Death Before Time (15 page)
“OK.”
Jo, driving back to Latchvale, thought about Fraser’s doubts and wondered if she was beginning to get them too.
Oh sure, the place was a bit claustrophobic and incestuous, but so were a lot of self-contained hospital departments ... and, as Fraser had said, nothing was happening.
Oh well, she thought philosophically, ten grand plus getting away from David Petterman, who’s complaining?
But when she got back to the ward at four on Sunday afternoon, it was to find that Rose Parker had developed pneumonia on Saturday and was being treated with ampicillin …
“When did it start?” she asked, trying to curb the urgency in her voice.
“I’m not sure, yesterday morning, I think ... ” Sarah, the staff nurse she was taking over from, stared back at her strangely …
“Have you got the notes?”
“Here.” Sarah handed them to her and she flicked through them.
Restless
with
coughing
Friday
night
,
examined
by
Dr
Oakley
Saturday
0830
and
put
on
oral
ampicillin
.
She looked up. “Let’s go and have a look at her.”
Rose was not well. Her face was flushed, her pulse and respiration up. Her skin was hot and dry and her temperature 39C, but she didn’t appear to be in any pain.
“Was she like this yesterday?” Jo asked.
“Not quite so bad.”
“When’s her next dose of ampicillin due?”
Sarah consulted the drug chart. “Two hours.”
“Are there any other patients showing the same symptoms?”
“Well, there’s Mr Tabor with bronchopneumonia – “
“I know about him, I mean new cases.”
Sarah shook her head. “No.”
Jo went back to the sisters’ office, thought for a few moments, then, after making sure no one was near enough to overhear, phoned Fraser’s mobile number and explained what had happened.
“What’s she like?” he asked.
She told him, said, “The ampicillin should be working by now, surely?”
“It can take a while - I don’t like the sound of this, though …”
“Should I give her some more out of a new pack?”
“You’re the one on the spot, what do you think?”
“I think she should have more now, intravenously, and two further doses over the next eight hours.”
“Can you do that without being seen?”
“I think so, yes.”
He thought for a second, then said, “Do it. Too much ampicillin’s better than none in her case. Tell me if there are any developments.”
“When are you coming back?”
“I could come now, but there wouldn’t be much point - I’ll stick to tomorrow morning. Can you come to my flat at lunchtime?”
“What time’s that?”
“One. I’ll let you know if I can’t make it. You’d better go and give the first dose now. Oh, and keep some of the ampicillin for analysis.”
“Yes, doctor.”
She found the key to the drug store and went over to the door. Two nurses were talking at the station while an HCA was turning a patient over.
She walked out of the room and down the corridor. Sarah was in one of the other rooms, chatting to Mrs Grove. She reached the store and let herself in …
No one there. No reason why there should be.
Ignoring the drugs trolley, she went over to the glass-fronted cupboard, unlocked it and pushed the glass to one side … broke open a new box of ampicillin vials and slipped one into her pocket.
How to do this? Openly, or surreptitiously?
Openly - if you’re seen acting surreptitiously, people remember. They don’t remember normality.
She found a small trolley and put on it a sharps bin, kidney dish, medi-swabs, syringe and needle and more ampicillin from the new pack. She found some water for injection and made it up, put the loaded syringe into the kidney dish and covered it with a cloth. She re-locked the cabinet, then, as an afterthought, unlocked the trolley and put some of the oral ampicillin into her other pocket. Then, she re-locked it and set off.
A nurse pushing a squeaky trolley up the corridor, what could be more normal? - And yet she felt as though the walls had grown eyes in addition to the ears they’d always had, and were following her every inch of the way …
Into Rose’s room and over to her bed. No nurses or HCA’s, but one of the other patients was watching her - she smiled back. “Everything all right, Mrs Johnson?”
“Yes, thank you dear.”
She quickly drew the curtains round Rose’s bed. Rose was barely conscious.
“Just going to give you some more medicine, Mrs Parker,” she whispered into her ear, “OK?”
She squeezed the flaccid warm flesh of her upper arm, feeling for a vein with the fingers of her other hand … There! A quick wipe with the mediswab and in with the needle - Rose didn’t even jump.
Ease
back
the
plunger
till
a
wisp
of
blood
shows
you’re
in
the
vein
,
then
quickly
push
it
home
.
Withdraw
and
press
down
with
swab
to
seal
the
puncture
wound
...
When she was sure it wasn’t bleeding anymore, she discarded everything into the sharps bin, pulled the curtains back and wheeled the trolley over to a corner. Not a soul in sight, other than the patients.
When she got back to the office, she realised she was trembling slightly. Reaction. And she was going to have to do it twice more.
C’mon
Jo
, she told herself,
There’s
nothing
to
it
…
Maybe not, but for her, it was unknown territory - she’d never given an unauthorised drug before.
There was plenty to do and the four hours to the next dose passed quickly enough. No problems. Rose even seemed a little better, enough to mumble sleepily, “What are you doing, nurse?”
“Just giving you some more medicine.” She used the other arm to avoid bruising.
By the time the third dose was due, she was feeling more relaxed; it was nearly midnight, the patients were all asleep and there were less staff about. She made up the injection as before and carried the loaded syringe to the trolley in the kidney dish.
The first thing she noticed was that the site of the second injection had bled slightly, staining the sheets. Cursing, she cleaned it up as best she could without starting the bleeding again. Rose was breathing noisily, certainly no better, maybe even a little worse …
She found another site in the first arm and injected. It was while she was holding the swab against the wound to make sure it didn’t bleed that she heard Tessa, another of the staff nurses, come in with one of the HCA’s … “I saw her come in here - Jo,” she called, “Jo, where are you?”
Shit
! If they found her here with the trolley, she’d have no explanation …
She swallowed, then hoping for the best, she bent Rose’s arm over the swab and tucked it inside the sheet … manoeuvred the trolley round to the other side of the bed, quietly parted the curtain and eased it through into the no man’s land the other side … then she noisily drew the curtain on Tessa’s side – “Hello?”
Tessa came over. “Ah, there you are Jo,” she said, “Katie’s a bit worried about Mrs Drew …”
It took her five minutes to sort the problem out and go back to Rose to check on her arm … It had bled a little, but seemed to have stopped now. She tidied it up, then quickly wheeled the trolley back to its corner, just before Geraldine, her replacement arrived.
Jo handed over, asking her to keep an eye on Rose, then walked slowly back to her room. She needed a stiff whisky and a couple of cigarettes before she’d wound down enough to sleep.
*
When Fraser got in Monday morning, he was told by one of the nurses that Rose had taken a turn for the worse and that Tim Oakley had added Erythromycin.
They went to look at her. Pulse, respiration and temperature were all up again although, as before, she didn’t seem to be in any pain or discomfort.
“When did she start the Erythromycin?” Fraser asked.
“Two hours ago.”
Not enough time for it to have worked yet.
But if it
didn’t
work, Rose was going to die ...
What to do?
If he changed the antibiotic again now, and
that
didn’t work, he’d have to produce a pretty good explanation. And even if it
did
work, for that matter …
Better leave it for now.
An hour later, she was worse.
He found Edwina. She told him to put her on oxygen, but give the Erythromycin more time to work.
He was almost certain now that Rose was going to die whatever they did. There was nothing more he could do for her, but … there was, perhaps, something he could do for subsequent victims.
It was morbid, maybe even gruesome, but the more he thought about it, the more he knew he had to.
He found a couple of swabs and a vacutainer set and went to Rose’s room. The curtains were drawn around her bed. No other staff around, so he stepped through. She was still alive.
First, the swabs ...
He removed the oxygen mask and, placing his hand under her neck, gently tilted her head back. Mentally begging her pardon, he pushed one of the swabs into her mouth and down the side of her throat …
She gagged, he simply wasn’t as good at it as the nurses – less practice …
The other side and out. Put the swab back into its tube, then used the second swab on her nose before replacing the oxygen mask.
He swallowed – now the blood.
He listened, couldn’t hear anything. Took the Vacutainer set out, fitted the needle, slotted a tube into the sheath.
No time for a tourniquet – he squeezed her upper arm and felt for a vein with his other hand … there!
Picked up the sheath and pushed in the needle –
Missed
,
feck
it
!
Drew it back, pushed again … felt the faint pop as it punctured the vein … pushed the end of the tube – a quick hiss and it filled with blood. Withdraw and press cotton wool to stop bleeding …
Footsteps …
“She’s over here, doctor … “
He stuffed the sheath, needle and all, into his pocket, whipped away the cotton wool and put her arm back under the sheet … stepped back – just as the curtain opened and the nurse came in, followed by Edwina …
“Fraser, what are you doing here?”
“Oh, hello Edwina. I was just wondering if there was any more we could do here.”
“Mm.” She picked up the chart and studied it for a moment, felt Rose’s forehead and then pulled back the sheet to take her wrist –
“She’s been bleeding – hadn’t you noticed, Fraser?”
He shook his head. “I only got here just before you … the Erythromycin injection, presumably.”
“Mm. D’you have any ideas?”
“Add another antibiotic?”
“Which?”
“Cefataxin?”
“That presupposes we’re dealing with pneumococcus.”
“I think it must be, don’t you?”
“Mm.” She looked at him, then nodded slowly. “All right.” She turned to the nurse – “But make it tetracycline.”
“Yes, doctor.”
As they turned to go, something stabbed into Fraser’s side and he let out a grunt.
“Are you all right, Fraser?”
“Sure. Just a twinge in my back.”
Just
the
bloody
vacutainer
needle
…
Should
be
all
right
, he thought,
Don’t
suppose
she’s
got
Hepatitis
or
HIV
…
She died an hour later.
A couple of hours and a ward round later, Fraser hustled Jo through the main entrance of his block and up the stairs to his flat.
“She’s dead,” he said as soon as they were inside.
She sat down quickly on his bed. “She can’t be, she wasn’t that bad when I left her.”
“Well, she deteriorated pretty quickly after that. They called Tim and he added another antibiotic, but it was too late. She died two hours ago.”
She was looking at him curiously as though not quite sure what to say, and before she could, he said, “Yes, I was wrong to doubt - she was killed like the others.”
Jo let it out as a sigh. “Poor Rose,” she said. Then: “Well, there’s no point in going through that again. What shall we do next time?”
“How easy was it,” he asked, “Giving the ampicillin?”
“All right, except for the last dose - I nearly got caught then ... ” She told him what had happened ... “If I’d been seen, I wouldn’t have had any excuse … what’s so funny?”
“Nothing. Nothing’s funny really.” He described how he’d acquired his needle stick injury.
“Bloody hell,” she said.
“Exactly.” He paused. “You’ve still no idea how it’s being done?”
She shook her head. “None. Either
all
the ampicillin’s no good, or the bug’s resistant to it ”
He sighed. “Neither have I.” He looked at her. “Could you do it again, if you had to?”
“Jesus, Fraser – after what happened to
you
? Sooner or later one of us is going to be caught - sooner, probably.”
“Just once more?”
“
Why
? What’s the point?”
“I’ll get hold of some cefataxin for next time, there can’t be many pneumos resistant to that.”
“Haemophilus is though, isn’t it?”
“This has got to be pneumococcus to kill so quickly – and I may be able to prove it this time.”
“How?”
He smiled – “With these … “ He showed her the swabs and the blood he’d taken. “They might not grow anything,” he said, “But then again, they might. Did you get the ampicillin samples?”
She nodded and showed him. He said, “You’d better get them all down to Tom, the sooner he can - ”
A knock at the door …
They looked at each other –
“Who is it?” he called.
“It’s me, Helen. “
He motioned Jo to the loo.
“Just coming,“ he said loudly to cover any sound.
The loo door silently closed and the handle moved slowly up … he went over to the door and, arranging his features into a smile, opened it.
“Helen … “ He kissed her “How did you get in – downstairs, I mean?”
She came inside. “Someone was coming out – Fraser, I’ve been trying to ring you, Philip’s looking all over for you, you’re supposed to be going to a meeting with him … “
“Ah,
shit
- “ He didn’t have to pretend - “I’d forgotten all about it.”
She looked at her watch – “If you hurry, you’ll catch him.”
“Let me get my jacket … “
As he turned, he saw Jo’s handbag on his bed beside the samples - he snatched up his jacket and virtually manhandled Helen out of the room and pulled the door shut behind him.
Had
she
seen
it
?
“Where
is
your mobile?” she said as they clattered down the stairs.
“In my office.“
Perhaps
she
hadn’t
… “Thanks for coming to get me Helen,” he said.
“If you’d had your mobile … “
“Yeah, I know.“ He held the door downstairs open for her. “Is Philip really mad?”
“Well, he isn’t pleased.“
He swore again. They half walked, half ran across the road and round the corner of the unit to see Philip waiting at the entrance, looking at his watch.
“Fraser!” he called out, “Where the hell have you been?” Extreme language, for Philip.
“I’m so sorry Philip, I clean forgot.”
“So it would appear – haven’t you got your bleep, or your mobile?”
“In my white coat, in there … “ He indicated the unit.
“Well, thank God Helen found you – come on, we’ve got five minutes.”
With a quick, grateful glance at Helen, Fraser followed Philip over to the playing field and round its perimeter.
His stomach rumbled, he hadn’t had time for breakfast and had been counting on a quick dash to the canteen for lunch after he’d seen Jo. They walked in silence past the social club and up the steps to the Georgian portico of the Trust.
The boardroom was on the ground floor. Places were set round the polished oak table, but only two or three people were seated; most still mingled round the tea and coffee trolley where George Woodvine was being mother.
“Philip,” he called as they made their way through. “And will ye take a biscuit?” he said to Fraser as he served them.
“I’ll take two please - I missed lunch.”
Patrick, dapper as ever, came over and said hello, then the meeting was called to order. Woodvine formally opened it, then more or less handed over to Fleming.
Today, the Chief Executive was wearing a black pinstripe suit which made Woodvine’s tweeds look slightly shabby, and his black hair was brushed back so carefully that the widow’s peak looked as though it had been painted onto his pale forehead. His voice wouldn’t have been out of place in Christie’s and Fraser found himself disliking him even more than he had at the orgy.
He took them through the minutes of the last meeting, and then matters arising from the minutes.
Fraser glanced round at some of the others. The middle aged lady opposite him was making notes, paying careful attention to everything that was being said, while the younger, rather attractive woman next to her seemed about as interested as Fraser – she caught him looking and her mouth turned down slightly at the corners.
Woodvine drooped at the head of the table, as though he might drop off at any moment, and if it wasn’t for the gathering discomfort in his stomach, Fraser thought he might have joined him. It (his stomach) obviously regarded the two biscuits it had been offered an insult and was threatening to make its protest audible.
Fraser heaved it in, aware of the pain still lurking in his muscles … the strategy seemed to work and after a few moments, he relaxed slightly – and just as Fleming’s modulated voice paused, it (his stomach) rumbled like an ill tempered geyser.
Fleming’s eyes flicked at him in irritation over his half-moon spectacles, then he continued his drone. Fraser felt himself flush and his eyes went involuntarily to the younger woman … who was trying not to smile.
Another rumble, louder this time, which everyone studiously ignored - he grimly hauled his guts in and held them there.
Then the middle aged woman started speaking and Fraser tuned into her “How ever did we get into this state, Nigel?” she was saying, “Twenty million pounds in debt …”
“I’m assuming that’s a rhetorical question, Maddy,” Fleming said in a tired voice, “We have been over this before, on many occasions.”
“Maybe we have, Nigel, but
I
still don’t understand it – and I’m sure I’m not the only one here who doesn’t … “ She looked deliberately round, then back at Fleming - “How
did
it happen?”
Fleming, who knew perfectly well that she doing it just to rub his nose in it again, spoke quickly: “It was a combination of the building of the new community hospital which, I’m sure we all agree, was imperative in the circumstances, and the Euro conversion. Thanks to Philip here, we managed to save some money on the hospital, but the costs of the Euro conversion took us by surprise.”
“How much was that again, Nigel?” enquired his tormentor.
“Five million. A memorable figure as I’m sure you recollect, Maddy.”
The younger woman obviously felt that this was the cue for her to contribute - “Why
did
we go on spending so much on it when it was obvious that a referendum in this country would kick it out?”
“Ah,” said Maddy, “Now that’s something I
can
recall – I do clearly remember suggesting on several occasions that we should drop it before all the money was spent.”
“As you know perfectly well Maddy,” Fleming said, his anger barely under control now, “Our political masters wouldn’t hear of it. They were sure – they still
are
sure for that matter – that our joining is inevitable in the end, and wanted it done as quickly as possible.”
“Five million,” mused Maddy, lingering over the figure, “I wonder how many hip replacements that represents.”
“Or doctors,” said the younger woman, “Or nurses …”
“I couldn’t say,” Fleming said. “How many more times, Maddy, are you going to insist on looking backwards, to this, rather than forward?”
“As many times as it needs to ensure this can’t happen again,” she retorted. “On which note - ”
Fleming seemed to make up his mind about something and firmly overrode her - “As it happens, I do have some good news for the meeting, although it must remain confidential at this stage.” He looked round the table, sure of their attention now. “My sources inform me that the Grade II listing of St James’ is to be lifted, so we shall be able to go ahead with the sale of the land shortly. That should enable us to recoup a good deal of the money.”
“Well, thank God for that,” said Woodvine, who seemed to have woken up, and there were murmurs of agreement around the table, although not from the two ladies.
“Thank God indeed,” said Fleming, “Or at least, thank the good sense of the architectural listing committee. But I must emphasise that it is confidential at this time. The official announcement will be made next month.”
Looking at him, Fraser had the sudden conviction that he’d had no intention – and maybe no authority - to make the announcement just then, but had been forced to in order to deflect attention from the money spent on the Euro preparation.
Five
million
…! Had they really spent that much on it?
He knew that all the Trusts had been ordered to prepare for it, and to find the money from their existing budgets, but he hadn’t realised how much had been involved.
He glanced over at Philip, who was staring down at the pad in front of him, and realised that the news had come as no surprise to him … then he remembered Fleming’s visit to the hospital the previous Friday with Patricia Matlock – they must have told him then.
But why wasn’t he happier about it?
The rest of the business was dealt with quite briskly and about forty minutes later, Fraser and Philip started back to the unit. At first, Philip didn’t say anything and Fraser thought he was going to remain as silent as he had on the way.
Suddenly, he turned to him: “Having sat through all that Fraser, d’you still think you want a career in community medicine? Edwina told me what you said,” he added.
“Surely, most of that wasn’t directly concerned with it?”
“No, I suppose not.” He thought for a moment. “It was mostly concerned with money, wasn’t it? So I suppose I meant …” he paused again, “How do we balance the care of human beings against pure economics? As doctors, we have a duty to do our best for our patients – however we construe that - but how far are we constrained,
adulterated
, by economics?”
“A fair bit, I dare say,” Fraser murmured.
“A fair bit, as you say.” He sighed. “I’ve spent my career trying not to be corrupted by money, but maybe we’re all doomed to failure in the end.”
Fraser looked at him. “You really think you’ve failed?”
“Yes – as I said, to the extent we that all fail.” He paused, then, “The thing is not to allow yourself to be corrupted beyond that extent.”
“How do we know when we’ve reached it?”
Another pause. “I suppose we have to use our individual judgement.”
“Isn’t that the same thing as having principles?”
“Having principles should go without saying. Maybe I’m thinking more about being on your guard against manipulation – by government, or anyone.”
Fraser would have liked to pump him a bit more, but Philip smiled suddenly, brilliantly, and clapped him on the shoulder. “The thoughts of Philip Armitage - forgive me for burdening you with them … But think carefully about your career, Fraser. Give it time.”
Fraser said, “Doesn’t what you say apply to all areas of medicine?”
Philip thought for a moment, then slowly shook his head. “I’m not sure that it does,” he said, and wouldn’t be drawn any more.