Philippa told Shinji Nyarko about handover where she had been introduced to the members of her team and when she received the phone call at the end of the meeting.
‘Was anything particular about the voice on the phone? Anyone you might recognise?’
‘No.’
‘How did it sound?’
‘Most likely modified through an app of some sort.’
Philippa continued, detailing the nature of her first tasks including that discussion with Mary Surrey’s daughter which had practically broken out into an argument and the subsequent riddle.
Shinji typed the riddle down onto a fresh document, then asked: ‘This caller – they addressed you as Dr Haven?’
Philippa nodded.
‘This is a personal attack then,’ he said. ‘Can you think of anyone who might do this to you?’
‘I’ve probably upset a few patients in my time but no one stands out who would go as far as doing something like this.’
‘What about this lady’s daughter, Davina?’
‘My interaction with her was the first time I had ever encountered Davina or her mother Mary. She had no reason to hold a grudge against me before our conversation, which puts the timings out of sync.’
‘Do you have any leads so far?’
‘A blue scarf that I found at the crime scene.’
‘Placed before or after the murder?’
Philippa had not considered that the scarf could have been placed after the event. There would have been time…
‘I’m not sure; before or after, I suppose. I do know that the killer was on the ward close to the time Jonathan Wickshaw died.’
‘How?’
‘The first part of the riddle was an instruction – to trace the call. It led to Surgical Four.’
‘Which means they could still be inside the building.’
Philippa shuddered and peered behind the blinds on the door, in case someone was watching.
‘And can you recall what happened, when Jonathan Wickshaw died?’
‘It’s still frighteningly fresh in my mind.’
‘What do you remember?’
Philippa shut her eyes and as she relayed the events of that cardiac arrest, it felt as though she was being transported back in time.
Surgical Four… it meant nothing to her in this foreign building. She darted out of A&E where there was a map of the hospital on the wall but before she had the opportunity to study it, somebody brushed past her.
It was Karan Ghatora. He had been nearby, in the A&E department when the call came through.
‘This way,’ he said.
She followed the senior house officer.
He was very fast.
They sprinted up the stairs.
As soon as they set foot on Level Two, she heard the wailing of the arrest siren in the distance. It became louder as they approached the ward. Philippa Haven’s adrenaline surged in a correlating manner.
This can’t be happening, she thought.
They bolted past a couple who were heading towards the exit. They were very, very late; visiting time finished at eight. The only unit that permitted visitors after eight was Intensive Care…
‘Karan, if this is a true arrest, I want you to try and get a blood gas ASAP.’
‘Got it.’
Karan used his pass to open the door.
Philippa Haven checked her watch: 22:45. Every two hours, you will be put to the test… your time starts at nine…
‘This way!’ screamed Maria who was standing by the nurse’s station. ‘Quickly, this way!’
If locating the wards in an unfamiliar institution was not disabling enough, there was little to be said for the way every ward had a differing arrangement for boxes of latex gloves – some outside each bay, some inside… that only served to delay her bedside arrival by precious seconds.
‘Philippa, medical registrar,’ she announced, signalling for the alarm to be switched off. She was here now.
Maria, who had followed her from the nurse’s station pushed the triangular button firmly into the wall.
Now the team could hear each other.
‘Who is he? Anyone? Anything?’ Philippa asked. She had less than two minutes to gather as much information as possible.
‘I’ll just grab the notes,’ Maria replied.
‘Notes?’ asked Philippa. ‘He’s your patient; don’t you know anything about him already?’
Gemma Oliver placed a hand on Philippa’s shoulder. ‘We’re short-staffed tonight. There are only two nurses on this whole ward,’ she told her.
‘Two nurses for what – twenty-four patients?’ Philippa exclaimed.
Gemma nodded solemnly.
If the cuts kept happening, things would only get worse. Which person in their right mind aspired to be a nurse in current times?
Maria, whose diminutive frame almost cowered at the back, half-hidden by the set of notes she was hugging, now came forward in wary pigeon-steps. Her head dipped downwards as if in shame and her bob flopped over the top of her glasses. Her voice stuttered like a schoolchild in detention but she had not done anything wrong… had she?
‘His name is Jonathan Wickshaw,’ she said.
The anaesthetist, Rob Gadra was masked in case the patient vomited as they sometimes did in these situations. He had manoeuvred a long tube into the patient’s windpipe and was squeezing a green bag of oxygen.
Justin, the recent graduate was performing CPR. Beads of sweat swung desperately off his gelled black curtains like monkeys in the rainforest.
Maria continued reading the notes aloud: ‘He’s twenty-six-years-old, admitted two days ago with a ruptured appendix. He had surgery yesterday.’
There were multiple clues within her words. Philippa listened carefully, trying hard not to be distracted by Karan’s rummaging through the drawers of the arrest trolley.
He scavenged a green needle and a syringe, connected them together then felt for an artificial pulse in the groin – one created purely from the compressions up north. He must have felt something for he plunged the needle at ninety degrees.
At first, nothing happened.
Then Karan adjusted the needle slightly and successfully drew blood into the syringe.
Even now, when that occurred, Philippa would feel a brief excitement and relief wash over her. Blood meant results and results gave answers – usually…
‘Defib here,’ said another voice.
Philippa turned to see a stocky man wearing a baseball cap puffing furiously away. The porter had arrived, bringing the cavalry in the form of a defibrillator machine.
Another nurse now joined in on the action. ‘Hi, I’m Ellen. I’ve come from Surgical Five next door. Do you need help?’ the brunette asked.
Gemma thanked the Good Samaritan for coming.
Philippa delegated Ellen the job of hooking up the defibrillator pads whilst taking the blood sample from Karan and handing it to the porter.
‘Do you know where to run this?’ Not that she knew herself.
‘Yes,’ the porter replied, ‘In A&E?’
Karan nodded.
‘We need more access guys. Let’s push that fluid through,’ commanded Philippa.
‘Good compressions,’ praised the defibrillator machine as soon as it had woken up.
For a moment, Jonathan Wickshaw became nothing but a mere pin-cushion as Justin traded CPR for needles. He inserted a large cannula into the young man’s flaccid veins and connected fluids to it.
The night team shocked the patient with the defibrillator. That was when Philippa attended to the brief distraction provided by the patient Bill, next door…
‘The couple you walked past on your way to this arrest; was anything odd about them?’ asked Shinji Nyarko.
‘I can’t even remember what they looked like except that the woman had a black fur hat, the man, a tanned trench coat holding an umbrella. Nothing struck me as odd.’
‘How did they seem to you?’
Philippa shook her head and shrugged. ‘I don’t know.’
‘Wouldn’t someone be more distressed or panicking if this alarm was going off?’
Shinji had a point.
‘And this patient who interrupted you – it did not sound like he was truly in much pain.’
‘No, I harbour strong doubts. He was just being rude.’
‘Rude or trying to test you… what happened next?’
Philippa thought hard at every detail…
When she had dealt with Bill and returned to Jonathan’s bedside, she was landed with the weight of six questioning stares upon her.
Philippa chose not to voice her exact thoughts – that this was no natural death. ‘Maria, can you tell me what happened here?’ Her words came out like machine-gun fire.
Less than two minutes before the next pulse-check.
‘My last observations were an hour ago and they were completely fine.’ Maria spoke with an accent that sounded a fugue of American and Filipino.
‘Had he been having temperatures?’
Maria shook her head frantically. ‘I did my drug round and he seemed well, lying in bed. This is his obs chart.’
‘Thanks.’
‘Then whilst I was in the next bay, Jonathan pressed the buzzer and I found him on the floor like this.’
‘Was there anyone else here? Any relatives?’
‘No; no one except for the other patients.’
‘Wait, you said you did your drug round before this all happened?’
‘Yes.’
‘Get me his drug chart.’
Maria reached to the side and offered a different folder.
Philippa snatched it from her hands. It glistened momentarily as the light reflected off its laminated surface. It took a juggling act to keep the folder from falling apart.
Jonathan Wickshaw had been administered paracetamol and antibiotics before he died. An allergic reaction could have killed him but his clinical picture did not match that.
‘Two minutes,’ came the dreaded announcement from Gemma.
‘Have we got a pulse?’ asked Philippa.
Justin shook his head.
‘Back on the chest then.’
Karan prepared another shock.
Thud.
It was now the nurse Ellen’s turn to fatigue and they swapped back but this was not a sustainable solution.
I will have to step in eventually if they both become too exhausted, she thought. Her biceps flinched at the idea and she rued this missing junior.
‘You were supposed to have someone else with you tonight?’ Shinji clarified.
Philippa nodded.
‘Who… and why haven’t they turned up?’
‘I think it’s just a rota gap rather than sickness.’
‘Is there a way to be sure?’
‘I could ask one of the other juniors perhaps.’
‘Maybe… sorry, do continue. I’m just sharing my immediate impressions.’
It was after this shock that Philippa requested a member of the team to contact Jonathan’s family. Such request often translated as a white flag but Philippa was not giving up yet.
Maria took on the unenviable task.
‘Doctor?’ a recognisable voice suddenly said. It was the hospital porter. He swallowed hard. ‘The… the erm machine is broken,’ he stammered, out of breath.
‘Broken? Is there not another machine?
‘I don’t think so.’
‘We only have one machine in this hospital?’ she bellowed, glancing at Gemma for confirmation of this fact.
The SNP sighed angrily, as if this was a regular occurrence. ‘Give it here,’ she said, ‘let me run it up to Intensive Care. That’s our last chance.’ She placed a hand on Philippa’s shoulder before she skipped from the scene and informed her: ‘A minute-and-a-half before the next pulse-check, boss.’
Philippa Haven’s arid tongue was sticking to the roof of her mouth. Her heart and mind were pitted in a competitive sprint against each other. She considered for a second, passing the role of timekeeper to the porter, but she could not bring herself to do it.
‘Could it be a bleed? Or infection?’ Karan suggested but they were directed at natural causes for Jonathan’s heart to stop beating. Philippa needed to solve how someone would murder him…
The team persisted with two more cycles of CPR but each time the tracing on the defibrillator got flatter and flatter.
Philippa had pinned her hopes on Gemma’s return but when she did, it was only to hammer the final nail in Jonathan’s coffin. The blood had clotted; the sample was no longer usable.
With no means of working out what was going on, Philippa was left cursing the hospital’s lacking facilities.
One final negative pulse-check…
Jonathan Wickshaw was dead. True cardiac arrests never ended like they did in the sitcoms.
A knock on the door prevented Philippa from disclosing any more of the story.
Philippa opened the door.
Effy stood there. She was holding the medical registrar bleep.
‘Is everything okay?’
‘Someone kept trying to bleep you. I assumed it was urgent, so I answered it.’
‘Who was it?’
‘I don’t know -’
‘Was it from an outside line?’
‘Yes, how did you know?’
‘What did you tell them?’
‘They seemed surprised when I spoke,’ Effy replied. ‘I said you were reviewing a sick patient. That is what you’re doing… right?’
Philippa turned and locked eyes with Shinji, as doctor and patient demonstrated a mutual understanding.
‘Did they leave a message?’
‘Not really; they simply asked that you check your email as soon as possible.’
Every few days... 