Saturday Read Free Page A

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 ataxia - unsteadiness. These symptoms failed to dispel her suspicion that her condition was part of a plot - the hospital, in league with her guardians, the school, the police - to 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.
    Andrea's operation lasted five hours and went well. She was placed in a sitting position, with her head-clamp bolted to a frame in front of her. Opening up the back of the head
    10 Saturday
    needed great care because of the vessels running close under the bone. Rodney leaned in at Perowne's side to irrigate the drilling and cauterise the bleeding with the bipolar. Finally it lay exposed, the tentorium - the tent - a pale delicate structure of beauty, like the little whirl of a veiled dancer, where the dura is gathered and parted again. Below it lay the cerebellum. By cutting away carefully, Perowne allowed gravity itself to draw the cerebellum down - no need for retractors - and it was possible to see deep into the region where the pineal lay, with the tumour extending in a vast red mass right in front of it. The astrocytoma was well defined and had only partially infiltrated surrounding tissue. Perowne was able to excise almost all of it without damaging any eloquent region.
    He allowed Rodney several minutes with the microscope and the sucker, and let him do the closing up. Perowne did the head dressing himself, and when he finally came away from the theatres, he wasn't feeling tired at all. Operating never wearies him - once busy within the enclosed world of his firm, the theatre and its ordered procedures, and absorbed by the vivid foreshortening of the operating microscope as he follows a corridor to a desired site, he experiences a superhuman capacity, more like a craving, for work.
    As for the rest of the week, the two morning clinics made no more demand than usual. He's too experienced to be touched by the varieties of distress he encounters - his obligation is to be useful. Nor did the ward rounds or the various weekly committees tire him. It was the paperwork on Friday afternoon that brought him down, the backlog of referrals, and responses to referrals, abstracts for two conferences, letters to colleagues and editors, an unfinished peer review, contributions to management initiatives, and government changes to the structure of the Trust, and yet more revisions to teaching practices. There's to be a new look - there's always a new look - at the hospital's Emergency Plan. Simple train crashes are no longer all that are envisaged, and
    11 Ian McEwan
    words like 'catastrophe' and 'mass fatalities', 'chemical and biological warfare' and 'major attack' have recently become bland through repetition. In the past year he's become aware of new committees and subcommittees spawning, and lines of command that stretch up and out of the hospital, beyond the medical hierarchies, up through the distant reaches of the Civil Service to the Home Secretary's office.
    Perowne dictated