For lunch he had a factory-wrapped tuna and cucumber sandwich with a bottle of mineral water. In the cramped coffee room whose toast and microwaved pasta always remind him of the odours of major surgery, he sat next to Heather, the much-loved Cockney lady who helps clean the theatres between procedures. She gave him an account of her son-in-law's arrest for armed robbery after being mistakenly picked out of a police line-up. But his alibi was perfectat the time of the crime he was at the dentist's having a wisdom tooth removed. Elsewhere in the room, the talk was of the flu epidemicone of the scrub nurses and a trainee Operating Department Practitioner working for Jay Strauss were sent home that morning. After fifteen minutes Perowne took his firm back to work. While Sally was next door drilling a hole in the skull of an old man, a retired traffic warden, to relieve the pressure of his internal bleedinga chronic subdural haematomaPerowne used the theatre's latest piece of equipment, a computerised image-guidance system, to help him with a craniotomy for a resection of a right posterior frontal glioma. Then he let Rodney take the lead in another burr hole for a chronic subdural.
The culmination of today's list was the removal of a pilocytic astrocytoma from a fourteen-year-old Nigerian girl who lives in Brixton with her aunt and uncle, a Church of England vicar. The tumour was best reached through the back of the head, by an infratentorial supracerebellar route, with the anaesthetised patient in a sitting position. This in turn created special problems for Jay Strauss, for there was a possibility of air entering a vein and causing an embolism. Andrea Chapman was a problem patient, a problem niece. She arrived in England at the age of twelvethe dismayed vicar and his wife showed Perowne the photographa scrubbed girl in a frock and tight ribbons with a shy smile. Something in her that village life in rural north Nigeria kept buttoned down was released once she started at her local Brixton comprehensive. She took to the music, the clothes, the talk, the valuesthe street. She had attitude, the vicar confided while his wife was trying to settle Andrea on the ward. His niece took drugs, got drunk, shoplifted, bunked off school, hated authority, and "swore like a merchant seaman." Could it be the tumour was pressing down on some part of her brain?
Perowne could offer no such comfort. The tumour was remote from the frontal lobes. It was deep in the superior cerebellar vermis. She'd already suffered early-morning headaches, blind spots and ataxiaunsteadiness. These symptoms failed to dispel her suspicion that her condition was part of a plotthe hospital, in league with her guardians, the school, the policeto curb her nights in the clubs. Within hours of being admitted she was in conflict with the nurses, the ward sister and an elderly patient who said she wouldn't tolerate the obscene language. Perowne had his own difficulties talking her through the ordeals that lay ahead. Even when Andrea wasn't aroused, she affected to talk like a rapper on MTV, swaying her upper body as she sat up in bed, making circular movements with her palms downwards, soothing the air in front of her, in preparation for one of her own storms. But he admired her spirit, and the fierce dark eyes, the perfect teeth, and the clean pink tongue lashing itself round the words it formed. She smiled joyously, even when she was shouting in apparent fury, as though she was tickled by just how much she could get away with. It took Jay Strauss, an American with the warmth and directness that no one else in this English hospital could muster, to bring her into line.
From Samurai William by Giles Milton. Copyright 2003. All rights reserved. No part of this book may be reproduced in any form without written permission from the publisher, Farrar, Straus and Giroux.
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