I don't recall noticing that the sun had set; dismay had rendered me almost insensible of my surroundings and I sat shocked and motionless in the dull drone of silence. I remember looking at my watch, peering at the numbers on the dial yet struggling to make sense of them, like a child who has not yet learned to tell the time. As the room around me slipped gradually into focus, I was conscious only of a rather hellish headache, one which had been increasing exponentially with every box I opened. But it wasn't until I lurched awkwardly to my feet, the room swimming drunkenly, and disgust weighing me down like iron ballast, that I was filled with an intense and almost overwhelming urgency. Louisa was waiting for me, and I must get back to the flat.
Climbing the stairs, my legs had felt leaden and feeble and, when she met me at the door, I'd stood like a statue in her embrace. I was overwhelmed I suppose by the implications of my discovery and, equally, my shame at what had been my own response. Rather than maintaining the required clinical and dispassionate approach, I'd found myself vomiting like a lambasted child, shame an accelerant to the fear that smouldered like dampened ashes in the pit of my stomach. As much as I wanted the comfort of her embrace, I'd felt suddenly conscious that my breath might still be rancid from bile and so I'd kept my mouth tightly closed, holding my breath as I pressed my lips to her cheek.
"So, how was it?" She'd asked, with her usual breathless enthusiasm, clutching her hands together at her chest.
I'd lied to her then, just a small, white deception that I hoped was enough to deflect any suspicion. As she'd gazed up at me, a sweetly expectant smile on her face, I'd wondered if this was the start of it, Louisa's first touch of the gossamer thread, her unconscious initial step toward ensnarement in the tangled web my mother weaves.
"It was fine." I'd replied dully, glancing around the room, stiff and uncomfortable, in my feeble effort to avoid her scrutiny
"Well, I'm glad you're home." She'd said slowly. "I was starting to get a bit worried about you actually…you know, that something might be the matter…"
"No." I'd muttered, ducking my chin and edging away from her. "There's nothing the matter. But, umm, I do have rather a headache...so…I'm just going to…"
She'd frowned at me then, her confusion and disappointment obvious but, because I was a coward, I had fled from her regardless. At the time, it seemed as if there were no words available to me, as if I were required to explain the inexplicable, but I realise now that I was simply unable to admit the truth. I could not countenance Louisa thinking ill of me, yet it seemed miserably inevitable. I had made what appeared now to be a dreadful, and possibly irreversible, career decision, my mother was a charlatan of the most appalling kind, and my family name was about to be dragged through the mud in the worst possible way. The agony of it all bit into my flesh, like the sadistic slash of a headmaster's cane, and I'd found myself muttering an incoherent rejection of her offer to prepare supper, abandoning her for the dismal isolation of the empty bedroom. Longing for her as I was, walking away had felt like a penance somehow, a hair shirt, a self-flagellation. Unable to bear the sight of myself in the mirror, I'd forced down some paracetamol, before showering and crawling into bed.
But Louisa is nothing, if not kind and generous. In the cool pale light of morning, she had offered me relief and I had snatched it from her hand; hungry and impatient, the actions of a man desperate to bury himself in a place he knows he will find peace. If she sensed how on edge I was, how in need of solace, she said nothing, choosing instead to smile gently up at me, dreamy and silent, only an occasional, breathless gasp escaping her throat. Recalling it now, my god, I'd exploded like a corroded boiler as I felt her hand slide beneath the fabric of my underwear. And I'd been unambiguous in what I wanted yet she'd appeared even to find some delight in that; wrapping her legs around me, urging me into her with a fervency that had been invigorating and yet so very reassuring. For just a few moments, my rational mind was lost to me but, as my hand gripped hers in a sort of mutual urgency, I knew she was the only thing that mattered. As I muttered her name helplessly, as all weight lifted momentarily from my shoulders, all I could do was savour the sensation, an abandon myself to my need of her.
Afterwards, for that brief but most perfect of interludes, my thoughts had been crystalline in their clarity. As I'd showered too, reluctantly rinsing the last vestiges of her delicate sweet scent from my overheated flesh, lucidity had returned to me. Staring at myself in the mirror as I shaved brought everything so sharply into focus. Just as Louisa should not be tarnished by the actions of her father, neither need I partake of my mother's shame.
To that end, there was one option available, and one alone. I must meet immediately with both Sholto and Zalman and remove myself from the department. Anything else was a flagrant conflict of interest and, though I had only faint hope that my own good name would not be irreparably damaged by the inevitable fallout, when it passed, I would still need to live with myself. I must be able to examine my conscience and find it impeccable; it was imperative that I could console myself that, whatever the long term outcome might be, at least I had behaved with dignity, my morals above question, my honour in tact.
As I fetched my briefcase, I'd paused for a moment in my study, glancing indecisively at the box which contained my espresso machine and a selection of the other accoutrements I'd always ensured were on hand in my office at St Mary's. It had been an absolute necessity really, to try and maintain a sense of normalcy when ones hours were erratic, when ones life was disrupted by working late into the night, and being so frequently on-call. But it struck me then that everything was suddenly so up in the air, my situation so utterly unpredictable. Professionally, I was in a state of flux, from what I would do if I removed myself, temporarily, from the Imperial vascular team, to whether it became something that Sholto might decide should be permanent. I found the uncertainty deeply troubling; as quickly as it had returned, my sense of calm began to evaporate again and I felt a sudden flash of fear, a terror at what felt like a loss of control, the prospect of a humiliating fall from grace that had seemed simply unthinkable forty eight hours ago.
The idea was so horrifying and inconceivable that, at that moment, I found myself rooted to the spot and in desperate need of reassurance. I felt exposed, and vulnerable and unsure, like a smattering of inconsolable school boys on their first day at Prep, the same pathetic, streaky-faced crybabies that I had always pushed past so briskly, exuding my own well-practiced air of impatience, a supercilious sneer twisting my expression toward disdain. And so I had slipped back, anxiously, into the bedroom, hopeful of something I could not quite describe; a slow languid smile perhaps, the soft warm fervency of a lover's kiss, or an intense embrace, one where she enfolds me as firmly and all encompassing as a surgical body stocking, her skin so delicate against my own, my fingers buried deeply in her silky mane of hair.
But, instead, I discovered her face down and fast asleep, her arms wrapped instead around her pillow, a delectable glimpse of creamy thigh and curvaceous buttock emerging from the tangle of the bed linen. My god, how I loved her in that moment, so utterly divine and so unfettered that it had drawn the words from me out loud.
"I love you." I'd whispered, my voice hoarse and low as all the air was expelled, suddenly and vehemently, from the deepest vestiges of my lungs.
Once, not so long ago, I had been incredulous to find myself even capable of this kind of love, equal parts thrilled and disbelieving that I might ever have the chance to know it for myself. But now, as a word, it seemed such an inadequate expression of my feelings for her. I'd allowed myself to gaze upon her for just a moment, and I was paralysed, suddenly cognisant that there was actually something more important to me than my career; I had a purpose, a philosophy, a salve I suppose, that made the possibility of having to start again somehow bearable. As inconceivable as it was, the idea of finding myself as a lowly general surgeon, banished to some pokey little backwater and lopping out appendixes for a living, might actually be tolerable if only Louisa might come with me. I snatched one last, lingering glance at her before reaching down and easing a loose portion of sheet across to offer modesty to her utterly glorious, bare behind.
For the rest of the day, despite the relative uncertainty of my position, I was able to approach my new role with a slight degree of vigour. Resolved and purposeful, I knew what I must do. As soon as I stepped foot in my office, I had left messages for both Sholto and Zalman, insisting calmly yet assertively upon an urgent meeting, my insistence implicit in my tone. I had then exercised considerable self control, ignoring the remainder of the files I had still to sort, in favour of installing my espresso machine, populating the cutlery and crockery drawers with my own spotlessly-clean possessions, plugging in my spare electric toothbrush, and organising my toiletries in the cupboard in the wet room. I hung a fresh shirt and tie in the wardrobe, placed clean socks and undergarments on the shelf below, and chose a logical location for the clothes brush, the shoe polish, and the small personal medical kit I like to keep on hand at all times. Glancing around, I was quite satisfied with the result. Reorganising the books on the shelves could wait for another day but order was now imposed in a way I found heartening. Thus encouraged, I retrieved the newest edition of the Vascular Journal from my brief case, and prepared myself a small reward by way of a double espresso in my preferred white porcelain demitasse cup and saucer.
I had only been half way through the first article when I'd received the phone call I'd been expecting, summoning me, however, to Zalman's office. Even though I had rehearsed in my head what I'd planned to say, disappointingly the Head of Vascular did not seem to want to read from the same script as me. From the moment I knocked on his door, I'd watched him closely, noting with interest how he'd avoided meeting my eye. Whatever his motives, he preferred instead to stand up and walk over his window, standing with his back to me, as if he were attempting to hide the fact that his skin appeared suddenly pale and sallow, and that his jaw was clenched so tightly it was if he had contracted tetanus.
"Are you suggesting that all of the trials are somehow…fraudulent?" He'd asked eventually, his voice a quiet incredulous growl, his fingers gripping ferociously at the windowsill.
"I'm saying that eight boxes were presented to me yesterday afternoon and, of those eight, five appear fallacious." I'd answered crisply. "I cannot comment further, obviously, on how much deeper this issue runs because I have yet to review all of the files in their entirety."
"Of course." He'd replied. "I see…It seems to me then that the best thing to do is to have everything current sent up to you straight away. Obviously the sooner we understand how serious this is, the sooner we can strategise a response…"
He had stood motionless, clearly expecting my acquiescence but, instead, I'd cleared my throat, lifted my chin defiantly, and begun to speak, slowly and with unmistakeable formality.
"Unfortunately Zalman, I must disagree entirely. For me to be involved in investigating these blatant falsehoods any further would appear to be nothing short of a massive and untenable conflict of interest. I strongly recommend that the board and all the relevant authorities are informed as a priority, and an independent auditor appointed as soon as possible to scrutinise the questionable trial data. We must proceed to the letter of the law and if, as I suspect, there are medico-legal ramifications then you must see what an impossible position my ongoing involvement in any of this places me in…"
He had swung around to face me then, snatching at his glasses impatiently and tossing them down onto his desk.
"Martin, one vague piece of correspondence signed by your mother does not make you Ronnie Biggs. As much as I admire your scruples, have you not considered that your reaction might be somewhat premature?"
"Are you suggesting that I'm over-reacting?" I had asked him slowly, suddenly grim with disbelief.
"I'm sorry, Martin, but that's exactly what I'm saying." He'd replied, his voice dripping with a thoroughly irksome, oily condescension. "If a patient comes to you with high blood pressure, you don't insist on an immediate cardiac transplant…"
"Please don't patronise me to make your point…" I'd interrupted, my tone as cold as dry ice.
"I'm not patronising you, I'm correcting you. You've lost your objectivity, man, you've lost all sense of perspective…"
"Perhaps we should leave it to Sholto to decide that." I'd growled back at him, glowering at him furiously. "Is he in his office?"
"Trust me, Sholto does not need to hear this now, he will not thank us for turning up at his door with yet more vague and unsubstantiated rumours of impropriety. For goodness sake, stop and think Martin, you and I need to assuage ourselves of the situation in full before we take it upstairs. We will tell Sholto only when we know exactly what we are dealing with…"
"With respect, if you actually stopped to think, you'd realise that, under the circumstances, Sholto has no alternative but to transfer me from the department, either temporarily or permanently, as he sees fit." I'd barked back at him, my frustration now no longer able to be contained. "The charter definition of a conflict of interest is..is…clear and definitive. So frankly, Zalman, bugger what else is distracting him. He's head of surgery, he needs to be made abreast of the situation and, if you're not prepared to damn well do so, then I certainly am…."
"Martin, you need to calm down and listen to me." He'd said, walking toward me and raising his voice in a way that seemed vaguely threatening. "Neither you nor I are going to barge into Sholto's office, based on unproven assumptions. If, in the event you are mistaken, and we discover there's a perfectly reasonable explanation, what's it going to look like if you've already been, to all intents and purposes, demoted, hmm? Think about that for a minute, will you? Not only will your removal from the department be forever on your record but your demise will be on the lips of your every rival; everyone you've ever rubbed up the wrong way, Martin…all those women you've infamously rebuffed, every man you've ever shown up, publicly and privately. You know what hospitals are like. Your detractors, your rivals, they will have a field day at your perceived comeuppance…and your innocence and your integrity, well that won't even come into it…"
I'd stared back at him for a few uncomfortable seconds and then I'd simply grunted, folding my arms defensively as I was forced to admit that he was not referring to an insubstantial number of people. And I was now beyond angry with my mother for placing me in such a position; instead my fury had been replaced by a sickening sense of disgust and shame. In that moment I detested her with such bitterness and fervency that I even shocked myself. I never wanted to see her again and yet I wanted to rage at her, with an odd and disturbing string of Anglo-Saxon insults that burned like bile in the depth of my throat. Taken aback, and briefly pondering their source, I'd suddenly recalled an argument, lost in the midst of time. Christmas Eve I believe it was, though I cant be certain of the year. I was still very young, and rather transfixed, too; listening breathlessly at my bedroom door as my Aunt Ruth baled her sister-in-law up on the third floor landing, neither of them aware that I was within earshot.
"What's a guttersnipe please?" I'd asked Nanny later, my voice a tentative stage whisper, as she'd hovered behind me, supervising my strict, naval-like preparations for bed.
I'd already leafed through the heavy Collins Oxford in the library earlier and though, admittedly, I still had little cognisance of their meaning, I'd understood enough to know that 'duplicitous' and 'whore' were not intended as compliments by my thin, acerbic aunt. Before I'd concluded my research however, I'd heard the familiar sound of Henry coughing in the distance, his lungs objecting ferociously as he lumbered up the stairs toward my hiding place in the library. I had already begun to develop that sixth sense that detected approach and I had anticipated his arrival long before I'd looked up to see him standing in the door way. He must surely have been dying by then but I was far too young to comprehend that fact. I had noticed the change in his appearance however; the way his face had become thin and drawn, and the proliferation of the rounded, dark red nodules that had began to develop on his forehead, cheeks and neck.
I respected my grandfather but I don't believe I ever feared him. In turn, he didn't seem to consider me quite as irksome an individual as everyone else I encountered did; in fact the sicker he became, the more he appeared to seek out my company on the rare occasions I found myself under the same roof as he. A gentleman, albeit a gruff monosyllabic one, he growled my name in a manner which commanded obedience and, despite struggling to return the heavy dictionary to its rightful place, I had scampered as quickly as I could to sit down beside him on the Chesterfield, thrilled to claim even a modicum of his time. Despite his stern demeanour, he was a patient teacher; the carving of a joint at lunch became an anatomy lesson; the lighting of fires, the switching on of lights, the operation of gramophones, even the whistles that fell out of the crackers that Joan would invariably send at Christmas, Henry took every opportunity he could to educate me in what he termed the irrefutibility of science.
"You have the vague makings of a surgeon." He had told me once, rather thoughtfully, as he'd supervised my disarticulation of a plump warm wing from a partially plucked chicken. "But you must be prepared to work very hard, young man, very hard indeed. In surgery, just to do one's best is simply not good enough. In surgery one must BE the best. And we Ellinghams, we must be the best of all. Are you prepared to do that for me, Martin? Are you prepared to work tirelessly to keep the Ellingham name at the forefront of medicine?"
It was a lifetime ago, and I'd assumed the details long since lost to me. I would never forget the sentiments of course, nor the slow burning fuse my grandfather's belief in me had quietly lit. But its sudden reemergence had shaken me, the details I'd recalled bringing Henry suddenly and rather colourfully back to life. As a consequence, I'd found myself staring back at Zalman rather vacantly, emerging from my daydream helpless, and torn utterly in two as my certainty and determination slipped slowly away. His eyes now seemed to glitter self-assuredly as he spoke, as if he could now locate my soft, vulnerable underbelly as easily as if he were performing a midline incision.
Yet, I was still unconvinced; I felt sure that my mother must be somehow culpable, just as I knew that Henry Ellingham would want me to redress the damage his daughter-in-law had already inflicted upon his precious family name. The conflict of interest evident in even my minor involvement to date seemed as obvious as the cutaneous metastases that had blemished Henry's face. But I also sensed that the subject was no longer up for debate; as much as he professed to finding the practice deplorable, my chief was in fact intent on pulling rank.
"I have ten minutes." Zalman said firmly as he glanced at his rather oversized watch. "Show me what you have."
He'd accompanied me back to my office, and listened with a rather grim expression as I'd outlined my concerns, taking pains to point out to him any subjects where no consents appeared to have ever been been signed. I'd begun my disclosure at the most dishonourable point, the excruciating mesh trial that bore all the hallmarks of my my mother's inherent duplicity. In total silence, he had flicked through the content I'd managed to roughly collate, occasionally pausing to read a page in its entirety, his brows knotted fiercely, his lips pursed and contemplative. Eventually, he had dropped the files into the box with obvious disappointment, looking at me intently, his eyes searching my own.
"Did you study languages at school, Martin?" He'd asked, his voice oddly casual, as I'd frowned back at him in confusion.
"The usual, French and Latin, why?"
"You see, there's a reason Tzippy likes me to go to Barcelona with her, and it's not because she craves my company." He said, a faint, self-reflective smile hovering about his face. "It was very helpful when I was in California, too, to have a reasonable grasp of Spanish, it helped to put a lot of patients at their ease."
"Spanish?"
"Yes, Martin…and, as such, I believe this…this company, this Empresa de Suprimentos Medicos Antiéticos are unlikely to be Spanish in origin. In my humble opinion, I suspect that, if they had Spanish origins, they would have a Spanish name…something along the lines of Empresa de Suministros de Médicos Poco Éticos… so I think, in fact, what we have at the heart of this investigation is a company that probably demonstrates more of a link to Portugal…"
It hit me then, like an unexpected blow to the solar plexus; that appalling sinking feeling I'd experienced so many times before, an almost constant companion at prep school; a rugby ball hurled into my midriff, a punch thrown when I was fast asleep, and I'd clenched my fists involuntarily, as surely as if I'd been struck again. And it was the same visceral reaction I'd felt as a student, a black and white young man in a grey and uncertain world. Certainly the humiliation was familiar, as was the slow and sickening creep of dawning comprehension. The glib way rumours of her infidelity had reached my ears had cut me to the quick but even the pain of Edith's licentiousness paled when compared to the ongoing shame of my father's public indiscretions, or my mother's humiliating attempts to marry me off as she attempted to improve her social standing. Yet, despite my attempts to excise each them all from my life, and despite my grim determination to maintain my dignity, to fiercely uphold my own moral code, it seems, still, as if my parents are determined to see me demeaned and to see my name as worthless and besmirched.
"Portugal..?" I'd croaked in disbelief.
"Yes, Portugal, not that I suppose it makes much difference in the scheme of things. But I think it might be worth having my Secretary telephone their Justice Department…see if we can get an idea of who the directors might be? Because it's not a name that rings any bells personally but it might be a very good place to start…"
"Mm." I'd managed to reply hoarsely, struggling to project my customary and usually unshakeable self-belief, oddly desperate to portray myself as a man whose situation has not become almost untenable and whose hard won promotion is most certainly not at risk.
"I'm going to take this box away with me and I want you to set aside any others that you have even the slightest qualms about." Zalman said firmly. "I mean it, I don't want you to waste your time on a load of bollocks once you've identified them for what they are. Focus on the legitimate research and when you've worked your way through this lot, I'll arrange to have the next batch sent up."
I'd muttered in agreement, my lips cracked and my mouth as dry as if I'd developed spontaneous xeristomia.
"And, Martin. Not a word to anyone, understand?"
However reluctant I was, I'd nodded helplessly, effectively giving him my word. I knew, of course, exactly to whom the Portuguese company would eventually be traced, and I could only hope now that Zalman's secretary, too, was impeccably discreet. After arranging to complete my orientation with him the next morning, I'd walked stiffly back to my office, closing the door and committing myself less than enthusiastically to my task. To my indescribable relief however, I discovered no further anomalies. Though the filing and collation methods showed scant improvement on the haphazard systems I'd already encountered, the trials themselves seemed to have at least been properly administered, all the necessary documentation seemed to be present, and all of the required checks and balances were well in place. At least, occasionally, it seemed Geoffrey Rushton had deigned to place a well manicured finger on the erratic Imperial research pulse.
With so much to think about, once again I ate my lunch alone, unable to countenance even having to talk to strangers, never mind any attempt to be congenial. Instead, I attended to details, recording an answer phone message and perusing a raft of paperwork that had already accumulated atop my desk. I read guidelines, I glanced at staff lists and, rather optomistically, I completed a plethora of tedious forms; requisitions for business cards and associated personalised stationary, a parking space request, and seemingly endless reams of NHS documents, each a vague duplication of the one before. After a while I realised I'd been staring at the final page too long, absently twisting my pen through the coiled telephone cord as I contemplated the step I was about to take.
I thought about it later, as I walked home in the bracing coolness of a fine Scotch mist. Her parents might not have taken their responsibilities to her seriously but I certainly intended to do so. And, if the last few days had proved anything it was that having her in my life could mitigate even the most distressing turn of events. Therefore, it did seem only logical that, now I'm aware that I can't bear to be without her, I must think about what practical steps I should organise to take. Of course, I can't mention any of this to Louisa. Young people don't see any necessity to plan, not when life seems like a lush, green, fertile plain stretching out endlessly toward the horizon. Even her studies, that loose, informal smattering of lectures appropriately referred to as a liberal Arts degree, seem inadequate preparation to help her achieve the professional career she insists that she desires.
Her very existence is an enthusiastic quest for simple pleasures, a thirst to pursue such intangibilities as fun and cool and brilliant. If I factor in her bohemian ideals, and her resistance to any obvious pecuniary support, even though her circumstances are almost permanently strained, then it's obvious my plans are best kept firmly under wraps. Life Insurance, real estate, share portfolios (however modest) and minor assets all sound like reasons for the two of us to row. And it would all be so pointless too because I have already made up my mind and, really, this had been such an ideal place for me to start. So, in the end, it had been as simple as drawing in a deep breath, pressing firmly, and using large, bold letters. In the section next-of-kin, I wrote her name, and that was that. Indisputably, from now on, it would always be Louisa, in emphatic capitals, as had become my wont. And while to some, it might seem only a small stride towards legitimacy, to me it felt life-changing and gargantuan. As I allowed the implications to sink in, even more enormously, I was now almost certain what my next step should be.