Mend the Living (4 page)

An hour later, death shows up, death announces itself, a moving spot with an irregular circumference opacifying a shape that is lighter and more vast, here it is, it has arrived. Vision sharp as a cudgel blow but Revol doesn’t blink, concentrating on the shots of the body scan on his computer screen, labyrinthine images with legends like geographical maps that he rotates in all directions and zooms in on, getting his bearings, measuring the distances, while on his desk, within arm’s reach, a folder with the hospital’s logo contains a paper copy of the images considered “relevant,” provided by the medical imaging department where Simon Limbeau’s brain was scanned – his head was swept by x-rays to produce these images, and, according to what’s called electron tomography, the data was seized by “slice,” “cuts” of a millimetre thick that could be analyzed on all planes of space, coronal, axial, sagittal, and oblique. Revol knows how to read these images and what they confirm in terms of the state of the subject, what they herald in terms of developments; he recognizes these shapes, these spots, these halos, interprets these milky rings, decrypts these black marks, deciphers legends and codes; he compares, verifies, starts again, carries out his investigation all the way to the end, but there’s nothing to be done, it’s already over: Simon Limbeau’s brain is on the verge of destruction – it’s drowning in blood.

Diffuse lesions, severe cerebral swelling, and nothing that could keep the intracranial pressure under control, it’s already much too high. Revol sinks back in his chair. His hand comes to cup his chin as his gaze trails across the desk, skims over the disorder, the scribbled notes, the administrative circulars, the photocopy of an article issued by the ethics committee of the Paris public hospital administration on organ recovery “after the heart has stopped”; his eyes glide over the small objects placed there (including the turtle carved of jade, a present from a young patient with severe asthma), grind to a halt on the mauve slopes of Mount Aigoual draped in streaming runoff and Revol probably thinks back, then, in a flash, to that day in September when he was initiated into peyote at his house in Vallerauge – Marcel and Sally arrived at the end of the afternoon in an emerald-green sedan, the rims splattered with dried mud; the vehicle stopped heavily in the courtyard and Sally waved her hand out the window yoo-hoo we’re here! her snowy white hair flying about inside the car, revealing her wooden earrings, duo of varnished scarlet cherries; and later, after dinner, when night had fallen over the plateau, a rain of bright stars, they went out into the garden and Marcel’s hands pulled back a newspaper wrapping to reveal a few small verdigris cacti, round and without spines; the three friends rolled them in their palms and breathed in the bitter smell; these fruits came from far away, Marcel and Sally had gone to get them in a mining desert in northern Mexico, illegally stowed and carefully transported them all the way to the Cévennes, and Pierre, who studied hallucinogenic plants, was impatient to try it: he was fascinated by the idea of these visions from nowhere, brought on by the combination of powerful alkaloids contained in peyote, one-third mescaline, visions with no link to memory – visions that played a major role in the ritual use of this cactus, usually consumed by Native Americans during shamanic ceremonies. Even more, Pierre was interested in the synesthesia that sometimes happened during hallucinations: psycho-sensory alertness was supposed to be most intense in the first phase after ingestion, and he hoped to see tastes, see odours, see sounds and tactile sensations, and hoped that the translation of senses into images would help him to understand – to pierce – the mystery of pain. Revol thinks back to that sparkling night, when the canopy of heaven tore open over the mountains, revealing unsuspected spaces into which they attempted to dive, lying in the grass with their backs to the earth, and suddenly he’s struck by the idea of a universe in expansion, in a state of perpetual becoming, a space where cellular death would be the catalyst for metamorphosis, where death would shape the living the way silence shapes sound, darkness the light, or static the mobile; a fleeting intuition that persists on his retina even now when his eyes come back to skim over his computer screen, this sixteen-inch rectangle radiated by black light announcing the cessation of all mental activity in Simon Limbeau’s brain. He’s not able to connect the young man’s face with death, and his throat grows tight. Nearly thirty years, though, that he’s been working in death’s vicinity, thirty years that he’s been hanging around death’s door.

Pierre Revol was born in 1959. Cold War, triumph of the Cuban Revolution, first vote for Swiss women in the canton of Vaud, filming of Godard’s
Breathless
, release of Burroughs’s
Naked Lunch
and Miles Davis’s mythical opus,
Kind of Blue
 – only the most important jazz album of all time, to quote Revol, who likes to show off, lauding the vintage quality of his birth year. Anything else? Yes – he adopts a detached tone, crafting his delivery carefully (we imagine him avoiding the gaze of his interlocutor and doing everything else possible, digging in his pocket, punching in a number on his phone, deciphering a text) – it was also the year they redefined death. And at that moment, he’s rather pleased with the mix of astonishment and fear he glimpses on the faces of those around him. Lifting his head and smiling vaguely, he adds: which, for an intensive care anaesthetist, is hardly insignificant.

In fact, in 1959, instead of being that placid infant with the triple chin of a provincial senator, stuffed in a romper with complicated fastenings, and instead of sleeping away two-thirds of his time in a Moses basket of pale straw with checked lining, Revol often says to himself that he would have liked to be in the room during the fateful Twenty-Third International Neurology Meeting – the day when Maurice Goulon and Pierre Mollaret stepped up to the podium to share their work. He would have paid good money to see them addressing the medical community; in other words, to see them standing face-to-face with the world itself, these two men, the neurologist and the infectious diseases specialist, forty and sixty-some years old, dark suits and polished black shoes, bow ties most likely; he would have loved to observe what showed of their relationship, the mutual respect shaded by an age difference that would instate that silent hierarchy common in scientific assemblies, my dear colleague, my dear colleague – but who would speak first? who would have the privilege of concluding? yes, the more Revol thinks about it, the more he would have liked to be there on that day, to take his seat among the pioneers of intensive care, men, mostly, keyed up and concentrating, to be one of them, there, at the Claude-Bernard Hospital – a trailblazing medical facility: in 1954, Pierre Mollaret would inaugurate the first modern intensive care unit in the world, he would form a team, transform the Pasteur wing to hold nearly seventy beds, would install the famous Engström 150, electric ventilators developed to combat the epidemics of poliomyelitis besieging northern Europe – these would replace the “iron lungs” that had been used since the 1930s; and the more Revol concentrates, the more he fleshes out the scene, this primitive scene that he never witnessed, the better he’s able to hear the two professors quietly exchange a few words, arrange their papers on the desk, and clear their throats in front of the microphones; they wait, impassive, for the hubbub to die down, for silence to fall, before finally beginning their talk with that cold clarity of those who, conscious of the fundamental import of what they have to say, abstain from any embellishment and simply describe, describe, describe, playing their conclusions like the ace in poker; and every time he does so, the enormity of their pronouncement stuns him again, explodes in his face. Because what Goulon and Mollaret came to say can be summed up in one sentence, in the form of a slow cluster bomb: the heart stopping is no longer the sign of death – from now on it’s the cessation of brain function that is the indication. In other terms: if I don’t think anymore, therefore I am no more. Deposition of the heart and coronation of the brain – a symbolic
coup d’état
, a revolution.

And so the two men addressed the assembly, described the established signs of what they now call an irreversible coma, detailed several cases of patients whose cardiac and respiratory functions were maintained mechanically by ventilators, even though all brain activity had ceased – patients who, had the resuscitation equipment and techniques for keeping blood flowing to the brain not been perfected, would have indeed tipped over into cardiac death. They posited that the increase in medical resuscitation had changed the game, that progress within the discipline required a new definition of death, and they believed that this scientific event – of an incredible philosophical impact – could also pave the way for organ recovery and transplantation.

Goulon and Mollaret’s announcement was followed by the publication of a crucial article, in the
Revue neurologique
, that exposed twenty-three cases of irreversible coma – and everyone will remember the titles of those few books in Revol’s office, including that review from 1959, it’s easy to guess which issue: a document that Revol would have tracked on eBay, bought without bidding, and picked up one November evening at the Lozère–École polytechnique station on the RER B line – he had paced in the cold for a long time, keeping watch for his seller; she finally emerged in the form of a little woman crowned with a topaz turban, who scampered along the platform until she reached him, then pocketed the cash, pulled the journal out of a plaid shopping bag, and did her scheming best to swindle him.

Riveted once more to his computer screen, Revol takes note of what appears, closes his lids, opens them again, and suddenly stands up as though he’s about to set off on a race. It’s 11:40 when he calls the department front desk, Cordelia Owl picks up, Revol asks her if Simon Limbeau’s family has been notified, and the young woman answers yes, the police phoned his mother, she’s on her way.

M
arianne Limbeau enters the hospital through the main doors and walks straight to the information desk where two women are seated behind computer screens, two women in light-green shirts who speak quietly to one another. One of them has a thick black braid over her shoulder, she lifts her head to Marianne: Hello! Marianne doesn’t immediately respond, doesn’t know which department to go to – emergency, intensive care, trauma surgery, neurobiology – and struggles to decipher the list of services on a large sign attached to the wall, as though the letters, the words, and the lines were overlapping and she couldn’t put them back in order, couldn’t make sense of them. She finally says: Simon Limbeau. Pardon? The woman frowns – eyebrows thick and also black, they come together in a fuzzy cluster over her nose – Marianne starts again, manages to form a sentence: I’m looking for Simon Limbeau, my son. Ah. On the other side of the counter, the woman leans over the computer and the tip of her braid grazes the keyboard like a Chinese paintbrush: what’s the name? Limbeau, L–I–M–B–E–A–U, Marianne spells out and then turns toward the hall, immense, the high ceiling of a cathedral and the floor of a skating rink – the acoustics, the sheen, and the marks – scattered pillars, it’s quiet here, not many people, a guy in a gown and shower shoes walks with a crutch toward a pay phone, a woman in a wheelchair is pushed along by a man wearing a fedora with an orange feather – a neurasthenic Robin Hood – and far off, near the cafeteria, in front of the row of doors in the dimness, three women in white stand together, plastic cups in hand, I don’t see him, when was he admitted? The woman keeps her eyes on the screen and clicks her mouse, this morning, Marianne exhales her answer, the woman lifts her head, oh so maybe it was an emergency? Lowering her eyes, Marianne nods as the woman straightens again, throws her braid over her shoulder and with a wave of her hand indicates the elevators at the end of the hall and the path to follow to get to the emergency department without having to go outside into the cold and all the way around the buildings. Marianne thanks her and continues on her way.

She had just fallen back to sleep when the telephone rang, nestled in an interlacing of pale dreams that sifted the light of day and the strident, synthetic voices of a Japanese animation on the television – later, she would look for signs, in vain: the more she tried to round up the memory, the more her dreams dissolved; she couldn’t grasp anything tangible, nothing that could make sense of this shock that had happened thirty kilometres away, at the same moment, in the mud of the road – and it wasn’t she who answered, it was Lou, seven years old, who came running into her room, not wanting to miss a single moment of the show she was watching in the living room, and who simply put the phone against her mother’s ear before rushing right out again, so that the voice in the receiver also wove itself into Marianne’s dreams, growing louder, insistent, and it was only when she finally heard these words, please, can you answer me: are you Simon Limbeau’s mother? that Marianne sat straight up in bed, brain blinking awake in terror.