This etext was produced from Analog Science Fact & Fiction September 1963. Extensive research did not uncover any evidence that the U.S. copyright on this publication was renewed.
AM I STILL THERE?
Which must in essence, of course, simply be the question "What do I mean by 'I'?"
by JAMES R. HALL
ILLUSTRATED BY LEO SUMMERS
* * * * *
Lee slid off the examining table and began buttoning his shirt. He had had a medical examination every six months of his adult life, and it always seemed strange to him that, despite the banks of machines the doctor had which could practically map a man from a single cell outward, each examination always entailed the cold end of a stethoscope against his chest.
He tucked his shirt into his pants and turned to the examining doctor who was writing on a chart.
"Well?" Lee asked him.
"Sound as a dollar," replied the doctor. "Of course Dr. Flotman or Dr. Roberts might turn up something on their electronic monsters, but I see no reason why we can't go ahead on schedule."
Lee felt relieved. Even while being examined by technicians, M.D.'s and biologists, he had been conscious of the hundreds of little dull pains which had nibbled like mice in every corner of his brain. Sometimes he felt like a piece of his brain was being completely smothered, a horrible sensation of having a part of his head severed from him. This would go away, but would appear again in a different area, usually in about fifteen to thirty minutes. Well, the doctor said he was fit for surgery. That would end this nagging pain, just as it always had in the past.
"... If you're ready now." Lee became aware the doctor was speaking to him.
"Oh," Lee said. He had no idea what the doctor was talking about. "I'm sorry, I guess I didn't hear what you said—"
The doctor smiled tolerantly. "I said you can see Dr. Letzmiller this afternoon to get the final O.K."
"Letzmiller? Who's he? I thought you said I was ready to go." Lee knew he sounded a little petulant, but he was tired from all these examinations, and besides, his head hurt.
The doctor, Gorss, Lee thought his name was, was rather young but seemed used to this kind of thing. He turned on his tolerant smile again. "Dr. Letzmiller is chief of the Familiarization and Post-Operative Adjustment Section. He can explain himself better when you see him."
"Is he the last one?" Lee asked. He was already following Dr. Gorss out the door and down a corridor.
Dr. Gorss stopped before a door marked "Dr. C. L. Letzmiller," and opened it. "The last one. You take these," he handed Lee a thick manila folder, "and tell the girl Dr. Gorss sent you for your interview." He waited until Lee had entered, then closed the door and left.
* * * * *
Evidently Dr. Letzmiller had been expecting him, for very shortly Lee found himself sitting at the doctor's desk, comfortably seated in a brown leather armchair. He was facing a rather pudgy man, who was leafing through the manila folder Lee had given him. Finally Dr. Letzmiller looked up.
"Well. Well now, Mr. Lee, suppose you first tell me about yourself, and then I'll tell you about me."
"Tell you about me?" Lee asked.
Dr. Letzmiller smiled. It was another tolerant smile, but it seemed more sincere than Gorss'. "I suppose the best way would be for me to review these facts on your medical history. You are Vincent Bonard Lee?"
"Date of birth?"
"August 11, 1934."
"That would make you four hundred nine years old."
Lee hesitated. He never really thought of his age. It had long ago ceased to be of any importance to him. Of course he remembered his birth date. It was one of those facts that always appears on your records, like your social security number. He did some calculation in his head, as rapidly as the constantly shifting blank spots in his thinking would allow him.
"It shows here that you first underwent replacive surgery in 1991. Correct?"
"Remember what it was for?"
"Yes, I had heart trouble. They fixed me up with one of those big jobs requiring my carrying batteries under my armpit."
"One of those early models. And this shows that at various times since then you have undergone replacive surgery some eighty-seven times, including three replacements of a pulmonary nature."
Again Lee hesitated. The number of times he had had a worn organ or tissue repaired or replaced was more than a little hazy. After the novelty of the first few times when he found himself with a new stomach, or liver, or muscle, he had started to take these things as a matter of course. He gave a little nervous laugh. "If that paper says so, I suppose so, doctor."
"Yes. Well, everything seems to be functioning properly now, doesn't it? With the exception of your head, of course."
"Yes, yes I feel fine otherwise." Lee was feeling uncomfortable. "Doctor, could you tell me what this is all about? I must have answered these questions half a dozen times before to those other people."
"In just a moment. First I need to know you a little better. Your medical history lists your occupation as 'cabinet maker'."
"That's right." Lee was becoming more and more uncomfortable. The extensive examinations had tired him, and repetition of the answers to all these questions was making him edgy.
"Doctor, can't you at least tell me what type operation I'm going to have?"
"What do you think it will be?"
"I don't know. Some sort of repair on my head, I guess."
"Mr. Lee, this isn't going to be a matter of repair. We have found it necessary to replace the entirety of what could roughly be called your 'brain', as well as part of the spinal cord."
"My whole brain?" Lee sat, stunned, comprehension slowly filtering into him. He voiced the only coherent thought which materialized. "Why that will mean there won't be anything left of me at all."
Dr. Letzmiller regarded him. "What do you mean?"
"Doc, you've got my records there. At one time or another, since they first put a new heart in me, every single inch of me has been replaced by an artificial part. I mean all of me. There's not one bit of me, heart, eyes, toenails, nothing, that is me. That bothered me quite a bit when this left eye was put in. I mean I thought, 'Well, this isn't me. This is my brain walking around in a jumble of artificial flesh.' I tell you it bothered me. But I went to a doctor, you know, a psychoanalyst, and he convinced me that as long as I had what he called a 'sense of identity', that I was me." Lee stopped. How could he explain it?
But Letzmiller seemed to understand. "And you think that your brain is all that is left of 'you'?"
"Doc, it's a funny feeling. Like this." Lee raised his hands, brought them together and touched his fingertips. "See that? I can raise those hands. I can make them touch each other. I can feel them touching each other. But it is just not quite right. It's just a little bit off key, like one trumpet player out of twenty being about one-sixteenth of a note flat. Know what I mean?"
"I think I do," said Letzmiller, nodding slowly. "Now, just what does that have to do with your operation?"
"Doctor—" Lee had to stop, for the patchwork quilt of blank spaces was dancing in his head. The helplessness went away, slowly, like smoke drifting from a fire. As his mind cleared, he realized that he didn't know why he was being interviewed by this doctor.
"Anything wrong?" Dr. Letzmiller asked.
Lee knew he wasn't being too coherent, jumping about with the conversation this way, but he asked the question, anyway. "Doc, why am I seeing you?"
"You haven't guessed?"
The doctor paused to light a half-gone cigar. "My job here at Merkins Replacive is to deal with just such fears as you have expressed. I'm an M.D. and a psychologist, and"—Letzmiller smiled to himself—"a kind of historian."
"Well, you see I was supposed to give you the regular formal lecture on the history of replacive surgery when you first came in. Like to hear it?"
Lee nodded, so Letzmiller continued. "Replacive surgery is actually quite old. Old as medicine itself, I suppose. Very early attempts at dentures were tried, though with little success. And, of course, peg legs and hooks for persons who had lost their hands might be called replacive surgery, though they were very crude. Later on came more refined dentures, artificial limbs, corrective lenses, skull plates, hearing aids, plastic or cosmetic surgery, blood transfusions, all types of skin grafts, et cetera.
"The 1950s saw the beginning of bone and corneal transplants, use of plastics in arteries, those huge heart-lung and kidney machines, implantation of electrodes in the heart to steady its beat—many things which were mostly emergency or stop-gap measures. All through the late 1900s refinements continued to be made, but it wasn't until 1988 that the fathers of replacive surgery, Doctors Mills, Levinson and McCarty made the breakthrough that revolutionized the whole concept. In very simplified language they unlocked the key to producing specialized living tissue through a bombardment of an extremely complex carbon compound with amino acids and electricity, then making it selective in function by a fantastically intricate application of radiation.
"That pulmonary replacement you received in 1991 was undoubtedly one of the first successes. You were quite lucky, you know. Up until 2017, only about five per cent of their synthesized hearts lasted more than thirty days. At any rate, the principle was established, and it was proven that it could work. Most of our work from then till a few years ago has been in improving and refining the work those three good doctors did over three hundred years ago."
Letzmiller's cigar had gone out, and he discarded it in favor of a cigarette. "That would be the end of my history lecture, if it were not for the nature of your trouble."
Lee looked at him closely. "Why's that?"
"Well, Mr. Lee, the big thing missing in that summation is the seemingly impossible task of synthesizing nerve tissue, especially that of the cerebral cortex. It's been approximated, at any rate closely enough to give us good enough results to allow an artificial tissue to respond to brain signals about ninety-eight per cent as well as the original would. But actual duplication? No. At least not until about three years ago. To tell you the truth, it is barely out of the experimental stage."
* * * * *
"Yes, this will be the first complete replacement of a human brain. Oh, of course it has been done with animals, and it has been successful with partial replacements on humans. But you will have the honor of being the first human with a complete substitution."
Lee could not contain himself. "Doc, that's just it! There won't be a single atom of me except what you fellows have conjured up—"
Letzmiller broke in mildly. "I think 'conjured' is hardly the proper word, Mr. Lee."
"Well, of course, I didn't mean that. But don't you see what I'm driving at? You could just as well start from scratch and duplicate me without bothering about going about it piecemeal. And what does that make me?"
The doctor had been looking at Lee intently, studying him through this outburst. "I think I see what you mean. And I can't answer you. The question you raise may be philosophical, or metaphysical, but it certainly isn't medical. And from a doctor's point of view complete substitution is the only course open, risky as it may seem."
Lee mulled this over. Of course he knew surgery was the only solution to his decaying mentality, actually the only alternative to his becoming a virtual idiot, and, shortly after that, dead. And he did not want to die. He had lived a long time, but thanks to the methods of Letzmiller, Gorss, and all their predecessors, he was as full of juice as he had been at thirty-five. But the question that kept plaguing him Letzmiller seemed determined to avoid. He didn't understand very much about replacive surgery, really didn't care to. If Letzmiller said it could work, then he wasn't worried about that. Well, he guessed he really didn't have much choice. With this realization, he had only one more question for Letzmiller.
"Doc, if I'm not me when this is over, do you think I'll know it?"
Letzmiller looked at Lee's troubled face. "Do you think that you would want to?"
Lee answered slowly. "No, no I guess not."
Letzmiller rose from his chair. "I'll talk to you again after the operation. Do you think you're ready to go to your room now?"
Lee nodded and obediently followed the doctor.
* * * * *
Lee was asleep when the nurse came, but with the efficiency of all good nurses since time immemorial, she woke him to give him the sedative to prepare him for surgery. She chattered brightly as she prepared the hypodermic.
"You know, you have all the nurses speculating, Mr. Lee. I mean we're wondering just what Dr. Lakin, he's the anesthesiologist, is going to use for you when you won't have any brain for the anesthesia to work on." She stopped, the needle poised above Lee's arm, realizing the inaptness of her remark. "Oh. I shouldn't have said that."
"No, that's all right," said Lee. "I've already reconciled myself to being the headless horseman for a while." He had, too, although it was wonderfully strange to think of himself lying on the operating table with a cavity where he right now thought, felt, knew that he was a person.
* * * * *
Lee didn't actually lie on the table in the literal sense. The table was inclined to about forty-five degrees, with his head exposed and supported by a clamp on the cheek and jaw bones. This arrangement was necessary to allow the waiting machinery access to the area where it would perform.
Physicians, surgeons, biologists and the like were gathered in the amphitheater to see a bit of medical history. Actually there wasn't much to see. A team of technicians, radiologists and surgeons were working around Lee. Some were attaching electrodes to parts of Lee's body to maintain the electrical impulses necessary to keep his vital processes in motion while the main switchboard was out of commission. Others were sensitizing the exposed brain, from which the skull had already been removed, to guide the delicate fingers of the huge automatic Operating, Recording and Calculating Complex through its precisely programmed steps.
Letzmiller was among those in the amphitheater, as a spectator, drawn both by professional curiosity and a desire to know the answer to Lee's question, "Doc, what will there be left of me?" Of course he couldn't find out even part of the answer for some weeks. Even the ORC complex, now being fitted to Lee's unconscious brain, adjusted and activated, would not finish with its job for something like thirty-two hours.
The synthesizer would reconvert the data, translate it into countless chemical and electrical formulae, and apply it to the raw material of carbons, amino acids, proteins, and other components. When the basic organ had been reconstructed, a process requiring another week and a half in the synthesizer, it would be grafted back. The nerve lead-ins would then be reconnected, one by one, spaced at intervals to avoid shock. Lee would be unconscious the whole time, of course. Or rather Lee would be unconscious part of the time. Most of the time he wouldn't have the capacity for either consciousness or the lack of it.
Dr. Letzmiller observed the huge ORC complex for a time, but there wasn't anything to see. It simply sat over Lee, doing its job. Unwanted, the thought came to Letzmiller that the machine looked like a frog with a long worm dangling from its mouth. Lee was the worm.
* * * * *
"You can talk to him now, doctor." Oldenreid, Surgeon in Charge, addressed Letzmiller outside Lee's room where he had just finished his examination. "Personally, I think things went exactly as they should. All physical and mental responses check out. I guess here's where I'm finished and you go to work."
Lee was sitting up in bed as Letzmiller entered. He looked just like he had in Letzmiller's office before the operation, except for the small white bandages around his head to protect his healing skull. "Well," the doctor said, "how do you feel? Your head hurt?"
* * * * *
Letzmiller checked at Oldenreid's office, and was admitted to give his report, as had been planned.
"Well?" asked Oldenreid.
Letzmiller lit the end of his cigar before answering. "I wholly agree with you. Everything seems to have worked out exactly according to plan. I found him essentially the same as he appeared to me during his pre-operative interview. Of course he's a little foggy yet, but I suppose that's just the post-operative shock."
"Yes, that will clear up in a few days."
"He seems alert, responsive, full memory. I don't think there will be any difficulty with my part of his post-operative treatment. Except—
"Doctor, have you ever listened to a group of violins and sensed, just sensed, not actually heard, that one of them seemed about a quarter of a note flat?"
Oldenreid looked at him strangely as Letzmiller left the office and closed the door.
* * * * *