A Fatal Cut
Priscilla Masters
* * *
UK
(2000)
* * *
His patient was ready. He stood for a moment staring down at her his mind working out the correct incision. Then the first cut...
A body has been discovered in undergrowth in the grounds of a Birmingham hospital, wrapped in a clinical waste bag and, even more bizarrely, wearing little but a garish Disney tie. The scar and stitches evident on the dead man's groin suggest he may have recently been a patient at the hospital. But when pathologist Karys Harper is brought in to examine the body she makes a discovery that is more grotesque still -- the surgery wound was inflicted after death. Clearly this is no ordinary killer. And he's about to strike again.
A FATAL CUT
Priscilla Masters
© Priscilla Masters 2014
The right of Priscilla Masters to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act, 1988.
First published in the United Kingdom in 2000 by Macmillan.
This edition published in 2014 by Endeavour Press Ltd.
This book is dedicated to my son and his flatmates, due to qualify as doctors this year. May they never make such mistakes as some of the characters in this book.
I would also like to point out that neither of the surgeons in this book is based on any surgeon I have ever known — least of all my father!
Also to Kerith and Catrin, two truly good friends.
26 June 1987
It was supposed to have been a joke. Something said in jest when they were stiff and sticky from sitting too long in a hot examination room. It had not been meant to be taken seriously.
But he had taken it seriously.
His question. ‘What will you do if you fail your A levels?’
Her answer. Flippant. ‘Shoot myself. I will. I’ll shoot myself. I’ll feel such a failure. I won’t know what else to do. Not to get in to do the right degree would be worse than death. There wouldn’t be any point them offering me another course. There isn’t anything else I want to do with my life.’
His eyes, opened as wide as they could go. Fringed by dark, girlish lashes. ‘Would you really? I mean, shoot yourself.’ A pause. ‘How would you get hold of a gun?’
And so easily it had progressed further than she had meant it to. Much further. ‘Easy. My uncle’s got a gun. He doesn’t even keep it locked up like you’re supposed to. He’s ever so careless.’
His interest, feigned she knew afterwards. ‘What does he use it for?’
‘Clay pigeons.’
‘Does he keep it loaded?’
‘No. Even he’s not that negligent. He keeps the pellets in a special box at the bottom of the gun cabinet!’
So she had spread the noose on the floor in a perfect circle, and watched him step inside it without understanding. Anything.
‘Who is your uncle?’ Asked without deliberation, casually.
‘My mum’s brother. Lives a couple of doors away from us.’ She echoed his question back at him. ‘What would you do, Sam? If you failed? If you didn’t get in?’
It was the question that had dominated that whole summer. What they would do if...?
‘The same.’ His answer had been said with enough empty bravado for her to believe she could safely disregard it.
‘You wouldn’t.’ She’d said it scornfully, with derision. ‘I bet you wouldn’t.’
He’d held out his hand. ‘I bet I would.’
She’d stood up then, brushed the newly mown grass from her skirt. ‘I don’t know why we’re having this stupid conversation. We’ll both pass.’
But he’d fallen silent and looked away from her, beyond the playing fields of the King Edward the VI School – which hated losers – towards the skyline and the university across the road. Students’ Union block, tall clock tower, gracious Victorian buildings, waiting for the successful.
If not earlier, she should have known then.
23 July 1991
The surgeon was sweating. His paper cap and facemask were already damp. Dewdrops of sweat shone on his forehead, picked out by the operating lights overhead.
The theatre sister watched him. She glanced over his shoulder at the list of names written on the whiteboard, all cases set for this afternoon. He couldn’t be ill. There were six more patients lined up, the next probably already in the anaesthetic room, nervously preparing to sink into oblivion. The others would even now be having their pre-med on the ward. The operations must go on. But not without the surgeon.
He was still sweating.
Opposite, and to his left, stood the registrar, new the week before. A Greek. In his luminous eyes she saw he had noted the surgeon’s condition and she read his own misgivings: that he wouldn’t be able to handle the remaining cases. Not alone. She guessed – whatever his references said – that he’d performed only minor solo ops before moving to England. He didn’t have the skill of the operating consultant.
She took another surreptitious look at the surgeon. Sweat was trickling towards his eye. Unable to wipe it himself he was blinking rapidly, his gaze drifting away from the open wound. She sensed it was a struggle for him to concentrate on the operation. He was even having difficulty holding the scalpel handle accurately. Instead of holding it delicately, like a fine fountain pen, he was grasping it in his hand like a ham-fisted amateur, his face flushed with effort. The theatre sister glanced round for some explanation. Maybe the problem was the heating. It was always kept warm in here in deference to the still figure on the operating table. She called the theatre porter across and asked him to turn the air-conditioning dial down by three degrees. Then, using a pair of long, angled forceps, she dropped a sterile gauze swab into the student-nurse’s hand and asked her to wipe the sweat from the surgeon’s brow.
He couldn’t do it himself without contaminating his gloves. And that would mean abandoning the entire operation and having to rescrub, while the patient waited and bled.
Silently the student nurse moved behind the green-gowned figure and wiped the sweat away with the gauze. The surgeon should have been grateful for this courtesy. Normally he would have been.
But today the act seemed to annoy him. He half turned from his patient and snarled at the nurse, so violently that she dropped the swab onto the sterile green towels. There was a horrified silence, broken only by the rhythmic rise and fall of the ventilator. Everyone knew. The swab, touched by the nurse’s ungloved hands, was contaminated. And now the green towels were too. And the green towels surrounded the gaping open wound; flesh unprotected by skin. True, only a hernia repair but nevertheless a deep slice through the skin, muscle and blood vessels of a living person. A living person now exposed to infection through the clumsiness of a member of staff. The silence emanating from the surgeon was both tense and angry. Breathing heavily, his hands remained poised a few inches above the ‘dirty’ swab as though the air around it was also infected.
The theatre sister rescued the situation. Muttering a swift, ‘Sorry, sir,’ she placed a spare pair of artery forceps into the nurse’s shaking hand so she could retrieve the gauze swab without crossing the invisible barrier of sterility. Then, using another pair of long artery forceps, she draped a fresh green towel across the suspect patch before shooting the unfortunate nurse a comrade’s look of sympathy. They’d all gone through the same experience at least once before. A tetchy surgeon, a hot day, a stuffy theatre, complicated surgery.
Only this was none of those things. ‘Pinky’ Sutcliffe had a reputation throughout the hospital for being calm and even tempered, a cool professional who tended to limit his conversation to demands for instruments and spasmodic explanations to teach th
e medical students. A snarl from him was out of character. For him to sweat he must be hot – or ill. The theatre sister frowned. The case on the table was not complicated, bread and butter work in a healthy subject. So far.
The entire theatre suddenly fell quiet as though all the staff sensed something was not quite right. For a couple of seconds even the ventilator seemed to be holding its breath. Over her mask the sister’s black eyes scanned the operating room, trying to hunt down the cause of the surgeon’s poor humour. Her gaze rested first on the registrar. An incompetent import, but with a steady hand for holding retractors. No more was demanded of him. The problem was not here. She glanced across the room at the two medical students. Fourth years. One a plump male, the other a small female. Both were dressed appropriately in theatre greens and white leather clogs, and that was as far as their involvement in the proceedings went. They were leaning against the far wall, sharing some private joke. Mentally she tut-tutted. A perfect chance to study the anatomy of the rectus sheath and they were more interested in the gossip of the day. She watched them giggling, for a fleeting second almost envious of their lack of responsibility in the proceedings. She took in the male student’s arm lightly resting round the girl’s shoulders. They seemed to have no worries. Her eyes moved back to check the surgeon’s face and her alarm intensified. He was staring down into the wound as though struggling to focus. Oblivious to the medical students. His distress was nothing to do with them.
She shifted her attention to her side. A thin, shy figure in white cotton, hands subserviently tucked behind his back – like a member of the royal family – or someone who did not know quite what to do with them. The theatre porter. Quiet and unobtrusive as a ghost. Earnest, new, inoffensive. However seriously the porter took his job no one really took much notice of him, least of all the surgeon. She smiled at the thought that the theatre porter could possibly be responsible for Pinky Sutcliffe’s uncharacteristic behaviour. She was still smiling as her eyes rested speculatively on Bill Amison. Tall, muscular, blond, the anaesthetist was, as usual, struggling with The Times crossword, paying the patient the very minimum of attention. He looked up for an instant and caught her gaze. She gave him a broad wink which he returned before glancing meaningfully across at the surgeon. His message was clear, what’s up with him today?
She shrugged an ‘I don’t know’ and continued pondering. But there was only one more person in the theatre. The unfortunate student nurse who had dropped the swab and whose face was still flushed with embarrassment. As flushed as...her eyes swivelled back to the surgeon with alarm. As flushed as the surgeon.
The theatre sister continued handing him the instruments but her unease mounted. She was mechanically going through the motions of something so routine she hardly needed to think about it: assisting at a hernia repair; automatically passing instruments – sutures, scissors and forceps – most of the time without the surgeon even needing to ask for them. Something she did five days a week. But not like this.
Today something was very wrong. He was fumbling, awkwardly holding instruments that were as familiar to him as his own fingers as though they were foreign. He kept staring at them as though he had never seen them before. Thrice he grabbed hold of forceps by the blades. Once he requested a stitch when there was nothing to stitch. She handed it to him and watched him drop it in confusion. As she retrieved it she peered at his face and saw someone unfamiliar to her.
It was a few moments more before she knew exactly why she could not relax. It wasn’t just his clumsy hold of surgical instruments. There was a fine tremor in his hand which was making him dangerously inaccurate. Hardly noticable if you only watched the fingers. But when you studied the pointed end of the scalpel blade you could see it vibrate like a tuning fork which has been struck against a hard surface. Dumbly she watched the surgeon’s fingers, pale and dehumanized, encased in sterile latex as they fumbled the scalpel through bleeding tissue. The blade, meant to peel away a band of muscle, hacking through it instead, like a butcher.
‘Truly alarmed now she looked again at the surgeon’s face, at his two visible features, blank eyes and furrowed forehead. His nose and mouth were shrouded by the paper mask, which was saturated with his sweat. The sister’s discomfort turned to panic. She didn’t know what to do. Pinky Sutcliffe was a respected senior surgeon; she was only a junior theatre sister. She was aware that her primary responsibility was to her patient, the man who lay beneath all their hands, unconscious of the drama being played out above him. So she stood between her two obligations, her professional duty and the invisible hierarchy that permeated the medical profession. It was not done to question the competence of a senior surgeon.
Once again she cast a desperate glance at Bill Amison. He had stopped struggling with the crossword. The paper lay discarded on the floor and he was holding the respirator tube hard against the patient’s mouth, his other hand checking the radial pulse. As she watched he registered the patient’s blood pressure before looking straight at her.
They were both watching the surgeon now. His head was swaying, his eyes glazed unaware. He was ill. He must be ill. And he was getting worse. Sutcliffe glanced up. He seemed unable to focus on her. Concern forced her to say, ‘Sir, are you all right to carry on?’
The surgeon giggled.
Both medical students stared across at him, startled. The student nurse opened her mouth to speak, met the sister’s warning glance and shut it again. The Greek registrar picked up a large artery clamp and held it like a defensive weapon, ready – if needed. Bill Amison looked at the cardiorator and pressed his fingers even harder against the radial pulse. He muttered something. No one knew what, but no one asked him to repeat the words. The theatre porter backed against the wall, as though he wanted to disassociate himself from the proceedings. They all watched as the scalpel slipped and severed a minor blood vessel. The theatre sister mopped the oozing blood away. The registrar touched it with the diathermy. There was an acrid scent of scorching flesh. Blue smoke hung over the body and turned hazy under the operating lights.
The bleeding stopped. The registrar used a swab on some sponge forceps to mop around the wound.
Bill Amison checked the patient’s blood pressure yet again and speeded up the IV drip. He sat, upright on his stool at the patient’s head. The crossword was forgotten. They were all tense. All except the patient. Oblivious to it all.
The surgeon giggled again, blood smearing the forefinger of his glove. He moved the finger in front of his eyes and gazed at it, fascinated.
The theatre sister peered into the abdominal cavity with a mounting sense of alarm. Less than a centimetre away from the surgeon’s blade pulsated the femoral artery, a major blood supply to the lower part of the body. She watched the rhythmic beat with a feeling of absolute dread. As the scalpel descended towards it she involuntarily closed her eyes.
Chapter One
23 November 1999
They took the short cut which led them towards the back of Queen’s Medical School, through an ever-open fire door and straight into the side entrance of the lecture theatre. If you were late, and lucky, you could slide into your seat halfway through and no one would notice your arrival, including the lecturer, because of curtains draped loosely at the side of the seats. Easy then to shuffle up one – or two – or three. The four flatmates often used the side door to give them a way in for a lecture almost missed. Another party, another late night, another skinful. But, late and hasty though they were, a block of colour drew them away from their usual hurried path, towards a patch of waste ground, and the bottom of a shallow ditch.
Something yellow. A plastic bag.
Six months into their clinical years they were already aware that objects in hospitals are colour coded. Reds and yellows stood for danger; radiation; contamination. Yellow plastic bags were used to contain clinical waste, a fact that was printed in large black letters on both sides of them. They were meant to be heaped straight away into the hospital incinerator — not lef
t out here in the open. The object of their attention was a double-sized clinical waste bag. Two taped together.
Body-long, bright as a canary, particularly on this dull, late November day when earth, sky and hospital all seemed to blend into the uniform grey of 1930’s concrete. Shapes were blunt and ill-defined, outlines blurred in damp, insubstantial fog, indeterminate and shadowy. Not this shape though.
Medical students are curious creatures. Late as they were for the third lecture of the day all four took a few steps forward to peer at the bright parcel in its gaudy, plastic shroud. Tom stretched out a tentative hand.
‘I think it’s a stiff,’ he said incredulously.
Their eyes scanned the patch of scrub, and returned to the bright plastic. And yet, because bodies are not an unusual object on a hospital site they stood around and discussed it.
Michael was the joker. ‘I suppose,’ he said, laughing uneasily, ‘that someone’s committed a murder and wants the hospital porters to dispose of the body for them. In the incinerator.’ As though the joke had been made by a consultant on a ward round, the other three gave a polite, forced chuckle.
‘Or a surgeon made a bodge of an operation, and just had to dispose of the evidence.’ This was Jake’s contribution.
Used to laughing at the macabre they stood and joked with something like bravado. It was Ben who brought them to heel. ‘I think,’ he said seriously, ‘that we’d better let someone know.’ His three friends nodded in agreement. All four of them knew the implications. They wouldn’t be at lectures for the rest of the day.
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