by Rob McCarthy
‘This isn’t the way to the ICU,’ Noble said. ‘Where are we going?’
‘Roll up your sleeves and take your watch off.’
‘Harry, where are we?’
‘Tennyson Ward,’ said Harry. ‘It’s the neurological rehab unit.’
The doors opened and he headed for the nurses’ station, Noble following reticently. Both of them worked alcohol gel between their hands, the steps a rehearsed muscle memory for Harry, requiring Noble’s attention as she tried to imitate him. The ward was quiet, more homely. Every patient had their own room, and the nurses almost looked out of place in their blue tabards.
‘Ah, the elusive Dr Kent,’ a quiet, measured voice said.
It belonged to a thin, wiry man with a comb-over and perfectly circular glasses, several pink folders of patient notes under one arm. He was dressed in a white cotton shirt and tan chinos, his bow tie pastel blue.
‘This is Professor Niebaum,’ Harry said. ‘He’s the ward’s head consultant.’
‘And to whom do I have the pleasure of speaking?’ Niebaum asked.
‘I’m Frances Noble. Detective Inspector, Southwark CID.’
Harry could tell from the stuttering that Noble was nervous, and that he had successfully removed her from her comfort zone. He felt a small stab of pride.
‘Ah!’ Niebaum said, smiling. ‘It’s fantastic that you’re here! Let me take you through.’
Noble was about to speak but Harry cut her off. ‘DI Noble is at the hospital investigating a different matter, actually,’ he explained. ‘But we had some spare time and I thought I’d bring her up here.’
Niebaum was already walking towards one of the side rooms off the ward, and Harry instinctively fell into step behind him.
‘One of the physios is in with Zara at the moment, so it’s probably best if she isn’t disturbed. Sorry, Harry,’ said the neurologist, before turning to Noble. ‘I don’t usually turn him away. If it wasn’t for Harry’s visits, I don’t think we’d be making any progress at all.’
Niebaum’s phone started ringing, and he dashed to the nurses’ station to take the call.
‘Who’s Zara?’ Noble asked. Her body language was passive-aggressive, hands on hips, legs braced. They were standing outside the side room, and Harry craned his neck to look through the door’s small window. He could see the shocking pink of her hair contrasting with the off-white bedding, the grey hospital gown. Two physiotherapists in white polos were going through the exercises used to maintain her muscle tone while she remained in a coma.
‘Her,’ Harry explained. ‘Zara’s her name. Well, it’s not; we don’t know her name, but it’s what we call her. She’s in the system as Female, Unknown.’
‘She’s unidentified?’ Noble said. ‘How’s that possible?’
‘She’s in a minimally conscious state. She was found unconscious with no identification on her, and she’s never regained enough cognitive function to respond to us, even if she does know who she is.’
‘A vegetative state?’
‘Close,’ said Harry. ‘Slightly better. She can follow simple commands, like moving her eyes from one side to the other. But she can’t process information. And we can’t communicate with her, so we’re not really sure to what extent she’s aware of her surroundings.’
‘Why Zara?’
‘She was wearing a pair of denim shorts from Zara when they found her,’ Harry said. ‘It stuck. It was the only identifiable feature on her. It’s a little more dignified than Unknown Female.’
‘What happened to her?’ Noble said.
‘August before last. The riots.’
Noble looked up, slackjawed.
‘She’s been here since 2011?’
‘Yup,’ said Harry. ‘I still remember it. The Monday evening. I’d been working a double shift in A&E – completely illegal, but fuck it. The hospital could barely cope, we were seeing so many injured. Some paramedics found her in an alleyway near Clapham Junction, rushed her in here. She’d been kicked in the ribs, hit on the head with something blunt. She had these little pinprick wounds on her chest, the kind you get if you’re lying on gravel and someone stamps on you. Whoever did it tried to strangle her, too, but didn’t succeed. When she came in, the hyoid bone was broken. That’s the—’
‘The bone across the front of the throat,’ Noble interrupted. ‘I know. I worked Homicide & Serious for two years.’
‘I had to do an emergency tracheotomy in A&E,’ Harry said. ‘She spent twelve weeks in intensive care. During that time it became clear that things hadn’t been perfect before she was attacked. She had needle tracks in her elbows, but none of the usual complications of long-term drug use. She was severely anaemic, had a vitamin D deficiency, her immune system was barely functioning. We analysed her hair and it suggested a history of benzodiazepine use and severe malnourishment. We spoke to some of the people who deal with child abuse, refugees and the like, and they say the results are in keeping with someone who was kept against their will for some time before she was attacked.’
‘Some time? How long?’
‘At least a month, according to them,’ said Harry. ‘Maybe longer, even.’
‘Fucking hell.’
A passing nurse frowned at the language and Noble muttered an apology.
‘She’s stable now, medically speaking,’ Harry continued. ‘And there’s little brain damage visible on the scans. But she’s been here more than eighteen months now, no improvement. You lot were interested at the start, but the case got shuffled around. No one’s come forward to claim her. Homicide & Serious poked around for a few weeks, so did Missing Persons, but since last year she’s had no one visiting her. Apart from me.’
‘You mean no one’s currently working the case?’ Noble asked, sounding surprised.
‘Not actively,’ said Harry. ‘I’ve been told that it’s the remit of the riot crimes unit, but as far as I can tell that’s all being wrapped up.’
Noble said nothing.
‘There’s got to be a family somewhere,’ he continued. ‘Someone who cares about her, who needs to know where she is.’
He remembered the first time he had seen her, a memory as clear as almost any of his life. She had no identity, save for her shocking pink hair and the T-shirt she had been wearing, a grimy off-white crewneck with the slogan ‘What the f*** are you staring at?’, each asterisk a different colour. The initial investigators had found that it was a relatively popular one, sold on the Internet and at several London markets. Likewise the bracelet she had on: a simple bronze chain, with a one-pence coin hanging from it, a hole drilled through the middle. Generic, possibly home-made, nothing that assisted them in identifying her. Every time the colour in her hair started to fade, Harry arranged for it to be redyed. Just to preserve what semblance of individuality remained.
‘You’ve got nothing else for an ID?’ Noble said, incredulous.
‘Nope,’ said Harry. ‘Nada.’
‘Dentistry? DNA analysis? Bone isotopes?’
Harry shrugged. ‘We sent DNA. No match on the UK register. Met wouldn’t fund the smart stuff.’
‘Will she get better?’
‘Probably not. In some similar cases, there have been reported recoveries after months, even years. Niebaum’s a world expert in minimally conscious states. But probably not, no.’
A short silence. A nurse headed past, comforting a crying relative.
‘Why do you keep visiting her?’ Noble asked.
‘No one else does. Also, Niebaum thinks that she responds better to me than to any of the other staff. Sometimes she displays spontaneous eye movements, patterns of blinking and rotation that might be an attempt at communication. I think it’s just coincidence, but he wants me to keep coming.’
Noble said nothing. The two physiotherapists left the room, discussing whether to go for a coffee or not, leaving the girl with the pink hair lying on her side, still attached to the monitors.
‘Bloody hell!’ Noble exclaimed. ‘S
he’s only a kid!’
‘Between twenty and twenty-three,’ said Harry. ‘At least, that’s what the experts think. But if she had been severely malnourished, she could be older.’
‘Jesus.’
Harry took a deep breath in and spoke quietly. ‘I just think she deserves more than this existence. She’s not a vegetable. She’s capable of some interactions with her environment, and she deserves to have her family here with her. And I can’t find out who she is by myself.’
‘So that’s why you’re working with the Met?’ Noble said. ‘You’re hoping you just stumble on this girl’s identity?’
‘Well, no one else is looking for her,’ Harry said, turning out of the room. ‘And she didn’t just appear by magic, half dead in Clapham, did she? Somebody in this city knows who she is, and I’m not going to find them sitting around in this hospital.’
Noble looked at him the way she might have done at one of those people who ring up the police claiming to have solved the identity of Jack the Ripper. Harry considered a variety of responses, from pleas for help to condemnations that she, like the others, was only interested in the glamorous cases, the ones with press conferences at the end and promotions a few weeks afterwards.
Instead he just said, ‘Let’s go downstairs.’
Back in the ICU, Dr Rashid was surrounded by a crowd of junior doctors and medical students as he strode from bed to bed. He was recounting Idris’s history as a perfect example of the type of patient that intensive care doctors were particularly suited to treating. Critically ill, a combination of medical and surgical problems, several interacting systems which all needed to be controlled. Rashid noticed Harry and walked over to him.
‘You’re late, Harry. Ward round’s at nine, sharp. I guess I’ll let you off, given recent events.’
Harry mumbled some thanks.
‘I’ll carry on with the round. Maria’s the long-day reg, so you two sort out the tasks that need doing. Central lines out, beds twelve and nineteen need a trachy, we think, and we have a transfer in from Canterbury at about lunchtime.’
Harry added the tasks to the mental list in his head. Rashid appeared to be done, but then noticed Noble standing behind Harry.
‘Who’s that?’
‘She’s a detective,’ said Harry. ‘She’s investigating the shooting.’
Rashid nodded. The ward round had moved away to the next patient, and Harry turned, hoping to catch a glimpse of Idris.
Bed eighteen was empty.
‘Where’s he gone?’
A transfer out so early in the day would be for only two reasons – either he’d been rushed back to theatre for some emergency procedure, or he was in the mortuary.
‘Calm down,’ Rashid said, touching Harry on the arm. ‘We moved him to the side room. Police request, so the guard could keep an eye on visitors.’
Bay ten was an isolation room, with just one set of doors as opposed to the cubicle set-up of the other ICU beds. As Harry looked over, the copper on duty was making conversation with Noble. To protect Idris from infection, he wasn’t allowed inside the room itself.
‘Maria will fill you in,’ said Rashid, before leaving to rejoin the ward round. Harry looked around for the other registrar, who had the unpleasant job of working eight until eight as opposed to Harry’s kinder nine to five. When he finished turning, a short, tanned woman was waiting. It wasn’t unusual for Harry never to have met the junior registrars, who were often rotating from a different training programme, such as A&E or general medicine.
‘Maria Saltis.’
‘Harry Kent. Did we get a Micro opinion on bed ten, Solomon Idris?’ Harry asked.
Saltis brought it up on the computer screen. ‘Yeah, based on the X-ray they said treat for PCP, and cover for a secondary bacterial as well. We’ve started co-trimoxazole.’
‘Do you mind if we quickly go and see him before we go through the list?’ Harry said. ‘I’m not sure if Dr Rashid told you, but I brought Idris in last night. And there’s a police officer who wants to see him, too.’
Saltis appeared hesitant, and Harry clocked why. She was a new registrar on a new rotation, and with the consultant on the unit she didn’t want to be seen as taking liberties.
‘Start without me, and give me all the crap jobs, then,’ Harry said. ‘I’ll be ten minutes, I promise.’
Saltis smiled and nodded.
‘OK, then.’
Harry thanked her and headed towards the side room where Idris was. Outside the room, the plainclothes cop on guard duty leant against the wall, a pistol on his belt. Noble caught Harry’s eyes as he headed into the isolation room.
‘Can I come in, too?’ she said.
‘Roll your sleeves up, wash your hands in that sink and put gloves and an apron on,’ Harry said, pointing at a roll of plastic aprons attached to the wall.
‘Mornin’, Dr Kent,’ said a voice from inside the room. Each ICU patient had their own assigned nurse, and Idris’s was Gladys Lane. Despite a number of frustrated conversations, Gladys insisted on calling him Dr Kent.
‘How is he?’ Harry said, stepping into the room. Idris looked tired – as the ventilator kept breathing for him, his chest expanded beyond what it normally would, the skin stretching across his ribs and making him look even emptier than he was. As he watched Idris breathe, Harry briefly wished he could read minds.
‘Been OK in the mornin’. His saturations dropped down at about six-thirty so they had to put his oxygen back up.’
‘What’s he on now?’
‘Point six,’ said Lane.
‘Is that bad?’ said Noble, who had entered the side room behind him.
‘It means he needs to breathe sixty per cent oxygen,’ said Harry. ‘You and I make do with twenty-one per cent. So it’s not brilliant.’
He hunched over the computer screen in one corner of the room and started scrolling through all of the results. Idris’s blood gases had improved steadily throughout the night, and his kidney function appeared good, which was reassuring. The rest of the blood work was as expected. He was anaemic, but that was because he had almost bled to death. His platelets were on the low side, too, but Harry looked up at the drip-stand and saw that there was a bag of them running in now. Whoever the night registrar had been, he or she had done a good job.
‘Try and drop him down to point five on the ventilator,’ Harry said. ‘His last gas was good.’
‘As you wish,’ said Lane, moving over to the machine to make the change.
‘So what’s the deal?’ said Noble.
‘He hasn’t got worse,’ Harry said. ‘He’s stable now. Which I was worried he’d never be, after the state he was in.’
‘That’s good, right?’
Harry nodded. ‘But as you can see, the surgeons still need to get in there and fix the problem. His spleen needs a definitive repair. Might even need to be removed.’
He pointed down and Noble followed his gaze, looking at the plastic covering, about the size of an A4 paper sheet, which sat between peeled-back skin edges over the centre of Solomon Idris’s abdomen, stapled crudely in the four corners and covered with a transparent dressing. Beneath it, the dark pink shapes of Idris’s abdominal organs pulsed and twisted, reminders that the teenager connected to the tubes and wires was still alive, not just an exhibit in a human museum.
‘That’ll happen today?’ said Noble.
‘Probably. The sooner the better,’ said Harry. ‘I’d be happy for him to go today, and I’m sure the anaesthetists will be too. We don’t like leaving patients with their bellies open.’
‘So when do you think he’ll be waking up?’ Noble said.
‘I can’t answer that question,’ Harry said. ‘He’s in a serious condition. Not today, by any means, and not tomorrow, either. And that’s assuming he wakes up at all.’
‘But we’re looking at days?’ Noble said.
‘That’s the best-case scenario,’ Harry said. ‘It could well be a week or two, here in the ICU, if t
here are complications. And I’ve known cases like this where it’s been longer.’
‘Right.’ Noble sighed. ‘We’re not going to get to sit down with him for two weeks, is that what you’re telling me?’
‘I don’t want to keep him asleep any more than necessary. And believe me, I want to find out what’s going on with this kid just as much as you do. But if he needs to be under for two weeks, or a month, then so be it.’
Noble backed away, shaking her head.
‘I’m sorry, Harry, I didn’t mean to—’
‘Forget it,’ Harry said. He started scrolling down to see if the tests Rashid had ordered in the early hours of the morning were back yet.
‘Well, you haven’t wasted a trip,’ he said, tapping the computer screen with the end of his pen. Noble leaned forward to read the results and Harry moved out of the way. Tapped the part where it said: Microbiology Result Available – Urgent Serology (HIV-1): antibodies detected.
‘He’s HIV-positive?’ said Noble.
‘Yes, he is,’ said Harry. ‘And all the evidence points to him having no idea. And he might be able to hear us, so keep your voice down.’
‘What kind of evidence?’
‘Well,’ Harry said, ‘the organism causing his pneumonia is called pneumocystis, and we only ever see it in patients with a poorly functioning immune system. When people get infected with HIV, it kills their white blood cells, particularly a type called CD4, and eventually they get these opportunistic infections. We call them AIDS-defining illnesses.’
‘And he’s got one of them?’ Noble said.
‘Exactly,’ said Harry, flicking to another page on the screen. ‘Solomon’s CD4 count is low. Which, combined with his youth, suggests to me that he’s not been undergoing any HIV treatment, and this is the first presentation of the illness.’
Noble took in the information and sucked air in through her teeth.
‘Christ,’ she said.
‘Yeah, he must be especially vulnerable to have developed an infection so soon, but even then he was probably infected two or three years ago. We’ll start him on therapy,’ said Harry. ‘What with our catchment area, we see more HIV than most other hospitals in the country. Our guys are good. And there’s this.’
