A busy night might have been a blessing in disguise. Almost anything would have been better than lying there on that rock hard surface, on a mattress so unforgiving it was more akin to a medieval torture device than any place of rest.
"I could come with you, if you like…Just to keep you warm…"
My gracelessness was too dismal to contemplate but, in the darkness it was hard to find distraction. Listening for pages that did not come, craning my ears for any sound beyond those flimsy walls, only to be met with a silence more unnerving than even the usual hospital commotion.
"Actually, it's not much fun just being here by myself every single night, if I'm honest…"
My scrubs smelt faintly of starch, and another unidentifiable but vaguely savoury odour. Wrinkling my nose and grimacing sharply, I realised how impossibly tight my jaw was, my teeth clamped together with a sort of grim determination, my temples rigid and painful. Being alone, and loneliness itself, were two completely different things, I'd come to realise.
"God forbid I should actually go out anywhere, live any sort of normal life…"
The dull ache that lingered in my lower abdomen could no longer be denied, and I was crushed by a sense of need that became weightier by the hour. A few moment's reflection is enough to reveal the last month to resemble nothing short of a battlefield. Oh god, Louisa, what have I done? Like a cactus, left dry and dusty in the shadows, who suddenly finds itself on a windowsill, you are my heat and my light, you are both sun and sustenance to me.
"She's only gone and invited me to Sydney for Christmas."
Avoidance was no longer any sort of option; my clenched fists and dry mouth were testament to that. How had I become like a passenger in my own life, an automaton barely functioning? How had it come to this when my intentions were so good, and when I'd started to believe that the future held so much more promise than I ever dared hope? With only a thin blanket for comfort, I was no longer able to avoid the enormity of my own failure.
But, at the time I was so bewildered by her fury; it made no sense to me when I had tried so hard. I had been honest with her from the very start, brutally clear about the sacrifices we both must make in order for me to maintain the trajectory of my career. She'd clung to me, wrapped herself around me, kissed me with a fervency that had almost made me weep; all to reassure me, she said, that she loved me for who I was, and understood the importance of what I did. But, alone in that Cimmerian darkness, all I could do was berate myself, realising how deluded I was to think she understood, how naive I was to believe her acceptance of my responsibilities was a box I could consider vehemently ticked.
"Ellingham, old man, I was hoping I'd run into you. I've something for the sumptuous Louisa. I don't suppose you're still seeing her, are you?"
Johnny Sodding Bamford. I was still furious at his interruption this morning, though I'd managed to maintain control the situation by utterly refusing to engage with him. I'd gestured coldly and dismissively for him to be removed him from my sight by the new vascular registrar, barely missing a beat as I brushed past the obnoxious little cretin and into the ward. How dare he even approach me, how dare he allude to my personal life in a way that caused a noticeable ripple to pass through the uninspiring entourage that joins me for rounds. Jumping on a first year registrar who had dared to be distracted, I'd demanded an explanation; why are patients undergoing vascular procedures particularly vulnerable to infection? He had garbled enough preposterous rubbish that it had had the desired effect, jarring everyone's attention quickly and firmly back to the task at hand, with most of them barely brave enough to breathe as we completed the wards at a ferocious pace.
"Well, if you do still have her locked up somewhere, would you mind passing this on to her with my compliments?"
All day, the existence of that envelope had been like a thorn in my side. It suggested an association, an understanding of some sort, god help me, perhaps even a relationship between them. I'd been short with a ward clerk, and terse with a student nurse, finally venting rather a lot of frustration on the hapless house surgeon who'd paged me as I was leaving, wanting a consult for what turned out to be a superficial phlebitis at a catheter site. My sarcasm had been withering, and I'd left him with what appeared to be a trembling lip but even several hours later, I could not banish the lingering disquiet, the short-tempered edginess that saw me lying there exhausted, yet incapable of sleep.
"I'm going to that concert Martin and if you don't want to come with me, I'll just find someone who does!"
My fists clenched every time I recalled his cockiness, wincing again at his vile assumptions, his derogatory conclusions. He got what he wanted; I can't imagine a myocardial infarction could be any more painful than watching her abscond from the flat again, as I did last night. I think I understand her disappointment in me, and even her unhappiness at our present situation, but her determination to accept a gift from someone of his ilk is not only utterly baffling it actually feels completely devastating. Being alone has never caused me this much discomfort, but I find myself longing for her, wretchedly, in a way I've never known before. So I must acknowledge what it is that causes me to feel this miserable, that now terrifies me beyond all belief; the grief of losing Louisa would be unfathomable but to lose her to another man would surely be a wound that would never heal.
I'd shifted uncomfortably in the bed, flexing my fingers and clasping my hands together mid sternum. A television I hoped might provide the sort of entertainment she craved turns out to be the worst thing I could possibly have done. Yet last minute tickets to a cacophonous concert cause her to become absolutely radiant with glee, as if she is thrilled beyond belief by the actions of a man who undeniably has an ulterior motive. What is it about fun that makes it such a sought after attribute? Why is it that clowning buffoonery, and the tomfoolery of horseplay, seem virtues that hold everyone in their thrall? Stuff and nonsense delivered by the charismatic appears to mitigate any personal lack of honour or integrity, or decency, or morals. The more I thought about it, the less I understand.
It's just as you always suspected Ellingham, a voice pointed out calmly…of course you could never be enough for her…you will never be capable of providing the sort of excitement and activity she craves… you're dour…rigid…too humourless to ever be the man she actually needs…inevitable that she will go to concert…inevitable she finds someone else to go with her…someone amusing….entertaining…light hearted…someone….plainly and irrefutably…not you. Louisa please, I murmur as I drift into a restless, fitful sleep…but she is a swirl of vapour that volatilises as I reach for her…I feel her heat in my loins…my pulse races and then she is gone, leaving only the delicate sweetness of sun-ripened pears as a faint glaze upon my tongue.
The telephone beside the bed shrieked, the pagers went off simultaneously, and I was catapulted violently back to consciousness. For a split second, I could not recall where I was but years of practice saw me wide awake instantly, staring at the tiny display disbelievingly and hastening downstairs at speed. Scrubbing was a blur, and I made my way into theatre two, only to be confronted by a scene reminiscent of a bomb going off at an abattoir. As a result, I'd taken a moment to gather my thoughts, listening carefully as the theatre team loudly and concisely conveyed patient information, and scrambled to control the significant blood loss. An accidental laceration of the femoral artery, apparently, a general surgeon and an orthopaedic registrar attempting to repair injuries sustained in a traffic accident. Unsurprisingly, the surgical lead wouldn't look at me, as he barked needless instructions, neither would the anaesthetist, who seemed focused on instructing a nurse to warm the blood, and prime the lines for rapid transfusion. Another two nurses were frantically suctioning the blood away, aided and abetted by a terrified young house surgeon, who attempted to brief me again, in a timorous voice, as if I had lost the ability to estimate blood loss. Glancing at him dismissively, I stepped into the sterile field.
"Out of my way." I'd growled at the surgeon, ignoring his attempts at further explanation.
"Pean forceps in place." He'd blustered, briefly standing his ground as I glanced into the soupy mess that used to be the patient's thigh and hip.
"What do you want? A medal?" I said with no attempt to hide my contempt. "I don't suppose it occurred to you to clamp above and below the tear…"
Above his mask, his eyes narrowed. "How dare you! Of course it did. I was about to…"
"Yes, of course you were…" I'd replied cuttingly, peering closely into the wound and asking for the table to be raised, feeling oddly satisfied by the way the room was now almost silent
"And get that music turned off. Now." I'd added, to no one in particular, before informing everyone exactly what I planned to do.
In the end, it had been a fairly routine repair, an end to end anastomosis just as I'd performed hundreds of times before. But the patient had already lost a lot of blood prior to my arrival, as evidenced by the state of the drapes, the floor and even the team themselves. Before I left them to it, I did make the observation that more blood products were needed on hand, and suggested that another trip to the blood bank might be prudent before continuing. Of course, my recommendation was met with absolute silence, a few disgruntled glances passing rather obviously between the surgical team, though the anaesthetist did manage to utter a quick thank you in reply.
I glanced at the clock, noting that it was just after three. Another shower, another fresh pair of scrubs and I'd crawled back into bed, suffused by an odd mix of exhaustion and irritation and despair. For a while, I'd just lain there, wide awake again, my forearm over my eyes, the events of the day on a constant loop in my mind, feeling so agitated I'd almost become fixated on the idea of abandoning my shift and running home to her. It was only for a couple of hours but she would surely be there, and I could just slip quietly into bed beside her; in the dark, with my arms around her, perhaps I could explain how I feel, I might be able to whisper into her hair of the sorrow that tears at my heart. Would her skin still ripple with goosebumps when I touched her? Would she still welcome me with her warm velvet-like embrace?
I'd had to stop myself quickly, shifting uncomfortably in the bed and chastising myself severely as my heart rate began rapidly to elevate. Clearing my throat, I reached for the glass of water next to the bed only to startle rather guiltily as the pagers summoned again. But, this time, I was furious, unable to contain my rage at the incompetency of whoever this ham-fisted idiot was. One accidental nick of an artery is careless, but two is bordering on being struck off. As I crashed through the doors into theatre, I'd pulled no punches, demanding the imbecile leave immediately, berating him for his butchery and questioning him on the legitimacy of his qualifications.
"You haven't heard the last of this, Ellingham!"
Neither had he, I suspected, but this was no time for a debate. And, of course, I was right. There wasn't enough blood on hand and, not for the first time, I wondered why these people just won't listen to me when I tell them what to do. Some lowly staff member is despatched, returning shortly after, as breathless and panting as if he has sprinted there and back. By the time I finish the second repair, the unfortunate patient has had his entire blood volume replaced at least once, over the course of the procedure, and is now looking at a stay in ICU. Mercifully, the orthopaedic repair has already been completed and I decide to close up myself, rather enjoying the opportunity to utilise my full range of skills, even calmly providing a few pointers to the wide-eyed house surgeon who stands across from me, silently watching on. The room actually seems peaceful again, with only the sound of the ventilator providing the rhythm to our task; the count is completed, and the femur ORIF case is wheeled from theatre.
The rest of the morning is a blur. I don't bother to try and sleep again, instead I check on the patient in recovery, before forcing myself to run up the stairs. I shower once more and shave, change into my street clothes, and make an inferior espresso in the consultants lounge. As the clock approaches six, I sit down to dictate my case notes while they are fresh in my mind, including a lot of detail that I suspect might be important when this malpractice event is inevitably looked into. Apropos of that very occurrence, I then phone Bernard's extension and leave him a crisply delivered message. Funding cuts and staff shortages aside, this incident was absolutely untenable and I don't mince my words when I express my disgust. I also enquire, quite curtly, how they are proceeding with the search for Ben Dixon's replacement, inferring that I do not know how much longer I can continue the way things are.
Fortunately, I have no procedures scheduled here this morning so, after rounds, I stop in at the greengrocers and purchase a banana for breakfast, before I hail a taxi to take me to Imperial, and my ten o'clock outpatient clinic. The day is cool and blustery but the sun is shining, low and blinding in the pale blue sky. As I stare dully out of the window, it just reaffirms that I meant what I implied in my message to Bernard: I cannot go on like this. What little energy I have seems to foment into anger and frustration, leaving me fatigued and bitter and almost in despair. Where my legs used to feel like coiled springs, now they are heavy, leaden pipes. My mind is almost numb yet I feel constantly and exhaustingly on edge. And, if I am honest, the yearning, the helpless longing, it is becoming almost unmanageable, despite all my attempts at denial. The door of that flat kept the world at bay, and all that matters in the privacy of it is Louisa. That throaty laugh, her fingers as they caress my skin, it always seems too much that I was ever allowed to place a hand on her, more incredible that she ever wanted to touch me in return. And I wonder, if I could just get home to her, if I could just ignore how unfavourably I compare to charismatic, leather-clad pop stars, scantily clad surf life-savers and fatuous nefarious malaperts, then I might be able to demonstrate to her how I really feel.
I think about her in that delicate floral print she showed me, so colourful and feminine and soft, and even I'm surprised by the effect the idea has on my blood pressure. I've never been more resolved to conclude a clinic promptly and the first thing I do when I arrive is check the schedule. Three follow up patients and a new referral to see; a simple, reasonably straightforward series of consultations, after which I will be free for the rest of the afternoon. Excellent, post treatment results for all three cases buoys me and I feel almost light-hearted as I organise a raft of testing for the last appointment of the day. I leave a message for Zalman that I'd like to meet with him on Monday, and I phone down to the receptionist to inform her that I am unavailable for the remainder of the day. As an afterthought, I clean my teeth again and quickly run a flannel across my face. A glance at my watch tells me I have almost the entire afternoon at my disposal, and the realisation energises me; I can fix this, if only she will give me the chance.
As I lock the door to my office behind me, I hear the telephone ring but, almost jubilantly, I ignore it; everyone can go to hell as far as I am concerned, whatever it is can surely wait. Everyone has had their pound of flesh, and in such a short time it has almost cost me everything. I hurl myself into the back of the first taxi that comes along, and announce the flat address clearly and crisply, and then it dawns on me I probably should have telephoned her, I should have checked that she was, as usual, at home. I feel myself deflate a little after that; all my plans, then a walk, and perhaps an early supper at one of the restaurants she's so partial to, might all be utterly in vain. But I must try and make it up to her, even if it's only to pre-prepare a meal or two for her if she's not there. It even crosses my mind that I could buy her flowers though I'm terrified to admit to my many shortcomings on the card.
And there is still a reasonable chance that Louisa will be home. I recall a few months previously, arriving home early, laden with reports, a backlog of reading that was starting to become unmanageable. She'd met me at the door, fresh from the shower, her hair tied loosely in a messy topknot, still damp around the nape of her neck, the moisture darkening the spiraling locks that fell around her face. She was wearing the tight Japanese robe that she favoured and, as she pressed against me in welcome, her mouth soft against mine, I found myself running my hands across her hips and buttocks appreciatively, her gently fragrant nakedness beneath the silky fabric instantly distracting. I had no idea what I'd done to deserve it, but I was never in a million years going to ever say no.
I feel hungry again now, remembering how our kiss intensified, and the way I seem to forget everything else other than how provocative her touch is. I wonder how she'd respond if it happened again. Would she slide her arms inside my suitcoat and fumble for my shirt buttons? Will she caress my abdomen and explore my chest with that exhilarating combination of her teeth and her tongue? And, if my reaction is apparently exactly what she wants, will I hear that deep, suggestive laugh as she propels me, unresisting, towards the sofa. I hear her voice in my head, low and demanding, instructing me to sit, as she straddles my lap; loosening her belt and exposing her body to me as the robe slips from her shoulders. My breath catches in my throat as I think about it, the way my hands went to her breasts, gazing at her in helpless disbelief.
There was something so highly charged about feeling her naked, astride me, while I was almost fully dressed. My heart thumped so hard it was about to hammer free of my chest. I'd relinquished my grip on her to tear off my coat, but she didn't seem to care about whether my torso was clad or not; the look she gave me was smouldering, her smile wicked as I felt her hands on my waistband. Feeling so utterly helpless had never seemed so arousing. She'd gasped as she positioned herself, gently shifting her weight as she momentarily buried her face my neck, muttering my name as some sort of desperately aching command. I can picture her now, her knees against my waist as she pushes herself upright, her eyes closed, searching for the rhythm that I knew would cause both of us to explode in some sort of exquisite paroxysm.
I reach over and attempt to wind down the window, grateful for the cool air against my face, desperately hoping I haven't left it too late to fix up this mess. Last night it seemed as if she couldn't bear to be in the same house as me; she'd run away and, as bloody usual, I'd had to leave before she'd came back. Closing my eyes, I grimace, knowing that if I have burned too many bridges, I have only myself to blame. How does someone like me possibly come to believe I might deserve someone like Louisa, the sort of woman who leaves you sitting, dumbstruck and incredulous, on the couch, legs like jelly and a brain consumed by a delicious post-coital fog? The sort of woman who has you gazing after her in disbelief, letting out a long, deep and disbelieving sigh of satisfaction, as you adjust your clothing and try and reclaim some sort of sense of decorum.
The taxi pulls into De Vere Gardens and I can barely wait for him to come to a standstill, tossing twenty quid at him I'm so desperately keen to alight. By the time I'm at the front door, I've already decided that, if I must, I'll tell her about my parents. I'll tell her of the disaster at Imperial, I'll tell her anything she wants to know, I'll even consider taking her to that appalling bloody concert if only there's a hope that she might still in some way love me. I hear the thumping bass of loud pop music, coming from up the stairs and, instead of being annoyed, I'm utterly elated. The only thing that prevents me from running as fast as I can is the idea of arriving at the door breathless, and sweating like a horse. I pause at the door, and reach for my keys, closing my eyes briefly to offer up a plea to the heavens.
"For god's sake Ellingham, whatever you do, don't muck this up."