Paul, hurrying through Ward 2 in search of a patient called Mrs Dimoglou, was feeling a little less than crisp. He’d meant, on his very first morning as a house officer, to arrive on the ward at half past eight and thus give himself a leisurely half hour for orientation before the start of the round; instead, after hitting the snooze button at least four times, waking with a shout of panic and getting dressed in forty-five seconds, he had turned up, panting slightly, at ten to nine. At which point Sister Blake, visibly annoyed, had issued him with an operation consent form for the first patient on the morning list and had told him to go and get it signed, now.
What was worrying was that he had fully intended to have a quiet night in. He had said to Crispin, calmly and firmly, ‘I am not going out for a drink,’ and Crispin had replied, ‘Christ, Pud, don’t be such a pathetic dildo,’ and ten minutes later he’d somehow found himself in the snug of the Ball and Crown with a glass in his hand. And when he’d arrived back at the flat, six pints to the bad and ravenous, there’d been nothing to eat apart from the contents of a cupboard labelled ‘HANDS OFF! EVERYTHING IN HERE BELONGS TO ARMAND’. Paul had wrestled with his conscience and won, and had turned instead to the only other edible object in the entire kitchen: the Jurassic-era hamburger at the back of the freezer. The strange thing was that even as he had chipped away at the ice with a butter knife, even as he had watched his meal dwindle under the grill to the diameter and thickness of a beer mat, even as he had raised the flabby grey disc to his mouth, he had known to the core of his being that it was a bad idea.
It was a familiar sensation, this occasional compulsion that impelled him not only to start doing the wrong thing but to carry it through with masochistic thoroughness. It was the same impulse that had persuaded him, in the third year, to scale the rusting access ladder that led onto the roof of the medical school. Everybody else had thought it was a great idea, but only Paul had actually got to the top, placed a wavering foot on the parapet and then found himself dropping twenty feet into a flower bed, thereby breaking only his leg and not, as the Dean had acidly put it, his miserable spine. He had spent six weeks in hospital, failed his exams and had to repeat the entire year; nevertheless, he had still heard the incident referred to as the funniest thing that had ever happened at Birmingham Medical School. By Crispin, in fact, now he came to think of it.
He found Mrs Dimoglou standing between her bed and the window, slowly taking family photos out of a plastic bag and arranging them on the top of her locker. She looked to be, at a rough first estimate, about three hundred years old – a tiny woman, her face meshed with wrinkles, a white plait hanging halfway down the back of her quilted dressing gown.
‘Hello, I’m Doctor Gooding,’ said Paul, smiling and nodding and speaking rather loudly in the way that he found hard to avoid when talking to extremely old people. ‘I’ve come to consent you for your operation this morning – to make sure you know what it’s all about and what’s going to happen and everything.’
‘Thank you,’ she said placidly, angling a photo frame so that it could be seen from the bed, ‘you’re very kind. You know, when I first had operations in this country, no one ever tells me nothing about them. I come in, they cut me open.
And then when I come in three years ago for my knee operation there’s a lovely lady doctor call Ann and she draws a picture and tells me so clear about what they’re going to do, and tells me to ask anything I want, and when I wake up and there’s no kneecap on the middle of my leg I don’t get a sudden shock. And now you’re coming to explain like that, are you?’
‘Yes.’
‘You’re a good boy.’
‘Thank you.’
‘Because when I see Mr Gorman the surgeon, it’s always too quick to ask things I want to ask. What is the “P”?’ She pointed to his mutilated name badge.
‘Paul.’
‘Paul is one of my favourite names. My cousin was called Paul, what was in the navy during the war. We used to call him Paulie. Does your mother call you Paulie?’
‘No. No, she doesn’t. OK, so shall we have a –’
‘This picture,’ she said, gently rubbing one of the frames with her thumb, ‘this is my youngest son, Trevor, he was born in England so we give him an English name but for a joke my husband always call him Trevios, like a Greek name.’ She smiled at the middle-aged multi-chinned porker in the photo and then looked at Paul. ‘You look a little tiny bit like my Trevios,’ she added, encouragingly.
‘Oh,’ said Paul. ‘Thank you.’
‘On Wednesday it’s his birthday. Today I was going to make him a special honey cake what has to stand for two days but then the hospital ring me and say to come in for the operation, so it’s a shame he won’t get no special cake, isn’t it?’
‘Yes,’ said Paul, holding up the consent form and waggling it slightly as a reminder of what they were supposed to be talking about. ‘So, if you’ve had operations before, then –’
‘Twenty-two operations,’ she said. ‘Not counting having my babies. Twenty-two, and I remember every operation like it’s yesterday. The biggest is in 1968, I have my heart valve replace because I keep falling in a faint and my own doctor hears a noise in my chest and sent me to hospital and the surgeon, he’s call Mr Crabbe, come in and make me take off my top in front of six doctors, writes a big mark on my chest with a pen and say, “See you tomorrow, Mrs Dimoglou,” and I only knew what happened inside my heart when a nurse tells me afterwards. I have a scar from here to here,’ she added, drawing a sweeping crescent across her breast. ‘And two years after that there is a gland in my neck that keeps working too much and a different surgeon, Mr Slater, he say, “Don’t you worry, Mrs Dimo–”’
‘Sorry,’ said Paul, ‘sorry to interrupt.’ Out of the corner of his eye he could see Crispin heading for the ward office, the designated start of the round. ‘It’s just that I need to get this signed before the ward round starts.’
‘Of course, of course,’ said Mrs Dimoglou, lowering herself onto the edge of the bed. ‘You are very busy – it’s very important, your job.’ She lifted a large green handbag onto her lap and took a pen from the inside pocket. ‘So, you explain to me and then I sign.’ She looked at him expectantly; a few yards behind her Armand hurried into view, caught Paul’s eye and tapped his watch.
‘OK,’ said Paul. Precision, he thought – precision, clarity, speed. ‘OK. Well, what you’re having done today is an elective cholecystectomy, which means a non-urgent operation to take your gall bladder out because it’s got stones in and it keeps getting inflamed, and it’s safer to have the operation than to keep getting the inflammation.’
‘Paulie?’
‘Yes?’
‘You speak a little bit fast.’
‘Sorry. OK, what you’re having done today is …’ He repeated the explanation rather more slowly and tried not to think about the imminent arrival of Mr Gorman.
‘And I don’t need my gall bladder?’ asked Mrs Dimoglou, tentatively.
‘No.’
‘Why not?’
‘Because the gall bladder’s just a storage organ for bile, which helps you digest food – it’s just a bag, really.’ Her expression remained doubtful. ‘Like a handbag,’ he added, inspired by the one on Mrs Dimoglou’s lap. ‘Which is why it can be cut out, you see. Because although it’s useful, it’s not essential.’
‘No, it is essential,’ she corrected, stroking the bag protectively. ‘If someone cut out my handbag, I never find another as good.’
‘But what I meant was, you don’t really need it, do you?’
‘Yes I do.’
‘No, I mean, what you need are the things that are in it, not the bag itself.’
‘I need this bag,’ she said, with a tiny edge of steel in her voice.
‘Yes, but what I meant–’ Paul could see one end of the notes trolley nosing out of the office ‘– what I meant was that if, say, you needed your wallet in a shop –’
‘Purse, I have a purse.’
‘– OK. If you needed your purse in a shop, it wouldn’t make any difference if you had a handbag or not, because you could take your wallet –’
‘Purse.’
‘– I mean purse – you could take your purse into town whether you had a handbag or whether you didn’t have a handbag. It wouldn’t make any difference.’
She took a moment to absorb this. ‘What about my house keys?’
‘It’s the same thing. Look, if you think of your gall bladder as the handbag, and your purse – or your keys – as the bile, and the … the …’ He stopped; the whole simile, he realized, was sliding inexorably out of control. What, for instance, could possibly represent Mrs Dimoglou’s liver? Her house? Her sideboard? Her purse manufacturer? She was still looking at him, mouth puckered with faint puzzlement. ‘Let’s start again,’ he said. ‘What you’re having is an elective cholecystectomy. “Elective” means it’s not an emergency, so it can be done at a convenient time rather than –’
‘A convenient time?’ She looked suddenly hopeful.
‘Yes. But –’
‘Because today was not really convenient for me, I want to be at home to make the honey cake but they phone me yesterday to say someone else can’t come in for an operation and can I come instead.’
‘Well, by “convenient” what I really meant was –’
‘Ready, Dr Gooding?’
Mr Gorman, Crispin, Armand and a cluster of medical students were standing at the end of the row of beds, Mr Gorman wearing an expression of dangerous politeness. ‘Nearly,’ said Paul, realizing immediately that this was not an answer that would win him many points.
‘Nearly,’ repeated the consultant, as if the word were unfamiliar to him. ‘Well, perhaps in future we can all remember that the ward round commences at precisely nine a.m. rather than nearly five minutes later. And perhaps,’ he continued, apparently gratified by the chorus of student titters, ‘you’d care to join us when you’ve absolutely finished?’
‘Yes,’ said Paul, stolidly.
‘He’s very, very good,’ said Mrs Dimoglou, patting Paul’s hand as the group started to move away. ‘He’s explaining things to me. About my handbag.’
He’s explaining things to me about my handbag. Paul watched Mr Gorman lead his little audience up the ward, and knew that each of them would have marked, learned and inwardly digested that particular phrase, and that it would be resurrected on every possible occasion for the rest of his time at Shadley Oak unless the memory of it was superseded by something even more embarrassing. He sighed.
‘You go,’ said Mrs Dimoglou, giving his hand another pat. ‘Don’t be late.’
‘But I need to finish talking to you.’
‘You go. Look, I write my name down now –’ she carefully appended her signature to the consent form ‘– and then when it’s convenient it’s all ready. Isn’t it?’
‘Yes,’ he said uncertainly.
‘So, go then.’
The others had already gathered round a bed at the end of the ward. ‘Ah, a belated welcome to our fashion advisor,’ said Mr Gorman as Paul eased into the back row, ‘we were just discussing the differential diagnosis of right iliac fossa pain in a young woman. Would you care to name five potential causes that might result, rightly or wrongly, in surgical intervention?’
‘Er …’ Paul looked at the occupant of the bed, a comatose teenager on an antibiotic drip. ‘Appendicitis, mesenteric adenitis, endometriosis, ruptured ovarian cyst, ectopic pregnancy.’ The teenager’s eyes opened very suddenly. ‘Which this isn’t,’ added Paul, hopefully.
Mr Gorman looked faintly disappointed. ‘All right,’ he said and Paul wanted to punch the air and roar with victory; all that revision had paid off after all. He waited, with something approaching confidence, for the next question.
‘So could you also tell me,’ said Mr Gorman, meditatively, ‘could you also tell me … what that is?’ He pointed suddenly towards the window, and Paul turned and gazed in the direction of the finger and saw nothing remotely medical, only sky and a church spire.
‘What?’ he asked, stupidly.
‘No,’ said Mr Gorman, ‘I’m afraid that’s not quite the answer I was looking for. Dr Roux? Do you know?’
Armand looked at the view and then back at Mr Gorman, his mouth slightly open.
‘Dr Finnerty?’
‘It’s the spire of Shadley Oak Abbey, the finest example of English perpendicular architecture in the West Midlands,’ said Crispin, warmly, ‘begun in the 1380s but not finished until 1465.’
Mr Gorman nodded. ‘Extensively damaged in the Civil War, of course, the dates of which were …?’ He looked at Armand and Paul again and absorbed the silence for a moment. ‘Well, I’m sure you’ll know next time,’ he said, genially.
‘I’m Canadian,’ said Armand as they followed the notes trolley towards the ward office at the end of the round. ‘I … I simply can’t be expected to know these things.’ He looked shocked, as if some international law had been violated.
‘I had a teacher like him once,’ said Paul. ‘He was called Mr Lever and he always had to find something you couldn’t answer, in fact one day he asked a question about –’
‘Have you two decided who’s on call?’ Crispin was waiting for them in the door of the office. He was different this morning; not just sober but somehow detached. It was as if he’d taken a pace back or grown a couple of inches in the night, so that the angle of his gaze had changed subtly; he no longer felt like a contemporary, and the effect was dislocating.
‘I’m taking the bleep,’ said Paul. ‘We tossed for it yesterday. I’ve told switchboard.’ His pulse had danced a little samba when the coin landed tails up.
‘In that case you’d better get on with your routine admissions before the GPs start bleating on the phone.’ He held up a sheaf of folders. ‘Three hernias each and a couple of circumcisions. Take your prick.’
‘Listen Crispin,’ said Paul, accepting a random handful, ‘I think I might accidentally have confused Mrs Dimog–’ There was a sudden burst of electronic pips from Paul’s chest pocket and he clutched it self-consciously.
‘There she blows,’ said Crispin. ‘Typical Monday. Phone zero and give your bleep number and remember we’re acute surgical. No time wasters. That means virtually any admission from the Ferris Road surgery.’
‘Right, I–’
‘And always check we’ve got a bed before you start sending out invites.’
‘OK, so –’
‘And do up your coat, you look like a butcher’s assistant. Though that’s what you are, I suppose. Ha.’ The pips began again. ‘You’d better answer it, hadn’t you?’
Fumbling with a coat button, Paul moved towards the office and as he did so the noise stopped momentarily, and then resumed as a deafening, continuous warble, like a pelican crossing at volume eleven. He spun around. ‘Does that mean a cardiac –’
Crispin shushed him violently; under the noise a disembodied voice said something with the word ‘arrest’ and the word ‘unit’ in it.
‘Go,’ said Crispin. ‘I’ll deal with the GP.’
Paul ran a few paces up the corridor, and then turned and ran back again. ‘Where did it say?’
‘The Pickering Unit.’
‘Where’s that?’
‘Downstairs, out the back, next to Obstetrics, get going, get going.’
Two visitors pressed themselves against the wall of the corridor as Paul tore past, and he caught their look of alarm; all over the hospital, he realized, the scene was being repeated as on-call staff hurled themselves towards the Pickering Unit and he felt a rush of exhilaration, an awareness that he was living the cliché of the TV doctor, sprinting to save a life. For a moment he wished his mum could see him.
Spurning the bank of lifts he pushed straight through the swing doors to the stairwell and galloped down the four flights, biros rattling in his pockets. He could feel his shirt pulling free from his trousers and he hastily retucked it before bursting into the foyer. The seating area was half empty, but a long queue wound from the reception desk, and a row of heads watched as he jogged past, scanning for the rear entrance. There didn’t seem to be one, specifically, but he spotted a fire exit, and wrenched it open and emerged into a dank passage between two prefabs that led in turn to a yard full of giant bins; he squeezed between two of them, skirted a hillock of green plastic bags, tore past the back of the mortuary and found himself, unexpectedly, at the edge of the staff car park, only yards from his own Peugeot. He looked around, disorientated; there appeared to be no logic to the layout of the hospital – the components were scattered as if someone had upended a bucket of buildings and cemented them where they fell. The Pickering Unit might be the nearby high-tech structure with the glass porch, but then again it might be that distant thing that looked like a Nissen hut or even the yellow plastic igloo with the laundry lorry outside.
In any case it seemed imperative to keep running and he maintained a sort of sideways canter as he looked around for help. A bosomy woman in jeans was walking up the internal road towards him and he shouted a query.
‘It’s my first day,’ she said. ‘Sorry. Why don’t you –’
‘It’s OK, I’ve just seen something …’ and he was already past her, accelerating towards the green sign revealed by the departure of the laundry lorry, straining as he did so to spot the vital three words. He picked them out while still yards away and executed a teetering ninety-degree turn in order to follow the new direction of the arrow; the Nissen hut, the Pickering Unit had to be the Nissen hut. He stretched his stride and swallowed a mouthful of vile-tasting saliva. It was a long time since he’d run this far and this fast and from all over his body little protests were being raised – random twangs in his muscles, sudden sharp pains in his joints, an uneasy slopping of his viscera.
He was within ten yards of the entrance when the door of the Pickering Unit opened and a doctor came out, immediately followed by another. Paul flailed to a halt just in front of them.
‘Crash call?’ he managed to ask, and then had to lean forward with his hands on his knees.
‘Balls-up,’ said one of them, a gingery girl with glasses. ‘A man with dementia who was supposed to be Do Not Resuscitate but no one looked at his notes till we’d been pounding away at his chest for five minutes, and he died anyway. All a bit depressing, really.’
‘Did you get lost?’ asked the other, brightly. She was a small Chinese woman with a coat that came almost to her ankles. He nodded and she broke into delighted giggles. ‘He got lost!’
‘So are you all right?’ asked the ginger girl.
Paul nodded again, tried to smile and made do with an insouciant wave.
‘See you later then.’ They ambled away across a stretch of grass, back towards the Eddery Building, and Paul dropped his head and got on with some serious breathing. What was beginning to worry him even more than his general level of fitness was the growing awareness that yesterday’s hamburger was hanging around, still very much … undigested.
After a while he straightened up and began to follow his colleagues across the balding lawn, maintaining a careful, even, elderly pace. Twenty yards ahead the two other doctors entered the Eddery Building, and as they did so Paul’s bleep sounded again with the imperious trill that signalled yet another cardiac arrest, and a tinny voice summoned him to Ward 2, his own ward. Running was now impossible, but he began to glide a little faster, like someone doing an impression of a cross-country skier. He swung onto the path, overtook a man on crutches and pushed aside the flabby polythene doors to the foyer, and it was then, as he inhaled the mingled aroma of Jeyes fluid and boiled vegetables, that his stomach gave a rolling heave and a wave of nausea reared up his throat and lapped at the base of his tongue. He halted just beside the queue for reception and stood very, very still. He could feel a rime of sweat on his forehead and his face tautened with concentration, as if sheer will could hold back the tide. People in the queue began to look at him. He stared hard at a spot on the far wall.
‘Are you ill, love?’ asked a woman, placing a gentle hand on his arm.
‘No,’ he said, through stiffened lips. ‘Just need a …’ He tried to look around, and found the movement challenging. ‘Is there a toilet near here?’
‘He wants a toilet,’ said someone in the queue.
‘There’s one by the shop.’
‘It’s just on the other side of the desk, by the seats.’
‘Shall I show you?’ asked the woman.
‘No I…’ Before she could actually take his hand and lead him there he started walking very slowly, keeping his torso as level as possible, moving his legs only from the knee downwards.
‘Wrong way,’ said someone. ‘It’s more to your left.’
He shifted direction gradually, like a dinghy heeling to the wind.
‘Left,’ called someone, with some urgency. ‘More to your left.’ Paul raised his eyes from the point on the floor on which they’d been fixed and saw that he was heading for the ladies. He adjusted his angle of approach.
‘That’s the way.’
‘He’s got it now.’
‘In you go.’
As the door swung to, he just caught a little burst of applause.
He wasn’t actually sick but it was fifteen minutes before the nausea subsided – fifteen minutes of sitting in a locked cubicle with his eyes closed and his head resting on the soft cushion of the toilet roll while in his pocket the bleep chirruped monotonously and in his mind the scene on Ward 2 played to its tragic conclusion. (‘Damn. She’s gone. We could have saved her with just one more pair of hands.’) Though there were always too many doctors at an arrest, he reminded himself, too many thrill-seekers, getting in the nurses’ way and clashing hips round the bed. He dried his forehead with a piece of toilet paper, checked his pulse and when the bleep called him for the tenth time he was ready; he rose gingerly and, relieved to feel no more than fragile, left the cubicle.
He tried to be diffident in his jumping of the reception queue; he apologized and said ‘excuse me’ and held out the bleep like a talisman, but the old man at the front with the bizarrely trendy flat-top haircut and a face like a clenched fist was having none of it. He half rose from his wheelchair and spread his arms along the desk, claiming the entire expanse.
‘I’ve been waiting ten minutes. Ten minutes.’ His voice was a half-vocalized roar, as if there was still plenty of volume held in reserve.
‘I just need to use the phone,’ said Paul.
‘No, no, you’ll just have to get in line.’
‘Dad …’ said the man behind him, wearily.
The receptionist, a small, pale youth, wordlessly passed the phone to Paul.
‘Oh, that’s right,’ said Fistface, ‘let him jump the queue – I’ll just lie down here and die on the floor.’
‘Dad, he’s a doctor …’
‘Hello?’ said Paul when switchboard answered. ‘Dr Gooding.’
‘Oh there you are,’ said an irritated voice. ‘I thought you’d run away. Let’s see …’ There was a rustle of paper. ‘The first time I bleeped you was to say that the arrest call on Ward 2 was a false alarm. The next three times were admissions, which I ended up telling that French doctor about, and the last five were Ward 2 wanting to know where the bloody hell you are. So call them on 6868 and tell them where the bloody hell you are.’
Paul dialled. It was engaged.
‘Of course, I’m here against my will,’ said the old man, leaning further across the desk. ‘The GP’s arranged these tests behind my back.’
‘I’m just reading your letter, Mr Riceman,’ said the receptionist in a monotone.
‘You needn’t, because I can tell you what’s in it – he says he doesn’t like my blood pressure.’
‘Dad, just let him read the letter.’
‘My GP thinks I shouldn’t be working fifty-five-hour weeks.’
‘Dad …’
‘And my son thinks so too but then he would, wouldn’t he?’
‘Dad, for God’s …’
Paul redialled with the same result; it would be quicker, he realized, just to return to the ward.
‘And if either of them thinks I’m going to stay in when I’ve got an entire central-heating system to install by a week Monday, then …’
The doors on the lift were just closing as Paul approached, and he hurried forward and hit the button. For five seconds or so nothing happened, and then with a clunk they reopened, revealing a row of irritated faces. ‘Sorry,’ he said, easing his way between the passengers. He pressed ‘Floor 4’, the only number not already illuminated, and a series of sighs rustled round the interior. Another long pause ensued. Paul stared at the wall and listened to the buzz of voices drifting round the corner from reception; as the doors at last began to close one voice, louder than the rest, became detached from the background rumble.
‘I’m not staying in. I’ve got a sink to collect. Two sinks, and one of them’s a reconditioned –’
Paul just caught a glimpse of the wheelchair before the doors slid together. He saw the whole of it five seconds later when they reopened. There was a collective groan, and then a shuffling rearrangement to allow room for the chair.
‘Sorry … sorry,’ said the son, blushing miserably as he adjusted the brakes. He was middle-aged, shoulders drooping like a bent coat hanger. Mr Riceman looked around irritably.
‘Why aren’t we moving? “Floor 2”, someone press “Floor 2”.’
Paul looked at his watch and wondered if he could have made it up the stairs by now. The doors closed for the third time, and with a little preliminary shudder the lift suddenly descended. There was a chorus of ‘oh for Christ’s sake’ and Paul placed a hand on his stomach; the unexpected direction had been bad for it.
‘We’re going down,’ said Mr Riceman, outraged. ‘Why are we going down? What’s down here?’
His last question was answered when the doors opened onto a dim and empty corridor, heavy with heat, ringing with the unmistakable din of the kitchens; as the occupants shifted impatiently a little electric car trundled by, driven by a man wearing a white hairnet and towing a train of metal trolleys, each stacked with plates. Accompanying the train was a warm blanket of air, laden with breakfast smells: bacon fat and kippers and tinned tomatoes and fried bread and scrambled eggs and kippers and baked beans and overcooked sausages and kippers. It drifted into the lift and curled chummily around the occupants, and as the doors closed Paul’s stomach finally and irrevocably rebelled.
It was Mr Riceman who, when the doors opened at ground level, headed the stampede into the foyer, fleeing for the exit while his son, still pushing the chair, pleaded behind him.
‘Dad, come back–’
‘No.’ There was a certain triumph in his tone.
‘Dad, the GP said that your blood pressure was –’
‘NO!’ The roar, at full volume, snapped all heads towards him. ‘I DID NOT COME HERE TO BE VOMITED ON BY A DOCTOR.’ Paul, cringing in the horrible interior, pressed the ‘Call’ button and wished for instant death.
Back in the quiet flat he dozed for an hour or so, and then lay staring at the rectangle of clear blue sky visible between the half-open curtains. He felt limp, toneless, as if someone had scooped out his intestines and filled the cavity with damp kapok. He couldn’t imagine any circumstance in which he would ever want to eat again.
‘I shall not prescribe you anything,’ Mr Gorman had said after being summoned to the scene, ‘because that would be shutting the stable door after the horse has caused extensive decorative damage to the entire area. Dr Roux?’
‘Yes, Mr Gorman?’
‘Which famous pop record of the 1960s does Paul’s face currently remind us of?’
‘Excuse me? I –’
‘Dr Finnerty?’
‘“A Whiter Shade of Pale”.’
‘Very good, Dr Finnerty. And now, Paul, just before you go away and lie down, perhaps you could explain precisely what it was that you said to the elective cholecystectomy patient that caused her to get dressed, inform reception that she would return on a more convenient date and leave the hospital, thus missing her operation …’
A tiny plane dawdled across the cloudless blue, followed by a herring gull, followed, after a minute or two, by a cormorant. Paul had heard that, geographically, Shadley Oak was at the dead centre of England, equidistant from both the Bristol Channel and the North Sea, but it seemed that no one had told the birds and a second cormorant trailed the first. Sticks with wings, thought Paul; a photo taken of a cormorant in midflight barely gave a clue as to which direction it was travelling in – only on closer examination could you spot the slightly greater thickness at the head end. This was the type of information he had learned to keep to himself. No one was interested in birds – he wasn’t so very interested in them himself any longer, but a country upbringing of supreme and solitary dullness had left him with a bedrock of ornithological wisdom. He knew about birds the way he knew about types of biscuit or the cast of Neighbours: he didn’t have to delve for the knowledge, it was just there. Nothing since had stuck as firmly.
The only noise in the bedroom was the tick of the alarm clock, and he rolled his head and looked at the dial. Half past eleven; the ward round would long be over and Armand would be clerking the routine admissions by now, struggling to finish them single-handed before the emergencies started coming in.
In daydreams Paul had pictured a different sort of first day (‘Well done, Dr Gooding, I’ve never heard of a house officer correctly diagnosing a phaeochromocytoma before.’) but he was not really surprised by the outcome; nothing in his entire life had ever turned out the way he’d imagined – some stumbling carelessness or other had meant that he’d always missed the obvious path from A to B and ended up wading through an unmapped swamp. Maybe, he thought drearily, if he tried to confine his imagination to the mundane and the competent (‘Well done, Dr Gooding, you’ve managed to take a blood sample without fatally injuring the patient.’), he might hit the mark a little more often.
He closed his eyes again, and when he awoke it was nearly two o’clock. He glanced at the window and saw a swan, startlingly near; it crossed the gap in two giant wing beats and seemed to leave the sky thrumming in its wake. Mute swans were the heaviest flighted birds in the world. In the world. As a ten-year-old that fact had delighted him, and even now it brought him a tiny tweak of pleasure. He stretched, and his body felt almost normal, intestines restored to their usual position; he might just possibly be able to manage a cup of tea, and maybe some toast. If there were any tea in the flat. Or milk. Or bread.
Armand’s sugar-free pop tarts came in three flavours: cherry, apricot and toffee, and Paul chose the latter. He could buy another packet this afternoon, he thought, and substitute it without Armand ever knowing. And while he was out shopping he could happen to drive past the newspaper office. And when he got back, if he still felt well, he could return to the ward and humbly offer his services; there was time yet for redemption. He ate the whole of the pop tart in three bites, burning his lip in the process, and then started to wonder whether a simple glass of boiled water, sipped slowly, mightn’t have been a better idea.