Faith

by Peter James

  Trying to maintain his composure he looked around carefully. No one was in view, apart from Susan Gilliatt with her back to him. He reached out, and moved a few of the dishes closer to each other.

  When the technician returned, he noted nothing amiss.

  54

  There were two floors of operating theatres at the Harley-Devonshire Hospital. On the third was a suite of smaller theatres for minor operations, and on the fourth, larger ones. Originally, the majority of the work carried out in the hospital had been cosmetic and reconstructive surgery, but the insurance company that owned it had invested in setting up the most modern ITU in London, directly below on the second floor, and there was now a lucrative general surgery practice, fuelled predominantly by the long-established wealthy Middle Eastern clientele, together with an increasing stream of new Russian money.

  Like all the theatres on the fourth floor, 4-2 had pale blue tiled walls, speckled terrazzo-tiled floors and a well-recessed scrub area. As befitted the prices charged for surgery here, everything in the theatre was state-of-the-art. The high-spec fittings included an internal sterilisation system up to NASA standards. The only way for a bug to get in here was by hitching a ride on a human.

  And right now a whole cluster of hostile creatures, too small to see with the naked eye, slipped into this theatre inside a sealed plastic dish concealed deep in the right-hand pocket of Ross Ransome's surgical pyjamas.

  It was twenty past two. Between twelve and two, Ross had performed five small operations under local anaesthetic in the small room annexed to his office that served both as an examining room and an operating theatre. At three o'clock he would be operating in theatre 4-2.

  The theatre was empty. He had maybe ten minutes if he was lucky, but did not plan to use anything like that amount of time. In his white clogs he crossed over to the scrub recess, where he was out of sight of anyone peering in through the small glass portholes in the theatre doors.

  Although he'd rehearsed this carefully, now that he was doing it he felt vulnerable and exposed. He grabbed a pair of surgical gloves from the dispenser and pulled them on. Then he removed the Petri dish, careful to hold it level, took a deep breath and unscrewed the lid, which he laid carefully in the basin.

  Still holding his breath, he pushed the gloved fingers of his right hand into the culture in the dish, then knelt and wiped the fluid in the place he had already selected, to the right of a rivet underneath the sink.

  Standing up, he checked once more over his shoulder, then replaced the lid of the Petri dish securely and dropped it into the incinerator bin. He washed his gloved hands twice in sterilising gel, peeled off the gloves and dropped them, too, into the incinerator bin.

  Then he left the theatre and sauntered casually along to the small rest lounge, where he fixed himself a cup of coffee.

  * * *

  At two minutes past three, Lady Geraldine Reynes-Rayleigh, hooked up to drip lines, a breathing tube down her throat, was trolleyed into the theatre and lifted on to the steel operating table. While Tommy Pearman and his assistant monitored her carefully, the team began prepping her.

  Ross stood at the sink, making a big deal of washing his hands and forearms, diligently using the brush to scrub his nails. He wanted them to remember him doing it. Then, for good measure, he said, 'Foul, this new gel. Stinks of cheap perfume. Can't we have something that smells better? For God's sake, this is an operating theatre, not a tart's boudoir!'

  Jane Odin, his scrub nurse, said, 'It's ordered centrally.'

  'And someone's probably getting a nice kickback.' Ross held out his hands for her to glove him up. 'That's the problem, isn't it? Everyone's on a bloody kickback.'

  'Wouldn't mind if I was,' she said.

  'I think for this operation we'll have Beethoven's Fifth, Jane.'

  She grinned at his choice. 'I'll check to see if we have it.'

  'I brought it in myself,' Ross said. He nodded at his patient, brightly lit beneath the octopus lamp. 'Damned if I'm going to let that bitch listen to anything peaceful. If she wants to drag us through the mill, she can suffer with it.'

  'Not a nice lady, by all accounts,' his scrub nurse said, pulling the second glove tight.

  Everyone in the room was concentrating on the patient. Ross secured his mask, then slipped unobserved back into the scrub recess, knelt and rubbed his left hand beneath the sink, where, half an hour earlier, he had smeared the septicaemia culture.

  Moments later he walked casually over to the operating table. All that was visible of Lady Reynes-Raleigh, beneath the folds of green wrapping, was her nose.

  He looked down at her with anger. Bitch, beneath those wraps you look your age now, lying on your back, with every muscle in your body slack from the anaesthetics and gravity doing its worst to you. I'd love to take your photograph and send it to the gossip columns. What do you think they'd make of the great society beauty now? I'll tell you something, you wouldn't have screwed your way to the top of the heap looking like that.

  Since complaining about his surgery on her nose, Lady Reynes-Raleigh had decided she was displeased with his work on her cheekbones too. She was desperate to look like someone she saw in her mind and in her dreams — someone she could never ever be. Because, in truth, Ross knew that what she really wanted was to look like was herself aged twenty-two.

  You're fifty-two, bitch, and counting. I've cut and sewn you back to forty-two and that's as good as you're ever going to get. If you were a decent human being, I'd give you a pep talk, tell you to count your blessings, enjoy what you have and stop craving the impossible.

  But you aren't.

  The specialist registrar began discussing a car he was thinking of buying with Tommy Pearman. Jane Odin found the CD and put it on. As the rousing strains of Beethoven's Fifth burst out of the speakers, Ross stood still, keeping his left hand low, palm inwards, close against his gown but careful not to touch it and leave any tell-tale marks.

  Raising his right arm, he began to conduct an imaginary orchestra, and said, loudly, 'Everyone knows, of course, that Beethoven's Fifth stands for victory. The opening corresponds to V in Morse code.'

  Looking around at the sea of blank eyes above the surgical masks he said, 'Don't tell me I'm operating with Philistines today! This is very apposite music because today we shall have victory over Lady Geraldine Reynes-Raleigh's nose and cheeks!'

  He leaned forward and made a play of studying the patient's nose for some moments. Then he announced, 'I'm going to begin with the rhinoplasty. We'll do this closed — I think it will work better.'

  There was always a decision to be made on whether to open up the nose or to work, blind, inside it. Today working blind was perfect for his needs.

  'Nasal speculum,' he said.

  He inserted the blade of the speculum into the left nostril and squeezed the handle, forcing the nostril wide open. Then leaving it in situ, he said, 'Osteatome.'

  The scrub nurse proffered the chisel. He took it in his right hand and made a play of seeming dissatisfied with it, peering at the blade for a moment, then pinched it tightly between the fingers of his left hand, careful not to cut through the rubber.

  'Do you want a different one?' the scrub nurse asked.

  'No, it's fine.'

  Feeling his way carefully with the dirty chisel, he pushed up until he could feel that the point was against the cribriform plate, which separated the cavity of the nose from the cranium, and was riddled with tiny perforations through which the olfactory nerves passed.

  No one in the theatre could have any idea what he was doing. He pressed harder, forcing the point of the chisel into one of the tiny cavities, then discreetly exerted more pressure still, until he could feel the bone give and the tip of the chisel penetrate the cranium itself.

  Then he withdrew it, and could see, to his satisfaction, there was a tiny amount of blood on the tip. The bleeding in the nose would mask the leakage of the CSF fluid from the tear.

  More than enough to show
he'd hit the target.

  Beneath his mask, his lips moved, as he mouthed the great music to himself, feeling the adrenaline rush surging through his veins.

  Then he began on the reshaping of her nose. He did a great job, he was inspired, he was on a roll. His eyes beamed at his staff.

  She was going to look sensational'.

  55

  'The thing is, that beech glade is mentioned in all the guidebooks.'

  'They'll still be able to see it — we're only talking about moving the footpath fifty yards.'

  'But what you have to consider is that some of the trees are over two hundred and fifty years old.'

  There was a pause. Then Donald Fogarty, a retired borough surveyor and, in Faith's opinion, one of the few members of this committee to talk any sense, said, 'Yes, we're aware of that — but it's the footpath we are talking about moving, not the trees. What point are you making?'

  It was the fourth meeting of the Little Scaynes Footpath Action Committee. Faith sat at the oak refectory table in Ruth Harman's converted barn, half listening, contributing little beyond her presence.

  Another voice butted in. 'Gary Taylor is generously offering to donate ten acres of woodland on his farm to the community, in exchange for planning consent to move the footpath fifty yards further to the west of his property just for the two-hundred-yard stretch that passes his house. I don't see how the age of the beech trees comes into this.'

  'The point is, the footpath was there long before the farm.'

  I don't need this, Faith thought. I really don't. I don't want to spend what might be my last year arguing about footpaths. Or bypasses. Or saving church roofs.

  She stirred her coffee.

  'What are your feelings, Faith?' another voice said.

  'Gary Taylor's a decent man,' she said. 'I don't see why he should have to put up with endless hordes of nerds in gaudy cagoules traipsing past his front door. The point of a footpath, historically, was to enable people to get from one place to another — any view they happened to have was incidental. What Gary is proposing doesn't stop anyone from using the path for the purposes for which it was intended. Tell the ramblers to take a hike elsewhere.'

  That made her feel a little better. She glanced with satisfaction at the startled expressions all around her, then stirred her coffee once more.

  * * *

  After the meeting was over, Faith drove a short distance then pulled on to a garage forecourt, stopping well short of the pumps, and switched on her mobile phone. It was nearly one o'clock. They were having a dinner party on Saturday night. Ten people were coming, four of them medics including her least favourite, Jules Ritterman, as well as the Chief Constable of Sussex, and a High Court judge, to add some gravitas. She had all the shopping to do, and at three thirty she had to collect Alec and four of his friends.

  Three sharp beeps told her she had a new message. It was from Oliver.

  'Faith, hi, wondering how you are. I should have the test results all back by tomorrow afternoon latest. I could see you Monday, or over the weekend if you could make it, but I guess you'd have problems getting away. Call me at the office, I've told them to put you straight through.'

  She played the message a second time, just to hear his voice again.

  Then she played it a third time, and saved it when it had finished, wanting to know it was there, comforted that she could dial her voice-mail and hear him any time she wanted.

  I'm behaving like a besotted teenager.

  Her desire for the American was intense, constant, dominating her every thought. Oliver Cabot. Her secret.

  Was she deluding herself about him? Was Ross right? Was he just a conman?

  Never.

  She had lain awake most of the night thinking, fantasising about a life with him, a different kind of a life from the one she had, far away from narrow village concerns, in a wider dimension, where they discussed things in ways that she and Ross never discussed anything. She thought back over the conversations she had already had in the short time she had spent with Oliver, on life, religion, philosophy, art, literature, travel.

  She was certain that somehow — and she did not know how, but somehow — Oliver Cabot was going to make her better, not the pills in the container in her handbag.

  It was one o'clock. She should take two now. Oliver hadn't told her not to take them, but neither had he encouraged her to take them. She pulled out from the bottom of her handbag a slip of paper he had given her to read. He had told her that it had been written in 1887, and that she should read it three times a day, with the pills, or instead of them. She obediently read it now. He said that few doctors understood it, and fewer still ever took note of it.

  The wise physician, when making a prognosis, does not confine himself or herself to the virulence of the particular microorganism involved or the nature of an abnormal growth; the wise physician makes a careful estimate of the patient's will to live and the ability to put to work all the resources of spirit that can be translated into beneficial biochemical changes.

  From her handbag, she removed the Moliou-Orelan container, and tipped out two pills. Then, holding them in the palm of her hand, she climbed out of the car and dropped them into the litter-bin.

  That felt good.

  56

  They slipped the Fatslide board beneath Lady Reynes-Raleigh three hours and eighteen minutes after the operation had begun, and heaved her on to the trolley. Her cheeks, nose, jaw and forehead had been changed in accordance with her instructions, and were now covered with rows of neat stitches. One of the talents for which Ross was highly admired was the quality of his sewing. Few surgeons could come close.

  Even so, discoloured by internal bruising and trauma, she looked like a pastiche of one of Andy Warhol's 'violent period' paintings.

  Less than five minutes after being taken into the recovery room, she began to regain consciousness. Another five minutes, and the breathing tube was removed from her throat. Tommy Pearman remained with her a short while longer, checking her pulse and blood oxygen levels until he was confident that she was out of danger, then joined Ross in the changing room.

  As Ross removed his pyjama top and pulled on his shirt, Pearman said, 'I must give you some stuff I printed out for you — from the Net on Lendt's.'

  'What else have you found?'

  'Well, not much. Merck announced they've had some encouraging results with tests they are doing on rats, but I wouldn't get too excited — they're at least two years off starting any human trials.'

  'Any more on the Moliou trials?'

  'No.' Pearman slapped his belly, as if the mere act of doing this might reduce its girth. 'I really must do something about this.'

  'You should take up running marathons.'

  'My legs are too short.'

  'Maybe they should have special marathons for fat midgets like you.'

  Pearman pulled on his shirt, then began knotting his tie. 'There is something else about the Moliou-Orelan trials,' he said. 'Could be significant. This disease seems to be increasing at quite a rate and they're hoping to fast-track the drug through the FDA.'

  'That means they're confident with it,' Ross said.

  'It still only has a thirty-five per cent success rate.'

  Pearman dragged on his trousers.

  Ross put one foot on the bench and tied the laces of his black oxfords. 'Tell me something, you use ketamine a lot, don't you?'

  'I've used it in certain circumstances for years — it's effective for burns patients, particularly when you have a lot of painful changes of dressings. Why?'

  'It's related to LSD, isn't it?'

  'Closely.'

  'Do you use it in combination with other drugs?'

  'No. It's a single-agent anaesthetic and non-sedative. I normally give it intravenously where it has a short half-life — about ten minutes.'

  'How does a patient feel under it?'

  Puzzled by his interest, Pearman said, 'They'll often hallucinate, feel delirious
and scared. One of the bad things is that although it has a short half-life its effect can go on repeating for up to forty-eight hours or even longer. Paramedics use it sometimes for people trapped in accidents — it numbs pain and constricts arteries, reducing blood loss. But it also causes horrific hallucinations and some patients get the sense they're having an out-of-body experience.'

  'What does it do biochemically?'

  Pearman adjusted his meagre strands of greying hair in the mirror. 'It selectively excites brain activity close to mood centres. Heightens blood-flow to the brain, sending sparks of electricity to everything around it. Blood pressure rises, but it maintains muscle tone, stabilises breathing. Patients will sometimes whimper and have signs of nystagmus.'

  'Can it be taken orally?'

  'Well, yes, but I wouldn't administer it orally. It has a much longer half-life taken that way.'

  'How long?'

  'At least an hour and a half, sometimes more.'

  'Does it have any taste?'

  Pearman gave him a strange look. 'I don't think so, no.'

  'Any acidity?'

  'It's neutral. You can look it up in the pharmaceutical books — or I can scan the details in and e-mail them to you if you like?'

  'I'd appreciate that,' Ross said. 'Thanks.'

  Ross hung around in the changing room, checking his messages on his mobile phone while Pearman left. Then from a window in an empty office, he looked down at the street until he saw the anaesthetist's elderly Bristol emerge from the underground car park and pull out into Devonshire Place.

  Immediately Ross walked along to the anaesthetics room, which, slackly, was always left unlocked, and went in. He found what he was looking for in the third cabinet he tried: a whole shelf stacked with 10cc vials of ketamine.

  He palmed one and slipped it into his jacket pocket.

  57

  Spider sat in his regular booth at the back of Trader Vic's in Park Lane, drinking his Hawaiian Sundowner and smoking his Marlboro Light. He liked this place, with its plush leather banquettes, its exotic flavour and its smart clientele. It had tone, sophistication. And it was always dark in here, whether day or night. He liked that the most.