If you performed a procedure against conventional wisdom, and the outcome was bad, then your reputation would never recover because calamity had resulted from your being reckless and arrogant. And if you performed a procedure against conventional wisdom and the outcome was good, you would be condemned equally for the same recklessness and arrogance. You could expect censure, investigation and condemnation. They would say that it was more by luck than judgment that you succeeded: that it was an anomaly, and therefore did not change anything. Perhaps they needed to reassure themselves that they would have been right to do nothing in the same circumstances, and tell themselves that their inaction was something other than cowardice.

When a patient would surely die without intervention, how could it be wrong to try?

Raven knew the answer: it was the same one that forbade hastening a patient’s end. It would be argued that the patient’s condition was ‘almost universally fatal’, and a great weight rested upon the first of those words.

It was almost certain that the patient would die, but what if she didn’t? Intervene to save her or to end her suffering, and you were taking it upon yourself to decide her fate. It was not yours to make such a decision, they would say, because how could you be sure?

The possibility that such a patient might rally and recover if you did nothing was the bedrock of the moral case against attempting anything outside of established practice. But how did something ever become established practice? Someone had to take the risk, not merely in terms of outcome but of reputation, and very few doctors were prepared to place that stake.

Raven peered into the cavity he had opened up, curiosity suppressing all other emotion, and stated precisely what his examination revealed.

‘The abdomen contains a quantity of semi-purulent fluid, and on the right side a large cyst is attached to the ovary.’

He cut into the cyst. A thick fluid began to ooze out.

‘The cyst contains a considerable amount of gelatinous matter.’

He could hear the scratch of Sarah’s pen noting down what he said.

As he continued to poke about at the bottom of the cyst, he momentarily became aware of her standing at his shoulder, craning her neck to see. He could feel her breath on his neck. Raven closed his eyes for a moment, his concentration interrupted. He took a deep breath – through his mouth – and forced himself to focus on what he was doing.

‘Look,’ he said, pointing out what was encased in the heart of the tumour.

Sarah’s composure finally broke and she gasped, but it was in fascination rather than shock.

‘Hair, bone and teeth,’ she stated.

‘Indeed. One incisor, one bicuspid and one molar.’

‘How bizarre … and revolting.’ Her face puckered in distaste.

‘Are you all right?’