by Greg Egan
So why did I feel so bad? Why did the sight of the clear blue sky through the window when I opened my eyes every morning – with the freedom to sleep-in as long as I chose, with my father or mother home all day treating me like royalty, but keeping their distance and letting me sit unnagged at the computer screen for sixteen hours if I wanted – why did that first glimpse of daylight make me want to bury my face in the pillow, clench my teeth and whisper: ‘I should have died. I should have died’?
Nothing gave me the slightest pleasure. Nothing – not my favourite netzines or web sites, not the njari music I’d once revelled in, not the richest, the sweetest, the saltiest junk food that was mine now for the asking. I couldn’t bring myself to read a whole page of any book, I couldn’t write ten lines of code. I couldn’t look my real-world friends in the eye, or face the thought of going online.
Everything I did, everything I imagined, was tainted with an overwhelming sense of dread and shame. The only image I could summon up for comparison was from a documentary about Auschwitz that I’d seen at school. It had opened with a long tracking shot, a newsreel camera advancing relentlessly towards the gates of the camp, and I’d watched that scene with my spirits sinking, already knowing full well what had happened inside. I wasn’t delusional; I didn’t believe for a moment that there was some source of unspeakable evil lurking behind every bright surface around me. But when I woke and saw the sky, I felt the kind of sick foreboding that would only have made sense if I’d been staring at the gates of Auschwitz.
Maybe I was afraid that the tumour would grow back, but not that afraid. The swift victory of the virus in the first round should have counted for much more, and on one level I did think of myself as lucky, and suitably grateful. But I could no more rejoice in my escape, now, than I could have felt suicidally bad at the height of my Leu-enkephalin bliss.
My parents began to worry, and dragged me along to a psychologist for ‘recovery counselling’. The whole idea seemed as tainted as everything else, but I lacked the energy for resistance. Dr Bright and I ‘explored the possibility’ that I was subconsciously choosing to feel miserable because I’d learnt to associate happiness with the risk of death, and I secretly feared that re-creating the tumour’s main symptom could resurrect the thing itself. Part of me scorned this facile explanation, but part of me seized on it, hoping that if I owned up to such subterranean mental gymnastics it would drag the whole process into the light of day, where its flawed logic would become untenable. But the sadness and disgust that everything induced in me – birdsong, the pattern of our bathroom tiles, the smell of toast, the shape of my own hands – only increased.
I wondered if the high levels of Leu-enkephalin from the tumour might have caused my neurons to reduce their population of the corresponding receptors, or if I’d become ‘Leuenkephalin-tolerant’ the way a heroin addict became opiatetolerant, through the production of a natural regulatory molecule that blocked the receptors. When I mentioned these ideas to my father, he insisted that I discuss them with Dr Bright, who feigned intense interest but did nothing to show that he’d taken me seriously. He kept telling my parents that everything I was feeling was a perfectly normal reaction to the trauma I’d been through, and that all I really needed was time, and patience, and understanding.
* * *
I was bundled off to high school at the start of the new year, but when I did nothing but sit and stare at my desk for a week, arrangements were made for me to study online. At home, I did manage to work my way slowly through the curriculum, in the stretches of zombie-like numbness that came between the bouts of sheer, paralysing unhappiness. In the same periods of relative clarity, I kept thinking about the possible causes of my affliction. I searched the biomedical literature and found a study of the effects of high doses of Leu-enkephalin in cats, but it seemed to show that any tolerance would be short-lived.
Then, one afternoon in March – staring at an electron micrograph of a tumour cell infected with herpes virus, when I should have been studying dead explorers – I finally came up with a theory that made sense. The virus needed special proteins to let it dock with the cells it infected, enabling it to stick to them long enough to use other tools to penetrate the cell membrane. But if it had acquired a copy of the Leu-enkephalin gene from the tumour’s own copious RNA transcripts, it might have gained the ability to cling, not just to replicating tumour cells, but to every neuron in my brain with a Leu-enkephalin receptor.
And then the cytotoxic drug, activated only in infected cells, would have come along and killed them all.
Deprived of any input, the pathways those dead neurons normally stimulated were withering away. Every part of my brain able to feel pleasure was dying. And though at times I could, still, simply feel nothing, mood was a shifting balance of forces. With nothing to counteract it, the slightest flicker of depression could now win every tug-of-war, unopposed.
I didn’t say a word to my parents; I couldn’t bear to tell them that the battle they’d fought to give me the best possible chance of survival might now be crippling me. I tried to contact the oncologist who’d treated me on the Gold Coast, but my phone calls floundered in a Muzak-filled moat of automated screening, and my e-mail was ignored. I managed to see Dr Ash alone, and she listened politely to my theory, but she declined to refer me to a neurologist when my only symptoms were psychological: blood and urine tests showed none of the standard markers for clinical depression.
The windows of clarity grew shorter. I found myself spending more and more of each day in bed, staring out across the darkened room. My despair was so monotonous, and so utterly disconnected from anything real, that to some degree it was blunted by its own absurdity: no one I loved had just been slaughtered, the cancer had almost certainly been defeated, and I could still grasp the difference between what I was feeling and the unarguable logic of real grief, or real fear.
But I had no way of casting off the gloom and feeling what I wanted to feel. My only freedom came down to a choice between hunting for reasons to justify my sadness – deluding myself that it was my own, perfectly natural response to some contrived litany of misfortunes – or disowning it as something alien, imposed from without, trapping me inside an emotional shell as useless and unresponsive as a paralysed body.
My father never accused me of weakness and ingratitude; he just silently withdrew from my life. My mother kept trying to get through to me, to comfort or provoke me, but it reached the point where I could barely squeeze her hand in reply. I wasn’t literally paralysed or blind, speechless or feeble-minded. But all the brightly lit worlds I’d once inhabited – physical and virtual, real and imaginary, intellectual and emotional – had become invisible, and impenetrable. Buried in fog. Buried in shit. Buried in ashes.
By the time I was admitted to a neurological ward, the dead regions of my brain were clearly visible on an MRI scan. But it was unlikely that anything could have halted the process even if it had been diagnosed sooner.
And it was certain that no one had the power to reach into my skull and restore the machinery of happiness.
2
The alarm woke me at ten, but it took me another three hours to summon up the energy to move. I threw off the sheet and sat on the side of the bed, muttering half-hearted obscenities, trying to get past the inescapable conclusion that I shouldn’t have bothered. Whatever pinnacles of achievement I scaled today (managing not only to go shopping, but to buy something other than a frozen meal), and whatever monumental good fortune befell me (the insurance company depositing my allowance before the rent was due), I’d wake up tomorrow feeling exactly the same.
Nothing helps, nothing changes. Four words said it all. But I’d accepted that long ago; there was nothing left to be disappointed about. And I had no reason to sit here lamenting the bleeding obvious for the thousandth time.
Right?
Fuck it. Just keep moving.
I swallowed my ‘morning’ medication, the six capsules I’d put out on the bedsi
de table the night before, then went into the bathroom and urinated a bright-yellow stream consisting mainly of the last dose’s metabolites. No antidepressant in the world could send me to Prozac Heaven, but this shit kept my dopamine and serotonin levels high enough to rescue me from total catatonia – from liquid food, bedpans and sponge baths.
I splashed water onto my face, trying to think of an excuse to leave the flat when the freezer was still half full. Staying in all day, unwashed and unshaven, did make me feel worse: slimy and lethargic, like some pale parasitic leech. But it could still take a week or more for the pressure of disgust to grow strong enough to move me.
I stared into the mirror. Lack of appetite more than made up for lack of exercise – I was as immune to carbohydrate comfort as I was to runner’s high – and I could count my ribs beneath the loose skin of my chest. I was thirty years old, and I looked like a wasted old man. I pressed my forehead against the cool glass, obeying some vestigial instinct which suggested that there might be a scrap of pleasure to be extracted from the sensation. There wasn’t.
In the kitchen, I saw the light on the phone: there was a message waiting. I walked back into the bathroom and sat on the floor, trying to convince myself that it didn’t have to be bad news. No one had to be dead. And my parents couldn’t break up twice.
I approached the phone and waved the display on. There was a thumbnail image of a severe-looking middle-aged woman, no one I recognised. The sender’s name was Dr Z. Durrani, Department of Biomedical Engineering, University of Cape Town. The subject line read: ‘New Techniques in Prosthetic Reconstructive Neuroplasty’. That made a change; most people skimmed the reports on my clinical condition so carelessly that they assumed I was mildly retarded. I felt a refreshing absence of disgust, the closest I could come to respect, for Dr Durrani. But no amount of diligence on her part could save the cure itself from being a mirage.
Health Palace’s no-fault settlement provided me with a living allowance equal to the minimum wage, plus reimbursement of approved medical costs; I had no astronomical lump sum to spend as I saw fit. However, any treatment likely to render me financially self-sufficient could be paid for in full, at the discretion of the insurance company. The value of such a cure to Global Assurance – the total remaining cost of supporting me until death – was constantly falling, but then so was medical research funding, worldwide. Word of my case had got around.
Most of the treatments I’d been offered so far had involved novel pharmaceuticals. Drugs had freed me from institutional care, but expecting them to turn me into a happy little wage-earner was like hoping for an ointment that made amputated limbs grow back. From Global Assurance’s perspective, though, shelling out for anything more sophisticated meant gambling with a much greater sum – a prospect that no doubt sent my case manager scrambling for his actuarial database. There was no point indulging in rash expenditure decisions when there was still a good chance that I’d suicide in my forties. Cheap fixes were always worth a try, even if they were long shots, but any proposal radical enough to stand a real chance of working was guaranteed to fail the risk/cost analysis.
I knelt by the screen with my head in my hands. I could erase the message unseen, sparing myself the frustration of knowing exactly what I’d be missing out on … but then, not knowing would be just as bad. I tapped the Play button and looked away; meeting the gaze of even a recorded face gave me a feeling of intense shame. I understood why: the neural circuitry needed to register positive non-verbal messages was long gone, but the pathways that warned of responses like rejection and hostility had not merely remained intact, they’d grown skewed and hypersensitive enough to fill the void with a strong negative signal, whatever the reality.
I listened as carefully as I could while Dr Durrani explained her work with stroke patients. Tissue-cultured neural grafts were the current standard treatment, but she’d been injecting an elaborately tailored polymer foam into the damaged region instead. The foam released growth factors that attracted axons and dendrites from surrounding neurons, and the polymer itself was designed to function as a network of electrochemical switches. Via microprocessors scattered throughout the foam, the initially amorphous network was programmed first to reproduce generically the actions of the lost neurons, then fine-tuned for compatibility with the individual recipient.
Dr Durrani listed her triumphs: sight restored, speech restored, movement, continence, musical ability. My own deficit – measured in neurons lost, or synapses, or raw cubic centimetres – lay beyond the range of all the chasms she’d bridged to date. But that only made it more of a challenge.
I waited almost stoically for the one small catch, in six or seven figures. The voice from the screen said, ‘If you can meet your own travel expenses and the cost of a three-week hospital stay, my research grant will cover the treatment itself.’
I replayed these words a dozen times, trying to find a less favourable interpretation – one task I was usually good at. When I failed, I steeled myself and e-mailed Durrani’s assistant in Cape Town, asking for clarification.
There was no misunderstanding. For the cost of a year’s supply of the drugs that barely kept me conscious, I was being offered a chance to be whole again for the rest of my life.
* * *
Organising a trip to South Africa was completely beyond me, but once Global Assurance recognised the opportunity it was facing, machinery on two continents swung into action on my behalf. All I had to do was fight down the urge to call everything off. The thought of being hospitalised, of being powerless again, was disturbing enough, but contemplating the potential of the neural prosthesis itself was like staring down the calendar at a secular Judgement Day. On 7 March 2023, I’d either be admitted into an infinitely larger, infinitely richer, infinitely better world … or I’d prove to be damaged beyond repair. And in a way, even the final death of hope was a far less terrifying prospect than the alternative; it was so much closer to where I was already, so much easier to imagine. The only vision of happiness I could summon up was myself as a child, running joyfully, dissolving into sunlight – which was all very sweet and evocative, but a little short on practical details. If I’d wanted to be a sunbeam, I could have cut my wrists anytime. I wanted a job, I wanted a family, I wanted ordinary love and modest ambitions, because I knew these were the things I’d been denied. But I could no more imagine what it would be like, finally, to attain them than I could picture daily life in twenty-six dimensional space.
I didn’t sleep at all before the dawn flight out of Sydney. I was escorted to the airport by a psychiatric nurse, but spared the indignity of a minder sitting beside me all the way to Cape Town. I spent my waking moments on the flight fighting paranoia, resisting the temptation to invent reasons for all the sadness and anxiety coursing through my skull. No one on the plane was staring at me disdainfully. The Durrani technique was not going to turn out to be a hoax. I succeeded in crushing these ‘explanatory’ delusions … but, as ever, it remained beyond my power to alter my feelings, or even to draw a clear line between my purely pathological unhappiness and the perfectly reasonable anxiety that anyone would feel on the verge of radical brain surgery.
Wouldn’t it be bliss, not to have to fight to tell the difference all the time? Forget happiness; even a future full of abject misery would be a triumph, so long as I knew that it was always for a reason.
* * *
Luke De Vries, one of Durrani’s postdoctoral students, met me at the airport. He looked about twenty-five, and radiated the kind of self-assurance I had to struggle not to misread as contempt. I felt trapped and helpless immediately: he’d arranged everything; it was like stepping on to a conveyor belt. But I knew that if I’d been left to do anything for myself the whole process would have ground to a halt.
It was after midnight when we reached the hospital in the suburbs of Cape Town. Crossing the car park, the insect sounds were wrong, the air smelt indefinably alien, the constellations looked like clever forgeries. I sagge
d to my knees as we approached the entrance.
‘Hey!’ De Vries stopped and helped me up. I was shaking with fear, and then shame too, at the spectacle I was making of myself.
‘This violates my Avoidance Therapy.’
‘Avoidance Therapy?’
‘Avoid hospitals at all costs.’
De Vries laughed, though if he wasn’t merely humouring me I had no way of telling. Recognising the fact that you’d elicited genuine laughter was a pleasure, so those pathways were all dead.
He said, ‘We had to carry the last subject in on a stretcher. She left about as steady on her feet as you are.’
‘That’s bad?’
‘Her artificial hip was playing up. Not our fault.’
We walked up the steps and into the brightly lit foyer.
* * *
The next morning – Monday, 6 March, the day before the operation – I met most of the surgical team who’d perform the first, purely mechanical, part of the procedure: scraping clean the useless cavities left behind by dead neurons, prising open with tiny balloons any voids that had been squeezed shut, and then pumping the whole oddly shaped totality full of Durrani’s foam. Apart from the existing hole in my skull from the shunt eighteen years before, they’d probably have to drill two more.
A nurse shaved my head and glued five reference markers to the exposed skin, then I spent the afternoon being scanned. The final, three-dimensional image of all the dead space in my brain looked like a spelunker’s map, a sequence of linked caves complete with rockfalls and collapsed tunnels.
Durrani herself came to see me that evening. ‘While you’re still under anaesthetic,’ she explained, ‘the foam will harden, and the first connections will be made with the surrounding tissue. Then the microprocessors will instruct the polymer to form the network we’ve chosen to serve as a starting point.’