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'The dark ages,' the registrar said eerily, waggling his fingers at her. 'We're practically into the new millennium yet most of the surgeons around here have panic attacks when he suggests any technique invented after the Beatles. The work of the specialist surgical teams—trauma, vascular, plastics, orthopaedics and even urology—in this place is state of the art, but apart from Profs work and one or two others' plus the stuff we registrars manage to sneak behind the other consultants' backs, general surgery's still languishing in the seventies.'

'Three surgeons have hinted at retirement at the end of the year and Profs already chosen their replacements,' Lindsay told her. 'So things are going to get better soon.'

'But for now he's stuck with them,' Douglas added.

Merrin pushed back a blonde ringlet which had worked its way out of her braid and fallen across her face. 'But if they're not good surgeons...'

'They're competent enough,' the registrar said briskly. 'Just not interested any more. They spend too much time making money in their private practices and not enough keeping up with surgical advances. NHS work obviously leaves them cold. But Prof keeps an eye on their work.

Believe me, if there were any signs of actual incompetence they'd be out of here before you could blink.'

'Doug. Lindsay. Let's go round.' As Douglas finished talking, the man they'd been discussing appeared at the door and rapped his fingers against the frame.

Merrin looked up at him, tensing a little as his gaze brushed impersonally across her face. 'Hello.' He held his arm out towards Merrin when she approached and she watched her small hand being swallowed briefly by his large, cool one. 'You must be Dr Ryan. Neil McAlister. Welcome to the team. Started to recover from your weekend yet?'

Relieved that she wasn't about to be chastised for her tardiness earlier, she managed a nod. 'I had some sleep last night.'

'Good to hear.' His attention swung back to her more senior colleagues. 'Doug, this is going to have to be quick—I'm giving a lecture at ten. Let's race.'

They did race. As a student Merrin had never been on a ward round that had moved so quickly. Not that she thought he rushed the patients because, pleasingly, with them he seemed thorough and patient, but still the three of them and the nursing staff who rushed to pull curtains around and to bare dressings and present charts had to work fast to keep up with him.

Her job seemed to be to scrawl everything he wanted done into a large ward notebook while Lindsay wrote his findings and decisions into the hospital notes and Douglas charted fluids and medication and re-presented X-rays and scans for his inspection.

In between moments of intense concentration while he talked, Merrin watched her new boss in awe, bemused and fascinated both by the man himself and by the decisive speed of his decision-making. The only chance the rest of them had to catch their breaths was when he paused between each patient to wash his hands but even then he was still giving orders.

And where she and, she knew, Douglas had spent ages examining a man they'd admitted at two o'clock in the morning with a two-hour history of abdominal pain, which Douglas had hesitantly diagnosed as possible appendicitis, he didn't even slow.

'I wasn't sure before and I'm still not positive,' Douglas told him. 'He's been nil by mouth all night and on intravenous fluids but I haven't booked a theatre.'

His boss took only a few seconds to make up his mind. 'It's definitely your appendix,' he said briskly, after laying a single hand on the man's abdomen. He nodded to Douglas. 'Dr Grey will whip it out for you this morning,' he told their patient. 'Depending on what your abdomen feels like just before the operation, you'll have an incision in your umbilicus, plus a tiny one here on the left, another tiny one in the middle plus possibly one here,' he said, indicating the spots he meant. 'Or alternatively just a single scar here,' he added, drawing a line across the right lower quadrant of the man's abdomen. 'You'll be out of here in a couple of days. No lifting for six weeks. What's your job?'

'I'm an accountant,' the man answered. 'I have my own practice.'

'You'll get away with just a week off if you want to get back to work quickly,' Merrin's boss declared. 'Take another one or two if you feel you need it but it won't be necessary from a surgical point of view.'

Merrin guessed from the man's decisive nod that that was exactly the sort of information he'd wanted. 'Thanks very much, Doctor.'

'I'll see you tomorrow. If you think of any questions, Dr Grey will be back to talk to you before you go across for the surgery.'

They moved on to the next bed but the professor's hand on Merrin's arm stopped her as she went to move inside the curtains. 'Ring Theatre's charge nurse on extension eight-one-two-two and book him in as an emergency,' he said in an undertone, referring to their last case. 'His pulse has gone up since his last observations. Tell her I want him done a.s.a.p. Understand?'

'Yes.' Merrin's mouth had gone nervously dry at his touch, but she nodded, then passed Lindsay the notebook and rushed away to one of the telephones at the main desk. 'Prof McAlister wonders if we could do an emergency appendix as soon as possible,' she said, after getting through to Theatre's charge nurse and explaining who she was.

'Is this Neil asking personally, or just Douglas throwing his weight around?' the nurse asked sceptically.

'Prof personally,' Merrin told her. 'He asked me to call you. But I think Douglas is going to do the operation.'

'Tell him to give us fifteen minutes,' the nurse said briskly, the change of her tone suggesting Professor McAlister's name had worked a magic Douglas's would never have. 'The duty anaesthetist's here with us—I'll send him up. Does he want the laparoscope or is he doing it open?'

'I don't
think
he's
going to
decide until he's ready to start,' Merrin told her hesitantly.

'Typical.' The nurse sighed but she didn't sound particularly upset, 'OK, fine. Fifteen minutes.'

By the time Merrin got back to the other doctors they were at the end of the ward. 'Fifteen minutes,' she told the consultant when he looked at her expectantly. 'The charge nurse is going to ask the anaesthetist to come up.'

'Good girl.' He nodded to Douglas. 'That's for your appendix. If you want to peel off and organise the consent and so on, I'll finish next door and take these two down to Intensive Care.

They had another dozen or so patients next door on Red Ward and, with Lindsay taking over Douglas's role, Merrin
had to do the notes as well as keep up their task list, but, more used to her new consultant's way of doing things now, she almost managed to keep up.

From Red he took them to ICU, practically running down the two flights to the unit. 'What have we got, Lindsay?' he demanded when they stopped to wash their hands and don clean gowns, before going in. 'Still just our new man?'

'That's right.' Lindsay sounded breathless. 'The ruptured spleen boy.'

'The
glued
spleen boy, Lindsay,' the consultant amended, and Merrin caught a glimpse of a brief, wry amusement in the depths of his regard. 'The
glued
spleen. Mind you don't say
ruptured
spleen around old Mr Sanderson or he'll be rubbing his hands together. He's already hoping the poor organ's going to dissolve apart on us.'

'It's not, is it?' Horrified, Merrin spoke thoughtlessly, automatically, panicking at the thought of what she would do if she was on duty at the time.

'Relax, Dr Ryan.' He held open the door for them both to precede him into the unit. 'Have a little faith.'

Simon D'Souza was bleary-eyed above the plastic oxygen mask he wore but he was awake and sitting up in his bed, breathing without the aid of a ventilator. A nurse and a senior-looking doctor came rushing across when the professor appeared, and they met them by his bed.

'We extubated him last night and his gases have been fine,' the doctor said quickly, and Merrin knew that meant they'd taken the tube which they'd been using to ventilate him out of his throat and that his oxygen levels were fine when he breathed on his own. 'No other problems.'

'Eighty mils in drain one, fifty in drain two,' Lindsay observed, crouching to inspect them where they were hooked over the edge of the bed. 'Good urine output Not much up the nasogastric tube.'

'He can go to the ward.' The consultant moved aside
their patient's oxygen mask and talked to him as he briefly examined his abdomen. 'Simon, we spoke last night after your operation but you probably don't remember. In the accident you split your spleen. Your spleen's the organ inside your abdomen which produces blood cells and fights infection. Normally we have to remove it when it's injured but in your case we've managed to glue it back together. You're going to be in hospital a week or so longer while things heal, but you're going to be all right.'

Their patient nodded weakly. 'But my car...? I'd only just finished getting it back in good shape—'

'Write-off by the sound of it.' Neil drew back and Merrin registered the lack of sympathy in his tone. 'No doubt you're wondering about the young woman whose car you rammed. You've broken both her legs and her pelvis but she's going to survive.'

'Yeah. Yeah, I was wondering.' The younger man's eyes dropped beneath the surgeon's stony regard. 'Good. Um...that's good.'

'You'll be leaving the unit today and going to a surgical ward. We're giving you all your fluids through your drip. Nothing to eat or drink yet but you can suck two ice cubes an hour if you want them to moisten your mouth. No smoking.'

Merrin briefly caught the young man's expression of dismay but they were already moving on to the next bed.

'Mr Tom's not one of our patients,' Lindsay told her quietly, as the Prof and the ICU doctor began discussing highly technical points about the management of what Merrin assumed was a complicated surgical condition. 'Prof just advises on his management.'

While the two senior doctors talked, Merrin studied their patient, fascinated by the sophisticated gadgetry surrounding him. As a new house officer, her exposure to intensive care medicine so far had been minimal—a few lectures on
anaesthetics and one or two visits to an ICU as a student barely counted.

'What's that blue machine there?' she asked, puzzled by the tube-entwined machine and the bag of pale fluid hooked on one side of it.

'It's for haemofiltration,' Leslie explained quietly. 'His kidneys have failed and he's in heart failure. It's similar to a dialysis machine.'

Merrin nodded. She studied the rest of the equipment interestedly. A bag of something covered in black plastic was connected to a drip leading into his neck and he had other drips going into veins in his arms and one into an artery at his right wrist. He had a heart monitor and there was another machine connected to a drip in his leg, as well as a clip on his ear registering the oxygen saturation levels in his blood.

'There's just one other surgical patient we wanted your advice on, Prof. I'm afraid he's not one of yours again but we'd appreciate you taking a look for us.' The other doctor was drawing him away and Merrin followed automatically, but Lindsay grabbed her arm, holding her back.

'Wait, wait,' she whispered. 'They're not talking about one of our patients. We're not supposed to see this one.'

Merrin frowned. 'We're not supposed to see him being consulted about other patients?'

'Not when it's not official,' the SHO said quietly. 'The ICU doctors are going over the other surgeons' heads. It's very unethical.'

'But it happens all the time?' Merrin supplied, interpreting the SHO's look.

'Prof knows his stuff and for the patients' sakes they need someone like that around here,' Lindsay answered ruefully. 'But all hell would break loose if anyone else found out about it.' She clamped expressive hands over her eyes and ears. 'See no evil, hear no evil,' she chanted
lightly. 'Just keep out of the way when it's happening and don't look like you understand what's going on.'

Merrin studied the Profs face searchingly when he emerged from the side-room the other man had taken him to, disappointed that his expression bore no suggestion of the intrigue or drama she'd hoped to see.

'Move it, you two.' He was at the main doors and holding them open before they'd even had time to turn around. 'Let's go. Kiddies' ward next. How many have we got?'

'Five,' Lindsay told him as they chased after him again. Once they'd shed their ICU gowns and washed their hands she checked her notebook and said, 'Make that six. All except Billy should be going home today or tomorrow.'

Merrin and Lindsay had to jog to keep up with him. The children's unit was at ground level and behind the hospital in a separate block connected by a basement corridor. But they took the overland route and by the time they arrived, despite the sleety bleakness of the weather outside, Merrin was hot and uncomfortable. The back of her neck was sweaty beneath the weight of her plait and she was unhappily aware that it was more than twenty-four hours since she'd showered or changed her clothes.

Once again the professor's appearance on the ward set nurses and junior doctors running and he went though his patients so fluidly that Merrin's head began whirling just from trying to keep up with him. It amazed her that he managed to keep the pace so fast yet still seemed to spend adequate time reassuring each of his charges as well as his or her patients.

Finally, by the end of the round, she realised what it was. He did everything—examining his patients, listening to Lindsay's presentation of their surgical histories and results and the nurses' information, and talking with his patients' parents—simultaneously. It should have been chaos but with him it seemed the technique was so practised, his mind
so focused and incisive, that he somehow managed it while still appearing to give each person his full attention.

They finished at the main desk near the entrance to the two paediatric wards. 'Lindsay, try in my office for those notes on that baby last week if Medical Records can't find them,' he said crisply. 'One of my secretaries might have taken them up there. I'm on my mobile the rest of the day if you need me. Well, Dr Ryan?' Without pause, the consultant's grey eyes swung to Merrin. 'Still awake?'