Henry Ellingham lived in a large detached house in Primrose Hill; in hindsight merely an ugly gothic monstrosity but, at the time, to a reticent and ill-at-ease little boy, it was a grim edifice; cold and foreboding. I recall Sunday lunch with my grandparents as being a fairly frequent event. My mother would clap her hands behind me impatiently, hurrying me to the car, where my father would be waiting, bouncing his foot on the accelerator, engulfing the drive and the adjacent environs with billowing clouds of carbon monoxide. We would then proceed along the streets at speed; I would slide from side to side on the smooth leather of the back seat, holding my breath as my mother gasped and shrieked and berated my father for his apparent lack of care and attention to the obstacles in our path. By the time we pulled into the tree-lined cul-de-sac where Henry lived, I would have already assumed a demeanour of guarded acquiescence, my only aim to survive the meal unnoticed and unscathed.
If my Aunt Ruth were in attendance, she might speak to me but, even as an infant, I sensed that I was generally of little interest to my family; a watchful child, alone amidst a family of severe and choleric adults, most of whom interspersed their intellectual conversations with long periods of detached silence. As I grew older, both my aunt and my grandfather, especially, would engage with me more willingly but even then I walked a tightrope. I could feel my mother's icy gaze on me as I conversed with my grandfather, aware that expressing any enthusiasm or enjoyment would see her later accuse me of showing-off, in her eyes the most heinous of boyhood infractions. When the conversation turned, as it inevitably did, to medicine my ears would prick up and I would listen, enthralled, storing away both the jargon and the sentiments in order to unpack them later, in the safety of my bedroom where I could quietly ruminate upon what I'd heard.
When I was newly at Prep School, before I became a permanent fixture within the dormitories as one of a group of scorned and dispensable boys for whom going home was an impossibility, Bank Holidays would see me deposited into the care of Henry and, occasionally, my grandmother. I was aware, vaguely, that she was unwell and, as whichever Nanny was delivering me took pains to remind me, I must not make a nuisance of myself by asking questions, making noise or generally mucking about in the manner of a small unruly boy. Little did they know that my grandmother and I already had come to an informal sort of understanding on the days in which I was assigned to her supervision. For every hour I sat reading peacefully, she would place a half crown on the Victorian figured rosewood table next to the chintzy sofa upon which she sat, playing patience, reading a novel or dozing fitfully. Every so often she would startle awake, dab clumsily at the corners of her mouth with her handkerchief, and glance at her wristwatch. For all her remoteness and cool disregard, however, she was a woman of her word and by the end of the afternoon I would usually pocket four half-crowns, a not inconsiderable sum for an almost seven year old boy.
I'd already formulated a savings plan and a goal was clearly fixed within my young mind. Both Henry and my father had always extolled the virtues of exercising in fresh air and so, from a young age, I had been compelled to take an afternoon walk, usually in the company of the one of my mother's endless procession of thin-lipped, disinterested domestics. In the High Street, inevitably my disinterested chaperone would pause at the windows of the department store or, if I were really fortunate, the ladieswear boutique on the corner by the bus stop. The only interest I had in the latter was geographical; situated as it was in the lane directly opposite the overstuffed toy shop. I knew that I wasn't allowed into that particular hallowed building but I had not yet been forbidden to peer, breathlessly, through the plate glass at the wonders that lay within.
It had only taken a glimpse of the prize for the genesis of my idea to occur. As the condensation from my rapid and shallow respiration evaporated, I'd felt a surge of childish excitement. Ever since Henry and I had dissected the frog, I'd been conscious of a connection to him and, therefore I'd become determined to pursue a path in life that closely mirrored his own. To that end, I set my heart on the sturdy microscope that sat gathering dust in the lowest recesses of the shelves, displayed somewhat half-heartedly alongside its grey leather case. Amongst the brightly coloured, juvenile amusements, the candy floss for inferior minds, my magnificent instrument in drab monotones of ash and gunmetal was rendered almost invisible, but I knew it was there and I was determined to make it my own. Being bribed by my grandmother to behave in a way that was actually second nature to me seemed to make my future acquisition of the Bausch and Lomb student microscope particularly serendipitous. I would ensconce myself contentedly amongst the cushions of the bay window, enthralled in a medical text or a heavy encyclopaedia that I had wrestled down with some difficulty from towering shelves of Henry's extensive library, only too willing to hold up my side of the bargain.
When it came time to decamp, my grandmother had dismissed me, as usual, without ceremony but not before I'd slid across to the table beside her, and deftly pocketed the coins; my expression of gratitude received in her usual spiritless silence. Even at a young age I noticed that she showed more enthusiasm for the plate of biscuits that was invariably delivered to her at four o'clock than she ever did for my company. I'd found myself frequently transfixed, in that way children are, by the copious crumbs that adorned her ample bosom; strangely fascinated by the way they nestled in the fine hair around her mouth and congealed at the moist corners of her lips. Afterwards, I'd waited on the hard wooden settle in the hall for some time; my father was even later than usual and no one seemed to know what to do with me but I knew much better than to fidget or complain. Already hungry and somewhat cold, it was only as I scrambled gratefully into the back of his car that I realised the half-crowns were no longer in my possession. I'd sat in stunned, miserable silence all the way home, fighting desperately the tears that threatened not only to humiliate me, but also to reveal my covert fiscal scheme to my unsympathetic father. Ostensibly racing for the lavatory, ignoring his bellowed instructions not to run on the stairs, I'd shut myself in my bedroom, furious at myself, and choking with frustration. It was only later, when I hung up my blazer, after an hour of brutal self-recrimination, that I'd heard the muffled sound of metal on metal. Immediately, I'd felt an indescribable surge of delight and I'd thrown the unwieldy garment down on the bed, feeling my way along the chunky hemline, inch by inch.
I'd been so thrilled when I'd located them, safely nestled among the folds of the lining, between the wads of felt contained within the pocket seams. With a dexterity that would later serve me in good stead, I managed to retrieve them through the finger-sized gap they'd obviously slipped through, holding them in my hand momentarily and staring at them in absolute wonderment. For just a few minutes, I'd experienced the rarest of feelings: jubilation, and incredulity, and utter relief; I was truly a boy who could not believe his luck. Though I did not consciously seek to contain my joy, to an observer I have no doubt that my expression barely changed as I slipped the coins securely into the little leather purse I kept in the top drawer of my desk. Even then, either by a short lifetime of conditioning, or simply as a result of the cold unfeeling nature I assumed I possessed, I was utterly incapable of expressing the exultation I was experiencing inside.
And, when the time came, I'd cautiously revealed my plan to Henry, stuttering over my words until he'd nodded solemnly and offered to accompany me, thus providing incontrovertible justification should I be seen in the banned locality of the toy shop by my eagle-eyed mother. Thrilled, I'd brought home my prize and even my father had come up to look at it, revealing to me a brief and rather confounding hint of genuine paternal interest.
"Thank you, sir." I'd said solemnly, after he'd shown me how to adjust the focus, and swap over the eyepieces, and I'd peered excitedly at a technicolour smear on the thin glass slide.
Of course I'd already been well aware of what was required in order to optimise the performance of the device but, instead, I had listened studiously, gripped by the feeling that this moment of easy companionship between a father and his son was something rare and esoteric. I'd been desperate that it shouldn't end but I had no idea how to maintain his attention and so, rather quickly, he'd become bored and left me to it. But not before it had become glaringly obvious to me that science and medicine might somehow bring us together; an initiation if you will, an assumption that I would follow my forebears into family business and, in that moment, I felt the brief and exquisite sensation that I actually belonged. After such a series of paradoxical emotions I'd climbed into bed and lain there with a strange sense of satisfaction, so much so that the day was seared permanently into my psyche, being as it was, along with my holidays in Portwenn, one of my few truly pleasant childhood memories.
Strangely enough, I hadn't thought about my grandmother much in the years since she died but, during this morning's team brief, the new theatre sister stares back at me with the same pale blue, bloodshot, rapidly blinking eyes. Out of nowhere I recall that Henry's wife always wore fingerless gloves, even in summer, and how much like a rotund, myopic little otter she'd appeared as she dabbed at her face with her woollen mitten-clad fists. Unlike my grandmother, however, Sister Gillen is brisk and purposeful, and ruthlessly efficient, slipping seamlessly into our team in a manner that makes my leadership of them quite satisfying. Previously, I'd spoken to the patient, a woman of a similar age to my own and she'd smiled at me in a way that was only too familiar; encompassing hope and fear and a desperation to be free of the pain that had plagued her for years. The expression on her face reminds me of why I am a surgeon: a few hours is all it will take for me to improve her life significantly, and the results will be almost instant. She thanks me fervently and I nod at her, and take my leave.
I'd scrubbed with a heightened sense of anticipation and, as I stood at the basin, I ran through the procedure for one last time in my mind, confident that I was as well prepared as it was possible to be. I'd spoken to Robert on Friday and outlined how I'd planned to proceed, aware that he had previously performed two successful bypass surgeries on similarly severe presentations. He'd been his usual polished self; oily and rather talkative, full of nugatory observations and obviously keen to pursue a conversation of a more personal nature. However, I was wise to his soft soaping cajolery, and not about to be drawn on any subject other than the left renal venous hypertension I was there to discuss. I had managed to ignore his smirk but, buoyed I suppose by his thorough endorsement of my prospective treatment plan, I'd relented somewhat and, when he'd casually asked me how Louisa was, I'd conceded somewhat reluctantly that she was in good health.
"I've got to hand it to you, Ellingham, you certainly took the stuffing out of a few people, I mean, arriving so unexpectedly with such an attractive young woman on your arm. I was quite taken aback myself if I'm honest. Touché and all that." He says, shaking his head as if he's conducting an argument with himself. "I mean, good lord, I was on select committee business yesterday up in Cambridge and it even came up there..."
I'd felt my usual wave of annoyance at the intrusion into my privacy. It didn't seem to matter if it was a positive or a negative observation, it still seemed to rankle equally, and I'd sighed rather crossly.
"Doesn't that merely illustrate what puerile and lacklustre lives these people live?" I'd replied coldly, glancing at him disapprovingly as I'd bent to regather the patient notes I'd laid out on his desk. "God forbid that they might tackle some of the unprecedented challenges faced currently by the NHS..."
"Come on now Martin, you do know that the only thing worse than being talked about is not being talked about..." He'd replied, knotting his dark, ambulant brows together forcefully, a smile hovering about his thin slit of a mouth. "And I could think of a lot worse reasons for being the topic on everyone's lips..."
"I could live without either, thank you very much." I'd interrupted firmly, attempting successfully to steer him back toward the subject at hand by raising the possibility of a retroperitoneal hematoma.
However, a few minutes later, as I was leaving, paused with my hand on the door and in serious contemplation, he'd felt the need to tell me again of his impression of Louisa; how lovely she was and how vivacious, as if he, like so many of my colleagues, assumed that I mightn't have already noticed. As always, I sensed the unspoken sentiments too, the elephant in the room, the implication that whatever it is she sees in me is as perplexing as dark matter, or even Morgellon's disease. The general belief that I might be considered unworthy of her, and her attraction to me such an implausibility, is seemingly so entrenched that a rumour had even reached me a few days ago that she was likely an escort, a hired companion, a professional consort I'd simply employed for the evening. I hadn't reacted of course; such insults are like water off a duck's back to me but I did experience a moment of absolute disgust, and a fleeting sensation of fear should such salacious and patently false accusations reach Louisa's far more sensitive ears.
"I really must get on." I'd told Robert briskly, as my desire to remove myself from the conversation became overwhelming. "We will speak after the procedure, yes? At this stage, the LRV is first in line on Monday."
He'd nodded at me, his long floppy hair giving him the air of a suspicious spaniel, his expression quizzical and his stare penetrating. I'd felt justifiably irritated and I'd marched determinedly back toward my office, forcing myself to focus, and to compartmentalise my thoughts, glaring at anyone who even dared glance at me as I passed. For the life of me, I cannot understand the predilection for mindless gossip that seems to proliferate in the hospital environment. To have my time wasted by scandal and scuttlebutt is not only frustrating and aggravating but, to me, it smacks of negligence and illustrates a complete lack of professionalism. I feel not only an acute duty of care to my patients, but I also have significant responsibility for the leadership of my team, the training of others, plus I must contribute meaningfully to various research projects, as well as read and digest interminable reports and complete a mind boggling amount of paperwork. Yet there Robert was, my former tutor, himself a respected surgeon, cheerfully informing me that the most memorable topic of discussion at a recent committee meeting was not underfunding, or the reorganisation of the NHS, or even how to implement the adoption of rapidly evolving new technology but, in fact, idle baseless chatter about private matters pertaining to one of his consultants and of no consequence to anyone else.
The scrub nurse appears and assists me with gowning and gloving. I make my way into theatre, feeling energised and looking forward to what is to be my first renocaval reimplantation. After checking with my team that we are ready to commence, we go through the usual routine and I make my first incision: a transabdominal, transperitoneal midline approach. Calmly and without issue, we perform a textbook reimplantation of the left renal vein to relocate it out of the constrictive aortomesenteric space, immediately removing the source of the patients debilitating flank pain. Undoubtedly, too, this procedure will correct the macroscopic hematuria that baffled several doctors until she was finally referred to us by the most recent of a long line of GPs. As I will shortly detail in my notes, there is no distortion of the left renal vein which precludes the need for a patch graft and so, satisfied that there are no stray swabs, I leave my assistant to close and I make my way back up to my office, buoyant, and cautiously optimistic at the patient's future prospects.
After I've showered and dressed, there's a tentative knock on my door; the receptionist appears, holding out a courier satchel apparently addressed to me and I grunt my thanks back at her, somewhat distractedly. Inside are two large Manila envelopes, the larger one clearly addressed to me while the smaller one, somewhat bafflingly, has Louisa's name scrawled across it in a bold, imperative fashion. I pick mine up and turn it over in my hands a few times, feeling the weight of the contents but resisting the temptation to tear it open. I am almost completely sure that this is the formal offer from Imperial I have been anticipating. If I am correct, the weighty package will contain not only the latest glossy marketing pamphlets that seem to have become an almost compulsory feature of Hospital management but also an extensive job description for the coveted Senior Consultant's role and, most importantly, a detailed employment contract for my perusal. Carefully, I slip both envelopes into my briefcase, and I pause for a moment as I push the lid closed, my hands firm and lingering, as I press down on the warm black leather. As much as I attempt to maintain my sanguine appearance, I can't help but feel a spring in my step as I make my way back down to the post-op recovery ward.
As is often the case, today's surgical procedure becomes a valuable training exercise and, after I have written my notes, I find myself talking through the many options available to a group of registrars including a newly qualified young woman who has just transferred from an hospital in the north-east. Interpreting her thick accent becomes somewhat draining and her propensity for finishing almost every sentence with the word 'like' quickly begins to irritate me, especially in view of the almost endless questions she appears to have. As with everything pertaining to my profession, I do take my responsibilities for training junior staff completely seriously and so I persevere with her resignedly. Perhaps it is due to the other fortunate events of the the day mitigating my annoyance, or perhaps it is the undertone that seems to be flowing recently through all facets of my existence; the idea that perhaps life isn't always so unsatisfactory, and there are actually significant rewards to be discovered outside of these four walls. Either way, I maintain my patience, quietly grateful that of all the regional accents that Louisa might have had, hers has the soft charm of Cornwall; warm and low and rather melodic. Indeed, I answer everything, with a tolerance that even surprises me, my voice calm and quiet, until eventually even the registrar is mercifully silent.
With only a hint of abruptness, I then abandon the group to their mouth-breathing rumination. I hadn't been in any particular hurry to get home, faced as I am with an evening alone but, in view of the amount of reading I'm aware I must now get through, I opt for a taxi to deliver me as far as Kensington Gardens, satisfying my desire for fresh air and exercise by striding briskly through the park on the way to my flat. As my thoughts drift from the preparation of my evening meal back to the events of the day, my feet feel surprising light. Indeed my invigoration is so complete that I bound up the stairs, two at a time, barely needing to catch my breath as I force my key into the smooth, well-oiled lock of my front door.
And, like some sort of perfect bookend to my day, Louisa appears unexpectedly before me; gorgeous, and casual, and somehow slightly bashful, her demeanour that of an impish hellion. This time, I am truly a man who cannot believe his luck and, once again, I'm almost overwhelmed by the very same feelings that had gripped me so long ago. I gaze at her, drowning as I am in a warm sea of emotion, once again jubilant and incredulous and so incredibly relieved that by some miracle she chooses to be here with me. It's like peering down that microscope for the first time, the revelation of glorious and inexplicable new worlds that I previously could not have imagined existed. To come home and find her here fills me with solace and I feel suddenly replete. Even if I am unable to describe this feeling of elation to her, the prospect of the evening ahead is suddenly immeasurably enhanced and improved, simply by the opportunity to share my good mood with her.
"You're back." I tell her, and I wonder if she will ever understand how fundamental she has become to the rest of my life.