A Date with the Ice Princess

An ashen-faced man walked up the corridor, supported by another man.

She introduced herself swiftly. ‘So you have a headache and temperature, Mr McRae?’

‘Eddie,’ he muttered. ‘I feel terrible.’

‘Have you been in contact with anyone who has a virus?’ she asked.

‘I don’t think so.’

So it could be withdrawal or a bad reaction to the drugs he’d taken. His breathing was fast, she noticed. ‘Can I take your pulse?’

‘Sure.’

His pulse was also fast, so Eddie could well be suffering from sepsis.

‘Have you taken anything?’ she asked gently.

This time Eddie didn’t say a word, and she had a pretty good idea why. ‘I’m not going to lecture you or call the police,’ she reassured him. ‘My job’s to help you feel better than you do right now. And the more information you give me, the easier it’s going to be for me to get it right first time.’

‘He took something Saturday night,’ his friend said. ‘He’s been ill today, with a headache and temperature.’

‘So it could be a reaction to what you took. Did you swallow it?’

Eddie shook his head and grimaced in pain.

‘Injected?’ At his slight nod, she said, ‘Can I see where?’

He shrugged off his cardigan. There were track marks on his arm, as she’d expected, but the redness and swelling definitely weren’t what she’d expected.

‘Eddie, I really need to know what you took,’ she said gently.

‘Heroin,’ his friend said.

‘OK.’ She knew that the withdrawal symptoms from heroin usually peaked forty-eight to seventy-two hours after the last dose, but this didn’t seem like the withdrawal cases she’d seen in the past.

‘Are you sleeping OK, Eddie?’ she asked.

‘Yeah.’

‘Do you have any pain, other than your head?’

He nodded. ‘My stomach.’

‘Have you been sick or had diarrhoea?’

He grimaced. ‘No.’

Abigail had a funny feeling about this. Although she hadn’t actually seen a case at her last hospital, there had been a departmental circular about heroin users suffering from anthrax after using contaminated supplies, and an alarm bell was ringing at the back of her head. There was no sign of black eschar, the dead tissue cast off from the surface of the skin, which was one of the big giveaways with anthrax, but she had a really strong feeling about this. Right now she could do with some advice from a more senior colleague.

‘I’m going to leave you in here for a second, if that’s OK,’ she said. ‘I have a hunch I know what’s wrong, but there’s something I want to check with a colleague, and then I think we’ll be able to do something to help you.’

‘Just make the pain stop. Please,’ Eddie said.

She stepped out of the cubicle and pulled the curtain closed behind her. With any luck Max or Marco would be free—in this case, she needed a second opinion from a consultant.

But the first person she saw was Lewis.

‘OK, Abby?’ he asked. ‘You look a bit worried.’

‘I need a second opinion on a patient. Is Max or Marco around?’

‘Marco’s in Resus and Max is in a meeting,’ he said. ‘Will I do?’

Although they were officially the same grade, she knew that Lewis was older than her—which made him more experienced, her senior colleague. And really she should’ve asked him instead of trying to track down Max or Marco. She grimaced. ‘Sorry, I didn’t mean to imply that you weren’t good eno—’

‘Relax, Abby,’ he cut in. ‘I didn’t think you were saying that at all. What’s the problem?’

‘My patient took heroin on Saturday. He has a headache and a temperature, and what looks like soft tissue sepsis—not the normal sort of reaction at the injection site. At my last hospital, we had case notes about anthrax in heroin users. Do you know if there’s anything like that happening in this area?’

‘No—but you know as well as I do that if something affects one area of the city, it’s going to spread to the rest, so it’s only a matter of time. You think this is anthrax?’

‘There’s no sign of black eschar. I don’t have any proof. Just a gut feeling that this is more than just withdrawal symptoms or a bad reaction.’

‘I’d run with it. Do you want me to take a look to back you up? And if it is anthrax, we can split the notifications between us and save a bit of time.’

Anthrax was a notifiable disease, and the lab would also need to know of her suspicions when she sent any samples through for testing so they could take extra precautions. ‘Thanks, that would be good,’ she said gratefully.

Lewis walked back to the cubicle with her and she introduced him to Eddie McRae. Lewis examined him swiftly and looked at her. ‘I think you’re right,’ he said quietly.

Abigail took a deep breath. ‘I’ll need to do a couple more tests to check, Eddie, but I think you have anthrax.’

‘But—how? We’re not terrorists or anything!’ Eddie looked shocked. ‘We’ve never had anything to do with that sort of stuff. How can I have anthrax?’

‘Anthrax is a bacterium,’ she explained. ‘It can survive as spores in soil for years. It’s not that common now in the UK, but somehow anthrax has found its way into the heroin supply chain so the drugs have been contaminated. There have been a few cases of heroin users with anthrax in mainland Europe and Scotland—and parts of London, too, because we had some in my last hospital.’

‘My granddad was a farmer. His cattle got anthrax years ago and they all had to be killed. Is Eddie going to die?’ Eddie’s friend asked, looking anxious.

‘It’s treatable,’ Lewis reassured him. ‘We can give you broad-spectrum antibiotics to deal with the infection, but you’ll also need surgery, Eddie.’