Death Before Time

by Andrew Puckett

  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 left 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.

  *

  Dr Karys Harper had taken the morning off after a night on call and was padding round the flat in a white towelling dressing gown, yawning, brushing her hair out of her eyes and taking long sips from her mug of black coffee. Following on call duties there usually was a certain amount of weariness. When the telephone rang she muttered a soft curse. Always uncomfortably aware that a summons could arrive at any minute, it didn’t even occur to her that it might be a social call. No friend would expect her to be at home at eleven o’clock on a weekday morning.

  She took the call calmly, scribbling down the directions on a pad she kept near the telephone. By the time she had showered and pulled on some trousers and a thick sweater she had shaken off the yawns and tirednes
s, but she felt a heaviness that was never there when she was completely off-duty. She blamed it on an awareness of impending responsibility. A readiness for action.

  She drove to the scene in her black Mercedes convertible, accelerating along the Bristol Road, using the bus lane more than once to undertake drivers turning right. She couldn’t justify her driving with the usual doctor’s excuse — that she might save a life with the few minutes bought – she merely enjoyed the speed, for its own sake. She found the site easily. The area was familiar to her, no more than a few hundred yards away from her own slicing ground, the hospital mortuary. She turned into Edgbaston Park Road, left into Metchley Lane, and parked just beyond a crowd of rapidly gathering voyeurs clustered round a couple of police cars. It was strange how flashing blue police lights drew the spectators. She did her best to ignore the ripple of excitement that followed her. Having noticed her black scene-of-crime bag someone was helpfully informing the others who she was. She wasn’t ready to talk to anyone, yet. Not before she knew the facts.

  She kept her gaze on the ground, ducked beneath the police tape and slid down the short bank towards the white canopy erected over the corpse. There were two figures mounting guard over the body, a Detective Inspector in his thirties, casually dressed, slim with fair hair thinning on top, and a stout Detective Sergeant. Karys greeted both of them with a smile. They were old acquaintances.

  She set her bag down by the side of the body. ‘New experience for me, this.’

  Sensing what was coming, the two police officers shifted uncomfortably. They were familiar with Karys’s strange sense of humour.

  She indicated the yellow plastic bag with its descriptive black lettering along the side, CLINICAL WASTE. ‘Having the corpse gift wrapped and labelled.’

  There was a strained smile in return from DS Fielding. DI Forrest remained stony faced. Karys shrugged and opened her bag. ‘When was the body discovered?’

  ‘About an hour ago. By some medical students.’

  She looked up. ‘Skipping lectures?’

  Forrest shrugged. ‘Let the university sort that bit out. We’ve got enough to worry about.’

  ‘Hmm.’ She slipped on a pair of examining gloves before picking out a hunting knife, sharp with a serrated edge used to sever ties or nooses, cut bonds, preserve knots. ‘Any objections, Inspector Forrest?’

  ‘No.’

  ‘You’ve checked for prints then?’

  His face was already tinged with a sickly green. ‘I don’t know why we bother. They all use gloves these days.’

  ‘Right then. Here goes.’

  She made a slit in the thick, yellow PVC and all three peered in. Inside was a thin, bony man, lying on his back with a bloated, dead-fish face, his eyes bulging, arms folded across his chest, chin dropped down. He wore a blue-checked open-necked shirt and black ankle socks. No shoes. Otherwise he was naked — apart from a wristwatch and a tie, knotted but not tidily arranged around the collar. It had been pulled lethally tight around the neck.

  Karys stared at the victim for a few moments to absorb as much detail as she could. She wanted to forget nothing. When she had imprinted the picture on her mind she allowed herself to touch him. He felt cold. Ice cold. She tried to move his arms. They were stiff. Rigor mortis was still present. She peered closer. There was no discernible bruising but some lividity on his lower buttocks, shoulders and heels. Karys moved the tie to reveal a line of bruising, noticing it was a ‘fun’ tie sporting the Disney characters Mickey and Minnie Mouse — waltzing by the look of things. The only other visible injury was a narrow line of congealed blood in his right groin. Karys studied it closely before touching it with her gloved index finger. It was a neat, regular wound, quite straight and about four inches long. And it had been clumsily drawn together with five untidy silk sutures, their ends long enough to prickle her fingers. Karys pondered over the wound, trying to piece together the sequence of events.

  When she looked up she could see that both the DI and the DS were staring at the same scar. Neither of them spoke. They were waiting for her.

  ‘Interesting,’ she said.

  ‘Yeah,’ they chorused.

  ‘And what exactly do you think, Inspector Forrest?’

  ‘Well, it looks as if he’s had an operation.’

  ‘Possibly.’

  ‘What else could it be?’

  ‘I don’t know,’ she said. ‘Maybe it’ll all come clear during the PM.’ Her gaze went over and beyond the DI’s shoulder to the huge, grey hospital looming against the sky. ‘Are there any reports of missing patients?’

  ‘Not so far.’

  ‘Hmm,’ she said again. Her attention returned to the groin wound. Then she palpated the face, tested the knees for depth of rigor mortis and used a rectal thermometer to gain a core-body temperature. 12°C. Her thoughts galloped through the textbook graph. He’d been dead for more than twelve hours. Could be as long as twenty-four. A quick glance at her watch. Eleven forty-five a.m. He’d died sometime yesterday afternoon to evening and the body presumably dumped under cover of darkness. Not this morning. The hospital site was too busy for the killer to have risked dumping a body in daylight. Knowing DI Forrest would press her for a more precise time of death she tried to work it out. The victim was a thin man, only partly clothed, so he would have lost body heat relatively quickly, add to that the fact that it was a chilly, damp day and the plastic would have formed poor insulation.

  Forrest must have guessed what she was thinking about. ‘Eight degrees centigrade,’ he supplied gruffly.

  She smiled her thanks.

  His temperature had almost reached that of his surroundings, so probably the man had died sometime yesterday afternoon, late-ish. This was all straight-forward textbook stuff. But her mind was working furiously to try to piece together the sequence of events. What could have led to this man being strangled, then dumped on the hospital site? A recent operation? A patient who had wandered away from the ward? Certainly he had had the recent attentions of a medic blessed with only tolerable competence. The stitches weren’t that neat. And why had he been wrapped in a clinical waste bag? It was puzzling. Incredible.

  She was curious to know what other findings would be uncovered at the post-mortem.

  While Karys rang the coroner from her carphone, Forrest was already initiating primary investigations. By that afternoon the corpse was shelled of its PVC wrap and lay naked on the mortuary slab. More importantly, he was no longer anonymous. He had an identity and personal details. The pale Caucasian man was Colin Wilson, aged thirty-five, coincidentally the same age as DI David Forrest himself. They had an address for him too: 8, Jasmine Place, Erdington. Colin Wilson had had a wife, named Laura, and a ten-month-old daughter named Heather. He was now much more than a murder victim to the investigating team, he was a family man.

  *

  As soon as Karys entered the PM room she noted the tension in the waiting team of police which comprised Forrest, DS Fielding and a couple of SOCOs. As was her habit, she ignored them and busied herself with observing the primary details of Colin Wilson’s body. Thin and bony; undernourished rather than simply slim.

  Like most pathologists, Karys had her own unique way of conducting a post-mortem. A mixture of traditional methods plus personal foibles. Those who had worked with her before knew the drill inside out; she would frown all the time she tied the bows at the back of her surgical gown; she would push her heavy glasses hard up her nose as though daring them to slip once her hands were sheathed inside the surgical gloves. Those gloves which often tore because she pulled them on too hard, as she frequently did in cases of suspected murder. She had once confessed to Paget, the mortuary attendant, in an unprecedented burst of candour, that murder upset her more than it should a pathologist. It had been a frank apology for her weakness. She knew that murder should not upset her at all, it should not penetrate her shell. That shell was her protection against emotional involvement in the case. It was her job to be a scientific observer, d
etached, impartial and above all, accurate. That was the theory.

  Those who knew her well were perfectly aware of her involvement with murder cases.

  Paget stood by silently. He had been embarrassed by her admission and had done little more than grunt. But he had never forgotten her confession. The memory of her disclosure returned today as he watched her psych herself up to deal with the case, standing at the foot of the mortuary slab with her gloved hands clasped together, as though praying. He remembered something else she had said at the same time, in the same burst of candour – that she felt she should spend this silent time communing with victims of violence because it helped her to piece together the full sequence of events, each blow, which, in its turn, had finally led to the victim’s death. The evidence would all be there, waiting for her in the tissues, to be laid bare by her knife. And it was this sequence of blows, of defensive injuries and trauma, that would give her the truest of clues into the killer’s mind. She must not miss things. She owed it to her ‘patients’ to glean every cell of evidence a corpse could possibly yield and help point the finger. Towards innocence. Towards guilt. Towards accident. Towards manslaughter. Towards murder. Even, she believed, occasionally, towards the murderer.

  At last, to the relief of the waiting police officers, she sucked in a long, deep breath, as though preparing to dive from a high board. She unclasped her hands and finally broke the silence to begin a superficial examination of the head and the back of the neck, talking to the waiting police officers as well as into a small dictaphone.