I had no sooner finished unpacking the contents of my briefcase when Zalman appeared in the doorway, obviously harried and seemingly contrite. He'd held out his arm while exclaiming my name but, before I'd accepted his handshake, I'd glanced down at my watch, a pointed and censuring gesture that I was aware would not escape his notice. Somewhat ruefully he had smiled, offering me a belated yet apparently genuine welcoming speech but it still seemed to me that his attention was elsewhere. I was interested to observe how his distraction manifested itself however; he appeared somewhat twitchy, there was evidence of palpebration and I couldn't help but notice the bulging of his masseter muscles as he forced his words out through an apparent wall of tightly clenched teeth. For a man who had faced as many crises as he must have, it did seem a surprisingly immoderate response.

When he finally relinquished his grip on my hand, he'd gestured that I should follow and I'd walked alongside him, silent and brisk in a way that I intended should convey my deep displeasure. As I listened, I was wary too; as guarded as any man who fears he may have erroneously bestowed his trust. He offered no excuse nor explanation however, but nor did I demand one from him in return. I had no doubt that, whatever minor political drama had enfolded, it would be of absolutely no interest to me.

"It's been quite a morning, let me tell you." He had muttered, as he ushered me into his office and invited me to sit down.

I'd hesitated for a moment before acquiescing. As unimpressed as I was, and with a plethora of irritating assumptions chipping away at my good will, I would have definitely preferred to remain standing. But there was something about him that took the sting out of the situation. Self-deprecating and appearing unusually jaded, he'd pushed his glasses on to the top of his head and rubbed wearily at his blood shot eyes. I'd had the sense then that, whatever it was that had delayed him, perhaps it had not been so trivial.

"Yes…Sholto's secretary said that something had come up…" I replied carefully, snatching at my trousers and lowering myself into the chair with a haughty sort of dignity, my manner that of a man aware he holds the moral high ground.

"Martin, what can I say?" He'd admitted, after a moment "It was far from the welcome we wanted to give you, and for that I can only apologise."

I'd lifted my chin and gazed back at him coldly as he shrugged his shoulders and flashed a thin, pained smile at me. If I continued to appear sceptical and unimpressed, I had no intention of pretending otherwise, nor did I feel inclined to accept his apology. So far, my induction had been farcical and amateurish, and bordering on insulting, and I meant to hold Zalman completely responsible.

"Right, I see…" He had added ruefully, inclining his head in apparent resignation. "Well, as my father used to say, when life gives us lemons, should we not make limonana? Let us start again, shall we? You can punish me further with your first impressions, Mr. Ellingham…I'm sure nothing will have escaped your critical eye, my clever young friend. Who has been taking care of you? Where have you been?"

Clearing my throat, I had begun to speak, hesitantly at first and with a fair degree of caution. I was mindful however that not only did Zalman's rank demand I show him a degree of respect but also that, in all our previous encounters, he had shown himself to be an honourable man, straightforward and exemplary in his behaviour. As he listened, nodding thoughtfully, making encouraging noises, and occasionally scribbling notes down with a flourishing hand, I decided that I should perhaps give him at least some benefit of the doubt. And the room too was in itself assuaging; the walls lined with dark oak shelving and laden with a formidable collection of weighty texts, calf-skin bound and gilt inscribed. Behind him, a wall of certificates in matching frames, and a huge oil painting, a chiaroscuro portrait of a steely-eyed and rather severe Victorian, the tarnished gilding flaking from the gesso frame beneath. Slowly but surely, the breach between us began to be resolved.

It was hard not be encouraged by the close attention he appeared to be paying to my observations. His pinched and anxious expression was gradually replaced by a thoughtfulness that seemed progressively more relaxed, despite my occasionally acerbic opinions. There was an ease about dealing with him that reassured me, and I was glad of it. After all, it was Zalman's presence that had been key in my decision to accept Imperial's offer. His recruitment was a statement of serious intent on behalf of the Board and any consultant worth his salt would have moved heaven and earth to be part of his team. Those of us who knew him were aware that beneath his gentle demeanour and relaxed informality lay a ferocious intelligence; he was a highly skilled surgeon with a distinguished vascular career behind him. I was conscious that the opportunity to work alongside someone so highly respected, with a raft of lauded publications to his name, was indeed an honour I must not lose sight of.

"How many of us get the chance to build a department from the ground up, eh Martin?" He'd said over dinner, smiling and rubbing his hands together, his enthusiasm palpable, and just a little contagious. "I can tell by the gleam in your eye, you know the answer. What an opportunity. What an opportunity!"

I'd felt Louisa's hand slip over mine and she'd squeezed gently in encouragement, her long fingers caressing my knuckles as if she could no longer contain her delight. For a fraction of a second, I was suspended in time and I'd allowed myself to do more than just acknowledge how it felt. In fact, I had revelled in it, the burgeoning energy, expanding like steam within the cavity of my chest until I felt buoyant and replete. I'd glanced at her profile as she turned her head to smile radiantly across at our hosts, and I'd known then exactly what it meant to feel as if one's cup had runneth over. As my abdomen clenched involuntarily, I was momentarily an optimist and everything I'd ever wanted had suddenly felt within my grasp.

Professionally, of course, my advancement would be seen as simply the next, logical step in a promising career but I knew it to hold far more significance than that for me. Undoubtedly, it was she who made this appointment matter, it was she who coaxed and cajoled me to be a better version of myself. With Louisa in my life, it was impossible not to be aware of the enormous gulf that exists between a man who adequately functions and he who really lives. I'd felt that distinction washing over me like an incoming tide. And though it had been seeping in ever since that very first lunch with Joan, it had been the dinner with Sholto and Zalman that had cemented my understanding. I knew that it could only ever be Louisa that filled that void, it could only ever be alongside her that I might feel complete.

As a result, I seemed somehow altered; the sensation of invigoration had stayed with me, life had felt just a few degrees less difficult and there was nothing that ever turned out to be as bad as I had feared it might be. I'd even begun to enjoy the confidence it gave me, relishing it in fact on those rare occasions when it was safe to let it show. When faced with the debacle of this morning, however, the sensation had appeared to dissipate immediately and I had been left feeling hollow and rather bereft. But, as the situation appeared to resolve itself, I was aware that my limbs had begun to lighten and my fists to finally unclench. My diaphragm relaxed, my respiration slowed, and I was grateful for the return of my infamous and usually reliable composure.

Clearly, too, it helped that my first impressions today did seem somewhat accurate. Zalman had acknowledged it wordlessly, wincing theatrically as I'd expressed my reservations about the staff I had encountered. He had reminded me gently, but quite firmly, that the transition between consulting at a Major Acute Hospital and establishing a new department at a primarily Educational Facility would require a significant change of mind set on my behalf but just listening to him speak about it had had a reassuring and conciliatory effect upon me. Before I was even cognisant that I'd regained my equanimity, our discussion had become that of an amiable fireside conversation; a benevolent and reassuring uncle and a small inquisitive boy, in a private and comfortable library, a familiar and fortifying sense of tradition permeating the room.

"I'm not sure you met an accurate cross section of our staff, Martin." He'd said, chuckling to himself as he added yet another line to his copious screed of notes. "To be fair, most of the senior management were behind closed doors in the same blasted meeting I was…"

I'd raised an eyebrow at him, in half-hearted scepticism.

"Really?"

He'd lain down his pen and gazed back at me over the top of his glasses, his mouth twisting into a wry smile.

"Yes, really. And, as well you know, at that hour of the morning, the surgical teams would have been over at your old almer mater too…and, frankly, faced with the choice of a four hour meeting or an eight hour surgery, I know exactly where my preference lies..."

"Mm…." I'd murmured, in total agreement yet feeling just the merest hint of remorse, an inkling that I might have erred by making a fatal diagnosis based on an incomplete set of tests. "There did seem to be rather a…geriatric element to the introductions…"

"Yes!" He'd agreed, and he'd barked with laughter. "Though I suspect you only encountered those not fast enough to run from you and hide….but that's a topic for another day, Martin. Remind me, who was it that showed you around? I'll need to thank them."

I'd had to wrack my brain but, mercifully, the man's name had eventually come to me and I'd blurted it out almost triumphantly, as if it were the winning answer in an impossible sort of quiz. I'd folded my arms then, and gazed back at him, feeling just a hint of a amusement, fascinated to hear how he'd attempt to talk his way out of that one.

"Steve?" He'd replied incredulously, raising his eyebrows at me.

I'd nodded, somewhat haughtily, confident that there was no need to say anything further, his expression confirming everything that I'd surmised. It had indeed been a ham-fisted, and inelegant welcome, but possibly a fortuitous one in that it appeared to have highlighted every impedance we were likely to come up against. Strange though, with simply an enigmatic smile and an almost imperceptible roll of his eyes, Zalman had reassured me that, not only were my concerns justified, he was resolute in his intent to systematically dismantle every obstruction in our path. With that understanding, the remaining tension in my temples began to subside and I allowed myself the luxury of stretching one leg out before me and resting my elbows on the arms of the chair.

"Right." Zalman had added thoughtfully, as if he had needed a moment to compose himself. "I see, well, yes, an interesting choice but, in hindsight, mea culpa. I mean I did request that someone around your own age, someone with a bit of life in them, should be the one to take care of you in my absence."

"Mm." I'd muttered uncomfortably. "But, as it happens, umm, I suppose he was quite…useful. He, ahh…he reconfigured some of the shelving, and, yes, he did move some rather heavy furniture unassisted which was…umm…which was…good."

"I think I need an espresso." He'd croaked, leaping to his feet as suddenly and explosively as if he'd just been stung. "Will you join me Martin? I think you'll be pleasantly surprised at my skills. Tzippy bought me a machine you see…"

"Ahh…yes, actually, I will. No sugar, thank you."

"Of course..." He'd replied, cheerfully, before adding in a conspiratorial tone: "She said it was a present but, you know, I suspect the old girl was simply tired of my endless complaining."

He'd chuckled as he'd eased the lever down.

"Enough about the hospital coffee!" He'd squawked in a shrill voice as he smiled to himself and shook his head incredulously. "These women, they are so clever, don't you think? They know what we need before we know it ourselves…."

He had glanced over his shoulder at me, as if he'd hoped for an anecdote, some piece of wit or wisdom, or perhaps even a trotting out of one of the tired, old, misogynist statements I'd been forced to listen to for years; in the scrub rooms, in theatre, indeed anywhere where middle-aged men predominate, it was always the same. I cleared my throat, and looked at my watch.

"And, speaking of better halves, how is Louisa?" He'd asked cheerfully.

Finding myself examining my sleeves for imaginary specks, I'd shifted awkwardly, the chair squeaking abominably with my every movement.

"I have to tell you, Martin, Tzippy and I found her absolutely delightful actually."

"Mm." I'd grunted, resignedly, wondering what on earth was the point of these sorts of conversations.

"I must admit, she was nothing like what we expected. But, as my own charming wife pointed out, she will be very good for you Martin…"

Of course they'd discussed it, and I realised I was no longer even annoyed, just imbued with a dull ache of frustration I suppose, and tired of the intrusion, imagining how the speculation prior to meeting her would have provided endless entertainment for everyone concerned. Frowning, I'd stared into the distance, detached and taciturn, wondering with increasing weariness why people are always so intent on offering their opinions on matters that do not concern them. I care nothing for their point of view nor do I need to hear, inevitably and for the umpteenth time, that Louisa is younger, or prettier, or brighter, or kinder than anyone could ever have anticipated. I exhale heavily, consoling myself that at least, I suppose, Zalman is not offering his observations as most others have done; in tones of mockery, or breathless disbelief, his voice cracking with incredulity. But whoever it is, there's always that vague insinuation: what on earth does she see in him and, more uncomfortably, how long will she stick around?

He'd handed me the small red cup and saucer, and gazed at me expectantly.

"Thank you." I'd said icily and, for an instant, the room had become mired in a rather stony silence that did not bother me in the least.

I am unfazed by either awkward pauses or extended quiet, mainly because the atmosphere that usually surrounds me is often so heavy it can, figuratively, be cut with a knife. While I was prepared to concede that the morning's display of incompetence was simply an anomalous and unavoidable oversight, Zalman must learn that I am not to be trifled with and there are some subjects that are simply off-limit. Like everyone else, he would soon come to realise that I have no intention of saying or doing anything that might invite attention into my private affairs. As far as Imperial were concerned, they had wanted assurance that I was not the one dimensional, anomic recluse of my reputation and, in introducing Louisa to them, I had provided it. Any further enquiry, in my opinion, was simply prying.

He sat down again, his air now one of resignation, placing his cup neatly down in front of himself and squaring off one of the many stacks of papers on his desk with a series of smooth, precise movements. When eventually he looked up to face me, I had simply lifted my chin, raising my eyebrows and gazing at him imperiously over the top of the ridiculously tiny coffee cup, indicating wordlessly that I was prepared to continue our discussion as long as the parameters were rigorously maintained.

"So….Steve…" He'd ventured tentatively, as if he were stepping out on to a frozen lake. "Umm, interesting chap. Bit of an Imperial success story actually and a real bloody survivor, I think you'd call him…"

I'd sat motionless, the truth being simply that I'd sooner savour my espresso in peace and quiet; but discussing Steve was definitely the lesser of two evils and the easiest way I could ensure that our conversation did not deviate far from the professional.

"I know he won't object to me sharing this with you but he was one of those kids…the product of a chaotic childhood…alcoholic mother, absent father, in and out of care homes, you know the drill…"

I'd nodded lethargically, entirely uninterested in either Steve or his dismal past. If there were a point to his story then I wished Zalman would hurry up and get to it so that we could resume our review on his plans for the department. So far everything he'd told me was tantamount to gossip, the territory of overblown receptionists and giggling students. Pressing my hand to my mouth, I'd fought an irrepressible yawn.

"Then the poor kid was diagnosed with nodular-sclerosing Hodgkin's lymphoma at the age of nine…"

I'd looked up at him sharply at that point, having suddenly had my interest piqued. Oncology was a fascinating field and I was always keen for discussion, especially one that might provide an opportunity to learn. It was obvious though that that I was about to be disappointed, instead there was something in his expression that I hadn't seen before, a pointed sort of frown, and a flintiness in his gaze. The more I looked, it was almost as if he were delivering a sort of a reprimand perhaps or, inconceivably, a thinly veiled warning.

"You see, Martin, he came to the attention of an Imperial board member, through a post-treatment study he was part of at GOSH. He was just a troubled kid really, in remission but spending his days hot-wiring cars and nicking stereos. He'd missed so much school I suppose, which didn't help. So they gave him a job here on the condition he turned things around and kept his nose clean. He was fifteen when started; and he told me they had him fixing broken castors and replacing blown light bulbs for the first three months solid. And now he's worked his way up to be our head of maintenance, and one of the most obliging blokes you'll ever meet…an absolute heart of gold, you know, even if he is a little rough around the edges… But he can fix anything, especially electronics, so just remember that: he is a good man to keep onside…"

I'd gazed back at Zalman impassively. Though I know that, externally, my face was a mask of inscrutability, in my mind's eye all I could see was her face, and that look she would give me, the one that said so clearly: See Martin, I told you so. Her eyes would be so bright and clear, malachite green and unblinking as she gazed at me, Don't be so quick to judge. My pulse would race, of course, and my throat would constrict. Was it the challenge that I reacted to, I wondered then, the defiance that was so clearly evident as she folded her arms and stared me down? She would give me that look of penetrating intensity, twisting her jaw, and narrowing her eyes to a stare of such smouldering contemplation that it would hit me in the abdomen like a cannonball fired at very close range. She never said it but I loved the fact she thought it: Martin Ellingham, You don't intimidate me.

Whatever it was we were arguing about it suddenly ceased entirely to matter. I would try so hard not to reveal myself but I was absolutely putty in her hands. The slow burn would then begin; an aching, trembling, crippling need that still had the power to distract me entirely from almost everything else around me. And, for a fleeting few exquisite seconds, we would stand there, a no-man's land of desire between us, each waiting upon the other to make the first move, my heart thundering like a bass drum, while an enigmatic smile played about her flawless face.

"I can imagine what you're thinking, Martin." Zalman had said, loudly enough that I was startled; shocked instantly and shamefully from a brief but overheated reverie.

I'd felt my face colour dramatically and, fearful of discovery, I'd dropped my head, swallowing desperately, my mouth suddenly as dry as the Gobi desert, my heart thumping so wildly it was barely constrained within my chest. God knows, I could not have been more desperate that my thoughts should not reveal themselves yet my skin felt as if it were burning, chafing horribly beneath a collar that felt as if it were instantly three sizes two small. As my face turned crimson, beads of perspiration began to trickle slowly down my abdomen as the palms of my hands, too, began, alarmingly to sweat.

"But we're a small team here, you see, and a close knit one." Zalman had continued peaceably, apparently gaining in confidence once more, and seemingly oblivious to my sudden paralysing embarrassment. "Neither Sholto nor I subscribe to that traditional hierarchal approach to hospital management. That's one of the many reasons why we were both so keen that you should join us. A new generation, a fresh pair of eyes, contributing your modern thought processes, helping us to drive that culture of change we're all striving for. That's the way forward for Imperial and for medicine, Martin, not desperately clinging to that awful forelock tugging of days gone by…"

I hadn't entirely taken in what he'd been saying. I'd been too focused on swallowing hard and grunting my awkward assent like some blustering old fogey; bumbling and inarticulate as I reached for my handkerchief, wiping at my clammy hands with the fervency of a murderous Shakespearean noblewoman. His point was obvious but I'd allowed myself, rather appallingly, to lose concentration for less than a few seconds, and this was the result. Mercifully, before I was required to comment further, the phone had rung. Zalman had cursed lightly with irritation, and answered it, his voice rising an octave as he had cheerfully recited his name.

As he spoke, his voice grew more serious and, after a moment, he raised his hand at me by way, I assume, of an apology and a suggestion I suspected, that he may be some time. It was not necessary for him to express regret. We had been interrupted but it was an enormous relief. I watched on, dazed, focusing on slowing my breathing again, as he reached for a pen and began to scribble furiously in what I now assumed was his diary. I'd shifted in my seat, surreptitious in my discomfort, as a dull, residual heat still clung to me, ignited by my imagination and reluctant apparently to dissipate entirely. For a split second, I had cursed my laggardly self-restraint.

On reflection, as awkward an acknowledgement as it was, it was not a complete surprise to find myself being briefly overwhelmed. Recently, I had been asking rather a lot of my own capacity for asceticism. Not that I had in any way been keeping tally but she had pressed herself against me for the last three nights in a row, clinging to me with only a thin film of something soft and silky as a barrier between us. But I could sense her sadness, a sorrowful disappointment that emanated from her, diluting the joie de vivre I love so much. In fact, she'd seemed almost childlike, and so very vulnerable in the aftermath of her discovery that initiating anything further would have seemed like the worst sort of betrayal. So, instead, I'd lain quietly behind her, breathing in the delicate scent of her neck, and attempting desperately to fill my mind with hemangiosarcomas, and ponder the relationship with factor VIII-related antigen expression

All the while though, I believed Louisa's resilience to be extraordinary. Understandably, she'd been upset by the news of her father, but I did expect her to bounce back, given time to rationalise the situation. Martin, I don't know what to think, she'd said, her expression so full of anguish that I'd felt desperate to help, determining that she should have as much undisturbed time for reflection as it seemed she needed. To that end, I'd spent the weekend endeavouring to leave her alone as much as was feasible, busying myself in my study so that she might consider her situation. I expected that it would not take long. She is not prone to self-pity and I am aware of how quickly her innate optimism, her vitality, her unshakeable faith in human nature usually re-emerges. I waited, confident that it would suddenly explode with a vengeance, akin to the uncorking of shaken Nebuchadnezzar of champagne.

And I had done my utmost to avoid fussing over her, or hovering in a manner that I consider solicitous because I'm aware that it does seem to irritate her beyond reason. My plan appeared to be reasonably successful. Indeed, she had seemed relatively calm over the entire weekend; other than a loss of libido she had appeared functionally normal. Her appetite was as erratic as ever and therefore I considered it normal, and there appeared to be no insomnia, nor any indication of dissociative behaviours. When her attention was elsewhere, I'd quietly monitored her respiration, and checked for signs of hyperhidrosis, satisfying myself that her behaviour was well within normal parameters and she was exhibiting no clinical signs that indicated any cause for concern. I was confident, too, that my observations had gone completely unnoticed, that is until she had reached for my hand and I had been unable to resist the urge to slip my fingers atop her radial pulse.

"Martin!" She'd squawked indignantly, reefing her arm away and glaring at me. "I'm not your patient!"

Inexplicably, her reaction had rather saddened me and I had stared back at her forlornly. My disappointment and turned to frustration; it seemed that even when she was most in need of my care, a role for which I might finally have some aptitude, she refused to allow me to provide it.

"What?" She'd demanded crossly, scowling back at me as I stood there like an extraneous accessory, utterly deflated and unsure of what to do.

So it was inevitable I suppose, that I erred entirely on the side of caution. I was aware that offering my opinion will likely just be the cause of even further aggravation. And I know I'm deficient in this area, I realise that my skills are substandard when it comes to immediately assessing her needs and understanding the best way to respond. So, staring back at her helplessly, I begin to paint by numbers, trying to recall all the things that, in the past, have seemed to soothe her. And, one by one, over the course of the weekend, I attempt each of them until I seize upon the things that seem to work.

I'd made the best of my time, purging my filing cabinets and cleaning out drawers. Odd recollections of past events drifted into my mind and I attempted to make sense of them: Dad making frequent trips to Hatton Gardens when it appeared he had invoked the silent wrath of my mother, returning wreathed in guilty smiles, proffering more ostentatious reparations in yet another velvet box. And even Uncle Phil, as I recall, was not immune from the need to atone, dragging me into the Portwenn pharmacy and scouring the shelves in desperation, in an apparently vain attempt to find something that might raise the flagging spirits of my unhappy aunt.

But Louisa has never been the sort to hanker after gifts. In many ways her needs seemed as simple as my own. Painfully, and with great reluctance, I recall my callow youth, partnering Edith and how wet behind the ears I'd really been. Now I understand that, the entire time we spent together, I'd simply been going through the motions, enacting a liaison in a way I'd assumed, naively, was routine. No wonder it had always seemed somehow dissatisfying and I had felt so empty and third-rate. Yet, when I think back now, she'd been so determined, so absolutely driven on my behalf. But along with that, had come the trappings, and it's only now I have a sense of the trophy she clearly saw me as. It seems quite telling that Louisa's ambitions for me could not be more dissimilar; she will never care how accomplished I am in my career if it means I am a poorly rounded individual, hopeless in every other area of my life.

The receiver had clicked firmly down on to the cradle, and I had glanced up to see Zalman, his glasses flung down on the desk, his hands now obscuring his face, as he rubbed at his eyes with a slow, agonised motion. After a minute, he'd sighed and, suddenly, the rueful smile was back.

"Martin…right, well…seems I'm going to have to cut our discussion short today, I'm afraid. But, just quickly, is your office up to scratch? Is there anything you need in the meantime?"

"My office is perfectly adequate, thank you. Until I start actually being useful, I think I have everything I need."

"Let's start afresh then, tomorrow." He'd said amiably, glancing at his watch. "In the meantime, I need you to bring yourself up to speed with the Source Documents for all of the active departmental trials. In the past, I left all the nitty gritty up to Geoffrey so I'm embarrassed to admit that don't have a handle on where we are with everything."

"Of course." I replied, suddenly enthused. "Who is the Clinical Research Coordinator for this department? I don't seem to recall an introduction this morning…"

"Yes, well, herein lies the problem Martin. It was a young American woman named Veronica Palter…a pleasant thing she was too, always a box of birds, but she, ahh, she left rather suddenly about ten days ago."

"I see." I said, exhaling disapprovingly. "So Geoffrey's gone, she's disappeared and neither of them briefed you before they left?"

"What can I say?" He'd replied, in obvious discomfort. "Tzippy had threatened me with divorce if I didn't snatch a long weekend before you started, so we were in bloody Barcelona… and I when I came back, it was to an empty department…"

"And Sholto?" I interrupted, somewhat querulously, my frustration rising again.

"To be fair, it wasn't really his issue. And, in his defence he was tied up with budget revisions. The building was wall to wall NHS number crunchers, poor sod was snowed under." He said, his voice becoming slight shrill and almost defensive. "He said he wasn't even aware what had happened until some considerable time after Veronica had left the building."

In reply, I said nothing, I merely folded my arms and fixed him with a rather obviously sardonic and disbelieving stare. He had just admitted he wanted fresh young eyes to examine his department, and now I was only too happy to oblige. Shoddy governance was in no one's interest.

"I need to you to take ownership of this for me Martin, please.." He replied quickly, his face twisting into a wry, mirthless grimace. "You've seen what we have inherited…and I know you share my vision of where we want to go… But I suspect, if anything has come of all this, it's that you now have a far clearer idea of how much work you and I have ahead of us to get there."

"Yes. It is becoming clearer by the minute. If you will direct me to where the files are kept I will make a start. Or would you rather go through them with me first?"

He held up his hands, as if to silence me.

"As I said, I need you to manage this." He replied firmly, leaning forward and peering at me quite intently. "We may have the budget to set up a cracking unit here but we are perilously short on time, and especially front line experience. I trust you to sort this out, and quickly. As you'd be aware there are some significant figures tied up in the funding and it's important we all know where we are."

I stood up to leave. For all my disapproval of their process, or lack of it, I was relieved to have something I could get my teeth into, not least because innovation and improvement was one of the areas of my job I was most passionate about. I'd peer-reviewed a number of studies but it had been a while since I'd been actively involved in the running of clinical trials.

"Yes." I said crisply. "I understand."

"And Martin, a word to the wise. Neither of us want to see Sholto having to explain to the Board why the private funding has dried up." He'd added, and again that vague hint of warning flickered in his heavy-lidded eyes.

"No better time than the present then." I'd replied. "Perhaps you could organise for the files to be brought to me directly? Any obliging and golden-hearted staff currently at a loose end that might assist?"

He'd smiled at me then, knowingly, as if he were acknowledging that we understood each other.

"Of course, I'll see to it now, and again, I can only apologise for the welcome, or lack of it, Martin. I hope you don't feel like we let you down." He'd said, standing up and offering me his hand as if shaking it were the sealing of a truce. "Truth is, we were all…well, frankly, we were blindsided last night by…by…an enormous fire which is proving rather difficult to extinguish. And it's put a lot on Sholto's plate, and the Dean's too for that matter, and of course I can now see myself being dragged into picking up a lot of the slack… So, while they tackle the inferno, so to speak, I'm charged with putting out the spot fires…for the next day or so at least."

"I see."

"Sadly, in the short term, that's going to impact on the time I have available for you."

"Yes. Best if I just get on with things then. It sounds like I will have plenty to keep me busy in the mean time…"

"Good man." He'd said effusively and, as I'd turned to walk away, squaring my shoulders and tugging at my cuffs, he'd called after me, his voice low and cautious.

"Martin…umm, one more thing…you've worked alongside Ben Dixon for a few years, haven't you? What do you think of him?"

I paused.

"Professionally?" I asked.

"Your overall opinion…personally and professionally."

"Professionally, I consider his skills to be only average or below, and personally, I think he's an arse. Will that suffice?"

I heard him inhale heavily. "Yes, Martin, that will suffice. Thank you."

I'd then returned to my office, engrossed in my thoughts. Zalman's insistence that I tackle the research documentation without any prior briefing had left me somewhat concerned and not entirely sure what to make of the conversation. That he had no handle on the trials undertaken by his own department seemed highly irregular to me but I'd taken a few deep breaths and told myself that a throwing myself into an intensive evaluation of the department's research was an ideal way to get abreast of the situation, especially while I had time on my hands. I reminded myself, too, that the innovation I was seeking would, of course, be based soundly in the research I now had the opportunity to assess.

My patient list would come together over the next few days, and consults would begin next Thursday. Soon enough I would have a blade in my hand again and, from that moment on, every patient that set foot in my consulting rooms would be a problematic presentation, and every revascularisation would be complicated or very high risk. But, even when I wasn't operating myself, I would be focused on understanding how our current techniques might be improved. Medical textiles, vascular radiology and the rapidly evolving technology at our fingertips, everything seemed to be advancing and evolving at a rapid rate and the information flow via publications alone was incredibly demanding to keep on top of. And the new demands on my time did not even factor in the opportunities I would now have to shape the minds of not only med students but the next generation of vascular specialists. Despite the speed of current innovation, I was unconvinced that surgical skill was entirely keeping pace. It had been nearly forty years since old Felix Eastcott had first tackled a blocked carotid at St. Mary's yet carotid endarterectomies are still not considered a routine revascularisation. Ben Dixon was a case in point. Every single time, it would fall to me. Arse.

A knock at the door signalled the arrival of several large boxes of files and, with a distracted sweep of my arm, I indicated to yet another unfamiliar face that they should be placed neatly upon the floor. For a few revitalising minutes, peace had descended and, feeling a surprising glow of satisfaction, I washed my hands and retrieved my lunch from the refrigerator, squeezing a lemon generously over my salad, and slicing each of the cherry tomatoes in two with a sterile new scalpel I'd kept in my case. There was a lone fork in the drawer and, after gazing at it suspiciously, I had immersed it in boiling water before deigning it sanitary enough to use.

Tomorrow, I would bring my own espresso machine in and set it up, convinced that it was a superior piece of engineering to that which Zalman had seemed so proud of. In hindsight, I might blame his machine but it was not outside the realms of possibility that he'd simply chosen a particularly bitter blend of beans. God forbid, he might even be buying his coffee already ground. I did sense that about him; that he wasn't a purist and that he had, in some ways, a remarkably casual approach to things that were of the greatest importance. Punctuality for instance, and deference to a chain of command, and, obviously, the optimum mechanism for the delivery of caffeine.

Pursing my lips in disapprobation, I prepared myself a cup of tea, grateful that at least someone had had the good sense to put fresh milk into my fridge. After I'd wiped my mouth and rinsed my dishes, I'd checked the time and had been rather pleased to realise that it was just after two o'clock, making it well within the realms of possibility that I would be in a taxi and on my way home shortly after five. I was confident of that now because any emergencies that required my attention late in the day would be undoubtedly be few and far between. On my way back to the flat, I would call in at the supermarket and choose something special for dinner, something that might make Louisa's eyes light up again; a stuffed chicken breast or perhaps even a rack of lamb.

"There is such a thing as too much fish, Martin." She'd said last week with a certain air of crossness. "I wouldn't even mind so much if you fried it occasionally or perhaps made a coconut curry but it's always always grilled…"

"No it's not." I'd replied rather defensively, wincing at her words, animal fats and creamy sauces being total anathema to me. "Sometimes it's baked…"

Smiling to myself as I recalled the face she had pulled, I picked up the carton closest to my desk and examined the label. An interventional trial of less than fifty participants, sponsored by a Spanish Company I had never heard of, an outfit known as Empresa de Suprimentos Medicos Antiéticos. Inside the box, I was somewhat shocked to discover the pages were loose and unsecured. Some had been stapled together and others were slipped inside clear plastic sleeves but the majority of the reports were uncollated and merely floated, creased and dog-eared, within the box. Exhaling heavily, I began to churn my way through the results, attempting to catalogue them into some sort of order as I did so but I soon began to notice that were significant gaps in the provision of results.

Frowning, I'd reached for another box, feeling my eyebrow climb up my forehead as I realised this study too was sponsored by the same Spanish medical supply company. Inside, the paperwork looked like something my Auntie Joan would throw together; chaotic and tattered as if it had been retrieved from the bin. It did not take me long to observe that the missing pages appeared to have been ripped roughly from their counterparts, a suspicion that was soon confirmed when I tried to make some sense of the results. Sighing, I'd opened a third box, shaking my head as I discovered what appeared to be a virtual rats nest of notes. As I stared, I could think of no legitimate excuse for the state the records were in and, as I tried vainly to match the reported results to the original protocol, I began to feel a growing sense of concern.

The more I searched, the more alarmed I became. As I pieced each trial together it was clear that not only were there significant Protocol Deviations but there were a raft of egregious errors; in informed consent and, especially, a total disregard for the procedural safeguards put in place to protect the interests of the patient. By this point, I felt apprehension begin to weigh rather heavily upon my shoulders and the only obvious solution was to telephone Zalman immediately and inform him of my discoveries. I found his extension and dialled the number but, much to my frustration, it went directly to his answerphone.

Cursing under my breath, I'd hung up and reached with bated breath for the remaining carton. While the lid was oddly unmarked, the contents were extensive though, unbelievably, there seemed to be no identifying cover sheet at all. The trial reports revealed that this had been long and was still somewhat ongoing, with results recorded right back to before 1985. I'd uplifted the contents and was flipping cautiously through the contents when I located the original protocol. I was hardly surprised to see that the product was this time a polypropylene mesh, originating once again from this apparently inventive Spanish company I had, somewhat incredibly, never heard of. The whole scenario smacked of a bias that was causing me a discomfort that grew exponentially with every page I read.

What was becoming plainer by the second was that the breaches of standards concealed in this box went far beyond that which I had already discovered. Whoever had hastily removed screeds of identifying information from the other studies had not apparently had a chance to expunge the incriminating evidence from this file entirely. As I read the patient notes, it was as if the blood was drained away out of my body and I felt suddenly colder than I could ever recall feeling before. I had no doubt that what I was staring at was in flagrant breach of not only medical ethics but, indeed, the law of the land. There'd been minor scandals in research circles before of course but nothing as abhorrent as this. I reached into my pocket for my handkerchief and pressed it in stunned silence to my mouth.

Hesitantly, I removed the paperclip that held the protocol together, slipping out the sheets below and laying them out upon my desk. For a moment, I had simply stared at them in horror, my body rigid as if it were frozen in disbelief. There was an accompanying note, written in extravagant cursive beneath the boldly emblazoned letterhead; for some nefarious reason, The Friends Of St. Thomas were asking not to be publicly identified as the sponsors of this trial. As irregular and unethical as I knew this to be, it was not the cause of the salty dryness of my mouth, nor the reason my hands had developed a sudden uncontrollable tremble. As a philanthropic enterprise, of course they were only too familiar to me; I felt a surprising surge of anger as I recalled the way my childhood had been forced to fit almost entirely around their endless fundraising bacchanals. But it was the signature at the bottom of the page that had made me bolt to the lavatory, as a debilitating wave of nausea had overcome me and I'd heaved my lunch into the bowl. Whatever the moral bankruptcy of the situation, however repulsive and unethical it apparently seemed, I now knew without a doubt that, somehow, my mother was irrefutably embroiled.