One day in the middle of May, Vyvyan Basterd opened an official-looking envelope, read the paper inside, took several deep breaths and sat down suddenly. Rick was already occupying the chair he'd chosen at the dining table, but that didn't matter very much.

"Watch where you're putting that great huge fat arse of yours!" Rick protested, trying vainly to shove Vyvyan off his lap. Vyvyan leaned back, digging the studs of his vest into Rick's scrawny chest. Mike, reading the morning papers as usual, studiously pretended to ignore them. (Neil wasn't there anymore; he'd graduated last year and taken a job with the United Nations or Oxfam or something like that.)

"OW! OW! GET OFF!" Rick whinged, pinching Vyvyan's arm. Vyvyan leaned forward, let an enormous sulphuric fart straight from Hades and drove his elbow into Rick's solar plexus, knocking the fetid wind out of him.

"Next time, don't sit in my chair," Vyvyan growled, getting up and standing on Rick's feet.

"But I always sit here!" Rick protested. "What is your problem, anyway?"

Vyvyan handed him the letter.

"Oh great, is THIS house going to be demolished, too?" Rick snarled. Then he read it. "Worse – Vyvyan's going to be training in an A&E department!"

If he snorts, Vyvyan thought, I'm going to send him to the A&E department.

"Guess I'd better not have an accident or emergency in West London anytime soon!" The bastard snorted, and ended up in A&E with a pair of black eyes.

15:24, 3 July

Vyvyan had to swim through an ocean of red tape, of course, but sooner than he expected, he had started his training in the emergency department of a certain hospital in West London. Vyv had seen practice there while he was in school, so he thought he knew what to expect – but still, it was very strange to be there as an actual practitioner, not just a student with a real physician leaning over his shoulder.

He stood in front of the mirror in the doctor's lavatory and checked himself out one last time before going on duty. The chap in the mirror was completely unfamiliar – no nose ring, no star-shaped studs on the forehead, no denim vest, no tri-hawk, no studded belt or bracelets. His ginger hair was parted on the right and combed down conservatively; he wore a white coat over a white dress shirt with the knot of a dark tie peeking out over the top button of the coat, and dark pleated trousers with precise knife creases in them. He wore the cufflinks Dr Freddie had left him when he died – plain gold antiques of some sort – and Dr Freddie's old Rolex.

That was not the self he knew reflected in the mirror. That was some overprivileged twat who drove a Jaguar and didn't know what it was like to go to bed hungry and cold because there was no money. He'd never rooted around in bins for something vaguely edible. He'd never lain in bed, inside his house, under his covers, fully dressed and unable to sleep because he was shivering too hard. This twat looked like he'd grown up seeing beautiful things, eating savoury foods and saying clever things. The tie in particular bothered him. I have so much money, it said, that I can spend it on bits of useless silk fabric, tied like a noose, to remind you groundlings what the ruling class can do to you if you start thinking you're better than you are.

He hated that twat in the mirror. But he wanted to be like Dr Freddie, and Dr Freddie had emphasized many times to Vyvyan the importance of looking the part and acting the part. "Confidence in the physician was a powerful elixir," he would say. So Vyvyan loosened the tie just a tiny bit, ran his comb through his hair once more, and walked – straight, erect, unhurried, like a peer going to dinner, not swaggering shoulders-forward like the thug he had always been – to begin his shift.

His first case was straightforward enough, at least on paper: Male, age 35, fallen off a stepladder, apparent broken femur, probably complicated by the patients flatmate, who had no medical training but attempted to set the leg himself. The X-rays made Vyvyan wince – the leg had come up 45 degrees in the wrong direction. Vyvyan couldn't tell from reading the X-ray whether additional damage had been done by the inexpert manipulation, which included tying the man's ankle to a door and then slamming it ... ? What the bloody fuck? He decided that either the flatmate wasn't very intelligent or he didn't like the patient very much.

As Vyvyan approached the examination area, he could hear the patient whimpering and demanding painkillers, and another male voice telling him "Just shut up, Richie, you're giving me a headache."

"It's all the drinking you do," the first voice said somewhat fruitly. Great, Vyvyan thought. First case on the first day of the job and I get a pooftah and his boyfriend. Not that he really cared what other people did in their own good time, but he just didn't want to deal with a couple of girlies – biologically or otherwise -- simpering at each other. A third possibility crossed his mind – these two were having some kinky sex game, the patient broke his leg and they'd concocted a cover story. Did it really matter? Only if someone wanted to press charges ...

He stepped behind the curtain, but neither the patient, lying on his side on the gurney, nor his companion, sitting nearby, noticed because they were too busy squabbling.

"I ought to have the doctor admit you for your alcoholism!" the patient whinged. He looked a little effeminate, with collar-length sun-streaked hair, finely drawn features and long, slender hands.

Vyvyan cleared his throat.

"I'm not an alcoholic," the companion protested. He was completely bald and butch, dressed a cheap brown suit and wearing spectacles in the cheapest NHS issue frames available. A slight bulge in his sport jacket might have been a wallet or a flask of alcohol.

Vyvyan cleared his throat a little more loudly.

"Oh right, and I'm the Queen of England!" the patient simpered.

"Excuse me," Vyvyan said.

"Hello, Your Majesty, fancy seeing you here!" the companion shot back.

"Will you two shut up, please!" Vyvyan half-shouted. "Good afternoon, gentlemen, I'm Mr Basterd," Vyvyan said smoothly – at least smoothly for him – as he pulled up the padded stool and sat down, ignoring the Rick-like snort from the patient that was doubtless inspired by his surname. "What seems to be the trouble?"

He wondered if either of them was fooled by his assumed Standard Received accent. He had worked hard to learn that accent from age 10, when he was plucked from the gutters of the East End and sent to a prestigious prep school where everyone else talked like that. At sixteen he reverted to his working-class twang as a sign of defiance against the Establishment, only to go back to speaking posh in his last two years of university when he realized it gave him more authority with his patients. Sometimes when he was excited or upset he found himself lapsing back into what linguists called Estuary English, and that would cause anything from raised eyebrows to a hearty guffaw. But neither of these fellows was looking at him as if he had been caught out as a faker.

"What do you think it is? My bloody leg's broken!"

"How did this happen?"

"Well, I was up on a stepladder hanging decorations for my birthday party, and Eddie here, my flatmate, threw me a quid, and I fell, and ..."

Vyvyan looked from one man to the other; it was irrelevant, but he had to know: "Why was he throwing you a quid?"

"It's my birthday!"

"Oh, happy birthday, Mr ... ah ..." he reached for his biro – "Richard Richard? That can't be right."

"Actually it is," the patient said.

"Quite," Vyvyan muttered. Quite? He didn't know that word was in his vocabulary, at least in that context. It was one of those words that Dr Freddie packed full of meaning when he had more to say than he knew was prudent, but Vyvyan never had used it before. It was strange how his assumed accent subdued his entire personality – he would have just laughed at this man's redundant name otherwise. Instead, he simply muttered "Quite," and wrote "THIS IS CORRECT" above the man's name. He jotted a few notes in the chart, laid it aside and stood up. "Right, then, I shall have to examine you."

"But they already took X-rays! They were awful! They didn't give me any pain medication!"

"Yes, I saw them, but I still need to take a look at the real thing." He reached for the sheet, but the man slapped his hand away.

"But you'll see my bottom!"

"Please, Mr Richard, I am a professional. I've seen hundreds of bottoms, and anyway, I'm examining your leg." Bloody tosser!

"How old are you, anyway? You barely look old enough to drive."

Vyvyan ignored the question and lifted the sheet. This was the hardest part of being a professional – he had to keep his reactions to himself. He couldn't show his patient how annoyed he was with the rude question, nor could he cringe at the nasty compound break he was staring at. Vyvyan could see how the patient must have landed on it. There was likely to be significant damage to the soft tissues of the knee joint as well, and he wished he could just order an MRI without fuss, because it was certainly indicated here, if you weren't worrying about how much everything cost. But the break itself seemed clean enough, despite the reported attempt to manipulate it, and Vyvyan thought it would most likely not need to be held together with pins and plates – not the way Dr Freddie had reassembled his leg.

"Well, the good news is that it doesn't need anything more than some plaster. You'll be in a cast for at least six weeks, more likely eight or ten, and then there will be some physio. You're lucky, mate. I thought you were going to need surgery." He turned to the nurse. "Send in the anaesthesiologist to do an epidural, I don't fancy trying that myself, but I am going to set the break and cast the limb myself. And he'll need a wheelchair, too, for when he goes home." He turned back to the man. "You'll have to use a wheelchair – do you have stairs in your home?"

"Unfortunately," the man said. "The bedrooms are on the first floor but the bath's on the ground floor."

"Well, your friend here will just have to bring your bed down the stairs, unless he wants to carry you up and down them. And your trousers ... we're going to have to cut the leg off so you can wear them over your cast." When the man looked alarmed, Vyvyan said, still keeping his assumed accent in place, "Don't worry, I shall avert my eyes from your knob and your bottom."

Mr Richard raised himself up on his elbow and shook his finger at Vyvyan. "Now you listen to me, young man. I am a taxpaying, patriotic British citizen, and I expect to be treated with respect by the state-funded physicians whose salaries I help pay, especially ones who still have zits on their chins! Do you understand me?"

Vyvyan glanced at the man's friend, who surreptitiously made the wanking sign. He let one corner of his mouth quirk up a little before turning back to the patient.

"Perfectly, sir; perhaps better than you'd desire."

He set the leg and slapped on the cast a little more slowly than the nurse or a physio might have, but he was satisfied he had done as good a job as anyone.

"Right, we're going to keep you here a while longer until the plaster hardens. Any questions?"

"But I have a birthday party tonight!"

"Oh, give it up, Richie," said the flatmate, who seemed to have gotten drunker while he was here. "Nobody's going to come."

"What time does your party start?" Vyvyan asked.

"Seven. Why, do you want to come?"

"No," Vyvyan said off-handedly, not bothering to explain that he was working a 36-hour shift. "But that gives it plenty of time to harden and get you home, don't you worry."

"But I've still got decorating to do and –"

"Mate, you're not decorating anything with that cast, unless it's your birthday cake. Relax! If you got booze and music and birds, that's all you need." His accent was slipping, and he drew himself up and adjusted his tie. "Now if you'll excuse me ..."

"A child and working class to boot!" he heard his patient say. Bastard!

0608, 4 July

So far, his shift had been about what he expected for a Wednesday night/Thursday morning in west London – busy but nothing too horrific. Some kids who needed stitching up; some teens who'd had too much alcohol, one person who needed an evaluation after a car crash, a grandmotherly type with end-stage emphysema having trouble breathing. He'd managed to take a couple of short naps along the way and even had a sandwich and a packet of crisps uninterrupted. He felt a little tired, but nothing he couldn't work through.

Vyvyan took the chart and looked at it. Male, age 35, broken left femur.

"Now then, what –" He recognized his patient and the patient's bald companion. There were two other men to boot, one tall and fat with messy dark hair, the other short and dapper with neat dark hair, just beinning to turn gray. The three of them were all wobbly and unsteady, clearly very drunk.

"Oh, Mr Richard. Good morning."

"No, it's not bloody good!"

"I can see that ... how did this happen?" he demanded.

"I was upstairs, and Eddie and his friends were downstairs ... I had to go to the lavvy, which is downstairs, and I called and called, but they were too drunk –"

"You were playing sardines," Eddie slurred.

"It doesn't matter! I had to make my way downstairs all by myself, and obviously it didn't work."

"Well, then, Mr Richard, next time don't go upstairs at all," Vyvyan said with less patience than he would have liked. "You should have your bed downstairs on the same level as the bathroom so you can use it ... although with this break even using the lavvy will be difficult. It's worse than I thought. You're going to be casted up to the hips with this leg, too."

"Great," the poof said.

"Mr Basterd?" A nurse poked her head around the curtain. "We just had reports of a number of admits on the way from a bus crash. Dr Parker wants everyone ready to operate stat!"

"Bloody hell," Vyvyan muttered. "All right, we'll get to you as soon as we can, I'm incredibly sorry for the delay, I'll be right back!" He ran out of the examination room and down the hall to scrub up.

1425, 4 July

As the newest trainee Vyvyan got the least complicated surgeries, but it was still a long, tiring session, bending over open wounds, sewing, resectioning, fighting his way through fatigue thicker than a pea-soup fog in the dead of winter. And he was only halfway through the shift. He thought he'd done a good job, or at least a good enough job, on his patients. Somehow "good enough" didn't seem good enough when it was a living, breathing person under his knife.

He staggered out of the OR, yawning so hard his jaw seemed ready to dislocate, pulled all his clothes off, stepped into a shower stall and turned the cold water on full blast to shock himself awake. He downed a full pot of strong tea by himself, but he couldn't stop yawning. He hoped there would be a lull in the patient flow so he could sleep – not just a few minutes, but an hour or so.

"Anyone needing to be seen in the examination rooms, nurse?" he asked.

"Just Mr Richard, the chap who broke his other leg."

"He's still here?"

"Yes, there wasn't anyone available to help him."

"All right," Vyvyan said, taking the chart and heading down the hall. He bet himself £50 that Mr Richard was going to be apoplectic after his long wait.

"Well, it's about time you showed up again, young man! I'm going to complain to your supervisor in the strongest possible terms!"

Vyvyan's temper snapped. "Go ahead and complain! See if I care! You may have been lying here with a broken leg and some discomfort, but I just got done working on someone whose guts were trailing all over hell because some drunken arsehead was driving the wrong way on the f—Flyover! It's called triage, matey. Go home and watch MASH if you don't understand what it means."

Bloody unprofessional, he thought. "Anyway, that's all done now, and I can cast you up properly now." He managed a smile – the rant had at least let off some steam. He chatted with the chap's mates about football and rugby, while Mr Richard sat in stony silence.

"Now, you know the routine. Two hours and we'll let you go. Do us all a favor, try not to break anything else, OK?"

2118, 4 July

Vyvyan pulled the file out of the holder and read it aloud. "Male, age 35, given 'the bumps,' struck ceiling, two broken legs, recasting only, see notes of previous visits earlier today and yesterday by Mr Basterd – BLOODY HELL!"