Extract

It’s definitely autumn now. Summer wasn’t that hot, but it seemed to stay warm for a long time. Today there’s a breeze that spikes your skin with cold. The leaves are turning beautiful colours and the first have already fallen. I prefer summer to the other seasons, for the heat. You can be out all day playing football and not even have to worry about bringing a T-shirt. But autumn is loveable. It’s summer’s dying cousin. It’s somehow vulnerable, for the world to die so publicly. You feel tender about autumn.

I wrote that in an essay for my teacher, Ms Marquesa. I wasn’t there when she fed back on the essays but Carl said she (and I’m quoting him verbatim) ‘basically creamed’.

I’m trying to hurry along The Promenade, partly because of the cold and partly because I don’t want anyone to see me, the Walker kid, Stephen Walker’s kid, out of school. Everybody knows Dad. Most people know Mum. I get stopped in the street all the time by people I don’t know, talking about how great they are, how much they do for the community, how much more safe the area has been since Dad has been in charge, what it does for property prices. But if I’m stopped today I’ll crack. I’ll cry. I’ll faint. I’m so tired and out of it, and the pain in between my legs is really uncomfortable.
Finally I walk up the public footpath, past the church, and onto tarmac. This is where I stop, under a tree, at the corner of the surgery car park.

The surgery is an ugly dirty-salmon-pink-red and the bricks are too squared off and flawless. The windows are plastic, and the whole place is fronted by a waiting room with one wall of floor-to-ceiling windows. I stay under the tree, shaded from the harsh light out in the car park. There are a lot of people in the waiting room. There are lots of eyes. The counter where you go up and tell the receptionist why you want to see the doctor is at the far end. It’s set up so people don’t hear what you’re saying, but the door to the waiting room is often open and in any case there’s a window behind the reception into the waiting room through which they dole out medication and call people for appointments, so you can hear what the patients at the desk are saying.

It’s so much nicer outside. If I stand here, very still, then nothing is happening. My eyes drift over the building and I weigh up my options.
What are you going to say in there?
Shh. Don’t talk about it.
You’re just going to walk in there and blurt it out?
Shh.
You’re going to end up saying nothing. You’ll go in to tell her and you’ll chicken out and leave the surgery with eye drops.
Would you shut up? I’m thinking.
Max . . .
Shh.
Max. . .We need to go inside.

Sylvie

I only notice him because he’s there for so long, just standing under a tree, completely still, frozen like ice. I noticed him when the clock was chiming quarter past one. I didn’t think
anything of it, then at twenty to two, I see him still there.

It’s pretty cold, but he’s just standing broodingly under this tree and staring at the surgery. I know him. I know this guy enough to know that Max Walker just isn’t the brooding type. He’s the football-playing-wonder-boy type. He’s one of the most popular of the popular crowd. He’s the son of the wondrous Walkers, the barristers who were in the newspapers because they prosecuted that media billionaire. Max Walker is the boring, bland, blond, golden boy type. He’s the sort of person who will always be referred to as ‘Max Walker’ and never as ‘Max’. I don’t usually go for schoolboys, but if I did, it wouldn’t be Max Walker. There are a few guys in school who are older-looking and dark-haired, a bit taller and more muscular. But I know Max Walker has his share of skinny bambi-legged admirers. They trail around after him during lunch. Whenever I see him in the corridor someone is saying hi to him. He always says hi back, but you can’t read too much into
that.

I watch him not moving. He’s a few feet away, but I almost
don’t talk to him. I almost get caught up in all that nervousness about talking to the popular kid, but then I tell myself off, I tell myself to stop being so scared, stop judging people before I know them, stop being scared of taking a chance, and just freaking say
‘Hi.’
He looks up.
‘Oh, hello.’
I don’t read anything into it.

I look down at him, intrigued despite myself. The graveyard is to the side of and sort of above the surgery, on a little hill. So I’m sat on the grass, next to the wall, but I’m above Max, looking at him through the branches of the little tree.

‘It’s Max Walker, right?’ I say, because for some reason it’s good etiquette to pretend you don’t really know someone’s name, even when you’ve been at school with them for four years.

‘Yeah. Hello, Sylvie.’
‘Hey!’ I say, surprised that Golden Boy Walker has even registered me. ‘How do you know my name?’
‘You sat behind me in statistics last year.’
‘Ohhhh, yeahhhh,’ I say, remembering how badly I messed up that exam. I got drunk with Toby the night before and have to retake it this year. This thing, it sucks: if you’re smart you get put ahead in Maths, so you take GCSE Statistics in Year Ten and GCSE Maths in Year Eleven. Believe me, they do not expect smart people to be drunk during the exam and fail in the way that I did. Super fail.
‘How did you do in the GCSE?’ I ask.
‘Um, good.’ He nods and swallows, tossing his blond hair out of his eyes like Justin-freaking-Bieber.
‘Wait, I remember. You got an A star, didn’t you?’ I say with a grin. ‘That’s so sickening. I flunked it.’
He smiles pleasantly, but kind of blankly, like he doesn’t know what to say but wants to be polite.
‘So, how are you?’ he asks, as if he hasn’t been listening to anything I’ve said before.
I raise my eyebrows. ‘Great. What are you doing here?’

He looks over to the surgery. Then it is obvious to both of us what he’s doing. Nobody is so nervous they stand for half an hour outside the surgery for a doctor’s appointment they’ve been blase ́ enough about to schedule. Emergency appointment. Which means one thing for a guy in our year: STD check-up. He looks really uncomfortable and shifts his legs in an embarrassed way. I clock a look at his crotch to figure out if he’s itching himself or not. Wow, I hope for his sake it’s not crabs.

‘Did you do someone without a condom?’ I say, teasing to communicate this: that I’m cool to talk to, that I’m feeling sorry for him, that I understand, that I’m trying to make him feel less weird.
Instead of feeling better because of what I’ve said, he blushes red, his mouth turns down and he shrugs.
‘Are you OK?’ I ask.
He looks up and forces a smile that clearly takes a lot of effort. ‘Yeah, I’ll be fine. Just don’t feel well.’ He shrugs. ‘So, why are you bunking off?’
‘I’m bleeding and hormonal and I hate the world today.’
He laughs. ‘I know that feeling.’
‘I bet you don’t, actually,’ I say. ‘You don’t know pain until
you’ve wanted to commit suicide because your back hurts so bad. Period pain is the worst.’
He continues to smile but it fades a little and he searches for something to say. ‘Well, I hope you feel better. You should write more while you’re bunking off. I really liked that poem you read in assembly last year about your ex-boyfriend.’
‘That’s so weird you remember that!’ I exclaim, much too happily, and then I can’t think of anything more to say.
‘Yeah.’ He nods.
There is an awkward silence.
‘Pity you got cut off by the headmistress before you could
finish.’
‘Well, you know, censorship,’ I say. I brandish my notebook
and pen. ‘I’m actually writing now.’
‘Good. Cool.’
There’s a pause and I say, ‘Well, I’d better get going.’
‘Other bunking-off spots to occupy?’ he asks, in a sort of
sugary way. I feel like he’s teasing me.
‘No, I’m going to go get something to eat. Do you want to,
like . . . come?’
He hesitates. ‘I can’t.’
‘What about after you’re done?’
‘Um . . .’ He looks down again and chews his lip absentmindedly. After a too-long pause, he says, ‘I’m sorry, I shouldn’t.’
‘Suit yourself,’ I say, kind of relieved. I’m not great with company. I wish I was. But I’m not. Hey, somebody’s got to be the loner.
I scoot my legs over the wall and jump down beside him. He’s standing next to my bike, and he steps back as I get on it. He does it to give me some space to get on, but then he does a little second take at what I’m wearing: leather hotpants, long black socks, white Converse, a see-through top with a black bra, and a long black velvet coat. I’m aware I don’t dress like a sixteen-year-old. It’s one reason my boyfriends all tend to be older. Plus I find it never helps to wear school clothes when you’re bunking off, or shitty clothes when you’re feeling like shit. Rookie mistakes, both.
‘Good manners, haven’t you?’ I say, as he helps me put my backpack on. His fingers brush the fabric of my top and he gives a kind of embarrassed laugh, like I’ve caught him staring, which I have.
I push down my right foot and circle my bike once around the surgery car park.
‘Hey, I saw your cousin driving through town yesterday night. Around midnight?’
‘Oh,’ he says, the smile dropping instantly from his face. ‘What’s his name?’
He seems to consider for a second, before answering,
‘Hunter’.
‘He’s kind of a dick, isn’t he?’ I say casually. ‘I’ve seen him
around at parties. He gets way too stoned and he’s pretty rude.’ Max Walker’s face is very still. He shrugs.
‘Don’t you think he’s a dick?’
He shrugs again and looks away towards the door of the
surgery. ‘I have to go in now,’ he says quietly.
‘’Kay. See you around.’ I hold up one hand in a salute,
heading for the car park exit. I look back. He’s looking over at me, getting smaller as I bike away.
‘Bye,’ he says, and lifts up his hand to wave, wagging it back and forth like little kids do. ‘Bye,’ he repeats.
I bike away, thinking maybe Max Walker isn’t so bad after all. In my wing mirror he watches me ride, his head rolls down and he stares at his feet. His shoulders rise and fall and I realise he is sighing. He raises his head, bites his lip, regards the surgery in front of him solemnly, and he steps out onto the tarmac.

Archie

Medicine, my field of science, is always evolving and in flux. Some studies are bound to fail; methods of care we use today may be extinct in a few decades; people we treat still die. Approaches being used in busy centres like London and Manchester may not reach country hospitals for several years after their approval.

Most things here in Hemingway – including traffic, pedestrians, the passing of time and changes to medical care – are slow.

I moved here from Delhi almost twenty years ago to train as a general practitioner in London. During my studies, I spent six months in paediatrics at St Thomas’ Hospital, and came into contact with birth defects, deformities and sometimes illnesses that were fatal in the early years of a person’s life. The trick is to treat the sick like you treat the well. More than anything, they need to feel normal.
When I qualified as a GP, I moved to a practice in small, intimate Hemingway. Watching patients carefully, closely, over years makes an art out of diagnosis and prognosis. I am my patients’ first point of contact for diagnosis, and I provide continuing treatment, advice and evaluation for all their medical conditions. Perhaps, if I tried, I could predict the health of Hemingway’s individuals over the course of their lives. I could tell you who might be at high risk of cancer or diabetes or liver failure.

I could tell you which children will become obese, which might develop eating disorders, and which might have problems with drugs.

Due to my experience, I take most of the patients who are under twenty-one. It has become evident to me, after twelve years at Hemingway, that I have most contact with my young patients before the age of five and between the ages of thirteen and eighteen. I see the under-fives for vaccinations, chicken pox, colic, whooping cough, scarlet fever, the mumps, diarrhoea and parental hypochondria. I see the teenagers because of sex.

Thirteen seems young to start talking about sex, but I have heard it said that children are getting older. I think adults are getting younger. I also suspect, however, that the sexuality of adolescents has not changed in nature since we were apes. In fact, I am certain that in medieval times, in Hippocrates’ days and through the somewhat conservative Victorian era, thirteen-year-olds have been engaged in sexual activity, teenagers have procreated, and the LGBT issues we think of as contemporary existed in all their variations and multiplicity.

What has changed, perhaps, is that our ability to connect with these people in our society has grown via the internet. Some policy has advanced because of this, and is clearly outlined in best-practice documents and in medical school curricula, but some areas are still being debated. In particular, medical approaches to trans, intersex and asexual people can vary greatly between jurisdictions.

I know that our practice is ahead of most in our approach to these teenagers, but there are some areas where I do not know enough, and we need to improve. Like most clinics, like the curricula, like the policy-makers, we are struggling to keep up with scientific advancements, and also with our patients.

Between my list of patients and the adolescents who come to the drop-in sexual health sessions I run after hours at the clinic on Tuesdays and Thursdays, I look after about 700 adolescents, five of whom I know to experience some degree of gender dysphoria. About thirty have discussed a non-heterosexual preference with me. A number have come in to the after-hours clinic upset because they don’t ‘get’ sex. One hundred and thirteen are on the pill. Three have had abortions in the past year. I treat the occasional sexually transmitted disease. About eighty per cent of all my patients come to the clinic for free condoms.

As I run the late night clinics, I often work from 2 p.m. until 10 p.m. Today I pull my car into the drive in the early afternoon and the leaves crunch as I walk towards the doors.

Ahead of me reception is busy as always. A blond boy, a Hemingway teen, dressed in the high school’s uniform of suit trousers, white shirt, a black V-neck jumper, black tie and blazer, leans in close to the service window, his hand on the frame. The warmth of the low autumn sun is caught in his fair hair and on the skin of the other patients next to him, creating a blinding glow that makes it difficult to see. I lift my hand up to shade my eyes. As I move nearer a few of them turn hopefully towards me. To my left, the cluster of heads in the waiting room lifts, and I feel, as I usually do, bad that I can’t see all of them, that I will only be taking one person through to my office to release them from the long wait and bland magazines. Then the blond boy steps forward, out of the light.

He moves towards me purposefully and his lips part.
‘Can I help you?’ I ask.
He smiles and glances at my nametag. ‘Dr Verma? Can I talk
to you?’
‘Have you made an appointment? What’s your name?’
He hesitates, then whispers softly as I pass by, my step
brusque, ‘Max Walker.’

I stop and turn around to look at him. As an older couple pass, Max ducks his head down and hair falls over his face. The Walker family is a mainstay of the Hemingway Post, and all the local press. Max’s father and mother both frequently appear on the evening news. His mother advises people who call in on legal matters and his father often gives statements about current cases. They are both lawyers of some kind, and Max’s dad, particularly, is something big in local law enforcement. But I cannot recall having met Max before.

‘Are you a patient of mine?’ I ask.
‘The receptionist says so.’
I look towards the waiting room. People watch Max over their magazines.
‘It’s urgent? Will it be quick?’ Max nods emphatically.
‘Alright then,’ I say. ‘Let’s be quick.’
‘Thanks.’ He smiles, visibly relieved.
I slip into the office and murmur to the receptionist, ‘Hold
my list, OK? And I need Max Walker’s file.’
I escort Max briskly to my room and close the door, just as
the office phone starts ringing. ‘Let me just get that,’ I say to Max, slinging my bag on the table. It’s the receptionist.
‘No, I said Max Walker.’
Max sits down in the chair opposite me.
‘No, Walker. W-a-l-k-e-r.’
I roll my eyes at the phone for Max’s benefit. He gives a weak
grin and looks ready to burst into tears.
‘Yes, that’s it,’ I say into the phone, and replace the receiver. Max is staring worriedly at an appointment slip left on my
desk and wriggling uncomfortably on the chair.
I sit in my chair opposite him. ‘Now, what have you come to
talk to me about today?’
Max takes a deep breath, but falters. ‘Is this confidential?’ ‘Yes.’
This is not strictly true. There are various grounds on which I am able to break confidentiality, and I have done so before. But, by and large, confidentiality is key to being trusted, so I don’t explain the nuances of that statement. Particularly when it comes to helping young people.

He looks doubtful, but swallows, attempting to smile. I watch it fading gradually from his face, beat by beat, coming back as he pushes for it, fading away as he loses faith.