This was good. ‘Why might we think that’s the case here?’ Vaughan prodded.
‘The patient’s age and sex. Osteoporosis.’ And together these factors heightened the clinical suspicion for fracture.
‘Very good. Next step?’
‘CT or MRI without IV contrast to exclude or confirm fracture.’
There’d been no MRI back when Vaughan was starting out. His own mentors had had to rely on the incomplete picture given by X-rays and physical exams.
‘Or cast the arm and repeat radiographs in ten to fourteen days.’
At that moment the woman leaned back on her pillow and the mentor and his young charge reassured her and lowered their voices as they left the unit.
Vaughan had long excelled at this form of mentoring – what researchers call cognitive apprenticeship, in which thought processes are voiced and discussed and experience is shared. It was ironic how sharply this professional excellence contrasted with Vaughan’s personal life, which had long been messy. Messy, he thought to himself, was an understatement. Sometimes he wondered why no cognitive apprenticeship exists for learning to be a son or a father, a husband or a human being. All his life his only choice had been to teach himself to pass as neurotypical (a word, like MRI, not in any of his old undergrad textbooks), though he hadn’t always pulled it off. But his endurance had told, and in a career spanning fifty years medical advances had transformed many lives and, more recently, his own self-understanding.
Now, nearing well-earned retirement, he looked back on his life and career, took stock and followed his memories where they led him.
✲
In another life, he thought, he’d have been a geographer. The drawing of maps, sinuous treks, modelling landforms would have filled his days. He was born in a valley, not in Canada but in a village called Llangattock – in the south of Wales – as ruggedly Welsh a landscape as you could ever hope to find, as Welsh as his surname, which was Bowen, and though he left with his family as an infant, the misty hills and the ever-changing light had become a part of him and stayed with him always thereafter.
Vaughan remembered better Walton-on-Thames, the market town south of London where his mother, a reverend’s sudden widow, had found work teaching schoolchildren religious education. The transplant of the Welsh valley family to an English suburb succeeded, but not without rendering the Bowen brothers conspicuous. Their mother said things that were funny to English ears. She said ‘daro’ if she dropped something and what sounded like ‘dew dew’ for ‘well, well’. Vaughan did not speak like this. His accent was his own. He only mumbled and blushed when he started primary and promptly learned that he was fatherless. The English boys meant no harm by it – might their Welsh counterparts have been crueller? The boys in Walton simply meant to ask what it was like, but Vaughan had no way of answering. He’d never thought to consider it. Several of the older boys almost envied him and half regretted not being fatherless themselves – they fantasised fathers who had swollen up from the sting of a bee, sleepwalked off a cliff or been struck down by a Rolls-Royce. As if the glamour of such a passing might set a son apart.
No old man, they said, to give them a clip on the ear or worse.
Certainly Mrs Bowen knew how to hold a classroom, and at home she could tell off for two. She had four young sons to feed and clothe and she expressed her love in never-ending instructions: ‘Ych a fi, go and wash your hands! Pass me your coats! Fetch some mint and apples from the garden!’ She made every shilling of her salary go as far as possible.
With little money for toys, Vaughan and his brothers spent their free hours rambling about the town and outlying fields. He thrived on the fragrant air which smelled of recent rain and of grass crushed underfoot. In his memory, sunlight accompanied him across the browning grass beside the railway station as he walked parallel to the tracks. More so than his brothers he’d delighted in treading the same ground that carried these tracks for miles. The first time out here – sixty-something years ago, back when his life was only a life and not yet a story – an exiting train chugged past him bound for London. Full of sudden wonder, he stopped near the tracks and waited for the next one to pass. Presently he heard a clanking of rods and felt the air start to shudder and caught sight of the growing train fogging the air with its white puffs of smoke. He could taste the train – it tasted of smoke and hot metal and his own dry mouth.
He would have happily stood there all day until he ran out of trains to spot but he recalled then that he had a mother and dinner and a bath to be returning to.
In retrospect, it had been the beginning of everything: his whole life he could trace to that encounter with trains – so startling and stimulating. From that moment on he’d begun to catalogue data, classify, subdivide. Many an afternoon and weekend, he stood near the station and consigned all the passing trains’ names and numbers, wheels and sizes to a little notepad, and the thrill never waned as the familiar, delicious smoke approached and the platform became the scene of a minutely timed drama. ‘Union Castle,’ he wrote in biro under ‘Name’ and the date – 16/4/61 – along with the locomotive’s number, 35002, and its wheel arrangement, 4–6–2, while brakes groaned and a whistle flared and passengers clambered down or boarded.
He was also learning to dissect space and time, in railway stops and timetables.
Sometimes, for a treat, when family tickets were going cheap, his mother took her boys on a day trip to Southampton. ‘Hurry up,’ she’d shout as they ran with their bags along the platform, ‘or we’ll lose the train.’ They ran with heavier bags in the summer, when the Pembroke Coast Express transported the Bowens from Paddington to Swansea, to the hill overlooking Mumbles Bay where the grandparents lived. As they rode, all along the track quarter-mile posts reared up and whipped past, and from his window seat Vaughan counted the seconds between the posts to gauge the speed.
He’d hardly told anyone before Anu – Anu Sharma-Niwa, his psychologist in Calgary – that one of the reasons he’d gone on to study medicine in Edinburgh was so he could thunder up and down the coast aboard the Flying Scotsman. The journey always swift and sleek. Now that was what he called a train! He’d catch the 10 a.m. out of King’s Cross, with only the one stop in Newcastle. Sitting back, absorbing the steady hum of the diesel electric engine, watching the world roll by at 100 miles an hour.
Anu, whom he’d found online in 2012 at the collapse of his marriage of thirty-four years, proved a worthy successor to Frank, the doctor who had rescued him from his first breakdown in the seventies. She listened sedulously as Vaughan told her all about the trains and everything else besides, session after session, following which she’d found the words – words unavailable or unthinkable in Frank’s day – to explain that he was a savant and in a career perfectly tailored for him. ‘Autism?’ he’d repeated, seated for the first time in decades on the patient’s side of a desk. Autism: a retarding mental illness that renders children unable to function in society. Or so he’d been taught during his early seventies medical training. How inaccurate those textbooks had been. How misguided.
And so he had discovered in himself this enlightening autism, this savantism, at the age of sixty-three. It clarified so much, fed his self-discovery and confidence.
So that, ten years on from these early sessions with Anu, he could relate everything again to a youngish man named Daniel, corresponding freely with him, sharing all manner of details which had never before left his psychologist’s office, because this Daniel Tammet, aside from being a writer, was also what doctors called an autistic savant. The writer understood things about him that others might not have. Vaughan was excited at the thought of seeing his story put into print. Then, hopefully his ex-wife, with whom he remained on good terms, would come to a clearer idea, on reading it, of the often awkward, silent, confusing man who had loved her as best he could during all those years.
Years that had rolled by at the speed of life.
✲
The day after their rounds of the orthopaedic unit, Vaughan and the American put on gown, gloves and mask and positioned themselves around the operating table. The American observed in silence while Vaughan worked. The older surgeon’s gestures were deft and graceful. His patient had been put at ease with anaesthesia, and between the surgeons and the nurse there was no distracting small talk. The masks and the music – something delicately classical playing low – heightened Vaughan’s absorption in his task.
Head bowed, eyes focused, all his attention went to the slumbering hand in front of him. That morning he’d tended to a young and muscular forearm which for years had lobbed and served and sliced drop shots; in its place now lay a middle-aged thumb hampered by arthritis. Where the incision had been made, he could see past layers of skin and fat to the basal joint. The sight was familiar, blood and bone had never aroused any squeamishness in him; he was fascinated by the body’s intricate networks of nerve, artery and tissue, all those inner parts that go unseen and on which our visible surfaces depend. What things of beauty, of nature’s ingenuity, the violin strings that are the tendons! And the wrist bones shaped like a boat (the scaphoid), a crescent moon (the lunate), a pyramid (the triquetrum) – three among the twenty-seven bones in the human hand. In his mind’s eye, he could picture each one of these small bones in three dimensions, he could visualise their every binding ligament and every muscle, the galvanising sparks and the irrigating scarlet threads.
‘See the joint surface here?’ Vaughan said to the American, as he extracted the bone fragments one by one. ‘That’s the arthritis.’
Minutes later, ‘See here, the cartilage has all worn down.’ Then, addressing the nurse, ‘Give me a little traction, please.’ Then, to the American again, ‘Now I’m opening a channel in the trapezium.’
He was repeating the one he’d just opened in the trapezium in his mind’s eye. Deep into the joint he drilled. Close by, surrounded by forceps and scalpels and scissors, the implant to replace the patient’s lost bone shone bright. It was made of titanium – strong yet light and ductile and practically, most enviably, unbreakable.
The operation took just over an hour and was a complete success. Vaughan peeled off his scrubs and soaped his hands and smiled. He had barely stepped out from the operation room when he saw a woman approach him with a sheet of paper. He nodded when she said something about a schedule, less to signal assent than to cover his confusion. The woman thrust the sheet into his hands, turned on her heels and went back to her office. Only then did he realise she was his medical office assistant of twenty-plus years, and his face burned in embarrassment. He’d tried memorising her hairdo, and the comfortable jumpers she favoured, for all the good it had done him. At least she had been with him long enough to understand. From his earliest days, his memory for faces had been dreadful. He always imagined his assistant sitting attentively behind her desk, or busy with the phone. Without her desk, and walking to boot, he struggled to recognise her.
✲
Sometimes he wondered whether it had been quite the same for his grandfather, this near-illiteracy when it came to reading the expression on a face.
Vaughan’s resemblance to his mother’s father was in no way physical. He remembered a very short man, bow-legged (rickets was his medical opinion later on). It was rather his grandfather’s unusual mind that he’d inherited. A trained surveyor’s feel for geometry. A talented retailer’s head for figures. An eye for minute detail. Not that he understood this for a long time. John Sydenham Richards of Swansea, known in those parts as JSR, or as Papa by his grandchildren, was already an old man when the Bowens spent their summers visiting the grandparents. He was something of a local character, a staunch pillar of the community: he put the Richards into Manning, Martin and Richards, wholesalers formerly of Union Street. ‘Matting, Mats and Rugs’ proclaimed their slogan. They also sold linoleum, Acme wringers, Newmaid suction sweepers, paints and cloths. Inventorying would have been for Richards, the director, what trainspotting and medicine would become for his grandson.
It had never occurred to Vaughan to make these connections until quite recently – until, that is, the day back in the UK when a brother showed him one of their grandfather’s many diaries. He showed him 1939. It was pocket-sized and filled with meticulous, vigorous handwriting. Every page was not only dated but also timed. Vaughan’s brother flipped the pages to July, to the eighteenth, which had separate entries for 8.30 a.m., 9.15 a.m., 12.50 p.m., 3.23 p.m., 3.30 p.m., 4.45 p.m., 6.32 p.m., 6.34 p.m., 6.35 p.m., 6.37 p.m., 6.38 p.m., 6.40 p.m., 7.00 p.m., 7.10 p.m., 7.30 p.m.
On 18 July 1939 their grandfather and his wife May were holidaying in Bergen, Norway.
‘4.45 p.m. Harbour of Bergen. Loads of fish being transferred to a ship for England. All motor cars on Quay appear to be American. Passed customs in shed. Walked along Quay to Hotel Rosenkrants,’ he had written.
‘Keep reading,’ said Vaughan’s brother, his voice almost hushed. ‘Papa counted everything!’
‘Room No 309. Lady’s Gent’s cloakroom. Sitting room. 3 couches. Writing table. 3 tables. 2 armchairs. 2 chairs. 1 writing stool. Telephone. Cabinet. 19 lights. 2 reading lamps. Sewing materials. 3 radiators. 2 twin beds. Bath. Wash up. Lavatory (W.C.). 4 Drinking glasses. 6 towels.’
