‘So, I have the images from your MRI here.’ He pulled up a file that contained numerous black and white pictures of Lucy’s tumour, shot from many angles. He scrolled through them for a while, seeming to be so fascinated by the penetrative power of the technology that he forgot that there were other people in the room. On every image, a large white blob appeared at the top of the skull. McEwan eventually turned his chair away from the screen to face Lucy, like someone looking up from an engrossing novel to deal with a practical enquiry.
‘What I ask myself when I look at you is why you look so healthy and why you’re in such great shape? Why are your physical symptoms not more severe?’
‘I don’t know what to say,’ said Lucy. ‘You seem to be giving me a compliment and a death sentence in one blow: how can I seem so well considering how unwell I really am. Is that it?’
‘The border is very well defined,’ said McEwan. ‘If it were a glioblastoma, it would probably have bled out more into the rest of the brain and produced much more severe symptoms by now, but there is no way of knowing unless we do a biopsy. Also, you see the vascularisation here at the centre?’ He pointed with his pen towards what looked like two tiny clouds that were more brightly lit up than the rest of the tumour. ‘That makes me worry that it could be higher grade.’
‘So, what would the biopsy entail?’ asked Olivia, who could see that Lucy was close to tears and unable to speak.
‘We would drill a small hole in your skull and go in with a computer-guided needle to take a sample of the tissue that we can then analyse.’
‘Can I stay awake during the procedure?’ asked Lucy. ‘I’m terrified of not waking up, so I would rather not go under.’
‘Yes, you could,’ said Mr McEwan. ‘We frequently perform awake surgeries, but this is not a risk-free procedure and you should think very carefully before going ahead. The risk of death is less than one per cent, but there is also a chance of bleeding on the brain and having a stroke. That could leave you paralysed on the right side of your body. It’s not very common but it does happen.’
‘Jesus,’ said Lucy.
‘Also, these are not very detailed images,’ McEwan went on. ‘All we can see is that you have a lesion in the left frontoparietal area in the paracentral lobule. We need to do a functional MRI to understand what neural tissues surround or are inside the tumour. Hopefully, we won’t have to go through any key functional areas in order to get a sample, but there is a risk of damaging healthy tissue, which would leave you with certain impairments, depending on our approach.’
‘I see,’ said Lucy, closing her eyes.
‘Is there a case for just monitoring the tumour?’ asked Olivia.
‘That’s possible,’ said McEwan, ‘but I must emphasise that if this is a high-grade tumour, you will want to know as soon as possible so you can begin treatment to extend Lucy’s life expectancy.’
‘My life expectancy,’ said Lucy faintly.
‘After the fMRI, I am going to present your case to my colleagues. There’s a weekly meeting where sixty of our most senior doctors and researchers at Queen Square get together and discuss all new cases. I suspect they will all recommend the biopsy route since, without it, there is really no further treatment we can offer you.’
‘Well, I guess I don’t have much of a choice then.’
‘You should feel no pressure. This is entirely your decision.’
‘Assuming I want to proceed, what are the next steps?’
‘My assistant would book you in for an fMRI next week. And I might also send you for a cognitive evaluation with one of my colleagues in the Neurology Department. So, we are looking at a surgery date within the next two weeks or so.’
‘Okay, let’s do it,’ said Lucy, standing up. ‘Thank you for squeezing us in,’ she added, shaking Mr McEwan’s hand.
7
Hunter was frazzled, even by his own prodigious standards. He had stopped over in New York and reconvened with Saul before the two of them set out independently, Hunter to England to see what initiatives Lucy had come up with, and Saul to Paris to check out a Frenchman who claimed to have created a ceramic armour that was cheaper and more effective than those being developed by DARPA in the US or by the various Ministries of Defence around the rest of Europe. Before the two men could converge on Italy to explore further projects, Saul had dashed up to Edinburgh to meet John MacDonald, one of the world’s leading experts on inorganic life.
Hunter’s apartment was on the top two floors of a sudden, isolated skyscraper that had been driven, like a spike through the heart of Manhattan, well below the tall buildings of the Upper East Side and well above the tall buildings of the financial district. When Saul arrived, he had made some suggestive remarks about feeling tired out by his journey from California and his many meetings around town, expecting the usual line or two of coke, but instead Hunter asked him if he’d ever tried freebasing, snapping open a red leather briefcase, which turned out to contain two glass pipes and a small blowtorch embedded in red velvet moulds.
‘Wow!’ said Saul. ‘I’m not sure I’m ready to go down that road. Isn’t that like the most addictive thing in the world?’
‘The most addictive thing in the world is power,’ said Hunter, ‘if you have it, freebasing is just kidding around; without it, you can get addicted to stale doughnuts or rubber underwear.’
‘Or freebasing,’ Saul insisted.
‘Sure,’ said Hunter. ‘But when we finish with the pipe later tonight, I might go for a couple of months without even glancing in this direction again, because we’re brainstorming here, Saul.’
‘You’re the expert,’ said Saul, disinclined to argue openly with his overwhelming host. ‘Although Richard Feynman said that science is belief in the ignorance of experts,’ he couldn’t help adding.
‘That would make Donald Trump the world’s greatest scientist,’ said Hunter.
‘I guess he was thinking of people who have pushed existing knowledge to some kind of limit,’ said Saul, ‘rather than the ones who have turned their backs on it.’
Hunter loaded the pipe with a little pellet of paste.
‘Okay, okay, I’m sold,’ said Saul.
Although he had only taken the most tentative sip of the smoke lingering in the stem of his glass pipe, Saul felt remarkably reinvigorated and eager to tie together the many strands of conversation that he and Hunter had initiated since forming their alliance a year ago. Fatigue was a delusion he could hardly believe he had been taken in by, now that everything seemed to be edged with vibrant light. Hunter, who had taken a more voracious approach to his pipe, was staring fixedly ahead, perhaps at Francis Bacon’s smear of warped human anguish hanging above the black marble fireplace, or perhaps into the infinite space of an unfocused gaze, Saul couldn’t tell, but he was determined to take advantage of the wave of lucidity that was breaking over him.
‘I guess the thing I’ve been trying to get across to you over the last year is that if science offered a unified vision of the world, it would be a pyramid, with consciousness at the apex, arising explicably from biology, and life arising smoothly from chemistry, and the Periodic Table, in all its variety, emerging inevitably from the fundamental forces and structures described by physics; but in reality, even physics isn’t unified, let alone unified with the rest of science. It’s not a pyramid; it’s an archipelago – scattered islands of knowledge, with bridges running between some of them, but with others relatively isolated from the rest.’
Hunter let out a long trail of thin smoke.
‘We should be backing the bridge-builders,’ Saul continued, ‘people like Enrico, who is organising the scan of the Blessed Fra Domenico in Assisi, so we can nail the Catholic market with our Capo Santo helmet—’
‘The guy I want to back is the guy who builds the fucking pyramid,’ Hunter interrupted.
‘What I’m telling you is that that’s not going to happen,’ said Saul, ‘some things are just not reducible to each other or built on
each other. Nothing they discover at CERN is going to shed light on E. O. Wilson’s seminal account of life in an ant colony, let alone the other way around.’
Hunter gave Saul another pipe and lit it for him.
‘Hold it in,’ said Hunter.
Saul really sucked the smoke into his lungs until he couldn’t fill them any more. The tingling sensation that ran down the sides of his body from the crown of his head, like an overflowing fountain of electricity, was the prelude to a sense of gargantuan well-being and authority. He sank back in his armchair, exhaled and closed his eyes. He was now in territory he had never visited before. His mind was a far more powerful instrument than he had ever dared to imagine. It was like a great Alaskan river after a spring melt, but instead of flowing with churning brown water, this river flowed with mercury, the brilliant mirror of its surroundings reflecting the sky and the trees and the clouds, but also endowed with a penetrating intelligence that knew them for what they were. A few droplets scattered like scouts on to the banks of the quicksilver river could decipher the atomic structure of the rocks on which they landed and, joining together again, trickle their knowledge back into the imperious flood. If he could just get the world’s fifty top scientists and make them feel what he was feeling now, they could join into a single super-mind, they could build the pyramid, they could make all of human knowledge spring out of the desert in a perfect, monumental geometry.
‘Pyramid,’ he whispered.
Hunter clasped his hand and hoisted him out of the chair.
‘What did you say?’ he asked.
‘We can build the pyramid,’ said Saul, unclicking his eyelids and looking fervently into Hunter’s dilated pupils.
‘Yes!’ said Hunter, raising his free arm and bending it with a clenched fist, like a boy inviting admiration for his biceps. ‘Yes, we can!’
Things had gone downhill from there. They had stayed up all night, which had not been part of the plan, and although Hunter had been given an extremely high-dose vitamin C and mineral drip, a vitamin B shot, enough antioxidants to annihilate all the free radicals in New York City, and had managed to pass out during a four-hour session with Ocean, his favourite New York masseuse, he still felt like shit when he got on the plane. He ensured a heavy night’s sleep on the journey, but it was too short and as they approached Farnborough he popped an orange Adderall, the strong one, so he could be resolute and attentive at all those meetings Lucy had set up with a succession of supposedly brilliant scientists.
* * *
Lucy sat in the back of Hunter’s Maybach, behind the driver, naturally, where the leg room was ample but not the length of a child’s bed as it was on Hunter’s side, with the passenger seat moved fully forward. She had a pint of latte in a cup holder couched in the diamond-patterned white leather of the armrest next to her and an ignored file on her lap, page after page of bullet points. Bullet points and soundbites were made for a man like Hunter, whose combination of aggression and inattention needed bites and bullets to keep him focused. She had intended to revise these pages so as to be emphatically on top of everything, but since yesterday everything had been emphatically on top of her, even though the Xanax gave her a little shelter from the catastrophe, like one of those fragile enclaves in a collapsed building, where an earthquake survivor waits for rescue in the dust and the dark.
After leaving Queen Square the previous morning, Francis had apologised and said that he had to return to Sussex for work, but that he would see her soon. He gave her a heartfelt hug, in the most literal sense that she felt a pulse of strength and sympathy from his heart to hers, a transfer of energy that was palpable and astonishing, although Francis behaved as if nothing had happened.
‘Thank you,’ she said. ‘And thank you for coming along,’ she added, in case she had been imagining the whole thing and was making too much of the embrace. On their way back to Belsize Park, she said to Olivia what an amazing person Francis was, partly to please her, but mostly because she couldn’t think of anyone else who could have handled with such unobtrusive but deep engagement meeting a stranger who is almost immediately diagnosed with cancer.
Since they both worked at home, Martin and Lizzie Carr often had a break in the middle of the day and so Lucy asked Olivia, in case they ran into her parents, not to mention the tumour. Much as Lucy loved the Carrs, she needed time to adjust before deciding on the right balance between discretion and confession. She wanted to spend some time alone with Olivia, but as they slipped into the house, Lizzie happened to be in the hall and of course invited them to join her and Martin in the kitchen. She was so affectionate and welcoming that Lucy couldn’t refuse.
Martin also greeted Olivia and Lucy with great warmth, but immediately plunged back into the flow of the conversation he had been having with his wife. He was well known for being one of the rare psychoanalysts who was prepared to take on schizophrenic patients. They were referred to him, without the usual preliminary consultation he would have had with a private patient, at the mental health clinic where he worked once a week for free. He had been sent a new patient the day before and was complaining, as he often did, about the limitations of psychiatric approaches, which treated the disordered language of schizophrenics as a symptom that needed to be suppressed rather than a communication that needed to be understood.
‘The intelligent patient I saw yesterday had bought the Oxford University Press Very Short Introduction to schizophrenia, written not by one but by two professors, because he was trying to research his illness. And this is what he got for his pains,’ said Martin, opening a little green book at a page he had marked with a torn piece of kitchen towel. Olivia smiled at Lizzie in recognition of Martin in full flood.
‘This,’ he said, ‘was an IQ test for naming as many animals as possible in three minutes:
The errors of patients with poverty of speech and action tended to be of omission. These patients often failed to respond in the time permitted. For example, on a verbal fluency test one patient could name only three animals in three minutes. He commented, ‘The only one I can think of is cheetah.’ In contrast, the errors associated with the disorganization syndrome tend to be of commission, that is patients fail to inhibit inappropriate responses. For example, another patient performing the same verbal fluency task produced the sequence, ‘emu, duck, swan, lake, Loch Ness monster, bacon…’ In this example, the word ‘lake’ is closely associated with the word ‘swan’, but should not have been given since it is not an example of an animal. The word ‘bacon’ is also inappropriate, and why the patient produced it is difficult to understand, but this inexplicable conjunction of words is typical of the incoherent speech sometimes associated with schizophrenia.
‘“Inexplicable conjunction of words”,’ gasped Martin. ‘“Cheetah”! Perhaps the patient felt that the examiner was a cheater, making him do an IQ test while he was psychotic, perhaps he cheated on someone, or someone in his family was a cheater, we don’t know, but we know that it’s a communication. As to lake turning into Loch, what could be more explicable? Of course, the mind of such a person contains monsters that may be real or may not be, like the Loch Ness monster. Perhaps he thinks he’s a monster for eating bacon, the flesh of another animal, or he comes from a tradition in which pork is forbidden, or he feels like dead meat. We don’t know, but it’s a communication that could be deciphered by someone who is prepared to pay attention.’
‘Of course you’re right, darling,’ said Lizzie, ‘but it’s easier to just give them more anti-psychotics.’
‘To cheat them like the cheaters that we are.’
‘Are you all right, Lucy?’ asked Lizzie.
‘Not really,’ she said. ‘I had a brain scan yesterday and the results came in this morning.’
‘Oh god,’ said Martin, ‘and I’ve been ranting. What’s going on?’
‘I wish the evidence from my scan was being as outrageously misrepresented as the evidence from those IQ tests, but it turns out I have a brain tumour.’
For the rest of the day, the Carrs helped to look after Lucy in their loving and generous and sane way. Lizzie said that although it was against the recommendations of psychotherapy for them to talk formally, given how well they knew each other, she was of course available as a friend, and could guide her towards a colleague, if Lucy wanted professional help. After a quick sketch of Hunter’s personality, they all agreed that keeping her medical news private was essential to spending the next few days in his company.
That decision was one of the only firm reference points in Lucy’s mind as she arrived at Farnborough airport to pick up her boss. She waited, making every effort to work up some enthusiasm for their days together. Before long, she saw Hunter striding across the tarmac in a pink shirt, blue jeans, cowboy boots and, despite the cool morning, a brown suede jacket hooked over his shoulder. At six foot four, he was an indisputably big presence, with his square jaw and his broad shoulders. After his passport had been glanced at and his luggage loaded in the boot, the two of them settled in the back of the car and set off for Oxford.
‘I remember you saying that you used to live here,’ said Lucy, with mechanical brightness.
‘One thing you should know about me, Lucy, is that I’m a present tense kind of guy,’ said Hunter, ‘more tense perhaps than present at this precise moment but, in any case, not lost in beachcombing my memories.’
‘You can be present to your memories,’ said Lucy, ‘they’re not time machines.’
‘That’s true, although I’ve heard that some people can catch a ride on a madeleine,’ said Hunter, ‘but the French already have the patent on that low-tech time machine and anyhow it’s headed in the wrong way. The only direction I want to travel in is towards the future.’
‘I don’t think we have any choice about that,’ said Lucy, ‘annoyingly enough.’
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