Chapter Twenty-Two

By the time both Karan and the nurse had ditched their gloves, the hooded person had fled.

‘They’ve gone,’ said Philippa. ‘I don’t know who it was – someone was standing by those hedges.’

‘Are you –’

‘I wasn’t seeing things.’

‘I meant to say, are you alright?’

‘I’m fine,’ she snapped.

‘What happened at the cardiac arrest call in the anaesthetist’s mess –’

‘I don’t want to talk about that.’

‘With Justin… I think he was a bit upset by it.’

‘Did he manage to clerk any patients?’

‘Yes, he was finishing up on the second patient when I got to him.’

Was that the killer outside just now? She took a further glance. He had disappeared out of sight. She combed the hairs on the back of her neck with her fingertips.

The SHO interpreted Philippa’s lack of response as a sign to stop and not risk pushing her buttons any further.

Philippa on the other hand, interpreted Karan’s silence as a question of her own contribution to the Take. She scratched her ear and said; ‘Karan I know it looks bad but I usually see as many as any of my SHOs overnight. Tonight, has been… different.’ Would she be able to find the killer outside if she went searching now?

‘It’s fine, I’ve worked with all sorts of registrars. I have to respect how you choose to run the Take.’

‘You don’t believe me?’

‘I do.’ Then he smiled. ‘You’re not as bad as some of the others at the hospital.’

Philippa couldn’t hide her curiosity.

‘Tim Chung? He’s one of the ID registrars, you’ll meet him. He often goes through a whole night shift and doesn’t see any patients.’

Philippa was surprised by his answer. For a moment, she considered contacting him for help. No, the killer was smart. What if he had other ways of tracking her moves? But the mention of her friend Tim, provided some comfort – a stark reminder that the world was much larger and exotic than that contained within the walls of the Princess Royal Hospital.

‘Does he get away with it?’

‘He never used to be like that; changed a lot during the year. When I worked with him at the start, he could see eight or nine and then he turned into what some of us call, a saboteur,’ he elaborated. Karan began cleaning Charlottes’ pale skin with an antiseptic device. ‘Sharp scratch,’ he warned her seconds before injecting some local anaesthesia, superficially at first in order to form a bleb the size of the mole on the patient’s cheek.

The patient could have been twice her true age with stale, wrinkled skin. Her eyes were tinted yellow and Philippa noticed from the young lady’s roots that she was not a natural blonde either.

The injection caused Charlotte to stir temporarily from her stupor. She flinched and her left hand flexed automatically towards the needle.

The nurse seized the extremity just in time, when it was inches away from contaminating the procedure and forcing Karan to start over. ‘Sorry, try to stay still best you can, Charlotte,’ the nurse told her warmly.

The SHO withdrew the needle. A droplet of fresh blood roller-painted a near straight line down the side of her abdomen and onto the pad.

‘What’s a saboteur?’

‘Someone who has become so disillusioned, they’ve stopped caring about work. You’ll see them in all hospitals at both SHO and registrar level. Alfred for example couldn’t bear to handover more than two patients waiting for the night team but Tim would happily handover ten. Saboteurs have become immune to any shame. It’s as if they want things to fail so that the cracks in the system become apparent rather than just painted over. I questioned him about it once and he gave me the spiel about how the NHS is ruined and how medicine is dead. I think he has a point, though in his case, his partner died or something, which may have precipitated it all.’

‘He preached something similar to me. I know Tim from my university days. Very intelligent guy.’

‘I’m just going to inject the anaesthetic deeper…’ she heard Karan say.

The word anaesthetic reminded her of the pressing need to stop the killer. She grinded her teeth together. She was supposed to be supervising Karan and monitoring his performance yet she found herself thinking about nothing other than her precarious situation. Each thought was interrupted by the squeaks of Charlotte’s breathing via the non-invasive ventilator.

‘We’re just going to wait two moments for the anaesthetic to sink in now,’ the SHO told Charlotte though it was not clear whether the patient understood his words. ‘Tim tried to persuade me to go into Infectious Diseases at one point. He does research in a laboratory in China; travels there every so often and even invited me to visit the facilities. He said it might sway me if I went.’

‘Did you?’

‘Nah. I’m not interested. I get enough exposure to infectious diseases when I visit family in India,’ he said, chuckling to himself. ‘He obviously still cares about people, if not the job, though.’

‘What makes you say that?’

‘He told me about how when he worked at the Evelina Children’s Hospital, they had window cleaners dressed as superheroes. So, he brought the idea over here, as a one-off charity event. Turns out he’s a big fan of the Avengers movies and got some colleagues together to dress up and do a big window-clean for the paediatrics unit. Raised nearly five hundred pounds. Kids loved it obviously.’

Philippa spotted Charlotte sporting a silver wedding band which may still have held meaning to her heart. It was four o’clock, she observed from the hands of the Mickey-mouse watch around the patient’s wrist. The eroded faux leather strap had lost its colour, much like its owner.

‘Next bit now, Charlotte,’ he said.

And then she thought: what am I doing here? Karan was competent, more competent than the SHO who had ruptured a patient’s bowel from this exact procedure four years ago. That SHO had falsified her previous experiences of doing ascitic drains. Karan did not seem on par with her.

She remembered the mysterious photo that she had found at the scene of Rob Gadra’s death, which now slumbered in her dress pocket. She had forgotten to show Shinji Nyarko. She checked the photo was still there and inadvertently dragged her tangled notes with it.

They clattered to the floor.

Karan made an early move to pick them up for Philippa before acknowledging his hands were still in sterile mode and backed away. But it was plain he had noticed the peculiar symbol consisting of adjoining hexagons and pentagons that Philippa had copied from the whiteboard in Mary Surrey’s room and he seemed almost distracted by the sketch.

‘Can I see that again?’

‘What… this?’ Philippa clarified showing him the drawing.

He tilted his head at an obtuse angle. ‘That’s random, why have you drawn that?’

‘Do you know what it is?’

‘You drew it on there; don’t you know?’

‘I found it somewhere and thought it looked interesting, but I take it you do?’

He nodded. ‘I gave a fun talk on medicine in murder mysteries to the first-year docs a few weeks ago. It looks like the chemical formula for strychnine.’

Strychnine…

It was not the sort of thing taught at medical school, more the thing one picked up if an interest in the field of forensic medicine developed. That did not apply to Philippa Haven. She had heard of the chemical before but did not know enough about it, after all there were now hundreds more diseases and thousands more drugs to learn about first – things that more commonly took lives…

Twenty percent battery left on her phone but it was sufficient to find out more via Dr Wikipedia. No doctor knew the answer to everything…

‘Philippa?’ Karan’s voice said bringing her back into the Acute Medical Unit. ‘Are you okay?’

She blinked twice and stared at her junior poised with a needle the length of a school ruler, ready to introduce the drain. What was she doing here? Why was she wasting time? Someone had murdered two patients and her colleague yet she was still floundering here watching Karan doing this drain, which he had insisted he could do.

‘Yes, I’m fine thanks,’ she replied. ‘Karan, I think I’m going to let you do this independently.’

He seemed surprised. ‘Really… but you’ve kept me waiting till now to supervise me?’

‘Yes, I think you’ve proved your competence tonight. You can do this drain independently. Just call me if there are any problems.’

She hurried out of the bay and turned left to exit the ward. Strychnine was a neurotoxin. It had a rapid onset of action, as quickly as five minutes and could trigger life-threatening seizures, she read. Her ponytail was adhering to her neck where her sweat had pasted across like a strip of glue.

I’m sorry Rob, you didn’t deserve this but I will find out who did this to you…

There was a shortcut to the security office but it meant flaunting her feathers in A&E.

She made it no further than ten metres when her title was called.

‘How was that patient?’ It was Sophia, the nurse-in-charge of A&E.

‘Charlotte Barber?’

‘Yes.’

‘Not doing great actually; Hadn’t my SHO said not to transfer her before the drain?’

‘He did, but the consultant said we had to move her.’

‘Or she’d breach, I’m guessing?’

‘She was already at three-and-a-half hours.’

Perhaps this was an opportunity to provide some much-needed feedback to the department. ‘Your consultant; is he around at the moment?’ asked Philippa.

‘Dr Balsack? He should be here, come with me,’ Sophia said waving Philippa over. She led her through a set of double doors to an attached wing of the hospital. ‘Dr Balsack, I have the medical reg here to see you – her name’s…’

‘It’s Philippa.’

‘My team have been trying to get hold of you; it would seem that you’re not answering your bleep,’ he said. Menacing shadows waltzed across his face, created by the illuminated computer screen he was fixated upon.

Dr Balsack was a hatchet-faced fellow with olive skin wearing a striped shirt and teal tie. He had fine-tuned thistly hair. A smart man, just victim to a fashion faux-pas.

‘I’ve come to discuss Charlotte Barber?’

‘Is your bleep working?’

‘She’s the girl with hepatic encephalopathy?’

‘Have you been answering your bleep?’

‘You said she could be transferred to the Acute Medical Unit –’

‘I asked you a question: is your bleep working?’ He stood up, towering over her from heights exceeding six feet.

‘My bleep is working fine but how about you concentrate on what actually matters when you’re working in a goddamn hospital?’ Philippa replied, confronting him head on and raising her voice.

Sophia gasped and hardly made it subtle.

‘I suggest you swallow that tone you just used and try a more respectful one, young girl. We’re all under a bit of pressure.’ His finger slammed onto the mouse button, forcefully closing a programme. He shifted his gaze from the screen to Philippa and ran his fingers across his razor-sharp hairline. Tiny freckles of dried gel exploded from his scalp.

‘Charlotte Barber is a girl who came in under your watch to A&E tonight. You transferred her even when my SHO said she was not stable and she deteriorated on the ward. Do you think that’s acceptable?’

Dr Balsack shrugged nonchalantly and bit his little finger whilst scrolling through the A&E patient records, as if he did not believe the medical registrar before him. Then his eyes lit up. ‘It wasn’t that long ago… yep she had to go, she was half an hour from breaching four hours.’

Why could no one in this department see sense?

‘Surely a patient’s wellbeing should matter more? She could have died if my SHO had not been on the ball tonight. Luckily for all of us, he was because we’re down one junior doctor too in medicine.’

‘You still should have adequate staff to deal with one extra deteriorating patient.’

One? If only he knew…

‘When a patient is about to breach; they leave here and go to the ward. That’s the rule,’ he asserted.

Philippa began pulling her hair out. It was like talking to a rebellious teenager. ‘It’s a real shame that we all go through medical school to be taught how to look after patients and treat diseases. Then we get to the top and all we care about is the financial implication of breaching waiting times and getting rid of them.’

‘You know, I don’t actually agree with the four-hour target. Many of us don’t agree with it, but that’s what the Government judge us on,’ Dr Balsack protested.

‘Dr Balsack? Can I –’ said a young girl suddenly, with an identifiable Canadian accent. She was wearing oversized basil scrubs that were nearly falling off her, with a V-neck so broad, her hair had to flow underneath rather than over it.

‘Kristen, you don’t need to discuss every case with me; just refer on if you think they need referring.’

Philippa was shocked at the consultant’s lack of support, especially as she had recognised Kristen to be one of the better A&E doctors on tonight. This man was a monstrosity and enough was enough…

‘You know what, this might be my first shift at this hospital but everyone was right about you. You refer all the patients to medics and don’t show any understanding to the medical registrars, when you have eight or nine doctors referring to me often at the same time and I have just one junior doctor clerking!’

‘You need to watch what comes out of your mouth, young girl!’ He stepped forwards and Philippa genuinely thought he was going to land the back of his palm across her face.

‘My friend died tonight during this shift. One of my colleagues, one of your colleagues but you wouldn’t know because you barely know what’s going on and how sick patients are in your own department.’

‘Who is your supervisor? I’m going to speak with your consultant in the morning about you! Don’t think you’re getting away with this.’

‘Go ahead,’ she replied, ‘and by the way, my name is Philippa Haven. I’m not some young girl, I’m the medical registrar.’