Sisters of Mercy

by Andrew Puckett

  ‘How long will you be here, Mr Jones?’ asked Viv.

  ‘A few days at the most. Please don’t mind me. Just carry on working as you would normally.’

  He’d allowed his London accent to become more marked; at the same time carefully enunciating his Hs and Ts, sounding very much the working-class boy made good. It certainly made him seem harmless.

  The doorway darkened and I looked up to see Miss Whittington.

  ‘Good morning, Sister, Mr Jones. You’ve managed to find each other, then?’

  ‘Yes, indeed,’ said Jones.

  ‘Good. Perhaps we could go into your office for a few moments.’

  ‘Certainly, Miss Whittington.’ My, we are all being polite today, I thought, glad she wouldn’t be able to bring up the subject of the ‘stress’ I’d been under.

  Once inside, I listened respectfully while she told me what I already knew, viz, the ostensible reason for Mr Jones’s visit, fishing as she did for any hidden motive that might affect her. I nodded and said ‘yes’ in the right places, reflecting that it must be her way of keeping on top of things.

  After she’d gone, he said quietly, ‘Is she always like that?’

  ‘Yes. I sometimes wonder whether she’s slightly paranoid.’

  ‘She’s said nothing more to you about the dead patients?’

  ‘No. Not since a few days after I first spoke to her.’ I glanced up at the clock. ‘If I’m to show you any of the ward before the round, we’d better start now.’

  ‘All right.’ He stood up. ‘Has anything been said about last night?’

  ‘Nothing.’

  I took him to the gowning lobby, where he put on the gown I handed him without any help.

  ‘You’ve done this before,’ I remarked.

  ‘Yes.’

  Inside, Emma was at the nurses’ station, while James, Armitage and Pete Hadley were sitting with patients. Susan was taking blood from another.

  I glanced at the clock. A quarter-to.

  ‘Everything ready for the round?’ I asked Emma.

  ‘Yes.’ She nodded vigorously.

  ‘No problems?’

  ‘None.’

  I took him round the ward, telling him quietly what was wrong with each patient before explaining the functions of the monitors and other bedside equipment, and introducing him to Armitage, Hadley and Susan. They all looked slightly surprised. I don’t usually introduce visitors to them.

  ‘What are these rooms, Sister?’ He pointed to the isolation rooms and I explained.

  ‘The patients in these two are recovering from renal transplant. They’re on immunosuppressive drugs, which means they’re —’

  ‘They’re susceptible to infection,’ he finished for me.

  ‘That’s right.’ I acknowledged a wave from Sophie Marsh who was sitting with one of them.

  ‘How long will they have to stay there?’ he asked.

  ‘Until the transplant’s taken and the immunosuppressives can be reduced. Could be days or weeks.’

  ‘Who’s in this room?’ He pointed to the third.

  I glanced round before saying in a low voice, ‘That patient died yesterday in another ward. He’s being kept on life support for organ donation.’

  ‘A rather morbid contradiction in terms. A dead patient on life support.’

  ‘You know what I mean.’

  ‘How long will he stay there?’

  ‘Until an organ match is found. Then he’ll be moved to the site of the transplant operation.’

  Then there was a stir and the whole ward seemed to come to attention as Mr Chorley and his retinue filed in.

  ‘The ward round,’ I said.

  11

  We watched as they approached the first bed and Viv explained something to Mr Chorley. She was looking very much at home, I observed a trifle sourly.

  ‘Can you tell me their names?’ Tom said quietly.

  ‘The man talking now, that’s Mr Chorley, the consultant. Stephen Wall, you met. The others are Ian Hadmore, senior house officer, Paul Ridware and Jill Newton, house officers.’ I went on to explain how the round was conducted.

  ‘Do any of them carry out invasive treatments on the patients?’

  ‘Mr Chorley, very rarely. The others, yes, although it varies.’

  We watched a little longer, then he said he’d seen enough for the moment, we de-gowned and I showed him round the rest of the unit.

  We’d seen the pantry and sterile preparation room, and were in the relatives’ room, which was empty at the moment. He said, ‘I noticed that a lot of the patients had a nurse actually sitting with them — is that usually the case?’

  ‘Much more so than in an ordinary ward. Each patient has a nurse with them at least half the time.’

  ‘Is it always the same nurse?’

  ‘Usually, although not necessarily. For instance …’ I told him about Emma and Mr Phillips.

  ‘So the same nurse would also always give the patient an injection, or any other such treatment?’

  ‘Same answer — usually, but not necessarily.’

  He thought for a moment. ‘So wouldn’t that make it rather difficult for a nurse, or a doctor, to just go up to a patient and say: It’s time for your such-and-such, Mr Bloggs, and inject him with something that killed him?’

  It was my turn to think.

  ‘It would make it more difficult, yes. But it would depend on who they were, on their authority and how well they knew the system.’

  ‘But surely it would be risky? I mean, if Mr Bloggs was your patient, and you went in and saw another nurse giving him an injection, wouldn’t you want to know why?’

  ‘Yes, but if they said: Because Dr Brown told me to, that would answer it.’

  ‘Still too risky. Too easily checked.’

  ‘I suppose so …’

  ‘We’re looking for somebody, or something, that would obviate that risk.’ He took a breath. ‘Where d’you keep your fluids for drips and suchlike?’

  ‘In the store, just across the corridor.’

  That was empty as well. I showed him the drip sets, which were sealed in tough plastic bags.

  ‘Are these ever opened in here?’ he asked.

  I shook my head. ‘Each bag contains four sets, so we take two or three bags at a time into the ward and open them there.’

  ‘But it would be quite easy for a doctor, or nurse, to smuggle an unused set out of the ward?’

  ‘Er — yes, I suppose it would. But surely it would be obvious if one had been tampered with?’

  ‘Would it? Can I open one of these?’ Without waiting for an answer, he took out his penknife, slit one of the bags open and pulled out a set. ‘You lift the label so,’ he said, gently sliding the point of the knife underneath the label on the plastic pack and twisting the blade. ‘You inject your poison, then stick the label back down with glue. Who would know?’

  I shook my head. ‘Where did you learn that?’

  He smiled, rather sadly. ‘I’ll tell you some other time.’

  ‘You think that’s how it was done?’

  ‘It’s a possibility. It would certainly overcome the problem of being spotted giving an illicit injection.’

  ‘But how would the killer know which patient was going to —? Oh … I see what you meant now about whether the killings are planned or random. But how are we going to work out which?’

  ‘The patient records on computer might help us there. You did say all treatments are recorded?’

  ‘That’s right.’

  ‘Shall we go and look at them?’

  ‘If you like. I thought you said yesterday you wanted to see the Coronary Care ward?’

  ‘I did, didn’t I? Shall we do that quickly first?’

  Coronary Care is a bit more like most hospital wards —about twenty patients, with a much lower staff/patient ratio, not so much high-tech equipment and no gowning air-lock. Mr Chorley and his caravan had just started their round there.

  I introduced To
m to the sister in charge, quickly pointed out the ward’s features, then we returned to ITU.

  ‘And that’s where a patient would be transferred when their condition had improved in ITU?’ he said when we were in the corridor.

  ‘Yes. Or perhaps the Medical ward.’

  He lowered his voice. ‘Easier to kill someone in there, I’d have thought. Not so many nosey nurses to worry about.’

  ‘True.’

  ‘And yet only two of your group of eight died there. I wonder why? Opportunity? Something else we haven’t thought of?’

  ‘I don’t know,’ I said slowly. ‘Although, because of its nature, there are more deaths anyway in ITU than in other wards …’

  ‘So a sudden death wouldn’t be so unexpected …’ he said. ‘Like the wood and the trees. It took half a dozen sudden deaths before you spotted anything, and even then, nobody else believed you.’

  We arrived at ITU and went through to my office. Viv was in the Duty Room.

  ‘Everything go all right?’ I asked her.

  ‘No problem. I enjoyed it.’ She grinned. ‘How long did you say you’d be here, Mr Jones?’

  ‘Mm? Oh, only a few days.’

  ‘There’s no rush. Don’t hurry on my account.’

  ‘Oh, I wouldn’t do that,’ he said seriously. Viv made a face as we went into my office.

  As soon as I closed the door, he said, ‘Is it reasonably soundproof in here?’

  ‘Reasonably. If we keep our voices down.’

  ‘Are we likely to be disturbed?’

  ‘It’s a possibility, since I am supposed to be the sister in charge. Although people usually knock when they see my door’s closed.’

  ‘Then shall we have a look at the record of one of the patients who died?’ He indicated the computer terminal. ‘If anyone does come in, you’re just showing me how the system works.’

  I keyed in my password and called up the patient record system, then tapped in HANBURY, PAUL.

  ‘You certainly have plenty of information on them,’ he said, over my shoulder. ‘Can you print that one out?’

  ‘Now?’

  ‘Why not? We’ll be needing copies of them.’

  I pressed the right keys, but nothing happened, so I went over to the printer and switched it off and on again. Nothing.

  ‘Let me have a look,’ he said.

  He fiddled with it for a moment, then switched it off and undid something at the back.

  ‘Fuse.’ He held it up. ‘D’you have a spare?’

  ‘Somewhere.’ I found one in a drawer and he fitted it. Then I began printing all the files on the patients I suspected had been murdered.

  I’d just started on the last — Mrs Sutton — when there was a knock on the door and Viv came in. She was holding a printout.

  ‘Is this yours?’ she asked. ‘Patient record on Paul Hanbury. No one out there will admit to it.’

  I felt myself colouring. ‘It’s ours,’ I said, holding my hand out. ‘I was showing Mr Jones the patient record system and the printer wasn’t working. It must have defaulted to the one out there.’

  She gave it to me, glancing over at the screen as she did. ‘Thank you, Viv,’ I said.

  ‘You’re welcome.’ She went out, pulling the door to behind her.

  ‘I’m sorry about that,’ I said quietly.

  He moved over to the door and looked out through the glass panel.

  ‘Probably doesn’t matter,’ he said. ‘Who’s the girl over there?’

  I moved beside him. He was looking at Sophie, who was talking to Viv.

  ‘Sophie Marsh. She’s the staff nurse we saw earlier in with the renal transplant patient. Why?’

  ‘I remember her now. She’s the only one I couldn’t place.’

  The Duty Room was quite busy. Susan was replenishing her tray with sample bottles, while Armitage was hanging round looking superfluous. Pretty Jill Newton was talking animatedly to Stephen, and as I watched, I felt a sharp spurt of jealousy. Almost as though he’d felt it too, Stephen looked up at me. I turned away.

  Tom was looking at me as well. After a pause, he said, ‘What I’d really like to do now is go over these printouts with you in detail. We can’t do it here. Is there a library, or somewhere like that we could use?’

  ‘Not really, if we want to talk.’ I thought for a moment. ‘I’m afraid the best I can suggest is that we go back to my house for lunch.’ I looked up at the clock. It was just after eleven. ‘And I can’t really do that for another hour,’ I said.

  ‘That’s all right. I’ll go and study these on my own for a bit. Give you a chance to catch up on some paperwork or something.’

  I told him how to get to the library, then did as he suggested and attacked some of the paperwork that had accumulated during my absence. My mind was so full that it was a while before I could get into it, and no sooner than I had than a voice behind me said, ‘Excuse me, Sister …’

  I jumped as though from an electric shock and swivelled round to see the plain, plaintive features of Helen Armitage.

  ‘Please, don’t do that, Nurse Armitage,’ I said. ‘You frightened the life out of me.’

  ‘I’m sorry, Sister. Your door was open.’

  So it was.

  ‘How can I help you?’

  ‘Could I have an overtime form, please?’

  ‘Aren’t there any in the Duty Room?’

  ‘I couldn’t see any.’

  I gave her a handful. ‘Take one for yourself and leave the rest out there.’

  ‘Thank you, Sister.’

  I shouldn’t have jumped like that, I thought after she’d gone. Nerves. I hoped very much that Tom would find the killer soon.

  Almost as though he’d heard me through some form of ESP, he came in and shut the door.

  ‘I think I’ve spotted something,’ he said.

  12

  ‘Well? What is it?’ I asked eagerly.

  He tapped the pile of printouts. ‘With the exception of Mrs Sutton, every one of these patients was not only carrying an organ donor card, but also had their organs transplanted.’

  The disappointment must have shown in my face.

  ‘Well, wouldn’t you have said that was unusual?’ he demanded.

  ‘Not in this hospital, no.’

  ‘But seven out of eight, compared with the national average …?’

  ‘Miss Shenstone, who’s in charge of the Transplant Department here, was one of the founding fathers — mothers, I should say — of transplant surgery back in the ’sixties, and St Chad’s has always had a policy of trying to recover every organ we can. So seven out of eight is pretty good, but not a rarity.’

  ‘You’re missing my point. These seven all carried donor cards. What’s the national average of that — twenty-five, thirty per cent?’

  ‘There’s been an aggressive advertising campaign in this area. Obviously, it’s working.’

  ‘I can’t believe it’s working that well. It needs looking into.’

  ‘What are you trying to suggest?’ I demanded. ‘That these people were killed for their organs? That’s the most ridic —’

  ‘Keep your voice down,’ he hissed, looking round. Viv and Emma were in the Duty Room. ‘I said it needed looking into, that’s all.’

  ‘I can’t believe any doctor could be that callous,’ I went on in a lower tone. ‘Especially Miss Shenstone. She’s regarded as a near saint in some quarters …’

  ‘All right,’ he said quietly. ‘Arrange for me to meet her.’

  ‘I can’t do that …’

  ‘Why not? My brief is to look at interfaces between departments — remember? And considering the occupants of your three side rooms, I’d say ITU and Transplant have a considerable interface, wouldn’t you? Give her a try now, she can only say no.’

  I thought quickly. I had been told to cooperate with him, and he was right, there was an ‘interface’. And she could only say no. I picked up the phone.

  ‘You’re lucky,’ I said
thirty seconds later. ‘Very. She says if we’re there at two, she can give us ten minutes. And stop smirking,’ I snapped.

  *

  We drove back to my house in his car, an elderly, but beautifully restored Mini-Cooper, since he thought it would seem natural enough for us to go to lunch together. He was a careful, sensual driver. I asked him whether he’d found anything else on the printouts. No, he said, nothing concrete yet, but he’d be able to use them, and the staff rota sheets I was going to find to indicate the most likely suspects.

  I made some cheese and salad sandwiches while he phoned the Poisons Unit at Guy’s in London to check whether the sample had arrived.

  ‘Well?’ I said, as I handed him his sandwiches.

  ‘They’ve got the sample all right, but there’s not enough, especially as we ought to keep some of it as evidence. They want us to think about which are the most likely agents our killer would have used, so that they can start with those. You’re the nurse, Jo. Any ideas?’ He took a bite of his sandwich.

  ‘I suppose the most obvious would be potassium chloride,’ I said after swallowing my mouthful. ‘D’you remember that mercy killing by a consultant in Hants a couple of years ago? His patient was an old lady who was in so much pain from rheumatoid arthritis that even massive doses of heroin wouldn’t suppress it. She begged him to put her out of her misery and he injected two ampoules of the concentrate, which killed her.’

  ‘And that was from heart failure?’

  ‘Yes. An excessive blood—potassium level causes muscle debility, and that kind of dose leads to heart block and failure.’

  ‘But if I remember rightly, she died more or less instantaneously. I can’t imagine our killer risking that happening, not eight times. If they did, they’ll be easy to spot.’

  ‘If the injection were subcutaneous,’ I said slowly, ‘or intramuscular, the effect would be delayed.’

  ‘By how long?’

  ‘I’m not sure in the case of concentrated potassium chloride, but it could be two or three hours.’

  ‘Is it easy to get hold of?’

  ‘I think you can buy it in a chemist’s. Nothing simpler in a hospital.’

  ‘Would it show up on post-mortem?’

  I hesitated. ‘I think a large dose would, although the body naturally contains a certain amount.’