The nervousness had assailed me as soon as I'd closed the door. I can't recall ever arriving home to anything other than an empty and silent flat, where the only sound is the rhythmic ticking of clockwork, and everything is, always and inevitably, exactly just as I left it. Standing on the threshold, and knowing that she was here, had sent a cool spasm of anticipation through my abdomen. I'd felt a sensation akin to excitement, not just in a physical sense, more like a deep, intrinsic need to just be with her; listening to her conversation, her laughter, and even her teasing. All the way home I'd rehearsed the many different ways I might raise the suggestion, but every alternative, every gambit, had merely afflicted me with the same breathless degree of stage fright. As I ran up the stairs, I resolved to simply observe her, and wait for the opportunity to present itself.

I was unsurprised, and even slightly relieved, to discover her asleep, stretched out on the Chesterfield, and looking as perfect as it seems possible for any living being to appear. Even with her eyes closed, seemingly unconscious, she seemed to exude warmth and such a degree of comfort that I experienced an intense need to touch her, struck by the reality of how much everything has changed for me in such a seemingly short space of time. The realisation made me somehow even more anxious, as if suddenly I had everything I ever wanted within my reach, and all I had to do was to present my plan to her, suggesting that splitting her time between our two respective homes might offer us a solution, a respite to the endless time apart we are currently facing.

So much of my life now seems to involve venturing into the unknown, no doubt an important contributing factor to the nervousness I was experiencing. I am still getting used to the complete and utter change of mindset Louisa's arrival in my life has instigated. At the beginning, speaking from my point of view, nothing about my infatuation with her was very logical or particularly well thought out. I had succumbed to feelings that I hadn't previously believed actually existed; I'd been forced to rapidly eschew my belief that romantic love was somehow just a weakness, a trick of desire, a convenience of nature, all designed to defraud the mind, and procreate the species. In my own defence, what did I know of it though, really? I don't recall ever being involved much in the transaction of it, either the giving or the receiving. I'd watched with frank distaste as Chris Parsons had apparently fallen in and out of it on a weekly basis; I'd seen men lose their minds over it, and women give up their careers for it, yet I had about as much belief that this emotion even existed as I did that there might be pixies at the bottom of the garden.

But I had fallen, and I had fallen hard and, now, as I gazed down at her, almost overwhelmed by a plethora of emotions, some familiar aches but mostly sensations that are both confounding and quite new, I realised how effective the mind's ability to deceive itself really is. I have spent most of my adult life assuming that I am as complete a man as my difficult personality will ever allow me to be, convinced that I had absolutely everything under control; indeed anyone ever asking after my well-being would inevitably Hear me proclaim that I was fine. I honestly believed myself to be so; so sure that I needed no one, that need is merely a weakness too easily exploited, and that neediness itself is the absolute worst of conditions, bringing only derision and humiliation and misery.

Yet now I know without a doubt what it is I actually want, and I am reminded every time I see her, or hear her voice in the telephone, or even now if someone mentions her name. I want to be with Louisa, in every sense of the word, despite the difficulties this presents and despite how fearful I now realise I am that, tonight, she might reject my suggestion , that she, too, sees me as needy, or believes it is all too soon or all too much, or that I am too dull, or not enough to replace what she already has, or any of the million other possible reasons I'd come up with in my head for why she might rebuff me. I'm only too aware of her youthful insouciance, and her lightness of spirit, and even her mercurial personality; these are some of the the things I love about her but, as I pressed my fingers lightly to her forehead, overcome by a tremendous surge of protectiveness, and anticipation, and even fear, I felt suddenly, and debilitatingly, terrified.

In hindsight, most medical misadventures occur due to one sort of communication error or another. Professionally, we constantly reassess how crucial information can best be managed, and transferred, effectively. In my own case, I had been sceptical of the need for a preoperative briefing to my theatre team but, once I was convinced of the benefits, it has become second nature. Within Vascular, I am insistent upon the prompt recording of post-operative notes, having recently introduced the additional feature of diagrammatic representation of any laparoscopic surgical incisions, and the whole department has implemented a strict policy on clear and concise discharge notes for every patient, each requirement a valuable tool in our drive to remove human error from the adverse event equation. Which only makes me wonder why, as I sit on the bed, frozen in horror as Louisa begins to weep helplessly, if I could possibly have done a worse job at communicating my ideas to her.

There are few things in life that disconcert me more than failure, and more than women's tears and, at this moment, I feel as if I am to be crushed by both. Each rasping sob, each hopeless shudder of her shoulders, lacerates me, and I am momentarily paralysed by the horror, by my unutterable failure, my absolutely feeble attempt to find a solution. My whole being is still smarting from her words; her accusation that I'm somehow trying to buy her affections is particularly galling and, I struggle to manage the piercing sense of hurt, and the bitter disappointment I feel at my own inadequacy. I glance down and, noticing my bare chest, I feel a sudden and pressing need to put some clothes on, as if my naked torso somehow renders me even more vulnerable. I find that I am unable to even glance at her as I stalk across the room and into my wardrobe, fighting back tears of my own as I retrieve a tee-shirt from the drawer of neatly pressed, pale blue crew necks that are part of my usual night attire, and pull it savagely over my head.

As I emerge, our eyes meet and I experience a breathless feeling of despair. Her hands are clasped over her mouth and her eyes are awash with tears, glassy and, somehow, imploring, as if she wants something from me but I am paralysed by the hurt, with no idea of what to do, or to say to her that just won't make everything worse. Yet I can't move away and so I stand in front of her, in utter confusion, watching her helplessly wiping at her tears with the back of her hand, as she snatches upwards at the sheet, in a rather pathetically touching attempt at modesty.

"I'll make some tea." I tell her quietly.

Watching her weep, seeing the damp splashes darken and watermark the bed linen, appearing as a permanent reminder of her despair, is almost unbearable. I make my way briskly to the kitchen where I grip the countertop like a man possessed, my head slumping over as I wait for the kettle to boil. I can't seem to think, as I try to recall the name of that appalling confectionary Louisa seems so partial to, but all I remember is that it had a medically rather ironic name, and an eye-watering kilojoule to nutrition deficit which, in my eyes, should see it reclassified as a non-food. As much as I don't understand how such empty calories can provide her any solace, just for a moment I fervently wish that I had some on hand because I can't imagine anything else I could offer her that might provide any sort of comfort. Miraculously though, I suddenly recall the packet of Chocolate Mints that she bought with her some time ago, when she'd threatened me with actual bodily harm should I throw them away. Though I'd been tempted to dispose of them, I had other, more pressing temptations that had encouraged me to take heed of her wishes, however firmly against my principles they were. I reach into the back of the refrigerator to retrieve them, experiencing the tiniest flash of optimism, only to be shaken immediately by a strangled screech, and a horrifyingly loud crash, emanating from the direction of my bedroom.

I run and, seconds later, I discover her, sprawled across the floor of the ensuite, attempting somewhat gingerly to clamber to her feet.

"What happened? Are you hurt?" I bark at her as I bend down and clasp her arm, attempting to steady her.

"Ow." She says shakily, as I manage to get her onto her feet.

She won't look at me but she gesticulates at her knee, and begins a close examination of her wrist. She has wrapped herself in a silk robe, a pretty Chinese floral patterned thing that somehow makes her seem even more delicate and vulnerable as she tugs self consciously at the tie that encircles her waist. The fabric feels cool to my touch as I slip my arm around her waist and assist her back to the bed, and I steady her as she lowers herself carefully down on to the edge. Reluctantly, as I crouch down in front of her, she looks back at me, her skin is pale and the expression in her eyes is as downcast as I have ever seen it. I feel another stab of regret at the realisation that I am responsible.

"Let me see." I tell her, as gently as I can. "Where does it hurt?"

"It's fine." She tells me, somewhat shakily, before adding, more defiantly. "I just slipped."

I examine her fingers, her wrist, carefully checking her scaphoid, and bending and flexing her elbow but, with relief, I discover that there seems to be nothing amiss. She seems to have taken most of the impact on her knee and there will no doubt be some considerable bruising but, once again, nothing appears to be broken.

"Any other pain?" I ask her, as I manipulate her knee open and closed several times. "No impact on your hip? No rib contact with the floor?"

She shakes her head, slightly awkwardly, as if she is suddenly embarrassed. Conversely, I'm braver now, more confident in my interaction with her if only because, suddenly, I'm back to knowing exactly what I'm doing, knowing the questions to ask; self-assured and unflinching, examining and diagnosing. I look up at her, my steely gaze belying the way it feels to have my fingers against her warm flesh; the soft, smooth spot where I can feel her adductors move as I again twist and flex her leg.

"What happened?" I say, questioning her as gently as I can, lest I again provoke her ire. "How did you fall?"

She looks at me with glassy eyes, blinking at me rather sheepishly.

"I think perhaps I didn't get all the water up from the floor after...umm..after my shower."

"Aah." I reply, raising an eyebrow at her but offering no other immediate remonstrations.

Of course, I'd noticed the state of the floor earlier but, most uncharacteristically, I'd ignored it, as desperate I was to get back to her, to make the most of every available moment we had together. Louisa, naked in my bed, still felt like a something of a hallucination, an evanescence that might disappear without warning, a divine state of affairs that required my utmost attention, lest I turn around and she was gone. That would teach me to put the needs of the flesh ahead of the basic principles of health and safety, I think to myself ruefully as I stand up. I glance down at her and she seems impossibly vulnerable, hesitant and unsure. I clear my throat because I can't think of anything else to do.

"I'll fetch the tea." I tell her, and I feel her gaze follow me as I stride from the room, my purposeful demeanour belying the overwhelming sense of failure I am experiencing and, just for a moment I wonder if she feels as lost and hopeless as I do.

I find a tray, retrieve an ice pack from the freezer and wrap it in a clean tea towel. I stare disapprovingly at the After Eight Mints and, very reluctantly, I make myself open the box, putting one sole portion on a plate. After I pour the tea, I place the two mugs on the tray as well but I'm still rather bothered; one solitary chocolate mint might seem rather ungenerous, miserable and possibly provocative, but I realise that I have no concept of how many of the dreadful things it is customary to consume. I decide on three, due mainly to Louisa's rather trying day and, after hiding the box again in the furthest recesses of the refrigerator, which seems somehow important, I make my way cautiously back to the bedroom.

She is back on her side of the bed, and she appears somehow even more defenceless and exposed, her eyes huge and sad, her knees bent and her arms clasped around them, glancing at me morosely. I've seen her like this before, of course, in that rambling old house that overlooked the sea, when she was terrified that she was going to be exported to Spain, back into the so-called care of her appalling mother. I remember very clearly how she'd been so beseeching of me, begging me so forlornly to accompany her; she had clearly needed something from me that afternoon, and it pains me realise that I have no idea what it was that I offered her then that I so obviously can't provide now.

Quietly, I place the coasters and the mugs of tea next to her, and then I place the tray on the bed. Her eyes follow me but she says nothing, which somehow just makes everything seems so much worse.

"Do you mind?" I ask her, as sit on the bed by her feet and reach carefully for her injured leg.

As gently as I can, I remove her hand from her shin, placing it by her side while I separate her knees and slide the cool pack around the emergent bruising on her patella.

"No bag of frozen peas for Martin Ellingham." She says, as I adjust the position of the compress, her voice low and sad, and stripped of her usual levity.

My hand is large enough to envelop the whole joint and I decide to hold the ice pack in place for her while she sips at her tea. It seems like something I can at least do for her, as I feel the last of my anger dissipate, only to feel it replaced by a desperately sad, regretful longing.

"I shouldn't have said what I did Martin." She says suddenly, her voice croaky and despondent. "I'm just so sorry. I really am. I honestly didn't mean any of it."

I glance across at her. There's a huge part of me that wants to bury my face in her neck, that needs to feel her arms around me and to hear her reassure me that she loves me but the reality is that I have not survived my life to date without developing some fairly intense and effective, cast iron defence mechanisms.

"What did you mean then?" I say coolly, raising my chin at her. "Because that was quite an outburst, don't you think? It occurs to me that it must have a basis somewhere, despite what you say about it not meaning anything."

She looks back at me, crushed, and I notice that she is again biting her lip, this time rather brutally. I hope fervently that she is not going to cry again and, impulsively, I pass her the little plate of chocolate. It would be so easy to give in but I realise that I must know, I must try and understand because, if I don't, it would rather seem like an intensely important clinical trial where no one bothered to record the results. Her words, and the implications they suggest, if left unresolved, feel as if they have the power to really damage me.

"Louisa, I suppose what I'm trying to say is...just... that it didn't sound, umm, meaningless to me..." I add, as she frowns slightly at the proferred dish, before quietly taking two mints and slipping them into the pocket of her gown.

"I'm not sure I can even explain." She says quietly.

"But I would appreciate it if you could try." I tell her, and I find myself swallowing hard. "Because...I'm starting to think that I'm not ever going to make you happy...that I upset you every time we spend any time together and..."

"Please don't say that!" She says, launching herself forward and grasping my arm so firmly, I let go of the ice pack. "Martin, I know that my reaction was just horrible and so unreasonable. I don't know what came over me, and I don't know what to say to put things right."

"How am I supposed to know when it is acceptable to provide assistance to you, and when it is not?" I say, attempting to sound matter-of-fact yet all I can hear in my voice is the voice of a child; a hurt, resentful, confused boy who never seemed able to grasp his parents ever-changing rules.

"Honestly? I just don't know." She replies, and she looks at me with such an expression of hopelessness that my heart feels as if it lurches in my chest. "I think...I think that...maybe I haven't been able to get over some things as well I thought I had...I p'raps still have some issues from when my mum and then my dad left...I'm not making excuses for what I said. I know I was horrible..."

I move my hand, and the ice pack, to the inside of her knee, glancing at her again but finding myself unable to respond.

"You know, sometimes I feel like you think I'm incapable of taking care of myself. And that gets my back up. I just can't help it." She adds quietly, and our eyes meet.

"Because I try and do things for you?"

"Yes."

"If you don't mind me saying so, that seems unreasonable on many levels," I tell her and I hear the resentful tone in my voice again. "Firstly, one of the things I've always admired about you, umm, from that weekend at Aunt Joan's...was...is...your resilience, your...your...refusal to be defined by your parent's lackadaisical attitude to child rearing."

Her expression doesn't change, but I notice that she swallows and, for a moment, it looks as if she is chewing thoughtfully on the inside of her own mouth.

"But just because you are quite capable of battling for survival, ummm...against all the odds, does that mean it always has to be that way for you?" I tell her, more vehemently now as I struggle to contain the ridiculous flood of emotion that seems to be boiling over within me. "Are you telling me that, even if I can help you in some way, I shouldn't, because you prefer to do everything alone and unassisted?"

I watch as her eyes widen; her jaw fixes with an ominous firmness and, though I'm aware that she could be about to unleash upon me again, I suddenly don't care and I look away, aware of the peevish expression that seems to have hijacked my face.

"I suppose...I suppose I'm a bit scared, Martin...scared that I...umm...that I...that I might end up depending on you." She says and she sounds as nervous and uncomfortable as I think I have ever heard her. "I think that's what it is, why I reacted like I did..."

"So it makes you feel vulnerable, if I try to help you?"

"Umm, yes, vulnerable...and exposed."

"Okay..." I reply, trying to keep my frustration under control. "So, how vulnerable do you think I feel, hmm? When you insist that I kiss you in the street, most likely in full view of my colleagues and, potentially, even some of my patients? When you know how I feel about revealing myself like that? You seem to have a need to force me to confront my own fears constantly, whilst avoiding facing up to any of your own."

I hear her exhale noisily and I look up to notice that she is glowering at me, narrowing her eyes and breathing heavily, as she erupts.

"My fears? You really want to know about them, do you? Right then, I mean other than the fact that, if I start to rely on you, like just almost every other person in my life, anyone I've ever come to rely on, you will leave me high and dry; you'll abandon me, find something or someone more important to you and that will be it... Is that enough fear for you Martin? Or how about how insecure I feel about all these women that seem to be around you? Batting their eyelids at you, talking to you about stuff you're interested in, all clever and accomplished and successful? And then there's me, a bloody student, and not even a science-y one, an arts student! A penniless country kid from a hopeless family, battling to get a degree that might secure her an average job if she's lucky. So, by all means, I should start relying on you, because, I mean, what could possibly go wrong?"

Her words are like a stinging slap and I don't know where to start to refute her assumptions; I can't quite believe what I am hearing and I'm momentarily dumbfounded, struggling to respond when all I feel is complete and utter bewilderment.

"Louisa, I'm well aware of how let down you've been in your life, and, believe me, I understand that you've paid a high price for the inconstancy of others. But right now it feels bloody unfair that I shouldn't be allowed to do anything for you because so many others have let you down."

She looks at me bullishly, lifting her chin, pulling her dressing gown across her chest and folding her arms defiantly. I feel as if I must get all of my frustration out in the open because, suddenly, it feels as if it might bury me. As much as I know that I love her, it seems as if huge gulfs in our expectations are appearing, a massive differential between what we each think we need and that which we determine we are able to offer in return. I clear my throat.

"In hindsight, I realise that I did not communicate my thoughts to you in an ideal manner. Umm, please try and understand, I spend all day, every day, analysing problems and finding solutions and I admit that, rightly or wrongly, that was my approach to the dilemma I felt we faced...umm...over the amount of time we are able to spend together. And, it seems reasonable to me that, since it is the demands of my career that force us into this position, I should be the one to find a way to mitigate the situation. Was that unreasonable of me Louisa?"

"No." She replies, a slight tartness evident in her tone. "Not unreasonable in concept but you did a pretty rubbish job of making me feel like I had any say in it."

"Yes. I realise that now."

"You know, you're always banging on about my flat but it never seems to dawn on you that it's the best I can afford, or how grateful I was to find it when I first came to London and I hardly knew a soul."

"Louisa, in my defence, I have not asked you to abandon your flat." I tell her as I glance up at her. "And, I reiterate, nor would I..."

She hesitates, and slides her hand over the top on mine, as I clasp the ice pack to her knee.

"Could we just give it a try then, me staying over during the week, just to see how it goes?" She says cautiously, glancing at me self-consciously as she speaks. "You know, before you go buying a telly and all that?"

I stare back at her, struggling to conceal my confusion.

"You mean, you want to come and stay?"

"Yes, Martin, I want to come and stay." She says and, finally, she smiles at me, a nervous little glimpse of herself, an expression that seems to release a very tight rope that's been wound around my diaphragm, and I exhale heavily as I feel the return of one of the predominant associated emotions I associate with Louisa, yet another important reward that I crave; the hope she provides me.

"Stupid thing is, I always did." She adds, with a pained little grimace.

"Right." I say and all I can do is stare at her, feeling the relief flood through me, like a man who has just had his death sentence commuted, a warm tide of love and gratitude and need. "Umm, thank you."

She squeezes my hand and leans toward me, pushing herself up with one arm as she reaches toward me with the other, touching my cheek. For a moment I feel utterly helpless; drained and exhausted, and almost consumed by the way I feel about her. Nothing in my life could ever have prepared me for the intensity of the need I have of her and, as if she reads my mind, I close my eyes as I feel her fingers running through my hair. The ice pack hits the floor with the dull thud as she shifts her weight and I feel the overwhelming sensation of her mouth on mine, her hands under my jaw; the way she murmurs my name filling me with the most incredible relief. I feel her breath on my throat and the soft warmth of her lips as she turns her attention to my earlobes, and I struggle to maintain my sense of reason as everything seems, rather dramatically, to spin. Moments ago I feared she might be lost to me forever and now she swings herself across my lap, straddling my hips and slipping her hands beneath my shirt.

"Are you sure?" I ask her, incredulously, as she undoes her belt and slides her dressing gown from her shoulders.

Louisa at her most mercurial, her eyes flashing as she gazes at me with a fierce intensity, reaching for my hand, and sliding it up to her chest as she nods at me briefly, a wicked smirk transforming her from merely beautiful to completely mesmerising. So many times I have dreamt of her like this, hungry, and assailing me with a passion equal only to my own. I'd wanted her to want me I suppose, I'd wanted so badly to hear her cry out my name and, over those long desperate nights, my subconscious had filled in the gaps for me as I'd lain in bed and physically ached for her. But now she is in my lap, and all I am aware of is the glorious weight of her breasts in my hands and the desperation of her mouth on mine.

Having spent so much of my life knowing I was unwanted, in this moment I experience something I can only describe as an incredible lightness of spirit; a transformative moment where I am bound indelibly to another human being, and I am enveloped by such a profound degree of emotion that I hear myself professing to her, breathlessly, the depth of my feelings. Candid and impulsive, for a split second I bare my soul to her and she to me; we are two the same, both damaged and discarded, yet finding in each other some sort of refuge, some kind of guarantee. Helpless, I collapse backwards, gazing up at her and, just like my dream, I say her name again, and it sounds like an invocation.