Роберт Уоррен - All the king's men

I did see Adam a few times in June. He was more deeply involved than before in the work of the medical center, more grimly and icily driving himself. There was, of course, some letup in the work at the University with the end of term, but whatever relief was there, was more than made up for by an increase in his private practice and work at the clinic. He said he was glad to see me when I went to his apartment, and maybe he was, but he didn't have much to say, and as I sat there he would seem to be drawing deeper and deeper into himself until I had the feeling that I was trying to talk to somebody down a well and had better holler if I wanted to be understood. The only time he perked up was one night when, after he had remarked on the fact that he was to perform an operation the next morning, I asked about the case.

It was a case of catatonic schizophrenia, he said.

"You mean he is a nut?" I asked Adam grinned and allowed that that wasn't too far wrong.

"I didn't know you cut on folks for being nutty," I said. "I thought you just humored and gave them cold baths and let them make raffia baskets and got them to tell you their dreams."

"No," he said, "you can cut on them." Then he added, almost apologetically, "A prefrontal lobectomy."

"What's that?"

"You remove a piece of the frontal lobe of the brain on each side," he said.

I asked would the fellow live. He said you never could tell for sure, but if he did live he would be different.

I asked how did he mean, different.

"Oh, a different personality," he replied.

"Like after you get converted and baptized?"

"That doesn't give you a different personality," he said. "When you get converted you still have the same personality. You merely exercise it in terms of a different set of values."

"But this fellow will have a different personality?"

"Yes," Adam said. "The way he is now he simply sits on a chair or lies in his back on a bed and stares into space. His brow is creased and furrowed. Occasionally he utters a low moan or an exclamation. In some such cases we discover the presence of delusions of persecution. But always the patient seems to experience a numbing, grinding misery. But after we are through with him he will be different. He will be relaxed and cheerful and friendly. He will smooth his brow. He will sleep well and eat well and will love to hang over the back fence and compliment the neighbors on their nasturtiums and cabbages. He will be perfectly happy."

"If you can guarantee results like that," I said, "you ought to do a land-office business. As soon as the news gets around."

"You can't ever guarantee anything," Adam said.

"What happens if it doesn't come out according to Hoyle?"

"Well," he said, "there have been cases–not mine, thank God–where the patient didn't come cheerfully extroverted but became completely and cheerfully amoral."

"You mean he would throw the nurses down right on the floor in broad daylight?"

"About that," Adam said. "If you'd let him. All the ordinary inhibitions disappeared."

"Well, if your guy tomorrow comes out like that he will certainly be an asset to society."

Adam grinned sourly, and said, "He won't be any worse than a lot of other people who haven't been cut on."

"Can I see the cutting" I asked. I felt all of a sudden that I had to see it. I had never seen an operation. As a newspaperman, I had seen three hangings and one electrocution, but they are different. In a hanging you do not change a man's personality. You just change the length of his neck and give him a quizzical expression, and in an electrocution you just cook some bouncing meat in a wholesale lot. But this operation was going to be more radical even than what happened to Saul on the road to Damascus. So I asked could I see the operation.

"Why?" Adam asked, studying my face.

I told him it was plain curiosity.

He said, all right, but it wouldn't be pretty.

"It will be as pretty as a hanging, I guess," I replied.

Then He started to tell me about the case. He drew me pictures and he got down books. He perked up considerably and almost talked my ear off. He was so interesting that I forgot to ask him a question which had flitted though my mind earlier in our conversation. He had said that in the case of a religious conversion the personality does not change, that it is merely exercised in terms of a different set of values. Well, I had meant to ask him how, if there was no change in personality, how did the person get a different set of values to exercise his personality in terms of? But it slipped my mind at the time.

Anyway, I saw the operation.

Adam got me rigged up so I could go right down in the pit with him. They brought in the patient and put him on the table. He was a hook-nosed, sour-faced, gaunt individual who reminded me vaguely of Andrew Jackson or a back-country evangelist despite the white turban on his head made out of sterile towels. But that turban was pushed pretty far back at a jaunty angle, for the front part of his head was exposed. It had been shaved. They put the mask on him and knocked him out. Then Adam took a scalpel and cut a neat little cut across the top of the head and down at each temple, and then just peeled the skin off the bone in a neat flap forward. He did a job that would have made a Comanche brave look like a tyro with a scalping knife. Meanwhile, they were sopping up the blood, which was considerable.

Then Adam settled down to the real business. He had a contraption like a brace and bit. With that he drilled five or six holes–burr holes they call them in the trade–on each side of the skull. Then he started to work with what he had told me earlier was a Gigli saw, a thing which looked like a coarse wire. With that he sawed on the bone till he had a flap loose on each side of the front of the head and could bend the flap down and get at the real mechanism inside. Or could as soon as he had cut the pale little membrane which they call the meninges.

By that time it had been more than an hour, or so it seemed to me, and my feet hurt. It was hot in there, too, but I didn't get upset, even with the blood. For one thing, the man there on the table didn't seem real. I forgot that he was a man at all, and kept watching the high-grade carpenter work which was going on. I didn't pay much attention to the features of the process which did indicate that the thing on the table was a man. For instance, the nurse kept on taking blood-pressure readings and now and then she would mess with the transfusion apparatus–for they were given the patient a transfusion all the time out of a bottle rigged up on a stand with a tube coming down.

I did fine until they started the burning. For taking out the chunks of brain they use an electric gadget which is nothing but a little metal rod stuck in a handle with an electric cord coming out of the handle. The whole thing looks like and electric curling iron. In fact, all the way through I was struck by the notion that all the expensive apparatus was so logical and simple and homey, and reminded me so completely of the stuff around any well-equipped household. By ransacking the kitchen and your wife's dressing table you can get together in five minutes enough of a kit to set up in business for yourself.

Well, in the process of electrocautery this little rod does the trick of cutting, or rather burning. And there is some smoke and quite a lot of odor. At least, it seemed like a lot to me. At first it wasn't so bad, but then I knew where I had smelled an odor like that before. It was the night, long back when I was a kid, when the old livery stable had burned down at the Landing and they hadn't managed to get all the horses out. The smell of the cooking horses was on the still, damp, ripe night air and you couldn't forget it, even after you didn't hear any more the shrieks the horses had made. As soon as I realized that the burning brain had a smell like the burning horses, I didn't feel good.