Chapter Eight

Thursday

3rd October 2019

00:00

A serendipitous comment had yielded Philippa Haven a potential first clue. It made her consider the possibility of yet more clues lying within the perimeter of Bed Sixteen. What was the significance of the scarf that did not belong to Jonathan Wickshaw? Perhaps it was not a clue at all, but an innocent mistake?

Then there was the second part of the riddle, which she had yet to solve: I’m four before V and three after S, it would help to know, how to prevent a death… What did it mean?

The cancer ward was named the Chartwell Unit and as Philippa made her way down there, she felt the hairs on her neck stand on end, trying to detect whether the killer was close by. He or she had after all been on Surgical Four shortly before Jonathan’s death. Had the killer placed the scarf there for her to find? Was it supposed to trigger a memory of some sort?

She rehearsed her assessment of the patient. Wash hands, introduce yourself, A for airway… Philippa clocked her mobile phone. There was very limited signal on the lower ground floor. She had only one hour before the next test.

When she entered the ward, a janitor was mopping the floor by the sluice. Most of the lights had been switched off. The janitor’s name was visible on her bright yellow badge which gleamed through the duskiness: Janet. Janet was engaged in an inaudible conversation with the hospital porter – somebody Philippa was briefly familiar with from the cardiac arrest call earlier.

The stocky porter spotted Philippa and as if she was his supervisor, he quickly bade Janet farewell. He walked past her with his head bowed then lifted his cap to salute her, revealing a well-trimmed lawn with two precise parting lines mown into each temple, which seemed rather fashionable for someone in their late forties. Then again, Philippa had always been taught to be non-judgemental at medical school. Unlike Janet, the porter was not wearing his ID badge.

 The janitor shone her torch at the spot she had been scrubbing before giving it the green light and moving onto the next.

The Chartwell Unit had originally been designed as a private ward with twelve separate cubicles. That contract took a horrendous downturn but at least the Princess Royal Hospital found an apt alternative use for the space.

Philippa squinted at the board. Unlike the other wards, the Chartwell Unit labelled its beds alphabetically.

There were two nurses at the station, writing swiftly in folders that were illuminated by pint-sized tabletop lamps.

One of them glanced up to greet Philippa and ask: ‘Have you come to see Mr Nyarko?’

‘Yes.’

‘Bed D is the second door to your right as you walk down the ward,’ she replied with a gesture. ‘The notes are in the trolley over here.’ She spoke with a very deep voice for a woman so petite and this distinctive feature confirmed she must have been the nurse who had contacted her.

‘Is Justin still around?’

‘No, you just missed him. I can bleep him for you?’

‘It’s fine, thanks though.’

‘He left the gas results in the notes.’

So, the machine was up and running again…what macabre timing.

The heavy tome was dusty enough to trigger Philippa’s allergy. She gave them a pat down to unearth the patient’s details. Let’s make this quick, she thought. I’ve got less than hour before the killer strikes again…

She opened the file.

An important red form surfaced.

Good, at least that’s been discussed and decided.

Shinji Nyarko was forty-six-years-old and his birthday was exactly a month ago. His wife was his next-of-kin. He lived in Kingston? That last point was odd…

After establishing the events leading to Mr Nyarko’s current admission and reviewing Justin’s recent hard work, Philippa proceeded to meet the man in person.

Before entering, she had to don latex gloves and an apron which resembled a chartreuse bin-bag. By doing so, she became the most luminescent feature at this withdrawn end of the ward.

The pinewood door was shut. The fenestration was covered loosely by the narrow blinds on the inside. A laminated sign was pinned to the door with bits of blue-tack. It displayed a fiery hand print underlined with the stern warning: Protective Isolation.

Philippa hesitated outside the cubicle. She double-checked she had the correct room and took a deep breath before pushing open the door.

The small square room was stuffy and Philippa tugged lightly at the collar of her dress, granting entry the remnants of the cool air outside. Matching the heat was the intense light emitting from the ceiling. It felt as though she had just walked into a furnace.

She heard the ticking of a pump, encouraging saline through a drip. A laptop with its lid half-down continued to whirr in perfect harmony on the bedside table. Adjacent to the laptop was a vomit bowl containing what looked like frothy sputum mixed with fresh blood.

The patient was at forty-five degrees on the bed, his head turned away from the doorway. The hospital gown looked baggy on his withered frame with his blankets pushed down to his cachectic knees.

Philippa observed his chest movements. At least he’s still alive, she thought. ‘Mr Nyarko?’

The man circulated his weary expression towards her. ‘Yes?’

‘I’m Philippa, the doctor on overnight.’

‘Dr Philippa…’

‘Dr Haven, but please; call me Philippa. I’m sorry to have woken you.’

Mr Nyarko pursued a smile but his facial muscles were decrepit. ‘I wasn’t asleep; I don’t sleep well anymore.’ He sighed. ‘I suppose you’ve come to see how close to dying I am…’

This was not a response Philippa had encountered before. She was unsure how to respond so she simply asked: ‘You’re forty-six-years-old right?’

Shinji Nyarko migrated to the UK from Japan when he was seven-years-old. His brain tumour was diagnosed in March this year by which point, staging scans duly revealed the horrific extent of metastasis. He had accepted his oncologist’s offer of chemotherapy but as so few people understood, it would not be curative – it was merely life-prolonging and an intervention that would induce an iatrogenic fragility to his whole body.

‘You live in Kingston, I noticed?’

He nodded delicately.

‘That’s the opposite end of London. How did you end up here – at the Princess Royal?’

‘You make a fine observation,’ he replied, sounding impressed. ‘Do you know Kingston well?’

‘I’ve worked at the hospital before – many years ago in fact. So how comes the ambulance brought you here?’

He dithered a little. ‘Honestly?’ He paused for a second. ‘I was visiting family close by when I became unwell.’

‘I see… I’m sorry to hear that,’ said Philippa.

Shinji Nyarko was brought into hospital when she would have been sitting in the first talk at induction. His current admission had yielded more damning news as the gravity of his clinical state became further defined.

‘How are you feeling?’

Philippa had read Justin’s notes. The first-year doctor had been called to review Mr Nyarko after his breathing became more laboured with an increasing oxygen requirement. Justin had run some urgent blood tests which were consistent with infection.

‘A bit better now. I think your colleague started me on some antibiotics.’

‘One of the strongest agents we have available,’ Philippa reassured him.

‘I’m very grateful. It seems rather wasteful to be doing all this for a dying man,’ he said. Shinji Nyarko was emaciated. The chemotherapy had caused his hair to characteristically fall out, exacerbating the taut skin on his face. His immune-system had also suffered a blow from the toxic drugs and now he had succumbed to pneumonia.

Through all of this the patient was fully alert and compos mentis; Philippa pondered whether it would be better sometimes, to be low in consciousness and not fully aware of what was going on.

‘It doesn’t mean we just leave you to die, Mr Nyarko.’

‘Please, if you insist that I call you Philippa, then do call me Shinji.’ He coughed hard and a sudden wave of panic consumed him as he drafted all his strength together just to retrieve the vomit bowl.

‘I’ll help you with that.’

He declined her offer. ‘I can manage,’ he said with a grimace.

‘Are you still coughing up much blood?’ asked Philippa.

He nodded then spat out the contents of his mouth into the bowl, proving it to the doctor. If there was one thing Philippa found extraordinary about her job, it was the enthusiasm with which strangers exhibited their bodily fluids.

A smattering of Get-Well cards, were lined up along the window sill. The single card which had fallen onto its side, stood out like a man dressed in black and white within an identity parade. One particular card caught Philippa’s attention – an online creation with photographs of Shinji and presumably his wife, when they were younger and he possessed a well-groomed mop of black hair. Its design reminded her of a very similar birthday card Julia got her the year before she disappeared.

‘How long has this been happening?’ Philippa asked, although she already knew the answer from reading his notes outside.

‘One week.’

‘Has anyone explained why this is happening?’

‘Something about the cancer nibbling at my lungs?’ he replied. The oxygen tubes by his nostrils slipped down his face and he adjusted them. That seemed to give his troubled breathing some respite.

‘How much do you want to know?’

‘I may as well know everything,’ he said with a hint of resignation, before cryptically adding, ‘I’m used to finding things out in full.’

‘Unfortunately, where the cancer has spread to the lungs, it is now breaching one of the large blood vessels. We’ve put you on a tablet with the aim of preventing a serious bleed but I can’t guarantee it will work…’

‘In other words, I’m a ticking time-bomb…’

He wasn’t inaccurate with his analogy; at any moment, the cancer would gnaw through the vessel, causing him to exsanguinate and drown in his own blood. It would be a tragic and fatal event, but most frightening of all, was that it was an inescapable one.

‘I don’t like to describe it as that…’ commented Philippa.

‘But strictly speaking it’s true,’ they both said in tandem.

For a second, Philippa was adrift in the thought of how somebody might kill this man lying before her, if they accrued knowledge of this vulnerability. Was Shinji’s life also in an artificial danger?

‘And you know it is,’ added Shinji with an incongruent calmness.

Philippa felt her shoulders grow heavy. ‘I’m sorry.’

‘It’s not your fault. In fact, I’m very touched by your concern… so thank you.’

She didn’t know, why but she suddenly felt obliged to explain. ‘My father died from cancer when I was very young.’

It was the patient’s turn to be sorry in a brief role-reversal.

‘Shinji, are you in any pain?’

The man shook his head and tapped a device called a syringe driver by his bed. ‘The morphine is keeping that at bay.’

‘If we need to titrate the medications to give you more relief, we can always do that,’ Philippa told him. ‘But there was something else.’

‘More bad news?’ Shinji moaned and his composure suddenly revealed tiny cracks.

‘Not in the context of everything else. Your chest x-ray; it showed a finding known as asbestosis.’

‘What does that mean?’

‘It means you must have been exposed to asbestos previously – most likely a long time ago; even a couple of decades perhaps. It’s not particularly relevant right now but you may be eligible for compensation. Is that something you were aware of?’

‘No… no one has ever mentioned it to me before. But if you are correct, I will definitely explore that – anything to help my Suki.’ Shinji’s eyes became damp.

‘Did you work in the docks? That’s how many people were exposed.’

‘No, I didn’t actually,’ he replied, ‘I worked for the police force… for fifteen years until this all happened. Thought it was a stroke at first… but that was before the scan.’

Philippa smiled as the patient’s reminiscing clearly brought him some bliss.

‘I still tried to do some work for them even after I was diagnosed with brain cancer but although my heart remains willing, my body has become unable…’

‘But it’s probably better you stay as rested as you can, surely?’

‘Maybe. Though I do miss my work,’ he admitted. ‘Not many people can say that.’

‘That’s true,’ she replied. ‘Shinji, what was it that you did in the force exactly?’

Shinji Nyarko smiled, revealing a golden incisor then replied proudly: ‘I was a detective and one of the greatest, I’d like to think!’