at it, and the thick fingers were as clumsy-looking as ever. But the apple peel came off magically in one beautiful regular strip, a uniform half inch wide. There was no trace of green peel left on the body of the apple, and no sign of white overcut flesh on the lengthening spiral that came off it.

  By the time the injection took effect, at least one of my worries had been eased.

  - 3 -

  As Mark Hambourg remarked, three things are essential if you want to be a professional musician: the first requirement is good health, and the other two are the same. A performer's life is hard, and there's no way you can tell the critics that you didn't play well because you were feeling less than your best.