SISTERS OF MERCY
Andrew Puckett
© Andrew Puckett 2014
Andrew Puckett has asserted his rights under the Copyright, Design and Patents Act, 1988, to be identified as the author of this work.
First published 1994 by Collins Crime an imprint of HarperCollins Publishers.
This edition published by Endeavour Press Ltd in 2014.
For the siblings,
Harriette Mullins
and
Christopher Puckett
Table of Contents
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Extract from Death Before Time by Andrew Puckett
1
‘It’s Mr Peters — I think he’s dead …’ Student Nurse Armitage looked breathlessly from myself to Mary … then we were moving across the ward as fast as we could without actually running.
‘Screens,’ Mary said to Armitage as she hit the alarm at the end of the bed, and Armitage drew the curtains around us.
Mary had stripped away his pyjama jacket and I reconnected him to the monitors, although I already knew we were too late. There’s something about a dead person’s face; not just the slackness of mouth and jaw, but the way the eyes are focused on to something not of this world …
I started external massage on his heart, putting all my weight on to the heels of my hands on his chest … I was briefly aware of the arrival of the crash team, then felt hands on my shoulders and a voice said in my ear, ‘I’ll take over now, Jo.’ Stephen Wall, our senior registrar.
I stepped back.
The other members of the team were crowded round the foot of the bed with their equipment: James and Emma, staff nurses, and Graham Wood, the anaesthetist.
Stephen looked up at the cardiac monitor. ‘Ventricular fibrillation,’ he said. ‘Intubate and oxygen, please, Graham,’ then, ‘Jump leads, please,’ to Emma, who bought them forwards.
Jump leads is an example of the rather black humour we have to adopt in the Intensive Therapy Unit if we’re to stay sane. Their proper name is defibrillator paddles and they’re electric terminals which, applied to the chest over the patient’s heart, causes them to jerk and, with luck, restarts the heart.
I knew that that wasn’t going to happen this time, though. And it wasn’t just a sense of the macabre that sent a frisson through me as I watched Peters’s body forlornly twitching. Peters shouldn’t have died.
He made the seventh patient to die of heart failure when they shouldn’t, and now I was going to have to do something about it …
Mary said in my ear, ‘You’re wanted on the phone, Jo. We’re OK here if you want to answer it.’
I thanked her and hurried back to the nurses’ station where Armitage was holding it out for me.
‘Sister Farewell, ITU.’
‘Good morning, Sister. Miss Whittington here.’ Miss Ann Whittington, nursing officer and my boss.
‘Good morning, Miss Whittington.’
‘I’d like to speak to you some time this morning, Sister, if that’s possible.’
‘Er — yes.’ I glanced up at the clock. ‘Would twelve o’clock be all right? There was something I wanted to speak to you about as well,’ I added before I could change my mind.
‘Very well, Sister. Twelve o’clock.’
I put the phone down slowly, aware that I’d committed myself to an action I dreaded.
Better prepare for it.
I de-gowned in the air-lock before going back through the Duty Room to my office and closing the door. I took a breath, tapped my password into the computer and found Peters’s record.
Frederick Peters, age 49, married, two children … Address … Religion: Agnostic. Donor card: Yes. Tissue type …
My eyes flicked down …
Admitted on Monday with myocardial infarction but had responded well to isosorbide mononitrate therapy, and had had no further heart attacks. He’d been due to transfer to the Coronary Care ward tomorrow …
In other words, he shouldn’t have died, not of heart failure. It was why he’d been taken off the monitors, because he’d recovered so well … which is why we now didn’t know exactly when he had died …
I printed out copies for Stephen and myself, then noted down the pertinent facts and added them to the six files I already had. I was still analysing them statistically with the calculator half an hour later when there was a tap on my door. I covered them with the second Peters printout as Mary came in. She shook her head briefly, then looked down at the printout on my desk.
‘Anticipating events slightly, weren’t you, Jo?’
For a moment, as I looked at her classically moulded face with its cornflower-blue eyes and tawny blonde hair, I was overwhelmingly tempted to confide in her … then I remembered that although she was my deputy and we got on well, I’d only known her for a few months and she did have a slightly over-loose tongue …
‘Not really. It was pretty obvious.’
‘I suppose so,’ she said, still looking at me.
I said, ‘What time are you going to lunch today?’
‘One.’
‘Good. I’ve been summoned to the presence at twelve, so you can keep shop for me.’
‘What does the Witless want you for this time? Done something you shouldn’t?’
‘That, I shall discover at twelve.’
When she’d gone, I locked the files away and sat for a few minutes thinking about them. Then Stephen came into the Duty Room and I went out to meet him.
‘It’s no good,’ he said tiredly.
‘Are you putting him on life support?’ I asked.
‘Yes. James is setting it up now. Did he have a donor card?’
‘Yes.’ I handed him the printout.
‘Hmm. Well, I’d better go and contact the next of kin, I suppose.’ He heaved a sigh. It was not a job any of us relished. It was bad enough informing someone of a loved one’s death, let alone having to ask for their organs, but Stephen was the most scrupulous registrar I’d ever worked with so far as organ transplant was concerned. He was also a dish: an athletic six feet with russet hair and blue eyes in a strongly sculpted, somehow very English face.
Many doctors found excuses for not asking for the organs, but not Stephen. As he would say himself, it can sometimes be a comfort to relatives, knowing that another life can be saved. But not always …
*
At exactly twelve o’clock, I walked into the anteroom of Miss Whittington’s office. Her secretary said, ‘She’s expecting you, Sister, go straight in.’
I tapped on the door though, before pushing it open. ‘Ah, Sister Farewell. Please have a seat.’
Her desk was positioned so that her back was to the window — a psychological trick many people in positions of authority like to adopt.
‘Now, I believe you said there was something you wanted to speak to me about?’ she said.
‘Yes, but it’s a rather … delicate matter. Perhaps after you’ve … ?’
‘Very well, although what I have to say concerns a matter of some delicacy as well. However …’ Her pale grey eyes met mine …
Pale grey seemed to be her colour — her hair was pale grey, although in crisp, permed curls. Sometimes, she even wore pale grey. She was tall, slim, ageless; her unmade-up face was unlined, not unattractive, and yet someho
w sexless. She was unemotional, firm, curiously formal.
‘I have become concerned recently about a certain … lack of gravitas that has become apparent in ITU,’ she said in her clear, incisive voice.
‘I’m sorry you should think that,’ I said slowly, then decided to call her bluff. ‘I’m not exactly sure I understand, Miss Whittington …’
‘I think you do,’ she said. ‘It is not you who are giving me cause for concern, but your new deputy — Mary Tamworth.’ So that was it. I took a breath.
‘I know Mary Tamworth can be high spirited sometimes, but she’s an excellent nurse and —’
‘I’m sure she is, but on a ward like ITU, certain types of humour are unacceptable. I have had a number of complaints about her from the medical staff, which my own observations have confirmed. Yesterday, for instance, I heard her — in the presence of a student nurse — refer to the mortuary technician as the bone collector: a clear and offensive allusion to this hospital’s transplant policy.’
I remembered it myself. I’d noticed that she’d come in and was behind Mary when she’d said it, and hoped she hadn’t heard. The point Mary was making was that by the time all the useful organs had been taken from the body, there wasn’t much left but bones. A gross exaggeration, obviously, but …
‘I’m very sorry this has happened, Miss Whittington, although I’m surprised that any of the medical staff should have complained, since she always seems to get on very well with them …’ I paused, hoping for some names, but when none were forthcoming, I continued, ‘However, I do take your point, and I’ll speak to her about it.’
‘Good. I must add though, that I’d have hoped a nurse with your experience would have grasped this particular nettle a little sooner.’
That irritated me.
‘I think it’s only fair to say that Sister Tamworth has had overall a good effect on ITU since she’s been there. Her high spirits and her humour cheer up patients who have a lot to be worried about.’
Miss Whittington’s lips tightened, although her voice remained light.
‘Perhaps that is so, Sister, but you should know as well as anyone that a hospital depends on hierarchical respect for its efficiency: respect that is lacking in Sister Tamworth.’
So the crack about the bone collector wasn’t all she’d heard.
‘As I said, Miss Whittington, I do take your point and I will speak to her about it.’
‘Good,’ she repeated. ‘That’s an end to the matter.’ She leaned back. ‘Now, what was it you wanted to speak to me about?’
I hesitated, wondering whether to leave it after this worst of possible starts … No, it had to be done now …
‘A delicate matter, you said,’ she prompted.
‘Yes.’ I took a breath. ‘Mr Peters, the MI who came in on Monday, died this morning. Cardiac arrest. He was due to transfer to Coronary Care tomorrow and we’d taken him off the monitors.’
‘You’re saying that you don’t know exactly when the fatal attack occurred?’
‘Yes, but that’s not —’
‘Potentially embarrassing, but it does happen. Write me a full report as soon as you can, please, Sister.’
‘Of course, but that’s only part of the problem. He shouldn’t have died, Miss Whittington.’
‘No, but patients sometimes do. I don’t think any blame will attach to you.’
‘That’s not quite what I meant.’ I searched for words. ‘Miss Whittington, didn’t you — don’t you find that your experience will often tell you which patients are going to live; which to die?’
She looked at me a moment before replying.
‘Yes. I think all good nurses have that facility to an extent. But it can be wrong. I assume you felt that Mr Peters would live?’
‘Yes, I did, but —’
‘You must know that in our profession we cannot afford to be sentimental, either with the patients, or with ourselves.’
‘Miss Whittington, Mr Peters was the seventh patient in the last six weeks who was either in — or had just left — ITU, to have died when I was certain that they would live.’
She looked at me for longer this time.
‘What exactly are you trying to say, Sister?’
‘That I think we may have a serial killer in this hospital.’
*
Why does she stare at me so, I wondered. I found myself staring back, mesmerized, for some reason comparing our appearances … I’m not beautiful like Mary, or a sexpot like Emma. Or plain, that most dreadful of words, like Helen Armitage.
Those who like me say that my face is elfin; those who don’t, say it is pointed. I have dark brown curling hair (worn up when on duty), hazel eyes and a clear skin. A good, although not sensational, figure. I don’t have to worry about men any more, although I did at one time. Girls at school used to make jokes about my surname, said it was what my boyfriends were always saying to me …
‘Sister Farewell,’ Miss Whittington cut into my reverie, ‘I have thought of you as one of the better nurses we have trained in St Chad’s. It seems a shame that you should spoil that impression in so whimsical a way.’
‘I assure you this is no whim,’ I said. ‘I have here’ — I held up the files I’d brought with me — ‘the details of all these patients. Perhaps, if we could go through them together, you will understand my anxiety.’
‘Very well.’
I took the files out.
‘The first is Mr Hanbury, nearly six weeks ago …’
Paul Hanbury, aged twenty — road traffic accident. It had been a miracle he’d survived in the first place, but after surgical repairs had been made and he’d been transfused with enough blood, there had been no reason for him to die, especially not from heart failure …
John Thorpe, fifty-six — a myocardial infarction, like poor Peters, that had responded well to drug therapy. An otherwise healthy, optimistic man with everything to live for. He had died, apparently from another heart attack, the day he’d moved out of ITU to the Coronary Care ward.
David Longford, forty-five — aortic aneurism repair. His death had seemed particularly hard. A man whose smile could light up the ward, he’d been unlucky enough to have an aneurism, doubly unlucky to die of heart failure after a successful operation.
Isaac Goldman, sixty-five, a heart bypass patient. The operation had been successful and he’d just transferred to Coronary Care when he’d died, from heart failure.
Anne Lawrence, fifty. She’d had a total hysterectomy and had gone into postoperative shock. After transfusion and drug therapy, she’d stabilized and had been about to return to the Gynae ward when she’d died, also of heart failure.
Henry Newton, sixty-six. He’d nearly died of pneumonia, but had made a complete recovery after antibiotic treatment. He’d been about to transfer to the Medical ward, when he’d died — once again, from heart failure.
And now, Mr Peters.
Miss Whittington had shown increasing signs of impatience as I related these cases.
‘Is that all of them?’ she asked when I’d finished.
‘Yes, but I’ve also —’
‘Four of these patients were postoperative, and you know as well as I that postoperative shock can cause heart failure.’
‘That’s true, I know, but —’
‘And that patients who have had one heart attack are likely to have others, even after we think they’ve stabilized.’
‘I know that, but —’
‘Sister Farewell, these things happen. Yes, there may have been a lot of deaths in a short time, but you will see that it evens up over a period.’
‘I know that’s true generally,’ I said, ‘but I don’t believe it is in this case. We’ve had seven unexpected deaths in the last six weeks, making a total of twenty deaths altogether.’ I handed her the sheet of paper with my statistical analysis. ‘You can see the number of deaths we’ve had in the last eight six-week periods, which I’ve converted into percentages. I’ve worked out the st
andard deviation on the mean of them, and the ninety-five per cent confidence limits. You can see that the percentage of deaths we’ve had in the last six weeks falls outside these limits. In other words, they didn’t happen by chance.’
‘But, Sister, being outside ninety-five per cent confidence limits is the same as a one in twenty chance, isn’t it? You know as well as I that that sort of coincidence occurs every day in a hospital.’
I tried to explain that ninety-five per cent confidence limits and a one in twenty chance are not the same thing, but my own poor grasp of statistics wasn’t a help. At last she said, ‘Is there any specific person you think is behind this, Sister?’
‘No, there isn’t at the moment, but —’
‘So how do you think it was done?’
‘I’m not sure, although there is a prec —’
‘Are there any similarities between these seven patients?’
‘Not that I’ve noticed, yet, but —’
‘I’m afraid I’m not convinced, Sister. What were you expecting me to do about it?’
‘I’m sorry about that. I was hoping that we’d both go to the police.’
‘There certainly isn’t sufficient reason to do anything like that. Besides, we would have to go to the hospital manager first and I know that his reaction would be the same as mine.’
‘Miss Whittington —’
‘If there are any further deaths that worry you, come and tell me about them and I’ll consider speaking to the hospital manager. Until then, we do nothing. Is that clear?’
‘Further deaths? But I’m the one who has to —’
‘Until then, we do nothing. Is that clear?’ She didn’t raise her voice. She didn’t need to.
‘Yes, Miss Whittington.’
‘I’m quite sure you’ll find that we now have a period with an unnaturally low death rate. It’s the way things happen. Meanwhile, I suggest you attend to the other matter we discussed, and also write me a full report on how Mr Peters came to die unsupervised.’
As I walked angrily back down the corridor, I tried telling myself that she was a good nurse and a good administrator (both true) and that her reaction was only to be expected. It didn’t help.
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