The Complete Short Stories: Volume 2. Adam Thirlwell

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 I …’

      ‘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 résumé 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