Saturday. Part 10

w Beach', is in all the anthologies and used to be taught in every school.

'Like your "Mount Fuji"/ Henry says, a remark that pleases Grammaticus immensely and prompts him to stand to propose a toast. John's in his twinkly mode, an effect heightened by his clownishly swollen nose. The evening has the appearance of being back on c.o.xirse, for in his hand is the proof copy of Mi/ Saucy Bark.

'Forget everything else that's happened. We're raising our gla.s.ses to Daisy,' he says. 'Her poems mark a brilliant beginning to a career and I'm a very proud grandfather and dedicatee. Who would have thought that learning poems by heart for pocket money would turn out to be so useful. After tonight I think I must owe her another five pounds. To Daisy.'

'To Daisy,' they reply, and as they lift their gla.s.ses she kisses him, and he hugs her in return - the reconciliation is made, the Newdigate Rebuff is forgotten.

Henry touches the wine to his lips, but finds he's lost his taste for alcohol. Just as Daisy and her grandfather sit down, the phone rings and since he's nearest, Henry goes across the kitchen to take the call. In his unusual state, he doesn't immediately recognise the American voice.

'Henry? Is that you, Henry?'

'Oh, Jay. Yes.'

'Listen. We got an extradural, male, mid twenties, fell down the stairs. Sally Madden went home with the flu an hour ago, so I've got Rodney. The kid's keen and he's good and he doesn't want you in here. But Henry, we have a depressed fracture right over the sinus.'

Perowne clears his throat. 'Boggy swelling?'

'Right on the spot. That's why I'm stepping in. I've seen inexperienced surgeons tear the sinus lifting the bone, and four litres of blood on the floor. I want someone senior in here and you're the nearest. Plus you're the best.'

From across the kitchen comes loud, unnatural laughter, exaggerated like before, almost harsh; they're not really pre232 tending to have forgotten their fear - they're simply wanting to survive it. There are other surgeons Jay can call on, and as a general rule, Perowne avoids operating on people he knows. But this is different. And despite various shifts in his att.i.tude to Baxter, some clarity, even some resolve, is beginning to form. He thinks he knows what it is he wants to do.

'Henry? Are you there?'

'I'm on my way.'

233.

Five.The family is used to Perowne's occasional departures from dinner - and in this case there may even be some rea.s.surance, a suggestion of a world returning to the everyday, in his announcement that he's been called to the hospital.

He leans by Daisy's chair and says into her ear, 'We've a lot to talk about.'

Without turning, she takes his hand and squeezes. He's about to say to Theo, perhaps for the third time that evening, You saved my life, but instead he half smiles at his son and mouths, 'See you later.' Theo has never seemed so handsome, so beautiful as now. His bare lean arms lie across the table; the solemn, clear brown eyes and their curling lashes, the blind perfection of hair, skin, teeth, the unbent, untroubled spine - he gleams in the half-light of the kitchen. He raises his gla.s.s - mineral water - and says, 'You sure you're up to this, Dad?'

Grammaticus says, 'He's right, you know. It's been a long night. You could kill some poor b.u.g.g.e.r.' With his swept-back silver hair and nose compress he resembles a patched-up lion in a children's book.

T'm fine.'

There's been talk of Theo fetching down an acoustic guitar to accompany his grandfather in 'St James Infirmary', for 237.

Grammaticus is in the mood for a Doc Watson imitation. Rosalind and Daisy want to hear the recording of Theo's new song, 'City Square'. There's an air of unnatural festivity around the table, of wild release which reminds Henry of a family outing to the theatre the previous year - an evening of b.l.o.o.d.y and startling atrocities at the Royal Court. At dinner afterwards they pa.s.sed the evening in hilarious reminiscence of summer holidays, and drinking too much.

When he's said his farewells and is leaving, Grammaticus calls after him, 'We'll still be here when you get back.'

Perowne knows this is unlikely, but he nods cheerfully Only Rosalind senses the deeper alteration in his mood. She rises and follows him up the stairs and watches him as he puts on his overcoat and finds his wallet and keys.

'Henry, why did you say yes?'

'It's him.'

'So why did you agree?'

They are standing by the front door with its triple locks and the keypad's comforting glow. He kisses her, then she draws him towards her by his lapels and they kiss again, longer and deeper. It's a reminder, a resumption of their morning lovemaking, and also a promise; this is surely how they must end such a day. She tastes salty, which arouses him. Far below his desire, lying like a granite block on the sea floor, is his exhaustion. But at times like this, on his way to the theatre, he's professionally adept at resisting all needs.

As they pull away he says, The had a sc.r.a.pe in the car with him this morning.'

The gathered that.'

'And a stupid showdown on the pavement.'

'So? Why are you going in?' She licks her forefinger - he likes this glimpse of her tongue - and straightens his eyebrows for him. Thickening, with unruly tendrils of ginger, grey and unblemished white tending to the vertical, evidence of the clotted testosterone that can also cause ear and nostril hair to grow like winter sedge. More evidence of decline.

238.

He says, 'I have to see this through. I'm responsible.' In reply to her querying look he adds, 'He's very sick. Probably Huntington's.'

'He's obviously nuts as well as nasty. But Henry. Weren't you drinking earlier? Can you really operate?'

'It was a while ago. I think the adrenaline's rather cleared my head.'

She's fingering the lapel of his coat, keeping him close. She doesn't want him to leave. He watches her tenderly, and with some amazement, for her ordeal is only two or three hours behind her and now here she is, pretending to be entirely herself again and, as always, keen to know the components of an unusual decision, and loving him in her precise, exacting way, a lawyer to the core. He forces his gaze from settling on the abrasion on her throat.

'Are you going to be all right?'

She's lowered her eyes as she orders her thoughts. When she lifts them he sees himself, by some trick of light, suspended in miniature against the black arena of her pupils, embraced by a tiny field of mid-green iris.

She says, 'I think so. Look, I'm worried about you going in.'

'Meaning?'

'You're not thinking about doing something, about some kind of revenge are you? I want you to tell me.'

'Of course not.'

He pulls her towards him and they kiss again, and this time their tongues touch and slide by each other - in their private lexicon a kind of promise. Revenge. He suddenly doubts he's ever heard the word on her lips before. In Rosalind's slightly breathless utterance, it sounds erotic, the very word. And what is he doing, leaving the house? Even as he frames the question, he knows he's going; superficially, it's simple momentum - Jay Strauss and the team will already be in the anaesthetist's room, starting work on his patient. Henry has an image of his own right hand 239.

pushing open the swing doors to the scrub room. In a sense, he's already left, though he's still kissing Rosalind. He ought to hurry.

He murmurs, 'If I'd handled things better this morning, perhaps none of this would've happened. Now Jay's asked me in, I feel I ought to go. And I want to go.'

She looks at him wryly, still trying to gauge his intentions, his precise state of mind, the strength of the bond between them at this particular moment.

Because he's genuinely curious to know the story, but also to deflect her, he then says, 'So we're going to be grandparents.'

There's sadness in her smile. 'She's thirteen weeks and she says she's in love. Giulio is twenty-two, from Rome, studying archaeology in Paris. His parents have given them enough money to buy a little flat.'

Henry contends with fatherly thoughts, with nascent outrage at this unknown Italian's a.s.sault on the family's peace and cohesion, at his impertinently depositing his seed without first making himself available for inspection, evaluation where was he now, for example? And irritation that this boy's own family should know before Daisy's, that arrangements are already in hand. A little flat. Thirteen weeks. Perowne leans his hand on the door lock's ancient bra.s.sy k.n.o.b. At last Daisy's pregnancy - the evening's buried subject - rises before him in clear light, a calamity and an insult and a waste, a subject too huge to confront or lament now, when he is waited for up the road.

'Oh G.o.d. What a mess. Why didn't she tell us? Did she think about a termination?'

'Out of the question, apparently. Darling, don't start boiling over when you're about to operate.'

'How are they going to live?'

'The way we did.'

In a bliss of s.e.x and graduate poverty, taking turns with baby Daisy as together they sleeplessly raced through a law 240.

degree and first law job, and the early years of neurosurgery. He remembers himself after a thirty-hour shift, carrying his bicycle four floors up a cement stairwell towards the insomniac wail of a teething infant. And in that one-bedroom flat in Archway, folding the ironing board away in order to f.u.c.k late at night on the living-room floor by the gas fire. Rosalind may have intended such recollections to mollify him. He appreciates the attempt, but he's troubled. What's to become of Daisy Perowne, the poet? He and Rosalind meshed their timetables and worked hard at sharing the domestic load. Italian men, on the other hand, are pncri acternac, who expect their wives to replace their mothers, and iron their shirts and fret about their underwear. This f.e.c.kless Giulio could destroy his daughter's hopes.

Henry discovers he's clenching a fist. He relaxes it and says untruthfully, 'I can't think about it now.'

That's right. None of us can.'

'I better go.'

They kiss again, unerotically this time, with all the restraint of a farewell.

As he opens the door she says, 'I'm still worried about you going in like this. I mean, in this mood. Promise me, nothing foolish.'

He touches her arm. The promise.'

As the door closes behind him and he steps away from the house, he feels a clarifying pleasure in the cold, wet night air, in his purposeful stride and, he can admit it, in being briefly alone. If only the hospital were further away. Irresponsibly, he prolongs his walk by half a minute by going across the square, rather than down Warren Street. The few fine snowflakes he saw earlier have vanished, and during the evening it has rained; the square's paving stones and cobbled gutters shine cleanly in the white street light. Low smoky cloud grazes the top of the Post Office Tower. The square is deserted, which also pleases him. As he hurries along the 241.

eastern side, near the high railings of the gardens, under the bare plane trees stirring and creaking, the empty square is reduced to its vastness and the simplicity of architectural lines and solemn white forms.

He's trying not to think about Giulio. He thinks instead about Rome, where he attended a neurosurgery symposium two years ago, in rooms overlooking the Campo dei Fiori. It was the mayor himself, Walter Veltroni, a quiet, civilised man with a pa.s.sion for jazz, who opened the proceedings. The following day, in honour of the guests, Nero's palace, the Domus Aurea, much of it still closed to the public, was made available, and Veltroni along with various curators gave the surgeons a private tour. Perowne, knowing nothing about Roman antiquity, was disappointed that the site appeared to be underground, entered by a gated hole in a hillside. This was not what he understood by a palace. They were led down a tunnel smelling of earth and lit by bare bulbs. Off to the sides were dim chambers where restoration work was in progress on fragments of wall tiles. A curator explained three hundred rooms of white marble, frescos, intricately patterned mosaic, pools, fountains and ivory finish, but no kitchens, bathrooms or lavatories. At last the surgeons entered a scene of wonders - painted corridors of birds and flowers and complicated repeating designs. They saw rooms where frescos were just appearing from under a sludge of grime and fungus. The palace lay undiscovered for five hundred years under rubble until the early Renaissance. For the past twenty years it had been closed for restoration, and its partial opening had been part of Rome's millennial celebration. A curator pointed out a jagged hole far above them in an immense domed ceiling. This was where fifteenth-century robbers dug through to steal gold leaf. Later Raphael and Michelangelo had themselves lowered down on ropes; marvelling, they copied the designs and paintings their smoking torches revealed. Their own work was profoundly influenced by these incursions. Through his translator, Signor Veltroni 242.

offered an image he thought might appeal to his guests; the artists had drilled through this skull of brick to discover the mind of ancient Rome.

Perowne leaves the square and heads east, crosses the Tottenham Court Road and walks towards Gower Street. If only the mayor was right, that penetrating the skull brings into view not the brain but the mind. Then within the hour he, Perowne, might understand a lot more about Baxter; and after a lifetime's routine procedures would be among the wisest men on earth. Wise enough to understand Daisy? He's not able to avoid the subject. Henry refuses to accept that she might have chosen to be pregnant. But for her sake he needs to be positive and generous. This Roman Giulio may be just like the admirable boiler-suited types he saw in the gloomy chambers of the Domus Aurea, dabbing away at mosaic tiles with their toothbrushes - archaeology is an honourable profession. It's his duty, Henry supposes, to try to like the father of his grandchild. The despoiler of his daughter. When he condescends at last to visit, young Giulio will need to exert much native charm.

On Gower Street the sanitary teams are still at work, cleaning up after the demonstration. Perhaps they've only just begun. From noisy trucks, generator-powered arc lights illuminate mounds of food, plastic wrappings and discarded placards which men in yellow and orange jackets are pushing forward with wide brooms. Others are shovelling the piles onto the lorries. The state's embrace is ample, ready for war, ready to clean up behind the dissenters. And the debris has a certain archaeological interest - a Not in My Name with a broken stalk lies among polystyrene cups and abandoned hamburgers and pristine fliers for the British a.s.sociation of Muslims. On a pile he steps round are a slab of pizza with pineapple slices, beer cans in a tartan motif, a denim jacket, empty milk cartons and three unopened tins of sweetcorn. The details are oppressive to him, objects look too bright edged and tight, ready to burst from the packaging. He must 243.

be in a lingering state of shock. He recognises one of the sweepers as the man he saw this morning cleaning the pavements in Warren Street: a whole day behind the broom, and now, courtesy of untidy world events, some serious overtime.

Around the hospital's front entrance there's the usual late night Sat.u.r.day gathering, and two security guards standing between the double sets of doors. Typically, people emerge, though not completely, from a drunken dream and remember they last saw a friend being lifted into the back of an ambulance. They find the hospital, often the wrong one, and emphatically demand to see this friend. The guards' job is to keep out the troublemakers, the abusive or incapable, the ones likely to throw up on the waiting-room floor, or take a swing at authority, at a light-boned Filipino nurse or some tired junior doctor in the final hours of her shift. They're also obliged to keep out the rough sleepers who want a bench or piece of floor in the inst.i.tutional warmth. The sample of the public that makes it to a hospital late on a weekend night is not always polite, kind or appreciative. As Henry recalls, working in Accident and Emergency is a lesson in misanthropy. They used to be tolerated, the a.s.saults as well as the dossers, who even had their own little corner in A and E. But these last few years what's now called the culture has changed. The medical staff have had enough. They want protection. The drunks and loudmouths are thrown out onto the pavement by men who've worked as bouncers and know their business. It's another American import, and not a bad one - zero tolerance. But there's always a danger of chucking out a genuine patient; head injuries, as well as cases of sepsis or hypoglycaemia can present as drunkenness.

Perowne pushes a way through the small knot of people. When he reaches the first door the guards, Mitch and Tony, both West Indian, recognise him and let him through.

'How's it going?'

244.

Tony, whose wife died of breast cancer last year and who's thinking of training as a paramedic, says, 'Quiet, you know, relative like.'

'Yeah/ Mitch says. 'We just got the quiet riot tonight.'

Both men chuckle and Mitch adds, 'Now Mr Perowne, all the wise surgeons got the flu.'

'I'm truly unwise/ Henry says. There's an extradural.'

'We seen him.'

'Yeah. You better get up there, Mr Perowne.'

But instead of going straight ahead to the main lifts, he makes a quick detour through the waiting area towards the treatment rooms, just in case Jay or Rodney while waiting have come down for another case. The public benches are quiet, but the long room has a battered, exhausted look, as though at the end of a successful party. The air is humid and sweet. There are drinks cans on the floor, and someone's sock among the chocolate bar wrappers from the vending machines. A girl has an arm round her boyfriend who's slumped forward, head between his knees. An old lady wearing a fixed, faint smile waits patiently with her crutches resting on her lap. There are one or two others staring at the floor, and someone stretched out full length, asleep on a bench, head covered by a coat. Perowne walks past the treatment cubicles to the crash room where a team is working on a man who's bleeding heavily from his neck. Outside, in the majors' area, by the staff base, he sees Fares, the on-duty A and E registrar whom he spoke to on the phone.

As Perowne approaches, Fares says, 'Oh right. That friend you phoned about. We've cleared cervical-spine. The CT scan showed a bilateral extradural with a probable depressed fracture. He dropped a couple of points so we called in a crash induction. They took him upstairs half an hour ago.'

An X-ray of the neck - the first investigative measure suggests there'll be no complications with Baxter's breathing. His level of consciousness as measured by the Glasgow Coma Score has fallen - not a good sign. An anaesthetist - probably 245.

Jay's registrar - was called down to prepare him for emergency surgery which will have involved, among other things, emptying Baxter's stomach. 'What's his score now?'

'Eleven down from thirteen when he came in.' Someone calls Fares's name from the crash room, and by way of excusing himself he says as he leaves, 'Bottle fight in a bus queue. And oh yeah. Mr Perowne. Two policemen went up with your friend.'

Pcrowne takes the lift up to the third floor. As soon as he steps out into the broad area that gives onto the double doors of the neurosurgical suite, he feels better. Home from home. Though things sometimes go wrong, he can control outcomes here, he has resources, controlled conditions. The doors are locked. Peering through the gla.s.s he can see no one about. Rather than ring the bell, he takes a long route down a corridor that will bring him through intensive care. He likes it here late at night - the muted light, the expansive, vigilant silence, the solemn calm of the few night staff. He goes down the wide s.p.a.ce between the beds, among winking lights and the steady bleeps of the monitors. None of these patients is his. Now that Andrea Chapman has been moved out, all the people on yesterday's list are back in their wards. That's satisfying. In the marshalling area outside the ICU, the s.p.a.ce looks unnaturally empty. The usual clutter of trolleys has been removed - tomorrow they'll be back, and all the bustle, the constantly ringing phones, the minor irritation with the porters. Rather than call Rodney or Jay out of the theatre, and to save time, he goes straight to the changing room.

He taps a code in the number lock, and steps into a cramped and homely squalor, a particularly masculine kind of pigsty suggestive of several dozen delinquent boys far from home. He uses a key to open his locker and starts to undress hurriedly. Lily Perowne would have been horrified - scattered 246.

across the floor are discarded scrubs, some clean, some used, along with the plastic bags they came in, and trainers, a towel, an old sweater, a pair of jeans; on the tops of the lockers, empty c.o.ke cans, an ancient tennis-racket press, two unrelated sections of a fly-fishing rod that have been lying there for months. On the wall a peevish computer-printed notice asks, Is it possible to discard towels and greens in the appropriate manner? Some wag has written 'no' underneath. Another more official sign advises, Don't take risks with your valuables. There used to be a sign on the lavatory door saying, Please Raise the Seat. Now there's one saving, in resignation. To complain about the state of the lavatory dial extension 4040. A prospective surgical patient would not feel rea.s.sured by the racks of white clogs, stained with yellow, red and brown, with dried hard little friezes of gore, and the faded, clumsily inscribed Biro names or initials. It can be vexing, to be in a hurry and not find a matching pair. Henry keeps his own in his locker. He takes his scrubs, tops and bottoms, from the Targe' pile and pulls them on, and makes a point of binning the plastic bag. Despite the chaos around him, these actions calm him, like mental exercises before a chess game. At the door he takes a disposable surgical cap from a pile and secures it behind his head as he goes along the empty corridor.

He enters the theatre by way of the anaesthetic room. Waiting for him, sitting by their machine, are Jay Strauss and his registrar, Gita Syal. Round the table are Emily, the scrub nurse, Joan, the runner, and Rodney - looking like a man about to be tortured. Perowne knows from experience how wretched a registrar feels when his consultant has to come out, even when it's an obvious necessity. In this case it hasn't even been Rodney's decision. Jay Strauss has pulled rank. Rodney's bound to feel that Jay has gra.s.sed him up. On the table, obscured by surgical drapes, is Baxter, lying face down. All that's visible of him is the wide area of his head shaved to the rear of the vertex, the crown. Once a patient is draped 247.

up, the sense of a personality, an individual in the theatre, disappears. Such is the power of the visual sense. All that remains is the little patch of head, the field of operation.

There's an air in the room of boredom, of small talk exhausted. Or perhaps Jay has been holding forth on the necessity of the coming war. Rodney will have been reluctant to voice his pacifist views for fear of being taken apart.

Jay says, Twenty-five minutes. That's pretty good, chief.'

Henry raises a hand in greeting, then gestures at the young registrar to accompany him to the light box where Baxter's scans are on display. On one sheet, sixteen images, sixteen bacon slices through Baxter's brain. The clot, trapped between the skull and its tough membranous inner lining, the dura, sits across the midline, the division between the two hemispheres of the brain. It's two inches or so below the vertex and is large, almost perfectly round, and shows pure white on the scan, with telltale precise margins. The fracture is clearly visible too, seven inches long, running at right angles to the midline. In its centre, sitting right on that midline, is shattered bone, where the skull has partially caved in. Right below that depressed fracture, vulnerable to the sharp edges of displaced bone tilted like tectonic plates, runs a major blood vessel, the superior sagittal sinus. It extends along the fold - the falx - where the two hemispheres meet, and it's the major vein draining blood away from the brain. It sits snugly in the groove formed where the dura wraps separately round each hemisphere. Several hundred millilitres per minute flow through the sinus and it's possible for a surgeon to tear it while lifting the broken bone. So much blood escapes, you can't see to make a repair. This is when a year-two registrar can panic. And this is why Jay Strauss has called Henry.

While he's looking at the scans, Perowne says to Rodney, Tell me about the patient.'

Rodney clears his throat. His tongue sounds thick and heavy. 'Male, in his twenties, fell downstairs about three hours 248.

ago. He was drowsy in casualty, with a Glasgow Coma Score of thirteen dropping to eleven. Skull lacerations, no other injury recorded. Normal C-spine X-ray. They did a scan, ordered a crash induction and sent him straight up.'

Perowne glances over his shoulder at the monitors on the anaesthetic machine. Baxter's pulse shows eighty-five and blood pressure one hundred and thirty over ninety-four.

'And the scan?'

Rodney hesitates, perhaps wondering if there's a catch, something he didn't notice that could compound his humiliation. He's a big lad, occasionally and toiichingly homesick for Guyana where he has ambitions to set up a head injury unit one day. He once had hopes of playing rugby for a serious team until medicine and neurosurgery took him over. He has a friendly, intelligent face, and the word is that women adore him and he puts himself about. Perowne suspects he'll turn out well.

'It's a midline depressed fracture, both extradural and -' Rodney points to an image higher up the sheet and a small white ma.s.s shaped like a comma - 'subdural too.'

He's seen the only slightly unusual feature, a clot below the dura as well as the larger one above it.

'Good,' Perowne murmurs, and with that one word Rodney's evening is rescued. There is, however, a third abnormality the registrar will not have noticed. As medicine progresses, certain diagnostic tricks fall into disuse among the younger doctors. In a frame further up the sheet, Baxter's caudate on both sides of the brain lacks the usual convexity, the normal healthy bulge into the anterior horn of the lateral ventricles. Before DNA testing, this shrinking was a useful confirmation of Huntington's Disease. Henry never doubted he was right, but the physical evidence confers its own bleak satisfaction.