The Terrible Beauty of Brain Surgery - The New York Times

1/5/2016
The Terrible Beauty of Brain Surgery - The New York Times
http://nyti.ms/1ZBh4ub
I arrived in Tirana, Albania, on a Sunday evening in late August, on a flight

from Istanbul. The sun had set while the plane was midflight, and as we
landed in the dark, images of fading light still filled my mind. The man next
to me, a young, red-haired American wearing a straw hat, asked me if I
knew how to get into town from the airport. I shook my head, put the book
I had been reading into my backpack, got up, lifted my suitcase out of the
overhead compartment and stood waiting in the aisle for the door up ahead
to open.
That book was the reason I had come. It was called Do No Harm, and
it was written by the British neurosurgeon Henry Marsh. His job is to slice
into the brain, the most complex structure we know of in the universe,
where everything that makes us human is contained, and the contrast
between the extremely sophisticated and the extremely primitive all of
that work with knives, drills and saws fascinated me deeply. I had sent
Marsh an email, asking if I might meet him in London to watch him
operate. He wrote a cordial reply saying that he seldom worked there now,
but he was sure something could be arranged. In passing, he mentioned
that he would be operating in Albania in August and in Nepal in September,
and I asked hesitantly whether I could join him in Albania.
Now I was here.
Tense and troubled, I stepped out of the door of the airplane, having no
idea what lay ahead. I knew as little about Albania as I did about brain
surgery. The air was warm and stagnant, the darkness dense. A bus was
waiting with its engine running. Most of the passengers were silent, and the
few who chatted with one another spoke a language I didnt know. It struck
me that 25 years ago, when this was among the last remaining Communist
http://www.nytimes.com/2016/01/03/magazine/karl-ove-knausgaard-on-the-terrible-beauty-of-brain-surgery.html?mwrsm=Facebook&_r=0
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states in Europe, I would not have been allowed to enter; then, the country
was closed to the outside world, almost like North Korea today. Now the
immigration officer barely glanced at my passport before stamping it. She
dully handed it back to me, and I entered Albania.
In the arrivals hall, a young man dressed in a bright white shirt came
over.
Welcome to Albania, Mr. Knausgaard. My name is Geldon Fejzo. Mr.
Marsh and Professor Petrela are waiting for you at the hotel. The car is right
outside.
The car was a black Mercedes, with leather seats and air conditioning.
It turned out that Fejzo had just completed his medical training as a
neurosurgeon. He was 31 and had studied in Florence. He had also worked
as an intern for a few months at a London hospital with Mr. Marsh, as he
called him, in the manner long preferred by British surgeons.
What is he like? I asked.
Mr. Marsh?
I nodded.
Hes a fantastic person, Fejzo said.
Marsh was in Tirana to demonstrate a surgical procedure he helped
pioneer, called awake craniotomy, that had never been performed in
Albania. The procedure is used to remove a kind of brain tumor that looks
just like the brain itself. Such tumors are most common in young people,
and there is no cure for them. Without surgery, 50 percent of patients die
within five years; 80 percent within 10 years. An operation prolongs their
lives by 10 to 20 years, sometimes more. In order for the surgeon to be able
to distinguish between tumor and healthy brain tissue, the patient is kept
awake throughout the operation, and during the procedure the brain is
stimulated with an electric probe, so that the surgeon can see if and how the
patient reacts. The team in Albania had been preparing for six months and
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had selected two cases that were particularly well suited to demonstrating
the method.
I leaned back in my seat and looked out into the darkness, which
extended all around, as if we were deep in the countryside, and then
increasingly it was broken up by lights from houses, shops, intersections. As
always when I was in a car driving toward a large town, I thought of a poem
by the Swedish poet Tomas Transtromer; it had become almost compulsive.
The funerals keep coming/more and more of them/like the traffic signs/as
we approach a city, he wrote toward the end of his life. And then I thought
of something Marsh put in his book, a quote from the French physician
Ren Leriche that begins: Every surgeon carries within himself a small
cemetery.
We stopped at a red light. A large square spread out before us.
Thats the national museum, Fejzo said, pointing at an imposing
building on the left. The Chinese built it during the Communist era. And
there, on the other side, is the opera. The Soviets built that.
I bent my head toward the window and stared up at a giant mosaic of
people in heroic poses. A shiver ran down my spine. If there is one thing I
have a weakness for, it is the Communist Era, especially the secretive
culture behind the Iron Curtain, with its working-class heroism, its
celebration of industry, its massive architecture, its Tarkovsky films, its
cosmonauts and its supernatural ice-hockey teams. I dont know why it
appeals to me, because in actual fact I oppose everything it represents: the
veneration of the collective, the industrialization of everyday life, the
monumental aesthetics. I believe in blundering man and in the provisional
moment. But something about the aura of the Soviet Age attracts me,
sometimes with an almost savage force.
The car swung to the side and stopped next to the hotel. A group of
people were seated around a table outside, and they stood up as we walked
over. I recognized Henry Marsh from photos and from a documentary
about him.
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Ah, the famous writer has arrived! he said.

He was shorter than I expected, with a body I at once thought of as
tough and resilient; his movements had a touch of old age about them,
while his eyes, the upper part of which were hooded by his lids, looked
simultaneously energetic and mournful.
His handshake was firm, and I glanced surreptitiously at his hands,
which were sturdy, with broad fingers, like the hands of a craftsman.
Fejzo introduced me to the others. Paolo Pellegrin, the photographer
who would be recording the procedure, a tall man with curly hair and
glasses who appeared to be in his late 40s; his strikingly handsome young
assistant, Alessio Cupelli, who had covered his long dark hair with a head
scarf; and Mentor Petrela, who ran the department of neurosurgery at the
hospital in Tirana. He was in his mid-60s, elegantly dressed, smiling, his
eyes full of warmth.
We have booked a table at a restaurant nearby, he said. Do you want
to join us?
At the restaurant, we gathered outside on a narrow terrace just as a
call to prayer was sounding. Fejzo conferred with the waiter, and while
Marsh and Pellegrin took up their previous conversation, I listened to the
strange voice of the muezzin rising and falling out in the dark. I didnt
understand the words, but the sound of them filled the air with
mournfulness and humility. Man is small, life is large, is what I heard in the
ring of that voice.
Pellegrin removed his glasses and rubbed his eye, and after he replaced
the glasses, he looked at me.
Were talking about an eye ailment that I have, he said. My vision is
gradually getting worse and worse.
He wonders whether that is what is driving him on, Marsh said.
Knowing that his time as a photographer is limited.
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Youre a war photographer, arent you? I said.

That too, yes, Pellegrin said.
Do you see any similarities with what you do? I said, turning to
Marsh. Brain surgery is about life and death, too, isnt it?
No, no, not at all, he said. As a neuro-surgeon, youre not risking
anything personally. Im a coward. Im full of anxiety, you know.
The waiters, all of them young men with close-cropped hair, came
gliding up with the hors doeuvres, and soon the plain white table, until
then colored only by the pale green olive oil in transparent bottles, was
filled with dark red tomatoes, green lettuce, blue-black octopus sliced to
expose dazzling white flesh, pink shrimp, reddish brown slabs of ham,
slices of beige bread with dark, almost black crust.
It was Marsh who kept the conversation going during the dinner. He
explained the awake craniotomy procedure, saying that for a neurosurgeon,
it is a constant temptation to try to remove the entire tumor, but if you go
too far, if you remove too much, the consequences can be severe. It may
lead to full or partial paralysis of one side of the body or other functional
impairments or personality changes. When the patient is awake, this allows
the surgeon first of all to determine where the dividing line lies, and second,
to observe the consequences of the procedure directly and immediately, and
stop before any serious damage is done.
Marsh was articulate, well informed and entertaining. He spoke just as
easily about political conditions in Zimbabwe or the books of the German
writer W.G. Sebald, which he loved, as he did about the various parts of the
brain. At the same time, I had the feeling that something else was going on
within him that had little to do with the conversation at hand. When
someone said something, he might say, Exactly, and elaborate on the
theme, but he might also become very quiet, as if he had fallen out of the
world, into himself. And thats where he doesnt want to be, it occurred to
me, as we sat around the table talking, under the strong light of the ceiling
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lamps, the sparkle of the glasses on the table and the gleam of the white
tablecloth intensified by the dense, impenetrable darkness beyond the
green bushes that grew on the terrace wall.
Before he decided to become a surgeon, Marsh studied philosophy,
politics and economics at Oxford University, where he took an interest in
the Soviet Union. After the Cold War ended, he began working pro bono at
a neurosurgical ward in Kiev, where conditions were primitive and
appalling. The 2007 documentary about his work there, called The English
Surgeon, showed some unbelievably brutal operations; in one, they used a
Bosch drill, the kind you would buy in a hardware store, to open the skull;
in another they used a wire saw, which sent dust flying and blood
spattering. He sent the surgeons medical equipment; once he drove there in
his own car, loaded with instruments. Seven years ago, he operated on the
future British ambassador to Albania and made friends with her, and she
introduced him to Petrela.
We became friends instantly, Petrela said as Marsh told the story.
Instantly! Henry Marsh is an honest doctor. His book is all about honesty.
The truth. It is so important, the truth.
Was it because of your son that you specialized in neurosurgery? I
asked, as I leaned back to make room for the waiter, who was laying lettuce
on my plate with a pair of tongs.
Marshs eyes narrowed, and the corners of his mouth pulled back in a
grimace, while he spread his hands as if to say that he had been asked this
question many times and that it might perhaps seem that way, but it
probably was not the case.
You can never know, can you, he said. Maybe it played a part. But
not consciously in that case. Either way, there is no doubt that it made me a
better doctor.
His son was only a few months old when he underwent surgery to
remove a brain tumor, while Marsh was still a medical intern. In his book,
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he describes the wild despair and the total helplessness he felt waiting to
hear the results, before it became clear that the operation was successful.
What I do keeps the wolf from the door, Marsh said. Maybe thats
why I have been doing it all these years. It has been a way to keep the wolf
from the door.
When the alarm on my cellphone woke me the next morning, I had a
faint memory of having panicked during the night, that I had gotten up
abruptly from the bed, unable to remember where the children were. Where
are the children, where are the children, I had thought, looking for them in
the bathroom, out on the balcony, down on the floor by the bed. But no
children. Where were the children? I finally realized that I had been
walking in my sleep, but I still couldnt understand where I was or where
the children were. Had I lost them? Then I remembered everything, and it
was as if I had suddenly become one with myself and with the room I was
in. Everything made sense and, relieved, I had lain down to sleep again.
I showered quickly, dressed and went to the reception area, where
Marsh, Pellegrin, Cupelli and Fejzo were already gathered and two cars
were waiting to take us to the hospital. We seemed to be driving through a
different city. What in the evening had seemed dark and mysterious was
now flooded in sunlight, completely stripped of its mystery. We followed a
river, framed in concrete, upward, past row after row of brick houses, many
of them run-down, full of small, makeshift cafes and simple shops. The
mountains beyond the city, which I noticed only now, rearing up steeply,
faintly blurred by the haze, but still a clear green against the cloudless blue
sky, seemed to frame the town and to provide its distinct character. They
stood there as motionless witnesses to the human struggle against entropy,
just as they had when this land belonged to the Roman Empire in the fourth
century and to the Ottoman Empire in the 17th.
The cars slowed down, and we parked in front of the hospital, a plain,
functionalist concrete building, the sharp angles and hard planes of which
contrasted with the people outside, sitting or standing in the sunlight with
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their soft bodies, wearing floral-print dresses or shirts and suit trousers, not
unlike the way my grandparents dressed, I thought, in the 1950s and 60s.
Inside at the neurosurgical ward, Petrela stood waiting for us,
immaculately dressed and smiling broadly.
Welcome, my friends, he said. You can leave your things in my
office, if you like. And then I can show you the operating theaters.
We were fitted with surgical gowns, caps and face masks and taken to
the second floor, through a small labyrinth of corridors and into the
operating theater.
To my horror, an operation was in progress.
The silence was total. The single focus of attention was a head clamped
in a vise in the middle of the room. The upper part of the skull had been
removed, and the exposed edge covered in layer after layer of gauze,
completely saturated with blood, forming a funnel down into the interior of
the cranium. The brain was gently pulsating within. It resembled a small
animal in a grotto. Or the meat of an open mussel. Two doctors were
bending over the head, each of them moving long, narrow instruments back
and forth inside the opening. One nurse was assisting them, another was
standing a few yards away, watching. A whispery slurping sound issued
from one of the instruments, like the sound produced by the tool a dentist
uses to suck away saliva from a patients mouth. Next to us was a monitor
showing an enlarged image of the brain. In the middle, a pit had been
scooped out. In the center of the pit was a white substance, shaped like a
cube. The white cube, which appeared to be made of firmer stuff, was
rubbery and looked like octopus flesh. I realized that it must be the tumor.
One doctor looked up from a microscope that was suspended over the
brain and turned to me. Only his eyes were visible above the mask. They
were narrow and foxlike.
Do you want to have a look? he asked.
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I nodded.
The doctor stepped aside, and I bent down over the microscope.
Oh, God.
A landscape opened up before me. I felt as if I were standing on the top
of a mountain, gazing out over a plain, covered by long, meandering rivers.
On the horizon, more mountains rose up, between them there were valleys
and one of the valleys was covered by an enormous white glacier.
Everything gleamed and glittered. It was as if I had been transported to
another world, another part of the universe. One river was purple, the
others were dark red, and the landscape they coursed through was full of
strange, unfamiliar colors. But it was the glacier that held my gaze the
longest. It lay like a plateau above the valley, sharply white, like mountain
snow on a sunny day. Suddenly a wave of red rose up and washed across
the white surface. I had never seen anything quite as beautiful, and when I
straightened up and moved aside to make room for the doctor, for a
moment my eyes were glazed with tears.
In the courtyard outside, the air was filled with voices, the roar of
engines, the shrill rasping of cicadas. The people there, sitting or standing,
some chatting busily, others silent and withdrawn, were the patients
relatives, who spent their days out here to be close to their loved ones, Fejzo
had told me.
I lifted my gaze and stared up toward the top floor of the hospital wing.
It was hard to imagine that the silent, faintly humming room, with its
islands of high-tech equipment, was just a few yards away from the chaos
out here. Still harder was grasping that within that room, there was an
opening into yet another room, the human brain.
Did I really look straight into it?
I felt a sudden, sharp pang of guilt. That brain was part of a human
being, with a personality entirely its own. But I had peered into it and
thought of it as a place.
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I went back inside and found Petrela and Marsh sitting in the outer
office, drinking coffee and chatting.
Are you ready to meet the first patient? Marsh asked.
I nodded.
Marsh always spoke with the patient before and after the operation; he
repeated several times that this could be the hardest part of his job. He had
to tell the truth, yet at the same time he must not deprive the patient of
hope.
You can meet him in my office, Petrela said.
I followed Marsh into the next room, where we sat down around
Petrelas desk. Soon there was a knock on the door. The patient, a short,
stocky man with a strong, youthful face, and Florian Dashi, the neurologist
who would talk to him during the operation, walked in together. The
patient smiled, and his movements seemed confident, but in his eyes, there
was a hint of concern, maybe even fear.
His name was Ilmi Hasanaj. He was 33 and worked as a bricklayer in
Tirana. He lived on the outskirts of town and was married but had no
children. He had been working at a building site, he said, on the roof, and in
the middle of the day he had gone to fetch something in a storeroom when
his left arm and hand began to tremble uncontrollably. His mouth and his
left eye moved uncontrollably, too. He managed to sit down on a chair.
Some colleagues, recognizing that something was seriously wrong, took him
to the hospital.
What did you think was happening? I asked.
I thought maybe I was just tired and stressed out, he said. I had
been working a lot lately.
There was a pause.
Are you afraid of the operation? I asked.
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He nodded even before Dashi could interpret the question.

Yes.
Marsh leaned forward.
I have done over 400 of these operations, he said. My experience
with English patients is that its usually very easy for them. And I suspect
that the Albanians are much tougher than the English. I believe that the
Albanians will do very well.
Hasanaj laughed when this was interpreted.
Its not painful, Marsh said. The reason for doing the operation like
this is to make it safer. First we will touch your brain with a little electric
instrument that I brought from London, and when we touch the movement
area, well make you move. And that way well know where the movement
area is. And the second part is, as we remove the tumor, well be
continuously asking you to move your foot, to move your knee, to move
your hip, to move your fingers, to see if you can still move them. And if,
when we are removing the tumor, you start to feel a little weak, then well
know that its time to stop. It is quite possible that after the operation there
will be some weakness on your left side, but you almost certainly will get
better. The risk of leaving you permanently paralyzed is not zero, but it is
very small, less than 1 percent. I hope we can remove all of the tumor, but
we might not, and you will need brain scans in the years to come. If there is
no weakness after the operation, I hope you will be back to bricklaying in
five or six weeks.
The next time I saw Hasanaj, later that afternoon, he was under
general anesthesia and lying beneath a sheet in the operating room, with
only his skull visible, clamped in a metal vise. His head was partly shaved in
preparation for the initial opening of the skull. The actual removal of the
tumor would take place tomorrow. Marsh more often performed both steps
in a single day, but in this case, largely because it was a new procedure for
this hospital, the operation would take place over two consecutive days.
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Petrela and his assistant surgeon, Artur Xhumari, the man with the foxlike
eyes, bent over the patient. Petrela waved a small mapping device around
the head as he looked up at a monitor. The images on the screen, which
showed the brain, changed as he moved the device, like the ultrasound
images I had seen of my children when they were in my wifes belly.
Petrela and Xhumari conferred in low voices, and I guessed they were
deciding where to open the skull. Then Xhumari placed the scalpel two
inches above the ear and pushed it hard, down through the skin. Blood
oozed up through the cut and ran down along the side of the head. Xhumari
drew the scalpel in a semicircle across the crown. Petrela used a suction
device to suck up the blood that was seeping out. Then, with a flat
instrument that he inserted into the incision, Xhumari folded back the skin,
along with the flesh beneath it and the sinews that fastened it to the skull.
Inch by inch, the scalp loosened from the bone of the skull. He partly cut,
partly pushed and scraped it loose from the underside, while
simultaneously pulling it backward from above, as if he were peeling an
unripe fruit, the skin of which still clung to the flesh. When he had finished,
he folded the scalp over to the side and quickly covered it with gauze pads,
which immediately turned red with blood.
The skull, now laid bare, was yellow-white, with thin stripes of blood
trickling in all directions. Xhumari brought out a shiny metal instrument,
shaped like a baton or a large soldering iron, with a bit at the end. He
placed the bit against the crown and started to drill. A hard, buzzing sound
rose faintly through the operating room. A small pile of finely ground bone
formed around the bit as blood flowed down over the hard skull. When the
drill had gone through the bone, Xhumari pulled it out; the result looked
like the hole for a screw in a piece of plastic furniture. Xhumari made two
more holes just like it. Then he took up another instrument, also made of
shiny metal, and inserted the tip into the first hole. I realized that this was
the saw. It, too, buzzed hard and intensely, and seemed to get louder as the
work got heavier. Xhumari dragged it slowly along toward the second hole,
while Petrela sucked away the blood and the bone dust. A narrow crack
grew slowly behind it, as when you cut a hole in the ice with a saw. When
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the saw had come full circle and reached the first hole from the opposite
side, Petrela lifted the top of the skull like a lid and held it up into the air in
front of me.
Every brain surgeon, at some point in his career, drops this on the
floor, he said, laughing. He handed the bloody lid to the nurse, who placed
it on a dish and covered it with a green plastic sheet.
Under the opened skull lay a wet, blood-tinted membrane.
Thats the dura mater, Petrela said. The outermost of the meninges.
Xhumari cut into it with scissors, creating a flap. Its underside was
white and resembled a piece of soaked cloth. He gently pulled the flap back,
exposing the brain. It pulsated slowly and looked bluish in the sharp light of
the lamps.
Now we sew it up again, Petrela said. And were all set for the
operation tomorrow.
The whole process was reversed. They sewed the meninges back down,
and the nurse handed Xhumari the lid of the skull. When he pressed it into
place, blood oozed up, as if he had put the lid on a cup that was overflowing
with thick cranberry juice. They fastened the lid with metal clips, then
stitched the scalp back together.
Not once had it crossed my mind that it was Hasanaj they were slicing
into.
Petrela invited us all to dinner at his apartment that evening. His
family owned a building in the center of town, just above the central
mosque. His predecessors had been politicians and businessmen; his great
grandfather was prefect of Tirana when the city capitulated to the forces
of the Austro-Hungarian Empire during World War I. His grandfather
traded in olive oil and was wealthy; it was he who had built the building, in
1924. When the Communists came to power after the war, the family lost
the house; it was confiscated, as all bourgeois homes were. His father, who
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was a professor, had to teach at a primary school in a village in the

mountains far outside Tirana, Petrela told me in the twilight on the terrace
that ran around the top of the apartment. His voice was full of sorrow when
he spoke about his father.
He told me we had to put on a mask before going out, Petrela said.
He pretended to put a mask on his face with his hands and made a
zippering motion across his mouth. And then we took it off again when we
closed the door behind us back home. I have a mask hanging on the wall in
the hallway to remind myself.
He laughed. It struck me that Petrela was still, first and foremost, a
son, for that was the nature of his charm boyish, joyful, vulnerable
somehow. But at the same time I sensed that there was a great deal here
that I didnt understand. I had noticed that his word was law to the other
hospital employees, and for the neurosurgical ward at the hospital in
Tirana, which otherwise was poor and lacked resources, to be able to
perform at such a high level, which Marsh called state of the art, surely
something more than kindliness was needed.
Standing there in the darkness, beneath the stars, while the sounds of
the city below us came rising up through the air, Petrela then told me a
story about his former boss: that he used to remove certain types of brain
tumors with his index finger. No instruments, nothing, he just poked his
finger down into the brain and plop! out came the tumor.
Petrela gave a demonstration. He held his long index finger up in the
air, bent it like a hook and pretended to jerk something out while he
laughed.
As he did it, I knew I would remember the gesture for the rest of my
life.
Dinner was served in a dining room, two floors below, that was
furnished as it must have been in the 1920s. The ceiling and the floor were
both made of dark wood, and the walls were covered with paintings; a long,
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antique pistol lay atop a rustic chest, and hanging in one corner was a white
dress like the one, Petrela said, that his grandmother wore to her wedding.
It was a deeply romantic room.
Not until we were seated around the table, which was covered with a
white tablecloth, stiff and formal, but also beautiful, set with porcelain and
crystal, did I think about what I had seen only a few hours earlier, the drill
that penetrated Hasanajs skull millimeter by millimeter, the lid that
Petrela had then removed. Hasanaj must be awake now, I thought. He was
lying awake in his hospital bed, with strange pains in his head and the
thought that tomorrow he would remain awake while two doctors the
ones who were sitting here now, eating and drinking and talking and
laughing cut into his brain.
Marsh once again dominated the conversation, in his typical English
way, full of wit and charm. My impression, after having spent a day and a
night in his company, was that he was a manual person. He bicycled
everywhere, he did all kinds of woodwork, and he kept bees at his garden in
London. He told us that he recently bought a lock keepers cottage by the
river in Oxford. The previous owner had died wretchedly, amid old junk,
garbage and loneliness, and Marsh said he was going to renovate the place
himself. It seemed that his way of living was to keep moving, filling his days
with things to do, as during dinner he filled it with things to say.
There was something reassuring about being in his company, because
he took charge of the conversation in such an entertaining way, but at the
same time there was a touch of insecurity there, for within the broad range
of topics that he mastered, there appeared from time to time traces of selfassertion, well camouflaged, but not so well that I didnt notice that it was
important to him to get across that his wife was beautiful and smart, that
his book had been very well received, that David Cameron, for instance, had
read it and apparently been moved to tears. When we talked about cars, the
story he chose to tell was about his old Saab, which he intended to drive
until the day he died, and that he had once driven it when he was going to
meet the queen, and how beat up and shabby it looked next to other
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vehicles. It was the kind of thing I might say and later feel ashamed about
for months. It was a big problem I had, the urge to put myself in a flattering
light by mentioning favorable events as if in passing, so that the others
would understand that I wasnt just a boring and silent Norwegian. It was
almost compulsive.
Could Marsh, this brilliant neurosurgeon, be troubled by a constant
need to call attention to himself? Werent his extraordinary qualities, so
obvious to everyone around him, fixed securely in his own image of
himself?
I thought of what he said the night before, about keeping the wolf from
the door. I had thought he meant something big. But perhaps, to the
contrary, it was something very small?
I looked at him, there at the end of the table, seated at the place of
honor, his strong fingers distractedly holding the stem of his wineglass as
he talked, the round spectacles in his round, lined face, the lively eyes,
which, as soon as he stopped talking, turned mournful.
The next morning, which was as warm and radiant as the day
before, Marsh was reclining on a black sofa in the lounge next to the
operating room, dressed in his blue surgical gown, the face mask dangling
beneath his chin. He smiled briefly as I entered.
Are you nervous before operations like this? I asked.
He nodded.
Always. But todays operation is relatively simple. The main thing is
knowing when to stop.
I entered the operating room. Hasanaj had already been wheeled in.
He was lying in the same position as the day before, partly upright, with
one arm on an armrest and his head clamped in a vise. This time, however,
he was awake. His eyes stared straight ahead. A doctor was swabbing his
head with a brown substance. When he was done, he pushed a syringe into
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Hasanajs scalp, pricking him all along the stitches from the day before. It
had to hurt, but Hasanaj didnt make a sound; he lay there motionless. A
green drape was stretched all the way up to his eyes, so that his face was
covered under a kind of tent, while his skull remained bare. Dashi sat down
on a chair next to him. Marsh entered the room and began studying a
monitor on which the last brain scan was displayed.
There you have the tumor, he said to me. So I think I know what to
expect. But you can never be certain until you see it in reality.
Xhumari began removing the stitches. He folded the scalp back, baring
the skull. The wet underside of the scalp was immediately covered with
gauze pads, which encircled the head like a red-and-white crater. Xhumari
and Petrela carefully unfastened the metal clips and removed the lid. Both
of them stood motionless, their heads bent at an angle of nearly 90 degrees,
the same as their arms, which they held close to their sides like bird wings;
for long stretches their hands were the only parts of their bodies that
moved. They didnt speak, and the hiss of the sucker filled the room.
Marsh paced to and fro. It struck me that he resembled an actor just
about to go onstage; he radiated the same restless, concentrated, faintly
anxious energy.
He came over to me.
In England, everyone would be lively and chatting away by now.
Distraction is a good painkiller. He looked at me. Here the culture is
different. Its more vertical. In London, its horizontal. Ah, this churchlike
silence!
He went over to Dashi.
Hows the patient?
Dashi leaned forward, almost into the tent. I heard Hasanajs voice say
something in Albanian. Dashi looked up at Marsh.
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He is well, he said.
Good! Marsh said.
Xhumari lifted off the top of the skull, the underside of which was
covered in congealed blood, and handed it to the nurse, who put it in a dish
By KARL OVE KNAUSGAARD
and covered it. Then he removed the stitches in the meninges, and I could
Photographs by PAOLO PELLEGRIN
look straight into Hasanajs brain, at the same time as he lay staring ahead.
DEC. 30, 2015
The brain was shiny and covered with blood vessels, which lay twisted
like little red worms on the otherwise gleaming yellow-gray surface.
Petrela splashed water on it with a syringe.
Xhumari took a few steps back to make room for Marsh, who leaned
forward.
Thats the tumor there, isnt it? Interesting.
He glanced up at me.
Can you see it?
I shook my head. Everything looked the same to me.
Its there, a slightly pinker area.
He straightened up, and I moved aside, realizing that the operation
was about to begin. He was handed an instrument that looked like a long,
narrow tuning fork, which was wired to a box on the other side, beneath a
monitor, where a nurse stood, ready to follow his instructions.
This should be the sensory cortex. If Im wrong, there will be
movement.
He asked the nurse to set the strength at Level 3 and touched the brain
with the fork. There was a humming, electric sound. I positioned myself so
that I could see Hasanaj.
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Dashi?
Nothing.
Set it to 4.
The nurse turned the power up. Marsh touched the brain again. Dashi
spoke to Hasanaj, who said something.
Feeling, Dashi said.
Sensing here, face here, Marsh said, as if to himself. Turn it up to 5.
Dashi spoke to Hasanaj.
Left arm, face, tongue, he said.
Marsh touched the brain again. This time, Hasanaj lifted his arm
rapidly into the air, as if it had been pulled by the string of a puppeteer, and
it shook for a few seconds, then lay down again.
I couldnt believe my eyes. It was like a robot had been switched on.
Left arm, movement, Dashi said.
Marsh moved the instrument. Hasanajs eye blinked a couple of times.
Left eye, movement, Dashi said.
We can bring in the microscope, Marsh said.
While they wheeled over the microscope, which was fastened by a
mobile crane to a large machine, to which a monitor was also connected, I
squatted down in front of Hasanaj.
How does it feel? I asked.
He smiled faintly and said something in Albanian.
Its O.K., Dashi said.
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Does it hurt?
He says only a little, in his ear.
All of Marshs restless energy vanished the moment he bent over the
microscope and started to operate. It was as if he had stepped onto a
podium, where other rules applied. He leaned forward and spoke to
Hasanaj.
The tumor is in a good position. In a little while I am going to ask you
to move parts of your body, especially your face.
On a monitor I could see that Marsh was digging a small hole in the
tumor, which to me looked identical to the surrounding brain. He held an
instrument in his left hand, which he used to make the blood congeal; in his
right hand, he held a sputtering suction device, which, with infinite care, he
used to pulverize and remove tiny pieces of tissue, shred after shred. They
vanished into the tube, along with blood and water; I could see them whirl
away down the plastic tube and disappear. Next to him stood Petrela,
splashing water over the surface.
With Dashi interpreting, Marsh asked Hasanaj to move his mouth, his
eyes.
The hole in the tumor grew slowly.
Marsh brought out the stimulator again. This time it was turned up to
8 before there was a reaction, and Dashi said, Face.
Marsh waved me over.
See this? This little spot here. Thats the center for facial movement.
We have to leave that in peace.
Were all the expressions the human face could make supposed to
originate in this little spot? All the joy, all the grief, all the light and all the
darkness that filled a face in the course of a life, was it all traceable to this?
The quivering lower lip before tears begin to flow, the eyes narrowing in
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anger, the sudden cracking up into laughter?

Marsh continued working with the two instruments. Using the sucker,
he pried and pushed and shoved continuously, while he used the other tool
in between, with no trace of hesitation, without stopping and, seemingly,
without thinking.
He brought out the electric stimulator again. This time he pushed it
toward the bottom of the hole.
This should be the face again, he said.
Nothing, Dashi said.
Nothing?
Dashi shook his head, and Marsh went on working.
The tumor is just like the brain here, thats the problem, he said. Do
you want to see?
He stepped back, and I bent over the microscope again. The view this
time was quite different. It was as if I were looking into an enormous
grotto, at the bottom of which lay a pool filled with red liquid. Sometimes
water came splashing in from the right, as if from a huge hose. I had never
seen anything like it, for the walls of this grotto were so obviously alive,
made of living tissue. Along the edges of the pool, above the red surface, the
walls were ragged. Behind the innermost wall, seeming to swell out slightly,
like a balloon about to burst, I glimpsed something purple.
When I stepped aside to make room for Marsh again, I struggled to
unite the two perspectives; it felt as if I were on two different levels of
reality at the same time, as when I walked in my sleep, and dream and
reality struggled for ascendancy. I had looked into a room, unlike any other,
and when I lifted my gaze, that room was inside Hasanajs brain, who lay
staring straight ahead under the drape in the larger room, filled with
doctors and nurses and machines and equipment, and beyond that room
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there was an even larger room, warm and dusty and made of asphalt and
concrete, beneath a chain of green mountains and a blue sky.
All those rooms were gathered in my own brain, which looked exactly
like Hasanajs, a wet, gleaming, walnutlike lump, composed of 100 billion
brain cells so tiny and so myriad they could only be compared to the stars of
a galaxy. And yet what they formed was flesh, and the processes they
harbored were simple and primitive, regulated by various chemical
substances and powered by electricity. How could it contain these images of
the world? How could thoughts arise within this hunk of flesh?
Marsh stopped and brought out the stimulator again and inserted it
into the hole.
Dashi said something to Hasanaj, who replied briefly.
Nothing, Dashi said.
Marsh stimulated the bottom again.
Nothing.
Nothing.
Left arm, face.
Left arm and face?
Yes.
Then well stop here.
Marsh took a few steps back, and the microscope was wheeled away.
His eyes, the only part of his face I could see, looked happy.
Xhumari and Petrela took over, and Marsh, after telling Hasanaj that
the operation had been successful, left the operating room.
I went over to Hasanaj and bent down to him. He looked tired, his eyes
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were narrow, his face expressionless.

How do you feel? I asked.
Hasanaj smiled and raised his thumb.
Dashi laughed. His back was completely wet with sweat.
After the operation, which lasted nearly three hours, we drove to a
park just outside the city center, where there was a rustic restaurant built of
brown-stained timber, with waiters dressed in traditional costumes, where
we had lunch. The temperature was 95 degrees, the cicadas were singing, all
the greenery surrounding us was lit up by the golden rays of the blazing
sun. Everyone was in a good mood, especially Marsh. There was a new
levity about him, and he seemed more open. Not that he seemed closed
before, but the shadow that I had sensed in him was gone.
I was happy, too. The sight of the mountains behind the city, so green
and haughty, lifted my spirits, and the sight of the brain, its physiological
aspect the ragged edges of skull within which it had pulsated, the
streaming red blood was also pleasant to think about, for the bright
colors within connected the landscape of the brain to the grass that grew
beneath the veranda we were sitting on and the trees rustling faintly and
nearly inaudibly in the breeze, and what that brain contained, all those
images and thoughts that could never be separated from their material
state, connected it nonetheless to the city beneath us, so full of dreams,
longings, hopes and imaginings.
That the same city was also full of illness and want, tragedy and death,
was something I didnt stop to consider, nor the fact that the brains I had
seen had been diseased. The operation had been successful, the tension had
been released. All I could see was life and the living.
The next morning we went on an excursion to the port of Durres and to
Berat, a town in the mountains. Even though we had spent only three days
together, it seemed as if we had known each other for years. Marsh
explained the architecture of the brain to me, and the way it functioned. He
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explained how they reached tumors that were lodged deep in the brain,
which is, very loosely speaking, crumpled up like a sheet of paper, and
therefore full of folds and ravines that you can push aside and move
through. There are also so-called silent areas, which could be cut without
damaging any of the brains functions. He told me about times when things
had gone wrong, and the patient had died on the operating table in front of
him. I have killed people, he said.
He told me about difficult operations that had succeeded and about the
euphoria they produced. He said that 50 percent of surgery was visual,
what you saw, and 50 percent was tactile, what you could touch. He said
that brain surgery was a craft. To become good at it, you had to practice and
sometimes make mistakes, in a profession where mistakes were fatal and
impermissible. If your child has a brain tumor, you want the best surgeon.
But to become the best, which is merely a question of gaining experience,
you must first have operated on children without having experience, and
what do you tell the parents then? That their child is important to the
future of the young and as-yet-untested neurosurgeon?
He talked for a while about the particularities of operating on children.
The tissues are soft and beautiful, very different from those of older people.
A child is as fresh and clean on the inside as on the outside. But the
problem with blood loss is very great; they can lose a life-threatening
amount of blood very quickly. And the desperate anxiety of the parents is a
heavy burden to carry. But for the children themselves, its easy. If theyre
not in pain, theyre happy. They dont have any existential perspective. He
talked about his father, who was a law professor at Oxford University, and
about his mother, who came to Britain as a refugee from Nazi Germany
before the war, and how they both helped form what is now Amnesty
International. He talked about his youth, about how shy he was, how he sat
at home reading books when everyone else went out, how he never went to
nightclubs, never spent time with girls. He told me about a breakdown he
had as a young man, when he fell into a deep depression and spent some
time in the psychiatric ward of a hospital. He told me he wrote poetry at
that time, inspired by Sylvia Plath. He told me that the medical profession
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he had chosen seemed safe to him, something to buoy him. He told me

about his relationship to his siblings and to his own children. I competed
with my children, he said, grimacing at the recollection. Can you imagine?
I always wanted to show them how clever I was. Thats one of the worst
things you can do to children. He told me how his first marriage ended,
and what his present marriage was like.
He was entirely open but not confessional; it was more that all our
conversations seemed to lead to more serious matters, almost regardless of
where they began, perhaps because the situations that gave rise to them
were so concentrated and involved life and death, and because the places
where they occurred were closed to us in a way, amid an alien culture, and
yet in another sense, so open: Sitting on a terrace on the seventh floor,
surrounded by dark blue sea extending in all directions, glittering in the
sunlight, a few tiny people wading through the green shallows, maybe 50
yards out, the slightly lighter blue sky arching above us. Standing in an old
Orthodox stone church in the mountains, in front of a row of icons on the
wall, in radiant colors, gold, red, blue, beneath a dome with three circular
holes that the light sifted down through. Sitting in a car whizzing through
the darkness of the Albanian countryside after a long day in the sun.
Walking through the heart of Tirana one afternoon, in small, narrow streets
that lay in deep silence, past dilapidated houses and walls, with improvised
electrical wiring, makeshift home extensions and dirty children playing in
back alleys, just a few hundred yards from the main boulevards. Several
times, when he mentioned something private, I reminded him that I was
going to write about him. You do realize that I might write about what you
just told me? He just smiled and said that was his strategy: The more
personal he got, the more likely it was that I would like him and therefore
write favorably about him.
The only time I saw Marsh angry was on the morning before the
second operation. He had planned on seeing the patient, only to be
informed by Petrela that she was already in the operating room and was
having her head cut open.
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Damn, he said loudly, stamping his foot and striking out at the air
with his hand.
You could see her tomorrow morning, before the operation, Petrela
said.
O.K., thatll have to do, Marsh said calmly, but his eyes were still
angry. Instead, he and Petrela went to see how Hasanaj was doing. I came
along. Petrela pushed the button by the elevator at the end of the corridor
and told us that when the king died, or rather, the kings son, his heir
apparent, the body had been brought to this hospital, and when it was
taken out again, they had used this elevator. The elevator stopped between
two floors, with the dead king inside, and it took them two hours to restart
it.
The doors opened, and we got in.
Its one thing to get stuck in an elevator with a corpse, Marsh said.
Quite another when the corpse belongs to the king.
Hasanaj was alone in a room on the third floor, sitting half upright in
bed, supported by pillows, with the entire upper part of his head swathed in
bandages. His face lit up when he saw Marsh and Petrela. But there was
something faintly grotesque about his smile, because one side of his face
was paralyzed, and his mouth seemed to droop a little, so that it was more
like a grimace than a smile. Marsh told him that he had a temporary
weakness on one side, that this was quite normal, and that it would get
better quickly. Hasanaj nodded, he understood, and he made the grimace
again, and laughed feebly, with eyes that shone.
I met the second patient the next day. Her name was Gjinovefa
Merxira, and she was 21. She grew up in Burrel, a small town of 15,000 in
northern Albania, and moved to Tirana to study medicine, she told me,
lying in a hospital bed. Her eyes were brown, her face was broad, her
features were pure and young. I asked her to tell me about her very first
seizure. She said she had her first fit when she was 7. It was wintertime, she
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was ice-skating with her friends, and she collapsed. She saw her friends as
if through a fog. When she got home, she didnt recognize her mother. She
looked straight at her mother, and she didnt recognize her. Her mother
asked, Why are you staring at me? and Merxira said she wasnt staring at
her, and then she began to cry. She was 7, and she had a terrible headache,
but no one thought that anything was seriously wrong with her.
She had fits like that once or twice a year. One time, when she was
watching TV, the letters of the subtitles began to move out of the TV and
into the room where she was sitting. Another time she saw a fire in a
garden, a big fire, and she was about to cry for help when it vanished. With
these fits came headaches, nightmares, occasional numbness. Sometimes
every noise sounded like the chiming of bells. Because the fits were always
of the same intensity and occurred seldom but regularly, she didnt think it
was anything serious. She didnt see a doctor until after an incident that
happened when she was 17. She was taking a math exam at school and saw
flowers instead of numbers. She started to cry. She wanted to do well at her
exam, but she couldnt do the calculations, because all she could see were
flowers, in black and white. Thats when she visited the hospital. They
examined her, but found nothing, gave her medication for her fits and sent
her home.
In November 2014, she was sitting at a cafe in Tirana with some
friends and saw things floating above the table. When she got home, she
couldnt see anything on her left side, and her friends, who were very
worried for her, took her to the hospital. As for her, she was calm; she knew
that it would pass. This time the doctors discovered what was wrong: She
had a tumor in the vision center in the brain. A decision was made to
operate, but not until August, and the operation would be carried out by
Henry Marsh, who now, this morning, finally stopped in front of her bed in
the patients ward on the third floor of the hospital in Tirana.
Her head was bandaged, after her skull had been opened the previous
evening, and she stared at Marsh with young, frightened eyes.
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He told her more or less the same thing that he told Hasanaj: that he
had carried out this operation more than 400 times; that it was practically
harmless; and that she was going to be awake because it was safer, but he
was a little more detailed with Merxira than with Hasanaj, presumably
because she was studying medicine and therefore more familiar with what
was going to happen. Maybe that is also why she seemed more afraid.
When I saw her again a few hours later, with her head fixed in the
clamp in the operating room, the anxiety was still there, in her eyes. She
seemed to sense everything that was in the room, as if she had a relation to
all of it, whereas with Hasanaj, it seemed that he held back from any
encounter, that he just submitted passively to everything and made up his
mind to endure it until it was all over. Pellegrins shooting of Hasanajs
operation had been almost unnoticeable, just a part of all the other
movements in the room, but now, because of Merxiras vulnerability, I was
increasingly aware of the camera and the flash.
The doctors attached the plastic drapes to a stand, so that her head lay
beneath a small tent and the lower part of her skull was covered while the
upper part was bare.
At operations in London, the drapes are transparent, Marsh said, so
that the surgeon can see the patient all the time.
When her head had been swabbed and the injections of local anesthetic
administered, the assistant surgeon, Arsen Seferi, began to remove the
stitches. Merxira lifted her arm to her eyes and let out a low, long moan.
Dashi spoke to her, and she answered, then fell silent again.
Seferi laid the scalpel aside and began to remove the clips that ran
around the skull. Soon the lid of the skull was put aside, the meninges were
cut open and the brain was exposed. From a distance, the bloodstained
gauze that wreathed the skull resembled flowers.
Marsh went over and studied the brain.
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Just as I thought. The surface looks normal. The tumor is

underneath. A nurse handed him a mapping device, which Marsh and the
others called a GPS, and he moved it slowly over the brain while he
examined the image that appeared on a monitor.
After a while he switched instruments. Now he pressed the electrical
stimulator against the surface of the brain. It buzzed briefly. Dashi spoke
with Merxira and said something to Marsh. He stimulated the brain again.
The same electric buzz sounded. Dashi spoke again, and Marsh began to
operate.
We should feel a rubbery tumor shortly, he said.
Aah, Merxira moaned.
I looked at her. She pressed her arm against her eyes again.
We were being misled by the GPS, Marsh said. Oh. Here it is!
If you trust the GPS too much, you could end up in the cemetery,
Petrela said to me in a low voice.
Here, you can see, Marsh said, waving me over. Do you see the
difference?
One area was more yellowish-gray than the other, but the difference
was so subtle that I would never have noticed it if Marsh hadnt pointed it
out.
He continued hollowing out the affected area of the brain.
Merxira moaned.
Suddenly there was almost a shout in the room.
Aah!
Theres no feeling in the brain, Marsh said. But what can hurt are
the blood vessels, when they are moved or get bent. Thats what she is
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feeling. It can be a shocklike pain.

He looked at Dashi.
Is the pain bad?
Dashi said something to Merxira, who answered him in a low voice.
She can feel it, but its O.K., Dashi said.
A flash went off. I looked up. Pellegrin was crouching close to the wall,
taking photos of the island of equipment, presumably with Merxiras face
visible beneath the green drape.
Marsh continued sucking out the tumor at the bottom of the hole.
Merxira moaned. Being there was almost unbearable.
You dont want to damage that, Marsh said and let me look at a blood
vessel in the microscope, blue amid the folds of the brain. If that is
damaged, the blood cant leave the head, and the brain will fill with blood.
How far away is it from the tumor? I asked.
Oh, one or two millimeters, Marsh said.
He went on with the operation, assisted by Petrela, who squirted water
on the surface. Dashi spoke with Merxira at regular intervals, asking her to
look at a special eye chart and assessing Marshs progress based on her
responses.
Marsh removed a whole piece of the tumor, which the nurse placed in a
dish.
Aside from the even whisper of the sucker, the operating room had
become completely silent. Marsh worked concentratedly. Only his hands
were moving.
Dashi held the paper in front of Merxira again.
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Slight blurring of vision on the left, he said.

Marsh stopped.
He lifted his head from the microscope and looked at me. You stop
when you start getting more anxious, he said. Thats experience.
He bent down to Merxira and said that the operation had been
successful, that everything had gone the way it was supposed to.
I hadnt dared to speak to her during the operation. But now I went
over. I wanted to ask her how she was doing, but when I saw her lying
there, with her hand shielding her eyes, I said instead, in a thick voice, You
were very brave.
Afterward, when I took off the disposable gown, the face mask and the
cap on the ground floor, I felt shaky.
Oh, man, Pellegrin said. It was like her mind occupied the room.
Later that day, I went to the National Art Gallery and looked at the
paintings from the Communist Era. They were hanging in two large
galleries, and during the hour I spent in there, I didnt see a single person.
Occasionally I heard some children playing on the lawn outside, their
shouts and laughter rose up above the even, distant hum of the city. Many
of the paintings showed people at work. In one of them, what appeared to
be an enormous radio tower was being hoisted into place in a barren,
mountainous landscape bustling with activity, while a woman, clearly an
engineer, studied some drawings and a man pointed ahead. A nation was
being built; a new world was being created.
In Norway in the 1970s, Albania was considered a pioneering country
by the young intellectuals. A sort of utopia, a land of the future, the ideal we
should be striving toward. When I mentioned this to Petrela at our first
dinner, he laid his head in his hands.
But that was just a lie, he said. It was all a lie. How could they have
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believed it?
I dont know, I said then. But when I saw the paintings in the
museum, I felt the pull from them.
The painting I looked at the longest portrayed a young, modern family.
The father carried a child on his shoulders, the mother had a satchel in her
hand, another child was running ahead of them. They were moving through
a landscape of mountains and valleys, the grass was green, bordering on
pastel, the sky was light, far up above them a helicopter hung suspended.
Everyone was smiling, the adults and the children. They were headed for
the future, full of joy and hope.
Everything was clear, pure, simple and forceful.
Why couldnt the world look like that?
What was so wrong with these paintings? What was wrong with the
world they portrayed?
When I came out onto the street again, the sun hung low in the sky,
and the previously limpid air had dulled a little. It was faintly hazy, the way
it gets in the hour before dusk. The cars on the avenue in front of me were
waiting for the green light. An old, crooked woman walked between them,
supporting herself on a crutch, a cup in her hand. She knocked on the
window of one of the cars. Two women were sitting inside, both of them
turned their heads and looked the other way, the way people have always
averted their eyes from beggars. I walked into a park, toward a large
complex of restaurants that lay in front of a shallow but wide pool, blue,
with peeling paint. The Chinese had built the complex, Fejzo had said, and
it was known locally as Taiwan.
I sat down in one of the few empty chairs outside and looked at people,
speculating about the relationships they had to one another and to the
world.
I had always considered my thoughts as something abstract, but they
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werent; they were as material as the heart beating in my chest. The same
was true of the mind, the soul, the personality; all of it was fixed in the cells
and originated as a result of the various ways in which these cells reacted
with one another. All of our systems, too communism, capitalism,
religion, science they also originated in electrochemical currents flowing
through this three-pound lump of flesh encased in the skull.
All of which was saying nothing. It was like examining a stone in the
foundation wall to find the answer to the secret of St. Peters Basilica.
That was all just a lie, Petrela had said about Albanian Communism.
But what wasnt?
I had asked Marsh if he believed in God, in a life beyond death. He just
shook his head. This is it, he said.
We use systems to keep the wolf from the door, I thought. And systems
are nothing but vast complexes of notions and concepts. Everything that
helps us lose sight of the petty, pathetic and meaningless parts of our own
selves. That is the wolf. The awkward, twisted or stupid part of the soul, the
grudges and the envy, the hopelessness and the darkness, the childish joy
and the unmanageable desire. The wolf is the part of human nature that the
systems have no room for, the aspect of reality that our ideas, the
firmament that the brain vaults above our lives, cannot fathom. The wolf is
the truth.
So why would Marsh want to keep the wolf from the door? Seen from
the outside, it seemed that the role of surgeon had provided him with a
larger context in which he could excel and rule over life and death, where
there was no place for whatever was small and insecure in him. The role of
surgeon gave meaning to his life, lifted the meaning outside of himself, into
a system it kept the wolf from the door. At the same time, that role
revealed the meaninglessness of it all. Tumors grew randomly, people died
randomly, every day, everywhere. You could choose to keep this from sight
behind numbers, behind statistics, behind the plastic drapes that made the
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patients faceless. His greatness was that he didnt hide the smallness but
instead used his insight into it to fight against everything that concealed it,
the institutionalization of hospitals, the dehumanization of patients, all the
rituals established by the medical profession to create distance and to turn
the body into something abstract, general, a part of a system.
Fejzo had told me a story he heard in London. Marsh had not
mentioned it in his book, and as far as Fejzo knew, Marsh had never spoken
about it it was one of his colleagues who had told Fejzo. Marsh had
operated on an infant, only a few months old, and the operation went badly;
the child died on the operating table. Marsh went in to see the parents in
person. He told them that he had made a mistake, and that their child had
died. He cried with them. No doctor does that, Fejzo had said. No one.
It began to get dark around me. A man came pushing a stroller
between the tables. A boy was sitting in it; he might have been a year and a
half, and when the father sat down at a table, the boy stretched his hands
out to him. The father loosened his straps, lifted him out and set him on his
lap. He fooled around with him for a while, and the boy laughed.
That, too, was the truth.
Then the father lit a cigarette, took out his cellphone and began texting.
The boy protested against the sudden lack of attention, and the father
handed him the pack of cigarettes, which he happily began to play with,
while the moon slowly rose over the rooftops, bright yellow against the
blue-black sky.
Karl Ove Knausgaard is the author of the six-volume autobiographical novel
My Struggle. He last wrote a two-part series for the magazine about tracing
the Viking trail from the first European settlement in North America to
Alexandria, Minn., site of a possibly fraudulent Viking runestone.
Translated by Ingvild Burkey from the Norwegian.
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34/35
1/5/2016
A version of this article appears in print on January 3, 2016, on page MM30 of the Sunday
Magazine with the headline: An Open Mind.
2016 The New York Times Company
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