The Private Patient

3

The cab ride was quicker than she had expected. She arrived too early at Harley Street and asked the driver to stop at the Marylebone Road end of the street, then walked to her appointment. As on the rare occasions when she had passed this way, she was struck by the street's emptiness, the almost uncanny calm which hung over these formal eighteenth-century terraces. Almost every door bore a brass plate with a list of names confirming what surely every Londoner would know, that this was the hub of medical expertise. Somewhere behind these gleaming front doors and discreetly curtained windows patients must be waiting in various stages of anxiety, apprehension, hope or despair, yet she seldom saw any of them arriving or departing. The occasional tradesman or messenger would come and go, but otherwise the street could have been an empty film set, awaiting the arrival of director, cameraman and players.

Arriving at the door, she studied the panel of names. There were two surgeons and three physicians, and the name she expected to see was there at the top. Mr G. H. Chandler-Powell, FRCS, FRCS (Plast), MS - the last two letters which proclaimed that a surgeon had reached the summit of expertise and reputation. Master of Surgery. It had, she thought, a fine ring to it. The barber-surgeons awarded their licences by Henry VIII would be surprised to know how far they had come.

The door was opened by a serious-faced young woman in a white coat cut to compliment her figure. She was attractive but not disconcertingly so, and her brief welcoming smile was more minatory than warm. Rhoda thought, Head girl. Girl Guide patrol leader. There was one in every sixth form.

The waiting room into which she was shown so matched her expectations that momentarily she had the impression that she had been there before. It managed to achieve a certain opulence while containing nothing of real quality. The large central mahogany table, with its copies of Country Life, Horse and Hounds and the more upmarket women's magazines so carefully aligned as to discourage reading, was impressive but not elegant. The assorted chairs, some upright, others more comfortable, looked as if they had been acquired in a country-house sale but had seldom been used. The hunting prints were large and undistinguished enough to inhibit theft and she doubted whether the two high-baluster vases on the mantelpiece were genuine.

None of the patients except herself gave any clue to the particular expertise they required. As always, she was able to observe them knowing that no curious eyes would be fixed for long on her. They glanced up as she entered but there were no brief nods of acknowledgement. To become a patient was to relinquish a part of oneself, to be received into a system which, however benign, subtly robbed one of initiative, almost of will. They sat, patiently acquiescent, in their private worlds. A middle-aged woman, a child in the chair beside her, gazed expressionlessly into space. The child, bored, restless eyed, began gently knocking her feet against the chair legs until, without looking at her, the woman put out a restraining hand. Opposite them a young man who looked in his formal suit the epitome of a City financier took the Financial Times from his briefcase and, unfolding it with practised expertise, concentrated his attention on the page. A fashionably dressed woman moved silently to the table and studied the magazines then, rejecting the choice, returned to her seat next to the window and continued her stare at the empty street.

Rhoda was not kept waiting for long. The same young woman who had let her in came over to her, speaking softly and saying that Mr Chandler-Powell could see her now. With his speciality, discretion obviously started in the waiting room. She was shown into a large, light room across the hall. The two tall double windows facing the street were curtained in heavy linen and with white, almost transparent net softening the winter sunlight. The room had none of the furniture or equipment she had half-expected, a drawing room rather than an office. An attractive lacquer screen decorated with a rural scene of meadows, river and distant mountains stood in the angle to the left of the door. It was obviously old, possibly eighteenth century. Perhaps, she thought, it concealed a washbasin or even a couch, although this seemed unlikely. It was difficult to imagine anyone taking his or her clothes off in this domestic if opulent setting. There were two armchairs, one each side of the marble fireplace, and a mahogany pedestal desk facing the door, two upright chairs before it. The only oil picture was over the mantelpiece, a large painting of a Tudor house with an eighteenth-century family carefully grouped in front of it, the father and two sons mounted, the wife and three young daughters in a phaeton. On the opposite wall was a row of coloured prints of eighteenth-century London. They and the oil added to her sense of being subtly out of time.

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...