The Private Patient

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by P. D. James


  Mr Chandler-Powell had been sitting at the desk and, as she entered, he rose and came to shake her hand, indicating one of the two chairs. His grasp was firm but momentary, his hand cool. She had expected him to be wearing a dark suit. Instead he was in very pale grey fine tweed, beautifully cut, which paradoxically gave a greater impression of formality. Facing him, she saw a strong bony face with a long mobile mouth and bright hazel eyes under well-marked brows. His brown hair, straight and a little unruly, was brushed over a high forehead, a few strands falling almost into his right eye. The immediate impression he gave was of confidence and she recognised it at once: a patina which had something, but not everything, to do with success. It was different from the confidence with which as a journalist she was familiar: celebrities, their eyes always avid for the next photographer, at the ready to assume the right stance; nonentities who seemed to know that their notoriety was a concoction of the media, a transitory fame which only their desperate self-belief could maintain. The man before her had the inner assurance of someone at the top of his profession, secure, inviolable. She detected, too, a hint of arrogance not altogether successfully concealed, but told herself that this could be prejudice. Master of Surgery. Well, he looked the part.

  ‘You come, Miss Gradwyn, without a letter from your GP.’ It was stated as a fact not a reproach. His voice was deep and attractive but with a trace of a country accent which she couldn’t identify and hadn’t expected.

  ‘It seemed a waste of his time and mine. I registered with Dr Macintyre’s practice about eight years ago as an NHS patient and I have never needed to consult either him or any of his partners. I only go to the surgery twice a year to have my blood pressure taken. That’s usually done by the practice nurse.’

  ‘I know Dr Macintyre. I’ll have a word with him.’

  Without speaking he came up to her, turning the desk lamp so that its bright beam shone full on her face. His fingers were cool as they touched the skin on each cheek, pinching it into folds. The touch was so impersonal that it seemed an insult. She wondered why he hadn’t disappeared behind the screen to wash his hands, but perhaps, if he considered it necessary for this preliminary appointment, this had been done before she entered the room. There was a moment in which, not touching the scar, he scrutinised it in silence. Then he switched off the light and sat again behind the desk. His eyes on the file before him, he said, ‘How long ago was this done?’

  She was struck by the phrasing of the question. ‘Thirty-four years ago.’

  ‘How did it happen?’

  She said, ‘Is that a necessary question?’

  ‘Not unless it was self-inflicted. I assume it wasn’t.’

  ‘No, it wasn’t self-inflicted.’

  ‘And you have waited thirty-four years to do something about it. Why now, Miss Gradwyn?’

  There was a pause, then she said, ‘Because I no longer have need of it.’

  He didn’t reply, but the hand making notes in the file was for a few seconds stilled. Looking up from his papers, he said, ‘What are you expecting from this operation, Miss Gradwyn?’

  ‘I should like the scar to disappear but I realise that’s impossible. I suppose what I’m hoping for is a thin line, not this wide sunken cicatrice.’

  He said, ‘I think with the help of some make-up it could be almost invisible. After surgery, if necessary, you can be referred to a CC nurse for cosmetic camouflage. These nurses are very skilled. It’s surprising what can be done.’

  ‘I’d prefer not to have to use camouflage.’

  ‘Very little or none may be necessary but it’s a deep scar. As I expect you know, the skin is layered and it will be necessary to open up and reconstruct those layers. For a time after the operation the scar will look red and raw, a great deal worse before it gets better. We’ll need to deal, too, with the effect on the naso-labial fold, that small droop of the lip, and the top of the scar where it pulls down the corner of the eye. At the finish I shall use a fat injection to plump up and correct any contour irregularities. But when I see you the day before the operation I shall explain in more detail what I propose to do and show you a diagram. The operation will be done under a general anaesthetic. Have you ever been anaesthetised?’

  ‘No, this will be my first time.’

  ‘The anaesthetist will see you before the operation. There are some tests I would like done, including blood tests and an ECG, but I would prefer those to be carried out at St Angela’s. The scar will be photographed before and after the operation.’

  She said, ‘The injection of fat you mentioned, what kind of fat?’

  ‘Yours. Harvested by syringing it from your stomach.’

  Of course, she thought, a silly question.

  He said, ‘When were you thinking of having it done? I have private beds at St Angela’s, or you could come to Cheverell Manor, my clinic in Dorset, if you prefer to be out of London. The earliest date I can offer you this year is Friday the 14th of December. That would have to be at the Manor. You would be one of only two patients at that time, as I shall be running down the clinic for the Christmas break.’

  ‘I’d prefer to be out of London.’

  ‘Mrs Snelling will take you to the office after this consultation. My secretary there will give you a brochure about the Manor. How long you stay there is up to you. The stitches will probably come out on the sixth day and very few patients need or wish to stay post-operative for more than a week. If you do decide on the Manor, it’s helpful if you can find time for a preliminary visit either for a day or overnight. I like patients to see where they’re to be operated on if they can spare the time. It’s disconcerting to arrive at a totally strange place.’

  She said, ‘Is the wound likely to be painful, after the operation I mean?’

  ‘No, it’s unlikely to be painful. A little sore perhaps, and there may be considerable swelling. If there is pain we can deal with it.’

  ‘A bandage over my face?’

  ‘Not a bandage. A dressing which will be taped.’

  There was one more question and she had no inhibition in asking it although she thought she knew the answer. She wasn’t asking out of fear and hoped that he would understand this without greatly caring if he didn’t. ‘Would this be described as a dangerous operation?’

  ‘There is always some risk with a general anaesthetic. As far as the surgery is concerned, it will be time consuming, delicate and likely to present some problems. Those will be my responsibility, not yours. It would not be described as surgically dangerous.’

  She wondered whether he was implying that there might be other dangers, psychological problems arising from a complete alteration in appearance. She didn’t expect any. She had coped with the implications of the scar for thirty-four years. She would cope with its disappearance.

  He had asked whether she had any other questions. She said she had none. He rose and they shook hands, and for the first time he smiled. It transformed his face. He said, ‘My secretary will send you the dates when I can fit you in at St Angela’s for the tests. Will that present a problem? Will you be in London in the next two weeks?’

  ‘I’ll be in London.’

  She followed Mrs Snelling into an office at the rear of the ground floor where a middle-aged woman gave her a brochure about the facilities at the Manor and set out the cost, both of the preparatory visit which, she explained, Mr Chandler-Powell thought would be helpful to patients but which wasn’t, of course, obligatory, and the greater cost of the operation and a week’s postoperative stay. She had expected the price to be high but the reality was beyond her estimate. No doubt the figures represented a social rather than a medical advantage. She seemed to remember overhearing a woman say, ‘Of course, I always go to the Manor,’ as if this admitted her to a coterie of privileged patients. She knew she could have the operation under the NHS but there was a waiting list for non-urgent cases and she needed privacy. Speed and privacy, in all fields, had become an expensive luxury.

 
She was shown out within half an hour of arriving. There was an hour to spare before she was due at the Ivy. She would walk.

  4

  The Ivy was too popular a restaurant to ensure anonymity but social discretion, in all other areas important to her, had never worried her where Robin was concerned. In an age where notoriety required increasingly scandalous indiscretions, even the most desperate gossip page would hardly waste a paragraph on the disclosure that Rhoda Gradwyn, the distinguished journalist, was lunching with a man twenty years younger than herself. She was used to him; he amused her. He opened up for her areas of life which she needed, however vicariously, to experience. And she was sorry for him. It was hardly the basis for intimacy and on her part there was none. He confided; she listened. She supposed that she must be gaining some satisfaction from the relationship or why was she still willing to let him appropriate even a restricted area of her life? When she thought about the friendship, which was seldom, it seemed a habit which imposed no more arduous obligations than an occasional lunch or dinner at her expense, and which it would be more time consuming and awkward to end than to continue.

  He was waiting for her, as always, at his favourite table by the door, which she had booked, and as she entered she was able to observe him for half a minute before he raised his eyes from studying the menu and saw her. She was struck, as she always was, by his beauty. He himself seemed unconscious of it, yet it was difficult to believe that anyone so solipsistic could be unaware of the prize which genes and fate had bestowed on him or fail to take advantage of it. To an extent he had, but seeming hardly to care. She had always found it difficult to believe what experience had taught her, that men and women could be physically beautiful without also possessing some comparable qualities of mind and spirit, that beauty could be wasted on the mundane, the ignorant or the stupid. It was his looks, she suspected, which had helped gain Robin Boyton his place at drama school, his first engagements, his brief appearance in a television serial which promised much but ended after three episodes. Nothing ever lasted. Even the most indulgent or susceptible producer or director eventually became frustrated at lines not learnt, rehearsals not attended. When the acting failed, he pursued a number of imaginative initiatives, some of which might have succeeded had his enthusiasm lasted for more than six months. She had resisted his blandishments to invest in any of them and he took refusals without resentment. But refusals had never prevented him from trying again.

  He got to his feet as she approached the table and, holding her hand, kissed her decorously on the cheek. She saw that the bottle of Meursault for which she, of course, would pay was already in the cooler, a third of it drunk.

  He said, ‘Lovely to see you, Rhoda. How did you get on with the great George?’

  They never used endearments. Once he had called her darling but it was not a word he had ever dared to repeat. She said, ‘The great George? Is that what they call Chandler-Powell at Cheverell Manor?’

  ‘Not to his face. You look remarkably calm after your ordeal, but then you always do. What happened? I’ve been sitting here avid with anxiety.’

  ‘Nothing happened. He saw me. He looked at my face. We made an appointment.’

  ‘Didn’t he impress you? He usually does.’

  ‘His appearance is impressive. I wasn’t with him long enough to make a character assessment. He seemed competent. Have you ordered?’

  ‘Do I ever before you arrive? But I’ve concocted an inspired menu for both of us. I know what you like. I’ve been more imaginative than usual about the wine.’

  Studying the wine list, she saw that he had been imaginative also about the cost.

  They had hardly started on their first course when he introduced what was for him the purpose of the meeting. He said, ‘I’m looking for some capital. Not much, a few grand. It’s a first-rate investment opportunity, small risk – well, none really – and a guaranteed return. Jeremy estimates about ten per cent per annum. I wondered if you’d be interested.’

  He described Jeremy Coxon as his business partner. Rhoda doubted whether he had ever been more than that. She had only met him once and had found him garrulous but harmless and not without sense. If he had any influence over Robin it was probably for the good.

  She said, ‘I’m always interested in a no-risk investment with a guaranteed return of ten per cent. I’m surprised you’re not oversubscribed. What is it, this business you’re involved in with Jeremy?’

  ‘The same as I told you about when we had dinner in September. Well, things have moved on since then, but you remember the basic idea? It’s really mine not Jeremy’s, but we’ve worked on it together.’

  ‘You mentioned that you and Jeremy Coxon were thinking of setting up some classes on etiquette for the newly rich who are socially insecure. Somehow I can’t see you as a teacher – or indeed as an expert on etiquette.’

  ‘I mug it up from books. It’s surprisingly easy. And Jeremy is the expert so he has no trouble.’

  ‘Couldn’t your social incompetents get it from books themselves?’

  ‘I suppose they could but they like the human touch. We give them confidence. That’s what they’re paying for. Rhoda, we’ve identified a real market opportunity. A lot of young people – well, young men mainly, and not only the rich – worry that they don’t know what to wear for particular occasions, what to do if they’re taking a girl out to a good restaurant for the first time. They’re unsure about how to behave in company, how to impress the boss. Jeremy has this house in Maida Vale which he bought with the money a rich aunt left him, so we’re using it at present. We have to be discreet, of course. Jeremy isn’t sure it can legitimately be used for business. We live in fear of the neighbours. One of the ground-floor rooms is set up as a restaurant and we use play-acting. After a bit, when they’ve got confidence, we take the clients to a genuine restaurant. Not this place, but others not too downmarket which give us special rates. The clients pay, of course. We’re doing pretty well and the business is growing, but we need another house, or at least a flat. Jeremy is fed up with giving up virtually his ground floor and having these odd characters turning up when he wants to entertain his friends. And then there’s the office. He’s had to adapt one of the bedrooms for that. He’s getting three-quarters of the profits because of the house but I know he feels it’s time I paid him my share. Obviously we can’t use my place. You know what the flat’s like, hardly the ambiance we’re looking for. Anyway, I may not be there for long. The landlord’s becoming very disobliging about the rent. Once we get a separate address we’ll be forging ahead. Well, what do you think, Rhoda? Interested?’

  ‘Interested in hearing about it. Not interested in parting with any money. But it could succeed. It’s more reasonable than most of your previous enthusiasms. Anyway, good luck.’

  ‘So the answer’s no.’

  ‘The answer’s no.’ She added on impulse, ‘You must wait for my will. I prefer to dispose of my charity after death. It’s easier to contemplate parting with money when you’ll have no further use for it yourself.’

  She had left him twenty thousand pounds in her will, not sufficient to finance one of his more eccentric enthusiasms but enough to ensure that relief at being left anything would survive disappointment at the amount. It gave her pleasure to watch his face. She felt a small regret, too close to shame to be comfortable, that she had mischievously provoked and was enjoying his first flush of surprise and pleasure, the gleam of greed in his eyes and then the swift descent into realism. Why had she bothered merely to confirm once again what she already knew about him?

  He said, ‘You’ve definitely decided on Cheverell Manor, not one of Chandler-Powell’s private beds at St Angela’s?’

  ‘I prefer to be out of London where there’s a greater chance of peace and privacy. I’m making a preliminary overnight stay on the 27th. Apparently that’s on offer. He likes his patients to be familiar with the place before he operates.’

  ‘He likes the money, too.’


  ‘So do you, Robin, so don’t be censorious.’

  Keeping his eyes on his plate, he said, ‘I’m thinking of visiting the Manor while you’re in residence. I thought you’d welcome a gossip. Convalescence is madly boring.’

  ‘No, Robin, I won’t welcome a gossip. I booked into the Manor specifically to ensure I’ll be left alone. I imagine the staff there will see to it that I’m undisturbed. Isn’t that the whole purpose of the place?’

  ‘That’s rather grudging of you, considering I recommended the Manor to you. Would you be going there if it weren’t for me?’

  ‘As you’re not a doctor and have never had cosmetic surgery, I’m not sure what your recommendation would be worth. You have mentioned the Manor occasionally, but that’s all. I had already heard of George Chandler-Powell. As he’s recognised as one of the six best plastic surgeons in England, probably in Europe, and cosmetic surgery is becoming as fashionable as health farms, that’s hardly surprising. I looked him up, compared his record, took expert advice and chose him. But you haven’t told me what your connection is with Cheverell Manor. I’d better know in case I mention casually that I know you and am met with stony stares and relegation to the worst bedroom.’

  ‘That could happen. I’m not exactly their favourite visitor. I don’t actually stay in the house – that would be going a bit far for both parties. They’ve got a cottage for visitors, Rose Cottage, and I book in there. I have to pay, too, which I think is a bit much. They don’t even send over the food. I don’t usually get a vacancy in summer but they can hardly claim the cottage isn’t free in December.’

  ‘You said you were some kind of relation.’

  ‘Not of Chandler-Powell. His surgical assistant, Marcus Westhall, is my cousin. He assists with the operations and looks after the patients when the great George is in London. Marcus lives there with his sister, Candace, in the other cottage. She doesn’t have anything to do with the patients; she helps in the office. I’m their only living relation. You’d have thought that that would mean something to them.’

 

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