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Jon crashed his shoulder against it, just managing to prevent it clicking back on to the latch. The doctor pushed from the other side and for a few moments they were cheek to cheek, just the layer of wood separating them. Jon felt his strength begin to show and the door started inching inwards.

Abruptly the resistance disappeared and the doctor fled down the corridor, surgical gown flapping behind him.

Jon took a step back and kicked the door open, part of the security chain spinning across the hallway tiles.

He raced down the long corridor and into the kitchen. The doctor’s briefcase lay partly open on the floor, files spilling out of it. Jon looked around. The door leading down to the cellar was in the opposite corner and it was slightly ajar.

He heard a voice behind him. ‘Where is he?’

‘Down there.’ Jon pointed to the door and then whirled round. Against one wall stood a Welsh dresser and next to it was a wicker basket containing walking sticks and umbrellas. Jon grabbed a thick walking stick with a V-shaped split at the top and approached the cellar door.

He pushed it fully open with the end of the stick and looked down. A flight of bare wooden stairs led to a concrete floor. He started downwards, holding the stick before him. A shudder caught his shoulders and then snaked down his back as the air grew noticeably cooler. The cellar’s central area was lit by a single bulb and three plywood doors led off from it, light shining from beneath two of them.

Jon stood listening.

To his side, an ancient-looking boiler came to life, a line of blue flames flaring behind a soot-speckled panel of glass. The row of pipes fastened to the bare brick wall above it started to creak and tick.

‘Doctor O’Connor, there’s no means of escape down here. Come out now.’

No reply.

Jon stepped up to the door for the unlit room and kicked it open. A dark and narrow space was beyond, the floor knee deep in coal.

He kicked open the next door. A larger room, lit by another single bulb which revealed stacks of medical journals, a pristine mountain bike, some folded-up deckchairs. At the back was a pile of clothes and women’s shoes.

He turned to Rick and pointed at the last door. Rick shook his head furiously and mouthed, ‘Wait.’

The flames of the boiler went out and, as the cellar became silent again, they could hear a faint, wet hissing sound as if someone was blowing a thin stream of air through their teeth. They looked questioningly at each other, then Jon bowed his head and listened.

As he did so, a trickle of blood began to creep out from under the door. He jumped backwards, lowered his shoulder and charged. The door splintered off its hinges and he nearly fell into the room beyond. A cluster of halogen lights shone down, adding a glare to bright white walls that were spattered with dry blood. In the centre of the room was a concrete block, topped with a layer of what appeared to be marble. Stretched out on it was the woman, still partly wrapped in the sheet. Jon could see that she was still fully clothed.

The hissing was coming from the side of the room and Jon turned his head.

O’Connor was sitting with his back against the wall. His hands were slick and red and he was clumsily trying to pick up a scalpel caught in the blood-filled folds of his surgical gown. Blood spurted from his neck, each little jet hissing like a snake as it erupted into the air.

Rick came in. ‘Oh my God, we need…we need cloth. Something to stem the bleeding.’ He grabbed the corner of the sheet wrapping the woman and tried to tear it.

O’Connor at last got a grip on the scalpel with his right hand. He turned his left wrist upwards and moved the tip of the blade towards it. Jon lifted the walking stick and brought the V of it down on to the doctor’s right hand, pinning it in the puddle spreading out beneath his legs.

He told Rick, ‘Leave it. The woman’s our priority. Has she got a pulse?’

With shaking hands, Rick felt her neck. ‘She’s alive.’

‘Then get upstairs and find out where the paramedics are. Now!’

Rick’s mouth opened and shut. He pulled his mobile phone out and hurried back up the stairs. Jon looked around. Next to the woman was a small trolley. In a stainless steel tray on top of it were two syringes and a pair of latex gloves. Medical instruments lined the back wall. More scalpels, blades becoming ever more thin and cruel. Next to them were saws, clamps, retractors, hammers, chisels. A drill with a shiny silver bit. His eyes were caught by a test tube filled with what appeared to be human teeth.

He felt the walking stick shift and he looked down. The doctor was feebly trying to lift his scalpel hand.

Jon leaned on the stick. ‘You’re not taking the easy way out. Not before you tell me why.’

The doctor slumped back against the wall and raised his eyes. Even under the harsh lights their shine was fading, and Jon knew he hadn’t long left. The little jets coming from his throat were getting smaller, weaker.

‘Why?’ Jon repeated. ‘Why did you do it?’

O’Connor’s eyes swivelled to Jon’s hands and his voice sounded like wind in a cave. ‘Enjoyable, isn’t it?’

‘What?’ Jon demanded.

‘Playing God, controlling whether I live or die.’

Jon looked at his knuckles, saw they were white with the pressure he was exerting on the end of the stick. He took his weight off. ‘I’m not like you, Doctor.’

O’Connor’s lips stretched in a faint smile as his head sagged forward and his eyes slowly shut. The blood now just trickled from his throat.

Jon knocked the scalpel from O’Connor’s hand and rammed the V of the stick against the man’s forehead, cracking his head against the white plaster. ‘Why? Tell me why!’

The tiniest slit opened between the doctor’s eyelids and a faint whisper emerged from his bloodless lips. ‘We’re just the same underneath.’

Violently Jon shook his head. ‘No. No, we’re not. Tell me. .’ His words faded to a whisper. The doctor had gone.

Jon stepped away from the pool of blood which was moving slowly across the floor like a living thing, easing itself into the gutter that ran around the table, dripping through the slats of the rusty drain.

He lifted the woman clear of the cold stone and carried her out of that terrible room with its cloying aroma of blood, both fresh and old.

Up in the kitchen he laid her on the table, lowering her head gently to the oak surface, tilting it back to make sure her airways were clear. He could hear Rick talking on the phone out on the front step. He sat down at the table, as if starting a vigil at the woman’s side.

The doctor’s briefcase and files still lay on the floor. Jon’s eyes settled on the uppermost folder and the name written on its front: ‘Alex/Alexia Donley’.

Alexia. The name of the prostitute Fiona Wilson was so desperate to find. He picked the file up and opened it.

A patient profile, Polaroid photo of a man in the upper right-hand corner. He was staring at the camera, self-conscious in its uncompromising gaze.

Alex Donley

Age

: 34

Initial assessment

:

3 /3 /01

Patient background

:

Alex came to me in a state of considerable agitation. In the last few years he has come to believe that he is a transsexual and has been seeking a gender reassignment through the NHS. His GP ‘reluctantly’ (to use Alex’s word) referred him to the gender identity clinic at Charing Cross hospital. After fully assessing him, a consultant psychiatrist there judged that Alex wasn’t a genuine transsexual. Alex scathingly told me that the consultant thought Alex is interested in becoming a woman because he believes it will resolve the violent outbursts to which he is susceptible. I questioned Alex more closely on this and he expressed his opinion that, once his testes have been removed and oestrogen prescribed, his masculine traits (which he sees purely in the form of aggression) will be replaced by feminine traits (which he sees purely in terms of compassion). Despite this obviously simplistic belief, Alex presents a rare and challenging case.