Death Before Time

by Andrew Puckett

  “What were you doing in the library that was so important?”

  “Ranjid, I think that’s enough,” Philip said sharply.

  “I was looking up C diff if you must know,” Fraser said, staring straight back at him. “And I have to say I’m getting’ a wee tad tired of your attitude, Ranjid.” His anger was quite unfeigned.

  “My room was broken - “ Ranjid began furiously, but Philip cut him off –

  “I said that’s enough, both of you.” He let the silence hang a moment before continuing: “Ranjid thinks his office was broken into as well, despite the fact that, unlike mine, it was locked. I’ll obviously have to follow suit in future,” he added. He looked round:

  “Does anyone else think their office was broken into? Edwina? Helen? Janet?” This last was Janet Towers, who was in charge of admin.

  They all shook their heads.

  “All right. The police think it was probably an opportunist looking for anything he could lay his hands on, and I see no reason to disagree with them. What it means for us is that we’re going to have to upgrade our security … “

  They discussed this for half an hour, then broke up.

  Fraser, aware that Ranjid was still watching him, caught up with Helen.

  “See you tonight?” he said.

  “Sorry, I can’t,” she said. “Wednesday?”

  He nodded. “OK.”

  Ranjid joined them. “You’ve cut your hand Fraser,” he said.

  “Yes.” He held it up. “Rose bush in my garden.”

  Ranjid nodded. “I thought somehow it might be a rose bush,” he said, and moved on.

  *

  Jo, who was starting that morning, probably wouldn’t have known there’d been an intruder if she hadn’t already known, so low key was the general reaction.

  She spent the first hour sorting out administrative details, then was left with Jackie Lee, one of the senior sisters.

  It was over ten years since Jo had nursed any older patients, or geriatrics, as she’d known them then, and if Wansborough Community Hospital was anything to go by, things had changed. She knew that most of the old ex-workhouse hospitals had gone now, but even ten years before, geriatric hospitals had tended to be in old buildings for which no one could think of a better use.

  Jackie Lee was a cheerful black woman of about 40 with a comfortable figure and hair sprinkled with grey. She told Jo in passing about the intruder.

  “Has it ever happened before?” Jo asked.

  “Not to my knowledge.” Then: “I’ve always thought the security a bit lax. They’ll have to do somethin’ now.” She spoke with a slight Caribbean lilt. “Anyway, let’s get started, shall we?”

  She showed Jo round.

  “Yes, we do,” she said in answer to Jo’s observation that they used a lot of Health Care Assistants rather than qualified nurses. “Most of the nursing here is routine. Also - “ she lowered her voice - “we’re on a very tight budget.”

  Much of the basic nursing was routine, but Jo was pleasantly surprised by the standards of the HCA’s. The patients were turned regularly to prevent bedsores, their bodily needs were attended to more or less when required (and there were one or two very difficult patients) and an effort was made to see that all those who were able to ate at least some of the food that was brought to them.

  “What on earth made you want to work with the wrinklies instead of ITU?” Jackie asked over a companionable cigarette in the courtyard (“If they do ban it even out here, I shall bloody well go out on the street if I want one,” she’d said mutinously when Jo raised the question).

  Jo explained about her fiancé and also about being enthused by Philip Armitage’s article.

  “Have you met him yet?” Jackie asked.

  Jo shook her head.

  “You will tomorrow on Ranjid Singh’s ward round. He’s a sweetie – Philip, that is.”

  “What about the rest?”

  Jackie made a face. “The usual mix.” She lowered her voice again – “Singh’s screwy, Edwina Tate floats around on a cloud and Saint Helen – well, you’ve met her, haven’t you?”

  Jo laughed. “Does everyone call her that?”

  “Not to her face. Oh, she’s all right, jus’ takes everythin’ too seriously, especially herself.”

  “What about the staff grades and housemen?”

  “None of them are really nasty – although you need to watch Becca Lake, she can be a cow. We’ve got a locum staff grade who’s quite tasty, although rumour has it that he’s got a thing going with Saint Helen.”

  “I’d have thought, from what you said, that she’d have taken herself too seriously for that.”

  “None of us here take ourselves too seriously for that,” Jackie intoned.

  They cackled briefly before stubbing their fags and going back in, where Jackie went over a few more things with her before turning her loose.

  It was, Jo thought, the opposite end of the spectrum from ITU. It was nursing in a lower key: no monitors, no jump leads for restarting stalled hearts, no adrenalin churning emergencies - and yet the time didn’t drag, far from it, because not only were there less nurses, but less staff per patient, so she was on the move throughout the day.

  When she came off duty at four, she drove to the hotel where Tom had booked a room and reported that she hadn’t got much to report.

  Tom said, “Better not tell Fraser what Sister Jackie said about him.”

  “Why not?”

  “Don’t want him getting ideas above his station, do we?”

  Jo smiled, said, “There’s not much likelihood of that. I don’t think he’s a happy man.”

  “No, I suppose not,” said Tom after a pause.

  They had early dinner together in the hotel.

  “In the unlikely event of anyone seeing us,” Tom said, “I’m your fiancé.”

  She decided not to tell him about Fraser’s comment.

  They chatted comfortably and Jo found herself thinking: He’s still the sexiest man I know, but if he were to make a pass at me now, I’d turn him down … but something told her he was never going to do that again.

  *

  Ranjid Singh’s ward round the next morning: Jackie introduced her to both him and Philip, who gravely shook her hand. When she mentioned the article of his she’d read, he smiled rather self-consciously.

  “Thank you,” he said. Then, ironically: “Well, I suppose your presence here would indicate that it’s done some good.”

  She instinctively liked him and was impressed by the professionalism of the team as they moved from bed to bed. She watched carefully, but every patient, she thought, was recommended treatment appropriate to their condition.

  She did spot one she thought fitted Tom’s “at risk” category: Shirley Norman, aged 71, admitted with acute phase MS. She’d lost a lot of body movement and found it difficult even to speak clearly, but Jo could see the glint of intelligence behind her eyes. She’d been prescribed Methyl Prednisolone, but it didn’t seem to be helping as much as it had. Singh opted to leave the treatment as it was for a while longer in the hope of improvement.

  *

  After he’d finished the morning clinic, Fraser closed the door of his office and started searching the computer for the information Marcus wanted. First, he called up Mary Bailey’s record – Cause of death: Cancer. No mention of pneumonia. Well, well…

  He found some of the others. Harold Carter – Cause of death: Cancer. John Bickenhall – Cause of death: Pulmonary embolus.

  Alice Steel, however, who’d had MS, was down as dying from pneumonia, as was Mavis Perrins. The trend seemed to be that where the patient had had a known killing disease, like Cancer or Heart Disease, this was put down as the cause of death, not pneumonia. But if they’d had a chronic condition, such as MS, Parkinson’s or Alzheimer’s, pneumonia was entered.

  So what were the proportions? He called up and printed out the figures from the computer and tried to work them out for a six-month peri
od.

  As taken from the records, deaths from Pneumonia were around 30% of the total, from Cancer 25%, from heart conditions 15%.

  He then rang his contacts in Glasgow and Bristol again and asked if they could do the same for their areas. They groaned aloud on hearing his voice, but said they’d try. He was still speaking to one of them when the door opened and Edwina came in.

  “I’d better go,” he said into the phone. “Thanks for your help, Gavin - speak to you later.”

  Edwina had sat down by the desk with the computer terminal and there was no way she could miss the printouts he’d been working on.

  “My, you have been busy,” she said, looking at the screen and the figures he’d written down. “What’s all this in aid of?”

  His mind raced - no point in trying to lie, she’d spot it immediately …

  “I’m trying to work out roughly the causes of death here over a period of time. Seasonal changes, things like that.”

  “Why?” she said sharply. “It’s not still the pneumonia business, is it? You were told to drop that.”

  “No, of course not, just the general trends and seasonal changes … “ He could feel himself floundering … “It occurred to me that a comparison with other hospitals might be interesting, even be worth publishing.”

  “Publishing! Not really within your remit, I’d have thought, Fraser.”

  Counter attack … “No, but since being here Edwina, I’ve been wondering about specialising in community medicine, making a career of it.”

  “Well … ” She stared back at him, lost for words … “Well, I’m glad we’ve inspired you so much … perhaps we should have a talk about it … ”

  “I’d really like that, Edwina,” he said as sincerely as he could.

  “Good. We’ll do that.” She took a breath. “Anyway, I only came to say I’m away some of next week - you weren’t thinking of visiting your mother again, were you?”

  He said he thought she was stable now.

  “Good. I know you can handle the ward round and clinics, but there’s a departmental meeting at the Trust on Monday. There have to be at least two medics from here, so you’ll have to go in my place.”

  “Wouldn’t Ranjid be better?” he asked.

  “No, as deputy, Ranjid has to stay. Besides,” she added pointedly, “Bearing in mind what you’ve just told me, you should be interested.”

  “Yes, I would, now that you mention it … “

  After she’d gone, he slumped in his chair and expired a breath.

  Bloody sodding typical - in future, he’d have to have a story ready for anything that wasn’t strictly part of the job.

  It occurred to him then that Edwina obviously didn’t feel it necessary to follow the rules she’d set down for him concerning closed office doors …

  In the evening, he drove down to Tom’s hotel. They went down to the bar and Fraser described the meeting about the intruder.

  “Singh’s attitude’s interesting, isn’t it?” Tom said. “Does he really think it was you, or is it just part of his general campaign against you?”

  Fraser shrugged. “God knows. I’m just glad the others don’t take him seriously.”

  “Sounds to me as though they don’t take the intruder too seriously, either.”

  “No. Something else happened, though … “ He told him how Edwina had caught him looking up the causes of death on the computer.

  Tom took a mouthful of beer while he thought about it. “Was her attitude reasonable?” he said at last, “Or could there be another motive?”

  It was Fraser’s turn to think. “Well, she’s generally pissed off with me at the moment,” he said, “What with the time I’ve had off and the previous pneumonia business, so in her mind, it could have been reasonable.”

  “All right,” Tom nodded, “But try not to let her catch you like that again.”

  Fraser felt himself bristling, but all he said was, “OK.“

  “Did you get anything useful on the death certificates?”

  Fraser told him what he’d found and how he’d rung his contacts for figures to compare it with.

  “It’s a good idea,” Tom said, “But did you think to ask them to check how their areas record pneumonia deaths? They might be doing the same as you and recording them as cancer.”

  “Ah, shit,” Fraser groaned.

  “Well, it’s only just occurred to me. Can you ask them tomorrow?”

  Maybe it had only just occurred to Tom, Fraser thought as he drove back to his flat, but Tom hadn’t had all day to think about it. He could already imagine the reactions of Gavin and Peter when he did ask them ...

  Chapter 15

  He was right, they swore at him keen and hard when he rang them the next morning, using almost exactly the same words, although in different accents. Then they resignedly said they’d try.

  Jo, meanwhile, had decided it was time she started earning her baksheesh and accompanied the two SRN’s on the drug round.

  It was as Fraser had said: one nurse read from the list while the other dispensed the drugs and signed the patient’s drug chart. The drug trolley itself was kept locked, as was the drug cabinet when not in use and there was only one set of keys, usually held by the senior nurse on duty.

  Next, she waited until Jackie had gone to lunch, then went to the office and asked the clerk where the notes of patients who had recently died were kept.

  “Cabinet in the corner, third drawer down. But we only keep them a month, they go to Medical Records after that.”

  Jo thanked her, then extracted the files of the six patients on Fraser’s list who’d died of pneumonia. She found the drug chart for each one and noted which nurse had given the patients their antibiotics in the final few days.

  With two of the patients, the same signature, C. Tucker, appeared throughout. With two of the others, C. Tucker had given some of the ampicillin doses, but not all, and with the last two, she didn’t figure at all. There was no discernible pattern with any other signature.

  Two out of six – four, if you counted the times C. Tucker had administered just some of the antibiotic. She looked through them again …

  In two of the six cases, the first dose of ampicillin had been given intravenously; in the others, it was all in tablet form, but C. Tucker had given both the injected doses.

  Significant?

  She said to the clerk, “D’you know off hand where I could find nurse –er – C. Tucker?”

  “Oh, that’s Carrie Tucker, she’s on late shift this week.”

  “Oh, right. I’ll catch her some other time.”

  She quickly scanned the notes again to see if there was anything else, but there wasn’t, so she returned the folders, thanked the clerk and left.

  Did it amount to a pattern? She’d have to talk to Fraser about it.

  An hour later, she saw him in the main corridor. She was holding a set of patient’s notes, so she went over to him.

  “Excuse me … Dr Callan?”

  He turned. “Hello - you’re new here, aren’t you?”

  “Yes, I started this week. Staff Nurse Jo Farewell.”

  “How can I help, Jo?”

  She pointed out something in the notes, said in an undertone, “I need to see you.”

  “This evening?”

  “If possible.”

  “Can you find my flat?”

  “I think so.”

  “Come round at six. I’ll be waiting by the outer door. If you see anyone you recognise, keep walking.”

  “All right. Thanks,” she said more loudly. She turned to go, then something made her glance up - Saint Helen had just come out of her office and was stood there staring at them.

  *

  “Well, she certainly didn’t waste any time sorting out the eligible male,” Helen said to Fraser in her room a few minutes later.

  “Ach, don’t be daft,” he said, genuinely irritated. “She was asking me about the drug dose of one of the patients.”

 
“Why you?”

  “It’s one of my patients. Besides, she’s married.”

  “What makes you think that?”

  “The ring on the third finger of her left hand.”

  “She’s engaged, actually, although trust you to look – “

  She broke off, closed her eyes and compressed her lips for a moment ... “I’m sorry Fraser,” she said, “I’m sorry, I’m just a bit stressed at the moment.”

  “Sure.” He squeezed her shoulders, acutely aware that a truly affectionate lover would do more.

  She said, “I know it’s short notice, but can you come round tomorrow instead of tonight?”

  “No, I’m sorry, but I can’t.”

  “Pressing social engagement?”

  “Not exactly … as a matter of fact, I’m playing in a darts match.”

  “A darts match?”

  He explained how he’d been enrolled into the darts team. “I did promise, so I can’t really let them down. I’m sorry.”

  “Oh, that’s all right - if a darts match is really more important than me, then OK, fine.”

  “Can you not manage tonight?”

  “Oh, I expect so. Assume I can unless I let you know otherwise.”

  He kissed her cheek, squeezed her shoulder again and then left, feeling foolish, inadequate, self-conscious, wishing the whole ghastly charade was over. Wondered how much longer he could keep it up.

  Later, when he got back to his room, he phoned Jo.

  “It’s Fraser,” he said. “Helen saw us talking – “

  “I know.”

  “Well, she cross-examined me about it afterwards, so I think, to be on the safe side, you’d better not come.”

  “Why? D’you think she might be watching or something?”

  “I know it sounds daft, but I don’t want to take any chances. Can you tell me what it’s about now?”

  “I’ll try,” she said, and told him what she’d found out about Carrie Tucker.

  “I know her,” he said “She was the one I spoke to on the drug round.”

  “What’s she like?”

  “Big, pushy lassie, red hair – we do need to talk about this, don’t we? How about tomorrow lunch time?”