‘
Surely. I’m sorry.’
By
the time we’d returned to my office, he was almost back to normal.
‘
Are conventional syringes ever used for blood-taking?’ he asked.
‘
Very rarely — I can’t remember the last time. Besides, a lot of patients watch when their blood’s taken, and they’d notice if something were being put in with a syringe rather than taken out.’
‘
All right, it was just an idea,’ he said after a pause. ‘What other paramedics come on to the ward?’
‘
Jacqui, the ECG technician. The physiotherapists — they come quite a lot.’ I thought. ‘That’s about it.’
‘
Would either of them ever use an invasive procedure?’
‘
No. Jacqui sticks on electrodes. The physiotherapist lays on hands.’
‘
So it comes down to a doctor or a nurse, doesn’t it?’ He paused. ‘And of the two, a nurse has to be the more likely, wouldn’t you think, Sister?’
‘
Would that be another example of your unfortunate manner?’
I sorted out the nursing rotas for him so that he could go back to my house and study them while I looked up the action times of insulin and digoxin. For the benefit of the staff, he bade me an ostentatious goodbye, saying he would see me later at Miss Shenstone’s lecture.
I
left for home about half an hour after that and found him immersed in paper in my living-room.
‘
You look as though you could do with some coffee,’ I said.
‘
Please. This is going to be more complicated than I’d hoped,’ he continued gloomily. ‘Assuming, that is, that insulin is still our favourite for the method.’
‘
I think it must be,’ I said, ‘considering its availability and ranges of times it takes to act.’
‘
What did you find?’
I
’d discovered that soluble insulin could act in anything up to four hours, insulin zinc in anything up to six hours, and PZI in a maximum of eight to fourteen. With digoxin, the times were two hours for the injectable form and six hours for the oral.
‘
Let’s take Mrs Sutton for example,’ he said, after I’d made the coffee. ‘She died at about half-past twelve in the morning. Only if she’d been given potassium chloride could it have been someone on that midnight shift.’
‘
That’s very unlikely,’ I said. ‘I was on the ward myself from midnight.’
‘
All right. If she’d been given soluble or zinc insulin,’ he continued, ‘it would have been someone on the previous shift, 1600 to midnight. And if it was PZI, it could have been on the 0800 to 1600 shift.’
‘
More likely to have been 1600 to midnight, though.’
‘
More likely, yes, but not certain.’
‘
Unless it was in a drip as you suggested,’ I said. ‘Although I don’t think she was on a drip …’ I found her notes. ‘No, she wasn’t.’
‘
Just because Mrs Sutton wasn’t poisoned via a drip doesn’t mean that the others weren’t.’
‘
But I thought you said yesterday that the killings were either planned or random. That would mean both.’
‘
If it’s a psycho, as you seem to think, they might take the chance to kill whenever it occurred. Let’s see how many of them were on drips when they died.’
In
fact, only two out of the eight were, which is about what I’d have expected under normal circumstances.
‘
Which suggests to me that the killings
were
planned,’ he said. ‘We’ll still have to consider the possibility of both, though.’
‘
But that’ll make it impossible,’ I protested.
‘
Tedious, perhaps, but not impossible.’ He looked up. ‘Why don’t you make us something to eat, Jo, while I think about it?’
If,
at that moment, I’d had some potassium chloride and a syringe on me, I think I might have used them. I gave him a filthy look which he didn’t even notice, then went through to the kitchen and made an omelette so that I could take it out on the eggs.
He
ate quickly and absent-mindedly, asking sporadic questions.
‘
What happens when a nurse is sick?’
‘
Either the shift does without, or someone else has to step in, like I did on Tuesday.’
‘
D’you keep records of that?’
‘
Yes — in that book by your elbow marked “Out of hours working”.’ A thought struck me. ‘But wouldn’t that suggest unplanned killings, just when we’d decided they’re probably planned?’
‘
It might give the killer the opportunity they’d been waiting for, especially if it was at night. I assume there are less of you there then?’
‘
Less, but in an ITU, that’s still a lot. That’s why it’s called intensive therapy.’
But
sarcasm was wasted on him.
‘
You know what we’re going to have to do, Jo?’
‘
I can’t wait to hear.’
‘
We’re going to have to make a chart — a list for each dead patient — of the staff who fit into the time-frame, then see which names come up on all of them.’
‘
I still think you’ll end up with a hell of a lot of names.’
‘
We can worry about that later. The thing is, the accuracy of these rotas is critical. I notice in places — here for instance — that names have been crossed out and others pencilled in.’
‘
That’s when two people have agreed to swap duties.’
‘
Does it have to be a swap? I mean, couldn’t one simply take over the duties of another?’
‘
That can happen, although not often. Too tiring, for one thing. It screws up their time sheets, for another.’
‘
Are all such changes marked here on the rota sheet?’
‘
They certainly
should
be. It has been known for people to forget, although I give them hell if I find out.’
‘
Is there any way these rotas can be checked?’
‘
No, not really.’
‘
You mentioned time sheets just now. Do the staff fill them in themselves?’
‘
Yes.’
‘
Who signs them?’
‘
I do, but —’
‘
D’you keep copies?’
‘
Yes …’
‘
Well, that’s how you can check these rotas.’
‘
But what’s to stop the killer simply leaving out the times they actually killed someone?’
‘
The person they swapped with — they’ll have put the right times.’
‘
But it’ll take hours …’ I protested.
‘
Another thing — these rotas only cover the nurses. What about the others — the doctors?’
‘
We keep a logbook which covers the doctors and all the paramedics.’
‘
We’ll need that as well, then.’
‘
Oh, my God!’
‘
Beautiful omelette, Jo.’
‘
Oh, get lost, Jones …’
*
‘We
stand
helpless
in
the
face
of
the
suffering
and
deaths
of
our
fellow
human
beings
.
To
somehow
intervene
in
this
inexorable
process
,
however
briefly
,
is
the
best
expression
of
our
humanity
.
’
I
sat up. That had to be the most riveting start to any talk I’d ever heard, and Miss Shenstone’s voice, with its dark Celtic overtones, was the best medium to convey it. Jones had left the house before me and saved me a seat near the front of the packed lecture hall.
‘
That statement, made by a fellow physician many years ago, is as true today as when it was first uttered.’ Miss Shenstone looked around the hall. ‘It was with that statement in mind that the transplant policy of this hospital was formulated.’
Dr
Cannock, who as chairman of the meeting had introduced Miss Shenstone, was now sitting to one side of her on the platform, busily taking notes.
‘
It is our policy in this hospital to attempt to recover every single organ that becomes available, so that it may be targeted as soon as possible to the most suitable recipient, wherever they may happen to be in the country. To that end, we have a standard procedure, the first step of which is to ascertain the tissue type of every patient who is admitted to St Chad’s.’
She
turned, seemingly taking in every member of the audience. ‘We do not want patients to die — that would defeat our purpose. But when they do, our policy is to immediately put them on life support and actively seek permission for transplant from the relatives. As soon as this is obtained, we send details of the organs available, together with the donor’s tissue type, to the British Transplant Headquarters in London. They have on computer details of all the patients in the country who require transplants and can decide which of them should be the recipient. Then the donor can be sent to whichever transplant unit is to be used.’ She paused again to look round.
‘
The successful working of this policy depends on you, ladies and gentlemen. Yes, every one of you is involved; every one of you has his, or her, part to play.’
She
does have this tendency to go slightly manic sometimes when giving a talk. Not in the operating theatre, though. I remember seeing her there once when I was training, and she was utterly confident, completely in control.
‘
The medical and nursing staff,’ she continued, ‘who have the unpleasant, and at times traumatic, task of approaching the relatives of the deceased for permission for transplant. Who then place and keep the donors on life support. The medical and scientific staff who perform the tissue typing and other laboratory tests. The clerks who type the results. The porters who carry the samples. All of you.’
Having
given us a large slice of the credit, she now went on to describe, with slides, case reports of recent successful transplants carried out in the unit. Not surprisingly, her audience wanted to hear about their altruism and gave her their complete attention.
When
the slides were finished and the lights went up, she said, ‘There has been a certain amount of … disquiet in the media over the last few years concerning organ transplant. The phrase
Spare
Parts
has been bandied about. We have been given images of wealthy ghouls prolonging their perhaps useless lives by a form of cannibalism. Not nice at all.
‘
But how would you explain to a young man with a defective heart, or a young woman with failed kidneys that: Sorry, we could give you a transplant, but it’s not regarded as being quite the thing?
‘
Transplants save lives. Young lives. Transplants very positively intervene in a human being’s inexorable progress to suffering and death, which is why I make no apologies for our aggressive policy at this hospital of re-using every single available organ we can acquire. In fact, I want to see our policy extended throughout the whole country.’
There
was a spontaneous burst of applause as she sat down, in which I joined, then Dr Cannock rose and asked whether there were any questions.
After
the usual silence — nobody wants to be the first — a hand went up and Cannock indicated for them to speak.
‘
Just as a matter of interest’ — the speaker was a nattily dressed man with a bow tie — ‘if no suitable recipient were found in this country, could the organs be used abroad?’
Miss
Shenstone said, ‘That can, and occasionally does, happen, but there’s nearly always a suitable recipient somewhere in this country. The usual problem is deciding which of many should receive the organs.’
Stephen,
whom I hadn’t noticed before, put up his hand.
‘
Miss Shenstone, is there not at the moment an imbalance in the number of organs we export to other regions, compared to patients benefiting in this area? And if so, what steps could be taken to redress this imbalance?’