‘Not as a single dose?’
‘No. I titrated it in.’
‘Titrated it against what?’
‘Against the patient’s response.’
‘What would you expect to happen to a patient’s respiratory rate when you infiltrate such a large dose of narcotic?’
‘It would become suppressed.’
‘Would this be significant in a patient with damaged lungs and airways?’
‘Yes.’
‘Could he stop breathing altogether?’
‘Yes.’
‘Dr Cameron-Strange, was it your intention, when you administered this medication, to kill your patient?’
Here it was. I had wondered about this question, I had asked it of myself, many times. How should I play this? What sort of message to convey? There are a hundred different ways of skinning a cat. Maybe. But there is only one truth. What was the truth?’
‘It was my intention to give him pain relief.’
‘Let me rephrase my question for you, put it another way. When you administered 50 milligrams of morphine to a severely traumatised patient with a major insult to the respiratory system, what did you expect the ultimate outcome to be?’
‘I believed I could make him comfortable.’
‘Yes, but what did you expect the ultimate outcome to be?’
‘I believed that, no matter what I did, even if I pulled out all the stops, my patient had no chance of survival. I also believed that in view of the particular nature of his injury, survival would not have been in his best interests.’
‘Ah yes, you decided, turning your back on an evidence base of which you testify you are aware – I think we have concluded that much …’ – Quint brandished his copy of the New England Journal of Medicine – ‘you decided, did you not, that your patient could not survive.’
‘Objection!’
‘Now we hear you decide, on the basis of – what? – two minutes’ acquaintance? – that your patient should not survive.’
‘Objection!’
‘My patient’s life expectancy could be measured in minutes to hours – maybe a day, if we had been really aggressive.’
I felt myself getting a little heated, and I’d told myself not to get heated. Letitia had told me not to get heated. We had even rehearsed this scenario, with one of the junior counsel taking Quint’s role and being as obnoxious as possible. ‘Whatever you do,’ Letitia had said, ‘don’t lose your temper.’ I think she must have sensed that I had a propensity to do just that. ‘Remember, Quint will test your evidence. He’ll try one line of attack after another. Just keep your cool and, no matter what, keep telling him you gave that morphine solely to provide pain relief. Got it?’
‘I ask you again, doctor. Did you intend to end your patient’s life?’
‘I intended to palliate his suffering.’
‘And wasn’t it a corollary of that, that you knew your patient would die?’
‘My patient was going to die, come what may.’
‘But you helped him along a bit, didn’t you? Oh come on, doctor! You didn’t give him 50 milligrams of morphine to take away his pain, you gave him it to kill him, didn’t you?’
‘You’re making a distinction that I don’t think exists in reality. I don’t think you know what it was like in that resuscitation room.’
‘Well then! Please enlighten us!’ Quint had lost his dry detachment. He was suddenly animated. He was like a hound who had picked up a scent of quarry. He was casting around the court room, making expansive gestures, summoning the spectre of Sir Edward Marshall Hall. ‘Perhaps you could tell us what happened in that emergency room. Tell us, for example, what happened to your patient over the next few minutes following the injection of narcotic.’
‘He lapsed into unconsciousness.’
‘Yes. Indeed he did. But more than that. Charge Nurse Mulholland has described to us how the oxygen saturation of the patient, measured by the technique of pulse oximetry, fell from 94 per cent to 73 per cent literally on the end of your needle. And she has explained to us, in clear, lay terms, what this means. We have also heard how, in the ensuing minutes, your patient suffered a cardiac arrest, which has been described as a “hypoxic arrest”, and that you ordered the nursing staff neither to assist the patient’s ventilation, nor to proceed with cardiac resuscitation. All this, doctor, literally on the end of your needle.’
Quentin Quint had become more and more animated as he described these incidents. Now he did something which caused the whole court room to jump. He had returned to his desk and he now proceeded to cast his notes thereon, and to swing round to face me again. He brought his clenched fist down on the lectern with a thump. ‘I ask you one last time. Isn’t it true that you intended to kill your patient?’
‘Yes! But you’re missing the point …’
Quentin Quint raised his arms aloft in a gesture of benediction and allowed them to slap down against his sides. ‘Thank you doctor! Thank you! I may be missing the point, but I have no further questions.’
Letitia O’Dwyer arose and moved into the cross-examination immediately. She did not wish to delay and allow the jury to recognise that an important point had been established. She approached the dock. She was a tall and attractive woman in her mid-thirties, with long dark hair worn up. She was dressed severely in an academic gown on top of a white blouse; a calf-length, dark-blue pleated skirt; dark stockings; and black shoes in patent leather with a slightly raised heel. Her candid, level blue eyes held no glimpse of sympathy or humour. They were grave and professional. Her features were even, the nose straight, and the chin firm. She walked with a long-limbed grace that might have been studied. All in all she was a powerfully attractive woman made, paradoxically, the more sensuous by the constraints of the dress code of her profession.
‘Dr Cameron-Strange, you have stated in your testimony that, in your view, survival for this patient would not have been in his best interest. Why is that?’
‘The patient had no viable limbs. The injury not only to the skin but also to the other tissues, fat, muscle, nerves, blood vessels, would have necessitated four amputations. In addition, the patient had lost sight. There was a very severe injury to the respiratory system which would almost certainly have resulted in chronic problems. Then there were the prospects of all the complications of a prolonged period of intensive care, perhaps as much as a year to eighteen months, involving adult respiratory distress syndrome, renal failure, infection, septicaemia, disseminated intravascular coagulation. The list is endless.’
‘I see. We have been discussing this patient for a few days now, and we all have a picture of the patient in our mind. I have with me some images of the patient taken at the time of the presentation, and I would ask that you identify the patient for the benefit of the court.’ Letitia O’Dwyer turned to the bench. ‘With the court’s permission?’ There was a curt nod. The light was dimmed, and a projector was linked to a laptop for a PowerPoint presentation. The image was projected on to a bare expanse of wall.
‘Doctor, is this Unidentified Male hospital number 5126EQX?’
I glanced briefly at the macabre, charcoal manikin. There was dead silence in the courtroom. ‘Yes, it is.’
‘And a couple more images, just to confirm.’ The projector clicked. One of the hands, the useless remains of the fingers like charred tree stumps in a bush fire. One of the trunk. The denuded torso. Not a square centimetre of viable skin. Lastly, the face. There was a gasp from a member of the jury. The judge said sharply, ‘All right, that’s enough. Lights, please!’
I surveyed the jury. They were visibly shaken. There was a momentary interruption to the proceedings while one of them put her head between her knees. Somebody fetched a glass of water. The Honourable Justice Lowell glared angrily at defence counsel. ‘Miss O’Dwyer, I won’t tolerate any more stunts of this nature. Clear?’
She looked contrite. ‘My apologies, Your Honour.’ But I knew she had just scored a major point on my behalf. O
ur relationship had not been easy. I distrusted the legal profession and I had a notion she felt the same way about medics. Maybe a family member, a loved one, a friend of hers, had suffered some sort of medical misadventure. At any rate we had treated one another with formal courtesy and there was little warmth, and absolutely no flirtation between us. The professional circumstances forbade it. But she had just done me a big favour. The message certainly wasn’t lost on the jury.
She returned to her desk, made to sit down, then swung round again with an afterthought. A look of curiosity had come over her face. I had a sudden premonition that she was going to ask a question that she did not know the answer to.
‘Dr Cameron-Strange …’
My heart started to thump.
‘You mentioned just now, in your testimony, that the patient spoke to you.’
‘Yes.’
‘What did he say?’
‘I’m not sure that I can recall. He asked for something for pain.’
‘Anything else?’
‘Nothing relevant to the proceedings.’
The judge transferred his glare from Ms O’Dwyer to me. ‘Doctor. Please recount, as far as your memory allows, everything that the patient said to you.’
‘I’m not sure that I am in a position to do that, sir.’
‘Why not?’
‘It’s confidential.’
There was a protracted pause.
‘What?’
‘I don’t think I can recount what he said to me without betraying a patient’s confidence.’
‘Even, doctor, in light of the fact that the patient is deceased?’
‘Yes, sir.’
‘Doctor Cameron-Strange …’ A new suspicion had crept into the judge’s voice. ‘Did you know, at the time of his presentation, who this man was?’
‘I can’t say.’
‘You are unable to say if you knew who this man was, or what he said to you?’
‘That is correct.’
I had swivelled round to address the bench. From the corner of my eye, I could see Letitia O’Dwyer, seated at her table. She was holding a hand across her forehead.
‘Doctor. I am directing you to divulge this information to the court.’
‘I’m afraid I can’t do that, sir.’
‘You will doubtless recall that you are on a charge of manslaughter.’
‘I’m unlikely to forget it, sir.’
‘The Hippocratic Oath, doctor, allows you to divulge confidential information to a court if your duty as a citizen overrides your duty to safeguard a patient’s confidentiality. If you do not divulge this information now, I have no alternative but to hold you in contempt of court.’
‘Your Honour, I have to say at this moment that I am feeling pretty contemptuous.’
I’d lost it.
There was a heavy silence. The public gallery licked its lips. Quentin Quint leaned back in his chair with both arms spread out across the backs of two neighbouring chairs. Letitia O’Dwyer had buried her attractive face in both hands. The judge had lost his avuncular beam. A pale spot, like a Cyclops, had appeared on the centre of his forehead.
‘The defendant will remain in custody to consider his situation. Court will adjourn until ten o’clock on Monday morning. Take him down.’
II
I’m thinking of getting married again.
Before you rush to congratulate me, may I remind you of a scene in the film The Graduate, starring Dustin Hoffman and Anne Bancroft, in which Benjamin announces to his parents that he is going to marry Elaine Robinson. Benjamin’s mother squeals with delight and reaches for the phone so that she may share her joy with Mrs Robinson. Benjamin suggests to his mother that she may wish to delay making that call. Elaine does not yet know that she is going to marry Benjamin.
Eugene Onegin, a spare prick at a wedding if ever there was one, made the biggest mistake of his life when he spurned Tatiana. But then, his head was full of shit. That’s what an old Kiwi girlfriend of mine used to say to me when I answered some obscure question in Trivial Pursuit. ‘Yer head’s full of shit!’ Onegin wandered around between his country estates and Petersburg, affecting the world-weary ennui he supposed befitted an aristocrat. When he fights a duel with his friend Lenski, pistols at dawn, he wins, precisely because he couldn’t care less one way or another. He treated life as a dalliance, blissfully unaware that the things that really matter in life are the things his grandparents would have told him to value, the things he turned his back on with his smug and all-knowing arrogance. Home, hearth, family, community, caring, the Church. Faith. Hope. Love.
These were the thoughts that occupied me while I kicked my heels in the remand cells and watched the minute hand of the clock creep round with pitiless inertia. Saturday morning. Another hour gone. Forty-eight to go! The cops were pretty nice to me. Even apologetic. They brought me newspapers. But mostly I sat and contemplated the events of the previous four months, which took me from a wintry New Year’s Eve in the northern hemisphere, all the way down to the New Zealand autumn and my present plight.
On Hogmanay, simultaneous with my decision to get out of the UK as fast as possible, never to return, there was a huge dump of snow, and I got stuck for hours at Heathrow waiting for the blizzards to abate. You forget the tedium of such nightmare journeys. I tried to gatecrash a BA executive lounge and was politely but firmly turned away. I went into the gents and put on a pair of full-length surgical stockings as protection against economy syndrome. That’s how I saw in the New Year. We boarded at 01.30.
And sat on the apron for two hours. Then a machine with the contour of an enormous stick insect de-iced the wings and we were pushed back. We taxied at a snail’s pace to the holding point. In the seat in front of me a child was screaming inconsolably. Thirteen hours of this … I was in anguish with sheer boredom. When the call for ‘doctor on board’ came over the PA system I jackknifed out of my seat so violently that my headset almost ripped my ears from my skull.
The patient was lying supine in the left-hand aisle at the rear of the aircraft. The cabin crew had already put an oxygen mask over his nose and mouth. First aid is as easy as ABC. Airway … patent; breathing … satisfactory; circulation … his radial pulse was thready and his skin cool and clammy. A crash box had materialised at my side and I extracted a stethoscope and a blood-pressure cuff. It was impossible to hear the Korotkoff sounds above the din of the air conditioning, but I could palpate his systolic pressure coming in at about 70 mmHg. After ABC comes D, for neurological disability. Rather a lame mnemonic. I pushed a knuckle into his sternum and he opened his eyes.
‘Whizz mah? Fu’un baas …’ The smell of stale liquor was almost comforting, and who could blame him? How else to while away the hours in Terminal 5? The cabin crew nudged my arm and whispered, ‘Here’s the captain.’
But for the yellow striped epaulettes on the white shirt he might have been a bank manager. We shook hands and exchanged courtesies. He said, ‘What do you think?’ After D comes E, for Environment, and this patient was definitely in the wrong one. I said, ‘I think we should get him off.’ Actually I was really thinking how extraordinary it was that, having been an anonymous cipher in seat 60K a few moments ago, I was now giving advice to the man in charge. But he looked relieved. He confided, ‘You know, we’d just been cleared by the tower. If he had collapsed literally 30 seconds later I’d have been committed. We would have had to climb to altitude, dump over 100 tonnes of fuel, and land again.’
I love opportunistic medicine; all your professional life you worry, not about the patient in front of you, but about all the other patients in the waiting room. Off-duty medicine affords you the rare chance to live in the present.
Seven hours later, the cabin crew knelt by my berth, seat 3A, and whispered, ‘Are you awake? Would you like to see Kabul?’
The Afghan Highlands, in their winter livery, looked very beautiful. But that was from seven miles up.
At the Sheraton Towers, 39 Scott Road, Singap
ore, I got bumped up again to the Edinburgh Suite on the top floor. Edinburgh. A certain irony there. The old country was reluctant to let me go. The suite was enormous. It was like an embassy. I rattled about in it, an ambassador without a staff. I counted the number of chairs. Twenty-seven. I would certainly be able to spread out.
I didn’t see much of Singapore. Instead, I sat with my laptop in the Edinburgh Suite and in three days blitzed a memoir of the events that had propelled me out of Britain in such a hurry. I mailed two copies to Edinburgh, one to my lawyer David Walkerburn, the other to Angela MacVicor MSP. I thought of printing a third copy for myself but I decided against it. I didn’t want the baggage. Once I’d mailed off the two copies I was going to wipe the whole thing from my laptop. I’d put it into trash and then I’d open trash and I’d wipe it again. I would be like a fastidious lover of hygiene whose zealous detestation of litter and clutter amounted to an obsessive compulsive disorder. Of course, you can never really get rid of these things from your computer. There’s always a trace of it left somewhere that some computer anorak will be able to find. I suppose it’s rather like a bad experience in life. You might get over it, forget it, stop having the flashbacks, and get on with your life. But you can never really expunge it. It’s always there, sitting somewhere in some remote filing cabinet of memory.
Once I’d finished, I emerged from my purdah and switched my mobile phone back on. I was a bit reluctant to do so. But I was only slightly apprehensive that the British authorities might come running after me, and if they preferred to airbrush me out of existence that would suit me just fine. I wasn’t going back there. Ever.
I hadn’t let too many people in New Zealand know I was coming. Joe and Hinemoa, my adopted parents, of course. They’d gone off down to Oban, Half Moon Bay in Stewart Island for their summer hols, so I wouldn’t catch them for a bit. Caitlin Roy, my sister-in-law, texted from Cheltenham and she sounded good, happy, and playing her oboe again. And my twin sister MacKenzie phoned me to say she was playing her viola in Auckland Town Hall next week and she’d catch up. I didn’t know she had a gig there. It was a last-minute thing. She’d needed to get away. Somebody in the Arnold Bax Quartet had developed an ‘unprofessional’ interest in her. I teased her. ‘One of the Baxes got the hots for you? Ha!’
The Seven Trials of Cameron-Strange Page 2
