Saturday (6 page)

It was a calamity – certainly an attack on
her
whole way of life – that brought Rosalind into his life. His first sight of her was from behind as he walked down the women's neurology ward one late afternoon in August. It was striking, this abundance of reddish-brown hair – almost to the waist – on such a small frame. For a moment he thought she was a large child. She was sitting on the edge of her bed, still fully dressed, talking to the registrar in a voice that strained to contain her terror. Perowne caught some of the history as he stopped by, and learned the rest later from her notes. Her health was generally fine, but she'd suffered headaches on and off during the past year. She touched her head to show them where. Her hands, he noticed, were very small. The face was a perfect oval, with large eyes of pale green. She had missed periods now and then, and sometimes a substance oozed from her breasts. Early that afternoon, while she was working in the law department library at University College, reading up on torts – she was specific on this point – her vision had started, as she said, to go wonky. Within minutes she could no longer see the numbers on her wristwatch. She left her books,
grabbed her bag and went downstairs holding the banisters tightly. She was groping her way along the street to the casualty department when the day started to darken. She thought that there was an eclipse, and was surprised that no one was looking at the sky. Casualty had sent her straight here, and now she could barely see the stripes on the registrar's shirt. When he held up his fingers she could not count them.

‘I don't want to go blind,' she said in a small, shocked voice. ‘Please don't let me go blind.'

How was it possible that such large clear eyes could lose their sight? When Henry was sent off to find the consultant, who couldn't be raised on his pager, he felt an unprofessional pang of exclusion, a feeling that he could not afford to leave the registrar – a smooth predatory type – alone with such a rare creature. He, Perowne, wanted to do everything himself to save her, even though he had only a rudimentary sense of what her problem might be.

The consultant, Mr Whaley, was in an important meeting. He was a grand, shambling figure in three-piece pinstripe suit with a fob watch and a purple silk handkerchief poking from his top pocket. Perowne had often seen from a distance the distinctive pate gleaming in the sombre corridors. Whaley's booming theatrical voice was much parodied by the juniors. Perowne asked the secretary to go in and interrupt him. While he waited, he mentally rehearsed, keen to impress the great man with a succinct presentation. Whaley came out and listened with a scowl as Perowne started to tell him of a nineteen-year-old female's headache, her sudden onset of acute visual field impairment, and a history of amenorrhea and galactorrhea.

‘For God's sake, lad. Irregular menstruation, nipple discharge!' He proclaimed this in his clipped, wartime news announcer's voice, but he was also moving down the corridor at speed with his jacket under his arm.

A chair was brought so that he could sit facing his patient. As he examined her eyes, his breathing appeared to slow.
Perowne watched the beautiful pale intelligent face tilted up at the consultant. He would have given much for her to be listening that way to him. Deprived of visual clues, she had to rely on every shifting nuance in Whaley's voice. The diagnosis was swift.

‘Well, well, young lady. It seems you have a tumour on your pituitary gland, which is an organ the size of a pea in the centre of your brain. There's a haemorrhage around the tumour pressing on your optic nerves.'

There was a tall window behind the consultant's head, and Rosalind must have been able to discern his outline, for her eyes seemed to scan his face. She was silent for several seconds. Then she said wonderingly, ‘I really could go blind.'

‘Not if we get to work on you straight away.'

She nodded her assent. Whaley told the registrar to order a confirmatory CT scan for Rosalind on her way to the theatre. Then leaning forward and speaking to her softly, almost tenderly, he explained how the tumour was making prolactin, a hormone associated with pregnancy that caused periods to stop and breasts to make milk. He reassured her that her tumour would be benign and that he expected her to make a complete recovery. Everything depended on speed. After a cursory look at her breasts to confirm the diagnosis – Henry's view was obstructed – Mr Whaley stood and assumed a loud, public voice as he issued instructions. Then he strode away to reschedule his afternoon.

Henry escorted her from the radiology department to the operating suite. She lay on the trolley in anguish. He was a Senior House Officer of four months who couldn't even pretend to know much about the procedure that lay ahead. He waited with her in the corridor for the anaesthetist to arrive. Making small talk, he discovered she was a law student and had no immediate family nearby. Her father was in France, and her mother was dead. An adored aunt lived in Scotland, in the Western Isles. Rosalind was tearful, struggling against powerful emotions. She got control of her
voice and, gesturing towards a fire extinguisher, told him that since this might be her last experience of the colour red, she wanted to remember it. Would he move her closer? Even now she could barely see. He said there was no question, the operation would be a success. But of course, he knew nothing, and his mouth was dry and his knees weak as he moved the trolley nearer to the wall. He had yet to learn clinical detachment. This may have been the time, rather than later in the ward, when he began to fall in love. The swing doors opened and they entered the theatre together, he walking at the side of the trolley while the porter pushed, and she worrying the tissue in her hand, gazing at the ceiling, as though hungry for last details.

The deterioration in her vision had come on suddenly, in the library, and now she was alone, facing momentous change. She steadied herself with deep, slow breaths. She was intent on the anaesthetist's face as he slipped a cannula into the back of her hand, and administered thiopentone. Then she was gone, and Perowne was hurrying away to the scrub room. He had been told to observe closely this radical procedure. Transsphenoidal hypophysectomy. One day he would perform it himself. Yes, even now, so many years later, it calmed him to think how brave she had been. And how benignly their lives had been shaped by this catastrophe.

What else did the young Henry Perowne do to help this beautiful woman suffering a pituitary apoplexy regain her sight? He helped slide her anaesthetised body from the trolley onto the operating table. Obeying the instructions of the registrar, he slipped the sterile covers into place on the handles of the operating lights. He watched as the three steel points of the head-clamp were fixed tightly onto her head. Again guided by the registrar, while Whaley was briefly out of the room, Henry scrubbed Rosalind's mouth with antiseptic soap, and noted the perfection of her teeth. Later, after Mr Whaley had made an incision in her upper gum, rolled her face away from the opening of the nasal passages, stripping the nasal
mucosa from the septum, Henry helped manoeuvre into position the massive operating microscope. There was no screen to watch – video technology was new in those days, and had yet to be installed in this theatre. But throughout the operation he was allowed frequent glimpses through the registrar's eyepiece. Henry watched as Whaley moved in on the sphenoid sinus, passing through it after removing its front wall. Then he skilfully chipped and drilled away at the bony base of the pituitary fossa and revealed, in less than forty-five minutes, the tightly swollen purplish gland within.

Perowne studied closely the decisive jab of the surgical blade and saw the surge of dark clot and ochre tumour the consistency of porridge disappearing into the tip of Whaley's sucker. At the sudden appearance of clear liquid – cerebral spinal fluid – the surgeon decided to take an abdominal fat graft to seal the leak. He made a small transverse incision in Rosalind's lower abdomen, and with a pair of surgical scissors removed a piece of subcutaneous fat which he dropped into a kidney dish. With great delicacy, the graft was passed through the nose and set into the remains of the sphenoid sinus, and held in place with nasal packs.

The elegance of the whole procedure seemed to embody a brilliant contradiction: the remedy was as simple as plumbing, as elemental as a blocked drain – the optic nerves were decompressed and the threat to Rosalind's vision vanished. And yet the making of a safe route into this remote and buried place in the head was a feat of technical mastery and concentration. To go in right through the face, remove the tumour through the nose, to deliver the patient back into her life, without pain or infection, with her vision restored was a miracle of human ingenuity. Almost a century of failure and partial success lay behind this one procedure, of other routes tried and rejected, and decades of fresh invention to make it possible, including this microscope and the fibre optic lighting. The procedure was humane and daring – the spirit of benevolence enlivened
by the boldness of a high-wire circus act. Until then, Perowne's intention to become a neurosurgeon had always been a little theoretical. He'd chosen brains because they were more interesting than bladders or knee joints. Now his ambition became a matter of deep desire. As the closing up began and the face, this particular, beautiful face, was reassembled without a single disfiguring mark, he felt excitement about the future and impatient to acquire the skills. He was falling in love with a life. He was also, of course, falling in love. The two were inseparable. In his elation he even had some love left over for the maestro himself, Mr Whaley, as he bent his massive form over his minute and exacting tasks, breathing noisily through his nostrils behind his mask. When he was sure that he had removed all the tumour and clot he strode off to see another patient. It was left to the predatory registrar to put together again Rosalind's beautiful features.

Was it improper of Henry, to try and position himself in the recovery room so that he would be the first person she saw as she came round? Did he really think that with her perceptions and mood cradled in a gentle swell of morphine, she would notice him and become enraptured? As it turned out, the busy anaesthetist and his team swept Perowne aside. He was told to go and make himself useful elsewhere. But he lingered, and was standing several feet behind her head as she began to stir. At least he saw her eyes open, and her face remain immobile as she struggled to remember her place in the story of her existence, and her wary, painful smile as she began to understand that her sight was returning. Not yet perfect, but in a matter of hours it would be.

Some days later he was genuinely useful, removing the stitches from inside her upper lip, and helping in the removal of the nasal packing. He stayed on after shifts to talk to her. She appeared an isolated figure, pale from the ordeal, propped up on her pillows, surrounded by fat law manuals, her hair in two heavy schoolgirlish braids. Her only visitors
were the two studious girls she shared a flat with. Because it hurt to talk, she sipped water between sentences. She told him that three years ago, when she was sixteen, her mother died in a car accident, and that her father was the famous poet John Grammaticus, who lived in seclusion in a chateau near the Pyrenees. To jog Henry's memory, Rosalind helpfully mentioned ‘Mount Fuji', the poem anthologised in all the school editions. But she didn't seem to mind so much that he'd never heard of it or the author. Nor did she care that Henry's background was less exotic – an unchanging suburban street in Perivale, an only child, with a father he didn't remember.

After their love affair finally began months later, past midnight, in the cabin of a ferry on a wintry crossing to Bilbao, she teased him about his ‘long and brilliant campaign of seduction'. A masterpiece of stealth, she also called it. But pace and manner were set by her. Early on, he sensed how easy it would be to scare her away. Her isolation was not confined to the neurology ward. It was always there, a wariness curbing spontaneity, lowering the excitement levels. She kept the lid on her youth. She could be unsettled by a sudden proposal of a picnic in the country, the unannounced arrival of an old friend, some free tickets for the theatre that night. She might end up saying yes to all three, but the first response was always a turning away, a hidden frown. She felt safer in those days with her law books, in the knowable long-closed matter of Donoghue versus Stevenson. Such distrust of life was bound to extend to himself if he made an unusual move. There were two women to consider, and to earn the trust of the daughter he would have to know and like everything about the mother. This ghost would have to be courted too.

Marianne Grammaticus was not so much grieved for as continually addressed. She was a constant restraining presence, watching over her daughter, and watching with her. This was the secret of Rosalind's inwardness and caution.
The death was too senseless to be believed – a late-night drunk jumping traffic lights near Victoria Station – and three years on, at some level, Rosalind didn't accept it. She remained in silent contact with an imaginary intimate. She referred everything back to her mother whom she'd always first-named, even as a little girl. She also talked about her freely to Henry, mentioning her often in passing and fantasising about her reactions. Marianne would have loved that, Rosalind might say of a movie they had just seen and liked. Or: Marianne showed me how to make this onion soup, but I can never get it to taste as good as hers. Or referring to the Falklands invasion: the funny thing is, she wouldn't have been against this war. She simply hated Galtieri. Many weeks into their friendship – affectionate, physically restrained, it was really no more than that – Henry dared ask Rosalind what her mother would have made of him. She answered without hesitation, ‘She would have adored you.' He took this to be significant, and later that night kissed her with unusual freedom. She was responsive enough, though hardly abandoned, and for almost a week found herself too busy in the evenings to see him. Solitude and work were less threatening to her inner world than kisses. He began to understand that he was in a competition. In the nature of things he was bound to win, but only if he moved at the old-fashioned pace of a slow loris.