‘Whoa! Hold your horses. Let’s get a few things straight first. As you say, restorative surgery goes back about fifty years, when the first kidney grafts were made, though for years before that corneal grafting was commonplace. If you accept that blood is a tissue the principle is even older – you had a massive blood transfusion after the accident, and later when Dr Nathan amputated the crushed knee and shinbone. Nothing surprising about that, is there?’
Conrad waited before answering. For once Dr Knight’s tone had become defensive, as if he were already, by some sort of extrapolation, asking the questions to which he feared Conrad might subsequently object.
‘No,’ Conrad replied. ‘Nothing at all.’
‘Obviously, why should there be? Though it’s worth bearing in mind that many people have refused to accept blood transfusions, even though it meant certain death. Apart from their religious objections, many of them felt that the foreign blood polluted their own bodies.’ Dr Knight leaned back, scowling to himself. ‘One can see their point of view, but remember that our bodies are almost completely composed of alien materials. We don’t stop eating, do we, just to preserve our own absolute identity?’ Dr Knight laughed here. ‘That would be egotism run riot. Don’t you agree?’
When Dr Knight glanced at him, as if waiting for an answer, Conrad said, ‘More or less.’
‘Good. And, of course, in the past most people have taken your point of view. The substitution of a healthy kidney for a diseased one doesn’t in any way diminish your own integrity, particularly if your life is saved. What counts is your own continuing identity. By their very structure the individual parts of the body serve a larger physiological whole, and the human consciousness is great enough to provide any sense of unity.
‘Now, no one ever seriously disputed this, and fifty years ago a number of brave men and women, many of them physicians, voluntarily gave their healthy organs to others who needed them. Sadly, all these efforts failed after a few weeks as a result of the so-called immunity reaction. The host body, even though it was dying, still fought against the graft as it would against any alien organism.’
Conrad shook his head. ‘I thought they’d solved this immunity problem.’
‘In time, yes – it was a question of biochemistry rather than any fault in the surgical techniques used. Eventually the way became clear, and every year tens of thousands of lives were saved – people with degenerative diseases of the liver, kidneys, alimentary tract, even portions of the heart and nervous system, were given transplanted organs. The main problem was where to obtain them – you may be willing to donate a kidney, but you can’t give away your liver or the mitral valve in your heart. Luckily a great number of people willed their organs posthumously – in fact, it’s now a condition of admission to a public hospital that in the event of death any parts of one’s body may be used in restorative surgery. Originally the only organs that were banked were those of the thorax and abdomen, but today we have reserves of literally every tissue in the human body, so that whatever the surgeon requires is available, whether it’s a complete lung or a few square centimetres of some specialized epithelium.’
As Dr Knight sat back Conrad pointed at the ward around him. ‘This hospital . . . this is where it happens?’
‘Exactly, Conrad. This is one of the hundreds of institutes we have today devoted to restorative surgery. As you’ll understand, only a small percentage of the patients who come here are cases such as yours. The greatest application of restorative surgery has been for geriatric purposes, that is, for prolonging life in the aged.’
Dr Knight nodded deliberately as Conrad sat up. ‘Now you’ll understand, Conrad, why there have always been so many elderly people in the world around you. The reason is simple – by means of restorative surgery we’ve been able to give people who would normally die in their sixties and seventies a second span of life. The average life span has risen from sixty-five half a century ago to something close to ninety-five.’
‘Doctor . . . the driver of the car. I don’t know his name. You said he could still help me.’
‘I meant what I said, Conrad. One of the problems of restorative surgery is that of supply. In the case of the elderly it’s straightforward, if anything there’s an excess of replacement materials over the demand. Apart from a few generalized degenerative conditions, most elderly people are faced with the failure of perhaps no more than one organ, and every fatality provides a reserve of tissues that will keep twenty others alive for as many years. However, in the case of the young, particularly in your age group, the demand exceeds supply a hundred-fold. Tell me, Conrad, quite apart from the driver of the car, how do you feel in principle about undergoing restorative surgery?’
Conrad looked down at the bedclothes. Despite the cradle, the asymmetry of his limbs was too obvious to miss. ‘It’s hard to say. I suppose
I...’
‘The choice is yours, Conrad. Either you wear a prosthetic limb – a metal support that will give you endless discomfort for the rest of your life, and prevent you from running and swimming, from all the normal movements of a young man – or else you have a leg of flesh and blood and bone.’
Conrad hesitated. Everything Dr Knight had said tallied with all he had heard over the years about restorative surgery – the subject was not taboo, but seldom discussed, particularly in the presence of children. Yet he was sure that this elaborate résumé was the prologue to some far more difficult decision he would have to take. ‘When do you do this – tomorrow?’
‘Good God, no!’ Dr Knight laughed involuntarily, then let his voice roll on, dispelling the tension between them. ‘Not for about two months, it’s a tremendously complex piece of work. We’ve got to identify and tag all the nerve endings and tendons, then prepare an elaborate bone graft. For at least a month you’ll be wearing an artificial limb – believe me, by the end you’ll be looking forward to getting back on a real leg. Now, Conrad, can I assume that in general you’re quite willing? We need both your permission and your uncle’s.’
‘I think so. I’d like to talk to Uncle Theodore. Still, I know I haven’t really got any choice.’
‘Sensible man.’ Dr Knight held out his hand. As Conrad reached to take it he realized that Dr Knight was deliberately showing him a faint hairline scar that ran around the base of his thumb and then disappeared inside the palm. The thumb seemed wholly part of the hand, and yet detached from it.
‘That’s right,’ Dr Knight told him. ‘A small example of restorative surgery. Done while I was a student. I lost the top joint after infecting it in the dissecting room. The entire thumb was replaced. It’s served me well; I couldn’t really have taken up surgery without it.’ Dr Knight traced the faint scar across his palm for Conrad. ‘There are slight differences of course, the articulation for one thing – this one is a little more dexterous than my own used to be, and the nail is a different shape, but otherwise it feels like me. There’s also a certain altruistic pleasure that one is keeping alive part of another human being.’
‘Dr Knight – the driver of the car. You want to give me his leg?’
‘That’s true, Conrad. I should have to tell you, anyway, the patient must agree to the donor – people are naturally hesitant about being grafted to part of a criminal or psychopath. As I explained, for someone of your age it’s not easy to find the appropriate donor . . .’
‘But, Doctor –’ For once Dr Knight’s reasoning bewildered Conrad. ‘There must be someone else. It’s not that I feel any grudge against him, but . . . There’s some other reason, isn’t there?’
Dr Knight nodded after a pause. He walked away from the bed, and for a moment Conrad wondered if he was about to abandon the entire case. Then he turned on his heel and pointed through the window.
‘Conrad, while you’ve been here has it occurred to you to wonder why this hospital is empty?’
Conrad gestured at the distant walls. ‘Perhaps it’s too large. How many patients can it take?’
�
�Over two thousand. It is large, but fifteen years ago, before I came here, it was barely big enough to deal with the influx of patients. Most of them were geriatric cases – men and women in their seventies and eighties who were having one or more vital organs replaced. There were immense waiting lists, many of the patients were trying to pay hugely inflated fees – bribes, if you like – to get in.’ ‘Where have they all gone?’ ‘An interesting question – the answer in part explains why you’re here,
Conrad, and why we’re taking a special interest in your case. You see, Conrad, about ten or twelve years ago hospital boards all over the country noticed that admission rates were starting to fall off. To begin with they were relieved, but the decline has gone on each year, until now the rate of admission is down to about one per cent of the previous intake. And most of these patients are surgeons and physicians, or members of the nursing staff.’
‘But, Doctor – if they’re not coming here . . .’ Conrad found himself thinking of his aunt and uncle. ‘If they won’t come here that means they’re choosing to . . .’
Dr Knight nodded. ‘Exactly, Conrad. They’re choosing to die.’
A week later, when his uncle came to see him again, Conrad explained to him Dr Knight’s proposition. They sat together on the terrace outside the ward, looking out over the fountains at the deserted hospital. His uncle still wore a surgical mitten over his hand, but otherwise had recovered from the accident. He listened silently to Conrad.
‘None of the old people are coming any more, they’re lying at home when they fall ill and . . . waiting for the end. Dr Knight says there’s no reason why in many cases restorative surgery shouldn’t prolong life more or less indefinitely.’
‘A sort of life. How does he think you can help them, Conrad?’
‘Well, he believes that they need an example to follow, a symbol if you like. Someone like myself who’s been badly hurt in an accident right at the start of his life might make them accept the real benefits of restorative surgery.’
‘The two cases are hardly similar,’ his uncle mused. ‘However . . . How do you feel about it?’
‘Dr Knight’s been completely frank. He’s told me about those early cases where people who’d had new organs and limbs literally fell apart when the seams failed. I suppose he’s right. Life should be preserved – you’d help a dying man if you found him on the pavement, why not in some other case? Because cancer or bronchitis are less dramatic –’
‘I understand, Conrad.’ His uncle raised a hand. ‘But why does he think older people are refusing surgery?’
‘He admits he doesn’t know. He feels that as the average age of the population rises there’s a tendency for the old people to dominate society and set its mood. Instead of having a majority of younger people around them they see only the aged like themselves. The one way of escape is death.’
‘It’s a theory. One thing – he wants to give you the leg of the driver who hit us. That seems a strange touch. A little ghoulish.’
‘No, it’s the whole point – he’s trying to say that once the leg is grafted it becomes part of me.’ Conrad pointed to his uncle’s mitten. ‘Uncle Theodore, that hand. You lost two of the fingers. Dr Knight told me. Are you going to have them restored?’
His uncle laughed. ‘Are you trying to make me your first convert, Conrad?’
Two months later Conrad re-entered the hospital to undergo the restorative surgery for which he had been waiting during his convalescence. On the previous day he accompanied his uncle on a short visit to friends who lived in the retirement hostels to the north-west of the town. These pleasant single-storey buildings in the chalet style, built by the municipal authority and let out to their occupants at a low rent, constituted a considerable fraction of the town’s area. In the three weeks he had been ambulant Conrad seemed to have visited every one. The artificial limb with which he had been fitted was far from comfortable, but at Dr Knight’s request his uncle had taken Conrad to all the acquaintances he knew.
Although the purpose of these visits was to identify Conrad to as many of the elderly residents as possible before he returned to the hospital – the main effort at conversion would come later, when the new limb was in place – Conrad had already begun to doubt whether Dr Knight’s plan would succeed. Far from arousing any hostility, Conrad’s presence elicited nothing but sympathy and goodwill from the aged occupants of the residential hostels and bungalows. Wherever he went the old people would come down to their gates and talk to him, wishing him well with his operation. At times, as he acknowledged the smiles and greetings of the grey-haired men and women watching on all sides from their balconies and gardens, it seemed to Conrad that he was the only young person in the entire town.
‘Uncle, how do you explain the paradox?’ he asked as they limped along together on their rounds, Conrad supporting his weight on two stout walking sticks. ‘They want me to have a new leg but they won’t go to the hospital themselves.’
‘But you’re young, Conrad, a mere child to them. You’re having returned to you something that is your right: the ability to walk and run and dance. Your life isn’t being prolonged beyond its natural span.’
‘Natural span?’ Conrad repeated the phrase wearily. He rubbed the harness of his leg beneath his trousers. ‘In some parts of the world the natural life span is still little more than forty. Isn’t it relative?’
‘Not entirely, Conrad. Not beyond a certain point.’ Although he had faithfully guided Conrad about the town, his uncle seemed reluctant to pursue the argument.
They reached the entrance to one of the residential estates. One of the town’s many undertakers had opened a new office, and in the shadows behind the leaded windows Conrad could see a prayer-book on a mahogany stand and discreet photographs of hearses and mausoleums. However veiled, the proximity of the office to the retirement homes disturbed Conrad as much as if a line of freshly primed coffins had been laid out along the pavement ready for inspection.
His uncle merely shrugged when Conrad mentioned this. ‘The old take a realistic view of things, Conrad. They don’t fear or sentimentalize death in quite the way the younger people do. In fact, they have a very lively interest in the matter.’
As they stopped outside one of the chalets he took Conrad’s arm. ‘A word of warning here, Conrad. I don’t want to shock you, but you’re about to meet a man who intends to put his opposition to Dr Knight into practice. Perhaps he’ll tell you more in a few minutes than I or Dr Knight could in ten years. His name is Matthews, by the way, Dr James Matthews.’
‘Doctor?’ Conrad repeated. ‘Do you mean a doctor of medicine?’
‘Exactly. One of the few. Still, let’s wait until you meet him.’
They approached the chalet, a modest two-roomed dwelling with a small untended garden dominated by a tall cypress. The door opened as soon as they touched the bell. An elderly nun in the uniform of a nursing order let them in with a brief greeting. A second nun, her sleeves rolled, crossed the passage to the kitchen with a porcelain pail. Despite their efforts, there was an unpleasant smell in the house which the lavish use of disinfectant failed to conceal.
‘Mr Foster, would you mind waiting a few minutes. Good morning, Conrad.’
They waited in the dingy sitting room. Conrad studied the framed photographs over the rolltop desk. One was of a birdlike, grey-haired woman, whom he took to be the deceased Mrs Matthews. The other was an old matriculation portrait of a group of students.
Eventually they were shown into the small rear bedroom. The second of the two nuns had covered the equipment on the bedside table with a sheet. She straightened the coverlet on the bed and then went out into the hall.
Resting on his sticks, Conrad stood behind his uncle as the latter peered down at the occupant of the bed. The acid odour was more pungent and seemed to emanate directly from the bed. When his uncle beckoned him forward, Conrad at first failed to find the shrunken face of the man in the bed. The grey cheeks and hair had already merge
d into the unstarched sheets covered by the shadows from the curtained windows.
‘James, this is Elizabeth’s boy, Conrad.’ His uncle pulled up a wooden chair. He motioned to Conrad to sit down. ‘Dr Matthews, Conrad.’
Conrad murmured something, aware of the blue eyes that had turned to look at him. What surprised him most about the dying occupant of the bed was his comparative youth. Although in his middle sixties, Dr Matthews was twenty years younger than the majority of the tenants in the estate.
‘He’s grown into quite a lad, don’t you think, James?’ Uncle Theodore remarked.
Dr Matthews nodded, as if only half interested in their visit. His eyes were on the dark cypress in the garden. ‘He has,’ he said at last.
Conrad waited uncomfortably. The walk had tired him, and his thigh seemed raw again. He wondered if they would be able to call for a taxi from the house.
Dr Matthews turned his head. He seemed to be able to look at Conrad and his uncle with a blue eye on each of them. ‘Who have you got for the boy?’ he asked in a sharper voice. ‘Nathan is still there, I believe . . .’
‘One of the younger men, James. You probably won’t know him, but he’s a good fellow. Knight.’
‘Knight?’ The name was repeated with only a faint hint of comment. ‘And when does the boy go in?’
‘Tomorrow. Don’t you, Conrad?’
Conrad was about to speak when he noticed that a faint simpering was coming from the man in the bed. Suddenly exhausted by this bizarre scene, and under the impression that the dying physician’s macabre humour was directed at himself, Conrad rose in his chair, rattling his sticks together. ‘Uncle, could I wait outside . . . ?’
‘My boy –’ Dr Matthews had freed his right hand from the bed. ‘I was laughing at your uncle, not at you. He always had a great sense of humour. Or none at all. Which is it, Theo?’
‘I see nothing funny, James. Are you saying I shouldn’t have brought him here?’
Dr Matthews lay back. ‘Not at all – I was there at his beginning, let him be here for my end . . .’ He looked at Conrad again. ‘I wish you the best, Conrad. No doubt you wonder why I don’t accompany you to the hospital.’
The Complete Stories of J. G. Ballard Page 101