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ould decide if the growth was benign or malignant。 Cathy hoped for the former； as the malignant variety of this tumor could be troublesome for its victims。 But the odds were heavily on the patient's side； she thought。 On visual examination it didn't look terribly aggressive； and her eye was right about 85 percent of the time。 It was bad science to tell herself that； and she knew it。 It was almost superstition； but surgeons； like baseball players； knew about superstition。 That was why they put their socks on the same way every morning…pantyhose； in her case…because they just fell into a pattern of living； and surgeons were creatures of habit； and they tended to translate those dumb personal habits into the oute of their procedures。 So； with the frozen section off to Pathology； it was just a matter of excising the pinkish…gray encapsulated mass。。。
〃What time is it； Geoffrey？〃 Dr。 Hood asked。
〃Quarter to one； Clive；〃 Dr。 Phillips reported； checking the wall clock。
〃How about we break for lunch； then？〃
〃Fine with me。 I could use something to eat。 We'll need to call in another anesthesiologist to keep Mr。 Smithson unconscious；〃 their gas…passer observed。
〃Well； call and get one； Owen； would you？〃 Hood suggested。
〃Righto；〃 Dr。 Ellis agreed。 He left his chair at the patient's head and walked to the wall phone。 He was back in seconds。 〃Two minutes。〃
〃Excellent。 Where to； Geoffrey？〃 Hood asked。
〃The Frog and Toad？ They serve a fine bacon； lettuce； and tomato with chips。〃
〃Splendid；〃 Hood said。
Cathy Ryan； standing behind Dr。 Phillips； kept her mouth shut behind the surgical mask； but her china…blue eyes had gone wide。 They were leaving a patient unconscious on the table while they went to lunch？ Who were these guys； witch doctors？
The backup anesthesiologist came in just then； all gowned up and ready to take over。 〃Anything I need to know； Owen？〃 he asked Ellis。
〃Entirely routine；〃 the primary gas…passer replied。 He pointed to the various instruments measuring the patient's vital signs； and they were all in the dead center of normal values； Cathy saw。 But even so。。。
Hood led them out to the dressing room； where the four medics shucked their greens and grabbed their coats； then left for the corridor and the steps down to street level。 Cathy followed； not knowing what else to do。
〃So； Caroline； how do you like London？〃 Hood asked pleasantly。
〃We like it a lot；〃 she answered； still somewhat shell…shocked。
〃And your children？〃
〃Well； we have a very nice nanny； a young lady from South Africa。〃
〃One of our more civilized local customs；〃 Phillips observed approvingly。
The pub was scarcely a block away； west on City Road。 A table was quickly found。 Hood immediately fished out a cigarette and lit it。 He noticed Cathy's disapproving look。
〃Yes； Mrs。 Ryan； I know it's not healthy and bad form for a physician； but we are all entitled to one human weakness； aren't we？〃
〃You're seeking approval from the wrong person；〃 she responded。
〃Ah； well； I'll blow the smoke away from you； then。〃 Hood had himself a chuckle as the waiter came over。 〃What sort of beer do you have here？〃 he asked him。
It was good that he smoked； Cathy told herself。 She had trouble handling more than one major shock at a time； but at least that one gave her fair warning。 Hood and Phillips both decided on John Courage。 Ellis preferred Tetley's。 Cathy opted for a Coca…Cola。 The docs mainly talked shop； as physicians often do。
For her part； Caroline Ryan sat back in her wooden chair； observing three physicians enjoying beer； and； in one case； a smoke； while their blissfully unconscious patient was on nitrous oxide in Operating Room #3。
〃So； how do we do things here？ Differently from Johns Hopkins？〃 Hood asked； as he stubbed out his cigarette。
Cathy nearly gagged； but decided not to make any of the ments running around her brain。 〃Well； surgery is surgery。 I'm surprised that you don't have very many CAT scans。 Same for MRI and PET scanners。 How can you do without them？ I mean； at home； for Mr。 Smithson； I wouldn't even think of going in without a good set of shots of the tumor。 〃
〃She's right； you know；〃 Hood thought； after a moment's reflection。 〃Our bricklayer chum could have waited several months more if we'd had a better idea of the extent of the growth。〃
〃You wait that long for a hemangioma？〃 Cathy blurted out。 〃At home； we take them out immediately。〃 She didn't have to add that these things hurt to have inside your skull。 It caused a frontal protrusion of the eyeball itself； sometimes with blurring of vision…which was why Mr。 Smithson had gone to this local doctor to begin with。 He'd also reported god…awful headaches that must have driven him mad until they'd given him a codeine…based analgesic。
〃Well； here things operate a little differently。〃
Uh…huh。 That must be a good way to practice medicine； by the hour instead of by the patient。 Lunch arrived。 The sandwich was okay…better than the hospital food she was accustomed to…but she still couldn't get over these guys drinking beer！ The local beer was about double the potency of American stuff； and they were drinking a full pint of it…sixteen ounces！ What the hell was this？
〃Ketchup for your chips； Cathy？〃 Ellis slid the bottle over。 〃Or should I say Lady Caroline？ I hear that His Highness is your son's godfather？〃
〃Well； sort of。 He agreed to it…Jack asked him on the spur of the moment in the hospital at the Naval Academy。 The real godparents are Robby and Sissy Jackson。 Robby's a Navy fighter pilot。 Sissy plays concert piano。〃
〃Was that the black chap in the papers？〃
〃That's right。 Jack met him when they were both teachers at the Naval Academy； and they're very close friends。〃
〃Quite so。 So the news reports were correct？ I mean…〃
〃I try not to think about it。 The only good thing that happened that night was that Little Jack arrived。〃
〃I quite understand that； Cathy；〃 Ellis responded around his sandwich。 〃If the news accounts were accurate； it must have been a horrid evening。〃
〃It wasn't fun。〃 She managed a smile。 〃The labor and delivery was the good part。〃
The three Brits had a good laugh at that remark。 All had kids； and all had been there for the deliveries； which were no more fun for British women than for American women。 Half an hour later； they headed back to Moorefields。 Hood smoked another cigarette along the way； though he had the good manners do stay downwind of his American colleague。 Ten more minutes； and they were back in the OR。 The pinch…hitting gas…passer reported that nothing untoward had taken place； and surgery resumed。
〃Want me to assist now？〃 Cathy asked hopefully。
〃No； thank you； Cathy；〃 Hood replied。 〃I have it；〃 he added； bending over his patient； who； being soundly asleep； wouldn't smell the beer on his breath。
Caroline Ryan； M。D。； FACS； thought to congratulate herself for not screaming her head off； but mostly she leaned in as closely as she could to make sure these two Englishmen didn't screw up and remove the patient's ear by mistake。 Maybe the alcohol would help steady their hands； she told herself。 But she had to concentrate to keep her own hands from trembling。
The crown and cushion was a delightful； if typical； London pub。 The sandwich was just fine； and Ryan enjoyed a pint of John Smith Ale while talking shop with Simon。 He thought vaguely about serving beer at the CIA cafeteria； but that would never fly。 Someone in Congress would find out and raise hell in front of the C…Span cameras； while enjoying a glass of Chardonnay with his lunch in the Capitol Building； of course； or something a little stronger in his office。 The culture was just different here； and vive la difference； he thought； walking across Westminster Bridge Road toward Big Ben…the bell； not the bell tower； which was； in fact； St。 Mary's Bell Tower； tourist errors to the contrary。 The Parliamentarians there had three or four pubs right there in the building； Ryan was sure。 And they probably didn't get any drunker than their American colleagues。
〃You know； Simon； I think everyone's worried about this。〃
〃It's a pity he had to send that letter to Warsaw； isn't it？〃