Cutting Edge

by John Harvey

“Yes, but not well. Consultant anesthetists, registrar, that’s who you should be asking.”

  “Oh, we will,” Resnick said. “We are.”

  “Well, Inspector, of course I’m anxious to help. But this is an especially busy day for me …”

  Resnick was already on his feet. “There’s nothing out of the ordinary strikes a chord, nothing that would have involved Amanda Hooson with either Dougherty or Fletcher?”

  “Not that I can think of. She could have had contact with Dougherty, of course, dealt with patients from the ward on which he worked. But only in the natural process of things.” He signaled with opened palms that Resnick’s time was up.

  “If anything does come to mind …”

  “Of course.”

  Resnick let himself out, past the secretary pecking away at her keyboard like a demented hen. One of the anesthetists who’d worked with Amanda Hooson quite frequently had since retired, but Resnick had spoken to two of the others and their responses had been largely identical. Neither of them could think of anything about Amanda’s work at the hospital that would have drawn attention to herself in any way; certainly there had been nothing about what she did or the way she did it which would have invited such violent wrath and anger.

  Dougherty was still in bed, the number of tubes running into and out of him down to two. He smiled as Resnick sat down, then grimaced.

  “What can you tell me,” Resnick said, “about anesthetic failure?”

  “Simply as I can, it’s this. Patient going into theatre, okay? They have an intravenous anesthetic to start them off, but that’s not going to last for more than the first few minutes. After that they’re breathing in a mixture of oxygen and anesthetic gases. What these do, they send the patient to sleep, numb all sense of pain, absolutely relax the muscles. Now occasionally, thank God not too often, but it happens, only the muscle relaxant works.”

  Dougherty paused for a while, regaining his breath, allowing Resnick time for the implications to sink in.

  “So,” Resnick said, something akin to nausea starting up at the pit of his stomach, “the patient’s lying there, unable to move, and all the while …”

  “Exactly.”

  “Jesus!”

  “Uh-huh.”

  “When this happens, they can feel everything?”

  “Not necessarily, not always. Most times, probably not.”

  “But sometimes?”

  Dougherty nodded.

  “During the actual operation?”

  He nodded again. “Right through it.”

  “Not able to move.”

  “Or scream.”

  Resnick was thinking about what had happened to Amanda Hooson, to Fletcher, to Karl Dougherty himself.

  “At least I could do that,” Dougherty said. He was smiling, but it wasn’t at the memory.

  “Not the sort of thing that gets broadcast about, is it?” Resnick said.

  Dougherty winced and eased himself forward, encouraging Resnick to lean past him and push his pillows into shape. “When I was in the States, just a twinge coming out of the anesthetic was enough to bring down lawsuits like they were going out of style. Everyone from the head of the hospital to the relief cleaner. It’s not like that over here, not yet, but with the spread of private medicine we’ll be getting there.”

  “You saying that’s a bad thing?” Resnick asked. “Compensation in cases like this.”

  “Absolutely not, But it does make a naturally secretive profession even more so. You know what it’s like trying to get a straight answer out of a consultant at the best of times.”

  Resnick nodded and poured him some Ribena, pinched a handful of grapes, and thanked him for his help. “How about your parents?” he asked. “How are they coping?”

  For a moment Dougherty closed his eyes. “My mother came in a couple of days ago. I was in a worse state than this, I don’t know if she knew what was happening. I’m not even positive she knew who I was. I mean, she said my name, stuff like that, but twenty minutes after she’d arrived she was on her way again.” He smiled gently. “My guess is, she thought it was all a big mistake.”

  “And your father?”

  “Doing pretty well considering. Comes in every day, sits for an hour, eats my grapes …” Resnick swallowed the last one guiltily, pips and all. “… doesn’t say much, but then I suppose he never did.”

  Resnick backed away from the end of the bed, raised a hand in farewell.

  “How about Paul?” Dougherty asked. “Is he still a suspect?”

  “I don’t think so.”

  “If he doesn’t know that already, it might help him a lot to be told. He’s not finding any of this easy, either.”

  “Okay,” said Resnick, “you’re right. I’ll see that it gets done.” As he left the bay, sidestepping the tea trolley, his stomach gave a definite grumble. He wondered what the chances were of trying the new sandwich bar on Bridlesmith Gate before reporting back to Skelton.

  Going into the hospital with a group of other medical students for one of their ward visits, a tasty little episiotomy to be viewed and mulled over, Ian Carew had spotted Resnick, recognized him from the rear and slowed his own pace, no wish to remind the inspector of his presence. That gormless little policewoman was one thing; Resnick, he guessed, was quite another.

  Coincidence wasn’t going to bring him so close to Sarah Leonard and, visit officially over and the students beginning to disperse, Carew took the lift up to the ward where he knew she worked. Through the end doors, he saw her, leaning across some old codger’s bed and laughing; Carew only able to see the light in her eyes, dark opening of her mouth, not hear the sound. So simple to walk through, fall into step alongside her as she went back down the ward, pretty words in her ear. No. Not now, he told himself. Not now: wait for the time to be right.

  Thirty-five

  The senior Consultant Anesthetist was a trim-looking man of medium build, a livid mark high on his left cheek, birthmark or burn. He greeted Jack Skelton as though he and the superintendent might long ago have been at school together, even shared the same dorm, eaten at the same refectory table, though, of course, they had not. The two men hadn’t even leaned elbows against the same golf club bar, though, true to say, the consultant had done so with the Chief Constable. Yes, and the Chief Constable before that. Skelton was a runner not a golfer, a few rounds of pitch and putt on long-past family holidays the nearest he had ever come to a tight-fought eighteen holes then large gins and business at the nineteenth. His education had been grammar school, a good one at that, bringing the industrious middle classes the trappings of a public school—houses, prefects, an emphasis on keeping a straight bat while all around you are flashing across the line—without the expense. Or the kudos, automatic entry into the élite.

  It would have been easy for the consultant to have patronized Skelton, so easy as to be automatic. Better, though, to rein that back, keep it under control; treat the man as a fellow professional, one who’s risen to the top, an equal.

  They shook hands and sat in comfortable chairs inclined towards the window; with only a slight effort it was possible to see the trees along the avenues of the university park, those around Wollaton Lake and the ornate turrets and chimneys of Wollaton House itself.

  Skelton declined sherry, accepted the offer of coffee, which came in white china and with biscuits on the side. There was a preliminary feeling-out, during which the consultant let Skelton know how many officers be knew in the Force who were senior to the rank of superintendent. In total it didn’t number many and the consultant knew nearly all of them.

  Skelton had his best suit on and he felt scruffy; the fact that the man was so clearly making an effort to be pleasant and polite made it all the worse. He set down his cup and saucer and explained in terms as sharp and defined as the crease of the consultant’s trousers what he needed to know and why.

  “Anesthetic failure,” the consultant said.

  “Exactly.”

  “You
really believe, as a line of inquiry, this is … er … germane?”

  “Amongst others, yes. Otherwise, I wouldn’t dream of wasting your time.”

  Don’t patronize me, the consultant thought, taking his china cup towards the window and gazing out. To the left, just out of sight, was the bridge across the ring road where this wretched business had all started.

  “What do you want to know?” he asked.

  “Everything,” Skelton said. “Everything that’s relevant.”

  The consultant drew a breath. “What you must realize. First. The phenomenon we’re talking about here is precisely that. Its occurrence is restricted to a tiny number of cases.”

  Skelton waited.

  “I wonder if you know how many operations are carried out each year in this country?”

  The superintendent shook his head.

  “Somewhere in excess of three million. So whatever incidents we’re discussing, they have to be seen against that context.”

  Skelton crossed his legs and waited some more.

  “Recent research suggests—and like all research of this nature these results should not be considered conclusive—there may be some degree of anesthetic failure in as few as one in every five hundred cases.”

  It was very quiet in the room.

  “As few?” Skelton said.

  “Exactly.”

  “But not exactly.”

  “I’m sorry …”

  “The figures, one in five hundred, you said they shouldn’t be thought of as conclusive.”

  The consultant nodded. “They could be less.”

  “They could be more.”

  “In theory, yes, but …”

  “But that’s not a theory you would necessarily go along with.”

  “That’s correct.”

  Time for Skelton to nibble a biscuit, recross his legs; for the consultant to check through his window that the trees were still there.

  “As far as the patient is concerned,” Skelton said, “some degree of anesthetic failure means …”

  “It means,” interrupting sharply, “there is likely to be some small form of awareness …”

  “Small form?”

  “Some awareness of what is happening.”

  “To the patient?”

  “Yes, yes, of course. That’s what we’re talking about. For some reason, some mechanical failure, or mismanagement, or something unique to that particular patient, the nitrous oxide, the anesthetic gases fail to function correctly.”

  “The patient feels pain.”

  “Yes, of course. The patient is being operated upon. The …”

  “Cut open.”

  “Generally, yes. The whole technique, the reason …”

  “Then why doesn’t he scream? He or she, whoever it is, as soon as the surgeon makes the first incision, why don’t they scream?”

  The consultant shook his head. “They can’t.”

  “Why ever not?”

  “Because, usually, although the anesthetic is failing to have the desired effect, the other substance that is being breathed in, the muscle relaxant, is effective.”

  “Effective?”

  “Yes.”

  “Please explain.”

  “The patient’s muscles are totally relaxed, any movement is impossible; there is no effect on either consciousness or the control of pain.”

  There was a fly now, in the still room, somehow a fly, impossibly loud.

  “All the patient can do, while the surgeon does his work, is lie there and give no sign.”

  “Not actively, that is correct.”

  “But there are signs?”

  “Oh, yes. Generally. Arrhythmia of the heart, a rise in blood pressure—the difficulty is that these same signs more commonly occur in association with other causes.”

  “So there is nothing specific? Nothing that somebody around the patient might recognize as a sign of pain, a cry for help?”

  “Sometimes,” the consultant said carefully, “the patient may sweat and sometimes …”

  “Yes?”

  “Sometimes, although the eyes are taped shut, there may be tears.”

  Thirty-six

  Otis Redding, that’s who the DJ was playing when Resnick went down the curved steps into Manhattan’s. “I’ve Been Loving You Too Long (To Stop Now).” It hadn’t been altogether true, what Elaine had accused him of that evening at the Polish Club. About having to drag him on to the floor, one dance before fumbling for the cloakroom ticket, fetching the coats. When they’d first been going out, going steady—only Elaine’s grandmother had used the term “courting” and then with the slyest of grins—there was a spell they’d be dancing—what?—every Friday night without fail. Once, at the second-string Palais that was now the MGM, the corner of Collin Street and Greyfriar Gate, they’d walked in on some kind of Otis Redding tribute, some anniversary, and just about every number that was played or sung had some association with him. “Sitting on the Dock of the Bay.” “Mr. Pitiful.” “Fa-Fa-Fa-Fa-Fa-Fa-Fa (Sad Song).” If they heard “My Girl” once that night, they must have heard it a dozen times. Resnick scarcely moving, pushed up against Elaine and her arms round his neck, saying, “See, just because it isn’t jazz, doesn’t mean it isn’t any good.” Right there and then, Resnick would have listened to Alma Cogan, Clodagh Rodgers, Des O’Connor, thought they were wonderful.

  Maura was collecting glasses from the tables, her hair like orange whip. “Hey!” she exclaimed. “What’re you doing here?”

  “It’s okay,” Resnick said, “I’m not wearing a cap.”

  “How about cheesecake?”

  “I’m not wearing that either.”

  Maura picked up another couple of glasses with her left hand and transferred them to the column she was balancing from the palm of her other hand all the way up to her shoulder. “That bloke,” she said, nodding behind where Resnick was standing, “he’s over there.”

  “Good,” said Resnick. “Thanks.”

  Paul Groves was sitting with a young Asian who was wearing a light-green polo shirt, bottle-green trousers, and ankle-high trainers with the tongue out and the laces mostly undone. Groves was wearing the same suit, tie slacked down to half-mast.

  Resnick pulled over a stool and sat opposite them and Groves introduced him to his friend, who had an accent that was Hands-worth via Hyson Green.

  “I was in to see Karl,” Resnick said.

  Maura leaned between them and placed a bottle of Czech Budweiser and a frosted glass on the table.

  “Thanks,” Resnick said.

  “I’ll put it on the manager’s tab.” Winking, moving away.

  “How was he?” Groves asked. “Karl?”

  “Seemed a lot better. Amazing, when you consider.”

  Groves glanced at his friend, flicked ash towards the ashtray and missed. “Did you see him?” he asked. “When he was in there, after it had happened? Before they took him off in the ambulance.”

  “No.”

  Groves blinked away the smoke that was drifting up past his eyes. Two girls, couldn’t have been more than sixteen, pushed past the back of his stool on their way to the ladies. “Bleedin’ cheek!” one said. “All right, though, isn’t he?” said the other. “Well, wouldn’t kick him out.” Giggling, they pushed into the crowd standing around in front of the DJ.

  “I keep thinking about it,” Groves said. “Trying to picture it. What he must have looked like.”

  “Don’t.”

  “Lying there in all that …”

  “Don’t.”

  “No. No, suppose it’s stupid. Daft.”

  “Want another?” his friend said, making the nail of his index finger ring against the rim of Groves’s glass.

  “Yeh, thanks.”

  “You?” he asked, standing, looking over at Resnick. Resnick laid a hand flat across the top of his glass. “I’m fine. Thanks.”

  There was an instrumental coming through the speakers, organ and sax, a churning, rolling b
lues and a few couples had started moving around the small dance floor.

  “Firm I work for,” Groves said, looking not at Resnick but at his almost empty glass, “got a vacancy. Northampton. I was thinking, you know, time I had a bit of a change. Might, like, take it.”

  Resnick nodded.

  “What d’you think? I mean …” Groves shrugged.

  “New place,” Resnick said. “Fresh start. Sometimes it’s a good idea.”

  “But as far as you’re concerned?”

  “Personally?”

  “The police.”

  “Oh. No. Let us know where you are if you like, but no, far as we’re concerned, feel free.”

  Groves relaxed on his stool, unfastened another button of his shirt. His friend was on his way back from the bar, carrying the drinks. “Pursuing a new line of inquiries, then?” Groves half-smiled.

  Resnick said he supposed that was true.

  “I know.” Groves pulled out the newspaper from beneath his stool and folded it back at the front page. “I was reading it in here.”

  UNDER THE KNIFE

  Hospital staff in the city are now working in fear of their lives after police confirmed today they are investigating a connection between the murder of attractive student Amanda Hooson and the earlier violent attacks on two young men employed at the hospital. Security precautions have been stepped up and there is a strong possibility that visitors will be routinely questioned and searched.

  Detective Chief Inspector Tom Parker said that connections between the three victims were being pursued as a matter of urgency. “The one thing we don’t want the general public to do,” the Chief Inspector told our reporter, “is panic.” He would neither confirm nor deny that until the present danger has passed, both plain-clothes and uniformed officers would be on duty in and around the hospital buildings and grounds.

  Resnick passed back the paper and stood up to go. “What if he wants to go to Madisons?” asked one of the girls, coming back. “Yeh, well,” said her friend, “what if he doesn’t?”

  Resnick offered Groves his hand. “If you go through with it, the move, I hope it works out for you.”

  “Thanks.”

  Resnick looked for Maura on his way out, wanting to wave goodbye, but she was intently talking at the bar, uncorking a bottle of Bulgarian red without taking her eyes off a man in a blue mohair blazer, short fair hair and a stud in one ear, more muscle across his shoulders than Resnick had in the whole of his body and roughly half Resnick’s age.