The steel doors of the mortuary proved a strain to open, allowing Philippa Haven to fully appreciate the strength Ariel must have possessed in those biceps.
She stepped out into the corridor.
It felt strangely warm.
Her bleep went off. And in that moment, her heart stopped, because she had heard this adrenaline-activating siren on more than one tragic occasion tonight.
‘Cardiac arrest, Chartwell Unit!’
I’m too late!
She broke into a sprint.
No, this can’t be true.
Justin must have somehow discovered her divulgence to the retired detective. Had Shinji told him deliberately, to make it obvious for her, that he was the murderer?
She burst onto the ward like an SAS soldier initiating a hostage operative.
The door to Bed D was wide open.
Effy was in a state of panic, drawing up something into a syringe.
‘No! Don’t do it!’ she yelled at the nurse. Philippa ignored the warning on the front door; there was no time to put on a gown and gloves.
Justin was placing a high-flow oxygen mask over Shinji Nyarko’s face. But was it really oxygen or was it something else?
‘What did you do to him?’ Philippa screamed, pushing him away from the patient.
‘What are you talking about?’ the first-year doctor asked.
‘What did you do to him, Justin?’
‘I didn’t do anything! He was seizing the moment I got here!’
‘What are you drawing up Effy?’
‘Lorazepam. Justin told me to draw some up.’
‘He’s been seizing for five minutes, so I asked Effy to get some lorazepam to try and terminate it.’
Shinji Nyarko lay motionless for a few seconds. The bag of blood was hooked onto a drip-stand feeding packed cells via a cannula in the patient’s right arm. Had the blood been contaminated?
Then the patient began jerking violently again, first his arms and then his legs.
‘Airway!’ shouted Philippa.
Justin heard her and responded, ‘I’ve put a Guedel in.’
The medical registrar ran over to Shinji’s side. ‘Shinji! Shinji, can you hear me?’ He was having a violent seizure and his eyes were rolled upwards, revealing bloodshot conjunctiva. ‘Shinji!’ She turned to the nurse and pointed an accusative finger at the first-year doctor. ‘Did he lose output?’
‘No, he never lost output,’ Justin replied.
‘Can someone tell me what happened?’ Philippa asked, throwing her arms up in the air.
Effy was caught in the middle of the medical standoff. ‘Shall I give the lorazepam?’
‘No,’ Philippa told her suddenly.
‘Why?’ Justin asked.
‘Draw up another syringe.’
‘Philippa, what is the meaning of that?’
‘Whatever’s in that syringe, I don’t want you to give it,’ commanded Philippa. ‘Draw up a fresh dose now, Effy.’
Confused, the nurse backtracked tensely out of the cubicle with her head down.
‘What is going on?’ Justin asked, squinting at her.
‘I think you should tell me what’s going on.’
‘I came onto the ward exactly as you asked me to. Philippa, you were the one who asked me to come here. I wouldn’t have otherwise. I was up on Surgical Nine.’
You’re lying, thought Philippa. You could have been anywhere. She grabbed Shinji’s laptop and held it like a buckler, a stance which screamed defence and attack simultaneously.
‘He was already fitting when I arrived. Effy was about to call for help. Why do you think I had something to do with it?’ he protested. And then he backtracked. ‘Wait a minute, you knew Shinji was going to deteriorate, didn’t you? What did you do to him?’
Philippa ignored him and frantically looked around. Her eyes scrubbed the room back and forth, like a janitor’s mop.
Where were the clues?
‘What did you do?’ Justin repeated.
And then a clean-shaven man arrived. He was a little taller than Philippa but shorter than Justin. He ogled at the doctors, then said to Philippa, ‘Are you leading?’
Philippa nodded and put the laptop down.
‘I’m Luigi, the anaesthetic consultant FYI,’ he said, directed at Justin.
Gemma was the next to arrive with her hands knotted into her hair. ‘Not another, surely?’
Philippa lifted her stethoscope from around her neck and threw the diaphragm onto Shinji’s chest. ‘Justin, stick the probe on his finger and get some obs,’ she ordered. She was going to monitor his every move. Let’s see what you’ll try in front of all these people.
For a few seconds, Shinji’s seizure stopped but then his body lifted off the bed and convulsed violently once more.
Philippa pulled the pen-torch from her pocket and raised Shinji’s eyelids. It was difficult to distinguish between her nervous wrist and the patient’s vibrant attack. She shone the light at his pupils, one at a time, and watched for a response.
His left eye constricted and she spotted the dot of light reflecting off his brown iris.
His right eye… had it been like that before?
‘Something’s happened intracranially; pupil’s blown. He needs a scan,’ she said.
‘Don’t worry, let’s get him sorted,’ said Luigi. He had the most soothing voice and it was difficult to imagine him being stressed…ever. But his eyes were tinted scarlet as if he too, had shed mourning tears recently. ‘He has good air entry, Philippa?’
‘Yes.’
‘Shall we give him some lorazepam then?’
‘It’s coming.’
Effy returned to the bedside with a fresh syringe and began cleaning the end of the cannula by second nature. ‘Lorazepam – two milligrams going in now at ten-to-five,’ she said to the team.
The patient continued to seize and although it was tricky pushing medications through a vibrating arm, locking it into position risked the perils of shoulder dislocation.
Philippa held her breath as the lorazepam went in. Please work…
‘Effy, what did you see before this happened?’
She appeared to struggle to find her words. ‘Mr Nyarko… he pressed his buzzer about fifteen minutes ago,’ began Effy with a trembling voice which soared to pitches Philippa had not expected her to be capable of. ‘He wanted to speak with you.’
‘With me?’
She felt Justin glare at her from the other side of the bed.
Even Luigi glanced up, curiously.
‘Yes, he asked to speak with you. I went to call you but then he went very stiff for maybe twenty seconds. He was completely unresponsive. Then he started fitting like this.’
‘Is he known to have epilepsy?’ asked Luigi.
‘No, he has a brain tumour,’ Philippa replied without hesitation. ‘Then what happened?’
‘The seizure didn’t stop, so I pulled the alarm. Sarah came to help me and I went to bleep you but Justin thankfully came to the ward at the right time. I know Mr Nyarko is not for resuscitation but he never lost output so I put the call out nonetheless…’
‘Thanks, Effy, you did the right thing.’
‘Do you know this patient?’ whispered Luigi. ‘Can you tell me anything more about him?’
Philippa nodded. ‘His name is Shinji Nyarko. He’s not for resus and has metastatic brain cancer with mets to his lung and bones. He has a lung met causing intermittent haemoptysis – he’s coughed up probably half a litre tonight and his Hb has dropped hence the blood he’s got going though at the moment. He’s also developed pneumonia, which I think is new and hospital acquired, but is on IV antibiotics for it.’
Shinji’s seizures settled at last. His fatigued body became as limp as a ragdoll. His breathing was shallow.
‘More hands,’ Karan said declaring his arrival, much to Philippa’s added relief. ‘Sorry, just finishing up someone in A&E.’
Was this over?
Had Philippa saved him? Had she passed the test?
‘Is he for Intensive Care?’ Luigi asked.
‘That hasn’t been decided yet but he had a good quality of life. I guess if there’s anything reversible causing this, it might… it will definitely warrant a try,’ Philippa replied. ‘Have you got beds?’
‘I can always make room,’ Luigi replied.
And then Philippa’s worst nightmare happened – something unimaginable at the time.
Bed D exploded into a galaxy of thundering alarms as every single bleep in the cubicle resounded in synchrony.
‘What. On. Earth?’ Gemma exclaimed.
Philippa Haven felt vertiginous, as if she was standing on a rubber dinghy at the mercy of the Atlantic. She was rocking wildly but this was going to capsize her.
She had been outsmarted yet again…
The killer was as usual, one step ahead.
There was a second’s silence but what followed was the roaring announcement: ‘Cardiac arrest, outside, by the east wall of the hospital!’
‘You have got to be kidding me,’ Gemma groaned. Even the SNP, who seemed to have endless stamina until now, was tiring from the marathon shift.
Five-to-five…
Still three hours to go before the day teams would arrive to begin shift.
Justin grabbed Philippa’s attention, bearing down on her with elliptical eyes and gelled curtains. ‘Are you going to suspect I’m behind this too?’ he growled.
Did the first-year doctor possess a black hoodie?
‘It’s okay, it’s fine,’ Luigi assured the team, raising a tranquil hand to roll up his already short-sleeved scrubs. ‘Philippa, what would you like us to do?’
The medical registrar pursed her lips and stared in disbelief at the other members of her team. The silence was painful and every precious second lingered tauntingly in mid-air, inches from her nose. She scratched her head and tried to focus her mind, jotting a mental list of the personnel she had at her disposal.
Shinji was not the test.
The real test was outside, but her situation called for the detective more than ever.
There had been another riddle, now sitting inside her dress pocket, a teasing reminder of how badly she needed his help. And he had discovered something. He had wanted to tell her something. What was it?
Two deteriorating patients, not enough hands.
She closed her eyes and let the light from above wash over her. She had to keep Justin under her watchful eye. It made sense for Effy to stay here too; Shinji was her patient, after all.
Julia, what would you do…?
Her thoughts flashed back to a time shortly after her father’s death.
‘Go upstairs and clean the bathroom like I told you!’ shouted their foster mother. Her name was Mrs Carmine and she was a fierce, butch lady with a face full of pimple scars. Mr Carmine was an Italian businessman. He treated them nicer. He just wasn’t around much.
‘But –’
‘No buts, you know the score. I’ve shown you how to do it once, you should be able to do it now.’
The two little girls did as they were told.
Philippa, in tears, ran to her room disobediently and tried to slam the door.
‘And if it’s not done when I come up in an hour’s time, there will be trouble,’ Mrs Carmine shouted after them.
Julia, almost reading her sister’s actions managed to stop the door with her hands. ‘Ouch!’ she whispered, before shutting it carefully. ‘Pips, we can’t slam the doors remember or we’ll get in trouble.’
‘I don’t care anymore. I just want to go home! It’s my birthday and we haven’t had any cake.’
Julia cuddled her tightly. ‘It’s just this one birthday, trust me. We won’t get cake just this one birthday okay?’
‘Diego doesn’t have to do chores!’
‘That’s because we’re Mrs Carmine’s fake children remember? Diego is the real one.’
‘I wish Daddy was here,’ Philippa cried, burying her face in Julia’s shoulder. Back then, Julia had silky hair that was both longer and darker than her own.
‘Me too, Pips.’
‘Why can’t we go home?’
‘Because no one will be there to look after us. Mum’s in hospital, her mind isn’t well. Look, next year, we’ll get two cakes on your birthday. I promise.’
‘Really?’
‘Really.’
Julia’s promise yielded contentment, though it was only temporary. ‘Why couldn’t Mummy be strong for us? Why did we have to be sent away?’
‘Pips, you’ll learn that you can’t rely on other people, not even Mum. The only person you can rely on and believe in, is yourself.’
But that wasn’t true. Sure, her mother’s six-month abandonment was unerasable from her life’s history and it would always remain a thorn in their slightly strained relationship, but there was somebody else she had always been able to depend on. Someone else who had been there for her when she needed it, in her teens, through university, in that horrible period under foster care… Julia.
That was the answer.
It was about who else she could trust.
Philippa opened her eyes and looked at her SHO. ‘Karan… go and lead it.’
Every few days... 