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'You open along the axis and close in the cross,' she breathed, amazed. By doing that, he automatically shortened the bowel but created a wider lumen. 'That's ingenious.'

'It's not my invention,' he said evenly, his eyes above his mask grave as they briefly surveyed her. 'And the lowest bit was so tight that I'll probably have to cut a small bit out, but you've grasped the principle, yes. Well done.'

Merrin knew from reading the notes and examining him that Toby had already had all of his large bowel removed. 'What about the pouch you made for Mrs Kale?' she asked as he repeated the procedure at the next site, referring to the case he'd started the day with. She hadn't seen the operation but he'd explained on the round that he'd be creating a special collecting pouch
of small bowel to act like a rectum for their patient so that although she'd had to have her diseased large bowel removed, she'd still not need to wear a bag permanently. 'Why couldn't Toby have had one of those?'

'Occasionally you can get away with a pouch with Crohn's. Douglas, suction,' he ordered, interrupting his answer. He took control of the suction from the registrar and finished the job himself. 'Back a bit more on that retractor, Merrin. Yes, you can do a pouch for Crohn's, but only if the rectum and the small bowel you need to make the pouch are disease free. It's a risk because if they don't stay that way then you'll lose the lot.'

'And Toby's disease was too widespread to make it possible?'

'Toby's disease is as severe as it gets,' he confirmed. 'He's done incredibly well to keep this much small bowel as long as he has.'

Merrin waited until he'd finished the next stricture. 'What will happen to Toby now?'

'All going well, he'll be out of here in a week. He'll be on TPN as an outpatient for another month or so to optimise his nutrition to help his healing, but then we'll be able to stop it and he'll be able to just eat normally.'

'And if all doesn't go well?' Merrin felt Douglas beside her go very still, and she saw that both he and Lindsay were looking down very deliberately at the wound. When the Prof didn't answer her question, his attention seemingly fixed on the fine knots he was tying to close the next segment of bowel, she added, 'Was that an idiotic thing to ask?'

He glanced up, his regard for a moment so bleak that it made her breath catch in her throat. 'If all doesn't go well we'll have another Eddie Jackson on our hands,' he said heavily.

Merrin remembered that Eddie Jackson was the man who'd died at the weekend. She remembered Toby's distress and she lowered her head. She decided it would be a good time to stay quiet.

Post-op, Toby had intravenous fluids and a pain-relief pump, as well as his intravenous TPN, and she assumed that he'd misunderstood the professor's promise to take him to Eddie's funeral on Friday. But the arrival of two ambulance officers on the ward as they neared the end of their Orange ward round the following morning proved her wrong. 'Toby ready to go?' one of them asked.

'Room twelve. The end side room on the right.' The Prof looked around from the CT scan he was showing them and started taking off his white coat. 'We'll come and help. Lindsay, are you ready?'

'Celia's coming, too,' the SHO confirmed, shedding her own white coat to reveal a dark suit. 'The other nurses are meeting us there.' She passed the registrar her coat and bleeper. 'All yours, Doug. Bye, Merrin.'

On the way to the children's unit, Douglas explained that the morning's day-surgery list had been postponed so that the others could go to Eddie's funeral. 'If they're not back by the beginning of clinic this afternoon I'll need you to come down and help till they arrive.'

But Lindsay caught up with them in the canteen just before one o'clock. 'Very sad but very Eddie,' she concluded, when Douglas questioned her about the funeral. 'They played a couple of those heavy metal tapes he loved during the service so he would definitely have liked that. His dad read some of his poetry and Prof gave a lovely speech about life being so short and about how Eddie had grabbed at every moment until the last. He had all of us in tears by the end of it, in tears but happy at the same time, sort of.'

'How was Toby?'

'Good.' Lindsay shook her head at Merrin's offer of one of her meat-paste sandwiches. 'I've eaten already, thanks. Eddie's family put on a morning tea. No problems medically with Toby. It obviously meant a lot to him that he could go. Must have cost Prof thousands, though.' She took a sip of the tea she'd bought. 'The ambulance wouldn't have come cheap and Toby certainly doesn't have any money.'

'You think Prof had to pay?' Douglas looked as surprised as Merrin felt. 'For the ambulance?'

'Of course.' Lindsay nodded. 'Yes, for a private thing like this. He would have had to charter it and the crew, wouldn't he? Celia's sure that's what he did. She said he organised the whole thing personally. But there was no choice, really. Toby's barely sitting yet after his operation. He couldn't have gone in a car.'

At two, Lindsay and Douglas went off to Outpatients on the ground floor of the main hospital, leaving Merrin behind on Orange Ward to finish the ward work. She had discharge letters to write and results to chase, as well as two patients scheduled for surgery on Tuesday who needed to be pre-assessed and to have their blood tests and X-rays and a heart tracing each.

She finally managed to get down to Outpatients just before four. The surgical side was chaotic, with doctors and nurses criss-crossing each other as they hurried between the maze of offices and examination rooms that led off the main clinic area.

Douglas passed Merrin a set of notes and suggested that she see the patient and take a history, before presenting the case to either him or Prof who'd then see the patient as well. But the professor himself emerged from one of the examination rooms and contradicted that.

'For the first two weeks, Merrin, just sit in with one of us and observe how we work things,' he amended quickly, pausing midway through the letter he was dictating into the Dictaphone he held to ease the notes she clutched out of her grip and pass them back to Douglas. 'After that you can start seeing people independently first.'

He opened a new set of notes onto one of the desks as he spoke, but Merrin thought that below his superficial distraction he looked tired and drawn. The morning, she imagined, must have been a strain on him.

'Thank you for referring Mr Summers to my clinic today,' he dictated fluently, speaking close to the microphone of his Dictaphone, checking yet another set of notes as he spoke. 'Examination today is normal but I agree that his symptoms require further investigation. I've arranged for him to attend my colonoscopy clinic Thursday in two weeks. Regards, Neil McAlister. Copy to colonoscopy audit.'

He looked up at Merrin as if surprised that she still hovered. 'Do you want to start by sitting in with Doug?'

'No.' Douglas was out of earshot now, talking to one of the clinic nurses about a dressing he wanted, and, she decided, was unoffendable. 'If it's all right, I'd rather start with you.'

'It's all right.' He barely looked at her. 'Room one. Wait for me.' He went towards one of the other nurses. 'Anita, Mr Wirral in room five needs the rest of his stitches out please. I've discharged the man in room seven. Mr Summers is booked for colonoscopy Thursday week. He needs an information sheet—the stock in the desk has run out. Mrs Louey can go home once that drain's out.'

'Prof, can I have some advice in here, please?' Lindsay called, and he immediately detoured towards her.

'Prof, I've got that barium enema for you to see,' Douglas added, following him with an X-ray envelope. 'We're going to have to add him to one of next week's lists.'

'Did you say Mrs Louey's drain?' Anita called.

'Mrs Louey,' he confirmed. 'Merrin, room one.'

'Room one.' Absently Merrin spun around to look for it, her head whirling. 'And I thought his ward rounds were fast,' she announced to no one in particular, although Anita, trotting back though the main area, obviously heard her.

'This is nothing,' she said breathlessly. 'We've only got about two hundred to see today. The administration started complaining about how much it was costing for our nursing overtime so he's had to cut it right back this year. We used to see at least three.'

'By five?' Merrin asked, aghast. The clinic was only scheduled to last three hours.

'More like seven,' the older woman told her wryly. 'Occasionally eight. He used to send the registrars home earlier but he always stayed till everyone was seen. He still does if there are problems needing more time.'

'It's not healthy for him to work like that,' Merrin argued.

'Try telling him that,' the nurse said, rolling her eyes before she bustled away. 'We've been saying it for years. He won't listen.'

Things moved so fast that the rest of the afternoon flew by but by six they still had twenty patients to see. 'I'll finish here,' the professor told them. 'Doug, check the ward briefly to make sure there's nothing major happening then you three should go. Tell the nurses I'll be around later.'

'Thanks, Prof.' Douglas and Lindsay dumped the notes they'd been holding, obviously happy to leave.

Merrin, guiltily aware that her questions about the cases they'd seen and the time he'd taken to teach her had slowed him down considerably, wasn't going anywhere. 'I'm staying,' she declared firmly, aware of the doubtful way the other junior doctors were regarding her, but nevertheless determined. 'I'm going to help you.' She crossed her arms. 'What next?'

The look he sent her was faintly exasperated but he didn't attempt to argue. 'Room three,' he told her. 'Take a history from Mrs Corby. I'll be in soon.'

Pleased that he apparently now considered her capable of doing something on her own, Merrin hastened to obey.

Mrs Corby was a thirty-two-year-old woman with a six-month history of vague abdominal symptoms. 'Everyone keeps telling me it's irritable bowel,' she said hesitantly, once Merrin had finished taking a detailed history. 'Even my GP. He took blood tests and they were all normal and he examined me very thoroughly but...something in my head won't let me relax. I mean, I'm sure it's nothing to worry about...'

'But it's important to check things out,' Merrin agreed.

'I hope I'm not wasting Professor McAlister's time,' the older woman said unhappily. 'I know my doctor didn't want to refer me to him because he has to pay extra to send anyone to this hospital but his name was in a newspaper article about the best surgeons in London and I just insisted on seeing him.'

'You're not wasting anybody's time,' Merrin soothed. Although she thought that Mrs Corby's symptoms sounded very much like irritable bowel syndrome and that as such she would normally have been best seen by either her GP alone or by a gastroenterologist—a physician—rather than by a surgeon, she knew enough now about her boss to know that he wouldn't mind.

But instead of offering the reassurance that she'd expected, after examining Mrs Corby, he said quietly, 'I'm going to arrange an investigation where I pass a narrow telescope along your bowel and inspect the inside wall. That will happen next Thursday afternoon.'

Rather than seeming anxious, Merrin thought that their patient looked relieved. 'Will I be asleep?' she asked calmly.

'You'll be awake but I'll give you something similar to Valium directly into one of the veins in your arm to relax
you,' he told her, retrieving a black notebook from the pocket of his white coat. 'It's not a painful procedure and you'll be able to go home afterwards but someone will need to drive you. Unfortunately my list next week's already over-booked so that might mean you'll have to have this quite late, perhaps even as late as you're here tonight. Is there someone who'll be able to look after your children again?'

'My mother can look after them and my husband can drive me home.' She looked up at him gravely. 'My children are only seven and nine. They need their mother. Should I be worrying?'

'You came to me because you're already worrying,' he pointed out quietly. 'If things look normal next week then you can stop. Statistically, given your age, the probability of this being nothing worrying is high. On the other hand, if things don't look normal then we'll simply get on and deal with whatever is causing the trouble.'

'Thank you.' Merrin saw that Mrs Corby managed a creditable smile. 'Thank you for taking me seriously.'

'Call my secretary Monday afternoon before four,' he told her, writing a number on the back of her appointment card. 'It's too late now to organise an appointment but she'll tell you then when and where to come. You'll need to have a special diet the day before and take some tablets Thursday morning. She'll explain about that.'

Wary of doing anything to slow him further, Merrin waited until he'd finished seeing the last of their patients before questioning him about Mrs Corby. 'I thought her symptoms sounded exactly like irritable bowel,' she said as they helped Anita gather up the last of the notes. 'I understand that you need to exclude any other cause but why does she have to have the colonoscopy so urgently?'

'Mrs Corby has a tumour in her ascending colon,' he said quietly.

Merrin looked up sharply, stunned. 'How can you know that?'

'I don't for sure but my suspicion's high.' He ejected the tape in his Dictaphone and slid it into an envelope containing the other tapes he'd used during the clinic. 'Experience or intuition, I don't know. Notice anything when you were examining her?'

'I thought everything was normal.'

'There was a fullness on her right side,' he said. 'Too subtle, I thought, to be worth increasing her anxiety by asking you to re-examine her.'

'I missed it,' Merrin said hollowly, feeling' sick. 'I examined her very carefully yet I missed it.'

'Every doctor at your stage would have missed it,' he said evenly, meeting her appalled gaze calmly. 'Fortunately every doctor would also organise barium studies or a colonoscopy so the problem would still be picked up.'

'Is she going to be all right?'

'I hope so.'