Dr Hunter’s office was a long, high-ceilinged room, with sash windows at the far end giving a view of a small, walled garden and, minimally screened by barren, wintry trees and shrubs, the stark metal fire escape of the building beyond. Lynn had often thought that in grander days, when this had been all one house, this office was probably the dining room.

She liked buildings, particularly interiors. One of her biggest joys was visiting country houses and stately homes that were open to the public – and there had been a time when Caitlin had quite enjoyed that too. It had long been her plan that when Caitlin was off her hands, and the need to earn money was not so pressing, she would do a course in interior design. Maybe then she’d offer to give Ross Hunter’s surgery a makeover. Like the waiting room, it could do with a spruce-up in here. The wallpaper and the paint had not aged anything like as well as the doctor himself. Although she had to admit to herself that there was something reassuring about the fact that the room had barely changed in all the years she had been coming here. It had a learned feel about it that always – until today at least – made her feel comfortable.

It just appeared a little more cluttered on every visit. The number of grey, four-drawer filing cabinets against one wall seemed to keep increasing, as did the index boxes in which he kept his patients’ notes stacked on the top, along, incongruously, with a plastic drinking-water dispenser. There was an eye-test chart inside a light box on one wall; a white marble bust of some ancient sage she did not recognize – perhaps Hippocrates, she thought – and several family photographs above a row of crammed, old-fashioned bookshelves.

One side of the room, behind a free-standing screen, contained the examination couch, some electrical monitoring equipment, an assortment of medical apparatus and several lights. The flooring here was a rectangle of linoleum inset into the carpet, giving this area the appearance of a mini operating theatre.

Ross Hunter motioned Lynn to one of the pair of black leather chairs in front of his desk and she sat down, putting her bag on the floor beside her, keeping her coat on. His face still looked tight, more serious than she had ever seen him, and it was making her nervous as hell. Then the phone rang. He raised an apologetic hand as he answered it, signalling with his eyes to her that he would not be long. While he spoke, he peered at the screen of his laptop.

She glanced around the room, listening to him talking to the relative of someone who was clearly very ill and about to be moved into the local hospice, the Martletts. The call made her even more uncomfortable. She stared at a coat stand with a solitary overcoat – Dr Hunter’s, she presumed – hanging from it and puzzled over an array of electrical equipment that she had not seen, or noticed, previously, wondering absently what it did.

He finished the call, scribbled a note to himself, peered at his screen once more, then focused on Lynn. His voice was gentle, concerned. ‘Thanks for coming in. I thought it would be better to see you alone before seeing Caitlin.’ He looked nervous.

‘Right,’ she mouthed. But no sound came out. It felt as if someone had just swabbed the insides of her mouth and her throat with blotting paper.

He retrieved a file from right at the top of one pile, put it on his desk and opened it, adjusted his half-moon glasses, then read for a few moments, as if buying himself time. ‘I’ve got the latest set of test results back from Dr Granger and I’m afraid it’s not good news, Lynn. They’re showing grossly abnormal liver function.’

Dr Neil Granger was the local consultant gastroenterologist who had been seeing Caitlin for the past six years.

‘The enzyme levels in particular are very elevated,’ he went on. ‘Particularly the Gamma GT enzymes. Her platelet count is very low – it has deteriorated quite dramatically. Is she bruising a lot?’

Lynn nodded. ‘Yes, also, if she cuts herself the bleeding takes a long time to stop.’ She knew that clotting agents were produced by the liver, and with a healthy liver they would immediately be dispatched to cause clotting and stop the bleeding. ‘How elevated are the enzyme levels?’ After years of looking up everything Caitlin’s doctors had told her on the Internet, Lynn had accumulated a fair amount of knowledge on the subject. Enough to know when to be worried, but not enough to know what to do about it.

‘Well, in a normal healthy liver the enzyme level should be around 45. The lab tests that were done a month ago showed 1,050. But this latest test shows a level of 3,000. Dr Granger is very concerned about this.’

‘What is the significance, Ross?’ Her voice came out choked and squeaky. ‘Of the rise?’

He looked hard at her with compassion showing in his eyes. ‘Her jaundice is worsening, he tells me. As is her encephalopathy. In lay terms, her body is being poisoned by toxins. She’s suffering increasingly from episodes of confusion, is that right?’

Lynn nodded.

‘Drowsiness?’

‘Yes, at times.’

‘The itching?’

‘That’s driving her crazy.’

‘The truth is, I’m afraid Caitlin is no longer responding to her treatments. She has irreversible cirrhosis.’

Feeling a deep, dark heaviness inside her, Lynn turned for a moment and stared bleakly through the window. At the fire escape. At a wintry, skeletal tree. It looked dead. She felt dead inside.

‘How is she today?’ the doctor asked.

‘She’s OK, a bit subdued. Complains that she’s itching a lot. She was awake, scratching her hands and her feet, most of the night. She said her urine’s very dark. And her abdomen is swollen, which she hates most of all.’

‘I can give her some water tablets to help get rid of the fluid.’ He made a note on Caitlin’s index card and suddenly Lynn found herself feeling indignant. Surely this warranted something more than a sodding index-card note? And why didn’t he have such things on a computer these days?

‘Ross, when – when you say deteriorated quite dramatically – how – what – I mean how – how is that stopped? You know, reversed? What has to happen?’

He jumped up from his desk, went over to a floor-to-ceiling bookshelf, then came back holding a brown, wedge-shaped object, cleared a space on his desk and set it down.

‘This is what an adult human liver looks like. Caitlin’s would be just a little smaller.’

Lynn looked at it, the way she had looked at it a thousand times before. On a plain pad he started drawing what looked like a lot of broccoli. She listened as he explained, patiently, how the bile ducts worked, but when he had finished the diagram she knew no more than she already knew about the way the bile ducts worked. And besides, there was only one question that mattered to her now.

‘Surely there must be some way to reverse the failure?’ she asked. But her voice carried no conviction. As if she knew – as if they both knew – that after six years of hoping against hope, they were finally arriving at the inevitable.

‘I’m afraid that what’s going on here is not reversible. In Dr Granger’s view we are in danger of running out of time.’

‘What do you mean?’

‘She hasn’t responded to any medication and there aren’t any other drugs out there that we can give her.’

‘There must be something you can do? Dialysis?’

‘For kidney failure, yes, but not for liver failure. There’s no equivalent.’

He fell silent for some moments.

‘Why not, Ross?’ she probed.

‘Because the liver’s functions are too complex. I’ll draw you a cross-section and show-’

‘I don’t want another fucking diagram!’ she shouted at him. Then she started crying. ‘I just want you to make my darling angel better. There must be something you can do.’ She sniffed. ‘So what will happen, Ross?’