Night Sisters

Helen Wright was at my elbow, less the wide-eyed student by now and anxious to help. I gave her the clothes to bag up, calling goodbye over my shoulder to the ambulance crew as they left. See you again, lads … The electrodes were already pasted to our patient’s scarred and bony chest, and Kathy was studying the readout. ‘How’re we doing?’ I asked.

I got the impression she wasn’t quite sure. But after fingering her way through the length of readout tape, and listening to his heart sounds again, she nodded to herself, and glanced across.

‘MI. We’ll make sure he’s stable, then get him upstairs to Coronary Care. Will you let them know, Rachel?’

I was already on my way over to the phone, handing my drug keys to Mike as I passed. ‘Diamorph?’ he asked, and I nodded.

‘We think you’ve had a myocardial infarction,’ Kathy was telling the patient, speaking slowly and clearly. ‘A minor heart attack. We’re going to have to admit you for …’

The man looked at her then, and that look left even Kathy lost for words. In the midst of that pale, sweating face, his eyes were glazed and staring – and the despair in them was almost frightening. Deep in his throat, he gurgled.

Here comes the vomit, I thought resignedly, and wondered if Karen would move quickly enough to avoid getting it all over herself this time. Kathy drew back prudently, and I was already reaching for the plastic bowl when I noticed something that made me hesitate … and frown.

A thin trickle of blood had started from the corner of his mouth.

My poised hand wavered. For an unreal second we were all of us still as he began bloodily to drool.

I’d seen it all before, of course. Haematemesis and haemoptysis; patients vomiting blood or coughing it up. But suddenly, as I watched that slowly lengthening dribble, strung out with saliva, I felt my stomach go cold and tight inside me. Somehow I’d known that things were about to go horribly wrong.

Kathy turned to me, still awaiting the bowl, and our patient managed one dry heave before coughing a splash of scarlet down her pristine white coat. She swore tiredly, and motioned to Karen to help her support the man as he retched again, convulsing. His mouth yawned open.

And the blood came bursting out.

It was sudden, incredible, horrifying: a niagara of gore that just came and came, dousing him, drenching Kathy and Karen, even spattering me. His body jerked, and jerked again, spraying liquid crimson halfway across the room. For a frozen moment I watched with the numb lightheadedness of sheer panic; then lunged forward, jostling with the others as we struggled to stem the flow. Infection-control procedures went out the window: there’s no point gloving-up when you’re in blood to your elbows, when it’s splashing in your face. And all to no avail; the stuff kept geysering out. Nothing we did could stop him spewing up most of his bloodstream on to our Resus room floor – a spreading crimson lake that threatened to escape under the doors. And as our frantic efforts began finally to slacken, some cold, detached part of me still found time to picture the reaction of the bored line of patients sitting outside the plaster room opposite, as that creeping bloody tide began to emerge.

So there you go. Joseph Kaufmann, vagrant; died very spectacularly in our department some eight months back. My eyes still on the readout screen, I took a sip of tepid coffee.

Just the basics were outlined here of course; his file contained the gorier detail. Kath had written up the summary: if her usual hieroglyphics were indicative of tiredness, then the scrawl she’d used on this occasion suggested a state of near-clinical shock. I knew: I’d looked through the notes often enough since. Not everything had been recorded for posterity, of course. No mention of Dr Kessler, our consultant, bursting in to demand what the fuck we were doing in there; nor of Mike skidding in the mess and spraining his knee. Nor yet of Helen, pale and shaken, finally crying it all out in the duty room, as Karen and I held her tight. One thing, however, did come over clearly: the fact that none of us knew what the hell had gone wrong.

There’d been a post-mortem, of course. It confirmed that death had resulted from massive internal haemorrhage – as if we hadn’t guessed. As to a reason for the bloodbath, the pathologist had been less forthcoming; but his findings had both puzzled and disturbed him. Not that I’ve actually seen a copy of his report to the Coroner, of course; but we get to hear these things. And maybe the tale had been distorted slightly in the telling – but the version that reached us said that friend Kaufmann had recently undergone major surgery. Abdominal and thoracic. Maybe he’d had cancer, because great chunks of his intestines had been cut away completely. Organs had been crudely trimmed and grafted. The strain on his ruined system had given him an infarct; and the whole bloody lot had gone together. Like a failed experiment. That was the rumour I heard.

Records had dutifully been checked, and backs covered; but no record had been found, either here in our hospital or anywhere else. If someone really had been attempting to broaden the frontiers of medical science, it hadn’t been on NHS time. The police had also made enquiries in the private sector – although no one could really see our meths-reeking ex-patient checking in at his local BUPA clinic. There too they drew a blank.

Back to square one.

Mike said it put him in mind of a particularly nasty backstreet abortion he’d had to deal with in his last job. I took his point, but open-heart surgery was hardly the sort of thing you practised on your kitchen table. It was Karen, in particularly ghoulish mood, who’d suggested that the animal experimentation labs had started dissecting people instead, seeing as the Great British Public was obviously more concerned about animal welfare than the human derelicts on their doorsteps.

We’d had a cynical smile over that one, and a couple more crackpot coffee-break theories besides. Resigned now to the fact that we were none of us any nearer the truth: no more than we’d been on that first awful evening, when the body had been wheeled away; leaving me standing in a room that looked as if, to coin Mike’s phrase, someone had loaded a sawn-off shotgun with spaghetti sauce, and let rip with both the barrels.

So life had gone on; until

JOHNSTON, MICHAEL arrived in our department. This was a month or two later, and too many patients had come in through the doors for us to be giving the Kaufmann case more than the occasional thought. Mr Johnston – the late Mr Johnston – had been a more urgent admission than most, having just driven a stolen car full-tilt into a brick wall.

Into Resus he’d come, bloody and wrecked and yet still raving. The ambulance crew had to help us hold him down. The team crowded round in that brightly-lit room, and once again it was all beginning to look routine. We scissored off his clothes and pulled them clear, while the doctor set about checking bones, and wounds, and reflexes: bending in close to shine his penlight in the patient’s rolling eyes.

‘What’s his name?’

One of the ambulancemen supplied it.

‘All right, Michael. Michael? can you hear me, Michael?’

But Michael was in a world of his own: a private hell of pain and panic. From his disjointed ramblings, I gathered he didn’t like doctors much. Well, he’d come to the wrong place. The doctor – it was one of the locums that night, Sayeed or someone – slipped his stethoscope back around his neck. ‘Right … I’ll need X-rays of left tib & fib, pelvis, chest, both arms … and a CT scan. That first of all, I think.’

I nodded, told Brenda to get the duty radiologist on the phone. When she answered, Sayeed conversed with her while we cleaned Johnston up as best we could and prepared him for his transfer to the CT unit on the other side of the building. He seemed quieter now; his eyes glazed over. With everything under control, I stepped outside for a moment, and found a couple of policemen hovering vulture-like in the corridor – par for the course with RTAs.

‘You won’t be able to talk to him for a while yet,’ I pointed out, a little impatiently. ‘He’ll probably be in theatre for the rest of the night.’

The taller of the two shrugged. ‘We’ll hang on for a while anyway.’

‘Joyriding, was he?’

‘Dunno. We get a report of a stolen car, and then whammo. He didn’t even slow down, according to the eyewitnesses.’

‘You’ll want to breathalyse him, presumably.’

‘At some stage.’ He glanced round. ‘Anywhere we can get coffee round here?’

‘There’s a machine round the front,’ I told him, and went on into the cubicle area to see how things were going there.

They managed to get their coffee; they never got their interview. Nor their breath sample. Michael Johnston died at ten past six that morning.

According to the CT scan, his skull was still intact, but his brain had suffered irreversible damage.

And some of it was missing.

Another post-mortem. More puzzles for the pathologists. Because Johnston too seemed to have undergone recent surgery. Brain surgery. Which came as quite a surprise, because the only medical history he’d had with us was one of drug addiction. A policeman who’d spoken to him a week or so before the accident reported that he’d seemed rational enough – yet after what had been done to his cerebral cortex, he’d have been practically a walking zombie, driving that car by sheer desperate instinct alone. There was another finding, too. Though the trephine and lobotomy seemed at one level to have been sophisticated – even audacious – there was indication once again of a certain crudity. And evidence that it had been carried out under conditions that were far from sterile.

‘Another backstreet job?’ Mike had wondered cheerfully. Me, I was just waiting for the tabloids to pick up on it all with screaming POLICE HUNT DERANGED DOCTOR headlines. And what had Johnston been muttering? Something about doctors, ‘fucking doctors … still after me. Still coming …’ Except he hadn’t called them doctors but something else – a more specialized term he could only have picked up from professionals.

Clinicians. He’d called them clinicians. A cold word. But I’d wondered why its mention made me shiver.

Three (#ulink_3422b219-0d95-57af-84f6-a72db8f0588b)

The phone rang as I was typing in the third name.

Startled despite myself, I reached over the keyboard for it, spilled the last of my coffee, and was still swearing as I brought the receiver to my ear.

‘If I’d wanted the Scatology Department,’ Mark said mildly, ‘I’d have dialled 221.’

‘I think that’s Pathology you’re thinking of, Dr Drew,’ I pointed out with completely informal formality: still checking to see whether I’d managed to get any over my uniform. ‘And by the way, where are you?’

‘The on-call room.’

Which was just up the corridor. ‘So why didn’t you just shift your bulk round here, you lazy sod?’

He grinned: his voice was full of it. ‘It’s what the telephone was invented for. But I might stagger round in a minute, if you insist.’

‘I won’t hold my breath.’ After a pause I added: ‘You guess where I was?’