6

In the consulting room, Olivia reached out and put an arm around Lucy’s shoulders.

‘I feel like someone dropped a car battery in the bath,’ said Lucy. ‘I’ve never felt like this before: these waves of terror coursing through me. Can I have some Xanax?’

‘I don’t think that’s a good idea,’ said Dr Hammond.

‘If this diagnosis isn’t a good reason to prescribe tranquillisers, what is?’ said Olivia.

‘All right,’ said Dr Hammond, ‘but don’t take too many at once.’

‘If I wanted to die, I’d be asking you for a bottle of champagne,’ said Lucy.

Dr Hammond’s face remained solemn.

‘I’ll give you a prescription for fourteen Xanax; that should tide you over until you see Mr McEwan, the surgeon. I am also prescribing a drug called Keppra, which will stop the seizures.’

‘When will I be able to see Mr McEwan?’

‘Early next week, when you were supposed to see me.’

‘Oh god, I can’t wait that long, I really can’t; I’ll go mad. Sorry, but my brain – I recognise that this may be about to change radically – has always been my main asset, my only asset really, and the more knowledge I have, the better. My new boss is flying in from America tomorrow and he absolutely cannot know what is going on, but that means that I absolutely must know what is happening to me – as well as stifling it with Xanax – by the way, can I have some right now?’

‘I’m afraid you’ll have to go and collect the prescription,’ said Dr Hammond.

‘Shall I ask Francis to get it?’ asked Olivia. ‘My boyfriend,’ she explained to Dr Hammond, ‘he’s in the waiting room.’

‘That’s fine,’ said Dr Hammond, handing it to her. ‘I’ll try to have a word with Mr McEwan to see if he can fit you in any earlier.’

Francis was trying to relax as best he could in the strange circumstances, fixing his gaze on a mid-point between a heap of wrinkled magazines and the silent, subtitled television news. Although Olivia told him nothing, which made him like her even more, she looked too distraught, when she asked him to collect the prescription, to disguise the serious nature of the diagnosis.

He went outside into the pale radiance of the morning. The fading leaves in the gardens and the fluorescent ambulances parked around the square both pointed to mortality in their more or less strident ways. He saw staff hurrying in to work and neurological patients with complicated walks making their way towards the central hospital. On a bench in the gardens a man repeatedly tried to eat a croissant but more often than not missed his mouth, his overcoat scattered with the debris of his failed attempts. Francis tried to irradiate him with strength and calm, but only realised how little he had of either.

After leaving Noble Rot, they had all known, more or less, that it was probably bad news, while hoping they were wrong. Olivia invited Lucy to stay at Belsize Park, in Charlie’s old room, which Lucy knew well from the years when they’d gone out together in their twenties.

‘You won’t find it changed much,’ she said, ‘as you know, my parents aren’t really into interior decoration. They’re too busy moving the furniture around in people’s psyches.’

‘God, I could do with some of that,’ said Lucy, switching off the intercom in the taxi.

They arrived at the Carrs’ house, where both of Olivia’s parents had consulting rooms, Martin’s in the basement overlooking the garden, and Lizzie’s on the top floor. Olivia left Francis in her bedroom and went downstairs to give Lucy a chance to talk to her alone. He took in the impressive surroundings that his new girlfriend had been brought up in and couldn’t help wondering whether she thought of Willow Cottage as ‘cute’ or ‘cosy’. The solidity of her background, with two parents who were still happily married, was at odds with the disturbing adoption story she had told him over the weekend. It turned out that Olivia’s ultra-Catholic father, Henry, had threatened to kill Karen if she had an abortion. He called it ‘God’s justice’. When it turned out that Karen was pregnant with twins, he had put up no resistance to Olivia’s adoption, but had insisted on keeping her brother, Keith. The photograph that Olivia spotted on the bookshelf was of Karen holding Keith in her arms when he was an infant. Was Olivia’s adoption a crack in the foundations of the upbringing she had received in this substantial house, where he was now sitting on the edge of her bed, or was it almost entirely irrelevant, given that it barely constituted an experience? She had battled against genetic fundamentalism for years and felt that victory might have been secured by the ‘reliably fearful’ mice that she told him about over the weekend. And yet, if their inherited characteristics came neither from the standard model of genetic transmission nor from any contact, Francis wondered if Olivia had liberated herself from one kind of legacy by arguing for a more subtle transmission of intergenerational trauma. She seemed so well; perhaps she would only find out when she had a child of her own.

Early the following morning, they had accompanied Lucy to her appointment with Dr Hammond. Francis had hesitated to come along, but Olivia seemed to want his support as much as Lucy wanted Olivia’s.

‘The name of the patient,’ said the pharmacist suspiciously, seeing the supposedly enviable tranquilliser listed on the prescription.

‘Lucy Russell. She’s with Dr Hammond across the square and I’ve been asked to pick this up for her.’

‘And you are?’

‘A friend,’ said Francis.

‘A friend,’ the pharmacist repeated, as if this were the name of a famous terrorist organisation.

‘Listen, I think she’s just been given some bad news,’ said Francis impatiently, ‘can you please give me the fucking medicine?’ He immediately regretted swearing and realised how disoriented he was by the situation.

The pharmacist pointed at a notice saying that abuse of the staff would not be tolerated.

‘I’m sorry,’ said Francis, ‘I was abusing the news, not you. I know you were just showing due diligence.’

He had wanted to say ‘absurd pedantry’, but managed to swerve at the last moment. If only the pharmacist could appreciate how little he envied Lucy’s Xanax, let alone whatever reason she had for needing it. The offended party dawdled before returning with the half-empty box of Xanax and three full boxes of Keppra.

‘Thank you,’ said Francis, taking the blue and white paper bag and heading back towards Dr Hammond’s room.

On his way, Francis spotted a fig tree hanging over the railings of the garden square; he had to cross the road to have a closer look. It was his thirty-second holiday on his way back to Lucy’s panic. He was as bad as the pharmacist, dragging his feet, except that he wanted to bring something from the ripeness of autumn back into the consulting room, from a tree that was pushing nutrients into its fruit and not just retracting them from its leaves. He reached up and touched one of the fig leaves, itself like a splayed hand reaching into the air and the light. He ran his fingers over the veined underside of the leaf, imagining for a moment the particular niche of life occupied by the fig tree. The fleshy sacs, usually thought of as themselves the fruit, in fact contained the hidden flowers and the hidden single-seed fruit of the tree: he felt the infolded richness of the plant, its reserves of sweetness and fertility. He also felt how he longed to return to Howorth. Much as he was infatuated with Olivia, he was rather stunned by the pace at which things were moving and he needed some solitude to take it all in. He was at Lucy’s obviously harrowing consultation fourteen hours after meeting her, adding another kind of precipitous closeness to his ever-expanding weekend with Olivia.

When he got back, he knocked gently on Dr Hammond’s door.

‘Here are the meds,’ he said to Olivia.

‘Thanks,’ she said. ‘We might have to see another doctor. Hammond has gone to check.’

‘I might go for a walk.’

‘I’m sorry,’ said Olivia. ‘Maybe you want to go back to Howorth. You must have things to do.’

‘No, no, I’ll stay. Just text me when you’ve finished. I won’t go far.’

Olivia went back inside, gave the paper bag to Lucy and walked over to the basin to fetch some water. It had been a savage and bewildering morning. When they first arrived at Dr Hammond’s, Lucy had left no time for platitudes or courtesies; her anxiety made her sound impatient, almost angry.

‘Please just tell me what’s going on,’ she said, as she was sitting down. ‘I’ve been awake all night.’

‘Well,’ said Dr Hammond, speaking slowly and clearly, knowing that the information was itself impairing. ‘I’m afraid the news is not good. Your scan indicates that you have a tumour in the left hemisphere of your brain that is affecting the right side of your body. The spasms you’ve been having are what we call “focal motor seizures”. I know you must be in shock right now and I want to make sure that you’re taking in what I’m telling you.’

‘Yes,’ said Lucy, repeating verbatim what she had just been told. ‘Is it cancerous?’

‘Yes. I believe this is a low-grade tumour, so after a biopsy, we’ll discuss whether to follow up with chemotherapy and radiation.’

‘Can it be operated on?’ asked Olivia, seeing that Lucy was having trouble absorbing so much devastating news.

‘That’s for Mr McEwan to decide,’ he said. ‘Would you like me to turn the heating on? I can see that you’re shivering.’

‘No thanks,’ said Lucy and then, after a silence, ‘Does this mean I’m going to die young?’

‘It might shorten your life, yes.’

‘Holy shit,’ said Lucy.

And that’s when she had asked for the Xanax.

Olivia handed the water to Lucy in a frail plastic cup that dented at the slightest touch.

‘Why me?’ said Lucy, swallowing two Keppra and a Xanax. ‘Why not me? Both questions make as little sense as each other. Somebody has to get a brain tumour, or they wouldn’t exist. It’s just the intimacy of the shock.’

Olivia watched Lucy build a cerebral defence against her brain tumour, as if it were a puzzle that could be solved.

‘It’s like being raped while you’re in a coma and only finding out when you see the CCTV footage,’ she went on. ‘It’s in my brain, but I never knew about it. Is it my brain that now knows? Don’t get me wrong, even though I’m questioning the relationship between my brain and my mind, I’m not filing for a divorce.’

Dr Hammond came back into the room with a brief, serious smile.

‘I’ve spoken with Mr McEwan and he can squeeze you in as soon as he gets through his current consultation. Is there anything else you want to know from me before you see him?’

‘If you got this diagnosis,’ said Lucy, ‘and you had unlimited resources, what would you do?’

‘I would have any surgery done here. Mr McEwan is really the top in his field. I would let him operate on me, or any of my family, without hesitation.’

‘Okay, thanks,’ said Lucy, getting up and shaking Dr Hammond’s hand.

After letting the receptionist know, the two friends went outside for some air. They paced the pavement in silence, until a man appeared before them, with his head and face swathed in gauze, except for a gap around his eyes. He was wearing a T-shirt, underpants and some knee-high circulation socks, visible through his open dressing gown. He seemed to be in his thirties, but his legs were rigid, and he moved forward with great difficulty.

‘Jesus, that poor man,’ said Lucy, after asking to go back inside.

‘Don’t worry, we won’t let you out of the hospital looking like that,’ said Olivia.

‘Promise?’

‘Promise.’

‘At least do my dressing gown up.’

‘You got it,’ said Olivia.

They had barely sat down on one of the black, steel-framed sofas in the reception area, when they heard Lucy’s name being called and saw, across the hall, a smiling man in blue scrubs, leaning out of his office door.

Mr McEwan welcomed them into his room. He was in his fifties with buzz-cut hair and eyes that matched his scrubs. He sat at his desk and swivelled his computer screen so they could all see.

‘So, I have the images from your MRI here.’ He pulled up a file that contained numerous black and white pictures of Lucy’s tumour, shot from many angles. He scrolled through them for a while, seeming to be so fascinated by the penetrative power of the technology that he forgot that there were other people in the room. On every image, a large white blob appeared at the top of the skull. McEwan eventually turned his chair away from the screen to face Lucy, like someone looking up from an engrossing novel to deal with a practical enquiry.

‘What I ask myself when I look at you is why you look so healthy and why you’re in such great shape? Why are your physical symptoms not more severe?’

‘I don’t know what to say,’ said Lucy. ‘You seem to be giving me a compliment and a death sentence in one blow: how can I seem so well considering how unwell I really am. Is that it?’

‘The border is very well defined,’ said McEwan. ‘If it were a glioblastoma, it would probably have bled out more into the rest of the brain and produced much more severe symptoms by now, but there is no way of knowing unless we do a biopsy. Also, you see the vascularisation here at the centre?’ He pointed with his pen towards what looked like two tiny clouds that were more brightly lit up than the rest of the tumour. ‘That makes me worry that it could be higher grade.’

‘So, what would the biopsy entail?’ asked Olivia, who could see that Lucy was close to tears and unable to speak.

‘We would drill a small hole in your skull and go in with a computer-guided needle to take a sample of the tissue that we can then analyse.’

‘Can I stay awake during the procedure?’ asked Lucy. ‘I’m terrified of not waking up, so I would rather not go under.’

‘Yes, you could,’ said Mr McEwan. ‘We frequently perform awake surgeries, but this is not a risk-free procedure and you should think very carefully before going ahead. The risk of death is less than one per cent, but there is also a chance of bleeding on the brain and having a stroke. That could leave you paralysed on the right side of your body. It’s not very common but it does happen.’

‘Jesus,’ said Lucy.

‘Also, these are not very detailed images,’ McEwan went on. ‘All we can see is that you have a lesion in the left frontoparietal area in the paracentral lobule. We need to do a functional MRI to understand what neural tissues surround or are inside the tumour. Hopefully, we won’t have to go through any key functional areas in order to get a sample, but there is a risk of damaging healthy tissue, which would leave you with certain impairments, depending on our approach.’

‘I see,’ said Lucy, closing her eyes.

‘Is there a case for just monitoring the tumour?’ asked Olivia.

‘That’s possible,’ said McEwan, ‘but I must emphasise that if this is a high-grade tumour, you will want to know as soon as possible so you can begin treatment to extend Lucy’s life expectancy.’

‘My life expectancy,’ said Lucy faintly.

‘After the fMRI, I am going to present your case to my colleagues. There’s a weekly meeting where sixty of our most senior doctors and researchers at Queen Square get together and discuss all new cases. I suspect they will all recommend the biopsy route since, without it, there is really no further treatment we can offer you.’

‘Well, I guess I don’t have much of a choice then.’

‘You should feel no pressure. This is entirely your decision.’

‘Assuming I want to proceed, what are the next steps?’

‘My assistant would book you in for an fMRI next week. And I might also send you for a cognitive evaluation with one of my colleagues in the Neurology Department. So, we are looking at a surgery date within the next two weeks or so.’

‘Okay, let’s do it,’ said Lucy, standing up. ‘Thank you for squeezing us in,’ she added, shaking Mr McEwan’s hand.