Chapter 1
September 2022
I don’t even know his name and yet despise him from the first moment I lay eyes upon him. He has an untidy fop of blond hair and a body tall and athletic. Like a rower. He moves with easy confidence and makes a beeline towards me as if this is the only direction he is interested in heading. He is so purposeful that at first glance I think he must know me, but that is impossible. He smiles - of course he has perfect teeth – damn him! He holds out his hand in greeting. I press my palm into his. His other hand reaches over and sandwiches my smaller mitt between his two much larger paws. His skin is soft and well moisturised. His nails clean and unbitten, quite unlike my own.
I am trapped with my hand imprisoned between his, my briefcase awkwardly pressed between my legs.
His smile twists into a goofy grin.
“The name’s Max,” he says with a home counties drawl. “I’m almost certain I saw you at the interviews. Well done for getting in.”
“Yes, and to you too. I’m Charlie, by the way. Charlie Gorham.”
My adopted surname sticks in my throat. It still sounds like it belongs to someone else.
“Pleased to meet you, Charlie. What do you make of this?”
His right-hand sweeps in an extravagant arc towards the glass containers behind us. There are hundreds. To my left, foetuses, some still contained within their wombs, others float like weird alien astronauts attached to severed umbilical cords. To my right, organs – livers, spleens, kidneys, brains – some intact, some sectioned into anatomical planes (sagittal, coronal, axial) with blue and red plastic arrows or ties; explanations imprinted beneath. 4.2 cm Astrocytoma arising from the parietal lobe of a 72-year-old man, says one. Others are less informative - Left MCA INFARCTION. You get the idea.
“It’s something else,” I say.
“Yes, it is, isn’t it? Strange place to hold a reception for us newbies. Where are you from?”
That’s the six marker. The question which defines you.
St Patrick’s is renowned for being the best of Medical Schools. Turn up in your Roller with your dad’s fishing tackle and you’re a shoo in, or so the story goes about its illustrious alumni.
I can’t fail to notice Max’s expensive stainless steel diving watch. His shoes are low cut black sneakers; there isn’t a mark on them – they could be fresh out of the box.
“Village outside of Maidstone. You won’t have heard of it,” I reply. It sounds more an apology than an explanation. I must rid myself of this whiny chip-on-the-shoulder grammar schoolboy. It doesn’t suit me, and will only make me stand out which is never a good thing.
“It’s small. More a hamlet than a village,” I add.
A pub at one end and a church at the other.
If Max notices any embarrassment, he’s careful not to show it. “Oh, The Garden of England,” he says. “The Weald’s absolutely stunning, isn’t it? I have a cousin, second actually, in Tunbridge Wells.”
The only surprise is he doesn’t say Royal Tunbridge Wells, but I am thrown by his next comment.
“You know,” Max says as he flicks his head towards the milling throng of Freshers behind him. “This is a bit much, isn’t it? And to be perfectly honest, I’m not even sure why I’m here. I suppose it’s expected of me. And I obliged, you see, because I always do. Destined to do medicine from the very beginning. To please my father! How pathetic! And do you know what, he was here too, a million years ago, of course. By the way, is your pater a medical man?”
“No, he isn’t.”
“So you’re doing this off your own back. Good on you, Charlie boy. You’re a better man than me. And probably half this room too.”
Max laughs as if he means it.
*****
I didn’t lie exactly. Max asked the question about my Father in the present tense, just like the Dean did at my interview.
*****
Actually, Dad wasn’t just a doctor, he was a double doctor – a medical one and a PhD one. A genius, really. Fifteen letters after his name.
BSc BM BCh MRCP PhD
I can scarcely comprehend the enormity of his efforts to make it here. I’ve taken the short cut. I’m a first-year medical student, but he did it the long way round - six years at Oxford (only five usually, but my father completed an extra year for his intercalated degree in Biochemistry. A first, naturally). A year as a houseman (now F1 as in you’re fucked for one year), two years as a SHO (now F2, as in you’re fucked for two years at least), a year as a medical registrar, and then three years completing his thesis, before his appointment as Post Doctoral Senior Research Fellow in Molecular Biology at St Patrick’s University Hospital, London. His PhD thesis: Novel Ways of Analysing Genetic Polymorphisms in Cancer Cell Lines. Not the catchiest of titles. Bound in thick blue vellum. Two hundred and fifty-three pages. Almost every single word unintelligible to my (as yet) uneducated eye.
I made a promise that I would understand his work one day.
An introductory Lecturer - a young woman unfazed to be standing in front of a hundred or so First Years – told us that the average person has a vocabulary in the region of 14,000 to 16,000 words. “That’s it,” she said. “But by the end of this, your first year, you’ll have learnt at least another 10,000. Ten thousand,” she repeated. “Double what some of you know now!”
I do a quick mental calculation. Thirty new words a day should do it.
I’ve always found things easier if you break them into bits.
******
There is nothing quite like dissecting a dead body to draw you closer. Ours is called Irma. I can't remember whether this is her real name or the one we invent for her. Six of us share our dissection class but the only one I pay attention to is the girl with the red hair. The fidgety girl I first saw at the Interviews. Sam is her name. A Harlow to my Gorham; our surnames sufficiently close in the alphabet to ensure we share the same tutorials for the major first year disciplines.
Irma has been pickled in formalin - the smell so strong, I take a step back, vision misty and blurred. She is swaddled in white cloth which when peeled away reveals her grey corpse beneath. Whatever made her, her, has now been sucked away. She is a desiccated imprint of a person akin to a forgotten leaf pressed between the fading pages of a forgotten book.
Sam is the first to note her missing breasts and the dual scars where they used to rest. “She must have died of breast cancer,” she says. Sam’s gloved finger traces the silver line on her chest wall. She is the only person who appears unaffected by the pungent vapours in the air around us. “Where do I start?” Sam has already unfurled her dissecting kit; the individual brown pockets contain a scalpel with a selection of different blades, tweezers, forceps and a single metal probe.
The Prosector demonstrates the best way of holding the knife – fingers just so - and then reaches forward and grasps Sam's hand between his own and presses the blade against Irma’s grey skin in an upward arc extending from the fine sparse grey pubic hairs to about an inch below the xiphisternum; the small lump of cartilage below the breastbone.
Successive cuts reveal a small amount of fat, then peritoneum and then a mattress of fat named the omentum.
“We call this a central laparotomy incision,” the Prosector says. “Ably demonstrated by...”
“Samantha Harlow. Sam to my friends.”
She has a sing song voice. It almost sounds as if she’s flirting.
Her eyes alight on me. I blink under the intensity of her gaze. I glance sharply downwards to the drapes around Irma’s body. When I look up, Sam’s focus is no longer upon me. She’s inspecting – greedily? - Irma's open abdomen. She plunges gloved hands into this newly exposed cavity. There are guts to unpack here, more than I can ever imagine - stomach, duodenum, jejunum, ileum, colon, and other stuff too. Vessels everywhere. And the largest of them; the calcified, atheromatous aorta.
“Atheroma,” the Prosector declares. “From the Greek athere for porridge or gruel.”
It is surprising how many pathological processes are named after food.
And who knew so much could be hidden within such a small space?
*****
Sam is pretty but doesn't trade on her looks. If she wears make up, it is artfully applied. Her dress sense simple and understated, combos of trousers and a variety of plain T’s. She has a favourite faded denim designer jacket with embroidered lapels and a green Kanken backpack. Her most striking feature is her blaze of fiery hair which she styles in a different way each day. But it is her dynamism which makes her impossible to ignore. She is always on the move. The first person to ask a question. The first person to do anything. She doesn’t seem to be afraid of the things which normal people are afraid of, but as much as I itch to get to know her, I can’t. Sam is polite. She knows my name. Sometimes she even nods at me in passing. But most of the time I don’t exist in her world.
I try to impress her by reading ahead. I’m the only one who knows the three arteries which supply the gastrointestinal tract, the only one who places my fingers with certainty within a centimetre of the Porta Hepatis. But this knowledge doesn’t cut it with Sam.
*****
Irma is the first naked woman I’ve ever seen. The opposite sex aren't just another country but exotic creatures from another universe. I went to an All-Boys Grammar. There were girls at the gates, but never for me.
I work hard, not because I care about the workings of the human body, but because I don’t want to be exposed to ridicule. As a first year, it is difficult to calibrate what you should and should not know. And I’m aware I’m overcompensating. In a weird way, I need not worry because the obvious dividing lines aren't knowledge or intelligence but privilege. It’s not just evident in the way they dress, (although a few privately educated prats insist on wearing blazers and old school ties) but through the confidence they belong.
Part of me is shocked that the Privileged don't mind making fools of themselves. They ask stupid questions in lectures. They drink themselves to oblivion in Lustys, the Medical School Bar on the first floor above the Canteen. They get away with this because they have always got away with this.
And I wonder whether this is part of the hidden curriculum. That in order to fit in I too must pretend that I don’t give a flying fuck what others think of me, because if you believe your opinion to be important, it will be.
