Pestilence

by Ken McClure

  Saracen realised that this was the second time in as many weeks that he had lain awake in the early hours feeling troubled about things at the hospital. The first time had been after the affair at the mortuary when the explanation on offer had seemed too pat and convenient, just like now. Thoughts of that incident had been receding but now they surfaced to niggle at him again. He reached out for the lamp switch and abandoned all hope of sleep. Any remaining reluctance to get up was solely concerned with temperature. The flat did not have central heating and maintained at best an ambience between lukewarm and cold. At four thirty in the morning it was on the freezing side of cold.

  Saracen turned on the gas fire and squatted down in front of it for a few moments, trying to cram as large an area of body as possible into the path of the radiant heat before making for the kitchen to switch on the electric kettle. He lifted the kettle first to make sure it had enough water in it. It had not. He breathed a single expletive and padded over the cold lino in his bare feet to the sink. In his haste to get back to the fire he wrenched on the cold tap too hard and overdid it. The mains pressure at that hour in the morning ensured that he received an icy spray all over his bare chest. Single expletives were no longer sufficient, he launched into an adjectival soliloquy.

  As he sat nursing his coffee Saracen’s gaze fell on his text books arranged in neat rows in shelves by the fire. The group nearest to him were concerned with pathological technique. Their titles reminded him again of the horror of waking up on the post-mortem examination table. It made him think of how he had come to be there in the first place. He imagined his body being dragged across the courtyard and into the mortuary, his wrists scraping the stone floor, the coldness, the stillness, the sweet sickly smell and the forgotten fact that still eluded him, the connection between formaldehyde and ammonia. He withdrew a large tome on histology and looked up formaldehyde.

  Saracen found only what he already knew. Formaldehyde was a gas that could be dissolved up to a concentration of forty percent in water. A ten percent solution, known as formalin, was commonly used as a general fixative for the preservation of dead tissue. The book went on to list appropriate occasions for the use of formalin fixation in preference to others. Saracen closed it and put it back on the shelf. He lay back and idly scanned the other titles on the shelves. His eyes stopped at Cruikshank’s Medical Microbiology and he sat up sharply. That was it! Formaldehyde did have another use. Ninety-nine times out of a hundred it would be used as a tissue fixative but it could also be used to kill bacteria. It was a powerful disinfectant!

  Saracen thumbed quickly to the relevant section on sterilisation and methods of disinfection. He found what he was looking for. Paraformaldehyde tablets, when placed in a spirit lamp evaporator, gave off formaldehyde gas capable of disinfecting entire rooms. At the end of the process the toxic formaldehyde gas could be neutralised by throwing in rags soaked in…ammonia! He had found the connection. It made sense. He had been lying unconscious for many hours in a room next door to one that was being disinfected by formaldehyde gas.

  One question had been answered but a much bigger one had loomed up. Why had it been deemed necessary to disinfect the entire mortuary in the first place and why all the lies about thieves in the night? Could it be that the affair at the mortuary and the cover-up over Myra Archer’s death were in some way connected? The flood gates to Saracen’s imagination opened up. Just how did Myra Archer die?

  Skelmore General did not have a full time pathologist of its own. Post-mortems were carried out by a rota pathologist, one of two who covered the County Hospital as well as forensic work for the district. They were both based at an office in the County Hospital. Saracen phoned Dave Moss, his friend at the County to find out which one was on duty. It was an important consideration for one of the two was approachable while the other was a paranoid alcoholic who attempted to cover up his failing abilities with increasing pomposity. The latter would not take kindly to inquiries coming from someone of Saracen’s lowly status. He would almost certainly mention the matter to Garten.

  “Dave? It’s James Saracen.”

  “Saracen! If you are about to tell me that you are sending down a dozen patients knee deep in shit I’m going to put down the phone and pretend you never called.”

  “Nothing like that…Actually it’s three nuns with gonorrhoea.”

  When the banter had stopped Saracen asked who the duty pathologist was.

  “Hang on, I’ll look.” After a few moments Moss returned and said, “It’s Peter Clyde. What’s the problem?”

  “No problem. I just want to check up on something.”

  “Uh huh,” said Moss knowingly. “I see, it’s cover up your mistakes time. Say no more.”

  Saracen tried to laugh then asked, “Is he in the office this morning?”

  “I think so. I saw him about half an hour ago come to think of it. His extension is 431…But I suspect it says that in your directory too…”

  Saracen took the point Moss was making and said, “I’m sorry, I had to make sure it wasn’t Wylie today. The inquiry I have to make is rather delicate.”

  “I understand,” said Moss. “I keep hoping that Wylie will retire soon and save us the continued embarrassment of pretending that he’s not pissed out of his mind all the time.”

  “At least his patients are dead.”

  “Just as well,” said Moss. “A hamster with a hacksaw could have made a better job of the last PM I saw him do.”

  They made their usual assertions about having to get together for a drink and Saracen put down the phone. He lifted it again and dialled 431. Peter Clyde answered. After an initial exchange of pleasantries Saracen came to the point and asked about the Post-Mortem report on Myra Archer.

  “The name doesn’t mean much,” said Clyde. “Hang on a moment.”

  Saracen could hear the sound of paper being shuffled at the other end of the phone while he waited then Clyde’s voice said, “Not one of mine I’m afraid. I’ve only had one at the General in the past four weeks and that…was a man…Robert Nolan, aged sixty nine, done on the eighth.”

  “Damn,” said Saracen softly. “I suppose that means that Cyril Wylie must have done it.”

  “He’ll be here tomorrow. You can give him a ring.”

  Saracen gave a non-committal grunt that Clyde took up on. “Is there some problem?” he asked quietly.

  “It’s rather awkward. I’d rather not ask Dr Wylie.”

  “I see,” said Clyde thoughtfully, assuming that Saracen’s reluctance had something to do with Wylie’s drink problem. Saracen saw no reason to disillusion him. “One moment.” said Clyde.

  Saracen was left holding the phone again. He hoped that Clyde had gone to check through Wylie’s records.

  Clyde returned. “No joy I’m afraid. I thought that Cyril might have left his filing cabinet unlocked but no such luck. You’ll have to approach him yourself tomorrow.”

  “Thanks anyway,” said Saracen. He put down the phone and rubbed his forehead with the heel of his hand.

  “Problems?” asked one of the nurses.

  “You could say that,” said Saracen with a wan smile but let it go at that.

  All thoughts of Myra Archer were dispelled from Saracen’s head with the arrival in A amp;E of a badly injured thirteen year old girl who had been involved in a road accident with her bicycle. Both legs had been badly damaged where the car had hit her side on and she had lost a lot of blood.

  “Have you alerted the theatre Sister?” Saracen asked.

  “Yes Doctor.”

  “Permission forms?”

  “There’s a problem.”

  “Can’t contact the parents?”

  “No, it’s not that. They are here…but they won’t give permission for a blood transfusion. Religious reasons. They are Jehovah’s Witnesses.”

  Saracen’s head dropped and he massaged his left temple with the fingertips of his left hand. It was his way of counting to ten.

  “Where ar
e they?” he asked.

  “The small waiting room.”

  “Put them in the office will you. I’ll talk to them.”

  Saracen took a deep breath and entered the room to find a middle aged couple sitting there with their arms around each other. The woman was sobbing quietly into a handkerchief. Saracen said who he was and came straight to the point. “Let me be perfectly frank with you,” he said, “If your daughter does not have a blood transfusion soon she will die. There is no other possible outcome. Do you understand?”

  The man nodded silently. The woman continued to sob.

  “Will you please give me your permission?”

  The woman sobbed harder. The man squeezed her shoulder and said, “I am afraid our beliefs forbid such a thing Doctor. We cannot give our permission.”

  Anger simmered inside Saracen and he remained silent for a moment until he had regained his composure. He was about to say something else when they couple looked up at him and his anger was replaced by frustration. Instead of the smug self righteousness he thought that he might find in their faces he could see only pain and torment. The couple were suffering doubly, firstly because their daughter had been so badly injured and secondly because they felt compelled to block the one thing that could save her.

  Saracen said, “I will now apply to have your child made a ward of court for the duration of her treatment. Do you have any questions?”

  The couple remained silent but as Saracen got to the door the woman asked, “How long will that take Doctor?”

  “One hour maybe two.”

  “Will she…” The words died on the woman’s lips as she realised that it was a question she should not be asking.

  Saracen left the room with the impression that the couple were really quite glad to have had the onus removed from them although he also suspected that they would never admit as much to anyone, not even themselves. The games people play, thought Saracen as he returned to the treatment room to check on the girl’s condition before entering Nigel Garten’s office to find the card that held the telephone numbers and instructions for instigating ward of court proceedings.

  The number was engaged and Saracen cursed under his breath. When he still got the engaged tone after the third attempt he slapped down his fist on the desk in frustration and caused some ink to jump out of its silver pot and splash on to the leather desk top. He searched quickly through the desk drawers for blotting paper and found some, but there, just below it, was an open letter. Saracen’s eye caught the underlined name near the top of the page. It was Myra Archer.

  When he had finally got through to the authorities and set things in motion Saracen returned to the drawer where the letter was lying and drew it out. He overcame his feelings of guilt at what he was about to do and read it. The letter came from British Airways and referred to a request made by Nigel Garten that all passengers and crew on the flight that had brought Myra Archer to the United Kingdom be contacted and treated as recommended. The letter confirmed that this had been done.

  “What the hell for?” said Saracen softly as he stared at the letter. If the woman had died of a heart attack. What was all this nonsense about treatment for fellow passengers? Did this mean that Myra Archer had not died of cardiac failure? To find out the answer Saracen knew that he would have to find Garten’s original to British Airways. He started searching through the files.

  After a few minutes which seemed like hours he found what he was looking for and read the letter still crouching down beside the filing cabinet. It advised the airline that Mrs Myra Archer, a passenger on their flight BA 3114 to London Heathrow had been shown to be suffering from a Salmonella infection. As a precaution it was deemed advisable for all persons on the flight to undergo a course of preventative antibiotic therapy as there was a possibility that food served on the aircraft might have been responsible.

  “Food poisoning?” said Saracen out loud. Myra Archer had been suffering from food poisoning? He shook his head in puzzlement but did not have time to consider the matter further before Chenhui came through the door and said anxiously, “Dr Saracen, I need your help. You come please.”

  Saracen followed Chenhui back to the side room where the teenage girl lay.

  “I not happy,” said Chenhui.

  Saracen examined the girl and checked the monitors. He agreed with Chenhui. “We can’t wait any longer,” he said. “We’ll have to give her blood right now. Has it come up from the bank?”

  Sister Lindeman said that it had.

  “Cross-matched?”

  “Yes. How about the paperwork?”

  “We can’t wait.”

  “If you say so.” Sister Lindeman enunciated the words very clearly and Saracen recognised that she was inviting him to take responsibility publicly. “I say so,” he said with a barely perceptible smile.

  Saracen had set up the transfusion and was washing his hands when Chenhui came up beside him and said, “I puzzled. Why parents say no blood?”

  “A religious objection to transfusion,” replied Saracen, pushing off the taps with his elbows.

  “I no understand.”

  “Frankly Chenhui, neither do I,” said Saracen, baulking at the thought of attempting to explain something he had no heart for. “It’s all part of God’s little obstacle course.”

  Chenhui looked more puzzled than ever.

  “Let’s go have a cup of tea.”

  As they walked across the floor towards the duty room a trolley came through the swing doors bearing a tear stained young boy holding his left arm gingerly. “He fell off a swing,” said the attendant.

  “I will do,” announced Chenhui and Saracen nodded. He went to have his tea and found Jill Rawlings had beaten him to it. She was sitting on a corner of the desk holding cup and saucer. “I hear you gave blood to the JW,” she said.

  “No option.”

  “The authorities might disagree.”

  “Sod ‘em.”

  “My hero,” grinned Jill.

  Saracen ignored the remark and asked, “Did Mary Travers say anything about Myra Archer having had a Salmonella infection?”

  “Yes she did, come to think of it. Some days after the Archer case she and the ambulance crew were given a course of antibiotics as a precaution. It didn’t seem to be relevant to what you were asking at the time.”

  “I suppose not,” said Saracen deep in thought.

  “You’re not dropping the matter?”

  Saracen screwed up his face. “So many things are bothering me. For instance how did they know the woman had a Salmonella infection if it was a treble nine call to a heart attack?”

  “Presumably it was something they discovered afterwards at Post-Mortem,” said Jill.

  “A Salmonella infection is hardly something the pathologist would be looking for in this woman’s case,” said Saracen.

  “What are you getting at?”

  Saracen shrugged his shoulders and sighed. “To be quite frank,” he said, “I’m not at all sure myself.”

  Jill smiled and touched him on the forearm.

  “I have another favour to ask,” said Saracen.

  “Go on.”

  “Would you ask Mary Travers what day she was given the antibiotic cover on?”

  “All right,” sighed Jill, “If it will make you happy.” Then, as an afterthought she said, “If they did know that Myra Archer had food poisoning at the time of the call that would explain why they decided to send her on to the County Hospital wouldn’t it?”

  “It would,” agreed Saracen. “But I don’t see how Chenhui could have made that diagnosis in the circumstances and that’s what’s niggling me.”

  Saracen was in the bath when the phone rang. His first thought, as always when the phone rang in early evening, was that it was Nigel Garten trying to unload his duty stint on some pretext or other so he was relieved to hear Jill’s voice.

  “I’ve spoken to Mary Travers. She started her course of treatment on the thirteenth. Is that what you wanted
to know?”

  “Thanks. You’re an angel.”

  Saracen felt a weakness creep into his knees. He sat down as the blood began to pound in his temples. Myra Archer had died on the twelfth; the post-mortem would not have been done until the thirteenth at the earliest, more likely the fourteenth or fifteenth. To determine that Myra Archer had been suffering from a Salmonella infection would have required a lab examination of specimens taken from her body. The result could not have possibly been known until the fifteenth or sixteenth. Whatever reason Garten had had for putting Mary Travers and the others on treatment on the thirteenth it had nothing to do with anything discovered at post-mortem. He must have known beforehand.

  The bath water had gone cold. Saracen dried himself and put on a towelling robe. He sat down to wonder how Chenhui and Garten could possible have made the diagnosis. From all accounts Myra Archer had been unconscious when the ambulance was called and had not regained consciousness. She had told them nothing and died of cardiac failure yet they had known that she also had a serious infection. It didn’t make sense. Not only had they been able to diagnose Salmonella but they had been able to determine that it was one of the more serious strains if Garten had deemed it necessary to contact the airline and to disinfect the mortuary. Could it have been typhoid? the ‘top’ of the Salmonella range. But if so why the secrecy? There were one or two cases every year. If only he could see a copy of the PM report, thought Saracen, perhaps he could work backwards from the exact cause of death and figure out how they knew. Wylie or no Wylie he would have to get his hands on that report.

  Saracen rested his neck on the back of the chair and looked up at the ceiling for inspiration. He was tracing the path of a thin crack that radiated out from the light fitting when the telephone rang; it was Dave Moss.

  “I’ve just had your Dr Tang on the phone,” said Moss.

  “Oh yes.”

  “She seemed to be in a bit of a state, ‘trouble is, I don’t really know what about. I only managed to pick up every fourth or fifth word. I think she wanted me to take a patient, maybe two, she kept saying ‘two’ then the line went dead.”