Probably my biggest problem is choosing the right anesthetic and the right dosage. I go with 1% lidocaine (epinephrine 1:100,000), an effective topical anesthetic and one that, unlike morphine, isn't guarded as carefully. The clinic won't notice the bottles missing until it's too late. Since the brain itself doesn't feel pain, I only have to use enough anesthetic to numb my work on the scalp and skull. We don't want any sudden twinges of pain to shake our hands while slicing and dicing the interior cerebral tissue.
Another challenge to the surgery is the patient's (my) body position. Traditionally, the patient is placed supine on an alternating air mattress with their head held in a Mayfield 3-pin holder. I'm using the Mayfield to hold my head steady, but have decided that I need to be upright. Since the surgery attacks the zygomatic arch (cheekbone), I don't think this will cause any real problems.
Of course, like any surgeon, I need to be able to see what I'm doing. I've positioned a dozen mirrors, at different angles, in a ring around my head and borrowed a set of professional photo floodlights from my brother's adult film company. After checking out my line of sight in the reflective glasses, I'm satisfied that I'll be able to get the job done, even with my head immobilized in the Mayfield.
THE OPENING
Since this procedure enters through the anterior of the face, it isn't necessary to shave my whole head, just the facial hair, so that I can make a standard curvilinear frontal temporal incision, similar to the pterional approach to the circle of Willis. With a little more lidocaine, I proceed to incise the temporalis muscle directly beneath the skin, making sure it's reflected with the scalp. I have to base the bone flap low in the middle fossa, so that it extends just above the sphenoid wing but remains within the confines of the temporalis muscle fan. After inserting earplugs (not an easy task while locked in the Mayfield), I use a high-speed cranial drill to enlarge the bone opening towards the middle fossa floor and anteriorly into the sphenoid wing for several centimeters. To optimize temporal tip exposure I open the dura with a cruciate incision extending about one cm above the Sylvian fissure. For the remainder of the operation, I'm going to have to proceed using the operating microscope.
We are prisoners of time, slaves to the passage of seconds, minutes and years. From the moment we're born we're dragged, like trophy animals, through a swamp of decades towards the death we can see coming at the end. Yet even as we experience it, we know that linear time is a lie. On a subatomic level, time is fluid, moving both backwards and forwards. Are we humans less than subatomic particles? I don't believe so, but a quark doesn't carry our disease of linearity. The site of this disease is the brain, the place where memory and time exist and are bound together, specifically in the hippocampus. While this growth was once useful and helpful — providing us with a link to our past and, therefore, a sense of self — it has continued to growth unchecked. The hippocampus is a cancerous tumor that locks us in a single, linear timestream. Like any dangerous internal growth, it must be excised, or the body will die.
To mark the posterior limit of the proposed lobectomy, I measure four centimeters from the temporal tip along the middle temporal gyrus posteriorly from the sphenoid wing, a tricky move since I have to do everything backwards while looking into a mirror. With a disposable scalpel I purchased under a false name through a veterinary catalog, I make an incision in the sulcus between the superior and middle temporal gyri and carry the cut mesially, entering the temporal ventricular horn.
Placing a cotton pledget into the ventricle helps me to maintain orientation. With an irrigating bipolar coagulator and sucker, the middle and inferior temporal gyri come out easily as a single surgical specimen. I then remove the superior temporal gyrus, remembering (and here is where the long hours of study pay off) to use subpial dissection technique and maintaining an intact pia along the Sylvian fissure and basal temporal regions. With the superior temporal gyrus removed to the level of the ventricle, I can then partially remove the amygdala.
Working steadily while simultaneously trying to contain my excitement, I remove the remainder of the inferior temporal structures mesially until the parahippocampal gyrus is before me. At this point, only the mesial-temporal structures remain and I can see the ependymal surface of the hippocampus. I administer more lidocaine and take a sip of my favorite calmative, mint tea laced with vodka. I must proceed carefully from here on.
I understand that, to the casual reader, the procedure I'm describing comes across as more than a little extreme. When researching possible cures for Chronalgia, I was inspired by the story of Dr. Jerri Nielsen who in 2000, while locked in a prolonged ice storm at Amundsen-Scott South Pole Station in Antarctica, had to self-treat her breast cancer. This courageous woman's ability to perform such dangerous therapy to save her own life gave me the courage to go ahead with my experiment, one that I'm certain will benefit all of humanity. In fact, I can already feel it happening. Simply by beginning this journey, I've removed myself from the flow or ordinary time and have defeated the tumor. Of course, that's only half the job. After I remove the hippocampus, there's another step to free myself from time completely.
Making an anterior incision along the choroidal fissure, from the level of the posterior boundary of the cerebral peduncle, I reach the tip. I then make a posterior incision at the level of the posterior margin of the cerebral peduncle laterally to the lateral hippocampal margin, then bring anteriorly and laterally until it meets a lateral resection margin. From here, I can joyfully remove the hippocampus to the level of the superior colliculus, taking care to coagulate and cut the numerous small vessels and cerebral arteries without damaging vessels supplying the peduncle and thalamus.
The idea for my somewhat radical self-surgery came from an entry I stumbled across in a medical book. It detailed the symptoms of Korsakov's Syndrome, a form of retrograde amnesia usually occurring in the later stages of acute alcoholism. The sufferer is unhinged from the present and floats into his or her own past, literally. Years, decades are lost and relived as the patient mentally grows mentally younger. But what if a healthy person were to induce a similar brain anomaly? Might that person not be able to move backwards and forwards along the brain's timeline? The key to Korsakov's Syndrome was in the destruction of the Mammillary Body, lying almost directly above the hippocampal tumor. Happily, this procedure was much simpler than removing the hippocampus itself. Since the cortex was already open to the proper level, all I had to do was lobotomize the offending organ by inserting the scalpel into the upper boundary of the cerebral peduncle and making a neat, lateral slice in the tissue, severing the MB, leaving it no longer an isthmus of tissue, but an island. I can feel the effects immediately. My body is loosened from itself, from the brain, from time. I must finish my work quickly.
Irrigating the resection cavity completely free of blood and closing the dura, I use tack-up sutures and secure the bone flap into place. The muscle, fascia, and galea I close with 2-0 Vicryl sutures, and the skin is closed with staples. No drain is needed and blood loss should not exceed 300 cc.
POSTOPERATIVE MANAGEMENT
The night of surgery I sit at the bedside and deep breathe for pulmonary toilet. I must watch for fever, infection, and seizures for the next twenty-four to forty-eight hours. I must keep my incision clean. I must return the lights to my brother's film company. Perhaps, under the circumstances, he'll come and retrieve them himself. I administer more lidocaine, drink my tea and vodka calmative and prepare to rest. Free from these cerebral tumors, my brain will do the rest of the job on its own.
I can feel physical and temporal shifts deep inside my body. It seems as if they are bubbling up from the center of the world, a subtle undulation from the earth's tectonic plates. I sense all this and believe I am feeling the first waves of geological time that have been locked away, hidden in my cerebellum. The sensation is both frightening and exhilarating.
Already, I am adrift in time. That, or I've overshot myself and gone forward in moment to my own death. And why shouldn
't I? The end is much part of the journey as the beginning. I expect to experience my death and birth many times on this pilgrimage. Let it come. Let it all come. Birth or death or anything in between. I've paid for my ticket. I'm ready for the ride.
THE END
Concrete Bouquet
He's in love, but doesn't have the words to express it or the courage to say it. He smiles at his love. He buys her presents. He takes her to the most expensive dinners he can afford. She cares for him, he knows. She has no problem saying or expressing it. Now she's waiting for something. She's waiting for him, for the words he can't get out.
After dinner, she doesn't ask him up. Things are going wrong. They kiss, but he can feel her drifting away from him, sadly, but steadily. He stands in the street and watches the light go on in her apartment. He wants to shout at her window, but his throat is dry. His tongue feels like old linoleum in his mouth.
He trembles with cold and frustration. Tears fall from his eyes. Not tears. Flowers. Wounds open in his hands. Roses fall from his palms. Lilies, magnolia blossoms, tulips, birds of paradise land at his feet. He tries to call to her, but the words still won't come from his dry throat.
Later, when she opens her window she sees him lying in the street. He seems to be asleep on a bed of fresh blooms. He's so weak from blood loss, that she has to practically carry him inside. He leaves a trail of orchids and hibiscus all the way to her room.
THE END
Confessions of a Mnemonist
In the morning it's Mad Love with the dregs of last night's vodka. In the afternoon, a couple of lines of Crazy Ivan with a port chaser and maybe a tab of Sky Saw to turn on the flood lights in my skull and drown out the world with white electric jitters. This ain't no party. This ain't no disco. This is medicine, son. I'll take Crazy Ivan migraines over drooling Haldol fuzzouts any day (Haldol turns you to warm pudding, but doesn't numb the memory centers and what's the use of annihilation when old Dragnet episodes keep streaming at you through the fog?). I need to turn off the past. To escape the third grade. Summer barbecues. The snows of Stalingrad. The day God drowned the world.
Fun facts to know and tell: I've never lost a key, a glove or a sock.
Forget. Forget. Forget. Be a mouse. So small. So quick to live and die. Live in the now. Be like the Buddha. Hum mane padme hum.
I am the past on two legs. I am history's broken-back coolie. They showed me MRI glossies of my brain (January twenty-first, nineteen ninety-nine, two forty-four p.m.), bright and colored like an infant's first crayon scrawl. Those swollen overheated temporal lobes and medulla oblongata. The poison fish swimming in my cerebral fluid.
I am a mnemonist. I don’t forget. I can't. Junkies have heroin. I have every pitiful moment and sensory experience of my life. Fuck your diaries and your datebooks. I have the facts, cold and hard and burning like dry ice crammed behind my eyes. I'm drowning. Sinking in black seas of fishstick school lunches, first kisses, old songs, a brown shoestring I broke on March fourth, nineteen seventy-eight.
Drugs ease my pain, but they're not enough. Sometimes the desire for obliteration is like slow seduction. Suicide smells like fresh-cut daisies and tastes like candy. What kind? You name it. I know them all, remember every gummy treat, fruity goo and chocolate you-name-it I ever tasted.
I remember every pill and electroshock session in the King's County Hospital (the taste of the rubber bit in the my mouth so I wouldn't bite my tongue, the nurse's blue eyes which were like the blue of icebergs which were like the blue on Dutch ceramics which were imperfect like the Indian bones we saw at the Museum of Natural History, June thirtieth, nineteen fifty-seven, which was the year they arrested Ed Gein and he had a lot of bones in his house…). You see what I mean? Imagine eating Proust's madeleine a hundred times a day.
While "curing" me, the doctors magically figured out how to make my condition worse. Hypnotherapy sessions with Dr. Janice Elizabeth Cruz, left-handed, black-haired, a mole on her left ear. She buried me in my past, looking for childhood traumas, sexual abuse, gruesome head injuries. Dr. Cruz jimmied and kicked in the doors of my consciousness, looking for a reason or an excuse for what I was.
She broke something in the attic of my brain. Opened a door I can't close. Other people pay a fortune for this and call it "past life regression." Who were you in former lifetimes? I know who I was. Those babbling strangers exploded into my head like a volcanic eruption. Boiling memories of a hundred lives poured into my skull, a bright and burning magma of recollection. Armies. Whale hunting on ice floes. Desert sands, like oceans of gold. Sea voyages with hard tac for food. Leprous sores, fevers and aneurysms. Wives, husbands, children and friends gone to dust, history's fodder. Horses, trains, airships, burning longboats. I knew the story of every scar on my body. Now I know the scars of a hundred. I remember God's great flood. Ice Ages flowing and receding. Dying in snow, fire and water in countries that haven't existed for a thousand years.
I need to forget. Undo time. Rewind consciousness. Help me. Smother me. Distract me with your bright lies, your sweet sex, your chemical dreams (the first dream of my first life, still in the crib: darkness, milk, the dusty scent of my mother's breasts; my dream last night: burning water, needles in my eyes, the puttering of the little engine that's my heart beating; it's beaten 7200 times as I've written this and I remember each and every beat). Kiss me or kill me. As long as this moment lasts, the others won't come. Is that too much to ask? I want a single moment that is itself and nothing else. Don't let me drift away and get lost in sunny pre-school playgrounds, Moroccan souks, mud trenches behind German lines, blacksmith shops, the claustrophobic stink in the belly of slave ships, the black death, herds of mammoths.
I am less than the sum of my shattered parts. I am everything that has ever happened to this body (these bodies). I am nothing.
THE END
DMV
Allegra waits in the line at the DMV, the Department of Meta-Virtuals. Technically, Allegra isn’t in line. Technically, Allegra doesn’t exist. She’s virtual, and not the good kind. The kind where you volunteer to be obliterated, morphed into data, a postmodern wraith. Allegra is virtual because she’s a convicted felon, though she can’t remember her crime or conviction. That happens to virtuals, she knows. Being semi-non-corporeal can mess with your mind. People forget they’re people. They think they’re cats or houseplants or the schematics for a fusion fuel cell. Allegra hasn’t gone that far yet. She knows who she is. She just can’t prove it. Sometime during her court-ordered virtuality, she’s dropped off the radar, her name and ID number lost behind some digital filing cabinet. Now that the end of her sentence is in sight, Allegra wants to get back on the books. Stick her big toe back into the river that’s real world and wiggle it around a little.
The line shifts and Allegra steps forward. She doesn’t recall how long she’s been waiting in line. Time moves for her in hallucinogenic bursts. A minute stretches on for eternity, and eight hours can be gone in the time it takes to smoke a single cigarette. It’s her own fault. She never liked wearing a watch, and now that it’s not an option, Allegra longs for one. The old kind like her grandmother had. Made of metal, with hands that looked like cat whiskers gliding quietly over a neat circle of numbers. Allegra imagines the impossibly thin second hand gliding over the watch face, describing eternity, an endless circle of life that she longs to return to. Each revolution of the second hand is another second closer to her being real again. Allegra drifts with the mechanical movement of the hand, feeling light, feeling high, until another virtual behind her ahems loudly and she takes another step forward. The DMV is an old building, clad in watery pale green carpet, with a white acoustic tile ceiling and fluorescent lighting fixtures from the last ice age. The DMV is one of those institutional behemoths that gives the impression that it’s been there forever. So old, it could have been built by the Aztecs or the space aliens who, her grandmother told her, bought the organic compounds to Earth that would someday grow and mutate into humans. Even bac
k then, they knew we’d fuck up. That we’d need a DMV, Allegra thinks. They built it that so we wouldn’t have to construct something so depressing. Why does Allegra even need to be here? She’s information, not a person. People stand in line, not data. Data streams don’t queue up at 5 a.m. just to get in the door, but Allegra did. She’s exhausted all the normal information channels to get her identity reinstated. Her prison sys-ops weren’t a help. Her AI public defender was useless. Her social worker liaison was less than useless. The DMV is Allegra’s last and only choice, so she stands in a hall of ghosts waiting to be served by the living. Secretly, she longs to be a real ghost so that she can appear from nowhere and swoop down over the bored clerks in their rat maze cubicles. She’d rain blood on them, and wail like a banshee, all red eyes and broken teeth.
“Next.”
Ahem. Allegra opens her eyes.
“Next.”
She looks up and hurries forward. The clerk behind the glass doesn’t look at her. Allegra stands there for a moment before she sees a blinking light in the counter. Holo-text over the light tells her to place her hands over the appropriate scanners. She does so and the light changes. The clerk looks up as Allegra changes. Bathed in heavy UV light, she gains enough presence to feel somewhat solid. Almost entirely visible. Nearly human. Allegra nods at the clerk and the young man behind the Lexan partition smiles back at her.
Devil in the Dollhouse Page 2