Chapter Nine

A detective…

The disclosure of her predicament was undeniably a serious temptation but just as Philippa Haven contemplated this, the killer’s haunting words slithered into her mind: if you do, there will be consequences – serious consequences.

That was when her bleep made her gasp, because this was neither A&E nor any of the wards in the hospital; this was the very recognisable: 88888.

It was as if the bleep had read her mind and was now taunting her.

Philippa’s heart clambered up into her throat. ‘Sorry, I have to get this urgently,’ she stammered, ditching her sweaty gloves with so much haste that one of them missed the bin completely and floated to the floor. She stormed out of the room and reached for the phone.

‘Sorry, I’ve just bleeped -’ Effy began to say.

‘Sorry, I need to call this number back now,’ Philippa said, cutting the nurse short. She knew she could not afford to let this opportunity slip. The killer had already proved their ruthlessness tonight and hardly seemed the type to hold patiently on a phone line. She dialled the number and heard the familiar switchboard lady.

The moment you hang up on me, I’m going to trace your call right back to wherever you are, Philippa thought as she waited to be transferred. And when I find out, I’m going to come looking for you.

But no one said anything for what felt like ages.

‘What do you want from me?’ Philippa asked, breaking the silence.

‘Philippa?’

‘Who’s…’ and then it dawned on her; this was not the killer. She felt nauseated with embarrassment.

‘Shouldn’t you introduce yourself as soon as you pick up the phone?’

She did not know if she should have been relieved that it wasn’t the killer. But this was hardly a consolation. ‘Sorry Dr Steer, I just thought it would be someone else.’

‘You thought it was someone else.’ Dr Steer spoke slowly, punctuating every syllable like a teacher about to dish out detention. ‘Is that how you answer the phone normally?’

‘No.’

‘Who else would call you at this time of night from outside the hospital? Are you mad?’

A twisted killer, thought Philippa, but she resisted the urge to say this out loud.

‘How is everything?’

‘We’re… managing,’ she replied without knowing she was about to rue this response.

‘Good because I forgot to mention that I saw a patient today named Laura Hemmingway. I think she’s on Medical Nine. She’s a young girl in her twenties who came in with a headache.’

Philippa bit her lip hard enough for it to leave teeth marks; she knew a despairing request was imminently heading her way.

‘She just needs a lumbar puncture for a suspected subarachnoid bleed,’ Dr Steer said.

Just needs a lumbar puncture – the words resounded in Philippa’s head. Clearly Dr Steer had forgotten how long lumbar punctures took from start to finish…

‘But Justin is covering the wards and he’s only an F1.’

‘Which is exactly why I’m calling you; he won’t be able to do it so you will have to, I’m afraid.’

‘Does she really need it tonight?’ Philippa asked. It was a leading question because in her opinion, Laura didn’t. These procedures were rarely necessary overnight.

There were headaches and then there were the severe ones known as thunderclap headaches which might have represented something more sinister such as a bleed in the brain, but the way Dr Steer had described this young girl’s symptom did not fit that description. Clinical judgement was being thrown out of the window; sticking a five-inch needle into Laura’s back was purely an invasive means of practising defensive medicine.

Litigation had completely divided medical practice and Dr Steer’s request exemplified this. Despite a normal head scan, unconvincing history and nothing abnormal to find on clinical examination, she still had to exclude this tiny bleed in the brain, for which realistically there was less than a one percent chance of being the underlying diagnosis.

‘What do you think? No, I called you to see what you thought; of course, I want it done tonight! That way, we should get the results back for the morning ward round,’ the consultant demanded.

Philippa’s weariness climbed another level as yet another bleep reminded her how difficult the job was without the extra dimension of solving the subtle murder of Jonathan Wickshaw. She had been swimming through deep waters and now Dr Steer’s request for a lumbar puncture had turned her situation into a highly viscous swamp. Where was she going to find the time to do it? Forget Laura Hemmingway’s headache, Philippa now felt as if she had a drummer inside her head, bashing away at her skull.

She jotted the task down grudgingly on her busy sheets of paper and almost lost sight of it instantly amongst the hundreds of other tiny notes.

‘I’ll do my best to fit it in. I’m getting rammed by A&E currently and we’re down one junior tonight – as you know.’

There was a terse silence and not one of understanding. ‘And how is Mr Nyarko?’

‘I’m reviewing him now,’ Philippa replied. Have you even acknowledged my comment?

‘I’ll see him on the ward round. I probably won’t call you again. See you sharp at eight in the morning, in the Ops Room.’

‘Wait.’

‘Yes?’

‘How did you know Mr Nyarko was unwell? Alfred never handed him over; he only got unwell recently.’

There was a pause.

‘Dr Harris is Mr Nyarko’s consultant. His usual F1, Justin who just so happens to be on-call with you tonight informed him and he in turn informed me as the consultant on-call tonight,’ she replied with a rigid tone. ‘What a very peculiar question to ask, Philippa.’

‘Sorry, Dr Steer. It’s just –’

‘I’ll see you in the morning, as I said. You can contact me via switchboard should you need me for anything.’

In truth, it was very rare for a medical registrar to push the emergency reset button and wake the consultant in the middle of the night. Some, like Philippa, considered a sign of failure, whilst others simply feared being potentially blacklisted.

Philippa proceeded to return to Shinji Nyarko’s side but stopped after two steps. She hypothesised that the next test would involve a vulnerable patient like Mr Nyarko; too many young, fit-and-well bodies would raise suspicion in even the worst trend-spotter.

She had to get this one right and make sure Shinji was protected and that meant A&E would simply have to do something they were not familiar with: be patient and wait.

‘Excuse me, Effy, could you look after this bleep for me, please? If anyone bleeps, just take the number down or call them back and say I’m with a patient.’

‘Sure,’ one of the nurses replied, taking the device from her hand.

Almost immediately it went off.

‘Starting with that one,’ Philippa groaned.

‘Everything okay?’ asked Shinji Nyarko. It was a novel sensation for the patient to be concerned about her wellbeing.

‘Everything is fine thanks,’ Philippa replied. ‘Where were we? Yes, can I examine you?’

Examinations usually began at the hands. Outstretched and trembling, there were nail changes consistent with his cancer diagnosis. His shallow pulse was fluttering rapidly, fuelled by the toxic grand-prix racing through his bloodstream. She spotted a moist tongue, but one littered with Candida, which was undoubtedly impairing his ability to swallow.

‘I’ll prescribe you something to help with the thrush,’ she explained. ‘Can you sit forwards so I can listen to your back?’

Shinji Nyarko heaved himself into position. Then suddenly, he surprised the doctor by placing a cool hand gently on her wrist. ‘Philippa…’ he whispered.

They stared at each other for what felt like a lifetime.

‘I am so frightened of death and the means by which I could die – that any minute this cancer may kill me and leave Suki on her own. But I can sense that tonight, I am not the only one in this room trying to put on a brave face.’

‘Wh- what do you mean?’ Philippa stammered.

Shinji Nyarko had to pause for breath. ‘Whether you realised it or not, when that thing on your belt went off, you gasped – a normal reaction perhaps but as soon as you saw the number, you gasped a second time. Your face lost all colour. Your right hand was visibly trembling as you opened the door. Something is worrying you, making you terrified in fact and you do not come across as somebody who would be scared of doing a night shift.’

Philippa was stunned into a silence so deep that she was sure she heard the painful throbbing of Shinji Nyarko’s pulmonary artery as the aggressive tumour eroded the vessel’s wall with every passing second.

‘Philippa, if something is wrong, I may be able to help?’

The doctor wavered then said, ‘I- I can’t.’

‘Why not?’

‘Because you’re –’

‘Dying?’

Philippa spied her reflection in the mirror by the sink. Her cheeks had turned bright pink.

‘If that is the case, then let me help you even more. At least I will feel like I am giving something back. Let us be grateful for each other’s existence.’

She had been forewarned by the caller but she had nothing to lose. How could the caller possibly know?

So, Philippa disclosed everything: ‘I received a bleep at the beginning of my shift. It was an external call telling me that every two hours I would be put to the test.’

‘Put to the test?’

‘I didn’t know what it meant either at first.’

‘What time did your shift start?’

‘We had a meeting briefly at half-eight. The caller stated my time would begin at nine…’

Shinji Nyarko coughed some more although this time it was non-productive. He raised the lid of his laptop and unlocked the home screen where the digital clock was visible at the bottom right corner. ‘You must have had one of these tests by now?’

Philippa rubbed her chin with the back of her hand. Latex didn’t scratch quite as well as skin. ‘I did – two hours after the phone call, just like the caller said.’

‘And what was the test?’

‘A patient died – was murdered…’

Her words seemed to have breathed life into Shinji Nyarko’s body. ‘How can you be sure it wasn’t just a coincidence?’ he asked.

‘The patient who died was only twenty-six; a young otherwise healthy man. I think he was chosen deliberately to prove that this was no coincidence.’

He nodded then whispered to her: ‘Tell me everything that happened, from the beginning.’