The evening patient

An original fiction passage set in the nineteenth century.

Until that evening, I believed Dr Harland's surgery to be the most orderly room in Mill Street. Bottles stood in obedient rows; the instruments shone upon their white cloth; even the accounts in the great ledger appeared to march evenly down the page. As his assistant, I took pride in returning every object to its proper place.

Mrs Cole entered without knocking. Rain darkened her shawl, and her son held one hand wrapped in a rag. Dr Harland looked first at the boy and then at her empty hands.

"There is already an account unpaid," he said.

Mrs Cole lowered her eyes. The doctor did not soften his expression, but he drew the boy towards the lamp. He removed the rag, cleaned the injured hand and bound it carefully. When Mrs Cole placed two small coins on the desk, he pushed them back beneath her fingers.

"Buy him supper," he said, turning away before she could thank him.

After they had gone, I watched him open the ledger. He entered the cost of the treatment beneath the name of Mr Pember, whose carriage waited outside every Thursday.

"But Mr Pember was not here tonight," I said.

Dr Harland continued writing. "He will not examine a single line, and the boy required what his mother could not buy."

He closed the book with a hand as steady as if he had corrected a spelling. For the first time, its straight columns seemed capable of leaning.

Analyse how the writer uses language and structure to change the narrator's view of Dr Harland and to leave his actions open to different interpretations. Support your answer with references to the passage.