Wednesday
2nd October 2019
23:00
The odour of death was rife on the ward. It lingered between the seven members of the team; their weariness epitomised by the faint rods of light above the bed. They glanced at each other with the same burning question: could they have done more?
Death was commonplace in hospitals and indeed for six of those present on scene, Jonathan Wickshaw’s death though unexpected and unfortunate would ultimately be attributed to some post-operative tragedy… a mere black statistic etched into his surgeon’s record. But for Philippa Haven, the most senior doctor on-call tonight, this was not just death; this was murder. Until recently, she had reason to be sceptical of the phone call she had received but Jonathan’s death changed everything.
Her blood ran cold as the heat emitted from the team’s efforts dissipated. She tried to muster the strength to speak but no words left her mouth. Her gloves adhered to her sweaty palms. Saving this young man was the killer’s first test and she had failed it. Now she had just two hours before the next.
Philippa heard Maria, a petite Filipino nurse with round glasses and a cautious bob apologise to the bearded patient next door. The nurse then briefly danced away. When she returned, she handed him two ovular tablets in a tiny paper cup not much larger than a thimble, fulfilling his order at last.
Philippa closed her eyes and recalled how she had snapped at the patient during the cardiac arrest. It was still so fresh in her mind…
The bedside cabinet had been dramatically kicked to the side, biting out a chunk of plaster as it smashed against the wall. Philippa was standing at the foot of the action where her presence would be most prominent, opposite the masked anaesthetist.
‘Can – someone – take – over?’ pleaded Justin between desperate breaths as he concentrated his energy down his arms and onto the shaved torso sprawled helplessly across the floor.
The remnants of Jonathan’s dignity were all but lost as the ripped hospital gown, torn from his body spilled across the nearby mattress.
Another nurse who had arrived from the neighbouring ward, answered Justin’s call for help and on the count of three, they transitioned smoothly. Right hand on top of her left, elbows locked in position – each action sprouted more beads of sweat turning her moistened collar a darker shade of blue.
‘Who’s timing this?’ Philippa asked.
‘I am,’ replied Gemma Oliver. It was reassuring to see the Site Nurse Practitioner here in her charcoal uniform, ‘Ten seconds left.’
Philippa’s thoughts were momentarily distracted by a crack; one of Jonathan’s ribs had given way under the force of the brutal chest compressions – a common adversity of CPR.
‘Two minutes gone,’ said Gemma.
‘Everyone, stop! Pulse-check…’
‘No pulse,’ the nurse reported.
‘Back on the chest!’ Philippa ordered. ‘What do we have, Karan?’
Karan, one of Philippa’s junior colleagues, shuffled his glasses up the bridge of his nose. He analysed the waveform on the defibrillator machine. ‘It’s showing VF.’
With the taller Gemma in the way, Philippa had to lean backwards to double-check the rhythm on the machine. ‘VF it is; you know what to do.’
He nodded. ‘Preparing to shock! Everyone, stand away!’
The masked anaesthetist disconnected the oxygen supply temporarily whilst the rest of the team jumped back.
The defibrillator gave a high-pitched squeal before punching three-hundred-and-sixty Joules of electricity into Jonathan’s heart. His torso rose off the hard flooring.
Then gravity took over.
Thud.
That was the moment a voice called out, ‘Can you people keep it down?’
Maria ushered herself out from the cubicle and tried to explain politely. ‘Sir, please we’re trying to –’
‘I don’t care what you’re trying to do. Your racket has woken me up and now I’m in pain! Get me some painkillers, nurse!’
‘I will once we’ve –’
‘Now!’ demanded the patient.
Philippa had heard quite enough. She surged around the fragile curtain and was met by the scent of BO coming from a wheezing man in his late fifties with a balding scalp sitting up on the side of his bed. His overweight frame, propped up by the crutch he seemed still too young to require, was causing him difficulty in breathing.
For a moment their eyes met and he suddenly seemed taken aback. Philippa spied the patient’s name on the board beside him. ‘Bill, is it?’
‘Yes, doctor?’
‘Right now, we are dealing with a dying person. We will sort out your pain afterwards but at this moment in time, you are by no means our priority! Unless you want to spend the next few hours sitting next to a corpse!’
She didn’t feel bad at all for the outburst, but Bill had been left truly stunned. He was a rude man and contrary to what many believed, patients were not always right…
The sound of Gemma’s comforting voice brought Philippa back to the nurse’s station on ward Surgical Four. Jonathan Wickshaw’s notes lay sprawled in front of her, a distasteful display in honour of their owner. But she had yet to write anything. How did the killer do it?
‘What do you think happened?’ Gemma whispered, nudging her on the arm.
Philippa scratched her chin and shook her head solemnly. ‘The case will most likely go to a post-mortem and the coroner will need to be informed.’
‘Well you shouldn’t have to worry about that; leave it to the surgeons. They’re the ones who need to deal with it.’
‘The surgeons? They can’t deal with anything outside an operating theatre.’
‘Speaking of which, someone should inform them that their patient’s RIP’d.’
‘I’ll do that… with much pleasure!’ exclaimed a rather cheerful voice from behind her, decorated by the whoosh of a pouring tap.
Philippa turned to face a lanky figure with wavy blonde locks washing his hands meticulously in the sink.
‘Hi, I’m Rob – Rob Gadra.’ It was the anaesthetist.
‘Philippa Haven.’
Rob dried his hands delicately with paper towels before discarding them.
Philippa winced. ‘That was the wrong bin.’
Rob shrugged. ‘Woops. Haven? That’s a bit of an omen given our occupation no?’
‘I didn’t choose it,’ she pointed out.
Gemma giggled, though it was unclear if the gesture was to Rob’s comment or Philippa’s response.
‘Not seen you here before. You must be one of the new-starters?’
‘Today in fact,’ replied Philippa as she stood to shake Rob’s persistent hand. He had a firm grasp which became a little overwhelming when coupled with the moisture left clinging to his palm. Now unmasked, Philippa noted Rob’s facial features in full; he had blue eyes and mature stubble.
‘Ah, you definitely drew the short straw then; starting on nights. Did you get much sleep?’
‘Barely any – my induction didn’t finish until five.’
Rob shook his head disapprovingly. ‘This job takes the Mickey some – most of the time.’
At that moment, Gemma Oliver’s pager chorused through the air, causing Philippa to jump.
Rob Gadra laughed at her expense.
‘Be easy on her, Rob,’ Gemma warned playfully, wagging a finger at him.
‘Yes, Miss Oliver!’
‘Right Philippa, ward Medical Two calls for my assistance… Maria, I will do my best to get you another set of hands.’
‘Thank you so much, Gemma. I’m desperate for anyone; I can’t be in charge of this ward with just one other nurse. Last night was already too much for my body to take.’
‘I understand,’ she replied. ‘Philippa, rendezvous at one – don’t forget. And watch out for this one,’ said Gemma, flicking her eyes over at the anaesthetist.
Rob rolled his eyes and poked his tongue out in retaliation. ‘I’m heading back to theatre now; we were finishing up a complicated case when all this happened so I’ll let the surgeons know about the arrest – what was his name again?’
‘Jonathan Wickshaw,’ Philippa said, double-checking the whiteboard.
‘Cool. Hopefully we won’t be seeing much of each other for the rest of the night,’ he said, ‘but… if you fancy a coffee sometime; the anaesthetist’s mess is just outside the back exit. Follow the path round and you’ll see two portacabins in front of you. It’s the top one! If I’m home, I’ll let you in; I doubt your badge will work for the door, its VIP entry only,’ he explained with a wink.
‘Thanks, but I doubt I’ll have the time for that,’ Philippa replied, managing a half-smile. I should have gone into anaesthetics, she thought.
‘Lighten up; it’s not that bad a place to work – except for the terrible rota and chaotic staff shortages… and the broken blood gas machines…’
Lighten up? I wish, thought Philippa, but you have no idea what predicament I’m in…
Her bleep went off again. If there was one thing she hated, it was the dreaded antiquated bleep system. If anybody anywhere in the hospital needed to get hold of her, they would do so by bleeping her and despite it being the twenty-first century, the National Health Service still glorified these ancient black boxes with fuzzy displays and irritating alarms. Six long years at medical school only to graduate and feel like a dog on a leash…
As usual, it was A&E trying to refer a patient for admission. Philippa added the patient to the electronic list. Hopefully Karan was checking the list frequently enough to notice the addition – he seemed a competent junior.
Twenty minutes after the incident, Philippa finally had the chance to scribble in Jonathan’s notes. At times, she shut her eyes to recall the finer details and covered her ears to black out the constant harassment from A&E…
It was 22:40 when the distress call was put out. I arrived on the scene at 22:45 because I always check my watch before entering a ward. Chest compressions were long underway. Rob had already skilfully inserted an airway tube; good oxygen was being fed to the lungs. The fluids – what time did they start… about two minutes after I arrived? Then we got the blood sample… if only the blood gas machine was working…
Why Jonathan Wickshaw? He was only twenty-six. He was otherwise fit and healthy and from his build, frequented both the gym and the tattoo parlour. He was even due to be discharged tomorrow… How did the killer manage to take his life subtly? Surely there were relatively easier targets in the hospital? Unless he had an underlying condition that only the killer was aware of.
Philippa concluded her notes and placed the folder back into the trolley. She would need them again later to document her discussion with his parents who were already on their way in. But before they arrived, she had just enough time to examine the scene for clues.
Every few days... 