by Ken McClure
Sandy stood up and shook Turner’s hand. ‘We really appreciate this,’ he said.
‘Let’s hope something works out,’ said Turner.
Turner left and Sandy waited for Kate to finish her tea. She was taking her time, trying to compose herself. She didn’t want Amanda to see that she had been crying. ‘What do you think?’ she asked as she put away her handkerchief and smoothed her hair back.
Sandy gave a long sigh as if suddenly releasing the tension he had been under. It was as if Kate’s question had acted as a relief valve. ‘I don’t know what to think,’ he confessed. ‘I feel numb. Everything seems to be happening at such a rate that I can’t keep up. I keep wanting to yell out, “Stop! Just a minute! Let’s all sit down and talk things over. This wasn’t meant to happen to my family. There’s been some kind of terrible mistake. It’s not really our daughter who’s supposed to have this thing.” But it is happening and time’s ticking away. I’m scared.’ He looked Kate in the eye.
She swallowed, before reaching across the table and taking his hand. ‘So am I,’ she whispered.
Sandy shook his head and said, ‘You know, I can’t believe it. I’m reduced to sitting here praying that some private hospital is going to take my daughter on as a charity case. Me! Ex-treasurer of the university Labour Club, veteran of a hundred campaigns to defend and support the NHS. Jesus! What a fake.’
‘You’re just a father trying to do his best for his daughter,’ said Kate softly. ‘There’s no shame in that.’
Sandy shrugged, not convinced. ‘Let’s go see her,’ he said.
They both broke into broad smiles as they walked into the room where Amanda lay, but the smiles were window-dressing to hide their worry. Amanda looked very ill. She had the distant look in her eyes that Kate had first seen on the day she fell ill. Her skin was pale, and she seemed slow and feeble in her movements. ‘I want to go home, Mummy,’ she said as Kate gave her a cuddle.
‘I know you do, darling, but you’re not well enough yet,’ crooned Kate. ‘But it won’t be long. All the boys and girls in the class send their love. They’ve sent you this card and look, they’ve all signed it.’
Amanda looked but her distant expression didn’t change.
‘Dr Turner says you’ve been a very brave girl,’ said Sandy but he was inwardly appalled at how weak Amanda appeared. There was hardly a flicker of spirit about her, despite the fact she had been dialysed that very morning. He tried not to think about it but logic insisted that he recognize that the chances of a suitable donor organ coming up in time must be remote.
Turner reappeared and ushered them out into the corridor to say, ‘I managed to see Dr Grayson and he has no objections to a formal request being made to Medic Ecosse. He’s left it up to me to take care of the paperwork so I’ll get on to it right away.’
‘We’re very grateful,’ said Kate. This was echoed by Sandy.
‘In the meantime, the lab people are ready for you, Nurse here will take you down.’
‘Do you really think she’s going to come through this?’ asked Kate as they drove home. ‘Honestly?’ Her voice had taken on a flat quality that Sandy hadn’t heard before. It unnerved him a little. He and Kate were finding out a lot about each other that they hadn’t known before the crisis. Sometimes he felt it was like being with a stranger. He knew false optimism wasn’t an option, even if he could have managed it; and that was in some doubt. ‘I honestly don’t know,’ he said quietly. ‘But if there’s a God up there, and he listens to hopes and prayers and knows just how much we both love her, then she’ll pull through.’
Kate squeezed his arm and said, ‘You know, I’m finding it difficult to know exactly what to hope for. I don’t think we can count on a miracle that will make Amanda’s own kidneys better, and Grayson and Turner were less than optimistic about either of us proving a suitable donor, so where does that leave us? Hoping that some other child with the same tissue type will die soon? Are we really hoping for a fatal accident to happen to someone else’s child?’ She broke down as she said it and searched for her handkerchief. ‘I’m sorry,’ she said.
‘I think in the first instance we should be hoping that Medic Ecosse says yes and agrees to take her on as a patient,’ said Sandy. He wanted to put his arms round her but had to concentrate on his driving. ‘If they really have better dialysis equipment, as Turner says they have, Amanda should start to look and feel better very quickly. That in turn would help us to feel better. As for the kidneys, let’s leave all that up to fate and the doctors. What do you say?’
Kate nodded and blew her nose.
Back at the Children’s Hospital in Glasgow, Clive Turner was filling in the paperwork required by Medic Ecosse for patient referral with fee waiver. He was using Amanda’s case notes as a source of information. The further he got into it, the less likely he felt it was that Amanda would be accepted as a patient. He should have thought of that before he said anything to the Chapmans. You didn’t need a medical degree to see that Amanda was a bad risk publicity-wise, and he could sense from the questions that this was what the free-referral scheme was all about. Medic Ecosse needed some good publicity after all the bad stuff it had received from a local press keen to expose it as a facility for the rich, with all the emotional fall-out that that entailed. People were quite happy to embrace the notion of hotels for the rich, cars for the rich and a host of other things that went with having money, but when it came to health care some special egalitarian principle surfaced. Woe betide the politician who didn’t — outwardly at least — bend the knee before that particular totem.
Common sense said that Medic Ecosse would be looking for patients they could mend or cure quickly and send on their way, preferably with press cameras waiting outside as they left the premises on the arms of delighted relatives. Prejudice against the hospital could be fought with proof of expertise. People respected learning and ability. But, as far as Turner could see, there was nothing to be gained in taking on risky cases who might die. That sort of concern was best left to Mother Teresa.
He became more and more despondent as he thought it through, especially when he realized that this was why Grayson had agreed so readily to his suggestion that they try for a referral. Grayson didn’t want a failure on his books either. He wished he’d never mentioned this to the Chapmans. He had unwittingly raised their hopes and now feared that they would soon be dashed. He wondered if a direct personal approach might help. Maybe talking to someone at Medic Ecosse would be better than just submitting an application form. Concluding that it could do no real harm to try, he picked up the phone and called the Medic Ecosse Hospital. The lines were all engaged.
Turner sat with his finger on the phone rest, watching the raindrops run down the duty-room window for a couple of minutes before hitting the re-dial button. This time it rang.
‘I’d like to speak to someone about your new NHS patient free-referral scheme.’
He was put on hold. He continued watching the raindrops chase each other down the window-pane, to the strains of Mozart’s Eine kleine Nachtmusik.
The music was interrupted and another female voice came on the line. Turner repeated his request for information.
‘I can send you out a form, Doctor. You just fill it in, giving the patient’s details and why you think a referral would be of benefit, and send it back for consideration by the relevant office.’
‘I already have the form,’ said Turner. ‘I guess I want to speak to someone in the relevant office about my patient.’
‘One moment, please.’
More raindrops. More Mozart. Outside in the corridor a child was crying as its mother scolded it over some misdemeanour.
‘This is Leo Giordano, administrative secretary of Medic Ecosse. How can I help you?’
Turner explained about Amanda and wondered about her chances of admission to Medic Ecosse.
‘We don’t usually take on transplant patients for free,’ said Giordano. ‘For obvious reasons. We’re talking
big bucks here.’
‘Does that mean never?’
‘No,’ replied Giordano hesitantly. ‘I wouldn’t say never but, frankly, transplants are awfully expensive and our hospital is not in the best financial position it’s ever been in. You may have heard.’
‘I was rather afraid you were going to say something like that,’ said Turner. ‘But really our main problem with Amanda at the moment is that she’s not responding well to dialysis. The machines you have up there are much more efficient than ours. Putting her on one of those might give her the extra time she needs while she waits for a donor match.’
‘I see,’ said Giordano. ‘I take it she has no brothers or sisters?’
‘She’s an only child,’ replied Turner. ‘We’re checking her parents’ tissue types, but of course the chances aren’t good.’
‘So we’re talking about a kid who might not make it any other way?’
‘Yes.’
‘There’s a very real chance that she might not make it here either,’ said Giordano.
‘Of course. Look, Mr Giordano, let’s level with each other,’ he said. ‘It doesn’t make any political or commercial sense for you to say yes to Amanda. I’m asking you purely on humanitarian grounds. She’s a lovely kid with a couple of real nice people for parents. I’d like to see them all get a break simply because they deserve it.’
‘I appreciate that,’ said Giordano, ‘and thanks for being honest with me. But the final say is not up to me. In this instance we’d have to put the request to our medical director, Dr Kinscherf, and, of course, to Dr James Ross, who’s in charge of the transplant unit.’
‘Would you at least do that?’ asked Turner.
‘Sure,’ agreed Giordano. ‘If it were up to me I think I’d say yes right now. I think it’s good if the local hospitals can help each other out. The trouble is that if we at Medic Ecosse so much as ask for the loan of a pint of blood it hits the headlines as the scandal of NHS blood subsidizing the rich. You know how it goes.’
‘Yup, I know.’
‘In the meantime, why don’t you send over the paperwork anyway? It’s as well to be prepared.’
‘Thanks. I’m grateful.’
‘Think nothing of it. Hope it works out for you and the kid.’
Turner put down the phone and tapped his pen end over end on his desk. He’d done his best; he just wasn’t convinced it was going to be good enough. He finished filling in the form and signed it. Grayson as head of unit would have to sign it too before it could be submitted. He looked at his watch. Grayson would have left by now. He’d get him to do it in the morning. He was about to put away Amanda’s case notes when the lab form listing her tissue type caught his eye. He moved over to an adjacent desk with a computer terminal on it and logged on to the International Donor Register. He had checked availability that morning but there would be no harm in checking again as he had the details in front of him. He entered Amanda’s details then requested a search for a match.
DEGREE OF HOMOLOGY? requested the computer.
80 PER CENT, entered Turner.
NEGATIVE.
Turner punched in, 70 PER CENT. NEGATIVE.
Turner logged off. Maybe tomorrow. ‘Tomorrow and tomorrow and tomorrow,’ he murmured as he left the room and returned to the ward.
Sandy looked at his watch and whispered an expletive. The traffic had been heavy on the way back and road works on the dual carriageway had reduced a five-mile section to single-carriageway with no overtaking.
‘Are you going to have time for something to eat before you start work?’ asked Kate.
‘’Fraid not,’ he replied. ‘I’ll just drop you at home and then get on up there. I’ll have something later when I get home.’
‘I’m sure Charlie won’t mind if you’re half an hour late,’ said Kate.
‘Normally no,’ agreed Sandy. ‘But it’s one of his kids’ birthday today. I said I’d be on time.’
Sandy dropped Kate at the foot of the hill leading up to their cottage, at her suggestion, and drove on up to the district hospital. He was only five minutes late.
FOUR
It was Sunday evening. Steven Dunbar took the airport bus from Glasgow Airport into the centre of the city. Outside it was dark and it was raining. That and the general gloominess of the dark Victorian buildings — made to seem even blacker by the rain water — did nothing to inspire good feelings in him. He was due to begin his attachment to the Medic Ecosse Hospital on the following morning.
It was something he certainly wouldn’t have bet on when he’d heard the Scottish Office contingent refuse to modify in any way their demand for swingeing cuts to James Ross’s research budget. Their intransigence had come as a complete surprise to almost everyone at the meeting. In retrospect it had been embarrassing that the Scottish Office had not seen fit even to make a token gesture in the interests of making the negotiations seem genuine. The feelings and work of an eminent surgeon had been of no importance at all.
Dunbar had fully expected Ross to tender his resignation and, in doing so, set off a train of events that would have led to the closure of the hospital and a backfire of the whole gamble, but it hadn’t happened that way. Instead, and to everyone’s surprise, Ross had acceded to the Scottish Office demands, taking it philosophically and saying simply that he understood the awkwardness of their position and the financial constraints they were operating under.
Dunbar supposed that some kind of behind-the-scenes deal between Ross and the Medic International group must have been done to retain Ross’s services and to avoid closure of the hospital, but there had been no official acknowledgement of this or of continuing research funding for Ross from an alternative source. Ross had simply stated that, as a doctor, he felt obliged to carry on with his work at Medic Ecosse. He had a waiting list of patients he felt responsible for and couldn’t let them down. It would be business as usual as far as the transplant unit was concerned.
It was clear that the Scottish Office people had pulled off a major triumph in the re-negotiation of terms of their involvement at Medic Ecosse. The look of surprise and relief on Bannon’s face when Ross had swallowed his pride and acceded to what he must have thought were impossible demands was only fleeting but Dunbar had seen it. Now it wouldn’t be known if he had ever intended to back off at the last moment. The injection of more public funds into the hospital would now be offset by the much more favourable terms of the agreement and by greater public access to the Medic Ecosse facilities. Even the Labour opposition at the meeting had been forced to concede that it was a good deal.
As part of the agreement there was, of course, his own secondment to Medic Ecosse as the government’s man on the ground, the overseer of public funds. His masters’ subterfuge had worked well. He was now in place to begin his investigation.
Sci-Med’s involvement had been precipitated by a complaint from a staff nurse who no longer worked at the hospital. She had maintained that there had been something improper about the treatment a transplant patient had received at Medic Ecosse some five months before. The young patient, Amy Teasdale, had died after rejecting the kidney she had been given during what was thought to be, at the time, a routine transplant operation. The staff nurse, one Lisa Fairfax, maintained that there had been a serious mix-up resulting in her patient being given the wrong organ. She was unable to be more specific, stating only that the sub sequent rejection had been so severe that no other explanation would suffice. In other circumstances her claims would almost certainly have been dealt with at local level but what had caught Sci-Med’s attention was the fact that a similar complaint had been lodged only months after the hospital opened, almost three years before and again by one of their nursing staff.
That time Sister Sheila Barnes had said much the same thing after a young boy in the transplant unit rejected the kidney he had been given. She had subsequently resigned in protest at what she saw as being ignored by the authorities, who had interviewed her but refused to take her cl
aims seriously or to mount an internal investigation. She had maintained at the time that the authorities were keen to dismiss her complaint because they feared the bad publicity would damage the new hospital. Sister Barnes had never retracted her claim. She had intended to press for further investigation, but shortly afterwards had contracted cancer and had had to abandon her campaign. She was now in the terminal stages of her disease, a resident at The Beeches, a hospice for the terminally ill down at Helensburgh on the Clyde coast. She and her allegations had been largely forgotten until Staff Nurse Fairfax made her own complaint and Sci-Med’s computer had drawn attention to the similarity as part of its collating programme.
All reports of allegations of wrongdoing in British hospitals were recorded, filed and collated on the Sci-Med computer, however trivial they might seem. Most of them were indeed trivial, usually disgruntled patients making unfounded accusations, or staff with grudges against their employers making equally spurious allegations. But occasionally the computer picked up something that might otherwise have been overlooked. This time it had noted the remarkable similarity between the two nurses’ allegations. Both women maintained that their patients had rejected their transplant because they had been given the wrong organ. Now one of these women was currently dying of cancer and the other, Staff Nurse Fairfax, had been dismissed from her post.
Dunbar checked into his hotel near the city centre and found it pleasantly anonymous. It was also warm, which was a bonus because he was feeling chilled. Scotland always seemed to be three or four degrees colder than the south of England, where he lived. He had noticed this again as soon as he had stepped off the plane. The raw dampness of early March made things worse. He threw his briefcase on to the bed and walked over to the window to look down at the traffic moving slowly below in the wet city streets, their lights reflecting in the puddles that were proliferating as the storm drains struggled to cope.
