gesturing towards a fire extinguisher, told him that since this might be her last experience of the colour red, she wanted to remember it. Would he move her closer? Even now she could barely see. He said there was no question, the operation would be a success. But of course, he knew nothing, and his mouth was dry and his knees weak as he moved the trolley nearer to the wall. He had yet to learn clinical detachment. This may have been the time, rather than later in the ward, when he began to fall in love. The swing doors opened and they entered the theatre together, he walking at the side of the trolley while the porter pushed, and she worrying the tissue in her hand, gazing at the ceiling, as though hungry for last details.
The deterioration in her vision had come on suddenly, in the library, and now she was alone, facing momentous change. She steadied herself with deep, slow breaths. She was intent on the anaesthetist's face as he slipped a cannula into the back of her hand, and administered thiopentone. Then she was gone, and Perowne was hurrying away to the scrub room. He had been told to observe closely this radical procedure. Transsphenoidal hypophysectomy. One day he would perform it himself. Yes, even now, so many years later, it calmed him to think how brave she had been. And how benignly their lives had been shaped by this catastrophe.
What else did the young Henry Perowne do to help this beautiful woman suffering a pituitary apoplexy regain her sight? He helped slide her anaesthetised body from the trolley onto the operating table. Obeying the instructions of the registrar, he slipped the sterile covers into place on the handles of the operating lights. He watched as the three steel points of the head-clamp were fixed tightly onto her head. Again guided by the registrar, while Whaley was briefly out of the room, Henry scrubbed Rosalind's mouth with antiseptic soap, and noted the perfection of her teeth. Later, after Mr Whaley had made an incision in her upper gum, rolled her face away from the opening of the nasal passages, stripping the nasal
43 Ian McEwan
mucosa from the septum, Henry helped manoeuvre into position the massive operating microscope. There was no screen to watch - video technology was new in those days, and had yet to be installed in this theatre. But throughout the operation he was allowed frequent glimpses through the registrar's eyepiece. Henry watched as Whaley moved in on the sphenoid sinus, passing through it after removing its front wall. Then he skilfully chipped and drilled away at the bony base of the pituitary fossa and revealed, in less than forty five minutes, the tightly swollen purplish gland within.
Perowne studied closely the decisive jab of the surgical blade and saw the surge of dark clot and ochre tumour the consistency of porridge disappearing into the tip of Whaley's sucker. At the sudden appearance of clear liquid - cerebral spinal fluid - the surgeon decided to take an abdominal fat graft to seal the leak. He made a small transverse incision in Rosalind's lower abdomen, and with a pair of surgical scissors removed a piece of subcutaneous fat which he dropped into a kidney dish. With great delicacy, the graft was passed through the nose and set into the remains of the sphenoid sinus, and held in place with nasal packs.
The elegance of the whole procedure seemed to embody a brilliant contradiction: the remedy was as simple as plumbing, as elemental as a blocked drain - the optic nerves were decompressed and the threat to Rosalind's vision vanished. And yet the making of a safe route into this remote and buried place in the head was a feat of technical mastery and concentration. To go in right through the face, remove the tumour through the nose, to deliver the patient back into her life, without pain or infection, with her vision restored was a miracle of human ingenuity. Almost a century of failure and partial success lay behind this one procedure, of other routes tried
The deterioration in her vision had come on suddenly, in the library, and now she was alone, facing momentous change. She steadied herself with deep, slow breaths. She was intent on the anaesthetist's face as he slipped a cannula into the back of her hand, and administered thiopentone. Then she was gone, and Perowne was hurrying away to the scrub room. He had been told to observe closely this radical procedure. Transsphenoidal hypophysectomy. One day he would perform it himself. Yes, even now, so many years later, it calmed him to think how brave she had been. And how benignly their lives had been shaped by this catastrophe.
What else did the young Henry Perowne do to help this beautiful woman suffering a pituitary apoplexy regain her sight? He helped slide her anaesthetised body from the trolley onto the operating table. Obeying the instructions of the registrar, he slipped the sterile covers into place on the handles of the operating lights. He watched as the three steel points of the head-clamp were fixed tightly onto her head. Again guided by the registrar, while Whaley was briefly out of the room, Henry scrubbed Rosalind's mouth with antiseptic soap, and noted the perfection of her teeth. Later, after Mr Whaley had made an incision in her upper gum, rolled her face away from the opening of the nasal passages, stripping the nasal
43 Ian McEwan
mucosa from the septum, Henry helped manoeuvre into position the massive operating microscope. There was no screen to watch - video technology was new in those days, and had yet to be installed in this theatre. But throughout the operation he was allowed frequent glimpses through the registrar's eyepiece. Henry watched as Whaley moved in on the sphenoid sinus, passing through it after removing its front wall. Then he skilfully chipped and drilled away at the bony base of the pituitary fossa and revealed, in less than forty five minutes, the tightly swollen purplish gland within.
Perowne studied closely the decisive jab of the surgical blade and saw the surge of dark clot and ochre tumour the consistency of porridge disappearing into the tip of Whaley's sucker. At the sudden appearance of clear liquid - cerebral spinal fluid - the surgeon decided to take an abdominal fat graft to seal the leak. He made a small transverse incision in Rosalind's lower abdomen, and with a pair of surgical scissors removed a piece of subcutaneous fat which he dropped into a kidney dish. With great delicacy, the graft was passed through the nose and set into the remains of the sphenoid sinus, and held in place with nasal packs.
The elegance of the whole procedure seemed to embody a brilliant contradiction: the remedy was as simple as plumbing, as elemental as a blocked drain - the optic nerves were decompressed and the threat to Rosalind's vision vanished. And yet the making of a safe route into this remote and buried place in the head was a feat of technical mastery and concentration. To go in right through the face, remove the tumour through the nose, to deliver the patient back into her life, without pain or infection, with her vision restored was a miracle of human ingenuity. Almost a century of failure and partial success lay behind this one procedure, of other routes tried
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