Saturday Read Free

probing of his Rhoton dissector - an entirely curative process. Sally closed that one up while Perowne went next door to carry out a multi-level lumbar laminectomy on an obese 44-year-old man, a gardener who worked in Hyde Park. He cut through four inches of subcutaneous fat before the vertebrae were exposed, and the man wobbled unhelpfully on the table whenever Perowne exerted downwards pressure to clip away at the bone.
    For an old friend, a specialist in Ear, Nose and Throat, Perowne opened up an acoustic in a seventeen-year-old boy
    -it's odd how these ENT people shy away from making their own difficult routes in. Perowne made a large, rectangular bone flap behind the ear, which took well over an hour, irritating Jay Strauss who was wanting to get on with the firm's own list. Finally the tumour lay exposed to the operating microscope - a small vestibular schwannoma lying barely three millimetres from the cochlea. Leaving his specialist friend to perform the excision, Perowne hurried out to a second minor procedure which in turn caused him some irritation - a loud young woman with an habitually aggrieved manner wanted her spinal stimulator moved from back to front. Only the month before he had shifted it round after she complained that it was uncomfortable to sit down. Now Saturday
    she was saying the stimulator made it impossible to lie in bed. He made a long incision across her abdomen and wasted valuable time, up to his elbows inside her, searching for the battery wire. He was sure she'd be back before long.
    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 perfect - at 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 epidemic - one 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 bleeding - a chronic subdural haematoma - Perowne 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 twelve - the dismayed vicar and his wife showed Perowne the photograph - a Ian McEwan
    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 values - the 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