“I sympathise,” said Marcus, “But you’ve got to carry on with it - for now, anyway.” He turned to Jo. “Have you had a chance to look at the drug system yet?”
Jo described what she’d seen. “It would be easy enough for someone to substitute bogus ampicillin beforehand,” she said, “Although it would mean that all the patients were getting it.”
Fraser shook his head. “That can’t be right, it worked perfectly well with the two false alarms.”
Marcus said, “Which leaves us with someone somehow targeting them.”
Jo told them about Carrie Tucker’s signatures on the drug chart. “And you’ve seen her on the drug round too, haven’t you, Fraser?”
He nodded.
Tom said, “She certainly does seem to be around the drug trolley a lot, doesn’t she? But how would she do it?”
“It would be easy for the nurse actually giving the drug to substitute a dummy,” Jo said, “But there’d be a pattern, wouldn’t there? It would be the same nurse’s signature on the chart with every death.”
“But didn’t you say there’re always two nurses on the drug round? Carrie could have been the other one.”
“But that would mean there were two nurses in on it … wouldn’t it?”
“No, I don’t think so,” said Tom. He jumped up and paced around a moment before turning back to them … “Case one: nurse X gives the proper drug to Carrie, who does a quick switch and gives the dummy to the patient and signs the chart – OK?”
They nodded.
“Case two: Carrie makes the switch when she takes the drug from the trolley and gives it to nurse X, who then gives it to the patient and signs the chart.” He looked at Jo. “You’re going to have to find out if Carrie was on the rounds with the dead patients where her signature doesn’t appear.”
Jo let out a groan. “I’ve already had one sister giving me a third degree ... ” She told them about Jackie’s interrogation.
“All right,” said Tom, “Do what you can without arousing suspicion.”
He asked how many “at risk” patients they’d noticed now.
“So that’s five,” he said when they’d finished, but Fraser couldn’t hold back any longer –
“It’s five supposedly at risk patients who’ve had absolutely nothing wrong with them,” he said. “We’ve also had two not at risk patients who’ve had pneumonia and got better. Either they’ve suspended operations, or … I’ve got it all wrong.”
Marcus said quietly, “The reason we’re here Fraser, is because when we checked your figures, they indicated that you were right.”
“But it’s been two weeks and there’s been nothing … ”
“And we’re going to give it another two weeks at least.”
Tom said, “Fraser, it’s not really surprising there’s been a lull. Everyone knew about your row with Singh over pneumonia deaths and then Edwina found you looking at causes of death.”
After a moment, Fraser nodded.
Marcus said, “These five patients, can you cover them all between you?”
They could, except for Daniel Pope, who was Singh’s patient and not on Jo’s list.
“What about the weekend?” said Fraser.
“You can’t afford to hang around with no good reason,” said Tom, “You especially, Fraser.”
“But it’s when they tend to go down with it … “
There was a silence, then Jo said, “I’m due back at four on Sunday, if that’s any help.”
Fraser said, “I told Helen I’d see her tonight. That means I can stay over, pick up something in my office tomorrow and look them up on the computer.”
“That’s the best we can do for now. You’ll be working some of the next weekends, won’t you Jo?”
She nodded.
“That’ll make it easier.”
The meeting broke up and Jo left. Fraser was about to go too when Tom stopped him -
“We were going to have a word, weren’t we?“ He took him aside, opened his case and brought out a torch combined with a screamer.
“You’ll be amazed at just how much noise it makes,” he said at Fraser’s look of disdain. “Enough to put anyone off their stroke.”
“What if they grab me before I can use it?”
“Always keep it in your hand when you’re walking in the dark, but if you are grabbed, try and stamp on their instep – it’s as good as a kick in the goolies and not so predictable.”
Fraser smiled as Tom showed him how to do it, remembering for some reason what he’d said to Helen about ghoulies on another evening.
“And Fraser,” Tom said quietly, “ Marcus and I wouldn’t be doing this if we didn’t think there was something to it. OK?”
“OK.”
Jo, driving back to Latchvale, thought about Fraser’s doubts and wondered if she was beginning to get them too.
Oh sure, the place was a bit claustrophobic and incestuous, but so were a lot of self-contained hospital departments ... and, as Fraser had said, nothing was happening.
Oh well, she thought philosophically, ten grand plus getting away from David Petterman, who’s complaining?
But when she got back to the ward at four on Sunday afternoon, it was to find that Rose Parker had developed pneumonia on Saturday and was being treated with ampicillin …
Chapter 17
“When did it start?” she asked, trying to curb the urgency in her voice.
“I’m not sure, yesterday morning, I think ... ” Sarah, the staff nurse she was taking over from, stared back at her strangely …
“Have you got the notes?”
“Here.” Sarah handed them to her and she flicked through them.
Restless with coughing Friday night, examined by Dr Oakley Saturday 0830 and put on oral ampicillin.
She looked up. “Let’s go and have a look at her.”
Rose was not well. Her face was flushed, her pulse and respiration up. Her skin was hot and dry and her temperature 39C, but she didn’t appear to be in any pain.
“Was she like this yesterday?” Jo asked.
“Not quite so bad.”
“When’s her next dose of ampicillin due?”
Sarah consulted the drug chart. “Two hours.”
“Are there any other patients showing the same symptoms?”
“Well, there’s Mr Tabor with bronchopneumonia – “
“I know about him, I mean new cases.”
Sarah shook her head. “No.”
Jo went back to the sisters’ office, thought for a few moments, then, after making sure no one was near enough to overhear, phoned Fraser’s mobile number and explained what had happened.
“What’s she like?” he asked.
She told him, said, “The ampicillin should be working by now, surely?”
“It can take a while - I don’t like the sound of this, though …”
“Should I give her some more out of a new pack?”
“You’re the one on the spot, what do you think?”
“I think she should have more now, intravenously, and two further doses over the next eight hours.”
“Can you do that without being seen?”
“I think so, yes.”
He thought for a second, then said, “Do it. Too much ampicillin’s better than none in her case. Tell me if there are any developments.”
“When are you coming back?”
“I could come now, but there wouldn’t be much point - I’ll stick to tomorrow morning. Can you come to my flat at lunchtime?”
“What time’s that?”
“One. I’ll let you know if I can’t make it. You’d better go and give the first dose now. Oh, and keep some of the ampicillin for analysis.”
“Yes, doctor.”
She found the key to the drug store and went over to the door. Two nurses were talking at the station while an HCA was turning a patient over.
She walked out of the room and down the corridor. Sarah was in one of the other rooms, chatti
ng to Mrs Grove. She reached the store and let herself in …
No one there. No reason why there should be.
Ignoring the drugs trolley, she went over to the glass-fronted cupboard, unlocked it and pushed the glass to one side … broke open a new box of ampicillin vials and slipped one into her pocket.
How to do this? Openly, or surreptitiously?
Openly - if you’re seen acting surreptitiously, people remember. They don’t remember normality.
She found a small trolley and put on it a sharps bin, kidney dish, medi-swabs, syringe and needle and more ampicillin from the new pack. She found some water for injection and made it up, put the loaded syringe into the kidney dish and covered it with a cloth. She re-locked the cabinet, then, as an afterthought, unlocked the trolley and put some of the oral ampicillin into her other pocket. Then, she re-locked it and set off.
A nurse pushing a squeaky trolley up the corridor, what could be more normal? - And yet she felt as though the walls had grown eyes in addition to the ears they’d always had, and were following her every inch of the way …
Into Rose’s room and over to her bed. No nurses or HCA’s, but one of the other patients was watching her - she smiled back. “Everything all right, Mrs Johnson?”
“Yes, thank you dear.”
She quickly drew the curtains round Rose’s bed. Rose was barely conscious.
“Just going to give you some more medicine, Mrs Parker,” she whispered into her ear, “OK?”
She squeezed the flaccid warm flesh of her upper arm, feeling for a vein with the fingers of her other hand … There! A quick wipe with the mediswab and in with the needle - Rose didn’t even jump.
Ease back the plunger till a wisp of blood shows you’re in the vein, then quickly push it home. Withdraw and press down with swab to seal the puncture wound ...
When she was sure it wasn’t bleeding anymore, she discarded everything into the sharps bin, pulled the curtains back and wheeled the trolley over to a corner. Not a soul in sight, other than the patients.
When she got back to the office, she realised she was trembling slightly. Reaction. And she was going to have to do it twice more.
C’mon Jo, she told herself, There’s nothing to it …
Maybe not, but for her, it was unknown territory - she’d never given an unauthorised drug before.
There was plenty to do and the four hours to the next dose passed quickly enough. No problems. Rose even seemed a little better, enough to mumble sleepily, “What are you doing, nurse?”
“Just giving you some more medicine.” She used the other arm to avoid bruising.
By the time the third dose was due, she was feeling more relaxed; it was nearly midnight, the patients were all asleep and there were less staff about. She made up the injection as before and carried the loaded syringe to the trolley in the kidney dish.
The first thing she noticed was that the site of the second injection had bled slightly, staining the sheets. Cursing, she cleaned it up as best she could without starting the bleeding again. Rose was breathing noisily, certainly no better, maybe even a little worse …
She found another site in the first arm and injected. It was while she was holding the swab against the wound to make sure it didn’t bleed that she heard Tessa, another of the staff nurses, come in with one of the HCA’s … “I saw her come in here - Jo,” she called, “Jo, where are you?”
Shit! If they found her here with the trolley, she’d have no explanation …
She swallowed, then hoping for the best, she bent Rose’s arm over the swab and tucked it inside the sheet … manoeuvred the trolley round to the other side of the bed, quietly parted the curtain and eased it through into the no man’s land the other side … then she noisily drew the curtain on Tessa’s side – “Hello?”
Tessa came over. “Ah, there you are Jo,” she said, “Katie’s a bit worried about Mrs Drew …”
It took her five minutes to sort the problem out and go back to Rose to check on her arm … It had bled a little, but seemed to have stopped now. She tidied it up, then quickly wheeled the trolley back to its corner, just before Geraldine, her replacement arrived.
Jo handed over, asking her to keep an eye on Rose, then walked slowly back to her room. She needed a stiff whisky and a couple of cigarettes before she’d wound down enough to sleep.
*
When Fraser got in Monday morning, he was told by one of the nurses that Rose had taken a turn for the worse and that Tim Oakley had added Erythromycin.
They went to look at her. Pulse, respiration and temperature were all up again although, as before, she didn’t seem to be in any pain or discomfort.
“When did she start the Erythromycin?” Fraser asked.
“Two hours ago.”
Not enough time for it to have worked yet.
But if it didn’t work, Rose was going to die ...
What to do?
If he changed the antibiotic again now, and that didn’t work, he’d have to produce a pretty good explanation. And even if it did work, for that matter …
Better leave it for now.
An hour later, she was worse.
He found Edwina. She told him to put her on oxygen, but give the Erythromycin more time to work.
He was almost certain now that Rose was going to die whatever they did. There was nothing more he could do for her, but … there was, perhaps, something he could do for subsequent victims.
It was morbid, maybe even gruesome, but the more he thought about it, the more he knew he had to.
He found a couple of swabs and a vacutainer set and went to Rose’s room. The curtains were drawn around her bed. No other staff around, so he stepped through. She was still alive.
First, the swabs ...
He removed the oxygen mask and, placing his hand under her neck, gently tilted her head back. Mentally begging her pardon, he pushed one of the swabs into her mouth and down the side of her throat …
She gagged, he simply wasn’t as good at it as the nurses – less practice …
The other side and out. Put the swab back into its tube, then used the second swab on her nose before replacing the oxygen mask.
He swallowed – now the blood.
He listened, couldn’t hear anything. Took the Vacutainer set out, fitted the needle, slotted a tube into the sheath.
No time for a tourniquet – he squeezed her upper arm and felt for a vein with his other hand … there!
Picked up the sheath and pushed in the needle –
Missed, feck it!
Drew it back, pushed again … felt the faint pop as it punctured the vein … pushed the end of the tube – a quick hiss and it filled with blood. Withdraw and press cotton wool to stop bleeding …
Footsteps …
“She’s over here, doctor … “
He stuffed the sheath, needle and all, into his pocket, whipped away the cotton wool and put her arm back under the sheet … stepped back – just as the curtain opened and the nurse came in, followed by Edwina …
“Fraser, what are you doing here?”
“Oh, hello Edwina. I was just wondering if there was any more we could do here.”
“Mm.” She picked up the chart and studied it for a moment, felt Rose’s forehead and then pulled back the sheet to take her wrist –
“She’s been bleeding – hadn’t you noticed, Fraser?”
He shook his head. “I only got here just before you … the Erythromycin injection, presumably.”
“Mm. D’you have any ideas?”
“Add another antibiotic?”
“Which?”
“Cefataxin?”
“That presupposes we’re dealing with pneumococcus.”
“I think it must be, don’t you?”
“Mm.” She looked at him, then nodded slowly. “All right.” She turned to the nurse – “But make it tetracycline.”
“Yes, doctor.”
As they turned to go, something stabbed into Fraser’
s side and he let out a grunt.
“Are you all right, Fraser?”
“Sure. Just a twinge in my back.”
Just the bloody vacutainer needle …
Should be all right, he thought, Don’t suppose she’s got Hepatitis or HIV …
She died an hour later.
Chapter 18
A couple of hours and a ward round later, Fraser hustled Jo through the main entrance of his block and up the stairs to his flat.
“She’s dead,” he said as soon as they were inside.
She sat down quickly on his bed. “She can’t be, she wasn’t that bad when I left her.”
“Well, she deteriorated pretty quickly after that. They called Tim and he added another antibiotic, but it was too late. She died two hours ago.”
She was looking at him curiously as though not quite sure what to say, and before she could, he said, “Yes, I was wrong to doubt - she was killed like the others.”
Jo let it out as a sigh. “Poor Rose,” she said. Then: “Well, there’s no point in going through that again. What shall we do next time?”
“How easy was it,” he asked, “Giving the ampicillin?”
“All right, except for the last dose - I nearly got caught then ... ” She told him what had happened ... “If I’d been seen, I wouldn’t have had any excuse … what’s so funny?”
“Nothing. Nothing’s funny really.” He described how he’d acquired his needle stick injury.
“Bloody hell,” she said.
“Exactly.” He paused. “You’ve still no idea how it’s being done?”
She shook her head. “None. Either all the ampicillin’s no good, or the bug’s resistant to it ”
He sighed. “Neither have I.” He looked at her. “Could you do it again, if you had to?”
“Jesus, Fraser – after what happened to you? Sooner or later one of us is going to be caught - sooner, probably.”
“Just once more?”
“Why? What’s the point?”
“I’ll get hold of some cefataxin for next time, there can’t be many pneumos resistant to that.”
“Haemophilus is though, isn’t it?”
“This has got to be pneumococcus to kill so quickly – and I may be able to prove it this time.”
Death Before Time Page 13
