We’ve got someone for you. A call at 10:12 a.m. Neutral, informative, staccato. A man, six feet, 150 pounds, about twenty years old, automobile accident, traumatic brain injury, in a coma—we know who this is, of course: his name is Simon Limbres. The call is barely over before the emergency medical team arrives at the ICU. The fire doors open and the stretcher is rolled through the department’s main corridor, people moving out of its way. Révol appears. He has just examined the patient admitted in the night after convulsions and he is pessimistic: the woman was not given CPR in time; a scan revealed that liver cells died after the heart stopped beating, a sign that the brain cells were affected too. Now, after being alerted, he sees the gurney at the end of the corridor and thinks: This is going to be a long day.
The emergency team’s doctor follows the stretcher. Bald, in his mid-fifties, he has the physique of a mountain climber: zero body fat, hard as stone. He exposes pointed teeth when he shouts out: Glasgow 3! Then, to Révol: The neurological examination showed no spontaneous reaction to auditory, visual, or tactile stimulation; there is also ocular damage (asymmetrical eye movement) and respiratory autonomic dysfunction; we’ve intubated him. He closes his eyes and smooths his skull, from the forehead to the occiput: suspected cerebral hemorrhage after a TBI, nonreactive coma, Glasgow 3—he uses this shared language, this language that banishes prolixity as time-wasting, forbids any notions of eloquence or seductiveness in articulation, abuses nouns, codes, and acronyms, this language where to talk is to describe or provide information about a body, to lay down the parameters of a situation in order that a diagnosis can be made, tests ordered, that the patient can be treated, saved: the power of concision. Révol absorbs each piece of information, then orders a body scan.
* * *
It’s Cordélia Owl who takes charge of the young man, supervising the transfer to his room, to his bed. After that, the emergency team leaves the department, taking its equipment—stretcher, mobile respirator, oxygen tank. Now she has to fit an arterial catheter, electrodes on the thorax, a urinary catheter, and to start up the monitor that displays Simon’s vital signs—lines of various colors and shapes appear on the screen, superimposed, straight lines or broken lines, hatched derivations, rhythmic undulations: medical Morse. Cordélia works with Révol: her actions are assured, her movements fluid, relaxed, as if the viscous ennui that clogged her every gesture only yesterday has been purged from her body.
* * *
One hour later, death clears its throat, knocks politely on the door, a moving stain, irregularly shaped, opacifying a clearer, larger shape: yes, there it is, that’s death. An abrupt vision, like a hard slap in the face, but Révol does not blink, concentrating on the body-scan pictures that appear on his computer screen: labyrinthine images, each with a key, like a map, that he has to rotate in every direction, zoom into, on which he must make reference points and measure distances, while close by on his desk lies a hospital-branded cardboard folder containing a paper printout of “relevant” images provided by the Radiology Department that scanned Simon Limbres’s brain. To produce these representations, the boy’s head was scanned by X-rays, and then, using a tomographic analysis, the data was divided into “slices,” each thinner than a sheet of paper, which could be analyzed in every spatial plane: coronal, axial, sagittal, and oblique. Révol can read these images, what they say about the patient’s state and what they augur for his future; he recognizes those shapes, those marks and haloes, interprets those milky rings, deciphers those black spots, those legends and codes; he compares, checks, recommences, continues his investigation until the inevitable conclusion: Simon Limbres’s brain is dying; it is drowning in blood.
Diffuse lesions, early cerebral swelling, and there is nothing they can do to control intracranial pressure, already way too high. Révol leans back in his chair. His gaze lingers on the disorder of his desk while he thumbs his jaw; he surveys the scrawled notes, the administrative newsletters, the photocopy of an article sent by the Ethics Unit of the Paris Hospital Administration on tests carried out in the moment of heart failure; his eyes glide over the various small objects that cover the desk, including that tortoise carved in jade, a gift from a young female patient who was suffering with severe asthma, then suddenly halt at the streaming purplish slopes of Mont Aigoual. In all likelihood, Révol is remembering, in a flash, that September day when he first used peyote in his house in Valleraugue. Marcel and Sally had arrived in late afternoon in an emerald sedan, its wheel rims caked with dry mud. The vehicle had come to a juddering stop outside his house and Sally had waved through the open window Hello! Hey! It’s us!, her snow-white hair flying, revealing her wooden earrings—a pair of lacquered scarlet cherries. Later, after they’d eaten, as night was falling over the limestone plateau, a rain of bright stars, they had gone out into the garden and Marcel had unwrapped a parcel containing a few little grayish-green cactuses, round and thornless, which the three friends rolled around in their palms before inhaling the bitter smell. These plants had come a long way: Sally and Marcel had gone to a mining desert in northern Mexico to find them, had smuggled them illegally out of the country, and had carefully brought them here, to the Cévennes. Now Pierre, who studied hallucinogenic plants, was impatient to try them: the combination of powerful alkaloids contained in peyote, a third of which were mescaline, provoked visions that seemed to come from nowhere, unrelated to memories, visions that played a major role in the ritual use of this cactus, which the indigenous Americans most often consumed during shamanic ceremonies. But, even more than this, what interested Pierre was the synesthesia that manifested during these hallucinations: psychosensory vividness was supposed to increase in the first phase of ingestion, so he hoped to be able to see tastes, to see odors and sounds, tactile sensations, and he hoped that this translation of the other senses as images would help him to understand, even to solve, the mystery of pain. Révol thinks of that brilliant night, when the celestial vault had split open above the mountains, releasing unsuspected places they had tried to dive into, lying in the grass, faces to the sky, and suddenly the idea crosses his mind of a constantly expanding universe, a place where cellular death will be the operator of metamorphoses, where death will shape the living like silence shapes noise, or darkness light, or the static the mobile—a fleeting intuition that persists on his retina even as his eyes refocus on the computer screen, that sixteen-inch rectangle irradiated with black light where the cessation of all mental activity in Simon Limbres’s brain is announced. Unable to connect the young man’s face with death, he feels his throat tighten. And yet he’s been working in this area for nearly thirty years. Thirty years.
* * *
Pierre Révol was born in 1959. The Cold War, the Cuban Revolution, Swiss women voting for the first time in the canton of Vaud, the shooting of Godard’s Breathless, the publication of Burroughs’s Naked Lunch and the release of Miles Davis’s mythical opus Kind of Blue—just the greatest jazz album of all time, according to Révol, who likes to glorify his own vintage. Anything else? Oh yes—he puts on a casual air in order to increase the power of the revelation: you can imagine him looking away as he speaks to you, turning his attention to something else altogether, perhaps rummaging in his pocket or dialing a phone number or reading a text—yes, it’s the year when death was redefined. And in that moment, he is not displeased by the mixture of stupor and dread that he sees on the faces of the people around him. Then, lifting his head and smiling vaguely, he adds: Which is not exactly insignificant when you happen to work in Intensive Care.
In fact, Révol often thinks that in 1959, rather than being a mere placid baby with the triple chin of a provincial politician, bundled up in a onesie, rather than spending two-thirds of his life asleep in a pale-straw, gingham-lined Moses basket, he would have preferred to be in that room, at the Twenty-third International Congress of Neurology, on the day when Maurice Goulon and Pierre Mollaret took the podium to present their findings; what wouldn’t he have given to see them speaking to the medical community—or, in other words, to the world itself—those two men, the neurologist and the specialist in infectious diseases, aged about forty and sixty, dark suits and polished black shoes, bow ties; he would have loved to have observed what he could of their relationship, the mutual respect that bridges the age gap, the silent hierarchy that always exists at meetings of scientists, my esteemed colleague, my esteemed colleague—but who speaks first? who has the privilege of concluding? Yes, the more Révol thinks about this, the more sure he feels that he would have liked to be there, that day, sitting among the pioneers of resuscitation—men, mostly, feverishly concentrated—would have liked to be one of them, in that place, the Hospital Claude-Bernard, a trailblazing hospital where Pierre Mollaret had created, in 1954, the first modern Intensive Care Unit in the world. He had formed a team, renovated the Pasteur Building so it could hold nearly seventy beds, ordered the famous Engstrom 150 electric ventilators, developed to deal with the polio epidemic that was raging in the north of Europe, and that would replace the “iron lungs” that had been used since the thirties. And, the more Révol concentrates, the better he is able to visualize this scene—this seminal scene that he never experienced in reality—the more he can hear the two professors whispering to each other, arranging their papers on the lectern, clearing their throats behind the microphones, waiting impassively for the hubbub to die down and silence to descend so that they can finally begin speaking in that cold, clear tone unique to those who, aware of the fundamental importance of what they are saying, feel no need to add anything, content simply to describe, describe, describe, laying down their conclusions the way you lay down four aces in a poker hand. Even now, the enormity of their announcement stupefies him. Because what Goulon and Mollaret said that day could be summarized in a single phrase that was like a cluster bomb exploding in slow motion: the moment of death is no longer to be considered as the moment the heart stops, but as the moment when cerebral function ceases. In other words: I no longer think, therefore I no longer am. The heart is dead, long live the brain—a symbolic coup d’état, a Revolution.
* * *
So the two men stood on the podium, facing their peers, and described the outward signs of what they now call the coma dépassé. They detailed several case histories in which patients, placed on ventilators, maintained their cardiac and respiratory functions without showing any cerebral activity—patients who, without new machines and techniques enabling a blood supply to their brains, would have suffered cardiac arrest. From there, they established that the development of medical resuscitation had changed everything, that progress in their field had led them to formulate a new definition of death, and that they assumed this scientific breakthrough—with its startling philosophical repercussions—would also have the consequence of authorizing and enabling organ transplants.
Goulon and Mollaret’s speech was followed by the publication of a crucial article in the Revue neurologique detailing twenty-three cases of coma dépassé. You undoubtedly remember the description of the books on Révol’s metal shelf, mentioning a copy of an issue of that magazine from 1959, so you will have already guessed that the article appeared in that very issue. Révol bought the issue on eBay and picked it up from the seller at the Lozère-École Polytechnique station on the RER B train line. He spent a long time waiting in the cold for the seller to arrive—a little lady in a topaz turban who trotted along the platform until she reached him, pocketed his cash, then extracted the magazine from a tartan shopping bag and craftily attempted to swindle him.
* * *
Révol, eyes riveted once again to his computer screen, duly records the boy’s death, closes his eyes, opens them, and suddenly sits up. It is 11:40 a.m. when he calls the department office. Cordélia Owl answers. Révol asks her if Simon Limbres’s family has been informed and the young nurse says yes, the police called his mother. She’s on her way now.