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Megan descended to her desk.

      ‘They told me to go in, doctor. The lady on the desk.’ The woman looked shyly at the ground. ‘Nice to see you again.’

      Megan’s mind was blank. She had seen so many faces recently, and so many bodies. She got a name, a date of birth and took a quick look at her notes. Then it all started to come back.

      The woman had been here a few weeks ago with this same small child, who was then in his other outfit of a grubby grey vest, and chomping on a jam sandwich.

      The brat had run his sticky paws through Megan’s paperwork while she examined his mother, confirming her pregnancy. The woman – Mrs Summer, although as far as Megan could tell, she wasn’t married, and she didn’t have a partner called Summer – had received the news like it was a final demand from the taxman. Not much older than Megan, who was twenty-eight, Mrs Summer was already beaten down by motherhood. The apprentice hooligan with the jam sandwich was her fourth from a rich variety of men.

      ‘How can I help you?’ Megan asked now, relieved that the brat seemed more subdued today.

      ‘There’s been some bleeding, Dr Jewell.’

      ‘Let’s take a look at you.’

      It was an early miscarriage. The woman had been depressed by the news of the pregnancy, but this was infinitely worse. Suddenly, catching Megan off-guard, Mrs Summer seemed to be choking.

      ‘What did I do wrong? Why did it happen?’

      ‘It’s not you,’ Megan said. ‘A quarter of all pregnancies end in – Here. Please.’

      Megan pushed her box of Kleenex across the desk. Mrs Summer’s scrap of kitchen towel was coming apart, and so was she. Megan came out from behind her desk and put her arms around the woman.

      ‘Truly, it’s not you,’ Megan said again, more gently this time. ‘The body runs its series of tests. It finds some abnormality in the embryo. Why does it happen? The honest answer is – we don’t know. A miscarriage comes out of the blue. It’s horrible, I know. The thought of what might have been.’ The two women stared at each other. ‘I’m sorry for your loss,’ Megan said. ‘I really am.’

      And Megan was sorry. She even sort of understood how Mrs Summer could be terrified at the prospect of another baby, and yet devastated when the baby was abruptly taken away from her. A fifth child would have been a disaster. But losing it was a tragedy, a death in the family that she wasn’t even really allowed to mourn properly, except for these shameful tears in a doctor’s surgery the size of a broom cupboard.

      Megan talked quietly to Mrs Summer about chromosomal and genetic abnormalities, and how, hard as it was for us to accept, they were simply incompatible with life.

      ‘You and your partner have to decide if you want any more children or not,’ Megan told her. ‘And if you don’t, then you need to start practising safe sex.’

      ‘I do, doctor. But it’s him. It’s me…partner. He doesn’t believe in safe sex. He says it’s like taking a shower in a raincoat.’

      ‘Well, you’ll just have to discuss it with him. And condoms are far from the only possibility, if that’s what he’s referring to.’

      Megan knew perfectly well that condoms were what he was referring to. But now and again she felt the need to adopt a magisterial tone, to reassert her authority, to keep her head above the sorry human mess that pressed its way into her surgery.

      ‘What about the pill?’

      ‘I blew up. Fat as a fat thing. Got thrombosis. Blood clots. Had to come off it.’

      ‘Coitus interruptus?’

      ‘Whipping it out?’

      ‘Precisely.’

      ‘Oh, I don’t think so. You haven’t met him. I’ve tried, doctor. Tried all the safe sex. What do you call it? The rhythm section.’

      ‘Rhythm method, yes.’

      ‘Tried that one when the doctor said it was the pill that was blowing me up. But it’s when I’m asleep. He just helps himself.’

      ‘Helps himself?’

      ‘Jumps on top of me and he’s away. Then snoring his head off the moment it’s over. You would never get a condom on him, doctor. I wouldn’t like to try. Honest I wouldn’t.’

      It was another world out there. The sprawling estates that surrounded the surgery. Where a baby was still a bun in the oven and the men still helped themselves when some poor cow collapsed at the end of another busy day.

      ‘Well, you tell him he can’t help himself. It’s outrageous behaviour. I’ll talk to him if you want me to.’

      ‘You’re nice, you are,’ the woman told Megan, and grasped her in a soggy bear hug. Megan gently prised her away, and talked about the glories of an intrauterine device.

      Women liked her. She was by far the youngest doctor at the surgery, a GP registrar only a month into her final year of vocational training, yet easily the most popular.

      She had spent the last seven years preparing for this job – six of them at medical school, and the last year as a house officer in two London hospitals. Now, in a surgery where the other three doctors were all men, she was finally in a position where she could make a difference.

      When women came in complaining of period pains that made them feel like throwing themselves under a train, Megan didn’t just tell them to take a painkiller and get a grip. When young mothers came in saying that they felt so depressed they cried themselves to sleep every night, she didn’t simply tell them that the baby blues were perfectly natural. When a nuchal scan said that the possibility of Down’s syndrome was high, Megan discussed all the options, aware that this was one of the hardest decisions that any woman would ever have to make.

      When Mrs Summer was gone, Dr Lawford stuck his head around her door. In the confines of the tiny room, Megan could smell him – cigarettes and a cheese and pickle bap. He bared his teeth in what he imagined to be a winning smile.

      ‘Alone at last,’ he said.

      Lawford was Megan’s GP trainer – the senior doctor meant to act as her guide, teacher and mentor during the year before she became fully registered. Some junior doctors worshipped their GP trainers, but after a month under his tutelage, Megan had concluded that Dr Lawford was a cynical, bullying bastard who hated everything about her.

      ‘Chop chop, Dr Jewell. Your last patient was here for a good thirty minutes.’

      ‘Surely not?’

      ‘Thirty minutes, Dr Jewell.’ Tapping his watch. ‘Do try to move them in and out in seven, there’s a good chap.’

      She stared at him sullenly. Growing up with two older sisters had made Megan militant about standing up for herself.

      ‘That patient has just had a miscarriage. And we’re not working in McDonald’s.’

      ‘Indeed,’ laughed Dr Lawford. ‘Dear old Ronald McDonald can lavish a lot more time on his customers than we can. Here, let me show you something.’

      Megan followed Lawford out into the cramped waiting room.

      Patients sat around in various degrees of distress and decay. A large woman with a number of tattoos on her bare white arms was screaming at the receptionist. There were hacking coughs, children crying, furious sighs of exasperation. Megan recognised some of the faces, found that she could even put an ailment to them. She’s cystitis, she thought. He’s hypertension. The little girl is asthma – like so many of the children breathing the air of this city. My God, she thought, how many of these people are waiting to see me?

      ‘You’re going to have a busy morning, aren’t you?’ Dr Lawford said, answering her question. ‘A good half of these patients are waiting for you.’ Chastened, Megan followed Lawford back to her office.

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