‘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?’
‘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.