Philippa drew blood at the first time of asking and handed the porter the sample to run. She needed these results more than ever.
‘Two minutes!’ Manuel said. He had a fresh Spanish accent.
Gemma took a breather as Philippa pressed for a pulse. ‘Still no pulse.’
‘Any more adrenaline, Philippa?’ Karan asked with a quizzical gaze.
‘Not for the time being,’ the medical registrar replied, getting up to her feet. Her knee clicked and she shuddered as the deluge hammered down onto her, creating a brisk current in between her shoulders and dress.
‘Wait!’ Karan yelled suddenly, ‘We’ve got VF.’
The yellow line on the screen had changed.
It was time to activate the defibrillator.
The SHO graciously punched the buttons on the machine.
It charged into action.
‘Preparing to shock,’ he warned the team.
Manuel got as close to the body as permissible and used the soaked blanket as an impromptu shield for the torso.
‘Everyone away,’ Karan shouted.
Luigi disconnected the oxygen and backed off with both hands visible in the air.
The force of the electrical pads took hold of Eric Pails’ body and threw it into the air like a stuffed toy but he landed hard on the soil with the power of a hammerhead.
‘Manuel, can we swap after the next cycle?’ Gemma pleaded, immediately exercising her arms once more. Her voice sounded hoarse and her lips were arid.
‘Sure,’ he replied flexing his arms and braving the harsh winds by rolling up his light blue sleeves further.
Philippa’s bleep went off and she fought off a strong urge to smash the pager against the wall close by. She rushed instead to the trolley and purposefully browsed the drawers like a burglar in the middle of a raid.
There was an orange medical kit the size of a school lunchbox hidden away in one of the drawers.
She sensed Karan bedazzled with intrigue like a willing apprentice but she had nothing to lose. The medical registrar cracked open a loaded syringe and attached a needle. Then she hurried back to the patient’s side, pinched his thigh and injected the contents without further ado.
‘Can we get that glucose in any quicker?’ she asked.
Manuel strode forwards to squeeze the bag with his bare hands.
‘I can do that,’ Wes said helpfully. Perhaps he had become bored from watching. The bulky security guard raised a sturdy hand and crushed the bag of fluid with an almost ostentatious ease.
‘Karan, what are you thinking?’
He seemed astounded to be asked by his senior. He poked his tongue out in concentration and budged his rain-splashed glasses up his nose. ‘This is cycle six now. We’ve had five cycles with asystole and the last one with a shockable rhythm. He’s young, would be a candidate for intensive care – I don’t see why we shouldn’t carry on…’ Karan was demonstrating a structured approach to the situation.
Luigi nodded, unable to fault him.
‘I say we give it two more cycles. If we don’t get him back, we call it quits.’
Philippa sensed her junior’s approval-seeking gaze fall upon her but she was too immersed in her own thoughts to endorse his opinion.
There must be other clues, even out here in the cold…
Philippa realised she had gambled all-in on her suspicions and it was now a matter of waiting to see if she was right. Those blood results had better come back soon.
‘Ten seconds,’ Manuel said, ‘nine… eight…’
Philippa closed her eyes.
Not since the devastating phone call informing her that Julia’s flight from Mataware had disappeared off the radar, had Philippa prayed so hard. Droplets of rain slid off the tip of her hair and abseiled down both cheeks.
‘Four… three…’
Please work, begged Philippa.
‘Ready to swap Manuel?’ Gemma asked, though with her level of burnout, she was in no position to accept a negative response.
‘Ready,’ he replied. ‘Two minutes!’
Philippa felt for a pulse.
There was something! The faintest of flutters, like the wings of a hummingbird beneath her gloved fingers.
‘I’ve got a pulse!’
‘Compatible rhythm on the defib,’ Karan added, startled.
Gemma felt the opposite groin to confirm Philippa’s findings.
They both looked at each other and said: ‘He’s ROSC’d!’
Return of Spontaneous Circulation or ROSC as it was better known in the profession was the desired outcome of any cardiac arrest call; when the heart’s muscular wall had awoken and decided to contract in response to the inbuilt electrical mechanisms once again. It just didn’t happen as much as people hoped.
Eric Pails was now alive in the most pedantic of levels but he was likely to remain unconscious for some time, have a significant stay in the Intensive Care Unit with tubes in and out of each orifice and if he eventually survived all of that, chances were he will have suffered severe brain damage from an event so destructive.
Perhaps such an outcome would be a blessing in disguise given it was unlikely he would retain the cognitive ability to keep injecting drugs. That was the reality of a cardiac arrest call. But a life saved was still a life saved and as long as his heart continued to beat, Philippa presumed she had passed the test. The burning question therefore was: what now?
She made subtle glances around the area. What were the clues for the next test? How was the final victim going to be murdered? And where was the item which belonged to a young female?
‘Heart rate is now ninety-six,’ Karan said, vying for her attention.
‘Manuel, I need you to run back to A&E and return ASAP with an obs machine and an ECG machine,’ Gemma advised.
‘No need,’ Luigi said. ‘We have a bed. We stabilise him now and get him to the unit as quickly as possible.’
The porter appeared from around the corner, jogging towards them. ‘Blood results, sorry there was a queue to use the machine,’ he said, handing the paper strip, to Philippa.
She declined and gestured for the porter to give it to Karan instead.
Karan held the strip taut with both hands to stop it flapping in the breeze. ‘Okay, blood gas here. Everybody: listen up!’ he said. He reeled off the results one by one and then: ‘Glucose 1.2…’
Philippa sighed with relief. She was correct.
‘But Philippa, how did you know…?’
The medical registrar pointed to the culprit device, lying guilty and tangled amongst the weeds. ‘Most of the needles here belong to standard syringes but that is an insulin-pen.’
‘Hence the dextrose and glucagon injection… and you would know, as the diabetes specialist,’ Karan acknowledged.
Luigi saluted Philippa’s problem-solving skills. ‘How did this patient get hold of an insulin syringe, I wonder?’
No one could answer his question except for Philippa who dared not to. The killer must have supplied it to him and convinced the patient it was some other drug…
It was twenty-past-five.
She noticed a missed call from Justin. Had he tried to bleep her first?
‘You haven’t got an Android charger by any chance? I’ve left mine at home,’ she asked the team.
They all apologised for not being able to help.
She had little choice and returned the missed call.
‘Hi Philippa.’
‘Justin, all okay?’
‘Are you still at the cardiac arrest?’
‘Yes, but he’s ROSC’d and will go to ICU soon.’
‘Is now a good time?’ He sounded concerned.
‘Sure, go ahead but you’ll have to make it quick; I only have eight percent battery left.’
‘It’s about the CT scan for Mr Nyarko? It doesn’t look good.’
It was as if she had driven into the brick wall, metres away from her. One problem after another…
‘I’ll be on the Chartwell Unit soon.’ Philippa hung up.
Now that Eric Pails had ROSC’d, it was time for Luigi to take charge. From experience, stabilisation often took a while; one wrong move and the patient’s heart could arrest again.
She would have to return to search for clues later. Right now, she had to check on Shinji Nyarko.
‘Luigi, I must return to that patient on Chartwell. Can I leave you to get Eric stable enough to go to ICU?’
‘Of course. Go now, I’m fine here.’
‘Karan, can I trust you to document what happened in his notes?’
The SHO nodded.
‘Great job with leading the cardiac arrest, by the way.’
‘Thanks.’
The medical registrar dabbled down the gentle slope onto a tiled path that led back to the exit of the hospital. She was wet with sweat and precipitation. The mud had seeped through her nylons and she made a detour to the ladies to discard them.
She turned on the taps and rinsed her legs then showered her face with tepid water. It was refreshing. She steadied herself with a hand on the mirror and stared hard at her green eyes in the reflection.
With every night shift that Philippa survived in her career, she would feel her body advance a few years and her furrows widen. She was a mess; her make-up, half down the sink, left her persistent acne much to be admired and her hair became frizzier as it dried under the influence of the stop-start hand dryer.
Her bleep consolidated her hatred for being the medical registrar on-call; even a toilet break in peace was too much to ask for, but this was sadly a rite of passage to becoming the consultant at the top of the food chain. This, had however, been the worst possible start to her year at the Princess Royal Hospital.
Focus Philippa. In less than three hours, Alfred will arrive to retrieve the bleep from me… but then I’ll be back in tonight. If the killer isn’t stopped tonight, what does that mean?
She had been correct; the killer had attempted to murder Eric Pails with an insulin syringe but there was only time for one more test before the end of the shift. How was the killer planning to kill the last victim? Who would be the target?
When the hand reaches seven,
Will it be Hell or Heaven,
This rhyme serves to assist you…
The first line was simple enough, but it confirmed Philippa’s worst nightmare. Passing the test did not mean her ordeal would end. The way the killer ended the riddle with: Lots of love… however, made Philippa’s skin crawl.
She mustered the strength to leave the bathroom and return to the Chartwell Unit, to find out what Justin had been meaning to tell her.
The first-year doctor was not present but the door to Bed D remained open for all to see. Shinji Nyarko was lying in the bed, his head turned away just as it had been when they first met.
The blood bag was nearly empty. Sitting next to the detective was a Japanese lady, sporting ragged extensions and an oversized tracksuit.
Philippa suddenly felt very cold. She took up a lone seat by the nurse’s station and logged onto the computer to review the scan herself. The images of Shinji’s head fluctuated along the screen. She slowed them down and replayed the pictures, this time using the scroll-wheel.
She was by no means a radiologist but the gravity of the changes meant that even she could easily identify the problem.
The tumour had quite obviously originated in the right half of his brain, where a grey golf ball had invaded the organ with a sickening nonchalance. That was the known and expected. The new finding however, was blood. The tumour had bled and badly so, leaving a glowing white moat. His ventricles, usually depicted on head scans as two kidney beans lying back-to-back, were squished from the pressure of the blood.
There was an attached report which confirmed what Philippa saw, with an addendum in capital letters – that the results had been relayed urgently to Dr Justin Hills.
The first-year doctor had written an entry in the notes. He was blessed with neat handwriting – immaculate in fact.
The neurosurgeons over at the specialist hospital in central London had already assessed the images. It was a foregone conclusion that they were not interested in operating on anyone over the age of eighteen; a previous colleague had once coined the phrase: “neurosurgery means no surgery”, but in Shinji Nyarko’s case, there simply was no heroic procedure in the entire arsenal that had the power to reverse what had happened to his brain.
Philippa Haven cursed her luck.
She buried her face in her hands.
Shinji Nyarko was not coming back from this.
Every few days... 