Despite Baxter's impaired ocular fixation, and his chorea, those quick, jerky movements, the blow that's aimed at Perowne's heart and that he dodges only fractionally, lands on his sternum with colossal force, so that it seems to him, and perhaps it really is the case, that there surges throughout his body a sharp ridge, a shock wave, of high blood pressure, a concussive thrill that carries with it not so much pain as an electric jolt of stupefaction and a brief deathly chill that has a visual component of blinding, snowy whiteness.
“All right,” he hears Baxter say, which is an instruction to his companions.
They grab Henry by his elbows, and as his vision clears he sees that he's being propelled through a gap between two parked cars. Together they cross the pavement at speed. They turn him and slam his back against a chain-locked double door in a recess. He sees on the wall to his left a polished brass plaque which says Fire Exit, Spearmint Rhino. Just up the street is a pub, the Jeremy Bentham. But if it's open this early, the drinkers are all inside in the warmth. Perowne has two immediate priorities whose importance holds as his full consciousness returns. The first is to keep the promise to himself not to fight back. The punch has already told him how much expertise he lacks. The second is to stay on his feet. He's seen a fair number of brain injuries among those unlucky enough to fall to the ground before their attackers. The foot, like some roughneck hick town, is a remote province of the brain, liberated by distance from responsibility. A kick is less intimate, less involving, than a punch, and one kick never quite seems enough. Back in the epic days of organised football violence when he was a registrar, he learned a good deal about subdural haematomas from steel-tipped Doc Martens.
He stands facing them in a little whitewashed brick cave of a recess, well out of sight of the march. The structure amplifies the rasp of their breathing. Nigel takes a fistful of Perowne's fleece and with the other hand seeks out the bulge of his wallet which is in an inside zipped pocket.
“Nah,” Baxter says. “We don't want his money.”
By this Perowne understands that honour is to be satisfied by a thorough beating. As with the insurance claims, he sees the dreary future ahead. Weeks of painful convalescence. Perhaps that's optimistic. Baxter's gaze is on him, a gaze that can't be shifted unless he moves the whole of his heavy shaven head. His face is alive with small tremors that never quite form into an expression. It is a muscular restlessness that will one day—this is Perowne's considered opinion—become athetoid, plagued by involuntary, uncontrollable movements.
There's a sense among the trio of a pause for breath, a steadying before the business. Nark is already bunching his right fist. Perowne notes three rings on the index, middle and ring fingers, bands of gold as broad as sawn-off plumbing. He has, he reckons, a few seconds left. Baxter is in his mid-twenties. This isn't the moment to be asking for a family history. If a parent has it, you have a fifty-fifty chance of going down too. Chromosome four. The misfortune lies within a single gene, in an excessive repeat of a single sequence—CAG. Here's biological determinism in its purest form. More than forty repeats of that one little codon, and you're doomed. Your future is fixed and easily foretold. The longer the repeat, the earlier and more severe the onset. Between ten and twenty years to complete the course, from the first small alterations of character, tremors in the hands and face, emotional disturbance, including—most notably—sudden, uncontrollable alterations of mood, to the helpless jerky dance-like movements, intellectual dilapidation, memory failure, agnosia, apraxia, dementia, total loss of muscular control, rigidity sometimes, nightmarish hallucinations and a meaningless end. This is how the brilliant machinery of being is undone by the tiniest of faulty cogs, the insidious whisper of ruin, a single bad idea lodged in every cell, on every chromosome four.
Nark is drawing back his right arm to strike. Nigel seems content to let him go first. Henry has heard that early onset tends to indict the paternal gene. But that may not be right. There's nothing to lose by making a guess. He speaks into the blaze of Baxter's regard.
“Your father had it. Now you've got it too.”
He has the impression of himself as a witch doctor delivering a curse. Baxter's expression is hard to judge. He makes a vague, febrile movement with his left hand to restrain his companions. There's silence as he swallows and strains forward, frowning, as if about to clear an obstruction from his throat. Perowne has expressed himself ambiguously. His “had” could easily have been taken for a “has.” And Baxter's father, alive or dead, might not even be known to his son. But Perowne is counting on Baxter knowing about his condition. If he does, he won't have told Nigel or Nark or any of his friends. This is his secret shame. He may be in denial, knowing and not knowing; knowing and preferring not to think about it.
When Baxter speaks at last, his voice is different, cautious perhaps. “You knew my father?”
“I'm a doctor.”
“Like fuck you are, dressed like that.”
“I'm a doctor. Has someone explained to you what's going to happen? Do you want me to tell you what I think your problem might be?”
It works, the shameless blackmail works. Baxter flares suddenly. “What problem?”
And before Perowne can reply, he adds ferociously, “And you'll shut the fuck up.” Then, as quickly, he subsides, and turns away. They are together, he and Perowne, in a world not of the medical, but of the magical. When you're diseased it is unwise to abuse the shaman.
Nigel says, “What's going on? What did your dad have?”
“Shut up.”
The moment of the thrashing is passing and Perowne senses the power passing to him. This fire escape recess is his consulting room. Its mean volume reflects back to him a voice regaining the full timbre of its authority. He says, “Are you seeing someone about it?”
“What's he on about, Baxter?”
Baxter shoves the broken wing mirror into Nark's hands. “Go and wait in the car.”
“You're kidding.”
“I mean it. Both of you. Go and wait in the fucking car.”
It is pitifully evident, Baxter's desperation to separate his friends from the sharer of his secret. The two young men exchange a look and shrug. Then, without a glance at Perowne, they set off back up the road. Hard to imagine they don't think something is wrong with Baxter. But these are the early stages of the disease, and its advance is slow. They might not have known him long. And a jazzy walk, an interesting tremor, the occasional lordly flash of temper or mood swing might in their milieu mark out a man of character. When they reach the BMW Nark opens a rear door and tosses the wing mirror in. Side by side, they lean on the front of the car watching Baxter and Perowne, arms folded like movie hoods.
Perowne persists gently. “When did your father die?”
“Leave it.”
Baxter is not looking at him. He stands fidgeting with shoulder turned, like a sulky child waiting to be coaxed, unable to make the first move. Here is the signature of so many neurodegenerative diseases—the swift transition from one mood to another, without awareness or memory, or understanding of how it seems to others.
“Is your mother still alive?”
“Not as far as I'm concerned.”
“Are you married?”
“No.”
“Is your real name Baxter?”
“That's my business.”
“All right. Where are you from?”
“I grew up in Folkestone.”
“And where do you live now?”
“My dad's old flat. Kentish Town.”
“Any occupation, training, college?”
“I didn't get on with school. What's that to do with you?”
“And what's your doctor said about your condition?”
Baxter shrugs. But he's accepted Perowne's right to interrogate. They've slipped into their roles and Perowne keeps going.
“Has anyone mentioned Huntington's Disease to you?”
A feeble dry rattling sound, like that of stones shaken in a tin, r
eaches them from the march. Baxter is looking at the ground. Perowne takes his silence as confirmation.
“Do you want to tell me who your doctor is?”
“Why would I do that?”
“We could get you referred to a colleague of mine. He's good. He could make things easier for you.”
At this Baxter turns and angles his head in his attempt to settle the taller man's image on his fovea, that small depression on the retina where vision is most acute. There's nothing anyone can do about a damaged saccadic system. And generally, there's nothing on offer at all for this condition, beyond managing the descent. But Henry sees now in Baxter's agitated features a sudden avidity, a hunger for information, or hope. Or simply a need to talk.
“What sort of thing?”
“Exercises. Certain drugs.”
“Exercise . . .” He snorts on the word. He is right to pick up on the fatuity, the feebleness of the idea. Perowne presses on.
“What has your doctor told you?”
“He said there's nothing, didn't he.”
He says this as a challenge, or a calling in of a debt; Perowne's been reprieved, and in return he has to come up with a reason for optimism, if not a cure. Baxter wants his doctor proved wrong.
But Perowne says, “I think he's right. There was some work with stem-cell implantation in the late nineties but . . .”
“It was shit.”
“Yes, it was disappointing. Best hope now apparently is RNA interference.”
“Yeah. Gene silencing. One day perhaps. After I'm dead.”
“You're well up on this then.”
“Oh thank you, doctor. But what's this about certain drugs?”
Perowne is familiar with this impulse in patients, this pursuit of the slenderest leads. If there's a drug, Baxter or his doctor will know about it. But it's necessary for Baxter to check. And check again. Someone might know something he doesn't. A week passes and there could be a new development. And when the line runs out in this field, the charlatans lie in wait for the fearful, offering the apricot-stone diet, the aura massage, the power of prayer. Over Baxter's shoulder Perowne can see Nigel and Nark. They're no longer leaning against the car, but walking up and down in front of it, talking animatedly, gesturing up the road.
Perowne says, “I'm talking about pain relief, help with loss of balance, tremors, depression.”
Baxter moves his head from side to side. The muscles in his cheeks are independently alive. Henry senses an approaching shift of mood. “Oh fuck,” Baxter keeps murmuring to himself. “Oh fuck.” In this transitional phase of perplexity or sorrow, the vaguely ape-like features are softened, even attractive. He's an intelligent man, and gives the impression that, illness apart, he's missed his chances, made some big mistakes and ended up in the wrong company. Probably dropped out of school long ago and regrets it. No parents around. And now, what worse situation than this could he find himself in? There's no way out for him. No one can help. But Perowne knows himself to be incapable of pity. Clinical experience wrung that from him long ago. And a part of him never ceases to calculate how soon he can safely end this encounter. Besides, the matter is beyond pity. There are so many ways a brain can let you down. Like an expensive car, it's intricate, but mass-produced nevertheless, with more than six billion in circulation.
Rightly, Baxter believes he's been cheated of a little violence and the exercise of a little power, and the more he considers it, the angrier he becomes. Another rapid change in mental weather, a new mood front is approaching, and it's turbulent. He ceases his murmuring and moves in close enough for Perowne to smell a metallic flavour on his breath.
“You streak of piss,” Baxter says quickly as he pushes him in the chest. “You're trying to fuck with me. In front of those two. You think I care? Well fuck you. I'm calling them back.”
From his position, with his back to the fire exit, Perowne can already see that a bad moment awaits Baxter. He turns away from Perowne and steps out into the centre of the pavement in time to see Nigel and Nark walking away from the BMW, back towards the Tottenham Court Road.
Baxter makes a short run in their direction and shouts, “Oi!”
They glance back, and Nark, uncharacteristically energetic, gives him the finger. As they walk on, Nigel makes a limp-wristed dismissive gesture. The general has been indecisive, the troops are deserting, the humiliation is complete. Perowne too sees his opportunity to withdraw. He crosses the pavement, steps into the road and around his car. His keys are in the ignition. As he starts the engine he sees Baxter in his rear-view mirror, dithering between the departing factions, shouting at both. Perowne eases forwards—for pride's sake, he does not want to appear hurried. The insurance is an irrelevance, and it amazes him now that he ever thought it important. He sees his racket on the front seat beside him. This is surely the moment to slip away, while the possibility remains that he can still rescue his game.
After he's parked, and before getting out of the car, he phones Rosalind at work—his long fingers still trembling, fumbling with the miniature keys. On this important day for her he doesn't intend to distract her with the story of his near-thrashing. And he doesn't need sympathy. What he wants is more fundamental—the sound of her voice in an everyday exchange, the resumption of normal existence. What can be more reassuringly plain than husband and wife discussing the details of tonight's dinner? He speaks to a temp, what they call in Rosalind's office a hot-desker, and learns that her meeting with the editor has started late and is running on. He leaves no message, and says he'll try later.
It's unusual to see the glass-fronted squash courts deserted on a Saturday. He walks along the row, on stained blue carpet, past the giant Coke and energy bar dispensers, and finds the consultant anaesthetist at the far end, in number five, smacking the ball in fast repeated strokes low along the backhand wall, giving the appearance of a man working off a bad temper. But, it turns out, he's been waiting only ten minutes. He lives across the river in Wandsworth; the march forced him to abandon his car by the Festival Hall. Furious with himself for being late, he jogged across Waterloo Bridge and saw below him tens of thousands pouring along the Embankment towards Parliament Square. Too young for the Vietnam war protests, he's never in his life seen so many people in one place. Despite his own views, he was somewhat moved. This, he told himself, is the democratic process, however inconvenient. He watched for five minutes, then jogged up Kingsway, against the flow of bodies. He describes all this while Perowne sits on the bench removing his sweater and tracksuit bottom, and making a heap of his wallet, keys and phone to store at one of the corners by the front wall—he and Strauss are never serious enough to insist on a completely cleared court.
“They dislike your Prime Minister, but boy do they fucking loathe my President.”
Jay is the only American medic Perowne knows to have taken a huge cut in salary and amenities to work in England. He says he loves the health system. He also loved an Englishwoman, had three children by her, divorced her, married another similar-looking English rose twelve years younger and had another two children—still toddlers, and a third is on its way. But his respect for socialised medicine or his love of children does not make him an ally of the peace cause. The proposed war, Perowne finds, generally doesn't divide people predictably; a known package of opinions is not a reliable guide. According to Jay, the matter is stark: how open societies deal with the new world situation will determine how open they remain. He's a man of untroubled certainties, impatient of talk of diplomacy, weapons of mass destruction, inspection teams, proofs of links with Al-Qaeda and so on. Iraq is a rotten state, a natural ally of terrorists, bound to cause mischief at some point and may as well be taken out now while the U.S. military is feeling perky after Afghanistan. And by taken out, he insists he means liberated and democratised. The U.S.A. has to atone for its previous disastrous policies—at the very least it owes this to the Iraqi people. Whenever he talks to Jay, Henry finds himself tending towards the anti-war camp.
/> Strauss is a powerful, earthbound, stocky man, physically affectionate, energetic, direct in manner—to some of his English colleagues, tiresomely so. He's been completely bald since he was thirty. He works out for more than an hour each day, and looks like a wrestler. When he busies himself around his patients in the anaesthetic room, readying them for oblivion, they are reassured by the sight of the sculpted muscles on his forearms, the dense bulk of his neck and shoulders, and by the way he speaks to them—matter-of-fact, cheerful, without condescension. Anxious patients can believe this squat American will lay down his life to spare them pain.
They have worked together six years. As far as Henry is concerned, Jay is the key to the success of his firm. When things go wrong, Strauss becomes calm. If, for example, Perowne is obliged to cut off a major blood vessel to make a repair, Jay keeps time in a soothing way, ending with a murmured, “You've got one minute, Boss, then you're out of there.” On the rare occasions when things go really badly, when there's no way back, Strauss will find him out afterwards, alone in a quiet stretch of corridor, and put his hands on his shoulders, squeeze tightly and say, “OK, Henry. Let's talk it through now. Before you start crucifying yourself.” This isn't the way an anaesthetist, even a consultant, usually speaks to a surgeon. Consequently, Strauss has an above-average array of enemies. On certain committees, Perowne has protected his friend's broad back from various collegiate daggers. Now and then he finds himself saying to Jay something like, “I don't care what you think. Be nice to him. Remember our funding next year.”