filling the shops and streets of the seaside town, their slow rhythms and hesitant walk overlaying everything like a grey veil.
By contrast, Dr Knight’s self-confidence and casual air, however brusque and aggressive, quickened Conrad’s pulse.
Towards the end of the visit, when his aunt had strolled to the end of the ward with Nurse Sadie to view the fountains, Conrad said to his uncle, ‘Dr Knight told me he could do something for my leg.’
‘I’m sure he can, Conrad.’ Uncle Theodore smiled encouragingly, but his eyes watched Conrad without moving. ‘These surgeons are clever men; it’s amazing what they can do.’
‘And your hand, Uncle?’ Conrad pointed to the dressing that covered his uncle’s left forearm. The hint of irony in his uncle’s voice reminded him of Dr Knight’s studied ambiguities. Already he sensed that people were taking sides around him.
‘This hand?’ His uncle shrugged. ‘It’s done me for nearly sixty years, a missing finger won’t stop me filling my pipe.’ Before Conrad could speak he went on: ‘But that leg of yours is a different matter, you’ll have to decide for yourself what to have done with it.’
Just before he left he whispered to Conrad, ‘Rest yourself well, lad. You may have to run before you can walk.’
Two days later, promptly at nine o’clock, Dr Knight came to see Conrad. Brisk as ever, he came to the point immediately.
‘Now, Conrad,’ he began, replacing the cradle after his inspection, ‘it’s a month since your last stroll by the beach, time to get you out of here and back on your own feet again. What do you say?’
‘Feet?’ Conrad repeated. He managed a slight laugh. ‘Do you mean that as a figure of speech?’
‘No, I mean it literally.’ Dr Knight drew up a chair. ‘Tell me, Conrad, have you ever heard of restorative surgery? It may have been mentioned at school.’
‘In biology — transplanting kidneys and that sort of thing. Older people have it done. Is that what you’re going to do to my leg?’
‘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 ‘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 rsum 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?’
