They kept looking, for anything, although the heart had gone out of them.
The first case of smallpox was reported eight days later on Thursday week.
It was the middle of a warm morning and I was with Sarah and Grace on the banks of the Exe when Roland called me. Sarah had her easel up and Grace was cooing and bubbling in her buggy. It was Thursday 7th March.
‘I think it’s started,’ he said. ‘There’s a girl here with what looks like smallpox.’
‘Where are you?’
‘Ward 11.’
‘I’ll be with you in half an hour. Can you call the others and take some samples for Tim?’
He hesitated… ‘If you don’t mind, I’d rather you took the samples from this one … we’ve got to get it right.’
‘OK, I’m on my way.’
I told Sarah I’d been called for an emergency. Her mother was in bed with a migraine, so she’d get a taxi back. ‘Is this it?’ she said.
‘Could be.’
‘Ring me when you can.’
I kissed her and left.
Since that Sunday, nearly two weeks ago, I’d spent as much of the time with them as I could. Nothing had been said, but I was thinking in terms of trying again.
It was as though she’d become a different person. Grace’s birth and Charles’ behaviour had made her… grow up, I suppose.
Had I ever stopped loving her? Just as importantly, did I
like
her?
I thought the answer to that was Yes, I did –
now
. When we hadn’t been playing with Grace, or with each other in bed, she’d started on the painting of the river she’d talked about, and watching it grow, it was as though I was watching her growing at the same time…
But now, this.
Rebecca had told me the previous week how they’d had to release the suspects, also how Blake, and Brigg’s boss Williams had indulged in wishfully thinking that the bodies we’d found were the result of either mass suicide, or murder and suicide. That the crisis was effectively over.
Like Brigg and Rebecca, I didn’t believe that, and now, as I drove to the hospital, I wondered if I should have called them first… No, wait until I’d seen the patient.
I got stuck behind a lorry along the Exe Valley and it was forty minutes before I joined Roland in Ward 11. Tim was with him. Helen was in a side room with the patient, while Anne was in another side room with the patient’s mother and GP, who’d both come in with her.
Roland was already gowned up and had gown, gloves and mask ready for me.
‘Is the air conditioning off?’ I asked him.
He nodded. ‘I did that as soon as I saw her.’
That was to stop the infection spreading to other parts of the hospital.
Tim had slides, glass capillaries and fixative ready. We followed Roland into the side room.
The patient, a girl in her teens, lay naked on the bed – other than for a couple of towels for decency. She was intubated, that is a tube inserted to support her airway, and drips ran into each of her arms. Helen was adjusting one of the drips.
I’d seen pictures of advanced smallpox, but nothing prepares you for the reality… The whole of her face, hands, arms and feet were a mass of suppurating, angry red pustules. There was more pustule than skin.
I turned on Roland – ‘Why the
hell
wasn’t she brought in earlier?’
‘The GP thought it was chicken pox, she didn’t realise –’
‘
Look
at her – the pattern’s the opposite of chicken pox…’
‘Be fair Herry, she wasn’t this bad even an hour ago. The GP hadn’t been warned and there was no reason for anyone to suspect smallpox.’ He added, ‘It
is
smallpox, isn’t it?’
I nodded. It wasn’t just the severity of the rash, it was the distribution. No other disease affects the extremities in the same way. With chicken pox, the rash looks similar – in the early stages, anyway – but it’s concentrated around the trunk. This girl’s trunk was virtually unmarked.
Tim had laid the slides and fixative on the table beside the bed and stripped the covering from the capillary tubes.
I chose two pustules from the face and one from each from the hands and feet. Roland watched intently as I dipped the end of each capillary into the weeping fluid until enough had run into it, then spread it on the glass slides. When these had dried, I immersed them in fixative and sealed the container. Then I double bagged it and handed it to Tim. He vanished without a word.
‘How long?’ Roland asked.
‘In theory, two hours, although Tim’ll hurry it along a bit. Have you done anything about getting the staff and patients here vaccinated?’
‘I was waiting for the go-ahead from you. What about the rest of the hospital?’
‘Get it started as soon as you can. What about her contacts?’ I nodded at the patient.
‘Anne’s talking to the mother and the GP now.’
‘Where are they from?’
He looked at me in what might have been pity, then said, ‘Newton-on-Exe...’
It took a moment to register, then I sank onto the only chair in the room…
Roland was saying something like – ‘It’s only one case Herry…’
I gabbled, ‘It must be the source, we’d better get out there now, get the whole village vaccinated…’
‘We can’t, not yet - ‘
‘Don’t you fuckin’ tell me what I can and can’t do…’ Then I took a deep breath and said, ‘I’m sorry… I’m sorry, Helen…’
She murmured something and Roland said, ‘It’s all right.’ He went on, ‘If we just go in now, there’ll be a panic and people will start running… We have to inform the spooks and the army before anything else…’
I nodded. ‘I’m sorry, you’re right. I’ll get onto that now.’ I looked at Helen. ‘What treatment are you giving her?’
‘Airway support, hydration and pain relief at the moment.’
‘What’s her temperature?’
‘A hundred and four, which is why she’s uncovered. That and the pain relief should bring it down.’
I nodded and went out of the room. Roland followed.
‘When are you moving her?’ I asked.
‘Just as soon as I can get the back-up team into Seven.’
The back-up team were those staff around the hospital who’d volunteered to run the isolation ward in an emergency. Ward Seven had been ready for nearly a week.
‘OK, do it. We’ll get this room bombed today… the rest of the ward maybe tomorrow.’
He hesitated… ‘It’ll be a hell of a job finding places for all the patients, and there’s no reason to think any of them are infected – we got her straight into the side room.’
I thought about it. ‘OK. Better keep it isolated though, just in case.’
He nodded. We stripped off the gowns, thrust everything into a bag and washed our hands. He went off while I took out my phone and called Brigg.
‘That’s been confirmed, has it?’ he said when I told him.
‘It will be soon enough. I take it you didn’t get any warning from John Amend-all?’
‘Not a thing. Different agenda, obviously.’
‘Yeah… Can you inform your masters in London? You’d better warn Gibb as well.’
‘He’s in Aldershot – d’you want him down now? D’you know the source yet?’
I hesitated… ‘Not yet. How long would it take him to get down here?’
‘Hour and a half, if he knows exactly where to go. Where are you going to be?’
‘Here at the hospital for the moment. I’ll get back to you as soon as I know any more.’
Next, Fenella. She answered on the third ring
‘D’you want any help from the other teams in your area?’ she asked when I finished.
‘Yes, although we’d look pretty stupid if there was an outbreak on any of their patches…’
‘D’you think that’s likely?’
I thought quickly… ‘Get them to send a nurse each,’ I said. ‘Two infection control and two clinical.’
‘Where d’you want them?’
‘Here, Ward Seven.’
‘I’ll do it now.’
As I thanked her and put the phone away, Anne stuck her head out of the other side room – ‘Herry, I’ve got the patient’s mother here and she’s getting hysterical, can you come a moment?’
I hurried in. The mother was standing, wild-faced, as the GP tried to calm her down.
‘Mrs Stokes, this is Dr Smith,’ Anne said…
The woman turned to me – ‘Doctor, what’s wrong with Lucy, is she going to be all right? Why have I been vaccinated, what’s
happening
…?’
‘Lucy’s got a virus infection and we’ve vaccinated you as a precaution.’ The truth, but not the whole truth. ‘Just to be on the safe side, we’re going to keep you in for a while to make sure you haven’t caught it as well.’
‘Does that mean I’ll be near her?’
‘Certainly…’
‘But is she going to get better?’
‘We have every reason to hope so. When did Lucy first get ill, Mrs Stokes?’
She thought for a moment… ‘Six days ago it started, I called Dr Shaw –’ she nodded at the GP – ‘she said it was ‘flu, then she said it was chicken pox, and today, she took one look at her and brought her in here…’
I slowed her down, interjected – ‘This is very important, Mrs Stokes, how many people have visited her while he’s been ill?’
‘Well, there’s her father, the doctor of course, her boyfriend –’
My eye caught Roland gesticulating through the window and I stopped her again. ‘I’d better go and check on Lucy – could you tell the nurse the names, please?’
I patted her shoulder and hurried out. Roland said, ‘Back-up are on their way, we should be able to move her in ten or fifteen minutes. Then we’ll start vaccinating this lot.’
‘Good. Have you done anything about clearing Ward Eight?’
‘No, not yet…’
‘I’ll do it. Can you make sure these side rooms are sealed after you’ve moved her?’
‘Sure.’ He hurried off.
I leaned back against the wall for a moment and thought… Have I done everything, told everyone…? Ambulance station to warn them we’d be needing them – I pulled out my phone and did that now.
Supplies: Red bags, green bags, vaccine and vaccination kit, emergency bags, gowns and gloves… Should all be in Ward Seven…
Have we got enough staff…? Back-up should cover most of it, including a couple to go with me and Anne when we went contact chasing… although I’d prefer nurses from the other teams for that…
Anne came out of the side room with a sheet of paper. ‘I think I’ve got them all,’ she said.
‘How many?’
‘Six, including her parents and the doctor.’
‘Addresses?’
‘Here –’ she held up the sheet. ‘When do we vaccinate them?’
‘Well, the sooner the better, obviously… but let’s get organised first...’ I told her back-up was on its way and Ward Seven would be ready in about ten minutes. ‘We can put the contacts into the side rooms there until we get Eight cleared. We’d better warn Six we might need that, too… God help us, if we do...’
‘Amen,’ she said. ‘Where will you be?’
I looked at my watch. ‘I’m going start getting Eight cleared and warn Six, then I’ll go over to the lab and see if I can chivvy the confirmation along. Then I’ll join you in Seven.’
She nodded and went back into the side room. I called the sister of Eight and told her to start clearing now, then Six to warn them, then the general administrator to keep her informed. Then I left for the lab.
Outside, it hit me as I walked… Sarah, Grace,
got
to get them vaccinated, and if that meant doing the whole village, so be it… but how, without being accused of nepotism?
Sort out whether it’s the source first… Can’t till we get more victims…
I arrived at the lab, keyed the code, hurried in – ‘Tim,’ I called… Glanced at my watch again… not much over an hour, but –
‘In here –’ The EM room – He was sitting at the microscope, fiddling with the controls. ‘I put one through early,’ he said without looking round –
I’d been hoping he would, although it’s verboten in the manual –
‘Just coming up now…’ he murmured…
I looked over his shoulder as he moved the field… then he upped the magnification and the familiar striated brick shape jumped into view… he looked at me enquiringly…
‘Good enough,’ I said. ‘I’ll tell Brigg while you work on the others.’ I already had my phone out and keyed in the numbers…
‘It’s confirmed,’ I said when he answered.
‘Shall I get Gibb on his way?’
Before I could answer, I was bleeped – ‘Hold on,’ I said to Brigg, and clicked over –
‘Roland?’
‘We’ve three more coming in…’
‘Where from?’ I asked.
‘One from Tivvy, one from Ditchmarch… and another from Newton.’
Tivvy was five miles from Newton, Ditchmarsh, two.
‘When are they due in?’
‘Ten minutes. I’ve told them to go straight to Seven.’
‘I’m coming over.’
I hesitated before switching back to Brigg…
It was my call, what should I do? Every instinct told me now that the source was in Newton… but with Roland knowing about my situation, could I call it yet? I clicked over to Brigg and told him quickly what had happened. ‘If Dr Wade-Stokes and I agree that they’re all smallpox, I’m going to proceed as though Newton’s the source.’
‘Shall I get Gibb on his way now?’
‘Give me another ten minutes to diagnose them.’
‘OK.’ He rang off. I told Tim to bring more sampling equipment over, then started back to Seven.
Roland was waiting by the door. I told him what I’d decided. ‘Until there’s evidence to the contrary,’ I said.
‘But if you’re wrong and it’s somewhere else –?’
‘If I’m right and we don’t do anything, it’ll be worse,’ I snapped. Then, ‘If something comes in to show us it’s elsewhere, it won’t be that difficult to divert.’
He thought for a moment, then nodded. ‘OK Herry, let’s decide when they get here.’
Unlike the watched pot, the watched clock
does
move… but very slowly. I drummed my fingers on the bench, paced up and down. Roland wasn’t much better. Five minutes, ten… it was nearly fifteen before the first came in.
It was a middle-aged man, barely conscious. Roland examined his face and hands, eased up the covering to look at his feet.
‘That’s good enough for me,’ he said looking up at me. ‘Agreed?’
I nodded and he called Helen over and told her to get him onto a bed. Anne, meanwhile, had taken the patient’s wife, who’d come with him, into a side room.
Then Tim and the next patient, a woman, turned up at the same time. I told Tim to do the sampling on the first one, while Roland and I looked at the second.
We examined him, looked at each other, nodded and handed him over to Helen. I took her husband, who’d come in with her, over to one of Anne’s assistants.
The last came in five minutes after that, also with her husband. Same diagnosis. I was about to call Brigg when Anne came out and called me over.
‘Something I think you should know,’ she said. ‘The girl who came in first – Lucy Stokes – her mother’s told me she’s an assistant in the County Stores in Newton – it’s a sort of up-market deli –’
‘I know it,’ I said. ‘Thanks Anne, that’s probably where it started. Tell me as soon as you’ve got anything from the others.’ I nodded to where the spouses were talking to her assistant.
I called Brigg – ‘Get onto Gibb and tell him I’m as sure as I can be that the source is Newton-on-Exe in Devon. If it isn’t, it’ll be somewhere nearby.’
‘Will do,’ he said, and rang off.
One of the spouses, a man, was shouting at Anne’s assistant nurse, so I went over.
‘I’m Dr Smith,’ I said firmly. ‘If you’ll calm down a minute, I’ll explain exactly what the situation is…’ It seemed to do the trick and I gave him the same story about a virus infection as before. ‘We’ll be keeping you here just as a precaution,’ I finished.
‘What virus infection exactly?’ he demanded.
‘We’re not sure yet, we think one of the tropical fever viruses,’ I told him, not quite a lie.
‘They’re pretty serious, aren’t they?’
‘They can be. Fortunately, we’ve every reason to hope we’ve got these in time. Tell me, does your wife use the County Stores in Newton?’
He nodded. ‘All the time.’
I turned to the other man, who said, ‘Quite a lot.’
And the woman – ‘Sometimes.’
‘Thanks, that’s a great help. Now if you’d like to go with the nurse, I can go back to them.’
They reluctantly followed her to another side room. Roland called me over…
‘The girl’s in a very bad way,’ he said in a low voice. ‘Fulminant, I think.’
‘She works in the County Stores, I think that’s where it started.’
‘She may not last the night,’ he said.
‘Do what you can. Has Tim done the samples on the others?’
‘He’s already gone off with them –’
My phone went again – Brigg…
‘He’s on his way, by helicopter,’ he said. ‘He says he needs to talk to you, can you come here?’
‘Not at the moment, it’s going mad here. What does he want?’
‘To ask what you know about Newton-on-Exe – where to land, and whether it’s feasible to cordon it off.’
I thought quickly. ‘There’s a village green in the middle that’ll take a helicopter.’
‘A Chinook?’
‘I think so,’ I said. ‘Yes, I’m sure. As for cordoning off the village, it’s bounded on two sides by the river…’
‘Yes, I’m looking at it now on the map… not too many roads going out either… D’you think it’s worth cordoning?’
‘Oh definitely, if it’s the source,’ I said, then told him about the County Stores and the girl who’d worked there.
‘That’s got to be it, hasn’t it?’ he said. ‘So why the hell didn’t my blokes spot it? I’ll get on to them later. So what shall I tell Gibb?’
I made my decision. ‘Tell him I’m going there myself now and I’ll meet him at the green. We can talk then.’
‘OK … he’ll be there in a little over an hour – can you do it by then?’
‘I think so…’
‘All right, I’ll pass it on. You’d better get going –’
‘Wait,’ I said, ‘Could you put me through to the desk sergeant, please?’
‘OK.’ There was a series of clicks, then –
‘Desk Sergeant, how can I help you?’
I told him who I was – ‘Could you page PC Gannon as a matter of urgency, please? Is he in the station at the moment?’
‘I’ll check, hold on…’
Should have called him earlier, I thought… Marty Gannon was the copper enlisted to help us with persuading reluctant contacts…
‘PC Gannon, how can I help you, Doc?’
I quickly explained.
‘Where d’you want me?’
‘Can you get over to Newton-on-Exe, now…’ I told him about the chopper and asked him to make sure the green was clear… ‘I’ll join you there as soon as I can.’
I rang off and went to look for Anne. She’d just come out of the second side room and was trying to calm the man, who’d followed her out…
‘What’s the problem now?’ I said to him.
‘I still don’t understand what’s going on,’ he blustered, ‘I want to know what’s wrong with my wife…’
‘As I told you, she’s got a virus infection. She’s in the best place she possibly can be for help, and you can best help her, and us, by cooperating. Please…’ I finished.
He gave a short nod.
‘We’ll tell you more as soon as we can,’ I told him. I patted him on the shoulder and he went back into the side room. I said to Anne, ‘We need to get over to Newton – have you got a list of all the contacts?’
She nodded and glanced at it. ‘Twelve… thirteen … I can’t swear it’s complete.’
‘It’ll do for now. Have they got enough staff here to cope? I’d like to take three with us…’
She hesitated, then - ‘Two, max,’ she said.
I nodded. ‘All right, it’ll have to do.’
‘Give me five minutes,’ she said.
‘No more, please. We’ve got to meet a helicopter.’
She hurried off. I leaned against the side bench and thought… What did we need to take? Red and Green bags… Vaccine, may as well take a boxful… Gowns, gloves…
I went to find Roland.
‘In the store,’ he said, pointing. ‘It’s all there.’
I quickly told him what I was doing, warned him about the awkward husband and said I’d be in touch as soon as I could.
As though on impulse, he held out a hand. ‘You’re doing all right,’ he said.
I grinned and took it. ‘You too. See you later.’
Anne came over with two of her staff. ‘Tom and Emily,’ she said.
I nodded to them, said, ‘In here,’ and took them to the stores. They grabbed the bags while I filled another with vaccine and instruments, then we hurried off.
It wasn’t until we’d loaded the car that I had a thought –
‘Anne, could you drive? I need to make a call.’
‘I don’t think my insurance covers it…’
‘Mine does,’ Tom said. ‘If that’s all right with you.’
I nodded and handed him the keys. Winced as he mashed the gears and stalled.
‘Sorry,’ he said as he restarted.
Thereafter, he seemed to get the hang of it. I found my phone, called Fenella and brought her up to date.
‘D’you think you could get two of the nurses coming here to divert to Newton-on-Exe?’ I asked her.
‘They’ll be well on their way by now,’ she said doubtfully. ‘Will they know how to get there?’
‘Come off the M5 at Tiverton and take the Exe Valley road from there. It’s well signposted. Oh,’ I added, ‘Make it the infection control nurses if possible, please.’
She said she’d do what she could and rang off. I explained to the others why we needed at least one more nurse to set up a vaccination chain, although of course Anne already knew that.
‘There are three of us already,’ said Tom, ‘isn’t that enough?’
‘I’ll need Anne to come with me to check the contacts,’ I said. ‘And we ought to have at least one spare.’
The way it’s usually done is for one nurse to clean the arms and put on vaccine, while the next needles it in and a third applies a dressing.
‘Have either of you needled vaccine before?’ I asked.
They both shook their heads.
‘Well let’s hope one of the others gets there.’
We had the answer to that when Fenella rang five minutes later. By now we were on the Exe Valley road ourselves...
‘Clare Searle thinks she can be there in half an hour,’ she told me. ‘She’s on her way from Barnstable.’
‘Anyone else?’
‘Brendon’s coming from Plymouth and says he’ll be there in under an hour.’
‘That should do it. Thanks Fenella.’
She asked if I wanted people from other areas and I said it would be a good idea to put them on alert. We talked for a few more minutes, then Tom said we were nearly there and asked exactly where I wanted him to go.
‘Just keep following this road through the village till we get to the green,’ I said.
Newton-on-Exe is centred round its green. From there, one road goes down to the river and over a bridge, while another follows the Exe east, and then north. Whoever first planned the village chose the site well. The river borders it on two sides and it’s on a sort of table about fifty feet above the river, so it doesn’t flood – which is why it could be fairly easily cordoned.
When we reached the green, Marty Gannon was already there.
‘I’ve cleared the kids off and put some yellow tape around,’ he said. ‘When’s this chopper supposed to arrive?’
I looked at my watch – ‘Any minute now. Any problems?’
‘The kids didn’t think much of it, as you can see.’ He indicated a row of small, disgruntled faces staring at us from over the tape.
‘That’ll change when they see the chopper,’ I said. ‘Let’s hope they don’t get in the way.’
I’d just finished introducing him to the others when we heard the unmistakable
whopwhop
of a helicopter in the distance.
We waited. Marty went and shooed away some boys who’d crossed the tape for a better look. Then Tom said,
‘Wow, a Chinook, no less,’ as the black shape like pair of spiders mating came over the trees. It hovered over the green for a moment before settling like thistledown on the grass. As the rotors slowed, a door opened in the side and the familiar form of Gibb emerged and ran half crouching towards us.
‘Well done,’ he said, enthusiastically pumping my hand.