28

‘WHO SHOULD WE PRESENT, Emma?’ said the Prof.

Emma stared at her.

‘Emma. It’s a Grand Round. We need someone special. Think!’

Emma’s mind was blank.

‘Well?’

‘Mrs Grahame?’ whispered Emma.

‘Ridiculous! Mrs Grahame? Why? What’s special about her?’

Nothing but the fact that it was the first name that had come into Emma’s head. She had seen Mrs Grahame with the Prof at the previous Thursday clinic and for some reason had just thought of her.

The Prof shook her head in disappointment.

Emma began to flush. She tried, in vain, to control it. The more she tried, the worse it got. In a minute she’d feel the warm blood pounding in her ears.

Once a year, when her turn came for the Grand Round that was held at eight o’clock on Thursday mornings, Andrea Small faced the same problem she faced before her unit meetings each month, finding someone interesting enough to present. But her unit meetings were small, trivial affairs, involving hardly anyone outside her own team, while the hospital Grand Round was a huge meeting involving half the doctors in the hospital, many of whom turned up, in accordance with ancient medical tradition, solely in order to attack the speaker as viciously as they could. So the problem was correspondingly bigger. There simply weren’t that many angles to Fuertler’s Syndrome, and it just wasn’t that easy to come up with an interesting case every year, or even every couple of years, at least not for a non-Fuertlerological audience that wasn’t going to shiver with delight at every tiny dot and squiggle in a Fuertler’s skin biopsy.

The Prof wasn’t the only one who faced this kind of difficulty. Dr Fulbright, the epilepsy specialist, hadn’t presented an interesting case in years. He could spend hours ecstatically examining every spike and wave on an electroencephalogram, but who else cared? Few people attended the Grand Round when it was Dr Fulbright’s turn. Those who did attend groaned when his SR began projecting the hieroglyphic tracings of the inevitable electroencephalograms, which no one could decipher except a great epilepsy specialist like Dr Fulbright, and wondered why they had bothered.

The only really interesting case for a general audience that the Prof had had for months was Mr Gust, the man with bruises on his back. But the man with bruises on his back hadn’t had Fuertler’s Syndrome at all. At a pinch, they could present him as ‘A case of Porphyria Cutanea Tarda masquerading as Fuertler’s Syndrome’, but the Prof thought that would be unwise, especially with Dr Mowbray in the audience, considering that the case had masqueraded for all of about four seconds once Dr Mowbray had begun to look at it.

The Prof really did need to pick a patient. The Grand Round was next week, which left barely enough time if Emma was going to do all the work required to prepare the presentation.

She pressed Emma to suggest a few more names, just to see who she would come up with, and laughed at her after each one. When it was clear that Emma wasn’t going to come up with anyone the Prof hadn’t been able to think of herself, she said: ‘What about Mrs Grahame?’

‘I mentioned her already!’ cried Emma.

‘Did you?’

‘Yes. And you said there was nothing special about her.’

There was nothing special about her. Mrs Grahame was a garden-variety Fuertler’s who had had the disease for years, slowly progressing, until she had recently stabilized. But it’s the way you present something, as much as what you present, that makes things interesting. Or so the Prof had often found, and she had learned a lot in this direction from watching the way politicians successfully presented the horrendous things – or ‘spun’ them, as she understood the correct terminology to be – that they were constantly doing to the health service.

‘The fact that she responded to Sorain so dramatically is interesting,’ remarked the Prof.

‘But she didn’t respond to Sorain,’ said Emma.

‘Yes, she did,’ said the Prof.

‘No, she didn’t,’ said Emma. ‘It was months after she had her last dose of Sorain that her condition stabilized. I can remember you saying it was far too late for the Sorain to have worked.’

‘You must have misheard me.’

‘But I remem—’

‘I said you must have misheard me.’

Emma bit her lip. She hadn’t misheard her! She had been with the Prof in clinic and had heard every word distinctly. But there was only so far she would go in disagreeing with the Prof, especially today. There was too much at stake.

‘How do you know it wasn’t the Sorain?’ asked the Prof.

Emma hesitated. ‘You said so, Prof.’

‘No, Emma. I would never have said it wasn’t the Sorain. I said it may have been the Sorain and it may just have taken a very long time. You’ll need to do a literature search looking for everything that’s been written about Sorain’s duration of action. Are there any other examples of a delayed effect? What are the characteristics of patients who respond in this way? You see, it really is an interesting case. You’ll have to check the data in the Fuertler’s files as well, of course.’

‘But how will I know who’s had Sorain?’

‘Almost everyone’s had Sorain.’

‘But there are hundreds of them, Prof!’

‘Yes,’ said the Prof with satisfaction, ‘there are.’

Emma stared at the Prof in despair. ‘I can’t look through hundreds of folders just for a Grand Round, Prof.’

‘Can’t you, Emma?’

Emma flushed with shame.

‘All right. I have a list somewhere of the names of patients who got better some time after their Sorain,’ lied the Prof, thinking that she must be able to remember a couple of others if she tried. For an instant, she wondered whether there wasn’t some way of organizing the files so you could find out things like that without having to trawl through every single one. Or make up the results.

‘Thank you, Prof.’

Maybe Sorain really did have a delayed effect in some cases, the Prof mused. She wondered how she could get Emma to look through all the Fuertler’s files properly. Or maybe that SHO could do it, the one with the name that sounded like something out of a Christmas cracker. But she was such a strange, heavy girl, the SHO, and as far as the Prof was aware, had never shown the slightest enthusiasm for anything. Sadly, the Prof didn’t see how she could avoid commenting on this lack of enthusiasm in any reference she would be obliged to write on the SHO’s behalf.

Maybe she should tell Emma she was doing a study. Maybe she really should do a study. Was it possible Sorain actually did have a delayed effect that no one had recognized before? What a wonderful discovery that would be, not only for her patients, but for herself, whose chief claim to therapeutic expertise was the ability to handle this difficult and complex drug.

The Prof was starting to feel very hopeful, very hopeful indeed. This might well be the most interesting Grand Round she had ever given.

‘This will be very good, Emma! I’m sure it will be. Don’t you think so? As long as you speak clearly and don’t mumble. You mumble when you get nervous. Did you know that?’

‘Yes, Prof,’ said Emma. ‘You’ve told me.’

The Prof laughed. ‘Sometimes you get so nervous one can’t make out a thing you say. Nothing. Did you know that?’

‘Yes, Prof.’

‘We’ll rehearse the presentation, of course.’

And not just once! Emma, as the SR, would present Mrs Grahame’s case to the audience before the Prof stood up to take questions about the wonderful new delayed effect of Sorain that she had just discovered. There was no way the Prof was going to let Emma muddle her way through the case history. It had to be crystal clear. It had to have the right ‘spin’, as she understood the terminology to be.

‘There won’t be anything for you to be nervous about,’ the Prof said reassuringly, just in case she had gone too far with the remarks about Emma’s nervousness. ‘But there’s still a lot more work for you to do,’ she added, just in case she had gone too far with the reassurance.

Emma nodded.

The Prof smiled brightly.

Emma didn’t. The time had come. It was now or never. Emma looked at the Prof glumly.

‘What is it?’ said the Prof.

Emma shrugged.

‘Don’t you want to do the Grand Round?’ asked the Prof, for whom the alternative – getting Malcolm Goldblatt to do it – was almost unthinkable.

‘Yes,’ replied Emma miserably. The alternative was just as unthinkable for her.

‘Then what is it?’ demanded the Prof in exasperation. Emma was such a sensitive creature that the slightest turbulence could shatter her for days. Sometimes the Prof wondered where she got the strength to cope with her.

‘Oh, nothing,’ said Emma leadingly.

‘It will be a very good presentation, Emma, really. I’m sure it will be.’

‘I hope so,’ Emma said listlessly.

‘Well?’

‘Oh, it’s nothing.’

‘Don’t tell me you don’t want to do the presentation. I know it isn’t easy, standing up in front of everyone. The way they all want to attack you, pick you apart, jump on any mistake you make, ask impossible questions just to... Yes, well... But you must learn to do it. You must, Emma. You’ll never get anywhere if you don’t. And I didn’t really mean it before, about the way you mumble when you get nervous. I mean, you do mumble when you get nervous, but I didn’t really mean it. And you won’t be nervous, will you? Because we’ll rehearse it and you won’t have anything to be nervous about.’

The Prof stopped and looked at her hopefully.

‘It isn’t the Grand Round,’ said Emma, sighing.

‘Then what is it?’ asked the Prof gently, leaning a little closer across the desk that stood between them.

‘You know what it is,’ said Emma.

‘Do I?’ said the Prof.

‘Yes,’ said Emma.

The Prof did. She drew back across the desk

‘I just can’t work with him!’ Emma felt tears spring to her eyes. She let them flow.

‘I know,’ said the Prof, who wouldn’t have been averse to shedding a few tears herself, and might have started, had Emma not beaten her to it. Although the Prof didn’t think it was a good idea to cry in front of staff, especially in front of Emma, before whom more than anyone else it was essential to maintain an air of impassive mastery. ‘A lot of us find him difficult,’ said the Prof, struggling to find her tone of masterful impassivity. ‘But he’s only here for a short time.’

‘Not short enough,’ Emma sniffled.

‘Perhaps not,’ said the Prof wistfully.

‘No one can work with him. The patients don’t like him.’

‘I know,’ said the Prof. ‘You told me.’

‘He’s so arrogant!’

‘I know,’ said the Prof.

Emma reached for a tissue from the box on the Prof’s desk.

‘You should get rid of him,’ she said abruptly, and glanced covertly at the Prof, with her nose in a tissue, to see how the Prof would react.

The Prof frowned. ‘That would be difficult,’ she murmured at last.

‘No, it wouldn’t. You’re the Prof. It’s your unit. You can do whatever you like.’

The Prof’s frown deepened. It never felt as if she could do what she liked, even if she was a Prof and even if it was her unit. Sometimes it felt as if the more of a Prof she was, the less people would let her do.

‘No,’ said the Prof eventually, shaking her head. ‘It would be difficult.’

‘Why?’ said Emma.

‘Well, for a start, because... how would we find someone to replace him?’ demanded the Prof, relieved to have discovered an explanation that circumvented all the unpleasant questions that the other explanations would have raised. ‘It would take time. And who would do his work?’

‘I would!’ said Emma.

‘And who would do your work?’

‘I would!’ said Emma.

‘No, no, no, Emma.’ The Prof chuckled indulgently, barely daring to imagine the catastrophe that Emma was volunteering to engineer.

Emma glanced at the Prof resentfully, pretending to blow her nose again.

She hesitated, nervously unsheathing the verbal dagger she had prepared for the occasion. The consequences of using it to stab the Prof were unpredictable. The Prof, she knew, would bleed. But the Prof was just as likely to pull out one of her own daggers – ten times bigger – and stab her back, perhaps fatally. If it went wrong, in other words, it would mean the end of the beautiful relationship she had established with the Prof. On the other hand, if it went right, it could mean the end of Goldblatt. But since Goldblatt had obviously dedicated himself to ending the beautiful relationship anyway, and since it looked as if he was going to succeed unless he was removed, Emma didn’t really see that she had anything to lose.

She took a deep breath – and stabbed. ‘He doesn’t respect you!’

The Prof’s face went very still. After a long pause she said: ‘I don’t know if that’s true.’ Her voice was very soft, as it usually was when she was lying to herself.

‘It is true, Prof. Someone needs to tell you what he’s saying. He laughs at you,’ said Emma, stabbing again. ‘You should hear him! You should hear the things he says. Calls you the great Fuertler’s... fraud. He says you don’t know any more about Fuertler’s than he does. He says you couldn’t tell Fuertler’s from Porphyria Cutanea Tarda. He mocks you all the time. He doesn’t care who hears him. Doctors, nurses, physios...’

‘Patients?’ whispered the Prof.

‘Oh, the patients!’ exclaimed Emma, stabbing with abandon. ‘Prof, you should hear what he says to the patients! He tells them... he tells them... he tells them they should all go and get their Sorain somewhere else. With Dr—’

‘Not Dr Jenkins?’

‘Exactly. With Dr Jenkins. Or anybody else. Anybody would be better than you, he says. He doesn’t take you seriously, Prof. He doesn’t respect you, he doesn’t respect anything about you. He doesn’t respect the way you run the unit and he doesn’t respect the way you treat the patients and he doesn’t respect—’

‘Enough! Stop! Stop stop stop stop stop!’

Emma stopped. She lowered her eyes, and then glanced secretly at the Prof to try to discern what effect her words had had.

The Prof leaned back in her chair, eyes closed.

Emma peered at her. ‘He doesn’t respect you, Prof,’ she said quietly, twisting the blade and pushing it home. ‘Someone has to tell you. It’s not easy, but I had to say something.’ She watched as the Prof continued to sit with her eyes closed. Emma felt an enormous sense of power. After all the times the Prof had reduced her to speechlessness, it was finally the Prof’s turn to sit dumbly in front of her. An extravagant image came into her head of the Prof, not her, trembling once a fortnight. ‘He says you’re scared of him, Prof, and you’d never do anything to get rid of him. I’ve heard him say it, exactly those words. She’d never do it. But you would, wouldn’t you? You can show him. You’re the Prof. You can do what you want.’

With a huge effort of will, Emma stopped. There was so much more she wanted to say, but something told her that she had said enough. Less was more. That was what her sister, knowing what Emma could be like, had told her the previous night. A dozen times. Less was more.

Less was something, anyway. The Prof was silent. Emma stared at the Prof, suddenly fearful. Her blood lust had abruptly given way to terror. Had she gone too far? She was desperate to know what was going on behind the Prof’s closed eyes.

Suddenly the eyes opened. ‘Have you dictated your letters from last week’s clinic yet?’ demanded the Prof, her tone like ice.

Emma jumped. Then she flushed. ‘Almost.’

‘Go and finish them!’

‘When?’

‘Now!’ said the Prof. ‘And I want to see them when they’re done!’

She held on until Emma had closed the door behind her. As soon as it was shut, the Prof leaned back in her chair and closed her eyes again. When she opened them, she had dropped her façade. She was naked and shivering in front of the Scale.

The shell of false confidence in which the Prof had encased herself for twenty-four hours, after the worryingly simple resolution of the Cancellations Crisis, had shattered completely. It had been fragile enough before Emma spoke to her, but at least the Prof had been able to ignore its fragility by the trusted expedient of not thinking about it. Avoiding Goldblatt like the plague had also helped. But thanks to Emma and her big indiscreet mouth, the Prof could no longer avoid facing up to it once more.

A horrible image came into her head. Everyone was laughing at her. Doctors, nurses, physiotherapists, occupational therapists, even that awful social worker who only came to her ward round for five minutes each week. She saw them in her mind’s eye. Laughing. Pointing at her. Laughing.

No, it wasn’t possible. Suddenly the Prof was filled with a crimson tide of hatred for Emma, that big lump of blonde obtuseness. She wished she had never appointed her. What had she been thinking? What did she expect from someone like that? Stupid girl. She wouldn’t know whether someone like Malcolm Goldblatt respected her or not. How could she? She wouldn’t recognize respect for a professor if it came along and knocked her on the head.

But Goldblatt didn’t respect her. A depthless, sickening feeling threatened to suck the Prof down into its gaping void. The boy had never respected her, and never would. But she respected him. Not only did she respect him, she was scared witless of him and what he might say or do. The Prof knew that, despite everything she had told herself the previous day, in her heart of hearts – a place best avoided, for obvious reasons – she had never really believed otherwise.

With a sensation of clammy nausea, the Prof began to wonder how long it would be until Goldblatt undermined her irreversibly with everyone on the unit. Perhaps he already had. If he was putting seditious thoughts into Emma’s head, which ought to have contained no thoughts but the ones she put there herself, no one was safe from his influence. She wondered what he had been saying to that impressionable young house officer who never got any tests done on time, or to the SHO with the ludicrous name. Maybe it was her duty to save them from his malign effect. The Prof took her educational duties very seriously, and made a strict point of never letting an HO leave her unit without first learning her name. Which reminded her, she must get her secretary to find out what it was...

Maybe she should get rid of him. What a relief that would be! Maybe she really should.

Then she remembered who had suggested it to her. Emma! That insolent, jumped-up SR, who, instead of showing even an inkling of gratitude for all the Prof had done for her, was running around telling people – or one person, at least – that Goldblatt didn’t respect her.

But he didn’t respect her. But that didn’t mean Emma should be saying it, or even thinking it!

Not for the first time in her life, the Prof found herself overcome with animosity and resentment towards someone who had told her something that, if she had been brutally honest with herself – which one could hardly expect her to be, not now, not having had such a shock – she knew was perfectly true.

But Emma could wait. There was plenty of time to work out what to do with her. What to do with Malcolm Goldblatt was a much more urgent question.

It was a difficult one. The Prof wasn’t even sure what the rules were, and whether, even if she wanted to sack him, she could do it without stepping into a legal minefield. On what grounds? Imagine announcing that she was going to sack him and then finding out that she couldn’t! That would be worse than anything. Worse than having the boy on her unit for another three months. Her enemies would have a field day.

But talking to the HR people would be risky. It would get back to the HR director, and from there who knew where else it would get to? The HR director, she knew, was close to a certain endocrinology professor, and probably to various of her other enemies as well.

Yet she needed to talk to someone. And it had to be someone she could trust to keep quiet.

‘I’m sorry. What did you say, Andrea?’ said Dr Morris, shaking his head and blinking. The Prof had enticed him into her office and launched into a long conversation about the latest twist in her struggle to have an extra physiotherapy session allocated to her unit, which she had been waging for almost a year. It wasn’t really a conversation. More a monologue. It had lulled him into such a state of stupor that he wasn’t sure if, in the midst of all that, she had casually slipped in the question that he thought he had just heard.

‘I said: “By the way, do you think I should get rid of our friend Dr Goldblatt?”’

‘Is he a friend of yours?’

The Prof shook her head impatiently.

Dr Morris climbed upright in his chair, having slumped during the physiotherapy tirade. For a while now he had begun to feel that he was becoming the Prof’s psychological crutch, and he wasn’t enjoying the experience of being an orthopaedic support. How had she managed before he joined the unit? The way he had been left to clean up the mess after the business with Mrs Constantidis made him realize that the Prof was turning him into her consigliere, accomplice, and confessor. But most of all she was turning him into something at which she talked. Her ‘little chats’ usually turned into Hitlerian monologues that could last up to an hour. A searching and excruciating – if not overtly paranoid – analysis of the Prof’s most recent conversation with Margaret Hayes was almost always on the menu, usually followed by a dose of vitriol poured over the character of Dr Jenkins in Leicester. Dr Morris had met Dr Jenkins a couple of times at conferences, and considered him a perfectly reasonable chap. And there was of course the omnipresent, Byzantine plot to force the head physiotherapist to allocate another three hours per week of outpatients’ physiotherapy to the Prof’s patients, bitterly opposed by the evil Dr Mowbray out of sheer bloody-mindedness, on which Dr Morris got a mind-numbing update at least twice weekly.

And now, if he heard correctly, she wanted to get rid of Malcolm Goldblatt?

‘Why?’ asked Dr Morris, totally bemused.

The Prof scrutinized him carefully. ‘Don’t you think he’s difficult?’

‘Do you?’ replied Dr Morris, who was wide awake now and knew that at all costs he had to avoid committing himself to an opinion that would definitely be used against him later.

‘I thought I could remember you saying that you did, Anthony,’ said the Prof, resorting to an old trick.

‘No, I don’t believe I did, Andrea,’ said Dr Morris, weighing each word before he spoke.

‘Oh,’ said the Prof.

Frankly, Dr Morris was shocked. Call him an old-fashioned traditionalist, but sacking another doctor wasn’t a step you took every day, not unless the doctor in question had been up to something with a patient, or had forgotten to turn on the oxygen supply during an anaesthetic. It wasn’t a step Dr Morris had taken on any day, or had ever been party to. He didn’t want to be party to it now.

‘Don’t you think he’s difficult?’ asked the Prof, probing again.

‘Difficult is one thing, Andrea, but getting rid of him is something else.’

‘So you do think he’s difficult!’

‘I didn’t say that,’ replied Dr Morris quickly, realizing that he had only one opportunity to set the record straight. ‘You know I didn’t say it.’

The Prof glanced calmly and imperviously at the desk in front of her.

‘I didn’t say it, Andrea.’

‘Oh, all right, Anthony, you didn’t say it!’

‘He’s a perfectly good doctor.’

‘I didn’t say he wasn’t a good doctor. Heavens, Anthony, what do you think I’m saying? That would be a libel. He’s an excellent doctor. I have the greatest confidence in him. If my own mother were unwell and—’

‘Andrea,’ said Dr Morris, ‘what is this all about?’

‘I just wanted to know whether you thought we should get rid of him.’

‘Can you get rid of him?’ asked Dr Morris.

‘Of course I can!’ replied the Prof with as much false confidence as she could manage. Nine times out of ten, she knew, it didn’t matter if you really had the power to do something, as long as people thought you did. If you were forceful enough no one would even check. That was one lesson she had learned from all the years she had been forced to spend amongst brusque, blustering men who constantly claimed the power to do all kinds of things they had no right to do, and usually got away with it. ‘He’s a locum, Anthony! I can sack him if I want.’ She watched Dr Morris closely to see how he would respond. It was, she felt, an important test.

‘I see,’ said Dr Morris glumly.

The Prof felt tentatively buoyed. ‘So you do think I should get rid of him?’

‘No! Of course I don’t! I can’t believe you’d even consider it. Isn’t that obvious?’

The Prof gazed at him. ‘Well, I shall have to think about it,’ she said at last. ‘But I’m glad to have your opinion, Anthony.’

Dr Morris was glad to have given it. Maybe he genuinely believed the matter would end there, as if it really were his encouragement, and not merely his acquiescence, that the Prof had been seeking.

‘You won’t mention this to anyone, will you, Anthony?’

‘Of course not.’

And thinking the matter was closed, he didn’t, not even to Goldblatt.