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.
‘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.’
‘
So potassium chloride’s a possibility.’ He made a note in his book. ‘What about the nurse who killed those children with insulin?’
‘
Yes,’ I said grimly. ‘In Thatchbury. And she tried all sorts of methods, including potassium chloride as well as suffocation and air embolism. That’s injecting an intravenous bubble of air,’ I added in response to his quizzical look.
‘
So that does actually work, then?’
‘
It’s a bit of an old chestnut really, since you have to inject a hell of a lot, at least a hundred mil. In her case, she didn’t inject enough, and it only made the victim ill.’
‘
So probably not that, then.’ He made another note. ‘You mentioned suffocation — is that really possible?’
‘
Certainly, if the patient’s unconscious. You pinch the nose and put your hand over their mouth.’
‘
But I imagine it would be pretty obvious if you were seen doing it? Which would be quite likely in ITU.’
‘
Yes, and it would also cause the alarm to go off when the heart stopped — if the patient were connected to a monitor.’
‘
That’s a point,’ he said. ‘How many of them were connected to monitors at the time they died?’
We
went through the printouts while we finished our sandwiches. Peters hadn’t been on a monitor, of course, nor Mr Thorpe or Mr Goldman, who’d both been transferred to Coronary Care. The others all had, which didn’t tell us very much.
‘
Shall I make some coffee?’ I said, and got up without waiting for an answer.
‘
Let’s get back to insulin,’ Tom said as I handed him a mug a few minutes later. ‘How did they find out that insulin was the agent used in the Thatchbury cases?’
‘
A post-mortem on one of the victims.’
‘
So it’s detectable on PM.’ He made another note. ‘How does it cause heart failure? I only know it as the stuff diabetics use.’
‘
It’s a hormone which controls the amount of sugar released into the blood. Diabetics can’t make it, so they have too much sugar. Conversely, if you have an excess of insulin, the blood’s starved of sugar and that leads to heart failure.’
‘
How long does it take to work? After you’ve injected it.’
‘
It varies. Soluble insulin acts in a minimum of thirty minutes, but it can take up to several hours.’
‘
And if you injected it intramuscularly …?’
‘
It would presumably take longer — I don’t know. But, Tom, the killer wouldn’t have to do that, since there are delayed action forms of insulin.’
He
groaned. ‘What are they and how long do they take to work?’
‘
Er — well, there’s insulin zinc, which takes a bit longer, and there’s protamine zinc insulin, or PZI, which takes longer still.’
He
was busily scribbling. ‘How much longer?’
‘
I’ll have to look that up when we get back. It’s a long time, though.’
‘
OK. So insulin’s a strong possibility.’ He looked up. ‘Are all these various forms easily available?’
‘
Yes, they’re just kept in a fridge.’
‘
I wonder if these could be copycat killings,’ he mused. ‘Should we be looking for a nurse with a similar sort of personality defect to the one in Thatchbury?’
‘
She had Munchausen’s syndrome, and also Munchausen’s syndrome by proxy.’
‘
Which means?’
‘
In the former, you gain attention by inventing symptoms of illness in yourself; in the latter, you bring about symptoms in those under your care. She had both. Also, she was inadequate.’