Pulse

by Felix Francis

  ‘I’ll see what I can do,’ I said. Not necessarily that easy when I was suspended from duty and barred from entering the hospital, but I wasn’t going to mention that if he didn’t. ‘Is that all?’

  ‘No, not quite,’ said the policeman. ‘We are still having difficulty putting a name to the dead man and wondered if you had any further clues to his identity.’

  ‘Like what?’ I asked.

  ‘Did you remove anything from him that could assist us? An identification bracelet or other jewellery, for example?’

  I shook my head. ‘There was nothing at all on him. PC Filippos said that he had searched the man’s pockets while he’d been waiting for the ambulance. He took away the man’s clothes and shoes after he died.’

  ‘Yes, I am aware of that. We have someone trying to ascertain where the clothes were bought. They don’t appear to have been available for sale in this country.’

  ‘Have you checked a list of people who are missing?’ I asked.

  DS Merryweather looked at me as if I were an imbecile.

  ‘That was our first line of inquiry. His DNA profile, photo, dental details and fingerprints have also been sent to Interpol and Europol but nothing has turned up so far.’

  I felt sorry for the poor fingerprint officer who must have had to take the dabs from the dead man’s digits.

  ‘How about the betting slip?’

  ‘The betting slip?’

  ‘PC Filippos told me that the man had had a crumpled-up betting slip in his pocket. Have you asked the bookmaker?’

  ‘Not yet.’ He wrote something in his notebook. ‘Do you happen to know the bookmaker’s name?’

  ‘No, but it should be printed on the slip. They all are these days.’

  He wrote it down then looked up at me.

  ‘Can you tell us anything else about the man that might be useful?’

  I thought back to Saturday evening. The details were clearly etched in my memory. I had spent much of the previous night in Bristol going over and over the events of those hours, wondering if I should have done anything differently.

  ‘I’m sorry,’ I said. ‘He was in a coma when he arrived at the hospital and he never regained consciousness. Prior to the blood-test results, he gave all the indications of suffering from SVT – supraventricular tachycardia – and that is how we were treating him when I was called away by the arrival of two motorcyclists severely injured in a road-traffic accident. The man died shortly after that.’

  He nodded as if he knew. Then he stood up.

  ‘Thank you for your time, Dr Rankin.’ He handed me a business card with his contact details. ‘Please give me a call when you have the blood-test results or if you think of anything else that might be useful.’

  Grant showed him out of the house while I remained sitting on the sofa, shaking.

  I had quite expected to be arrested.

  The police obviously didn’t know about my suspension from work or else they wouldn’t have asked me to obtain the test results. Maybe they didn’t believe I was responsible for the man’s death. Or were they just waiting for the post-mortem toxicology results?

  As was I.

  I spent the rest of the day in bed. Not that I was able to sleep.

  I should have been tired. I had dozed a little during the night and for the last half-hour on the drive home but it had been thirty hours since I’d got up on Sunday morning. Somehow, it seemed longer.

  The twins came home on the school bus at four-thirty and both of them came up to tell me about their day. They thought nothing of the fact that their mother was in bed in the middle of the afternoon. They were well used to me working shifts, leaving, returning and sleeping at odd times. Needless to say, I didn’t enlighten them that I hadn’t been at the hospital the previous night.

  ‘So what did you learn at school today?’ I asked them.

  ‘Nothing,’ Oliver said. It was his usual reply to my common question.

  ‘I did,’ Toby chipped in. ‘I learned that Mr Harris can tell us apart.’

  ‘How do you know?’ I asked.

  ‘Well,’ he said rather sheepishly, ‘me and Olly sometimes swap, like.’

  ‘Olly and I,’ I corrected.

  ‘Yeah, right.’ He made a silly face. ‘So me and Olly always swap PE and art on Mondays. I hate art and he can’t stand PE, like, so we just swap. No one notices.’

  ‘Except Mr Harris?’ I said.

  ‘Yeah. He grabbed me today in PE and said that he knew that I was Toby when I should have been Olly. Of course, I told him he was wrong, like, but he put his finger up against his nose and winked at me.’

  ‘He must have been guessing,’ Oliver said. ‘I assume you had my kit on.’

  ‘Yeah, of course.’ Their school PE kit had to have large nametapes sewn on the outside to prevent ‘borrowing’. ‘But he kept calling me Toby and told me not to do it again next week.’

  ‘Do you swap a lot?’ I asked.

  ‘All the time,’ Oliver said with a huge grin. ‘It’s fun.’

  Physically, the twins were almost truly identical. Even I had difficulty telling them apart unless they were both together in front of me. Toby’s left ear stuck out very slightly more from his head than Oliver’s, due, I’d been told, to the position he had been lying in my womb when his ear had developed. Other than that I reckoned they were indistinguishable.

  Mr Harris must know something I didn’t.

  The boys went off, supposedly to do their homework but I knew that they would be playing computer games online first. Only when it was time for bed would they moan that they still had their work to do.

  I smiled.

  I had been just the same when I was their age, although I’d have been lucky to be allowed to play Pong on an Atari games console plugged into the back of the family television rather than on the ultra-HD virtual-world headsets with interactive surround sound that they had now.

  I rolled over in the bed and thought about the boys some more.

  They had turned fourteen in September, an age at which, I was reliably informed, they would instantly transform from the sweet and adorable children I knew and loved into the spotty, rude and opinionated monsters that all modern teenagers are.

  ‘Good luck,’ a friend had said to me last year. ‘I’ve only got one boy and he’s a nightmare. You’re in for twice as much. It’s the surly behaviour and answering back that I can’t stand. It always ends in rows and name-calling. And he’s now got piercings in his lips and even a dragon tattoo on his arm.’

  She had shuddered in disgust.

  So far, clearly, Grant and I had been lucky. Or maybe our intentional plan of letting the boys have increasingly greater freedom was working. One of my therapists told me that most teenagers want to sack their parents from the job they have done in the past, only to rehire them a few years later, but as consultants not managers – all the while maintaining their current account at the family bank.

  But whatever our plan, I suppose we had been fortunate that our boys hadn’t fallen in with a bad crowd where drugs were prevalent.

  Drugs.

  Cocaine.

  The unnamed man.

  Anywhere I might try to turn my thoughts, they always twisted back like a magnet in a solenoid. I was becoming almost obsessive about it.

  Who was he? And why did he die?

  6

  At Grant’s insistence, I remained in bed for most of Tuesday. I think he believed it was the right thing for me but it just gave my mind the time and space to worry about every conceivable minor family problem, as well as some of the world’s major ones.

  I was actually better when I was doing something.

  Grant had taken a second day off work even though I’d told him it was unnecessary.

  ‘I need to look after you,’ he said.

  Keep an eye on me more like, I thought, in case I decided to disappear off to Bristol once more. But the aching desire to harm myself had subsided during that long night at the bridge,
at least for the time being, so I didn’t put up a fight. I simply stayed in bed as he requested.

  However, on Wednesday morning, with some trepidation, Grant went back to work.

  ‘You stay here all day,’ he instructed before he left. ‘I’m taking your car keys with me.’

  ‘But I need the car. I have an appointment with Stephen Butler.’

  Stephen Butler was my psychiatrist and Grant had given an assurance to the Bristol doctors that he would get me to see him as soon as possible.

  ‘Can’t you get a taxi?’

  ‘Grant, don’t be ridiculous. I’m quite capable of driving.’

  I held my hand out for the keys and, reluctantly, he handed them over.

  ‘Please, be careful,’ he said. ‘Don’t do anything stupid.’

  As if I would.

  I don’t think Jeremy Cook was pleased to hear from me when I called him at eleven. After all, it had been he who had spilled the beans to the Medical Director that I’d been hiding in the linen cupboard.

  ‘Ah, hello, Chris,’ he said when I called him, the embarrassment thick in his voice. ‘How are you doing?’

  ‘Fine, thank you, Jeremy.’

  ‘How can I help?’ he asked.

  Help? I thought. That’s a laugh. He’d hardly been much help so far.

  ‘I need some information for the police,’ I said.

  ‘The police?’

  ‘Yes, a policeman came to my home on Monday and asked me to get him the blood-test results and a copy of the medical file for the man who died in the department on Saturday evening. Do you remember?’

  ‘Yes,’ Jeremy replied. ‘The man with no name.’

  ‘Exactly. Normally I would come in and get the results myself but, as you must know, I have been barred from entering the hospital.’

  That did nothing to lower the level of Jeremy’s awkwardness.

  ‘Why don’t the police go direct to the hospital admin?’ he asked.

  ‘I have no idea,’ I said. ‘But they’ve asked me to get them instead. You’re on ten till six today, right?’

  ‘Yes.’

  ‘Good. Make copies and I’ll collect them from you in an hour. I can’t come in so bring them out to me.’ I wasn’t giving him a chance to refuse. ‘I’ll be outside the main entrance in a light-blue Mini.’

  ‘OK,’ he said unsurely. ‘If I’m not too busy.’

  ‘If you are, send somebody else out. I’ve told the police that I’ll get everything to them by half past twelve today.’

  ‘OK,’ he said again. ‘In an hour, you say?’

  ‘Yes. Can you make the copies straight away?’ I asked.

  ‘I suppose so,’ he replied.

  ‘Good. See you in a bit.’

  I hung up before he had a chance to change his mind.

  It wasn’t only the police who wanted to see those blood results. I was pretty interested in them too.

  Jeremy Cook appeared right on cue dressed, as always, in consultant’s purple scrubs. He looked around, saw me, and rushed over and thrust a buff folder through the open car window.

  ‘Must dash,’ he said. ‘There’s a suspected myocardial infarction arriving in two minutes.’

  He hurried back inside without another word – and no awkward questions. Never before have I been pleased that someone was having a heart attack. As I drove out onto College Road an ambulance came the other way, lights flashing and siren blaring. Jeremy Cook was welcome to it.

  I parked in a side street in Montpelier near the Queens Hotel and picked up the folder. My hands were shaking.

  Jeremy had been busy. The folder contained not just the blood-test results and the medical file for the time when the man was alive, but also the preliminary report of the post-mortem examination of his body.

  I had told Jeremy I’d promised to get everything to the police by twelve-thirty but that had been just a little white lie to encourage him to make the copies. I had all the time I needed to study them.

  It was the blood results I was most interested in.

  I stared at the paper with my heart racing and there it was in black and white.

  Cocaine.

  The blood-plasma concentration was 0.7 milligrams of cocaine per litre. Normally a minimum reading of at least 1.4 was required to be considered a lethal dose but, assuming the man had been several hours in the lavatory cubicle before being found, the initial dose would have been much higher. Cocaine has a blood metabolic half-life of about ninety minutes. So, in a three-hour period, the level would have dropped to only one quarter of the original. In four and a half hours it would only be one eighth.

  However, it was the level of benzoylecgonine, or BZG, in the blood that was the real clincher. BZG is the primary metabolite of cocaine and it has a much greater half-life, remaining in the system long after the drug itself has ceased to be detectable. It is BZG excreted in urine that is used by the police or employers to give a positive test for cocaine. Scientists even monitor the concentration of BZG in the River Thames as a means of estimating the amount of cocaine consumed by the population of London.

  In this particular case, the BZG in the man’s blood was over 8 milligrams per litre, indicating an initial cocaine dose several times greater than that required to kill him.

  The junior doctor had been right: there was nothing we could have done to save him. The only surprising thing was that, given the levels, he had been still alive when he’d arrived at the hospital.

  So I hadn’t killed him. Giving the adenosine had made no difference to the outcome.

  I suppose I should have been elated but, in truth, I just felt empty.

  I looked up from the papers and watched as a young mother walked along the pavement with a tiny newborn strapped to her chest. It gave me an enormous pang of regret. Our baby would have been a few months old by now – if only I had managed to get pregnant.

  I forced my eyes back down and glanced through the post-mortem report.

  It only showed preliminary results but did reveal that no puncture marks had been found in the man’s skin, other than the one we had made in his elbow to take blood and administer the adenosine. A dip test of urine found in the bladder had confirmed the presence of a high concentration of benzoylecgonine, confirming the existence of a large dose of cocaine in the man’s system.

  The pathologist suggested that, most probably, the cocaine had been ingested orally as he found no evidence of powder in the nasal passages, and no residues in the lungs as might be expected if that much of the drug had been smoked. He had sent samples for analysis taken from the lungs and stomach to confirm this opinion, along with other specimens from the man’s liver, kidneys, heart and brain. A sample of hair had also been acquired to establish if there was a history of prolonged illegal drug use.

  As DS Merryweather had indicated, there was no definitive cause of death recorded in the report even though the pathologist did hint that the urine dip test made it likely that a cocaine overdose was the culprit. His final conclusions would only be made on completion of the toxicology tests.

  I put the papers back in the folder and placed it down on the passenger seat. For some considerable time I simply stared out the windscreen, drops of fine rain periodically marking the outside of the glass.

  Why did I worry so much about this man?

  Sadly, death in hospital was not uncommon. Dealing with the dying was one of the pitfalls of being an emergency-care doctor. Strokes and heart attacks were the most common causes. Accident victims who arrived alive mostly stayed that way, at least until they had passed through to specialist surgical teams. Nevertheless, I had witnessed hundreds, if not thousands, of my patients as they took their last breath and their lives literally slipped away through my fingers.

  Not that I had become immune and unaffected by the process of death, especially if the victim was a young adult or, worse, a child. Over the years, I had shed more than my share of grief-driven tears for those I had never known before they had arrived in front
of me with non-survivable injuries or untreatable disease.

  Some of my colleagues tried to grow a thicker skin or build a shell of indifference around themselves, anything to allow them to continue to function when the natural instinct was to simply close one’s eyes and run away.

  But there was something about the death of this particular man that troubled me.

  Maybe it was because no one knew who he was – his wife and family would still be unaware that their husband and father had ceased to exist nearly four days ago. Or perhaps it was that, in my experience, smartly groomed men in sober suits rarely presented at hospital with massive cocaine overdoses.

  Had he overdosed on purpose in order to kill himself, or had it been an accident? A cubicle in a gentlemen’s toilet seemed a strange place to commit suicide, but who was I to talk? Was it really any more strange than the rocks below Clifton Suspension Bridge? Was shattering one’s body with a high-speed fall in a public place somehow preferable to privately swallowing a cocaine-laced sandwich in a locked lavatory?

  If one was so desperate to die, did the manner or the venue matter?

  But, if the man had killed himself, why did he dispose of any form of identification beforehand? I knew that many suicides go to great lengths to ensure that their loved ones are not the first to stumble across their lifeless corpse. Did this man simply want to die without his family ever finding out?

  It sounded like a sensible idea to me.

  I read through all the papers twice more before driving to Cheltenham police station and parking in one of the visitor spaces round the back.

  DS Merryweather had asked me to phone him when I had the blood-test results but I had no real desire to speak to him again. I decided I would just hand in the folder at the reception desk, marked for his attention, and then leave. But it didn’t quite work out like that.

  ‘Dr Rankin,’ called out a voice behind me as I climbed the three steps up to the back door of the police station. I turned around.

  ‘PC Filippos,’ said a young uniformed officer. ‘We met at the hospital last Saturday.’