5

‘You understand, don’t you, that the correct procedure is for the surgeon who carries out the biopsy to go on and perform whatever surgery is required?’

‘Yes.’

Brodskaya folds her arms, and frowns. ‘Very well. I’ll see the patient today, get an anaesthetist to check him over, and we’ll do the biopsy in the morning. You know that it has to be done under general anaesthetic?’

‘Yes, I’ve been reading up on it. But, Riva Grigorievna, you do realize, don’t you, the implications of all this? This boy is Volkov’s son. I’d understand completely if you didn’t want to become involved.’

‘You’ve already told me that.’

Her lack of reaction amazes him. Her strong, broad face is calm. ‘I’ll see him today,’ she repeats. ‘The sooner the biopsy is done, the better. I can’t imagine why Russov ever thought you should examine the boy, given that you’re neither an oncologist nor an orthopaedic surgeon.’

‘He thought the swelling might be due to arthritis, I suppose.’

‘Really? Did you think that, after you’d examined the child?’

‘No.’

‘Exactly.’

‘I suppose there’s still the possibility that the tumour is benign.’

Brodskaya shakes her head briskly. ‘I would doubt that very much. From the X-rays you showed me, the form and location of the tumour are absolutely consistent with osteosarcoma. But let’s get that biopsy done and then we’ll talk again. Assuming that you intend to remain in contact with the case?’

‘I – I’m not sure.’

She gives him a look that isn’t remotely critical, but is full of such comprehension that he has to turn away. Brodskaya is a single woman. As far as anyone knows, she’s never had any attachments. She maintains a cool, equal friendliness with all her colleagues. Suddenly, fiercely, he envies her. This is a filthy business. Each person passes the poison on to the next. If only he could just –

But maybe, even if he hadn’t got Anna and Kolya to think of, he wouldn’t be as heroically disinterested as he’d like to think. Don’t stick your neck out. Be careful. Put a padlock on your tongue unless you’re within the four walls of home, and even then –

He’s saturated with it. He’s no better than anyone else.

‘Thank you, Riva Grigorievna,’ he says quietly, hoping that she knows how much he means it.

All day an uneasy part of his mind tracks what will be going on in that private room. Brodskaya will be in there now. Maybe she’s already face to face with the Volkovs. She’ll be explaining that the swelling is due to a tumour, which has to be analysed in order to determine the treatment. The biopsy will require a general anaesthetic, and she will take charge of the surgery. He hopes they don’t talk in front of Gorya. Too many doctors assume that a child won’t understand words like ‘tumour’or ‘biopsy’. But children don’t need to understand the medical terms. They pick up the meaning from their parents’ reaction.

Brodskaya does some paediatric work, but she’s spent most of her career in adult orthopaedics. She has a fine wartime record; her work on limb salvage was pioneering. A good surgeon, and a strong, determined woman. But she’s not made the progress in her career that you’d expect. She doesn’t sit on the important committees.

Andrei works late. It’s after seven when Brodskaya comes to find him. Her face is as calm as ever as she sits down opposite him and says, ‘It’s impossible for me to treat this patient satisfactorily.’

He knows immediately that she’s talking about the Volkov boy.

‘But why? What’s happened, Riva Grigorievna?’

‘The family lacks confidence in the investigations that I proposed. They’ve asked to discuss the case and the course of treatment with you again.’ She shrugs. ‘I have to admit defeat.’

‘My God, I’m so sorry – what on earth were they thinking of?’

‘Who knows?’

‘I’ll go and see them, of course. It’s probably the shock. They don’t want to believe that the boy needs surgery. But you told them there was a tumour – didn’t they realize what it meant?’

‘Apparently not.’ She leans forward a little. ‘Or perhaps they feel that they need a different surgeon. They may not like my name.’

He stares at her. She looks at him with a touch of derisive pity, for all the things he doesn’t have to reckon with. ‘Brodskaya,’ she says. ‘Surely you understand.’

And of course he does. They might prefer a doctor who is not Jewish. But she must be mistaken. As if a parent with a sick child would care about anything but getting that child well again. If the doctor had two heads, it would scarcely matter.

‘You’d better prepare yourself,’ she says, and this time the pity is definitely there. ‘It’s you that they want. You can be sure that Volkov has checked the personnel files. Probably he finds that my “autobiography” is not to his taste. Well, there we are. Allow me to give you back these X-rays.’ She slides the brown folders across the table to him.

‘Was he there – Volkov?’ asks Andrei.

‘Yes. He’s still there now. He wants to see you.’

‘What – this evening?’

‘Yes.’

He looks down at the folders, then up at Brodskaya again.

‘Be careful,’ she says. ‘And if Volkov changes his mind, come back to me. It’s an interesting case. I know exactly how I would approach it. But if he doesn’t, I’d recommend Andropov to do the surgery. He’s good. The quality of the work makes all the difference to the outcome in such a case. The biopsy must be done in such a way that it won’t compromise further treatment. And when it comes to surgery, the judgement of the margin must be absolutely accurate. I remember a case where the surgeon was too conservative. He operated without leaving a sufficient margin. It’s vital not to be over-influenced by the desire to preserve the limb. A few months down the road, and what have you got? Seeding of malignant osteoblastic cells at the site, tumour regrowth, and very probably metastasis as well.’

‘I understand.’ Andrei stands up, holds out his hand. ‘Thank you, Riva Grigorievna.’

But she shakes her head again and the corners of her mouth crease in a small ironic smile. ‘You’ve got nothing to thank me for, Andrei Mikhailovich. Come back to me if you wish.’

Andrei makes himself walk more slowly as he approaches the door of the private room. It’s important that Volkov doesn’t hear him hurrying along, like one of his subordinates. Another policeman stands there, thickset, bored. His eyes survey the doctor. ‘Your papers.’ He examines the document, planting a finger on it and tracing down the print as if to demonstrate his vigilance, then hands it back to Andrei without a word. He jerks his head at the door to indicate that the doctor’s allowed to go in.

Gorya appears to be sleeping. His father sits in the chair by the bed, legs apart, arms folded. He’s a slighter man than Andrei expected. He has taken off his jacket and rolled up his shirtsleeves, as if he’s got a job of work to do here. He has one of those slim, strong bodies that age very slowly. He must be over forty, to judge from his face, but there isn’t an ounce of spare flesh on him.

He looks up. His eyes are a pale, clear grey. They scan Andrei for a few moments, and then Volkov says quietly, ‘The boy’s sleeping. Let’s find a room where we can talk without disturbing him.’

Andrei registers the quiver of Gorya’s eyelids. The boy isn’t really asleep. He wants to hear what’s going to be said, and maybe his father knows that too. He thinks quickly. There’s the secretaries’ office at the end of the corridor. The girls will have gone home long ago.

‘Follow me, please,’ he says, again wanting to take the lead somehow, to assert that this is his territory, not Volkov’s. But he hears himself sounding like a servant.

The office is empty. The big typewriters stand on their desks, covered. There’s a faint, beautiful scent. Yes, one of the girls has brought in a bunch of white lilac. Andrei pulls out two chairs.

‘Sit down, please.’

He’s used to the way parents react to bad news. Some are silent with shock. Some weep. A few can’t stop talking, telling him every detail of the illness from the first moment that they noticed something was wrong. Some try to use the language of the hospital, as if they were professionals too, building a wall of protective words around the sick child, distancing the blunt terror of the diagnosis. And he’s known a woman to throw herself to the ground at his feet and cling to them, writhing, as if he holds it in his hands to give life or to take it away.

There are many reactions, all of them personal and all of them belonging to a deep, shared human pattern.

But this man just watches him.

‘I am Doctor Alekseyev. Andrei Mikhailovich,’ says Andrei.

‘Volkov,’ says the man, as if it’s a name like any other. ‘I’ve read your file. Apparently’ – he lays a stress on the word which makes it sound ironic – ‘apparently you’re a well-regarded paediatrician here. You have a notable skill for the diagnosis of difficult cases. Is my son a “difficult case”?’

‘To diagnose, you mean?’

‘Let’s begin with that.’

‘We’re still at the stage of preliminary investigation. So far what’s clear from the X-rays is that your son has a tumour which is growing within the proximal tibia – that is, the shin bone – very close to the knee. The expansion of the tumour beyond the bone is leading to the pain and swelling. I believe that Dr Brodskaya showed you the X-rays?’

The man nods.

‘We need to discover the nature of the tumour as soon as possible. For this reason a biopsy has to be done. It has to be what we call an “open biopsy”, which requires an operation in order to take a sample of the tumour.’

‘ “What we call”,’ grumbles Volkov. ‘You doctors are not a secret society, I take it?’

It’s a fair point, but Andrei decides not to concede it. ‘In order to achieve the best possible outcome for the patient, the surgeon who does the biopsy should be the surgeon who is to perform any subsequent surgery that’s required.’

At this moment, for the first time, Volkov reacts like any other parent. He blinks as the words ‘subsequent surgery’ hit his understanding. Normally, at such a moment, Andrei would offer some reassurance, not to pull the punch but at least to soften it. But this time he says nothing. He doesn’t understand this man, and instinct tells him that it would be dangerous to pretend to do so.

‘You’re not a surgeon yourself, then?’ says Volkov, as if he’s exposed a flaw which Andrei has tried to conceal.

‘No. I’m a paediatric physician. I have a special interest in juvenile arthritis, which is why Dr Russov referred your son’s case on to me initially. The symptoms Gorya was experiencing when he was admitted might well have been due to arthritis.’

‘So, you’re telling me that a fully trained and experienced doctor in one of our finest hospitals knows nothing about tumours?’

‘My knowledge of them is general rather than expert. I do see patients with tumours in clinic, I examine them, I might order tests, but I would then refer them.’ He could add that there is a shortage of paediatric oncologists, which means that most of the hospital’s physicians have gained more experience with cancer patients than might be ideal for the patients. But to say any of that would be premature. He should not speak of cancer until the biopsy has confirmed it. It would be rash, anyway, to imply any criticism of the hospital’s staffing levels.

Volkov leans forward. His light, clear eyes are compelling. ‘Let me get this clear. Do you correctly understand my son’s illness, or don’t you?’

‘There are other doctors who would understand it better than I do. You need a good surgeon, although the surgeon wouldn’t necessarily take overall charge of the case.’

‘But you know what you’re doing. Remember, I’ve read your file. I know the extent of your experience. During the war years you weren’t referring patients here, there and everywhere. You had to treat them on the spot. You had to operate with your own hands. Didn’t you? Isn’t that the way it was?’

‘Yes, I suppose it was.’

‘You “suppose it was”? You know it was. You’re a blokadnik. So am I. We know how things were.’

Do we? thinks Andrei. Were things the same for the high-ups as they were for us? I doubt if there were many cases of alimentary dystrophy at the top level. But, then again, Volkov wasn’t at the top during the war. His rise is recent. The first Andrei heard of him was a few years ago, when a group of spies was unmasked within the Jewish Anti-Fascist Committee, and Volkov was named in Pravda as ‘the tireless investigator whose vigilance led to the downfall of these scum infected with private-ownership psychology, who plotted against the people’.

‘Let’s look at it another way,’ says Volkov. ‘A good surgeon isn’t hard to find. There are plenty in this hospital. You know who’s the best. A professional always does. You’ve got the laboratories, you’ve got access to the latest treatments. What I want is someone I can trust, to take charge of the case and keep on top of it. My boy likes you. I don’t want him messed around by some “surgeon-shmurgeon”.’

Andrei takes a breath. ‘I have to say, with respect, that’s not how we do things here.’

‘Hospital protocol, eh? You don’t have to worry about that. Listen to me. I like the look of your file. You were with the People’s Volunteers. You worked throughout the siege. But you’re not a Leningrader, are you?’

‘Not originally.’

‘No. You’re from Irkutsk. A Siberian, eh? You don’t believe that Leningrad’s the only place on earth. Your parents volunteered as settlers.’

Andrei looks down at his hands. He can barely believe this conversation. The man’s son has a tumour in the bone of his leg. Volkov is an intelligent man. He must, surely, understand what that means. And yet here he is, reciting the contents of Andrei’s personal file to him, as if this were an –

Don’t think of that.

‘As I said, I went through the siege myself,’ Volkov goes on, as if he’s about to recite his own autobiography in exchange for reading Andrei’s. ‘So these Leningraders have got nothing on me, any more than they have on you. But I was born in Krasnoyarsk.’

‘Really?’ In spite of himself, Andrei can’t help a surge of fellow feeling. Krasnoyarsk may be four hundred miles from Irkutsk but it’s the same world, and a world away from this city.

‘The reports on you are excellent,’ says Volkov.

‘I’m an ordinary doctor, that’s all.’

‘Exactly.’ Volkov smiles approvingly. ‘That’s what we need. The people don’t want cosmopolitan pretensions. They want ordinary, dedicated men. Apparently you have a high reputation as a diagnostician and your outcomes are exceptionally positive.’

Andrei sees that Volkov has actually forgotten that he is here as the parent of a seriously ill child. He looks down, so that Volkov won’t catch him watching at the moment when he remembers it again. There is a silence. The scent of the lilac seems very strong.

‘My boy wants you,’ says Volkov. ‘You’ve taken his fancy. He thinks you’re the best doctor here. He didn’t think much of your Dr Russov or your Brodskaya.’

‘Excuse me, but I have to tell you that the surgeon I would recommend in this case is precisely Riva Grigorievna Brodskaya. She’s not only a first-rate orthopaedic surgeon, but she also has the necessary special experience with … tumours. And she also has experience in paediatric orthopaedics. It’s a particularly valuable combination of expertise.’

Volkov half closes his eyes. ‘I don’t like the look of her,’ he says.

Andrei leans forward. It’s a risk, but he needs to take it. ‘Can I ask you to reconsider? In a case like your son’s – if further surgery should be needed after we know the result of the biopsy – then it’s very important that we have a surgeon who can evaluate the site of the tumour as accurately as possible at the time of the biopsy. In that way, she can base later decisions on firm ground. Obviously the section of tumour has to be analysed by the pathology lab, but a really good, experienced surgeon can gain a great deal of knowledge during the biopsy process. In my opinion, Brodskaya is best qualified to do this.’

‘There must be others.’

‘Of course. In the end it’s a question of confidence. I’d have confidence in her to make the most precise, impartial clinical judgement.’

Volkov nods slowly. ‘So you’re telling me that it’s definitely Brodskaya you want, and no one else.’

‘There are other surgeons, as you say. But if it were my son …’ he pauses, suddenly aware of danger. You should never so much as hint at your private life in front of such a man, who can so easily turn it into a weapon to use against you.

‘You have a son?’

‘A stepson,’ says Andrei, because this has always been the easiest way of describing Kolya. ‘My wife’s younger brother’ has never sounded right.

‘Hmm. And you’re telling me that all this should be done as soon as possible?’

Andrei can’t remember saying that. Perhaps Brodskaya made it clear to Volkov. ‘Yes. The biopsy should be done tomorrow, so that the results can be obtained as quickly as possible, and then treatment can begin. We’ve got Gorya’s medical records. As far as I can remember there’s nothing that would complicate anaesthesia or surgery, but obviously all that will need to be checked. He’ll need to be examined by both the anaesthetist and the surgeon.’

‘So you’ve got it all planned,’ says Volkov. His face is still hard and shrewd, but at this moment Andrei’s sure that he’s thinking only as a parent. The fear and anger in his voice are only what any father would feel. You have to be so careful, as a doctor, not to assume that because a procedure is routine to you, it is remotely normal to the families. To cut into a child’s leg, after all, is monstrous. To a father, the flesh and blood the scalpel touches is far more precious than his own.

‘It’s what we have to do, to give Gorya the best possible treatment.’ The best possible chance would come closer to the truth, but that can’t be said; not to any parent and certainly not to this one.

‘You say, “we”,’ observes Volkov. ‘You’ll take the case, then? The surgeon – the oncologist – whoever you need. Let them report to you. You’re the one I want to look after my son.’

There’s no way out of this. Hospital protocol and correct practice will count for nothing. Besides, in this particular case no one’s going to feel demeaned by not having ultimate responsibility for the boy.

‘We haven’t had the biopsy yet,’ says Andrei. ‘You’ll appreciate that I can’t prejudge the results. But you must understand that there’s a strong possibility that your son may be very seriously ill.’

‘Do you think I’m not aware of that?’ At that moment, suddenly and without warning, Volkov bangs his fist on the table. Andrei just manages to prevent himself from reacting. ‘Do you doctors think we’re all fools? Don’t you know who I am?’ He hasn’t been able to resist it, in the end. For all his intelligence, he’s like his wife, not quite able to believe that ‘who he is’ will make no difference to the cells that are proliferating in his child’s body.

Andrei lays his own hands on the table, palms down. There is silence. For one thing, Andrei cannot think of anything to say; for another, he suspects that whatever he says might be construed as a provocation. It’s quite natural for parents in this situation to vent their feelings. Volkov, above all, has to feel that here, in this hospital, he is a parent and nothing else.

Suddenly the tension relaxes. Volkov leans back in his chair and folds his arms. ‘You’re an Irkutsk boy,’ he says. ‘You don’t flinch.’