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  Perowne dictated monotonously, and long after his secretary went home he typed in his overheated box of an office on the hospital's third floor. What dragged him back was an unfamiliar lack of fluency. He prides himself on speed and a sleek, wry style. It never needs much forethought—typing and composing are one. Now he was stumbling. And though the professional jargon didn't desert him—it's second nature—his prose accumulated awkwardly. Individual words brought to mind unwieldy objects—bicycles, deckchairs, coat hangers—strewn across his path. He composed a sentence in his head, then lost it on the page, or typed himself into a grammatical cul-de-sac and had to sweat his way out. Whether this debility was the cause or the consequence of fatigue he didn't pause to consider. He was stubborn and he pushed himself to the end. At eight in the evening he concluded the last in a series of e-mails, and stood up from his desk, where he had been hunched since four. On his way out he looked in at his patients in the ICU. There were no problems, and Andrea was doing fine—she was sleeping and all her signs were good. Less than half an hour later he was back home, in his bath, and soon after, he too was asleep.

  Two figures in dark overcoats are crossing the square diagonally, walking away from him towards Cleveland Street, their high heels ticking in awkward counterpoint—nurses surely, heading home, though this is a strange time to be coming off shift. They aren't speaking, and though their steps don't match, they walk close, shoulders almost touching in an intimate, sisterly way. They pass right beneath him, and make a quarter-circular route around the gardens before striking off. There's something touching about the way their breath rises behind them in single clouds of vapour as they go, as though they're playing a children's game, imitating steam trains. They cross towards the far corner of the square, and with his advantage of height and in his curious mood, he not only watches them, but watches over them, supervising their progress with the remote possessiveness of a god. In the lifeless cold, they pass through the night, hot little biological engines with bipedal skills suited to any terrain, endowed with innumerable branching neural networks sunk deep in a knob of bone casing, buried fibres, warm filaments with their invisible glow of consciousness—these engines devise their own tracks.

  He's been at the window several minutes, the elation is passing, and he's beginning to shiver. In the gardens, which are enclosed within a circle of high railings, a light frost lies on the landscaped hollows and rises of the lawn beyond the border of plane trees. He watches an ambulance, siren off, blue lights flashing, turn into Charlotte Street and accelerate hard southwards, heading perhaps for Soho. He turns from the window to reach behind him for a thick woollen dressing gown where it lies draped over a chair. Even as he turns, he's aware of some new element outside, in the square or in the trees, bright but colourless, smeared across his peripheral vision by the movement of his head. But he doesn't look back immediately. He's cold and he wants the dressing gown. He picks it up, threads one arm through a sleeve, and only steps back towards the window as he's finding the second sleeve and looping the belt around his waist.

  He doesn't immediately understand what he sees, though he thinks he does. In this first moment, in his eagerness and curiosity, he assumes proportions on a planetary scale: it's a meteor burning out in the London sky, traversing left to right, low on the horizon, though well clear of the taller buildings. But surely meteors have a darting, needle-like quality. You see them in a flash before their heat consumes them. This is moving slowly, majestically even. In an instant, he revises his perspective outwards to the scale of the solar system: this object is not hundreds but millions of miles distant, far out in space swinging in timeless orbit around the sun. It's a comet, tinged with yellow, with the familiar bright core trailing its fiery envelope. He watched Hale-Bopp with Rosalind and the children from a grassy hillock in the Lake District and he feels again the same leap of gratitude for a glimpse, beyond the earthly frame, of the truly impersonal. And this is better, brighter, faster, all the more impressive for being unexpected. They must have missed the media coverage. Working too hard. He's about to wake Rosalind—he knows she'll be thrilled by the sight—but he wonders if she'd get to the window before the comet disappears. Then he'll miss it too. But it's too extraordinary not to share.

  He's moving towards the bed when he hears a low rumbling sound, gentle thunder gathering in volume, and stops to listen. It tells him everything. He looks back over his shoulder to the window for confirmation. Of course, a comet is so distant it's bound to appear stationary. Horrified, he returns to his position by the window. The sound holds at a steady volume while he revises the scale again, zooming inwards this time, from solar dust and ice back to the local. Only three or four seconds have passed since he saw this fire in the sky and changed his mind about it twice. It's travelling along a route that he himself has taken many times in his life, and along which he's gone through the routines, adjusting his seat-back and his watch, putting away his papers, always curious to see if he can locate his own house down among the immense almost beautiful orange-grey sprawl; east to west, along the southern banks of the Thames, two thousand feet up, in the final approaches to Heathrow.

  It's directly south of him now, barely a mile away, soon to pass into the topmost lattice of the bare plane trees, and then behind the Post Office Tower, at the level of the lowest microwave dishes. Despite the city lights, the contours of the plane aren't visible in the early-morning darkness. The fire must be on the nearside wing where it joins the fuselage, or perhaps in one of the engines slung below. The leading edge of the fire is a flattened white sphere which trails away in a cone of yellow and red, less like a meteor or comet than an artist's lurid impression of one. As though in a pretence of normality, the landing lights are flashing. But the engine note gives it all away. Above the usual deep and airy roar is a straining, choking banshee sound growing in volume—both a scream and a sustained shout, an impure, dirty noise that suggests unsustainable mechanical effort beyond the capacity of hardened steel, spiralling upwards to an end point, irresponsibly rising and rising like the accompaniment to a terrible fairground ride. Something is about to give.

  He no longer thinks of waking Rosalind. Why wake her into this nightmare? In fact, the spectacle has the familiarity of a recurrent dream. Like most passengers, outwardly subdued by the monotony of air travel, he often lets his thoughts range across the possibilities while sitting, strapped down and docile, in front of a packaged meal. Outside, beyond a wall of thin steel and cheerful creaking plastic, it's minus sixty degrees and forty thousand feet to the ground. Flung across the Atlantic at five hundred feet a second, you submit to the folly because everyone else does. Your fellow passengers are reassured because you and the others around you appear calm. Looked at a certain way—deaths per passenger mile—the statistics are consoling. And how else attend a conference in Southern California? Air travel is a stock market, a trick of mirrored perceptions, a fragile alliance of pooled belief; so long as nerves hold steady and no bombs or wreckers are on board, everybody prospers. When there's failure, there will be no half measures. Seen another way—deaths per journey—the figures aren't so good. The market could plunge.

  Plastic fork in hand, he often wonders how it might go—the screaming in the cabin partly muffled by that deadening acoustic, the fumbling in bags for phones and last words, the airline staff in their terror clinging to remembered fragments of procedure, the levelling smell of shit. But the scene construed from the outside, from afar like this, is also familiar. It's already almost eighteen months since half the planet watched, and watched again, the unseen captives driven through the sky to the slaughter, at which time there gathered round the innocent silhouette of any jet plane a novel association. Everyone agrees, airliners look different in the sky these days, predatory or doomed.

  Henry knows it's a trick of vision that makes him think he can see an outline now, a deeper black shape against the dark. The howl of the burning engine continues to rise in pitch. It wouldn't surprise him to
see lights coming on across the city, or the square fill with residents in dressing gowns. Behind him Rosalind, well practised at excluding the city's night troubles from her sleep, turns on her side. The noise is probably no more intrusive than a passing siren on the Euston Road. The fiery white core and its coloured tail have grown larger—no passengers sitting in that central section of the plane could survive. That is the other familiar element—the horror of what he can't see. Catastrophe observed from a safe distance. Watching death on a large scale, but seeing no one die. No blood, no screams, no human figures at all, and into this emptiness, the obliging imagination set free. The fight to the death in the cockpit, a posse of brave passengers assembling before a last-hope charge against the fanatics. To escape the heat of that fire, which part of the plane might you run to? The pilot's end might seem less lonely somehow. Is it pathetic folly to reach into the overhead locker for your bag, or necessary optimism? Will the thickly made-up lady who politely served you croissant and jam now be trying to stop you?

  The plane is passing behind the tops of the trees. Briefly, the fire twinkles festively among the branches and twigs. It occurs to Perowne that there's something he should be doing. By the time the emergency services have noted and passed on his call, whatever is to happen will be in the past. If he's alive, the pilot will have radioed ahead. Perhaps they're already covering the runway in foam. Pointless at this stage to go down and make himself available to the hospital. Heathrow isn't in its area under the Emergency Plan. Elsewhere, further west, in darkened bedrooms, medics will be pulling on their clothes with no idea of what they face. Still fifteen miles of descent. If the fuel tanks explode there will be nothing for them to do.

  The plane emerges from the trees, crosses a gap and disappears behind the Post Office Tower. If Perowne were inclined to religious feeling, to supernatural explanations, he could play with the idea that he's been summoned; that having woken in an unusual state of mind, and gone to the window for no reason, he should acknowledge a hidden order, an external intelligence which wants to show or tell him something of significance. But a city of its nature cultivates insomniacs; it is itself a sleepless entity whose wires never stop singing; among so many millions there are bound to be people staring out of windows when normally they would be asleep. And not the same people every night. That it should be him and not someone else is an arbitrary matter. A simple anthropic principle is involved. The primitive thinking of the supernaturally inclined amounts to what his psychiatric colleagues call a problem, or an idea, of reference. An excess of the subjective, the ordering of the world in line with your needs, an inability to contemplate your own unimportance. In Henry's view such reasoning belongs on a spectrum at whose far end, rearing like an abandoned temple, lies psychosis.

  And such reasoning may have caused the fire on the plane. A man of sound faith with a bomb in the heel of his shoe. Among the terrified passengers many might be praying—another problem of reference—to their own god for intercession. And if there are to be deaths, the very god who ordained them will soon be funereally petitioned for comfort. Perowne regards this as a matter for wonder, a human complication beyond the reach of morals. From it there spring, alongside the unreason and slaughter, decent people and good deeds, beautiful cathedrals, mosques, cantatas, poetry. Even the denial of God, he was once amazed and indignant to hear a priest argue, is a spiritual exercise, a form of prayer: it's not easy to escape from the clutches of the believers. The best hope for the plane is that it's suffered simple, secular mechanical failure.

  It passes beyond the Tower and begins to recede across an open patch of western sky, angling a little towards the north. The fire appears to diminish with the slowly changing perspective. His view now is mostly of the tail and its flashing light. The noise of the engine's distress is fading. Is the under-carriage down? As he wonders, he also wishes it, or wills it. A kind of praying? He's asking no one any favours. Even when the landing lights have shrunk to nothing, he continues to watch the sky in the west, fearing the sight of an explosion, unable to look away. Still cold, despite the dressing gown, he wipes the pane clear of the condensation from his breath, and thinks how remote it now seems, that unprompted, exalted mood that brought him from his bed. Finally he straightens and quietly unfolds the shutters to mask the sky.

  As he comes away, he remembers the famous thought experiment he learned about long ago in a physics course. A cat, Schrödinger's cat, hidden from view in a covered box, is either still alive, or has just been killed by a randomly activated hammer hitting a vial of poison. Until the observer lifts the cover from the box, both possibilities, alive cat and dead cat, exist side by side, in parallel universes, equally real. At the point at which the lid is lifted from the box and the cat is examined, a quantum wave of probability collapses. None of this has ever made any sense to him at all. No human sense. Surely another example of a problem of reference. He's heard that even the physicists are abandoning it. To Henry it seems beyond the requirements of proof: a result, a consequence, exists separately in the world, independent of himself, known to others, awaiting his discovery. What then collapses will be his own ignorance. Whatever the score, it is already chalked up. And whatever the passengers' destination, whether they are frightened and safe, or dead, they will have arrived by now.

  Most people at their first consultation take a furtive look at the surgeon's hands in the hope of reassurance. Prospective patients look for delicacy, sensitivity, steadiness, perhaps unblemished pallor. On this basis, Henry Perowne loses a number of cases each year. Generally, he knows it's about to happen before the patient does: the downwards glance repeated, the prepared questions beginning to falter, the overemphatic thanks during the retreat to the door. Other patients don't like what they see but are ignorant of their right to go elsewhere; some note the hands, but are placated by the reputation, or don't give a damn; and there are still others who notice nothing, or feel nothing, or are unable to communicate due to the cognitive impairment that has brought them in the first place.

  Perowne himself is not concerned. Let the defectors go along the corridor or across town. Others will take their place. The sea of neural misery is wide and deep. These hands are steady enough, but they are large. Had he been a proper pianist—he's dabbled inexpertly—his ten-note span might be of use. They are knobbly hands, bulging with bone and sinew at the knuckles, with a thatch of gingerish hair at the base of each finger—the tips of which are flat and broad, like the suckers on a salamander. There's an immodest length to the thumbs, which curve back, banana-style, and even at rest have a double-jointed look, more suited to the circus ring, among the clowns and trapezists. And the hands, like much of the rest of Perowne, are gaily freckled in a motley of orange and brown melanin extending right up to his highest knuckles. To a certain kind of patient this looks alien, even unwholesome: you might not want such hands, even gloved, tinkering with your brain.

  They are the hands of a tall, sinewy man on whom recent years have added a little weight and poise. In his twenties, his tweed jacket hung on him as though on narrow poles. When he exerts himself to straighten his back, he stands at six foot two. His slight stoop gives him an apologetic look which many patients take as part of his charm. They're also put at their ease by the unassertive manner and the mild green eyes with deep smile-wrinkles at their corners. Until his early forties, the boyish freckles on his face and forehead had the same unintimidating effect, but recently they've begun to fade, as though a senior position has at last obliged him to abandon a frivolous display. Patients would be less happy to know that he's not always listening to them. He's a dreamer sometimes. Like a car-radio traffic alert, a shadowy mental narrative can break in, urgent and unbidden, even during a consultation. He's adept at covering his tracks, continuing to nod or frown or firmly close his mouth around a half-smile. When he comes to, seconds later, he never seems to have missed much.

  To a degree, the stoop is deceptive. Perowne has always had physical ambitions and he's relu
ctant to let them go. On his rounds he hits the corridors with an impatient stride his retinue struggles to match. He's healthy, more or less. If he takes time after a shower to scrutinise himself in the full-length bathroom mirror, he notes around his waist a first thickening, an almost sensual swelling below the ribs. It vanishes when he holds himself erect or raises his arms. Otherwise, the muscles—the pecs, the abs—though modest, keep a reasonable definition, especially when the overhead lamp is off and light falls from the side. He is not done yet. His head hair, though thinning, is still reddish brown. Only on his pubes are the first scattered coils of silver.

  Most weeks he still runs in Regent's Park, through William Nesfield's restored gardens, past the Lion Tazza to Primrose Hill and back. And he still beats some of the younger medics at squash, centring his long reach on the “T” at the centre of the court, from where he flaunts the lob shots which are his special pride. Almost half the time he beats the consultant anaesthetist in their Saturday games. But if an opponent is good enough to know how to shift him from the centre of the court and make him run, then Henry is done for in twenty minutes. Leaning against the back wall, he might unobtrusively check his own pulse and ask himself whether his forty-eight-year-old frame can really sustain a rate of one hundred and ninety. On a rare day off he was two games up against Jay Strauss when they were called—it was the Paddington rail crash, everyone was called—and they worked twelve hours at a stretch in their trainers and shorts under their greens. Perowne runs a half-marathon for charity every year, and it's said, wrongly, that all those under him wanting advancement must run it too. His time last year—one hour forty-one—was eleven minutes slower than his best.