Pain

by Adam Southward

  The first video finally started playing. From St Bartholomew’s, dated three months ago, it was better quality than the one from St Mary’s. Alex watched the clock in the top-right corner of the screen. 23:08 – almost the same time. Shift handover – the perfect time to slip around inside a hospital while the staff were distracted.

  There he was, a silhouette at the entrance to the ward, lingering, checking the nurses, keeping his head ducked before slinking across towards four curtained bays. Something in the man’s posture made Alex pause and rewind the video. He stared, frowning, before continuing.

  The angle from this camera was poor. The suspect entered a bay and stood with his back to the camera, blocking out any sight of the patient. Alex watched for seven minutes, then fast-forwarded another twenty. The figure swayed, shifting, but Alex couldn’t make out what was happening, and then it was all over. The man left the curtain and walked towards the entrance, seeming less alert, shuffling. At one point he staggered, putting his hand out to steady himself at the doorway. The video ended.

  Alex frowned. It looked like the same person, but the video didn’t capture anything useful. He brought up the accompanying notes – the medical summary and cause of death. Reading through, he felt sick to his stomach.

  The patient had been sixteen years old. Still a child. Alex had a flash of Katie in a few years, lying helpless in a hospital bed, and shook it out of his head.

  This girl, Dawn Hitchens, had herniated a spinal disc at her gymnastics centre, where she was training for the regional squad. Alex knew the basic physiology of the injury – a disc ruptures and the gel inside leaks out, causing sudden and severe lower-back pain, often spreading to the legs. Most cases are treatable with painkillers and moderate intervention, but Dawn had been brought into the emergency room because of numbness in her feet and a high fever. Due to be checked out by a consultant the following morning, Dawn was only on mild painkillers and had complained, in some distress, about her level of pain. The parents had also complained to the matron. At handover the nurse had promised to explore stronger analgesics to see her through the night.

  Dawn never made it through the night.

  She was found dead after shift handover, turned on her side, her back scratched, bruised and swollen. Marks and contusions in the skin suggested the slipped disc had been repeatedly pressed and manipulated. The cause of death was asphyxiation, but this appeared to have taken place after the torture had finished.

  The doctor’s report, some of which had been withheld from the parents, pending the police investigation, stated that the girl must have been subjected to ‘extreme and punishing pain for an extended period’ before she died. The local police weren’t called until much later that night. Due to a technical oversight, the police didn’t request the CCTV until another week had passed. The case was opened, but was the first of its type. They had no idea who the hooded figure was, and no leads whatsoever.

  Alex took a moment. He stared at the floor, breathing slowly. As usual, four in, hold, four out. Reading the report had been worse than seeing the video. He knew he should be diagnosing, positing what might cause such behaviour, but found himself unable to think straight. That girl had been taken from her family at such an early age, before she’d had a chance to make her mark on the world. Who had the right to do that? Who would do it, knowing the trauma they would cause? A disturbed mind, either through nature or nurture, or through a temporary influence. But that was hardly a diagnosis. The police knew as much the minute they’d watched the video for themselves.

  You’ll need to do better than that, Alex, he thought to himself.

  Calming himself, he opened up the next video. This was one month ago at London Bridge emergency room. Four in the morning, not shift handover, but a quiet night. Alex scanned the notes first, wanting to prepare himself.

  Ian Jordan, a thirty-eight-year-old lawyer, brought in by ambulance with a burst appendix. Risk of sepsis was considered high and the surgical team was prepping. Ian was less than an hour away from having the troublesome appendage whipped out, being settled with a dose of antibiotics and having a few weeks off work.

  The paramedics handed over and the patient was left in a bay, in full view of the CCTV.

  The suspect appeared at the edge of the screen at 04:09, hovering, same posture, face down, hoodie up. He waited until three of the nurses ran out to deal with another situation – the report said a road traffic accident with four casualties was incoming.

  As soon as the nurses were out of sight the suspect ran over to the trolley holding Mr Jordan. Again, Alex narrowed his eyes. Something in the way the suspect walked bugged him.

  This time, Alex had an uninterrupted view of the suspect’s handiwork. His face remained in shadow, but his right hand went straight for the patient’s lower abdomen while his right slipped a strip of tape across the mouth. Using both hands and his weight, the suspect leaned in, putting pressure on the patient’s face, presumably to stop him screaming, and on the area of his gut already in immense pain. Alex watched as the man lifted his hand, bunched a fist and punched repeatedly into the patient’s stomach. It went on for several minutes like this, and Alex found himself swallowing, the nausea rising as he imagined the pain this victim must be going through.

  According to the clock, the suspect stopped eight minutes later, pulling off the tape and leaving. Again the suspect staggered, crashing into the next trolley before moving out of sight of the camera.

  Ian Jordan died shortly afterwards from an internal haemorrhage. It was unexpected and caught the attending doctors by surprise. They assumed sepsis, until the post-mortem revealed the truth several days later. Then the police were called.

  Alex rewound the video and watched the suspect stagger off. He did it again, and a third time to be sure. His first conclusion at least was something the police didn’t know.

  ‘You look pleased.’

  Alex spun in his chair to find Hartley behind him. She looked tired, but less stressed than before.

  ‘I’d hardly call it “pleased”,’ said Alex. ‘I’ve just watched the other two CCTV videos and read the reports.’

  Hartley screwed up her face. ‘Yeah. I know.’ She nodded and their eyes met. Neither needed to express how sick it made them feel.

  ‘So what can you tell me?’ she said, taking a chair, pulling a Thermos out of her bag. Alex was about to answer but Hartley cut him off.

  ‘Herbal tea. Doctor says I drink too much caffeine.’

  Alex nodded. He’d have to find his coffee elsewhere.

  ‘So?’

  ‘Not much,’ said Alex, ‘except he’s a she.’

  ‘Beg your pardon?’ said Hartley, pouring the steaming liquid into a mug.

  ‘Our suspect is female. Something bugged me in the first video. Baggy clothes hide a lot, but they can’t hide certain things.’ He rewound the second video and played a clip of the suspect moving away.

  ‘Look here. The hip rotation and extension of the legs. I attended a witness coaching course a few months ago – they covered this and it suddenly hit me. Male and female gait is subtly different. You can’t always detect it, but here you can. See.’

  Alex replayed the clip, pointing to the suspect’s waist and hips. ‘It’s the way women place their feet,’ said Alex. ‘Men don’t walk like that.’

  Hartley sipped her tea, screwed her face up even more, and took the mouse from Alex, playing the video another couple of times.

  ‘Lucky break,’ she said, giving him a smile.

  ‘You agree?’

  ‘I agree,’ said Hartley. ‘I’ll get a second opinion, but I think you’re right.’

  She continued to sip her healthy drink, clearly not enjoying it.

  ‘Does it change anything?’ she said.

  ‘Yes,’ said Alex, ‘I think it does.’

  ‘In what way?’

  ‘In that it rules out a lot of the usual motives,’ he said. ‘The psychological profile for this type of crime – even th
ough I’ve never seen anything quite like it, but I mean ABH, GBH, intent to cause severe injury and death – is predominantly male. That means . . .’ He tailed off, trying to process his thoughts, pick the right words. ‘It means we’re dealing with someone rather special.’

  ‘I told you that,’ said Hartley. ‘Tell me something I don’t know.’

  Alex flushed, a little annoyed. He’d made a contribution, if minor, to the case, but it seemed to go unrecognised by Hartley. He shook his head at her and she gave him another, less convincing smile. Her phone buzzed and she excused herself, heading towards a row of cubicles along the far wall.

  Alex watched her go, trying to focus, trying to make sense of what he’d seen so far. He leaned back in his chair, ignoring the anxiety tugging at his gut.

  Could it be gang-related? Alex knew little of such things, but the background information on the three victims didn’t warrant such a conclusion, particularly the sixteen-year-old gymnast. The individual investigations so far hadn’t revealed anything remotely associated with gangs or turf wars. Hartley hadn’t mentioned it. She would have done if she thought it had any relevance.

  If not a gang or another retribution-style cause, then Alex was left with the simple explanations or the extreme. Simple was more likely to be true: drink and drugs. But what possible combination of narcotics could elicit such wanton violence? These attacks were planned, premeditated. Not necessarily the victims themselves, but the timing, the situation. The location . . . Why hospitals? Full of vulnerable people, but also full of staff and security.

  Also full of drugs, but the suspect went straight for the patients, not for the pharmacy.

  Unless she had another reason for being at the hospital.

  Alex was grasping at nothing. He made a note on his pad to speak to Mikey. Their relationship was mainly business these days but based on a deep friendship that went all the way back to medical school. Mikey was a pharmacist for the NHS and sold prescription drugs on the side to fuel his gambling habit. Alex bought prescription drugs from Mikey to fuel his benzo habit. The two of them also went for the occasional beer, although that was rare of late. As they got older, each had become more conscious of their own failures, and the banter had become strained, serious. Each offered advice to the other. Both knew they were the worst type of hypocrite.

  He’d ask, but Alex wasn’t convinced this was drugs, and it almost certainly wasn’t alcohol.

  So if the explanation wasn’t simple, that left the extreme. The outlying psychological conditions that could turn a normal human into a monster.

  Hartley appeared over the desk partition. She looked puzzled.

  Alex raised his eyebrows. ‘Progress?’

  Hartley shook her head. ‘No. I just spoke to another witness.’

  ‘Oh?’

  Hartley edged forward, leaning on the partition. ‘I think our suspect is high when they’re committing their crimes,’ she said. ‘Seriously high.’

  Alex frowned. He didn’t tell her he was on the verge of dismissing this. ‘It’s possible,’ he said, ‘but there’s nothing I can think of that would cause such behaviour.’

  ‘The porter who caught our suspect in the act,’ said Hartley. ‘He said that when he gave chase our suspect got hit by a bus outside the hospital.’

  ‘A bus?’

  ‘Indeed. He said it clipped her shoulder and sent her flying, ten feet or more into the kerb. The bus stopped, the driver panicked, but guess what our suspect did?’

  Alex shrugged, not liking where this was going.

  ‘He or she got up, brushed themselves off and sprinted away faster than Usain Bolt.’

  Alex chewed his lip, nodding to himself. ‘The porter didn’t exaggerate?’

  ‘The bus driver corroborated it,’ said Hartley.

  Alex sniffed. ‘Well, the suspect could just have got lucky,’ he said, although he thought getting hit by a bus was a pretty unlikely trauma to run away from.

  ‘Or?’

  Alex thought about it. ‘OK. Possibly high. Some sort of NMDA receptor antagonist. Angel dust—’

  ‘PCP?’

  ‘Yes, or ketamine. That class of drug could provide enough pain detachment to allow you to walk away. But the person would need to be pumped to the eyeballs with it. I doubt they’d be able to sprint.’

  ‘Would PCP cause any other symptoms?’

  ‘You mean like a desire to sadistically torture somebody?’

  Hartley smiled. ‘Something like that.’

  ‘No,’ said Alex, his voice confident, although he was beginning to feel anything but. ‘PCP, ketamine and the like can cause all sorts of symptoms, and yes, mild aggression has been recorded in some patients.’

  ‘Well, there you go—’

  ‘Not like this, though,’ said Alex, remembering the video and the medical report. He lowered his voice. ‘Not like this, Detective. Our suspect might be taking PCP or any manner of drugs, but it didn’t cause her behaviour.’

  Hartley looked about to challenge him but saw his face and obviously thought better of it. She tapped the partition and left him to his musings.

  CHAPTER SEVEN

  Mia’s mood descended. She waited on a bench in Regent’s Park, collecting her wits, waiting for the right time.

  Sometimes several days could pass and Mia would feel almost normal. She’d enjoy the sunrise, take in the fresh air and stroll through the city streets, believing she was just one of many, a normal citizen of this alien city.

  But when Mia’s darkness fell and she plummeted into her inner nightmare, her body would quiver and scream, her mind falling in line. No matter how much she fought – and she did fight it – she could never hold out for long.

  St Mary’s was out of the question today, after the incident with the bus and the porter. It wasn’t safe to return, not when she’d been seen. But London City Hospital was only five minutes’ walk from the park; she’d go there. She knew all the London hospitals intimately. She relied on them. Mia was drawn to these places of suffering. They provided her with easy sustenance, and she didn’t know where else might offer the same.

  But they were more than hunting grounds. Something else drew her in: a familiarity that tugged at her gut, fleeting and incoherent. It flashed in her mind for an instant, then slipped away, leaving nothing but anguish. She had to go. She had to be there.

  Mia chose the direction and moved, her shuffle widening into a purposeful stride. Head down, she remained on the outskirts, always avoiding people, always ducking to the side, into a doorway, or skipping into the road. She had the knack of drifting through the crowds, leaving nothing but a shadow in her wake.

  She paused a short distance from the main entrance to City Hospital. Leaning against a railing, she held a folded tourist map, pretending to study it. Two police officers with clipboards stood at the doors, scanning the flow as people passed in and out of the building.

  Probably nothing, she thought, edging closer, remaining on the opposite side of the road. Two minutes later, Mia stopped again. One of the officers had hold of a young man dressed in dark jeans and a black hoodie. The officer pointed to the man’s head, and Mia watched him pull the hood back. His hands were out, palms up, protesting his innocence. After a few words, the officer let the man go and he continued on his way.

  Anxiety coursed through Mia. She heard her heart beating, battling between her desire to continue and her worry at being caught. The decision was made for her as the officer raised his head to scan the road. Panicking, Mia backed into the shadows, slipping down a side street and into an alleyway. She crouched out of sight behind a wheelie bin, cursing the police and herself. Stupid, she thought, and careless.

  Her first mistake. Or had she just been unlucky? Chance had brought the porter to the bedside and prompted the chain of events that followed.

  The hospitals were being watched and her frequent visits noticed. She wondered if St Mary’s was the only one they knew about. She’d been careful in the others, so many o
thers. In and out. People had suffered and died, but she’d never been caught. Never even come close.

  Her luck had finally run out.

  Rummaging in the wheelie bin, Mia found an old plastic bag and scrunched both her hoodie and coat inside it. She emerged from the alley in a vest top and jeans, carrying the bag. She was cold, and it left her splinted arm exposed, but she looked different; it was enough.

  The whirling panic crept back in as soon as she’d caught her breath. Mia walked and she sweated, her mind a mess. This couldn’t be happening. She couldn’t access the hospital. Her appetite hadn’t been satisfied, and she worried about the consequences. Mia was teetering on the edge and needed gratification. What would it take to tip her over?

  They couldn’t stop her. They mustn’t.

  She waited. The sun began to dip and the shadows snaked across the streets. Shivering, she held her bare arms against her body, hugging the heat into her thin chest.

  The police remained at the entrance of City Hospital, but there were other ways inside. Mia slunk past on the opposite side of the street, keeping out of sight, her arm hidden and her black clothing in the bag. The underground parking lot could be accessed by a side road, and Mia stuck to the shadows, joining the flow of pedestrians, workers and patients heading in and out.

  She followed a group of nurses. They headed down the tarmac ramp, turning at the bottom, not towards the parked cars but towards the staff entrance. Mia had been here before. The door was badge-access only; it led directly up to the emergency departments. But everyone tailgated. She could get through with a little patience.

  One of the nurses, a large lady with a rucksack slung over one shoulder, stumbled, grabbing a handrail for support. Mia stopped. The nurse was in pain; her leg throbbed. Mia watched, feeling the tendrils snaking out, teasing and coaxing her. A sprain, or something deeper. Mia couldn’t tell, but she glanced around, wondering if she could take a chance.