'Then, working quickly, I would dissect out both the left and right jugular veins and hitch these also to the heart machine to complete the circuit. Now switch on the machine, which is already primed with the right type of blood, and there you are. The circulation through your brain would be restored.'
'I'd be like that Russian dog.'
'I don't think you would. For one thing, you'd certainly lose consciousness when you died, and I very much doubt whether you would come to again for quite a long time - if indeed you came to at all. But, conscious or not, you'd be in a rather interesting position, wouldn't you? You'd have a cold dead body and a living brain.'
Landy paused to savour this delightful prospect. The man was so entranced and bemused by the whole idea that he evidently found it impossible to believe I might not be feeling the same way.
'We could now afford to take our time,' he said. 'And believe me, we'd need it. The first thing we'd do would be to wheel you to the operating-room, accompanied of course by the machine, which must never stop pumping. The next problem...'
'All right,' I said. 'That's enough. I don't have to hear the details.'
'Oh but you must,' he said. 'It is important that you should know precisely what is going to happen to you all the way through. You see, afterwards, when you regain consciousness, it will be much more satisfactory from your point of view if you are able to remember exactly where you are and how you came to be there. If only for your own peace of mind you should know that. You agree?'
I lay still on the bed, watching him.
'So the next problem would be to remove your brain, intact and undamaged, from your dead body. The body is useless. In fact it has already started to decay. The skull and the face are also useless. They are both encumbrances and I don't want them around. All I want is the brain, the clean beautiful brain, alive and perfect. So when I get you on the table I will take a saw, a small oscillating saw, and with this I shall proceed to remove the whole vault of your skull. You'd still be unconscious at that point so I wouldn't have to bother with anaesthetic.'
'Like hell you wouldn't,' I said.
'You'd be out cold, I promise you that, William. Don't forget you died just a few minutes before.'
'Nobody's sawing off the top of my skull without an anaesthetic,' I said.
Landy shrugged his shoulders. 'It makes no difference to me,' he said. 'I'll be glad to give you a little procaine if you want it. If it will make you any happier I'll infiltrate the whole scalp with procaine, the whole head, from the neck up.'
'Thanks very much,' I said.
'You know,' he went on, 'it's extraordinary what sometimes happens. Only last week a man was brought in unconscious, and I opened his head without any anaesthetic at all and removed a small blood clot. I was still working inside the skull when he woke up and began talking.
' "Where am I?" he asked.
' "You're in hospital."
' "Well," he said. "Fancy that."
' "Tell me," I asked him, "is this bothering you, what I'm doing?"
' "No," he answered. "Not at all. What are you doing?"
' "I'm just removing a blood clot from your brain."
' "You are?"
' "Just lie still. Don't move. I'm nearly finished."
' "So that's the bastard who's been giving me all those headaches," the man said.'
Landy paused and smiled, remembering the occasion. 'That's word for word what the man said,' he went on, 'although the next day he couldn't even recollect the incident. It's a funny thing, the brain.'
'I'll have the procaine,' I said.
'As you wish, William. And now, as I say, I'd take a small oscillating saw and carefully remove your complete calvarium - the whole vault of the skull. This would expose the top half of the brain, or rather the outer covering in which it is wrapped. You may or may not know that there are three separate coverings around the brain itself - the outer one called the dura mater or dura, the middle one called the arachnoid, and the inner one called the pia mater or pia. Most laymen seem to have the idea that the brain is a naked thing floating around in fluid in your head. But it isn't. It's wrapped up neatly in these three strong coverings, and the cerebrospinal fluid actually flows within the little gap between the two coverings, known as the subarachnoid space. As I told you before, this fluid is manufactured by the brain and it drains off into the venous system by osmosis.
'I myself would leave all three coverings - don't they have lovely names, the dura, the arachnoid, and the pia? - I'd leave them all intact. There are many reasons for this, not least among them being the fact that within the dura run the venous channels that drain the blood from the brain into the jugular.
'Now,' he went on, 'we've got the upper half of your skull off so that the top of the brain, wrapped in its outer covering, is exposed. The next step is the really tricky one: to release the whole package so that it can be lifted cleanly away,
leaving the stubs of the four supply arteries and the two veins hanging underneath ready to be re-connected to the machine. This is an immensely lengthy and complicated business involving the delicate chipping away of much bone, the severing of many nerves, and the cutting and tying of numerous blood vessels. The only way I could do it with any hope of success would be by taking a rongeur and slowly biting off the rest of your skull, peeling it off downward like an orange until the sides and underneath of the brain covering are fully exposed. The problems involved are highly technical and I won't go into them, but I feel fairly sure that the work can be done. It's simply a question of surgical skill and patience. And don't forget that I'd have plenty of time, as much as I wanted, because the artificial heart would be continually pumping away alongside the operating-table, keeping the brain alive.