Just before one, Bernard Newton pokes his head around the door of my office and greets me warmly; his genial and labyrinthine speech pattern belying his fierce intelligence, his first rate surgical skills well camouflaged beneath his floppy hair and foppish appearance. Unlike most uninvited visitors, full of idle chat and pointless platitudes, his arrival doesn't completely aggravate me. Pivotal to my early surgical training, Bernard was both my tutor and my mentor and, still to this day, whenever I encounter him, I am immediately conscious of the debt of gratitude I owe him. However, as significant a privilege as it was to study underneath him, that is not to say we haven't banged heads on many occasions; he has frequently expressed irritation with my particular style of communication on the wards, and I have often lost patience with his idiosyncratic flummery, the utter poppycock he spouts as he attempts to charm every patient he interacts with. He accuses me of bluntness, of impatience and even, occasionally, of rudeness; I counter that with the assertion that consultations are not popularity contests, that surgical skill and diagnostic ability should be paramount, and must be the only standard I am judged by.
"Bernard." I say, somewhat genially. "Come in."
"Martin. Jolly glad I caught you. I'm up for a spot of...of...of lunch. What say you? Care to join me?"
Glancing down at the papers that cover my desk, I think about his offer for a barely a moment. I still have rather a lot to get through this afternoon, a good portion of it wearisome and bromidic, but I am steeled by my determination to depart at a reasonable hour. I believe I owe Louisa that, at least after the cancelled plans of last night, as much as the thought of spending an evening in a cacophonous, Public House, elbow to elbow with boisterous inebriates appalls me.
"Umm. No." I reply, gazing at him equitably, only tempering my reply as I notice his expression darken and his brow crease into a surprised frown. "Umm, however, I can offer you a cup of coffee, if you like. If you'd care to join me?"
He chuckles, and I'm struck by the way his jowls quiver, and the appearance of several double chins, as he ducks his head to gaze at me with a sort of dismayed benevolence.
"As usual, so...so...forthright. Yes, please. And let me just say how...how...how much I appreciate always knowing where I stand when...when..when I step into your office..."
"Good. Yes." I reply briskly, as he closes the door and settles himself down in one of the two tub chairs that serve as guest seating in my office.
I notice how he sits, sideways, crossing his legs in an almost feminine manner, reaching awkwardly behind himself as he inadvertently sits on the tails of his own, rather boldly coloured jacket; a shade of scarlet probably more appropriate to a Master of Foxhounds than a senior consultant. I turn my back on him as I stand before the espresso machine in the corner of the room; a recent, rather self-indulgent purchase, a possible concession to hedonism, one which may seem like luxury unless one is familiar with the suppurative exudate commonly referred to as Hospital Coffee.
"Rather an..an...an eventful evening, Saturday, wouldn't you say?" He says cheerfully. "Not that you stayed long enough to..to..form an opinion, I suspect..."
"Mm." I reply, neutrally and without interest, meeting his comments with a straight bat in an attempt to close off that particular line of questioning, regarding an occasion which I'd mostly like to forget.
"But you were there, umm, long enough, weren't you, to...to...to...create quite a few ripples?"
He laughs again, and I'm familiar with his tone. These days our rare conversations seem always to vacillate somewhat unpredictably between paternalistic concern and papal decree, as he feigns shock at something at something I've allegedly said or done.
"Was I?" I say, indifferently, focusing my attention on tamping the grounds. "I hope you don't take milk."
"Well, you know, today might be just the day to...to...to give it up." He replies cheerfully.
I draw the shot, carefully place the cup onto the saucer and turn to hand it to him, suddenly aware of fact that he is gazing at me rather thoughtfully from under the voluminous, silver fringe that sweeps across his face, his eyes twinkling with mirth. As I meet his gaze, his eyes narrow, and an odd, little, upside-down smile forms on his shiny face.
"To...to..to paraphrase Mr. Churchill, it seems Martin Ellingham is a riddle wrapped in a mystery inside an enigma...even more so than any of us imagined."
Fixing him with the stoniest of expressions, I sigh impatiently. It's a shame everyone has to be so predictable, and I'm struggling not to sound irritated, when that's exactly how I feel. Again I turn my back, ignoring him as I prepare my own espresso, feeling a flash of anger as I smack the used grounds rather forcefully from the portafilter.
"There's a reason why it's termed a private life, Bernard" I say firmly, after a moment of awkward silence, as I return to my chair and lower myself into it, glowering at him with my most disapproving, steely-eyed expression, so he is aware that I mean what I say.
"Which is a real shame because, you know, Lillian and I were both rather impressed with Louisa...such a...a...a...delightful girl, in all senses of..of...of the word."
"Yes." I reply through tightly clenched teeth, conscious of a slight feeling of warmth that washes over me, and rather desperate that I should not reveal even the merest inkling of those feelings to my old tutor. "Sholto introduced me to Zalman Goldsmith by the way. He seems a smart operator. Just what Imperial needs."
Bernard smiles to himself and sighs, wearily clasping his hands across his stomach.
"You see, Martin, you...you...you think you've changed the subject rather cleverly, but I'm here to...to...to explain to you how, actually, all these things are...are...are one and the same. It's all connected you see."
"I see." I reply coldly, scowling at him again, unable to hide either my growing scepticism, or the dawning realisation that there was nothing casual or spur-of-the-moment in his dropping by. Obviously, I am about to receive a lecture from him, whether I welcome it or not.
"It's common knowledge that...that...that Imperial are going to make an approach to you." He says, taking a cautious sip from his cup, and grimacing slightly.
"Is it now?" I reply, somewhat tersely. Is there nothing in my life that I am allowed to keep confidential, I wonder, with more than just a little aggravation. Apparently not, judging by the way Bernard leans back, as if he is settling in for the afternoon, his expression circumspect
"I can't tell you how pleased I was to..to..to see you on Saturday, not only attending a social function, but...but..but with a partner. A lovely young woman, who..who...who...if you don't mind me saying so, compensates rather splendidly for your...your...your complete disdain for the rules of polite society."
I watch his lips twitch as he smiles at me ruefully, determined to give him nothing. I have an enormous amount of respect for Bernard professionally, but that does not mean I have any interest in his opinions on my personal affairs. Louisa, and everything about her, is strictly off limits.
"And, your point is?" I say, disdainfully, placing my cup carefully back in the saucer.
"My point is, Martin... well, frankly, you know, I've been...concerned...about you for quite some time now. There's no doubt of..of...of your brilliance, you know, no question at all about your talent or your...your...your ability whatsoever. And your career trajectory...impressive stuff, impressive stuff indeed. But I also know, you know, that administrators talk and...and...and there has been an enormous question mark over you... your single-mindedness, I suppose, your potential for burnout...for want of a better word...your lack of balance. In a...a...a profession full of terrifying geniuses, your capacity to frighten people is off the scale."
For a moment, I'm incensed, and I feel myself rising to my feet, glowering down at him, stung by the unfairness of his words. That Bernard, a man I have long considered my most significant mentor, should throw such ridiculous accusations at me, should point the finger at me for being too intense, of taking my career too seriously, of putting medicine first, angers me beyond belief. Yet another person my life who feels it is their right to point out my faults and chastise me me for being who I am, criticising me unashamedly for pursuing my goal in trying to be the most skilled vascular specialist I can possibly be.
"Thank you." I growl at him. "I will bear that all in mind. Now, I really must get on."
"Oh, Martin, do sit down." He says quickly, frowning up at me. "You need to..to...to listen to me. This is all part of the career process. I'm doing Sholto's bidding for him. You know as well as I do that..that...that vascular is a high pressure environment. I've seen first hand, Martin, first hand, what...what...what over exposure can do to even the most resilient, most robust of minds."
I stare back at him, and my head is suddenly filled with incidents, of quietly abandoned vocations and dramatic falls from grace; the senior consultant that tore off his gloves half way through establishing an AV fistula and marched out of theatre, never to be seen again, the students who fell by the wayside as we made our way through surgical rotations, the registrars who changed specialties, and even the early retirements; examples of which have featured all too prevalently even over my relatively brief scope of experience. It is true that good surgeons, even the occasional great one, can be eaten up and spat out. Sometimes it might be as a result physical damage, necks, fingers, shoulders, but, most often, a consequence of a mental collapse, usually a complete emotional breakdown. I continue to frown at him but I return to my seat, lowering myself down with as much dignity as I can.
"What are you saying?" I ask him, quietly.
"This is...is...is an important decision for Zalman, his first appointment, and, on paper, your presence at Imperial would...would...would be seen as a major coup for him. But you must understand, the last thing, the very last thing Zalman wants on the books is another Oskar von de Brunwe..."
I sigh heavily. Comparisons to the the young South African cardiologist strike slightly too close to the bone, known as he was for being the youngest fellow in his speciality; a genius with an acknowledged Midas touch, a man who had every hospital in London knocking down his door, and the rest of the medical fraternity watching on in awe as he lit up the sky like a comet in the early nineteen eighties. In only a few short years he had redefined transplant techniques that had saved countless lives, yet where was he now? Apparently, so the story goes, a gardener in Cape Town, tending to bougainvilleas with the same skill that he once lavished on the preservation of recovered organs, mixing up liquid fertilisers with a similar scientific intensity to that which he previously applied to the process of Plasmapheresis. His fall from grace was spectacular, whispered about in the halls of every hospital, and every medical school, from one end of the United Kingdom to the other. It was like a warning to which no one was prepared to listen; though we all became aware of the reasons for his demise, his well-hidden issues with stress and burnout and prescription drugs, and his discovery, rather aptly, in a shrubbery, near London Zoo, in a state of complete psychosis. But, like so many cautionary tales, in the ultra competitive world of post grad specialisation, it went largely unheeded.
"That's hardly a fair comparison." I tell him, and my voice sounds unintentionally surly.
"No, nor need it be, and hence this...this...conversation, Martin, and, you know, my...my...my absolute unmitigated delight in meeting Louisa on Saturday night. It hasn't been easy, watching you, living like some sort of monk, existing only for what happens within these hospital walls, and...knowing all the time that it's a recipe for disaster. Unsustainable. No one can...can...can live like that and you certainly won't survive long enough in vascular to reach your potential...which would be a terrible shame. A travesty in...in...in fact."
I am rendered speechless, no response seems available to me because I have no intention of informing him of my own feelings for Louisa nor wishing to offer him any sort of treatise on the progression of our relationship. I'm not sure I even see the relevance of either anecdotes or their correlations to my own professional performance, especially since I have absolutely no plans to either live like a monk from now on, nor have I ever felt the need to experiment with self medication.
"I'm sorry but, with respect Bernard, I really don't see your point. The day my professional performance is impaired, the day I can no longer perform surgery, the day I'm discovered cavorting naked in the Serpentine Lake, by all means point out that you told me so but, until then, please refrain from prying into my private life..."
"Martin, Martin, Martin! My point is that Zalman is...is...is a realist and Sholto is a family man...and, honestly, you know, most of us, we wouldn't be where we are today if...if..if it weren't for our wives. You know as well as I do that surgery is...is...is an hierarchical, male-dominated and exhausting business that relies on...on...on our better halves to shoulder the bulk of household labour and childcare... which, in turn, allows us as consultants to...to...to work uninterrupted."
I stare at him, and I realise with a sickening sense of disgust that, all the time I believed that my work was enough, that my abilities were all that mattered, and that how I chose to manage my time outside medicine was my own business, these men were watching; I was observed, I was discussed and, clearly, I was judged.
"Martin, the fact is, strictly off the record, you understand...you just didn't appear to have that safety net and...and...and that was seen as a negative..."
I think back to Sholto's apparent interest in Louisa; his enthusiasm when I introduced them, and his surprising subsequent suggestion to me that she join us for an upcoming, but as yet unconfirmed, dinner. I recall feeling momentarily confused, as my inherent solitude, my sense of separateness seemed suddenly and robustly challenged. I was not averse to the idea of her attending but I did need some time to process the implications, because it did feel as if yet another intrinsic part of my identity was being dismantled. And, as deeply as I care for her, as much as I believe that I could possibly spend the rest of my life with her, bringing her into my professional sphere was confronting, melding my personal life with my career, something I had little expertise in.
"Right." I reply bluntly, unsure now of what he requires from me, what sort of response would reassure him.
Despite her affability and social skill, picturing Louisa as a consultant's wife, subverting all of her career dreams and life plans to support my aspirations, somehow does not seem plausible. She is so young, and the idea of how panicked, how cornered she might feel should anyone broach the subject of marriage with her this early in our relationship, concerns me greatly.
"Sholto is...is...is..., you know, a firm believer in support structures, in the value of the home front, the crucial importance, you might say, of a secure marital partnership." Bernard says, uncrossing his legs and leaning forward, almost conspiratorially. "He wants to know that a sort of normalcy is in place almost as...as...as much as he wants to know that you can perform and end-to-end anastomosis with your eyes shut..."
I feel suddenly furious. Do they expect me to bring wedding banns to the Job Interview, in fact, should I be asking Louisa to join me before the panel as well? It feels insulting, and ridiculous and appallingly hypocritical, considering the fraught state of so many marriages within my profession. That one of the many adulterous arses that abound, such as my father and his dreadful cronies, would be seen as a preferred choice for a senior position simply because, on paper, they were married, disgusts me. That their behaviour was considered normal, yet mine was clearly viewed as abhorrent, is a disgrace.
"Then it seems I will be staying here for the foreseeable future." I tell him coldly, and this time I not only stand up but I stride across to the door and wrench it open, standing angrily and gripping the handle fiercely, glowering at him.
"Very well then, Martin." Bernard says, resignedly, standing up and gazing at me sadly. "But think on this. Lillian was only eighteen when I met her. Straight out of school, full of fun, full of...of...of life. It didn't take me long to realise that she was a keeper, you understand. And did you know that we are coming up fifteen years married this autumn? Yes, fifteen years, and never had a moment's regret..."
"Congratulations." I reply icily and, as he shuffles across in front of me, I avert my eyes until I can close the door firmly and loudly behind him.
