The Private Patient

by P. D. James

  ‘Not so easily now, and I’m not proposing to waste my talent. I’m going to Africa.’

  ‘To get away from me.’

  ‘No, Eric, to get away from myself.’

  ‘You’ll never do that; never, never!’ Eric’s tears, the slamming of the door were the final memory.

  He had been staring at the altar so intently that the cross seemed to blur and become a moving fuzz. He shut his eyes and breathed the damp, cold smell of the place, felt the hard wood of the bench against his back. He remembered the last major operation he had assisted at in St Angela’s, an elderly NHS patient whose face had been savaged by a dog. She was already sick and, given her prognosis, there must only have been a year of life at most to save, but with what patience, what skill George had put together over long hours a face that could bear the unkind scrutiny of the world. Nothing was ever neglected, nothing hurried or forced. What right had George to waste that commitment and skill even for three days a week on wealthy women who disliked the shape of nose, or mouth, or breast, and who wanted the world to know that they could afford him? What was so important to him that he could spare time on work a lesser surgeon could do, and do as well?

  But to leave him now would still be a betrayal of a man he revered. Not to leave him would be a betrayal of himself and of Candace, the sister who, loving him, knew that he had to break free and urged him to have the courage to act. She herself had never lacked courage. He had slept at Stone Cottage and spent enough time there during his father’s last illness to have gained some idea of what she had to bear during those two years. And now she was left with her job ended, no other in sight, and the prospect of his leaving for Africa. It was what she wanted for him, had worked for and encouraged, but he knew it would leave her lonely. He was planning to desert the two people who loved him – Candace and Eric – and George Chandler-Powell, the man he most admired.

  His life was a mess. Some part of his nature, timid, indolent, lacking in confidence, had led him into this pattern of indecision, of leaving things to sort themselves out, as if he put his faith in a benevolent providence which would operate on his behalf if left alone. In the three years he had spent at the Manor, how much of that was loyalty, gratitude, the satisfaction of learning from a man at the top of his profession, not wanting to let him down? All those had played a part, but essentially he had stayed because it was easier than facing up to the decision to leave. But he would face up to it now. He would break away, and not only physically. In Africa he could make a difference, more profound, more lasting than anything he had done at the Manor. He had to do something new, and if this were running away, he would be running away to people who desperately needed his skills, to wide-eyed children with appalling and untreated harelips, to the victims of leprosy who needed to be accepted and made whole, to the scarred, the disfigured and the rejects. He needed to smell a stronger air. If he didn’t face Chandler-Powell now he would never have the courage to act.

  He got up stiffly and walked like an old man to the door, then after pausing a moment, stepped with resolution towards the Manor like a soldier going into battle.

  10

  Marcus found George Chandler-Powell in the operating suite. He was alone and occupied in counting a new delivery of instruments, examining each carefully, turning it over in his hand and replacing it in its tray with a kind of reverence. This was a job for an operating department assistant, and Joe Maskell would arrive at seven o’clock next morning to prepare for the first operation of the day. Marcus knew that checking the instruments didn’t mean that Chandler-Powell had little confidence in Joe – he employed no one whom he couldn’t trust – but here he was at home with his two passions, his work and his house, and now he was like a child picking over his favourite toys.

  Marcus said, ‘I wanted to have a word with you, if you’ve got time.’

  Even to his own ears his voice sounded unnatural, oddly pitched. Chandler-Powell didn’t look up. ‘That depends on what you mean by a word. A word or a serious talk?’

  ‘I suppose a serious talk.’

  ‘Then I’ll finish here and we’ll go to the office.’

  For Marcus there was something intimidating in the suggestion. It was too reminiscent of boyhood summonses to his father’s study. He wished he could speak now, get it over with. But he waited until the last drawer was shut and George Chandler-Powell led the way out of the door into the garden, through the back of the house and the hall, to the office. Lettie Frensham was seated at the computer but, as they entered, she muttered a low apology and quietly left. Chandler-Powell sat down at the desk, motioned Marcus to a chair and sat waiting. Marcus tried to convince himself that the silence wasn’t a carefully controlled impatience.

  Since it seemed unlikely that George would speak first, Marcus said, ‘I’ve come to a decision about Africa. I wanted to let you know that I’ve finally made up my mind to join Mr Greenfield’s team. I’d be grateful if you could release me in three months’ time.’

  Chandler-Powell said, ‘I take it you’ve been to London and spoken to Mr Greenfield. No doubt he pointed out some of the problems, your future career among them.’

  ‘Yes, he did all that.’

  ‘Matthew Greenfield is one of the best plastic surgeons in Europe, probably among the six best in the world. He’s also a brilliant teacher. We can take his qualifications for granted – FRCS, FRCS (Plast), Master of Surgery. He goes to Africa to teach and to set up a centre of excellence. That’s what Africans want, to learn how to cope for themselves, not to have white people going in to take over.’

  ‘I wasn’t thinking of taking over, just of helping. There’s so much to be done. Mr Greenfield thinks I could be useful.’

  ‘Of course he does; he wouldn’t otherwise want to waste his time or yours. But what exactly do you think you’re offering? You’re an FRCS and a competent surgeon, but you’re not qualified to teach, nor even to cope unaided with the most complicated cases. And even a year in Africa will interfere seriously with your career – that is if you see yourself as having one. It hasn’t been helpful to you staying here and I pointed that out when you first came. This new MMC – Modernising Medical Careers – makes training schemes far more rigid. Housemen have become foundation-year doctors – and we all know what a mess the government have made there – senior house officers are out, registrars are specialist surgical trainees, and God knows how long all this will last before they think of something else, more forms to fill in, more bureaucracy, more interference with people trying to get on with their jobs. But one thing’s certain, if you want to make a career in surgery, you need to be on the training scheme, and that’s become pretty inflexible. It might be possible to get you back on stream and I will try to help, but it won’t be if you’re gadding off to Africa. And it’s not as if you’re going from religious motives. I wouldn’t sympathise if you were but I could understand – well, if not understand, accept. There are people like that, but I have never thought of you as particularly devout.’

  ‘No, I don’t think I could claim to be.’

  ‘Well, what are you claiming? Universal beneficence? Or postcolonial guilt? I understand that’s still popular.’

  ‘George, there’s useful work for me to do. I’m not claiming anything except this strong conviction that Africa would be right for me. I can’t stay here indefinitely, you said that yourself.’

  ‘I’m not asking you to. I’m just asking you to consider carefully which way you want your future career to go. That is, if you want a career in surgery. But I’m not going to waste breath trying to persuade you if you’ve made up your mind. I suggest you think it over, and for the present I’ll take it that I shall need a replacement for you in three months’ time.’

  ‘I know it will be inconvenient for you and I’m sorry about that. And I know what I owe you. I am grateful. I’ll always be grateful.’

  ‘I don’t think you need to bleat on about gratitude. That’s never an agreeable word between colleagues. We
’ll take it that you’ll leave in three months’ time. I hope you find in Africa whatever it is you’re looking for. Or is it a case of finding relief from whatever it is you’re running away from? And now, if that’s all, I’d like the use of my office.’

  There was one other thing and Marcus steeled himself to say it. Words had been spoken which had destroyed a relationship. Nothing could be worse. He said, ‘It’s about a patient, Rhoda Gradwyn. She’s here now.’

  ‘I know that. And she’ll be back again in two weeks for her operation, unless she takes a dislike to the Manor and opts for a bed at St Angela’s.’

  ‘Wouldn’t that be more convenient?’

  ‘For her or for me?’

  ‘I was wondering whether you really want to encourage investigative journalists at the Manor. And if one comes, others may follow. And I can imagine what Gradwyn will write. Rich women spending a fortune because they’re dissatisfied with how they look. Valuable surgeons’ skills which could be better used. She’ll find something to criticise, that’s her job. Patients rely on our discretion and expect an absolute confidentiality. I mean, isn’t that what this place is about?’

  ‘Not altogether. And I don’t intend to distinguish between patients on any grounds other than medical need. And frankly I wouldn’t lift a finger to muzzle the popular press. When you consider the machinations and deviousness of governments we need some organisation strong enough to shout occasionally. I used to believe that I lived in a free country. Now I have to accept that I don’t. But at least we have a free press and I’m willing to put up with a certain amount of vulgarity, popularisation, sentimentality and even misrepresentation to ensure it remains free. I suppose Candace has been getting at you. You’d hardly have thought this up on your own. If she has personal reasons for her antagonism to Miss Gradwyn she need have nothing to do with her. She’s not required to, the patients are not her concern. She doesn’t need to see her either now or when she returns. I don’t select my patients to oblige your sister. And now, if you’ve nothing else to say, I’m sure both of us have work to do. I know I have.’

  He got up and stood at the door. Without another word Marcus walked past him, brushing George’s sleeve, and left. He felt like an incompetent servant, discharged in disgrace. This was the mentor he had revered, almost worshipped, for years. Now with horror he knew that what he felt was close to hatred. A thought, almost a hope, disloyal and shameful, took hold of his mind. Perhaps the west wing, the whole enterprise, would be forced to close if there were a disaster, a fire, infection, a scandal. If the supply of wealthy patients dried up, how could Chandler-Powell carry on? He tried to shut his mind against the most shameful imaginings but they were unstoppable even, to his disgust, the most shameful and terrible of all, the death of a patient.

  11

  Chandler-Powell waited until Marcus’s footsteps had faded then left the Manor to see Candace Westhall. He hadn’t intended to spend this Wednesday becoming embroiled in arguments with either Marcus or his sister, but now that a decision had been made it would be as well to see what Candace had in mind. It was going to be a nuisance if she too had decided to leave but presumably, now that her father was dead, she would want to return to her university post for the next term. Even if that wasn’t the plan, her job at the Manor, taking over from Helena when Helena was in London and helping out in the office, was hardly a career. He disliked interfering in the domestic management of the Manor but if Candace now intended to leave, the sooner he knew the better.

  He walked up the lane to Stone Cottage in the fitful winter sunshine and, approaching, saw that there was a dirty sports car parked outside Rose Cottage. So the Westhalls’ cousin, Robin Boyton, had arrived. He remembered that Helena had said something about his visit with a marked lack of enthusiasm which, he suspected, was shared by both the Westhalls. Boyton tended to book the cottage at short notice, but as it was vacant, Helena obviously had found it difficult to refuse him.

  He was always interested in how different Stone Cottage had looked since Candace and her father had arrived some two and a half years previously. She was an assiduous gardener. Chandler-Powell suspected that it had been one legitimate excuse for getting away from Peregrine Westhall’s bedside. He had only visited the old man twice before his death, but he knew, as he suspected did the whole village, that he was a selfish, demanding and unrewarding patient to care for. And now that he was dead and Marcus about to leave England, no doubt Candace, released from what must have been servitude, would have her own plans for the future.

  She was raking the back lawn, wearing her old tweed jacket, corduroy trousers and boots which she kept for gardening, her strong dark hair covered by a woollen cap pulled down to her ears. It emphasised the stark resemblance to her father, the dominant nose, the deep-set eyes under straight bushy brows, the length and thinness of the lips, a forceful uncompromising face which, with the hair concealed, looked androgynous. How oddly the Westhall genes had fallen so that it was Marcus, not she, in whom the old man’s features were softened into an almost feminine gentleness. Seeing him, she propped the rake against a tree trunk and came to meet him. She said, ‘Good morning, George. I think I know why you’ve come. I was just going to break for coffee. Come in, will you.’

  She led him through the side door, the one commonly used, into the old pantry which, with its stone walls and floor, looked more like an outhouse, a convenient dump for worn-out equipment, dominated by a Welsh dresser hung with a miscellany of mugs and cups, bundles of keys and a variety of plates and dishes. They moved to the adjoining small kitchen. It was meticulously tidy but Chandler-Powell told himself that it was time something was done to enlarge and modernise the place, and wondered that Candace, reputed to be a good cook, hadn’t complained about it.

  She switched on a coffee percolator and took down two mugs from the cupboard, and they stood in silence until the coffee was ready. She had collected a jug of milk from the refrigerator and they passed into the sitting room. Seated opposite her at a square table, he thought again how little had been done to the cottage. Most of the furniture was hers, taken from store, some pieces enviable, others too large for the space. Three walls were lined with wooden bookshelves brought to the cottage by Peregrine Westhall as part of his library when the old man had moved from his nursing home. The library had been bequeathed by him to his old school and the books thought worth preserving had been collected, leaving the walls honeycombed with empty spaces on which the unwanted volumes fell against each other, sad symbols of rejection. The whole room had an air of impermanence and loss. Only the cushioned settle at right angles to the fireplace gave promise of comfort.

  He said without preamble, ‘Marcus has just given me the news that he’s leaving for Africa in three months. I’m wondering how far you influenced that not very intelligent plan.’

  ‘You’re not suggesting that my brother isn’t capable of making his own decisions about his life?’

  ‘He can make them. Whether he feels free to carry them out is something else. Obviously you influenced him. It would be surprising if you hadn’t. You’re older by eight years. With your mother an invalid for most of his childhood, it’s not surprising that he listens to you. Didn’t you more or less bring him up?’

  ‘You seem to know a great deal about my family. If I did influence him it’s been to encourage him. It’s time he left. I can see it’s inconvenient for you, George, and he’s sorry about that, we both are. But you’ll find someone else. You’ve known about this possibility for a year now. You must have a replacement in mind.’

  She was right, he had. A retired surgeon in his own field, highly competent if not brilliant, who would be glad to assist for three days a week. He said, ‘That isn’t what concerns me. What does Marcus propose? To stay in Africa permanently? That hardly seems feasible. To work there for a year or two and then come home? To what? He needs to think very clearly about what he wants to do with his life.’

  Candace said, ‘So do we all. He
has thought. He’s convinced this is something he has to do. And now that probate has been granted for Father’s will, the money’s there. He won’t be a burden in Africa. He won’t go empty handed. You surely understand one thing, the need to do what every instinct of your body tells you is ordained for you. Haven’t you lived your life like that? Don’t we all at some time or another make a decision which we know is absolutely right, the assurance that some enterprise, some change, is imperative? And even if it fails, to resist it will be a greater failure. I suppose some people would see that as a call from God.’

  ‘In Marcus’s case it seems to me more like an excuse for running away.’

  ‘But there’s a time for that too, for escape. Marcus needs to get away from this place, from the job, from the Manor, from you.’

  ‘From me?’ It was a quietly spoken response, without anger, as if this was a suggestion he needed to think over. His face gave nothing away.

  She said, ‘From your success, your brilliance, your reputation, your charisma. He has to be his own man.’

  ‘I wasn’t aware that I was stopping him from being his own man, whatever that means.’

  ‘No, you aren’t aware. That’s why he has to go and I have to help him.’

  ‘You’ll miss him.’

  ‘Yes, George, I’ll miss him.’

  He said, anxious not to sound intrusively curious but needing to know, ‘Will you want to stay on here for a time? If you do, I know Helena will be glad of help. Someone has to take over when she makes her trips to London. But I suppose you’ll want to get back to the university.’

  ‘No, George, that isn’t possible. They’ve decided to shut down the Classics Department. Not enough applicants. And they’ve offered me a part-time job in one of the new departments they’re setting up – Comparative Religion or British Studies, whatever that may mean. As I’m not competent to teach either, I shan’t be returning. I’m happy to stay on here for at least six months after Marcus leaves. In nine months I should have made up my mind what I’m going to do. But with Marcus gone I can’t justify continuing to live here rent free. If you’ll accept some rent, I’d be grateful to have this place until I’ve settled where I’ll go.’