It had taken longer to collect myself than I'd hoped. It was a highly unusual situation for me and I was totally at a loss. Most disconcertingly, while my body felt edgy and restless, my mind was assailed by a hopelessly incapacitating dullness and, all the time, I was miserably aware of Louisa's uncharacteristic silence and her growing discomfort. I knew that it was my fault. I knew that I must say something but I drove along with mounting despair, frustrated at my idiotic inability to find any words, or even a word, to tear through the suffocating cloak of silence that had descended upon us.

In the discipline of surgery, we practice, we imagine and we memorise until everything we do becomes second nature. Performing a Carotid endarterectomy becomes as automatic as breathing. But when it comes to moments like this one; new, terrifying and completely beyond anything I have ever experienced, I have no instinct, no practice to fall back on, and no natural inclination or native skill to carry me through. All I have is a gnawing fear that I will make a shambles of everything, a total and utter despair at my at my own reticence and, consequently, a menacing dread of my own inevitable, panic-stricken withdrawal.

So completely was I floundering, I'd even found myself contemplating longer, more circuitous routes to her home, just for the extra minutes of thinking time that it might buy me, until I realised that all the time in the world wasn't going to make one iota of difference to my oafish incompetence. It was a miracle I required, not a few extra traffic lights, and so I drove on despondently, repeatedly warning myself that this was my last chance. By the time we pulled into her street, I was desperate, choking on my own failure, and drowning in the despair of my own humiliating, silent ineptitude.

Ironically, it was a welcome distraction when the radio had gone on. I didn't even mind that it was some sort of dreadful, caterwauling monotone, accompanied by the most frivolous and inane commentary to which it has ever been my misfortune to listen. Because, as I pulled up across from her flat, the puerile nonsense in which she was seemingly absorbed, suddenly seemed a godsend, as Louisa sat, momentarily too lost in the music to immediately flee the car.

As I watched, her face transformed, becoming dreamy and reflective, and I realised that I'd seen that look before. Her movement became languid and I was transfixed as she pushed her fringe up from her sad, but still so beautiful eyes, as esoteric and unfathomable to me as the depths of some far off malachite ocean. Her lips moved silently with the lyrics and, as if I were mesmerised, I found myself drawn in to her world and, somewhere in the misty recesses of my desperate mind, the voice we are listening to seems to resonate within me, the lyrics echoing in my mind as clear as crystal.

"Good time for a change

See, the luck I've had

Can make a good man

Turn bad

So please please please

Let me, let me, let me

Let me get what I want

This time

Haven't had a dream in a long time

See, the life I've had

Can make a good man bad

So for once in my life

Let me get what I want

Lord knows, it would be the first time"

In the short time since our reintroduction, I have quickly realised that Louisa could have anyone she wanted; that she could choose from a plethora of charming, witty, good looking men who would always know just what to say and do, especially at times like this. And I know that she deserves so much better than my clumsy attentions, my anomic tendencies and my taciturn disposition. There's no man on earth who is more aware of his own extensive shortcomings and lack of appeal than I am at this very minute. But, as I'd listened to the words of the song, they'd exposed something resentful, hidden deeply within me. I'd suddenly wondered, angrily, if it would ever matter to anyone what I actually wanted, what I'd dreamed of; if I'd ever get that which I suddenly knew I so desperately needed. Battling with that need was hard enough but to think that I might be fighting for eternity was too debilitating to even contemplate.

Please let me get what I want this time.

How completely and totally apt. If anything had become blindingly obvious today it was that, physically, I wanted Louisa very badly indeed. But it was never, ever just that. Even if I couldn't always bring myself to respond appropriately, I still wanted her reassuring hand squeezes and her encouraging smiles. I wanted her feistiness and her spirited determination, and I wanted her joy. I wanted to hear what she thought about and what she wanted to do. I wanted her to challenge me, but most of all, I wanted so desperately for her to accept me.

I was terrifyingly aware that, if she got out of the car, I would lose all of that, along with her, forever. There would never be another chance to be with Louisa nor could I ever possibly meet anyone like her ever again. I just knew that as intrinsically as I knew to breathe. As I watched her remove her seatbelt, I felt a panic overtake me, the likes of such I have never ever experienced. Worse than anything a sadistic, cane-flexing deputy headmaster could provoke and far greater than the combination of every cruel, bullying schoolboy I had ever encountered could inspire; even surpassing the vomit-inducing dread triggered by my father's incandescent rage.

When she glanced at me and offered a cool, ambivalent farewell, I felt my composure crumble, and my desperation not let her get out of the car reached its zenith. Already I could hear the internal jeering starting and it caused an explosion of something inside me that I can't describe. There was the tiniest alteration in her expression, a softening, a minute display of concern and that was enough to galvanise me. Somewhere, somehow, a part of me decided to fight for Louisa and, as if I am some sort of oversized, feeble marionette, operated by a desperate unseen force, I reached for her hand and, almost disbelievingly, she yielded it to me and I felt the bewitching softness of her skin against my mouth.

I must have pressed my index finger against that very spot, feeling calmly for the radial pulse of literally hundreds of people over the years, and I've never given it a second thought. But the mere contact with the inside of Louisa's wrist seemed just so incredibly intimate and, when she didn't pull away, I was filled with an almost delirious relief. I wrapped my fingers around hers and there I remained, eyelids heavy, feeling utterly depleted, until my shallow breathing mercifully slowed.

"Are you okay?" I heard her say after a moment and the hesitancy in her voice was enough to finally reapply some steel to my backbone. I sat up straight and loosened my grip on her hand, allowing our gently linked fingers to rest on the centre console between us.

She was gazing steadily at me, a gently enquiring look on her face, and I heard myself clearing my throat in one last desperate effort to compose myself.

"I'm fine." I replied, knowing that it's one of the few lies I ever allow myself to tell. "I'm just...umm...tired. It's been...it's been a busy week and I..ummm...I...well...let's just say that this afternoon took me...a little by surprise."

She fixed me with her speculative stare but she didn't push me any further. I really was feeling completely exhausted and I found myself stifling a yawn and blinking against the sunlight.

"Bad surprise or good surprise?" She said and I detected a mischievous note in her voice.

I glanced up at her, feeling suddenly bashful.

"Do you really need to ask?" I replied quietly and I was rewarded with her shy, hopeful smile.

She hesitated momentarily and then she leaned over and kissed me softly on the cheek, and the relief I felt was inordinate. I recall her gazing at me thoughtfully as she pulled away, and I could see her lips twitching as if she wanted to say something. Louisa has many virtues, but a poker face is not one of them.

"Will you call me?" She says cautiously and her eyes don't leave mine for a second.

I stared back at her, wondering if she realises how much easier this will be for me if she just tells me what her expectations are.

"Of course," I reply carefully. "If that's what you want."

"Yes, Martin," she says, giving a tiny encouraging nod and smiling at me. "That is what I want."

Breathlessly, I'd watched her until she was safely in the house, noticing the awkward smile and the brief, jerky wave of her hand as she slipped through the door. A group of people had emerged from the pub on the corner and, as they filed past as some sort of raucous, high spirited, amorphous blob, they had obscured my final sight of her. By the time they had gone, so had Louisa, so I'd thrown the car firmly into gear and accelerated off up the road, my only thought now being a merciful retreat to the solace of my flat. I didn't give myself much hope of understanding exactly what had happened during the course of the afternoon, but I needed to at least try.

As I stood under the shower, less than half an hour later, experiencing the particular soothing glow that comes after adjusting the temperature up as high as one can stand, it was hugely alleviating to feel the cleansing pulse of the cascading water wash over my tense and agitated body. It felt as if the insecurity and disorientation of the day was swept away and all I am left with is the provocative memory of how it felt to capitulate, albeit briefly, to physical longing. Against my better judgement, I allow my mind a moment to wander and, as I recall so exquisitely how it felt, I am aware of a flash; of something combusting in my chest, an ephemeral moment of breathlessness, a slight sensation of vertigo, and it provokes an involuntarily, almost imperceptible shiver to ripple expectantly down my torso.

Is this a sort of excitement? lf so, I can't recall the last time I ever experienced anything even close to this, certainly never as an adult and, only rarely, as a very young boy. It's a strange sensation, more invigorating than debilitating, and it stays with me as I devote my evening to tedious tasks; paying bills and organising study notes, filing paperwork and making lists. I eat early, a light supper even though I don't feel hungry and, as I dry my dishes, out of nowhere, I realise that Louisa did not get the ice cream that she so craved and, though I know it was in her best interests, I hope it doesn't add to the litany of disappointments she had to suffer today.

It's still early but already, beyond my triple glazed windows and closed curtains, I am aware of the increasingly pervasive volume of yet another hectic London Saturday night. It's a warm evening and I'm thankful that I'm not on call. Balmy evenings always seem to increase the idiot factor of the general populace exponentially and there is no doubt that A&E will be run off its collective feet tonight. My eyelids are heavy and, although I pick up a medical journal with the best of intentions, it is not long before I am flagging, and longing for the physical and emotional relief of deep, uninterrupted sleep.

I have a routine and I like to keep to it. I secure the flat, fetch a glass of water and switch off the lights, dropping my open but unread Lancet back onto my desk as I pass my office. I place the water on the square, glass coaster atop my bedside table, and I fold back my bedding. Then, once my necessary ablutions are performed, I slip gratefully between the sheets and switch off the bedside lamp. Usually, I immediately assume my preferred sleeping position, on my back, hands clasped on my chest, but tonight I have this strange need to pandiculate, throwing out my limbs and wallowing in the enveloping comfort of the bed linen. I press my head gratefully back into the yielding softness of my preferred pillow and yet another yawn overtakes me.

Bent over in theatre for what can be many hours, one soon notices the benefits of correct stretching on tightening neck and shoulder muscles, but this is different. Immediately, as my parasympathetic nervous system reacts, I feel myself begin to relax and, not for the first time today, I feel the the soothing effect of an endorphin response. I have already tightly compartmentalised the events of the day but, as I lie here, I wonder if I dare allow a tiny sliver of light to fall upon that moment in the park. Warning bells immediately begin to ring and, seemingly, permission is denied, as I am reminded, rather insistently, that pent up emotions are usually confined for a very good reason and it wisest to leave them where they are; secure and well controlled. I certainly haven't spent years perfecting this particular skill only to abandon it when it is most required that is for certain.

So, as I wait for sleep to claim me, I mentally work through a useful checklist on my car's performance today. I wonder if the petrol consumption was in line with what one should expect from more open road performance. Recalling the dust accumulating on the surfaces of the dashboard, I also make a note to ensure that it is valeted at the next service, which also might be an opportune time to speak to the mechanic about a slightly noticeable new hum amongst the road noise. Yawning widely, I presume that it's the new tyres but it won't hurt to check as I suspect that I would find the frequency of the sound rather irritating if I were to venture further than, say, Richmond Park.

Surprisingly quickly, my mind submits to a relieving foggy nothingness, and all conscious thought departs. Appearing through the mist, just as sleep takes over, Louisa appears again; quietly materialising beside me as I slide into the torpid tranquility of early slumber, and the last thing I am aware of is how immeasurably soothed I am by the sensation of warmth her imaginary closeness provides.

Incredibly, it is already light when I awake on Sunday morning and I glance at my watch, somewhat surprised to realise that I have slept for over eight hours. I feel invigorated and replenished in both mind and body and, as I thoughtfully rub my hand across the emergent stubble beneath my jaw, the genesis of an idea has already begun to form in my mind. I feel almost buoyant as I make my way around my flat and, as I sip my coffee by the open window, and stare speculatively out at the grey London morning, I can't help but feel a pleasing, incremental increase in confidence.

I have honestly no idea about the protocols of attachment. Louisa expressly asked me to call her and I now know that to be a requirement but I am ignorant as to the acceptable parameters of timing, or even if there is anything specific she wants me to say. I do understand the expectation that I need to arrange another outing and I'm hoping that the flash of inspiration I received upon awakening will turn out to be an appropriate and well-received excursion for us both. So, while I know myself to be complete rubbish when it comes to romantic gestures, I am an effective organiser and, I hope that these skills will somehow compensate when it comes to my overall cluelessness about societal norms and, more importantly, the emotional needs of women.

After breakfast, when I'm showered and suitably dressed, I pull out my diary and begin to make some notes in preparation. I will need to behave in a manner that is quite foreign to me and which will no doubt render me highly uncomfortable but it is a measure of the regard I feel for Louisa that I am even prepared to contemplate what will be required. My thoughts go around in circles for a while until I remember the gallery opening invitation that prompted my purchase of the large abstract seascape that sits above the fireplace in my living room. I am sure that I will have kept everything from that memorable evening and, sure enough, a rummage through the insurance section of my filing cabinet produces the folder I am looking for.

It had begun with the legacy I inherited from my grandfather several years ago, and my determination to invest the proceeds wisely and, more especially, without input from my parents. I had felt an immediate connection to the work I chose for such a prominent position in my new flat. I'd found the simple act of contemplating it in the various intensity of light through the day and night, to be both intriguing and relaxing. So my interest in modern art was piqued, and it was only been a few short months ago that I had met a patient; prominent in the London Fine Arts scene with a youngish face and the worst case of varicose veins I have ever laid eyes on. As if that weren't bad enough for the unfortunate woman the accompanying Statis dermatitis was eye-wateringly unpleasant and I can't imagine the relief of the dermatologist when he was able to refer her across to Vascular. The case landed in my lap and I was pleased to perform a number of surgeries that were able to resolve her significant discomfort. One thing had then lead to another and I had received an invitation to a gallery exhibition where the now apparently rejuvenated woman had delivered a short introduction to the artist and his works. Unfortunately, she had then attached herself to me like a veritable limpet and even I could sense that there was more to her interest than just mere gratitude.

I'd been forced to escape when her champagne consumption and inappropriate touching started to alarm me greatly but not before I had managed a brief conversation with a pleasantly mannered, older gentleman who had stood alongside me before a large canvas and commented rather archly on what he termed the work's windy profligacy. While I had little idea of what he meant, I was grateful for any sort of protective construct I could find and so I allowed myself a conversation with him, actually finding his thought-provoking treatise on exaggeration vs. restraint quite interesting, even if barely a word of it had subsequently remained in my head. Later, when I was staring around me rather wildly, as I noticed the woman with the extreme penchant for fondling her surgeon approaching us, I observed with a mixture of relief and disconcertion as she slipped her arm through his and introduced him to me as her husband. Good lord, I thought at the time, there must be thirty years between them, and I tried desperately not to stare at them both incredulously as he pressed his business card into my hand. His eyes had lit up when his cuckolding predator of a wife had introduced me as her surgeon and his vehement thanks had made me feel rather uncomfortable, so much so that I had subsequently fled the function and, thus, drawn the line under yet another of my failed attempts at a social life.

And now, I had rediscovered his card and I was about to call in a favour, not something I had ever really done before, nor needed to, and especially not when it involved harnessing the gratitude of a patient's relived family. But needs must, and this feels important. I havel the same sense of determination and cautious enthusiasm that I experience when I'm scrubbing for a particularly challenging procedure. As it was Sunday morning, I doubted he would be at his desk but I hoped to leave a message regardless, in order to set the wheels in motion for what may possibly prove to be too difficult a proposition. There was, however, only one way to find out. I picked up the phone and dialled.