White death

EIGHT

Steven spent the weekend up in Glenvane. He took Jenny and Sue and Richard’s two children swimming on Saturday morning in Dumfries and then for a pizza lunch followed by ice-cream and a telling-off from Sue when they got back for being so indulgent with them. The children enjoyed seeing Steven being scolded, suppressing giggles behind their hands while he did his best to appear contrite, exchanging secret glances with them.

Things between him and Jenny were not as they’d been — the ghost of her outburst on the last occasion still hung in the air — but she seemed more relaxed and even happy again, and that pleased him. There would, however, be no going back. The one sure thing he had to face was the fact that Jenny was growing up.

Steven flew back to London on the Sunday night shuttle from Glasgow rather than wait for the packed flight first thing on Monday morning. He had some paperwork to take care of and some shopping to do. The fridge in his flat was nearly empty as was the freezer and ready meals played a big part in his diet. Cooking did not interest him. He’d had to look after himself at university but student cuisine was no basis for success in the kitchen. Apart from that, his mother had done all the cooking at home and the army had taken care of such matters throughout his time in the military. When he felt like eating ‘properly’ he would go out to one of a number of restaurants he visited regularly. Tonight, when he’d finished his shopping, it would be Chinese food at the Jade Garden.

‘The child’s name is Anwar Mubarak,’ announced John Macmillan on Monday morning. ‘He’s thirteen years old and he’s currently in the children’s hospital in Leicester. He’s been diagnosed with pulmonary tuberculosis, affecting both lungs, but the lab reports no problems with the strain. It’s sensitive to all front-line antibiotics.’

‘Really?’ exclaimed Steven. ‘That’s a surprise.’

‘Why?’

Steven told Macmillan about Jim Brewer’s assertion that the medical response at the camp had been over the top if there was no reason to believe a ‘difficult’ strain of TB was involved.

‘They wouldn’t know at the time if it was difficult or not,’ pointed out Macmillan. ‘Maybe they were just being ultra-cautious.’

‘I suppose,’ agreed Steven. ‘But it still doesn’t explain why Scott Haldane was so pissed off.’

‘You don’t let go, do you?’ smiled Macmillan.

Steven shrugged.

‘I need hardly remind you that HMG still wants the identity of the boy to remain a secret.’

‘Understood.’

‘Jean has the other stuff you asked for. Let me know when you want to lay this to rest.’

Steven smiled as he left Macmillan’s office. This was the nearest Macmillan would come to suggesting that he might be chasing rainbows. He collected the file from Jean and went to the unit library to read it, collecting a cup of coffee from the machine in the corridor on the way.

Steven learned that fourteen of the children who’d been present at Pinetops camp when Mubarak had been diagnosed with TB had subsequently sought treatment from their GPs. He read with some alarm that one had actually died. Keith Taylor, a thirteen-year-old boy, had succumbed to the ravages of necrotising fasciitis after having been admitted to hospital in Carlisle. Steven screwed up his face as he read the report, thinking how cruel fate could be and what his parents must have gone through, watching their son die a terrible death.

Patricia Lyons was on the list too, reported as suffering from vitiligo and currently recovering from a scalding accident. Two more children had been treated in hospital for burns. Three had been treated for broken bones — two with arm fractures, one with compound leg fractures after falling off his bike. Four of the children were being treated for impetigo…

Impetigo was a skin complaint. Steven had been looking for any early warning signs of TB among the green sticker children but now the four cases of impetigo leapt out at him. Trish Lyons had been suffering from vitiligo, another skin condition. That made five reports of skin complaints out of one hundred and eight children, six if the boy who’d died of necrotising fasciitis was included. Maybe not significant but… Steven read on and alarm bells started to ring when he read that three more children had been referred to their GPs suffering from unspecified ‘loss of pigment’ in their skin. Nine.

What the hell was going on? There was no sign of TB in the children but the incidence of skin complaints must be well above what could be expected in previously healthy twelve-to thirteen-year-old children. Four with impetigo, three with unspecified ‘loss of pigment’, Patricia Lyons with vitiligo and a boy who’d died of necrotising fasciitis — the flesh-eating disease… Surely this couldn’t be coincidence but if not, what was he suggesting? That there was some common cause of their ailments? That they had all contracted a skin condition through being at Pinetops camp?

Steven rubbed his forehead nervously as he tried to decide what to do next. The only thing the children had in common, apart from their age, was that fact that they had attended Pinetops camp at the same time and had been given BCG vaccine after a TB scare. BCG vaccine was something that had been used for fifty years so it was hardly likely to be that causing the trouble. According to Jim Brewer, it wasn’t the most effective vaccine in the world but it was certainly safe. This left the possibility that something the kids had been exposed to at Pinetops had been the cause of the problem although, he reminded himself, it did not seem to be a single problem. Vitiligo, impetigo, loss of pigment were all vague terms. Even necrotising fasciitis could have a number of causes. Maybe he had been precipitate in lumping them all together as ‘skin problems’ but he would certainly investigate further and he would start with the one that had caused Keith Taylor’s death.

The pathology report wasn’t included in the file Jean had given him — the cause of death had simply been put down as necrotising fasciitis. He needed to know more about the bacterium that had caused it. He wanted to know the exact cause of death.

Two days later, Steven finally got access to the PM report on Keith Taylor. His physician had made the original diagnosis of necrotising fasciitis after flesh ‘instability’ had been noted in several areas of Keith’s body. The Carlisle hospital pathologist had confirmed the diagnosis at post mortem but no cause had been given. The lab reports had all been negative.

Negative? Steven shook his head in frustration. The boy had an infection that was eating him alive and the lab had come up with nothing? What the hell did they imagine caused it, pixie dust? This was beyond… He stopped himself in mid-thought and cautioned himself to calm down. There had to be a rational explanation some where. It was just a question of finding it. He phoned the hospital in Carlisle and asked to speak to the consultant microbiologist. He turned out to be an Irishman by the name of O’Connor.

‘It was most unusual,’ conceded O’Connor. ‘We simply failed to grow any bacterium or virus from the boy’s tissues.’

‘But according to the medical report, his flesh was so infected it was falling off him,’ said Steven.

‘I know,’ said O’Connor. ‘But the fact remains, the cultures were all negative and so was the serology.’

‘What did you test for?’

‘Just about everything we could think of.’

Steven put the phone down, feeling far from happy but not quite sure what to do about it… or rather, he was sure but was unwilling to contemplate it unless he could convince himself and John Macmillan that it was absolutely necessary. It would involve the exhumation of Keith Taylor’s body.

Steven made his request to Macmillan the following morning having agonised about it long and hard and Macmillan had reluctantly agreed after unsuccessfully reminding Steven, unnecessarily, just how much upset and stress this was going to cause to the boy’s parents.

‘I know,’ agreed Steven. ‘But there’s something very wrong here. I have to find out why Keith Taylor died. I want a Home Office pathologist to carry out a second post mortem and a top lab to analyse the samples.’

Keith Taylor had been buried in a cemetery about half a mile from his home. A new granite headstone recorded his untimely death and the undying love of his parents. Bunches of fresh flowers marked the grave and cards spoke of his youth and all too premature demise. They appeared unreal under the lights from the rig set up by the police to illuminate the scene, an operation which started at midnight behind a canvas awning to avoid prying eyes.

‘I hope you’ve got a damned good reason for this,’ said the police superintendent who was overseeing the operation. The disapproval was plain in his voice. ‘As if losing their son wasn’t enough…’

Steven resisted the temptation to snap back: Of course I’ve got a good reason. Do you think I do this as a bloody hobby? Instead he remained silent, eyes fixed on the digging, aware of the patter of rain on the shoulders of his waxed cotton jacket. He saw the coffin hoisted from the ground and loaded into the back of an unlettered black van for transport to the city mortuary where the second post mortem was to be carried out. He left the scene and returned to his hotel to grab a few hours’ sleep before joining the Home Office pathologist who was due at nine.

The post mortem was carried out with full bio-precautions being observed. The danger associated with bugs causing necrotising fasciitis was not to be underestimated and the pathologist, Steven and two assistants were fully gowned and masked with full-face visors being employed.

‘All right?’ asked Mark Porter, the pathologist detailed by the Home Office to carry out the examination. Steven nodded.

‘Bloody hell,’ were Porter’s first words as he began his work. ‘I’ve seen a few cases of Nec Fash in my time but never one as bad as this… he’s absolutely riddled… the flesh is like… Jesus, what a mess…’

‘You’re absolutely sure about it being necrotising fasciitis?’ asked Steven.

‘What else could it be?’

‘But the hospital lab couldn’t grow anything.’

‘Crazy,’ said Porter. ‘His flesh must be hoaching with bacteria.’

‘Can you take lots of samples, please? It’s important we find out exactly what caused this. I don’t suppose you’d care to hazard a guess about the bug’s identity?’

Porter gazed down at the corpse. ‘I’d rather not. Like I say, I’ve never come across anything as bad as this although…’

‘Yes?’

‘It might be a one-off. I mean, the boy might have been ultra-susceptible to the bug. It happens. I’ve seen AIDS victims succumb to infections that rip through them like a tsunami hitting a beach simply because they have no body defences left when the HIV virus is finished with them. On the other hand of course, it could be the bacterium itself that’s ultra-virulent; in which case, we could all be up a certain creek without a paddle.’

Porter turned to the two assistants who were waiting to clean up. ‘Be very careful.’

Three days passed without any word from the London lab dealing with the Taylor boy’s samples. Steven was collating paperwork he had obtained from various sources over the past couple of weeks when he suddenly saw something that made his blood run cold. It was the entry in Keith Taylor’s medical notes that recorded his receipt of a bone marrow transplant and that he was receiving immuno-suppressive treatment. He snatched up his phone and called Jim Brewer at Great Ormond Street.

‘Is BCG a live virus vaccine?’ he asked.

‘It certainly is,’ replied Brewer, a reply that made Steven close his eyes. ‘It’s an attenuated form of TB isolated by two French scientists in the Fifties — Calmette and Guerin, hence the name. BCG. Bacille Calmette-Guerin. What’s the problem?’

‘One of the kids I told you about, the ones who were given BCG vaccine at the school camp, was on immuno-suppressive drugs when he was vaccinated.’

‘Jesus,’ said Brewer. ‘I take it they didn’t know?’

‘The kid’s dead,’ said Steven. ‘Necrotising fasciitis — it swept through him like a runaway train.’

‘Jesus Christ, what a fuck-up.’

‘Looks like the medics who gave him the BCG didn’t know about the kid’s background and the medics who treated him in hospital didn’t know he’d been given the vaccine.’

‘I take it the lab grew the BCG bug?’

‘They didn’t grow anything. There are secondary tests being carried out by another lab at the moment.’

‘They might not look for TB,’ said Brewer. ‘It’s a lung disease, not exactly the thing you’d expect to cause a rip-roaring flesh infection.’

‘The first lab said they’d checked for everything,’ said Steven.

‘It might be as well to check with them again. TB grows very slowly in the lab compared to other bugs and it needs a special culture medium. It can take six to eight weeks to grow up while something like a streptococcus grows up overnight.’

‘I’ll do that,’ said Steven. ‘Thanks again.’

Steven felt sick inside. It looked very much as if a mix-up in paperwork had led to Keith Taylor’s death, a mix-up which had also led to his requesting an exhumation and causing the boy’s parents a great deal of stress on top of everything else. It had all the elements of a Bungling Docs story in the tabloids. He called the lab dealing with the Taylor specimens.

‘Nothing yet, I’m afraid.’

‘Have you set up cultures for TB?’

‘Just a moment…’

Steven drummed his fingers on the desk while he waited.

‘We wouldn’t normally,’ came the reply. ‘But in this case, because it doesn’t seem to be one of the usual suspects, we’ve set up cultures on every bacterial growth medium we have, including those for TB. If this bug grows in the lab, we’ll find it.’

Steven hung up before he was asked about his interest in TB. He wanted to talk things over with John Macmillan first. Knowing now that it would take the lab the best part of six to eight weeks to grow up the BCG bacillus, he decided to check with O’Connor, the microbiologist at the children’s hospital in Carlisle. It was he who had told him they’d looked for ‘everything we could think of’ in the Taylor boy’s specimens.

‘We got such a surprise when nothing grew up overnight that I told the staff to inoculate his specimens on every other culture medium we use,’ said O’Connor.

‘Would that include media capable of supporting TB?’ asked Steven.

‘It would.’

‘And?’

‘And nothing. No growth on anything.’

‘Would you just check again for me please?’

O’Connor put down the phone with a clatter. He returned after two minutes. Steven had followed the second hand sweep of his watch.

‘The cultures were discarded as being completely negative after fourteen weeks.’

‘Thank you,’ said Steven without further comment.

He decided not to talk it over with Macmillan until the following morning. He needed time to get things clear in his head. He had been concentrating so much on Keith Taylor’s death that he had lost sight of the connection he was looking for with the other vaccinated children who had developed skin complaints.

He decided to phone the children’s hospital in Edinburgh to ask about the condition of Patricia Lyons.

‘She’s very ill.’

This was not what he wanted to hear.

‘She has some kind of an infection in the flesh of her burned arm and it’s not responding to treatment.’

‘Some kind of an infection?’ said Steven. ‘What does that mean?’

‘It’s hard to say. The lab hasn’t found anything.’