Chapter Twenty-Eight

‘Me?’ he stammered disbelievingly.

Philippa nodded. ‘Go and lead this arrest. I will stay here and try to stabilise Shinji. I’ll join up with you later, Karan.’

‘Are you comfortable with that?’

‘Are you?’

‘I’m happy to; I just want to make sure you are.’

‘I have full faith in you. Gemma, Luigi, can you both support him?’

‘I’ll try and grab any nurses in A&E who might be able to help on the way,’ Gemma said.

‘What’s the quickest route?’ asked Luigi.

‘Down the fire-exit by the mortuary,’ Gemma replied. ‘Let’s go team.’

The fire-exit, where the hooded figure had haunted her… stay calm, just try and stay calm…

The trio ran out of the cubicle.

‘Mr Porter, could you get the trolley outside to the second call please,’ Philippa heard Gemma instruct.

Had the porter really taken that long to get here?

‘Justin and Effy, you stay here with me,’ Philippa instructed. She watched as the three delegated members of her team jogged away from the Chartwell Unit to probe the latest cardiac arrest call.

The blood pressure cuff creaked as it gradually crushed Shinji’s arm and then, when it had achieved its purpose it loosened its bite.

‘Eighty-eight over forty,’ Effy said.

‘Can we get another five hundred millilitres of fluid into him?’

‘Saline? Hartmann’s?’

‘Whatever you’ve got.’

‘Shall I send some bloods?’ Justin asked.

Philippa hesitated and found it burdensome to look the first-year doctor in the eye. ‘Yes, that would be helpful, Justin.’

He disappeared to collect some equipment leaving Philippa to reflect.

If Effy’s description of the most recent events was accurate then Justin had played no part in Shinji’s deterioration, and he was with her when the second cardiac arrest call came through.

Shinji had not been the test; he was just a part of the norm for a hospital night shift; people were sick and many simply became more unwell but if Shinji wasn’t the test, who was?

The sound of the fire alarms echoed down the corridor to the unit, signalling the team’s exodus from the hospital building.

The detective’s fit had resolved but he remained unconscious enough to allow the airway tube to remain firmly lodged in his mouth to support his breathing.

Justin returned and wrapped a tourniquet tightly around the patient’s arm. With a graceful fluency, he drew blood.

‘I’ll send them,’ Effy said taking the samples and heading out of the cubicle.

What happened to you Shinji? Without you, I have no chance of stopping the killer… I need you to come round from this…

‘Is there anything else I can do?’ asked the first-year doctor.

‘Justin, earlier I spotted you in the cemetery, walking toward the portacabins. What –’

‘Why does… oh I get it: you think I had something to do with what happened to Rob, don’t you?’

‘I just need to know, what were you doing in the cemetery?’

‘Rob was more a friend and a mentor to me, than a colleague. Do you think I’d be malicious enough to commit murder, after spending the last six years of my life studying and graduating from medical school?’

‘I’m not suggesting that… you might have seen someone acting suspiciously around the time?’

‘I didn’t see anything. I was in the cemetery because my Nan died in this hospital several years ago. I can walk you to her grave if you don’t believe me.’

Philippa felt a huge weight fall onto her chest. ‘I’m sorry to hear that. And I’m sorry if you felt accused. It’s been one of those shifts…’

‘All done,’ Effy replied when she rebounded to the bedside. She was looking much more relaxed now though she still carried a wreath of sweat.

‘Can you book a CT scan?’ Philippa asked.

‘Yeah, I’ll escort him too,’ said Justin.

‘One-hundred-and-fifteen over seventy-five,’ Effy read off the portable screen.

‘I’m happy with that blood pressure. Let’s keep him on the oxygen and fluids and get him to the scanner urgently. I should find out what’s happening at the cardiac arrest. Any problems, call me right away.’

‘Will do,’ replied Effy.

‘And Justin… thanks for your help.’

The junior doctor did not acknowledge her.

‘I’ll be back when I’m done, Effy.’

‘Sure.’

The fire alarms had been reset and the exit kept wide open.

There had been an oversight on both her and Shinji’s part. Justin was present throughout Jonathan Wickshaw’s cardiac arrest. The culprit, who had been hiding under the covers of Surgical Four, Bed Fourteen therefore could not have been him. Unless he was not the sole participant in the events tonight.

‘Looks like we found him then,’ Wes, the security guard said to Philippa the moment she arrived on the scene.

A gust of wind washed over her, causing her to shiver. Her nose was filled with the scent of musky, damp grass.

‘This shift keeps getting worse…’ cried Gemma.

‘Did you put the call out?’ Philippa asked Wes.

‘Yes. My colleague told me to come; he got a call that someone was lying here motionless.’

‘From who?’

Wes shrugged. ‘Don’t know; you’d have to ask him who tipped him off. Is there anything I can do to help?’

‘I don’t think so, not yet.’

‘Two minutes!’ Gemma told the team.

‘Pulse-check,’ Karan responded.

‘Nothing,’ said a nurse Philippa had not seen before.

‘You managed to get help,’ Philippa said motioning with her head to the nurse.

‘From A&E – as we ran through the department. Manuel’s his name.’

Philippa battled the urge to say: ‘Back on the chest,’ but she was not leading this arrest and respectfully bit her tongue.

Karan however, who had taken her place, said the words right out of her mouth. ‘How are we doing with compressions?’ he added.

‘Fine for now,’ Manuel reported back.

‘Asystole, no shock.’

Even her heightened anxiety could not protect Philippa from the freezing outdoors.

Eric Pails was the centre of the frenzy with his hospital trousers pulled down to his knees and his wife-beater snipped off his torso. His limbs splayed in all four directions and his eyelids were partially drawn to reveal bloodshot conjunctiva.

It was dark outside. The rainclouds were intimidating. Perhaps the winter sun was behind them, beginning to rise at dawn, just completely shrouded. The halogen haziness nearby provided a miserly glimmer of light to discriminate Eric’s bountiful tattoos albeit with minimal detail.

The sweeping rainfall made it difficult for Philippa to focus and the muggy air lingered in her mouth with every breath she inhaled.

The team tried hard using blankets to avoid getting the defibrillator pads wet, holding them up as if they were playing ghosts in the night. In some ways, it was fortunate the pads were not required currently.

‘Luigi, are you happy with the airway?’ asked Karan.

‘I’m happy,’ Luigi reported manning the patient at the head. The oxygen canister whizzed as it was cranked up to maximum.

Luigi was a good representative of what most consultants were like nowadays – supportive and approachable. Dr Steer just happened to be an old-school anomaly.

‘Let’s get some more adrenaline into him. Gemma, watch out!’ Karan warned as the SNP almost trod on a used needle, one which pointed precariously to the sky.

‘Well clearly he’s been out here injecting,’ the SNP mumbled. But how long had Eric been here? Surely the security guards should have combed these grounds at some point?

‘What did you see when you got here, Karan?’ Philippa enquired, now that she unusually had time to think.

‘Unsure of downtime but no output on arrival; we’ve had four cycles of CPR, all asystole. Gemma’s tried getting access but we haven’t been able to yet; not enough hands. We haven’t even got a blood gas…’

‘Intravenous drug user… his veins are fried,’ Gemma added.

‘Time for the IO, Karan?’ asked Philippa.

‘I suppose. Have we got one?’

Philippa ran to the cardiac arrest trolley where Wes and the porter were conversing. She shielded her eyes from the turbulent rainfall. She cranked open one of the drawers and grabbed a small toolbox. Inside was a drill set with two heads of varying size. She selected the larger one and attached it to the front then tested the battery. The drill whirred as the head spun viciously.

She grabbed some gloves and knelt down by Eric Pails’ legs, being careful not to get too close to any of the contaminated needles discarded around the body.

The sound of drums interrupted her flowing thoughts.

Drums?

She turned towards the percussion and in the distance spied a member of domestics emptying cardboard boxes into a large black receptacle before shuffling brighter orange toxic-waste bins like a magician performing a ball-in-a-cup trick.

Heroin user – maybe he overdosed? ‘Have we checked his pupils?’ Philippa fired, training her thoughts once more.

‘Already done,’ replied Luigi assuredly. ‘They aren’t pinpoint.’

‘How long do I have for the IO?’

‘Seventy-five seconds,’ Gemma replied.

She had only done this once before.

Philippa felt her knee sink uncomfortably into the wet mud. She exposed Eric’s stick-thin lower leg. It was ravaged by weeping infected ulcers. She felt for a plateau in his shin-bone then began drilling, making sure she kept her mouth tightly shut and eyelids poised. The last thing she needed was for specks of this patient’s blood to fly into her face.

There was always more resistance at first but once the uppermost surface was broken through, the rest of the head went in easily. She disconnected the drill and attached the connector in its place.

‘I’m in. Let’s get some fluids running.’

‘I have some saline,’ Gemma said rummaging through the trolley.

‘That’ll do.’

‘Do you want to take over?’ Karan offered his senior.

Philippa hesitated then said, ‘No, I think you’re doing a great job. Carry on. I’ll try and get some bloods.’ Think Philippa, what was the clue? How did the killer do this to Eric Pails?

The oxygen tap, left on at Jonathan Wickshaw’s bedside signalled the killer’s intent to starve Mary Surrey of the vital gas. Then the chemical symbol for strychnine on the whiteboard inside Mary’s room pointed to the use of the poison in murdering Rob Gadra. What was present at the scene of Rob’s death, that directed her to the method of murder?

Philippa closed her eyes. She felt dizzy from the toxic combination of mental fatigue, physical exhaustion and adrenaline waves. Portacabin three… the mind-numbing bright lights on the ceiling, the stained green sofa, the rough carpet, the walls of expiring white paint with posters that had been stuck upon them in amateur fashion – posters that were important to the living body: pain relief, circulation and blood glucose…

Her knee was sinking very slowly, deeper and deeper into the mud in line with her efforts, as Eric Pails’ soul fell further away from her desperate grasp.

‘Two minutes!’ Gemma yelled.

Her call lassoed Philippa back into action. The intraosseous line she had inserted did not bleed back well. She grabbed a needle and syringe and palpated Eric’s groin for anything that pulsed.

‘Can someone swap?’ Manuel asked blowing hot air as he tried to catch his breath.

‘I’ll take over but you’ll need to keep timing for me,’ said the SNP.

Philippa’s fingers were already in the right place. ‘Nothing,’ she said.

‘Back on the chest,’ she heard Karan instruct. ‘Asystole again: no shock.’

Gemma and the nurse exchanged roles whilst Philippa Haven continued to feel for a pulse now that CPR had been restarted.

Her vision was starting to blur from fatigue. The occasional taste of rain was tantalising. Syringes polluted the area; some were empty whilst others contained differing amounts of clear fluid.

And then in the corner of her eye, Philippa noticed something odd. At first sight, it appeared to be a pen lying harmlessly beside the lifeless body, something easily mistakable for a blue fountain, with a distinct peach label. But to her, it stuck out like an albino bird within its flock.

Philippa Haven stopped to focus on it.

Her mind took her back to portacabin three. The poster with markings scribbled over it; that had not been from a teaching session. No, the killer had circled the damn thing, making it obvious how the next victim would be killed. It made complete sense.

‘Philippa? Are you alright?’ Karan asked.

She blinked and wiped her forehead in vain with her forearm. Her needle remained prepped, ready to fish for blood. But she was frozen in anticipation, belief that she was correct for the first time in her battle against this vile killer.

‘Philippa?’ Karan asked again. ‘Are you with me?’

She heard Gemma’s panting just a few centimetres away as she pummelled the patient’s chest with compression after compression, harmonising with the timely deflations of the oxygen bag as the anaesthetic consultant squeezed air directly into the patient’s lungs.

‘Adrenaline, let’s give some more adrenaline,’ Philippa said suddenly.

‘It’s not time yet – the next cycle,’ Karan reminded her.

‘It’s okay. Let’s give some more adrenaline now.  And Manuel, switch these fluids for some glucose.’

The nurse didn’t question her decision.

It was time to pass this test.