by Lucy Dawson
‘Oh my word! He must have come in to dot the i’s and cross the t’s before he leaves!’ Joan clutches her chest. ‘The little lamb!’
‘He didn’t have to do it in person,’ Tan points out. ‘I know they like to see you, but he could have got away with an email.’
Joan frowns. ‘You have to have closure, Tan! It’s healthy.’
No. Tan’s right. He has to have the last word. That’s what this is. He’s learnt nothing.
It’s as if he hears what I’ve just thought. Nathan suddenly stops, turns and looks up directly at the office, smiles… and blows a kiss.
‘Oh bless him, blowing me kisses!’ Joan says firmly – before blowing him one back. ‘You take care, my sweetheart!’
I open my mouth to point out that he can’t see in through the glass. The lights aren’t on. He has no clue if she’s here or not, but that would be unkind.
Michelle drops back quietly as Tan pointedly walks away too. Joan looks over her shoulder then whispers to me, ‘I destroyed the photo. Nathan asked me to. We’ll say no more about it, all right? I didn’t tell a soul, just so you know. To have loved and lost, Julia. To have loved and lost…’ She squeezes my hand, spins on her heels and leaves.
What on earth did he?… I twist back. He’s still there, staring right up at me, but no longer smiling.
He can’t see me! I turn my back on him, furiously. I’ve got work to do.
Fifty
Nathan
I wait until I’ve driven several streets away from the hospital before I pull over, gasping, and cover my mouth with my hand. What if that really is it? What if I never go back there again? I close my eyes and see Julia stood in the office doorway, handing over the coffee she bought me. Smiling gently.
I am at sea. I don’t know how to be this person… all of my mooring ropes have been cut overnight. Surgeon, best friend, father, husband… this time tomorrow I won’t even be in this country. I’ll be climbing the three steps to my parent’s picture-perfect Queen Anne shingle home. Crossing the porch to knock on the door; a moment I used to fantasise about all the time.
My phone rings and I glance down at it. Stefanie. I decline her call and instead open my photos. I find the one that Hamish took at the beach. I’ve permanently cropped it so that Julia pushing me away is not visible. Now we are simply kissing. Tears flood my eyes and I have to blink them away so I can see the picture properly.
I’ve not even left yet and all I want to do is come home.
*
Nine Months Later
September 2018
Fifty-One
Julia
‘Excuse me… Julia?’ One of the sparkier female students who has hung back at the end of the tutorial approaches me. I can see that using my first name is a bit uncomfortable for her, but debunking the hierarchy and pseudo-importance of ‘Mr’ and ‘Dr’ as early as possible in an educational setting is so important. ‘I just wanted to say that was really interesting, thank you. Can I ask, though – don’t you miss clinical practise?’
I smile. ‘Thank you, and no – I don’t. The change has been good for me – plus, this way I get to shape and define the programme you’re studying!’
She wrinkles her nose and I laugh. She reminds me of Cass: incapable of hiding her feelings.
‘But my real driver is to change outcomes for all patients by doing my research here,’ I continue. ‘I’ve got some exciting stuff coming up. I’ll tell all of you about it next week.’ I hold the door open for her. ‘Have a good weekend.’
She grins and bounces out, like Tigger, calling cheerfully over her shoulder. ‘You too!’
I’d like some of her energy for the drive home. I am tired. Turning to my desk to pack up my things, I glance out over the faculty lawns, where plenty of the students are relaxing in the late afternoon sunshine, enjoying the Indian summer and planning their Friday night. I should get going or the M5 is going to be a killer – but as I’m shutting down my laptop, my phone buzzes with a message from Tan. The inquest into Hamish’s death has just concluded. Thankfully, we were allowed to supply statements to the coroner rather than attend in person to hear her rule that Hamish’s death was a result of unavoidable complications from a subdural hematoma. He tripped and hit his head on the side of the desk. No one was to blame. Just one of those freak occurrences.
A tragic accident…
Unlike most texts when it’s hard to gauge a sense of tone, Tan’s implication is clear. I send him a ‘X’ to acknowledge his message. I’ll call him over the weekend. I hope he’s OK. I’m just glad he wasn’t forced into a face to face with Nathan, who we were both shocked to discover yesterday, is now permanently back in the UK and working for one of the London Trusts. Broaching this news with Storm – I have no idea if she knows – is also on my to-do list this weekend.
It’s mercifully a clear run home. Before long, green fields start to flash past me; the early evening sun is high and bright enough to need sunglasses, but even with them on, I’m still frowning, trying to focus my mind on something other than Hamish. The air is warm and I’ll be home in time to help Ewan fix tea. We can eat outside in the garden. I flip around the radio stations in search of songs I can turn up loud, which will drum the thought of Nathan being back in this country and seeing patients – asking them politely to slip off their things, placing his hands on them – out of my head. I do not want to think about him.
It’s a choice of Friday night request shows: callers ringing up to talk about their weekend plans for birthdays and barbeques. I force myself to sing along to a couple of classic songs, windows wound down. I fancy heading to the beach tomorrow with Ewan, as it’s just the two of us. Al will be with Dom at the flat and Cass is at Ben’s for his birthday… but try as I might, I keep coming back to the Exeter Memorial Hospital; Hamish shouting at me and Michelle…
I will message her too later, to let her know I’m thinking of her. I think of her often. Her mug has pride of place on my desk, and lots of my students remark on it. Sometimes it sparks some interesting discussions. On my first day at the university, when I was hiding in my office ahead of giving my first lecture, terrified and wondering how on earth I ever thought I could upstream into academia, Michelle messaged me to wish me ‘happy joint-first-new-job day!’, adding she knew I was going to be brilliant, she wished she’d had teachers like me.
I got my act together after reading that and did the lecture. I have no doubt now that I made the right decision to stop practising medicine to research and teach it instead.
I pull up outside the house and let myself in. ‘Hi gang! I’m home!’ I try to sound cheery, slinging my bag down, and wander into the kitchen, to find Holly sitting at the table with Ewan, still in her scrubs.
‘Hello!’ I’m surprised and pleased to see her, although my next thought is that I must have forgotten some plans we made, but then Ewan pulls out a chair for me and places a glass of wine on the table in readiness.
‘What’s wrong?’ I walk over slowly and sit down. Ewan leaves the room, closing the door gently behind him, and my friend reaches out to take my hand in hers.
‘This afternoon I removed a woman’s encapsulated breast implants.’ She holds my worried gaze steadily. ‘She came in as an emergency: sepsis symptoms. I went down to see her after she’d consented but before the op, because she was in a right old state – more than just feeling like complete shit – there was obviously something else. So I asked her if there was anything she wanted to discuss with me, as she seemed really distressed. I got the husband out of the room, in case there was something going on there, and the second he was gone, she made me promise to tell her afterwards if there was anything unusual about the implants. She said she was “very detail orientated” because she’s a barrister.’
I gasp.
‘YES!’ Holly exclaims, ‘Stefanie!’
I cover my mouth with my hands.
‘I know! So now I’m looking at her and thinking about the horrendous story my new fr
iend told me when I first arrived at the hospital, about the insane male surgeon she used to work alongside, who told my friend he’d written clues on the breast implants of living patients – one of whom was a local barrister he was shagging on the side. Anyway, we got her into theatre. Julia…’ Holly leans forward and squeezes my hand more tightly. ‘The left implant has a bloody great letter F on it. He did it – the bastard absolutely did it.’
I think of Alex lying on a mattress in a small dark cinema, under a blank screen, taped up, trusting Nathan to return… the skin of my back tightens, sending a rush of sensation up my spine that reaches over my shoulders and around my neck, before I briefly taste vomit I manage to swallow down. Nathan meant every word that he said to me.
‘I bet there are five other women out there somewhere with letters written inside them too. I took a photo of the implant. Look!’ She passes me the phone, and there it is. A clear ‘F’ – for Fowles.
‘Oh, love!’ She gets up and puts her arm round my shoulders. ‘Cry because of what you know he was fully intending to do, but then we get strong, OK? We’re going to hold him accountable, even if he is in America!’
I stare at Nathan’s handwriting on the bloodied, misshapen implant. He did this to a woman he was sleeping with; sliced into her and hid a clue in her body. He took my child and hid him. He filmed female patients undressed. He is at his most dangerous when someone is in an acutely vulnerable state – anesthetised, naked, alone – around him. It’s as if he has a compulsion to abuse their trust. ‘He’s back working in London. I found out yesterday.’
Holly is astonished. ‘What? Wow – that says it all, doesn’t it? You’d think he had the sense to slink off quietly, thank his lucky stars and stripes and stay put. The arrogance of the man!’
I shake my head. ‘We should probably be more surprised that he stayed there as long as he did. It’s not in his nature to be told what to do – especially by women.’
‘Well, bad luck him, because times are changing.’ She squeezes my hand again. ‘Times are changing.’
Fifty-Two
The Independent, 25 September 2019
A plastic surgeon who recklessly and excessively handled the breast implants of two patients, was today found guilty of Actual Bodily Harm at Plymouth Crown Court and sentenced to an eighteen-month suspended sentence. The court heard how Nathan Sloan, 51, removed the implants from sterile conditions in December 2017, marked them with surgical pen and, in one instance, returned them to containers open to bacterial contamination. The hazardous implants were then inserted into the bodies of two anaesthetised patients during private surgery. Sloan’s actions came to light when the first of the implants was removed in September 2018, by an NHS surgeon, after one of the women required emergency surgery. The surgeon dealing with the follow-up procedure noticed the unusual pen mark. Prosecutors argued that there was no clinical reason for Sloan to deface the implants, and in doing so he had knowingly and recklessly caused the two women harm by exposing them to serious infection risk.
Mr Sloan tendered his resignation from the Exeter Memorial Hospital in January 2018 before moving temporarily to Boston in the USA, returning to work for the NHS in London in August 2018. There is no suggestion any improper conduct occurred at any NHS hospital.
Carolyn Merrit QC, prosecuting, said the two surgeon’s victims felt ‘violated’ and one of them, referred to in court as Patient A, having already had breast cancer, was left suffering from psychological harm. The court heard a nurse from Sloan’s private practice witnessed Sloan mark three implants with surgical pen during surgery on Thursday, 20 December and Friday, 21 December 2017. She questioned the markings – a letter O, W and F. Sloan told her the letter ‘O’ was to assist him in ‘orientating’ the implant, and during the second procedure told her he ‘didn’t trust’ the efficacy of the national database and was considering creating an informal record of ‘my girls’ so that he could ‘identify them and look after them if anything went wrong at a later date’. She assisted Mr Sloan again on the morning of Patient B’s surgery on Friday, 21 December 2017 and did not see him mark any implants, concluding that Sloan ‘must have done it before the surgery started, put them back in their boxes and put them in the patients so that I couldn’t see the letter on them’.
Mr Sloan denied that he had, over his twenty-five-year career, potentially marked hundreds of women, creating what Ms Merrit referred to as ‘an astonishing “club” that not one woman had given her consent or any indication of her wish to join’. He also denied that he had on any occasion intended the markings to create any form of ‘possession, message, clue, mission statement, manifesto or plan’, describing the assignation of any letters as ‘a completely arbitrary index’ as denoted by the letter marked on the implant of Patient A being a random ‘F’ and the letter marked on Patient B a random ‘O’.
The Judge, Nicolas Fremantle QC, told Sloan: ‘You have been unable to provide any satisfactory evidence of the indexing system you say was your explanation for marking Patients A and B, and that this action took place at a private hospital rather than an NHS one, where it would have been almost impossible for you to remove the implants from sterile conditions without raising the alarm, as a serious deviation from normal procedure, is noted.
‘The court has heard evidence of your sexual relationships with both former patients and female staff at the hospitals you worked at, in a position of power. These relationships, while consensual were certainly inappropriate. That it may have been your intention to construct some sort of code hidden within one of these women – as was alleged to the General Surgery Clinical Lead at the EM Hospital, Exeter and the police in January 2018 – as part of a dubiously motivated “plan” to withhold information relating to the whereabouts of a colleague’s missing child, for your own personal and possibly sexual gratification – is deeply disturbing. You insist no such plan ever really existed, but you are a man who likes to tell stories. It is my belief you have told yourself a story in this instance which belies your actions as an accomplished liar and manipulator.
‘You are also a man who likes to demonstrate ownership, Mr Sloan – from your wife’s tattoo of your initials on her wedding finger, to the “smiley faces” you draw on patients’ skin, to the letters on implants.
‘I am satisfied, therefore, that your actions were reckless but premeditated, and not without risk of which – the court has also heard – you were fully aware, having discussed your typical approach to the insertion of implants on a separate occasion as “I did what I always did; out of sterile conditions, straight into her. No messing”. These women were not “your girls”, Mr Sloan. They do not belong to you despite your actions demonstrating you believed they did. You abused their trust in one of the most important relationships in society, that of patient and doctor.’
In a private hearing, the Medical Practitioners Tribunal Service found that Sloan had ‘failed to demonstrate any insight into the damage caused to both his victims and the reputation of the health service as a whole’. The disgraced surgeon was removed from the medical register with immediate effect.
The Goldtree Hospital said Sloan had not worked for it since it changed ownership in March 2018.
Fifty-Three
Nathan
I was, of course, the only person in the courtroom capable of appreciating the irony that I had been found guilty of something I hadn’t done, but it’s frankly outrageous that the case made it to trial in the first place. I was told by at least one barrister he couldn’t even see what crime I had committed. The marks I made on the implants were to ensure the women’s safety! The world really has gone mad. We now prosecute innocent medical staff for showing the diligence patients are entitled and deserve to expect when placing themselves in our professional hands. I have been found guilty of taking too much care. I was genuinely incredulous when I was stopped – mid-surgery – and the allegations dear Stefanie had made were put to me, kicking off the second suspension of my career.
I actually thought, when they walked into theatre, that Storm must have found out I’d pulled in a few favours and come back. I reasoned that I must have misjudged how angry she could still be with me after eight months, before concluding that she’d shown my new Medical Director the screen grab after all and I was toast… but then they started blathering on about letters. I kept expecting them to produce the screen grab as time went on, but they didn’t… and finally the penny dropped that there was no screen grab. I admit I was pretty furious about that.
But the bit that hurt the most? Watching Julia stand there in court and under oath, tell everyone about my ‘plan’ to mark women with clues inside their bodies.
Who the hell would do a thing like that in real life? It was an absurd story, something I said in the heat of the moment; too far-fetched to be true even in the most idiotic of minds. Julia cannot have believed I meant it. Not really. She knows me better than that and yet she painted me as a monster. Her performance in the witness box was every bit as accomplished as I imagine she was during her trial. She certainly didn’t come across as a serial destroyer of male colleagues’ careers, maliciously whistleblowing for a second time. Hamish was right about that, in the end.
All three women worked together against me. It was a witch hunt. I could see it of Storm and Stefanie – but Julia? Her betrayal was devastating. I had hoped once I’d put in some credible time in the London Trust – and she’d seen that I could do it – perhaps we might have… talked. I looked right at her when my sentence was passed. We both knew that my being struck off was now inevitable. She had got what she wanted; I would no longer be able to practise.
