'There is no other course of action, Colonel Sieverance. She'll die, I've seen it happen countless times.'

'But this operation, have you ever performed it?'

'It's rare. I've done it twice, but without success unfortunately.'

'Meaning what?'

'I was too late. The appendix had ruptured, sepsis was advanced, uncontrollable.'

'Jesus Christ, you want to cut her open and you've never saved a patient with this operation?'

'Look, Wieland's ridiculous purgatives are just going to weaken her faster. You might as well cast a spell for all the good it'll do. She has to have the operation.'

'I can't risk it.'

'Ask her.'

'She's in pain. How can she make a clear judgement?' His voice was shrill, girlish, demented with worry. He stood up and walked to the window and peered out into the night. 'Wieiand's due here in half an hour.'

'Don't ask him, man. He knows nothing. Take her to the hospital, we'll operate tonight.'

'I want to wait for Wieland. Then I'll decide.'

Dr Wieland did not bother to conceal his huge displeasure, and neither did Dr Cruz, whom Wieland had asked to accompany him, so he said, to confirm his diagnosis.

'Dr Carriscant has absolutely no business here,' Wieland said, anger distorting his voice. 'Mrs Sieverance is my patient.'

'He has my authority,' Sieverance insisted. 'My wife is ill and I want the best for her.'

Wieland had to accept this which he did with manifest bad grace before pronouncing his diagnosis.

'We think, and Dr Cruz agrees with me on this, that the gut is inflamed due to a lack of mobility. The calomel will encourage movement of the gut and at the same time the opium will control the pain. Within two or three weeks-'

'-she will be dead and buried,' Carriscant said brutally. He saw Sieverance flinch.

Cruz rounded on him and spoke harshly and rapidly in Spanish. 'How dare you contradict us. This is as clear a case of perityphlitis as I've ever seen. All this fashionable nonsense about the appendix is unforgivable in the current circumstances. I deplore your presence here and I order -'

'Gentlemen, please,' Sieverance said. 'Let me understand this: you completely oppose Dr Carriscant's idea of surgery, and you wish to continue with the purgatives and the opium.'

'And a broth four times a day,' Cruz added in English. 'With alcohol. For to strengthen.'

'Colonel Sieverance, do not delay, I beg you,' Carriscant said. 'Your wife must be operated on at once.'

'This is a colic which has inflamed the intestine!' Wieland shouted at him. 'To open the abdomen is tantamount to murder.'

'The king of England had his appendix removed a matter of months ago,' Carriscant retorted, keeping his voice calm. 'It saved his life.'

This seemed to silence them for a moment. Then Wieland said, without much confidence, 'We are not talking about the same problem here, it's a false analogy.' He turned to Sieverance. 'The problem with someone like Dr Carriscant is that he will operate without reflection. If you had indigestion he would suggest removing your appendix. This is the so-called "modern" approach, and Carriscant does not care -'

'Just one minute,' Carriscant interrupted, approaching Wieland, who backed off. 'Be very careful what you say, Wieland. If you slander me, I won't answer for -'

'For God's sake!' Sieverance was exasperated. 'I'm going to talk with my wife. A moment, please.' He left them alone in the room.

Cruz said, malevolently, 'You're finished, Carriscant. This is a gross violation of medical ethics.'

'Sieverance called me in himself, you stupid old fool.'

'Yes, you bastard,' Wieland shouted at him, 'only because of the filthy rumours you've been whispering in Taft's ear.' He pointed a shaking forefinger at him. 'What is it with people like you, Carriscant? You're knife-happy. Can't wait to cut, cut, cut. Mrs Sieverance isn't some corpse in a dissecting room!'

'Of course she's not.' Carriscant caught himself just in time, his voice heavy with emotion. 'She is on the verge of death. I can save her. You two idiots would just prolong her agony, draw it out for a day or two with your useless potions.'

'You disgust me,' Cruz said. 'You're a worm, an insect, you dishonour the profession.'

The three of them faced each other, silenced by their virulent animosity. Carriscant felt a vast weariness of spirit sweep through him. They could trade insults for hours, he realised; neither of them would yield an inch of ground. He turned his back on them and walked across the room. There was a small grand piano at the far end, with piles of sheet music stacked on the cover. This was her music, he knew intuitively, as he picked up some of the scores – Brahms, Mendelssohn, Mozart – and he raised the edge of a piano concerto to his nose as if expecting it to be redolent of her, somehow.

'Dr Carriscant,' Sieverance said, re-entering the room.

My wife would like to see you.'

Sieverance accompanied him back to the bedroom. Her face had a wracked, exhausted look to it. Her hair was damp around her brow and temples.

'I heard your voices raised,' she said. 'What's happening?'

'Dr Wieland counsels against surgery,' Sieverance said.

She looked at Carriscant, directly. The dark eyes seemed bigger than ever. 'What do you think?'

'I think… ' The question unmanned him completely and he felt an upswelling of an emotion in him that he did not recognise. Her gaze held him to the exclusion of everything else. 'I think Wieland is a fool and a charlatan and anyone who listened to him would be mad,' he said. He wanted to reach forward and take her hand and press it to his lips. 'You don't have much time,' he said with controlled passion. 'This operation is very straightforward. It's only when people delay that there is real danger.' He hoped his eyes said everything his words could not: I will save you, I will make you well, trust me with your life, no one else will cherish it like I do.

She raised her hand weakly, and seemed to offer it to him, as if she had heard his thoughts. Sieverance stepped forward and took it.

'I want to go with Dr Carriscant,' she said.

The morphine had sedated her, her mouth was slack, her eyes half closed, unfocused, seeing the world through the screen of her lashes. Pantaleon stood at her head with his mask and his chloroform drop-bottle. Two theatre nurses with their starched pinafores and frilled caps waited beside the grooved trays of gleaming instruments. Delphine Sieverance lay on the operating table still in her nightgown, having been brought directly to the theatre from her house. There was no time to lose; everything had been prepared with the utmost speed.

Pantaleon looked at him. 'The wind is freshening. Time to weigh anchor.'

Carriscant nodded and Pantaleon dripped chloroform on to the mask. She was unconscious within seconds. Carriscant reached for the hem of her nightgown and remembered. A crucial act of preparation…

He cleared his throat. 'Would you please leave the room. Just for a moment or two. Everyone, please, Pantaleon.'

The nurses and Pantaleon glanced at each other and left the room without further question. Carriscant closed his eyes and a slow shudder ran through his body. He gripped the nightdress hem and lifted it up, pulling it up her body until it bunched at her ribs. His eye went first to the dense golden-ginger furze of her pubic hair and then took in the paleness of her torso, almost bleached in contrast to the stretched inflamed area of her lower belly where the infection glowed luridly beneath her skin, the fateful roseate blush of incipient peritonitis. He drew a great gulp of air into his lungs, turned and went to search in a cupboard beneath the sink for the implements he needed. He found them and stropped the razor rapidly on the thick leather band hanging above the taps.