Professor Jonathan Graham, fifty-two, had just opened his address to the April 2032, forty-eighth International Conference of the Egyptian Society of Anaesthesiologists in Cairo. He was lean, clean-shaven, his greying hair cut short. He wore a suit made of a light material, especially chosen with Egyptian heat in mind, courtesy of a Colmore Row tailor in his home City of Birmingham, England. Now, having overcome initial nerves, Professor Graham moved away from the rostrum and fought the urge to throw off his jacket, to allow a freedom of movement more accommodating of the expanding passion he had begun to feel for his subject. He turned to a huge screen at the front of the auditorium and pressed a button on a remote device and a quote appeared for all to examine:
"The explanation of consciousness is one of the major unsolved problems of modern science."
“This, ladies and gentlemen, is a direct quote from Francis Crick and Cristoff Koch, and their excellent paper, ‘Consciousness and Neuroscience’, 1997. Crick was one of the greatest ever scientists working in the field of medicine. You may already know that he was awarded the Nobel Prize for Physiology or Medicine in 1962, for his work with Watson and Wilkins in determining the structure of DNA.In 1997,” continued the Professor, “Crick and Koch wrote the following, in the same paper, ‘Consciousness and Neuroscience’ – allow me to read to you verbatim.” Again, Professor Graham pressed a button:
“While most neuroscientists acknowledge that consciousness exists, and that at present it is something of a mystery, most of them do not attempt to study it, mainly for one of two reasons:
(1) They consider it to be a philosophical problem, and so best left to philosophers.
(2) They concede that it is a scientific problem, but think it is premature to study it now.” "
The Professor looked down briefly and appeared to gather his thoughts before continuing.
“In 1998, the influential Philosopher, David Chalmers, explored some of the ways in which neuroscience can contribute to the search for a consciousness theory. In his paper, ‘On the search for a Neural Correlate of Consciousness’, Chalmers sought to explore consciousness theory vis a vis a Neural Correlate model, which I define familiarly here as:
"The smallest set of neural events and structures sufficient for a given conscious percept or explicit memory."
As a philosopher, Chalmers modifies Crick’s and Koch’s assertion that the consciousness correlate can be reduced to 40-hertz oscillations in the cerebral cortex. He says with playful irony that, and I quote, “if we have 40-hertz oscillations in a test tube, that almost certainly won't yield consciousness.” Chalmers however conceded, as do I, that any serious, modern consideration of consciousness will rely on the presence of neurons for visual and perceptive consciousness recording. As anaesthetists, you will be familiar with many methods of determining levels of consciousness. This ability is important if only to avoid law suits.” There was a brief ripple of laughter. Professor Graham smiled broadly at his audience.
“More than thirty years after Crick, Koch, Chalmers and others, the time is ripe for a reconsideration of the nature of consciousness. Not least of all because neuroscience has progressed hugely in the last decade. And what has become increasingly obvious to me as I practise neurosurgery in a technical world undreamt of in the late twentieth century, is that neuroscience as a tool to measure consciousness is prima facie limited.
I think it’s possible that human consciousness exists independently of neurons.”
There was a slight ruffle of sotto exchanges and someone coughed in what sounded like an attempt to disguise an exclamation of some sort.
“When we limit our definition of what it is to be conscious to a consideration of the interplay between neurons and subjective perception, we are trying to determine the nature of the ocean by examining a bucket of salt water. Even were we to lift our heads and view the ocean, we still have not taken a single step towards discovering its origin.”
The vast hall was silent. For a split second, Professor Graham had an impression of the absurdity - as it would be perceived by many in the audience - of what he was about to do. He moved back to the rostrum and sipped a glass of water.
“I agree entirely with Crick and Koch when they said it was high time to grapple for a definition of consciousness. But I disagree with them fundamentally in their assertion that its nature is “neuronal,” and that this would become an incontrovertible truth which would, as Crick stated, “lead to the death of the soul.'' In his 1994 book, ‘The Astonishing Hypothesis,’ he asserted further that,” another click and a third quotation appeared. Someone got up and began to leave, excusing himself as he obscured the view of others in his row.
“ "In the fullness of time, educated people will believe there is no soul independent of the body, and hence no life after death.”"
Professor Graham added, “Crick died believing that, as far as we know, in 2004.” There was a brief pause. Someone else stood up and left. “Well, esteemed colleagues, I humbly submit that I am an educated person. I present for your contemplation that whilst Crick and Koch dared to ask all the right questions, their answers have put in our way an Ozymandian stumbling block which, today, I invite you to scale and look beyond. The nature of consciousness - like the DNA helix itself - is dual. It demands both scientific and spiritual consideration.”
Dr. Graham’s presentation could proceed no further, for in the few seconds during which he drew breath and prayed swiftly for divine guidance, an explosion of some magnitude blew the oak panelled doors to the Chefren Hall clean off their hinges. Twisted and splintered, they hurtled through the air with instantaneously fatal consequences for some of the anaesthetists and neuroscientists seated in the back rows. The momentary black noise of incomprehension that followed was succeeded by rapid gunfire from automatic weapons, propelling bullets through vital organs of at least twenty more of the most accomplished men and women on Earth.
There was no time to process events beyond a simple comprehension of their actuality. Even when an expertly aimed AK 14 Kalashnikov bullet tore through his left shoulder from a distance of fifteen metres, Professor Graham felt nothing. In fact, he did not experience emotion or sensation until some twenty minutes later, when the gurney on which his body lay, practically flew from an ambulance into the Emergency entrance of a Cairo City Hospital.
Struggling to discipline his thoughts, the Professor stared determinedly at a series of glass-encased lights in the green stretch of the A&E corridor ceiling. Undoubtedly a hospital. He became aware of the background screaming of sirens but could make nothing of the rapid injunctions of the Egyptian medics. And then the agony erupted in his shoulder, simultaneous with terror, at the recollection of the scene immediately prior to his loss of consciousness. So this was what it was like to be shot.
Professor Graham closed his eyes as nausea rose in waves and rivalled pain for his attention. Instinctively, he tried to roll on his right side to avoid choking on the inevitable vomit and would have cried out in the agony caused by the movement, but the vomit came instead.
Firm hands and unmistakable instructions to remain still insisted him back to a prone position. The vomit, it seemed, was of little consequence. All around him shouts and lights and voices wheeled giddily. The pain was stupefying but its location and his intelligence told him the injury should not be life threatening, if blood loss was controlled. Turning his head, he eyed the saline drip held aloft by a paramedic, followed its course into his right arm. He dared not look at his left arm. He knew the warm wetness along his left side and beneath him could only be blood. He wondered how much he had lost, hoped they knew what they were doing, passed out again.
Mr. Karim El-Sharif was a consultant Anaesthetist at the Cairo University Hospital. Tall, thin, discreetly bearded with heavily lidded eyes, Mr. El-Sharif was apparently inscrutable. He walked slowly, bony wrists protruding from an immaculately white and laundered shirt. Gold cufflinks occasionally flashed in the sunlight and a silk tie knot nestled snugly beneath his pronounced adam’s apple. Someone handed him a white coat which he donned as he walked, barely checking the giraffe-like gait with which he kept pace with Professor Graham’s gurney. Occasionally, Mr. El Sharif looked upon his patient, taking in his pallor, the blood loss rate, IV rate. He already knew the state of the Professor’s general health and his body weight.
As an anaesthetist, Karim El-Sharif would not normally regard the patient as his but he had been an interested listener in the audience at Professor Graham’s presentation on ‘The Nature and Origin of Consciousness: a combined Neurological and Ontological perspective for practising Anaesthesiologists ‘ so he had been on hand to assume authority in this case.
Theatre sixteen was ready. An orthopaedic surgeon, gowned, gloved and masked, stood by the operating table and waited for the patient with folded hands as though praying. A vascular surgeon, who nodded to him over her mask and assumed a similar attitude of composed attendance, joined him. In the time it took for Professor Graham to be prepped and lifted onto the table, El-Sharif was ready to anaesthetise him; a single nod from him indicated that the patient was ‘under’ and ventilated and the surgeons set to work.
The wound was serious but the bullet itself had passed clean through. The left clavicle was shattered from the posterior margin to the sterna extremity. Ripped from the bone and shredded by the impact too, was the left supraspinatus tendon. Miraculously, the bullet had missed the median nerve by a fraction of a millimetre. Extensive tissue damage was inevitable. Skilled surgery, however, would replace bone with rods and pins, replace tendon with synthetic material. After an estimated four month recovery period and adherence to a physiotherapy regime, Professor Graham should achieve at least partial left arm movement. It was possible, but not probable, that he would perform brain surgery again.
El Sharif watched impassively as four hours into the operation, a third surgeon entered the theatre. None spoke but the others, having done as much as they could to repair the shattered shoulder, left. The third looked to El Sharif for the nod which told him that Professor Graham’s vital signs were good and he was still deeply unconscious, then he positioned himself to the side of the patient’s head. He pulled towards him a surgical microscope and extended his left hand. A theatre nurse placed in it a tiny, sterile dish, in which lay a five micromillemeter transponder, invisible to the naked eye. It took a further thirty minutes to insert the device endoscopically, via Professor Graham’s right orbital cavity, into the optic nerve to a site in the visual cortex. Here it would receive neuroimpulses from his brain and transmit them, via a satellite, to a remote computer. The resultant data would be interpreted as sound, sight, smell and Professor Graham’s own voice, modified and re-transmitted in microwaves to the transponder, to be re-experienced as voices in his head or visual hallucinations. Not only this, but remote electromagnetic stimulation could alter the Professor’s brainwaves and even control his thoughts. And wherever the Professor went on the planet, he could be located.
Finally, all procedures concluded, the last surgeon left the theatre. El Sharif turned off the anaesthetic drug supply, removed the endotracheal tube from Professor Graham’s throat and administered forty milligrams of Methylphenidate iv. The patient began to exhibit signs of returning consciousness within seconds, which was the plan. After such a catastrophic local event as the terrorist attack on the Cairo Conference Centre, all surgical theatres needed to be cleared as quickly as possible. There was no time for patients to come around from anaesthetic at their leisure.
When he was sure the Professor could hear him, Mr. El Sharif spoke.
“Good evening, Professor Graham. You are in a surgical theatre in Cairo University hospital. I am Karim El Sharif, your anaesthetist. You have just undergone a five hour surgical procedure to repair your left shoulder. You were shot in a terrorist attack upon the Conference Centre. You are fortunate, Professor Graham – the operation was a success. You need to rest now. You will be seen on the surgical ward later.”
Two orderlies waited for Mr. El Sharif to beckon them forward and then deftly removed the Professor onto a gurney and wheeled him to Surgical Ward 10. As El Sharif’s words became clear in rapidly returning streams of consciousness, Professor Graham opened his eyes to glossy green paint, glass-encased ceiling lights and returning sensations of nausea and pain.
One year later
It was raining. A fact unsurprising to inhabitants of Birmingham, but one of some intrigue to Karim El Sharif as he stepped from the plane onto the disembarkation ladder at Birmingham International airport. He could not remember the last time it had rained in Cairo. He was certain he had never been exposed to rain of such driving and incontinent ferocity as greeted his arrival in England. It struck him as absurd that, just hours from Cairo’s dusty streets and sun-baked, half- finished buildings, its terraced pools and fly-giddy heaps of pavement refuse, there should be this drenched, dark, tarmacadamed sprawl.
His impressions of Birmingham through the steamy taxi windows, as he was transported to his accommodation in a luxury penthouse apartment, did nothing to ease his incredulity. It remained to him out of balance that such abundance of cold water should wash colourless the landscape of this place while Cairo’s shopkeepers had risen at dawn on the same day to douse the pavements with water to prevent dust from dulling the kaleidoscopic brilliance of their merchandise.
Karim was already homesick. He had travelled to various destinations in Europe, including London, on many occasions in the last twenty -five years but had never resided outside his own country for more than ten days. This new job was a leap into cultural as well as literal darkness. His tenure as Senior Anaesthetist specialising in Neurology, at the Birmingham Federation Hospital, was for a minimum of two years, contract renewable upon application. He made up his mind before the taxi turned into the luxury city centre development that would be his home, that he would not be renewing his contract.
The drama of Karim’s repugnance for Birmingham was not muted by the carpet of tended lawns and late summer flowers which spread before the brilliant glass and gleaming steel towers of the Park Central apartments. He wordlessly paid the taxi driver and walked towards the vestibule. He would not concede so much to the downpour as to run from it.
Karim’s apartment was glamorous by any standards. It dulled a little the edge of his antipathy for his new home. He surveyed the expansive, expensively furnished cream and chrome lounge, descended the marble steps from the front door and crossed to the designer coffee table. Picking up a remote control gadget, he made a disgusted face at the rain- lashed windows and pressed a button to shutter them from view. Another button lit the room. He loosened his tie, removed his jacket and ran a hand through his sodden hair. He wanted a shower and a set of dry clothes.
Before he had a chance to do more than locate the bathroom, however, the intercom buzzer sounded loudly and startled him. He was filled with a level of irritation bordering on fury as he made his way back to the door.
“Your luggage, sir,” came the reply in a barely tamed Birmingham accent, “it’s arrived from the airport. Can I bring it up now – if that’s convenient?”
“Yes, yes. Please.” Karim took his finger off the intercom and wondered impatiently how long it would take to get his luggage and get rid of the person who would be carrying it. They would expect a tip, perhaps. He dismissed the thought. He was suddenly very tired and couldn’t be bothered to grapple with exchange rates and notions of reasonable tipping amounts for luggage boys in England. In Cairo, a pound would have been ample – the equivalent of a few pennies in England. Well, he would act as foreign as he felt and feign a tipping etiquette deficiency.
Accordingly, fifteen minutes and two arduous elevator trips later, a rather young concierge hovered awkwardly in Karim’s front doorway, just long enough to cause the Egyptian to ponder him quizzically and raise a disingenuous eyebrow. Colouring slightly, the concierge nodded curtly and left. Finally, Mr. El Sharif could take his shower and change his clothes. Then, as previously arranged, he would dial a number in Cairo to confirm that he had arrived.
Around midnight, robed in a thick dressing gown and nursing a single malt whiskey, a bottle of which he had bought during the Amsterdam stopover, Karim was stretched out on his leather sofa. His eyes were closed as he listened to Saint- Saens, Piano Concerto number 5. Saint-Saens he admired for the elitism of his precision and method. Only the virtuoso could truly render the computational intricacy of the scoring; amateurish passion and enthusiasm could not. And then of course, Saint- Saens took much inspiration from North Africa and it fascinated Karim to hear the molten landscapes and exotic fauna of his continent rendered in disciplined ‘Europeen’.
Karim El Sharif saw in his ability to practise medicine in fluent English, a similar genius with that of Saint- Saens. He opened his eyes and lifted his glass, studied the sensuous roll of the whiskey as he turned it slowly. The consumption of alcohol, Karim saw as a mere extension of his translation. At home he had no trouble embracing the extreme Sharia Law that united 2033 Egypt with other Muslim member states of the Federal African Asian Alliance. At home, to be caught drinking such a fine malt liquor would mean instant imprisonment.
It was precisely his cultural fluidity that equipped Karim El Sharif for his assignment. It was no accident that he had secured the post of Senior Anaesthetist in the Federation hospital – though his professional credentials for the job were inarguable. Karim El Sharif was also an Agent for OWN, the One World Nation Federal Government. In this capacity, he owed allegiance equally to the USCSA - United States and Canadian Security Accord as well as to EuROPA, the pan European Republican Organisation for Political Alliance, the IASF – Indo-Australasian State Federation, the SRA – Sino-Russian Accord, the NNA – Northern Nations Affiliation and also, of course, to the FAAA -Federal African Asian Alliance, of which Egypt was a member. Between them, these legitimately ratified administrative and trading concords covered the ten major geo-political regions of the Earth: Australasia, North America and Canada, South America, Europe, Africa, The Middle East, The Far East, Indonesia, Russia and Scandinavia. The most recent 2033 OWN Summit had established a single agenda for all the Earth’s continents and was hailed as a triumph of human evolution. The One World Nation Federal Agreement was heralded as the world’s first joint council for peace, prosperity and political concord in all matters most nearly affecting its population.
Karim began to nod off as the Third Movement was gathering in relentless waves of frenzied, pianistic sequences and primitive drumbeats towards what promised to be a tsunamic crescendo. But he roused himself from his chair to the perfectly synchronised, classically controlled finale of majorly harmonic phrases. Draining his whiskey glass, Karim turned off the lights and made his way to bed.
The next morning, El Sharif took a taxi to the Birmingham Federation hospital to keep his appointment with Professor Graham, under whose auspices he would perfect his neurosurgical anaesthesiological techniques.
“I do not think you remember me, Professor Graham.” The anaesthetist’s hooded eyes lit for a moment with genuine pleasure when he met with Jonathan Graham. “It is not a surprise for me. When we first met, you were barely conscious for any conversation.”
“I’m sorry,” replied the Professor, clasping Karim’s extended hand and shaking it, “you clearly have the advantage. Your face, though, is familiar. Forgive me – I can’t assume...”
“It was Egypt,” assisted Karim, “Cairo, last year. I was your anaesthetist. I came with you into the ambulance from the conference centre. I spoke to you a few times afterwards.”
“Oh my goodness!” exclaimed the Professor, genuine shock and pleasure blending in his voice, “Oh my goodness! Yes, of course! Thank you – you may have saved my life.”
Karim bowed his head graciously, then shook it as Professor Graham placed his left hand over Karim’s to emphasise the handshake.
“It was my job, Professor. There was a fair chance you would be well attended at such a conference.”
Both men laughed a little, the handshake terminated. “I am so sorry – I feel I have been very remiss.” Professor Graham was blushing. “I of course knew the tenure - the Anaesthesiology Chair – was won by an Egyptian candidate of excellent credentials – I read your resume!” Professor Graham exclaimed and laughed at his own opacity. Karim smiled and made a languidly dismissive gesture with his right hand. “No, really, “continued Graham, “I’m truly very sorry. What, er - did you say your name? Sorry!”
“No, no I think I did not – It is Karim El Sharif.”
“Well, Mr. El Sharif, routine or not, you may well have saved my bacon – my life. I lost a lot of blood and was badly shocked. Those Kalashnikovs pack a punch. I am very grateful.” Karim, clearly embarrassed, nodded, said nothing. Seeing his discomfort, Graham changed tack. “Was no one ever found responsible for that day?”
“Oh, yes. Arrests were made. Some were executed, I think.”
“I heard that,” went on Graham, “I mean, was it ever definitively proven exactly who was behind it all?”
“No. Not definitive. Terrorists, extremists. Muslim activists, I think. Many Americans attend that conference. You know how it is.”
“Sadly, yes. All too well. It seems there is an incident of that sort every few months these days. How many were killed in Cairo – twenty five or something like that?”
“Something like that, yes.”
“Many great minds were silenced that day, Mr. El Sharif.”
“Yes and please, Professor, call me Karim. We are to be colleagues after all.”
“Karim. OK – if you’ll call me Jonathan – or even better, Jon.”
“Well, Jon, at least your mind was not silenced. I am surprised though that you were back at work so soon. Your recovery from your injury was most rapid.”
“Yes, I was fortunate – blessed actually. It’s been a year now, of course. And you guys in Cairo did a first rate surgical job.”
“And you are able to perform neurosurgery as before? This is truly remarkable.”
Professor Graham nodded and looked down, an enigmatic half smile playing around his eyes and mouth. “A miracle, you could say,” he replied.
“I do not know about miracles, Professor. I know you believe such things. I have read one or two of your publications.”
“And you were in my talk – in Cairo – so you must be curious about the qualian to some degree, Karim.” There was no response. “And very grateful I am that you are. Now, tell me how it is that you come to be in Birmingham, in the Senior Anaesthetist’s chair?”
Karim shrugged. “I applied. It is good money and an excellent chance for experience. Obviously, your work is world leading, Professor. And so, I wanted to work with you. That,” and here, Karim paused and looked meaningfully into Jonathan’s eyes, “is why I attended your talk. I am a great admirer of your neurosurgical techniques. I wish to specialise in neuro- anaesthesia, so listening to you in Cairo was a -what do the Americans say? ‘A no brainer’. ”
“Well, thanks for that – although I’m not sure that’s a useful saying for a neurologist.”
Karim saw the joke, laughed briefly, nodded.
“So, welcome aboard,” added Professor Graham finally, “it’s a great pleasure to have you here.” He proceeded to business. “The first case on which you are to assist me is an interesting one. Eighteen year old girl – medically intractable SE. Shall we?” Professor Graham indicated a way forward and began to walk. Karim fell in step.
“For how long has this been the case?”
“Forty days – absolutely no response to the epilepsy meds or multiple courses of cerebral suppressant therapy. Tests indicate that the intractability is a result of synaptic homeostasis. The anti-convulsant meds are triggering a homeostatic mechanistic response – a counter neuronal over-excitability, causing her seizures.”
“OK – so surgery is indicated?”
“Yep – all phase response analyses generated consistent results with previous models. We think we can synchronise neuron response and eradicate seizure by laser removal of specific neurons. There is a .5 mm region of her temporal lobe that I believe is the cause of all her problems. We have repeatedly mapped seizure evolutions by EEG and virtual modelling and we have a computed model of this girl’s brain and its seizure activity - which I am satisfied is accurate to a hundred compartments of a single neuron.”
“That is impressive.”
“The non-synchronous activity should cease following surgery, so no need for meds and no reactive homeostatic synaptic spiking.”
“A cure for temporal lobe epilepsy, Mr. Graham. I congratulate you.”
“It’s not our first here at FHB – although to be accurate, we are still conducting follow up tests on an earlier case. But all the indications are excellent. Computational mapping has transformed epilepsy treatment and morbidity. In the States – New York City Hospital particularly – voltage sensitive electrode implantation is almost routine in single focal and partial temporal lobe epilepsy cases which don’t respond to drugs.”
El Sharif nodded, “But your surgical laser solution – eradicating specific non-synchronous neuronal activity – surely pioneering, Jonathan?”
Professor Graham smiled “Modesty forbids.” Then he added, “I have a hunch Japan are just behind us. I can’t deny it’s gratifying the UK is in the vanguard of computational neuroscience - in the treatment of epilepsy at least.” They were almost at the patient’s bedside. “We’re operating tomorrow morning." Professor Graham, slowed his pace, lowered his voice so as not to be overheard. “I think it would be useful for you to meet Lara and introduce yourself as the anaesthetist. She’s a nice kid, but terribly nervous about the op.”
El Sharif stopped walking. Professor Graham, realising his colleague had ceased to accompany him, stopped also and turned to regard Karim from a few feet away, a mildly quizzical look on his face. El Sharif was contemplating the hospital floor as though he had dropped something. “Is there something wrong?”
The anaesthetist gazed frankly into Professor Graham’s eyes. “Forgive me – I do not wish to be...insensitive... but, I was with you when you were shot. I was the anaesthetist throughout your surgery in Cairo. How is it – Jonathan - that you are able to perform such accurate micro surgery a year after your left shoulder was reconstructed?”
Mr. Graham smiled quickly, began walking once more, “Simple concern, Karim?” he asked over his shoulder.
“Of course,” the Egyptian replied, also walking forward, “such a perfect recovery – surely worthy itself of analysis. I am impressed, that is all.”
“It was my left shoulder, not my right. And as I said earlier, your people in Cairo did an excellent job – top class. The rest, my friend, is ‘Grace a Dieu,’ though I have already detected your resistance to supernatural healing. Ah, Lara, how are you feeling?”
A rather pale girl, her head already shaven to assist repeated electrode attachment and conductivity during computer brain modelling sessions, regarded him wanly and attempted a smile.
“You’ll be fine, Lara. This surgical procedure will be life-transforming – you’ll see. And no scars! We are going to use a technique called transorbital neuro-endoscopic surgery to do this. Sounds scary but it isn’t at all. Basically, we’ll be accessing your brain via a tiny incision in your right eyelid and then introducing a microscopic laser to the epileptic site via a tube not much larger than a hair. You’ll be right as rain in no time.”
He paused, smiled at the frightened girl, who said nothing, so he continued. “This gentleman is Mr. Karim El Sharif. He will be your anaesthetist for tomorrow’s procedure. He comes with excellent credentials and I can personally vouch for his competence – he was my anaesthetist during a little op I underwent a while ago. There – can’t get a better recommendation than that, eh? Let’s check your obs.”
The two medics talked quietly together as they analysed the girl’s charts, discussed her medical status. Then, following more reassurances of Lara from Professor Graham, they took their leave.
“What about," continued El Sharif as soon as they were out of the girl’s earshot, “the non-physical effects of the trauma you underwent, Jon?”
Professor Graham became very serious and his brow furrowed, though in irritation or confusion, El Sharif could not discern. “What do you mean?”
“I mean, this was a very traumatic event – being shot by terrorists, seeing others dying around you. Have you recovered so quickly from the... psychological effects of it as well as you seem to have recovered from the physical trauma?”
There was a few moments’ silence. “I am a Neurosurgeon. I exercise reason. My life consists of imposing order on or determining patterns from chaos. I choose order. How about you, Karim? Are you coping? You were there too, after all.” Professor Graham slowed his pace and turned to regard his colleague, then smiled briefly and raised an eyebrow, tilting his head in a movement that suggested polite deference while emphasising the contentiousness of his last remark. Karim did not reply but nodded slowly as the Professor turned away once more, increasing his pace along the surgical ward corridor.
The Operating theatre in which Professor Graham was to perform surgery on Lara Tobin’s brain was state of the art, as one would expect in a hospital that had been awarded World Teaching Hospital status in 2029 and so, benefited from generous donations from the World Health Promotion Fund.
When Lara was at last prostrate and anaesthetised on the computerised operating tablet, angled with decimal point precision for optimum surgical access, Karim watched Professor Graham approach the three metre square screen on which a 3D digital projection of the girl’s brain rotated at alternate precise angles. The Professor studied it with intense concentration. Mozart’s Requiem Mass in D Minor played unobtrusively in the background. At a single command from Jonathan, a 3D projection of Lara’s brain appeared, suspended in mid air, as the urgent counterpoints of the ‘Kyrie Eleison’ opened like myriad blooms in spectacular sequence . Two more commands and the brain was enlarged so that it was possible for Professor Graham to walk into the construct and survey it from as many internal angles as he required. Another command and the projection was precisely divided into sections by fine laser bands. Still another and the .5 cubic mm area of misfiring neurons appeared in brightly coloured anatomical detail, mapped to within a fraction of a nanometre by computed coordinates.
Professor Graham had performed this surgery virtually twice already. The computer had guided his virtual endoscope with infinite precision to the depth and locations necessary for laser destruction of the misfiring neurons. The entire simulated procedure was saved to a bespoke computer programme and if he required, a soothing female voice would deliver exact instructions and comment on progress, as he operated in real time.
Once Lara was anaesthetised, the virtual image of Lara’s brain was synchronised with the actual. Professor Graham was ready to operate. A tiny red light marked the location for the orbital incision and a computerised instrument, using laser scanning microscopy and electron detection, located the misfiring neurons. Thereafter, Professor Graham destroyed neurons within mapped coordinate boundaries. Just as silence bowed to the last bar of the Lacrimosa movement, the surgery was complete.
Professor Graham met El Sharif’s eyes above their masks and Karim raised his eyebrows and nodded his appreciation.
“Epilepsy cured in twenty five minutes, Professor. Not bad,” quipped Karim.
“Not really – untold hours spent with neuroscientists and programmers in computational analysis and getting familiar with the programme,” answered Jonathan. “But,” he went on, “each time will be quicker, more efficient as we get used to this extraordinary technology. The applications for the future – for so many aspects of neurosurgery – are phenomenal. It’s a Brave New World, Mr. El Sharif.”
“It is new and brave indeed,” Karim assented, reducing the dosage of anaesthetic, checking Lara’s vital signs as Professor Graham withdrew the endoscope. Just as he was finishing, Professor Graham signalled to a theatre nurse and she turned up the volume. The choral final ‘Communio’ movement was gambolling sublimely to its major resolution with brass.
“I’ll leave our patient in your very capable hands, Mr. El Sharif. Thank you,” concluded the Professor, holding his arms forward so a theatre nurse could de-gown him. Karim nodded once more, terminated the anaesthetic supply and monitored Lara Tobin to a level of consciousness in which she could breathe once more for herself. This Professor truly was most impressive.
Karim El Sharif did not believe in God. His atheism was the product of a sort of empirical reductionism that melded Marx with ontological observation. As an anaesthetist, he knew for certain that if neuronal activity in the thalamus were inhibited by anaesthetic compounds, unconsciousness ensued; the sort of dreamless unconsciousness from which most people emerged without memories or impressions. He could not imagine that death brought experience. His Muslim inheritance he shrugged off. As far as he could see, religion was what Marx had defined as “illusory happiness” to compensate, no doubt, for the unpalatable reality that death was nothing more than the end of cortical and thalamic activity; a physiological oblivion in which art, philosophy and love found equal nemeses. All were, in any case, Karim believed, just phenotypic manifestations of a sophisticated nervous system.
Karim’s realism was another eminent credential for employment as an Agent for OWN. His indifferent tolerance of all religious practices was perfectly in keeping with the Masonic foundations which allied OWN’s most distinguished and influential leaders. World history had demonstrated that taking a man’s religion from him was similar with depriving a child of its pacifier. Why do it? And, from what Karim had observed, religion was not particularly controversial in prosperity. Most people with ample material security didn’t have any strong views on God. OWN’s objective was to reduce the spiritual to equivalence with Maslow’s highest hierarchical need – self actualisation; the last thing people sought once their bellies were full and they had roofs over their heads.
Sibyl, Jonathan Graham’s wife, was almost as finely tuned to the onset of an ‘attack' as was her husband. She would stop whatever she was doing or saying and eye him knowingly.
“It’s happening again, Jon, isn’t it? I can tell. Don’t try and pretend everything’s ok – it is not ok. Please, please let’s try and get help for this.” Her appeals to his reason in the form of pressure to seek medical help became less compassionate and more directive, the longer he ignored her. “You know, Jon, for a super intelligent person you can be very...well ...why are you being so stubborn? Darling, we both know you need help!”
But whether out of fear or faith, Sybil couldn’t be sure, Jonathan refused to seek medical help for his problem. He assured her things would get better in time; that a mere twelve months after a traumatic experience, four of which had been spent in physical recovery from major surgery, were nothing. It might, he reasoned, even be a reaction to the anaesthetic. There was such a thing as postoperative cognitive dysfunction. He was not a young man and had been heavily anaesthetised following severe trauma, for five hours. This could be a side effect.
“For twelve months, Jonathan?” Sybil almost shouted at him, “That’s brain damage! You’re the neurosurgeon!”
And always, he would look terribly sad, terribly tired and say nothing.
Both of them knew the uppermost reason why Professor Graham would not seek help. If he were discovered to be suffering from any sort of mental impairment, he would lose his job. He was one of the world’s foremost neurologists. He was only fifty-three. He was on the verge of surgical breakthroughs that could change the course of neurological medicine. As long as he was able to perform surgery without impairment, Jonathan was in no hurry to concede there might be something wrong with his own brain. His auditory and visual disturbances had never interfered with his surgical work. He could not account for this, but he promised Sybil that the moment he experienced an episode while preparing to incise someone’s brain, he would hold up his hands and admit his need for treatment. Until then, he would cope. And he would pray.
Jonathan had of course considered several possible causes of his debilitating headaches and hallucinations, which he had not shared with Sybil. Post traumatic stress following his experience in Cairo was the first hypothesis he explored. The violent dreams, in which he re-lived the events of that day, began about a week after the incident. He saw with vivid, technicoloured acuity and in slow motion, the huge doors of the conference hall suddenly bulge and then burst from the walls, splintering and hurtling towards the helpless delegates. He saw the shock waves of the explosion lift people out of their seats like leaves before wind. He watched as their bodies buckled and split on impact with masonry and wood and blood sprayed through the air in elegant fans. Then came the gunmen, hooded and merciless, pumping round after round of automatic machine gun fire into the fleeing, screaming people.
Professor Graham watched it all from his rostrum vantage point, even down to the detail of the gunman who aimed specifically at him. He watched as he could not have consciously conceived in real time, the carefully raised Kalashnikov and knew with absolute clarity that it was but moments before the bullet would impact. Always, he awoke drenched in sweat and terrified past speech.
Dreams had been an elusive and rather grainy aspect of Professor Graham’s existence prior to that day in Cairo, August 2032. Now, they were threatening, in lurid vividness, to define his existence. More terrifying than the unconscious variety, were the waking dreams. He would be in the middle of a seminar and be suddenly assailed by voices speaking to him so clearly and with such syntactical accuracy, that he would stop and look around the room to locate the interruption. His students’ quizzical or concerned faces met his scrutiny as they waited for him to explain the disjunction in his train of thought. In the first few months after his return to work, colleagues assumed it was posttraumatic stress that disturbed Graham’s equanimity and that he had returned too soon. The Professor dismissed suggestions that he should go home and rest. He insisted to the Hospital Administrator that he preferred to work. It was, he declared, the best therapy he could prescribe himself.
It was no mystery to Karim El Sharif that Professor Graham was able to perform surgery unaffected by neurological disturbance. The hybrid operating theatre suite, which was the pride of Federation Hospital, was lead lined to protect its state of the art imaging and surgical equipment. It was fitted at regular intervals with lead-lined glass and liquid crystal dispersion glass panes. Here, at least, Graham was free from satellite monitoring. But how the Professor managed to remain so congruent, Karim could not fathom. He knew that the bombardment of electromagnetic signals transmitted daily to the Professor’s brain had to be causing him neurological and emotional mayhem.