Richard Powers - The Echo Maker

“What about his higher…? What’s above reptile — some kind of bird?”

“The next higher structure is the mammalian.”

Her lips moved as he talked, assisting. She couldn’t help it. “And my brother’s?”

Dr. Hayes grew guarded. “That’s harder to say. We don’t see any explicit damage. There is activity. Regulation. The hippocampus and amygdala seem intact, but we did see some spiking in the amygdala, where some of the negative emotions, like fear, start.”

“You’re saying my brother is afraid ?” She waved off the doctor’s reassurances, thrilled. Mark was feeling. Fear or anything: it didn’t matter. “What about his…human brain? The part above the mammal?”

“He’s piecing himself back together. Activity in his prefrontal cortex is struggling to synchronize into consciousness.”

She asked Dr. Hayes for every pamphlet the hospital had on head injury. She underlined all the hopeful suggestions in green fine-line marker. The brain is our last frontier. The more we learn about it, the more we see how much more there is to know. The next time she met Dr. Hayes, she was ready.

“Doctor, have you considered any of the new head-injury treatments?” She scrambled in her shoulder bag for her little spiral notebook. “Neuroprotective agents? Cerestat? PEG-SOD?”

“Wow. I’m impressed. You’ve done your homework.”

She tried to look as competent as she wanted him to be.

Dr. Hayes steepled his fingers and touched them to his lips. “Things happen fast in this field. PEG-SOD has been discontinued, after poor results in a second Phase III trial. And I don’t think you want cerestat.”

“Doctor.” Her client-relations voice. “My brother is struggling to open his eyes. You say he may be terrified. We’ll take anything you can give him.”

“All research on cerestat — Aptiganel — has been halted. A fifth of all patients taking it have died.”

“But you have other drugs, don’t you?” She looked down at her notebook, tremoring. At any moment, her hands would turn to doves and fly away.

“Most are still in the early testing. You’d have to be in a clinical trial.”

“Aren’t we, already? I mean…” She waved toward her brother’s room. In the back of her mind, she heard the radio jingle: Good Samaritan Hospital…the largest medical facility between Lincoln and Denver.

“You’d have to change hospitals. Go where they’re running the studies.”

She looked at the man. With proper grooming, he could be the advice doctor on breakfast television. If he saw her at all, it was only as a complication. He probably found her pathetic, in every measurable way. Something in her reptilian brain hated him.

Rises up in flooded fields.There is a wave, a rocking in the reeds. Pain again, then nothing.

When sense returns, he is drowning. Father teaching him to swim. Current in his limbs. Four years old, and his father floating him. Flying, then flailing, then falling. His father grabbing his leg, pulling him under. Holding him beneath the surface, stiff hand pressing down his head until all bubbles stop. River will bite, boy. Be ready.

But there is no bite , no ready . There is only drown .

There comes a pyramid of light, burning diamonds, twisting fields of stars. His body threads triangles of neon, a tunnel rising. The water over him, his lungs on fire, and then he explodes upward, toward air.

Where his mouth was, just smooth skin. Solid swallows up that hole. House remodeled; windows papered over. Door no more a door. Muscles pull lips but no space to open. Wires only, where words were. Face bent wrong and folded up into its own eyes. Slipped in a metal bed, the hell he must be in. His smallest move a pain worse than dying. Maybe death is done already. Done all ways, in one tip of his life and lifting. Who’d want to live after such a fall?

A room of machines, the space he can’t reach. Something splits out from him. People move in and smooth away too fast. Faces push up to his mouthless face, pushing words into him. He chews them and puffs sound back. Someone says be patient, but to not him. Be patient, be a patient is what he must be.

This may be days. No saying. Time flaps about, wings broken. Voices pass, some circle back, but one’s as close to always there as there is. A face almost his face, so close it wants something of him, if only at least words. That face a she and like water weeping. Nothing she is will say what happened.

One need tries to tear out of him. Need to say , more than the need to be. If a mouth, then all would be out. Then this she would know what happened, know his death wasn’t what it seems.

Pressure fills, like fluid crushed. His head: endless pressure, buried already. Sap streams out of his inner ear. Blood out his gorged eyes. Killing pressure, even after all that seeps out of him. A million more schooling thoughts than his brain can hold.

A face hovers near, forming words on fire. Says Mark, stay , and he would die to make her stop keeping him alive. He pushes back against the thing collapsing him. Muscles pull but skin won’t move. Something slack. He works forever to winch the tendons in his neck. At last his head tilts. Later, lifetimes, lifts the edge of his upper lip.

Three words would save him. But all muscles can’t free one sound.

Thoughts throb in a vein. Red pulses his eyes again, then that one white shaft shooting up from the black he blasted through. Something in the road he’ll never reach now. Screaming up close as his life rolled. Someone here in this room, who will die with him.

The first word comes. It surfaces through a bruise wider than his throat. The skin grown over his mouth tears clear and a word forces through the bloody opening. I . The word hisses, taking so long she’ll never hear. I didn’t mean.

But words change to flying things as they hit the air.

Two weeks in, Mark sat up and moaned.Karin was at his bedside, five feet from his face. He buckled at the waist, and she screamed. His eyes twisted around and found her. Her scream turned into a laugh, then a sob, while his eyes twitched over her. She called his name, and the face underneath the tubes and scars flinched. Soon a raft of care-givers filled the room.

Much had happened underground, in the days he lay frozen. Now he poked out, like winter wheat through snow. He turned his head, craning his neck. His hands thrust out clumsily. His fingers picked at the invasive hardware. He hated most his gastric feeding tube. As his arms got better at clawing it, the nurses imposed soft restraints.

Now and then, something spooked him, and he thrashed to escape it. Nights were the worst. Once when Karin was leaving for the day, a wave of chemicals bucked through him and he surged upright, scrambling almost to his knees on his hospital bed. She had to wrestle him down to keep him from tearing out his hoses.

She watched him return, hour by hour, as in some grim Scandinavian film. Sometimes he gazed at her, weighing if she was edible or a threat. Once, a surge of animal sexuality, forgotten in the next moment. At times she was a crust he tried to brush from his eyes. He shot her that liquid, amused look he’d given her one night when they were teens, each of them crawling home from their respective assignations, drunk. You, too? I didn’t know you had it in you.

He started vocalizing — groans muffled by the tracheotomy tube, a secret, vowel-free language. Every rasp lacerated Karin. She badgered the doctors to do something. They measured scar tissue and cranial fluid, listening to everything but his frantic gurgling. They swapped his trach tube for a fenestrated one, pierced with tiny holes, a window in Mark’s throat wide enough for sounds to pass through. And every one of her brother’s cries begged for something Karin couldn’t identify.