Chapter Nineteen

‘I’ll be right back,’ Justin said, protecting the precious syringe of blood cautiously. But was he shielding much more; a secret that was linked to the events of both tonight and right now?

Philippa’s head oscillated between Justin and Karan, like a metronome dial. She had to act now.

‘No,’ she said suddenly. ‘Justin, you’ve clerked patients before, on Take right?’

He hesitated. ‘Yeah.’

‘Karan, how many patients are there waiting on the list?’

‘Three.’

‘Justin, give the blood to the porter to run. I want you to start seeing patients on the Take.’

His body did not respond.

Karan was staring at her in disbelief.

‘What –’ he began.

‘Philippa, we need hands here no?’ asked Gemma.

One of Rob’s ribs gave way.

Philippa flinched as she envisioned the bone snapping inside, releasing shards into the surrounding tissue. A stream of tears oozed down her cheek but it took her SHO to point this out for her to even realise.

‘Philippa!’ Gemma said again.

It was chaos.

‘We’ve got backup coming. When’s the next pulse-check?’

‘Kind of… now?’ Justin said, inching towards the door.

Philippa’s hand felt for a pulse through the neck of Rob Gadra’s scrubs, affording him limited dignity. ‘No pulse,’ she reported. ‘Karan, take over the timing please.’

‘I’ll take over the chest,’ Gemma said, her cheeks still glazed like iced buns.

Justin remained in a state of bewilderment.

‘Go now, help with the Take. We have this,’ Philippa told him. ‘Can we try and get the defib pads connected to his chest please?’

‘But why?’ asked Justin, still fixated on Philippa’s bizarre strategy.

‘Don’t ask questions. When this is over, you can switch back with Karan. Give the blood sample to the porter now, before it clots!’

The junior doctor disappeared down the metal staircase.

If the porter was behind this, he could ill-afford a repeat of whatever happened at the blood sampling machine. It would be too obvious.

This was a disaster.

Rob was the anaesthetist and that meant he was the master of supporting airways. Without him, they would have to make-do with less effective means of supplying oxygen to his lungs. For all she knew, Rob might have been dead for over an hour.

Her heart tried to hammer its way out of her chest wall. Despite the near-freezing air outside, her palms were forming beads of sweat. She felt hot but not from exertion, she was angry.

‘Come on Rob,’ she begged.

Karan at last, attached the defibrillator pads to the body, working around the tears and sweat of the usually ever-composed Gemma.

‘Pulse-check guys.’

Philippa placed two fingers on Rob’s neck. Gemma did the same at his groin.

Not even a flutter…

‘Asystole. No shock,’ Karan said. But he had detected how traumatising this was becoming for his two colleagues. ‘Let me take over compressions?’

‘No, I’ve got this,’ Gemma said, gritting her teeth. ‘After the next pulse-check.’

‘Have we got some adrenaline?’ asked Philippa, who was struggling to keep atop of the multitude of queries thrown at her.

Karan exited the portacabin in a blur and returned shortly with the porter and a stash of purple packages the size of unopened boxes of toothpaste.

Philippa grabbed one of them, wiped away a tear then cracked it open to reveal a preloaded syringe.

‘Have we got a line?’ checked Philippa.

‘Veins are all collapsed,’ Karan commented.

Philippa bit her lower lip and asked for some more equipment. She felt Rob’s hand, it was nothing like the hand that touched her shoulder. Now it was set in stone and his fingers were as chilly as the steel bars of the banister outside.

She skimmed over the back of his hand and up his arm. These were precious seconds searching for a blood vessel to rear its head. But Karan was right; there was no identifiable vein.

Rob’s face was now gaunt and sunken. He was barely recognisable. How beautiful life could be, how sickening death was.

What did the killer do to you? Give me a clue… please… Her thoughts returned to the last riddle – the statue of Fibonacci. How did Fibonacci die? Was that the link? Or was it a lethal dose of potassium again?

Her eyes narrowed.

It was worth a try.

‘I’m in,’ Karan announced, flushing the cannula.

His words were a helping hand that had appeared over the edge of the cliff she was clinging on. Then more helping hands arrived in the form of two nurses. One was Effy, the other she did not recognise.

‘Let’s give the adrenaline now,’ Philippa instructed. ‘Karan, can you fetch me some calcium chloride?’

‘Calcium chloride? But –’

‘We have nothing to lose,’ Philippa snapped.

Then she heard the sound of heavy footsteps climbing the stairs. The porter had returned. His denim cap was drenched.

He dug his hand into his pocket and withdrew a strip of paper. He handed it to Philippa. Some of the details had smudged ever so slightly, but she could make out the numbers.

‘What does it show?’ Karan asked.

Rob Gadra’s bloods were abysmal from the first value and continued to worsen as Philippa recited the results to the team. She had to pause between each number, fighting back further tears.

The extortionate lactate level was one of the highest she had ever seen, suggesting Rob’s heart had stopped perfusing his organs for some time. His blood had become currents of congealing acid, circulating only by the manual pumping on his chest.

Simply put, the results were not compatible with life.

‘How long do we continue for?’ Karan enquired.

‘What? We don’t even ask that here,’ Gemma replied sternly.

Philippa understood where she was coming from, but Rob was dead. She would have been a hypocrite to prolong the inevitable, especially after her lecture to Mary’s daughter in Resus at the start of the shift.

Time was ticking.

She needed Shinji more than ever now.

Three tests…

Three failed tests…

Another due soon…

‘Two minutes!’

‘No pulse,’ Effy said, before swapping places with Gemma.

Her colleagues turned their attention towards her, as the medical registrar and leader of the cardiac arrest call. The porter bowed his head. His lips fluctuated, as if mumbling a prayer.

Karan read the yellow flat line on the defibrillator. Every so often there was just a trickle of deviation before the line returned to the middle of the screen.

‘Then we stop,’ she told her team.

Effy was knelt, poised to restart chest compressions.

‘Philippa?’ Gemma stammered.

‘We stop…’ she re-iterated.

Philippa Haven took a few steps back, her trembling hand cupped her mouth. She leaned against the wall, steadying herself with her free hand.

‘Oh God…’ Gemma whispered before breaking down beside her.

Karan collapsed, exhausted in a heap onto the floor.

Her bleep went off and she became aware that there were in fact five missed bleeps during the mayhem but she had been too absorbed in striving to save Rob to notice them.

She felt hollow inside. She had only just met the guy but perhaps it was the what-ifs that made her stomach want to regurgitate its contents. Her tongue was glued to the roof of her mouth.

‘I’ll get one of the other porters and we’ll take him to the mortuary,’ the porter said though it was not clear who his words were directed to.

Should the police get involved? Now that a staff member had died unexpectedly, surely this was suspicious enough? But then there was no evidence of foul play.

For a while, the team did nothing but reflect in macabre quiescence.

‘Epilepsy,’ Gemma said suddenly, breaking the silence.

‘What?’

‘I think Rob’s brother had epilepsy. Maybe Rob had it too but didn’t want to tell anyone at work. Maybe he had a seizure which didn’t terminate.’

It would have explained the high lactate result… still, something must have triggered it, thought Philippa.

Then another bleep went off. For once, it wasn’t hers. That was refreshing.

It was Karan’s.

He walked over to the phone and answered it. It was Justin.

Justin Hills….

What had the first-year doctor been doing in the cemetery moments before this all happened? Philippa had spied him walking in the direction of the hospital and these portacabins were en route. And he knew Rob would be in here. He certainly knew where to get his coffee…

‘What a crazy night,’ she heard Karan say as he hung up and parked himself on the murky sofa. He stared in dismay at the dead anaesthetist on the floor. The SHO had thoughtfully covered the naked body with some blankets he had found in the vicinity.

It was just over an hour ago that her and Rob had been sat on that sofa together as he told her the stories of Eric Pails and Melissa Dowd.

‘One hell of a night to be short on the team. Screw the establishment,’ Karan growled.

‘It wouldn’t have made a difference,’ Gemma muttered despondently.

‘We’ll never know that. Medical staffing needs to sort this out.’

‘It’s not their fault – they’re working with their own restrictions and obstacles.’

‘They knew these shifts weren’t covered weeks ago. But you’re right, it’s the people at the top – and I mean the big guns who actually earn the megabucks but sit on their asses doing very little – they’re the ones putting restrictions; on when they can authorise shifts and cap how much the hospital can pay for cover – it’s no wonder they usually end up unfilled. It’s money over patient safety, I’m telling you. And these people at the top; have you ever actually seen any of these guys – these… names on emails? It’s not because they’re too busy, it’s because they know jack about being on the frontline and don’t care to find out either. Now look what’s happened? We barely had enough hands to manage this arrest call. If only they could witness this now…’

‘It wouldn’t have made a difference,’ Gemma whispered again.

But Karan was visibly shaking with anger. ‘When the shift is over and I’ve broken my neck to keep things flowing in the hospital, I won’t even get the smallest thank you. We’re on our own here.’ He threw his gloves on the floor.

Philippa had been paying attention to Karan’s accurate but damning assessment of the current NHS system. The SHO clearly spoke his mind and the night was taking its toll on him. All it took was one sick patient or one cardiac arrest to completely throw the night into disarray. Tonight, they had had the displeasure of two. She had to keep him as fresh as possible to keep the Take flowing however.

The portacabin no longer felt so cosy with the door inviting in the cold gales. Each gust diluted Rob’s final moments, his excellent humour, his existence…

Philippa stumbled over to Rob Gadra’s corpse. At least in this position, she had the warmth of the inefficient bulb dangling from the ceiling above. She crouched and rested a hand on his chest. She closed her eyes and hoped that when she opened them, Lazarus syndrome would have occurred and he would suddenly awaken.

I’m sorry I couldn’t save you but I’m going to find out who did this and when I do, I’ll make sure they pay…

There was movement by the door as the porter arrived with his bulkier Caucasian colleague dressed in identical light blue shirts and black trousers. The new face looked some thirty years younger and Philippa wondered if he had to be back for school in the morning.

Their arrival signalled the departure of Karan back to A&E.

‘Excuse me darling,’ the unfamiliar porter said. His name was Gerard according to the badge pinned to his shirt pocket. The other porter’s name remained a mystery.

Philippa moved out of the way. They covered up the body and lifted it out of the cabin. It was now pouring outside with great velocity.

Gemma swore. ‘I haven’t contacted his family. I don’t even know how we’ll get those details until medical staffing open at nine.’

A final tear rolled down Philippa’s eyes as Rob’s rigid body was put away. The transfer of his body to the coffin was like the true goodbye to this world, as though his soul was being transferred to Heaven.

‘What are we going to do now?’ Philippa asked. Who was going to help her at the next test, with the airway?

‘I’ll contact the anaesthetic consultant; he or she will have to come in and take Rob’s place. And I’ll see if domestics can help clear up in here.’

‘I’ll stay for a moment and reply to some of these bleeps,’ said Philippa. In truth, she just wanted to feel close to her colleague for as long as possible.

She sat for a moment on the floor with nothing but the background white noise of the television, which was amplified the moment Gemma shut the portacabin door. She stared blankly at the Periodic Table amongst other biochemical related posters on the wall. Rob Gadra had been chatting to her. He had been standing right there earlier…

That was when something out of the ordinary caught her eye. It happened whilst she was mulling over Gemma’s last comment.

I’ll contact the anaesthetic consultant; he or she will have to come in… He or she…?

Rob had mentioned that the Princess Royal Hospital had an all-male anaesthetics team. So why, under the corner-desk by an untidy pile of sports bags, scrubs and jackets was there a pair of women’s shoes?