Wildcard

FOURTEEN

Listening to the sombre sound of the bell, Steven wondered if it might not be tolling for all he had been taught about the mechanics of viral infection. None of this made any sense. Viruses needed a living host to maintain them and allow them to replicate. They did not have the wherewithal to lead an independent existence, not even as a simple sleeping spore, in the way that some bacteria could. Sister Mary Xavier must have contracted the infection from a living source, or else the textbooks would have to be re-written. The thought brought a wry smile to his face. Textbooks were always being re-written: it happened every time a fact emerged to take the place of expert opinion.

Steven was determined to keep thinking along logical lines. None of the other nuns was ill so Mary Xavier must have picked up the virus outside the convent. That left the unpleasant little fact that she hadn’t been outside the convent in the last nine months. Steven cursed in exasperation and leaned forward to rest his forehead on the top of the steering wheel while the tolling of the bell and the patter of the rain on the roof continued to mock him.

On impulse, he decided to drive into Hull and ask at St Thomas’s Hospital about the nature of Sister Mary’s illness and subsequent operation. He couldn’t see how it would help, but he would be amassing more information about a wildcard patient and, until such times as answers were forthcoming, no one could say what was going to be relevant and what was not. In the meantime, doing anything was better than doing nothing.

Mr Clifford Sykes-Taylor, FRCS was not at all sure about divulging information about his patient, and said so in no uncertain terms. He treated Steven to a monologue about slipping standards of patient confidentiality and the erosion of the patient-doctor relationship. He was a short, tubby man but with all the self-confidence in the world and a booming voice that belied his size. A spotted bow tie assisted in his quest to establish presence.

Steven imagined that he might have to stand on a box at the operating table, but certainly no one would have trouble hearing him.

‘I do have the authority to ask you for this information,’ said Steven calmly.

Sykes-Taylor sighed and said, ‘The authority, yes, of course, the authority, always the authority. Well, I’m not at all happy about authority’s role in this. I see it as a betrayal of my patient’s trust, and in my book my patient comes first. So far you haven’t given me one good reason why I should tell you anything.’

‘I’ll give you three if you like,’ said Steven. ‘One, like you I am a doctor, and the information will go no further. Two, I have the legal right to compel you to give me it if necessary. Three, your patient is dead; she died an hour ago.’

Sykes-Taylor looked surprised and then alarmed. ‘I hope you’re not here to suggest that my surgery played any part in her demise?’ he said, suddenly suspicious and defensive.

A surgeon’s epitaph for his patient, thought Steven. ‘No, Mr Sykes-Taylor, I’m not suggesting anything of the sort,’ he said. ‘But I would like to know why Sister Mary Xavier required your services in the first place.’

A look of relief spread over Sykes-Taylor’s face. ‘People sue if you as much as look at them the wrong way these days,’ he said, managing a half-smile for the first time. ‘Bloody legal insurance has gone sky-high this year, I can tell you. I sometimes wonder why I bother operating on the buggers, for all the thanks I get.’

Steven wondered what had happened to agonised concern about patients’ interests, but didn’t think it in his own interest to say so because Sykes-Taylor had got up to open his filing cabinet. He returned to his desk and flipped open a bulky cardboard file, slipped on half-moon glasses and began reading.

‘Ah yes, the good sister had a heart problem — she’d had it for the past five years or so. It manifested itself in the usual way, a lack of energy, breathlessness, that sort of thing. She was initially diagnosed as having a weak mitral valve — it was operating at around seventy per cent efficiency, but until the beginning of the year she wasn’t considered a high-priority case. At her check-up in December last year, however, it became apparent that the valve was becoming weaker and the stenosis worse: we thought there was a chance that it might fail completely, so we listed her for corrective surgery. She was brought in in February. She wasn’t in hospital long and the operation was straightforward and, as far as we were concerned, very successful. She left here feeling like a new woman and, to my knowledge, she hasn’t had any problems since — apart from the fact that she’s now dead.’

‘Nothing to do with her heart,’ said Steven.

‘Thank God for that,’ said Sykes-Taylor.

The milk of human kindness is not strained, thought Steven. It droppeth as the gentle rain from heaven…

He drove back from Hull feeling thoroughly depressed. He had felt sure when he set off that morning that this would be the day when he made definite progress but now here he was, driving back through the rain with an apparently insoluble puzzle for company instead of an answer.

As he entered the outskirts of Manchester and headed towards the city centre he saw newspaper stands featuring the word ‘Disaster’ prominently as the ‘hook’ on their advertising hoardings. Intrigued, he stopped and bought a paper, only to find that the story was the commercial disaster of Manchester’s Christmas. City stores’ takings were down by more than 60 per cent on the previous year. Fear was keeping people away from the shops. Good, he thought. Let’s have an old-fashioned Christmas, folks — just like the ones we used to know.

There hadn’t been time the previous evening to go through all the new material from Sci-Med on the wildcard patients, so Steven applied himself to it as soon as he got in. There was a lot on Humphrey Barclay, ranging from school reports to his dental records. He had been fined twice for speeding over the last ten years, and had spent three days in hospital in 1997, having a wisdom tooth removed.

This last piece of information reminded Steven of something in the original Sci-Med file about Barclay having been ill more recently, that being the reason for his poor rating at annual appraisal time. He looked out the file and found that Barclay had undergone heart surgery in the early part of the current year. Like Sister Mary’s operation, it had been straightforward and he had made a full recovery. No further details were available.

Steven’s satisfaction at having found some common factor, however tenuous, between two of the wildcards was greatly tempered by the fact that it hardly seemed relevant. Both Barclay and Mary Xavier had undergone successful surgery in the past year and both had made a full recovery. So what? Almost half-heartedly he thought he’d better check Ann Danby’s file and, to his no great surprise, he found no mention of surgery in her medical records, and the record seemed complete.

He was about to dismiss the surgery angle as mere coincidence when he reminded himself that Ann Danby’s status had changed. She was no longer a wildcard: she was a contact, because she had contracted the disease from Victor Spicer. Spicer was the real wildcard in the Manchester pack: it was Spicer’s medical records he should be looking at, and they were not yet available. The same applied to Frank McDougal. Steven contacted Sci-Med and asked for more details on Barclay’s illness and also for McDougal’s medical history. As for Spicer, he would go and see his wife, and find out for himself.

As he drove through the city, Steven was struck by how quiet it was. It was just after seven in the evening but it felt more like three in the morning. It was unusually dark. Many neon signs had been switched off because the premises they advertised were closed until further notice or FOR THE DURATION OF THE EMERGENCY, as the signs outside said. Pubs remained open at the licensee’s discretion, as did off-licences, the authorities having decided that closing them would be tantamount to prohibition, a measure not noted for its success in the past. Buses still ran, but on a reduced service schedule, and the night service had been abandoned altogether.

On his way to Spicer’s house, Steven came across three ambulances, blue lights flashing as they ferried patients across town, but there was no call for their sirens in the light traffic. Their silence added to the air of surrealism. Thinking about their destination made Steven wonder if Caroline would be working at St Jude’s this evening. He resolved to drive down there after he had spoken to Matilda Spicer.

He was shocked at her appearance when she opened the door. She was no longer the confident political wife with the ready smile and charm to spare. He had been wrong to categorise her as a traditional, stoic Tory wife, for in her place stood a pale, haggard figure with a haunted look that suggested she hadn’t slept properly for some time.

‘You!’ she exclaimed when she saw Steven. ‘Just what the hell do you want?’

‘I’m sorry. I hate to trouble you, but I need some more information about your husband, Mrs Spicer,’ said Steven.

‘Then why are you asking me?’ she snapped. ‘What the hell do I know about him? I seem to be the last person on earth to know what he gets up to.’

‘I’m sorry. I know this can’t be easy for you.’

‘Easy for me!’ she repeated. ‘Can you even begin to imagine what all this is doing to my daughter and me? We’ve lost everything, absolutely everything. You appear on the scene and, abracadabra, our life disappears in a puff of smoke. I don’t have a husband; Zoe no longer has a father; the charities I worked for don’t want to know me; even the au pair has been taken away by the agency — apparently we’re no longer a suitable placement for her.’

‘I’m sorry,’ repeated Steven. ‘I assumed that friends and family would rally round at a time like this.’

‘Oh, they are,’ sneered Matilda. ‘They’re rallying round him. Victor’s father more or less suggested that the whole thing was my fault. If I’d been a better wife, his precious son wouldn’t have needed to look elsewhere — that’s more or less how he put it.’

‘Like father like son,’ said Steven with distaste.

‘Well, what did you want to ask me?’

‘I need to know if your husband underwent surgery in the last year or so,’ said Steven.

‘Yes, he did,’ replied Matilda, making an obvious effort to pull herself together. ‘He had a heart operation last February.’

‘Successful?’

‘Unfortunately, yes.’

‘Can I ask where the surgery was carried out?’

‘He had it done in London.’

‘Privately?’

Matilda named a well-known private hospital. ‘We have insurance,’ she added.

‘Of course,’ said Steven.

‘Now, if there’s nothing else, I really must be getting on… I have to prepare for Christmas,’ she said with a look that challenged Steven to imagine what her Christmas was going to be like, and implied that it was all his fault.

Steven thanked her politely for her help and wished her well, although it sounded hollow in the circumstances. Matilda, who had shown no interest in why he had asked his questions, gave a half-smile tinged with sadness and regret and closed the door.

Steven heard the strains of ‘Claire de lune’ begin haltingly on the piano as he walked back to the car. He glanced back at the house and, through the branches of the half-decorated Christmas tree in the window, saw Zoe Spicer sitting on the edge of the piano stool, concentrating on her music while her mother, standing behind her, looked on.

The scene made him reflect on just how suddenly disaster could strike. Matilda Spicer must have seen herself as comfortable, confident and secure. She might even have imagined herself as a government minister’s wife in some future administration. Then suddenly, as she had said, abracadabra! None of it was there any more. The ball bounces, the cookie crumbles, shit happens and you’re left with… zilch.

Three wildcards and three heart operations was the thought uppermost in Steven’s mind as he drove back to his hotel. The coincidence had just got bigger, but on the downside it still seemed irrelevant when it came to understanding how these people got the virus. The fact that they had all undergone surgery — and successful surgery at that — was the only thing they had in common. As for the surgery itself, it had been carried out in different hospitals and in different parts of the country by different surgeons at different times. Taken at face value, this might suggest that people who had undergone surgery were more susceptible to infection, but that didn’t help at all in establishing where the infection had come from. There had to be another linking factor.

As soon as he got back, Steven requested that the kitchen put together a variation on a picnic hamper which would supply dinner for two people, complete with a couple of bottles of decent wine. If Caroline didn’t feel like going out to dinner — and it was odds on that she wouldn’t after yet another ten-hour shift at St Jude’s — dinner would come to her. He arranged to pick it up from the desk when he left just after ten, but in the meantime he went upstairs to see if any more information had come in from Sci-Med.

The first message contained the lab report on Victor Spicer’s blood sample. It had contained a high level of antibodies to the new filovirus, indicating that he had recently been infected with the strain. Steven let out a grunt of satisfaction: it was good to see loose ends tied up, and now there was no doubt that Spicer had been the cause of the Manchester outbreak.

More information about Humphrey Barclay’s medical condition had come. He had suffered from rheumatic fever as a child and this had resulted in a weak pulmonary heart valve in later years. His condition had worsened over the last two years, leading to the need for surgery, which had taken place in March this year. The operation was successful and, until he contracted the filovirus, Barclay had enjoyed better health than he had done for many years.

‘Just like Sister Mary Xavier,’ murmured Steven. ‘You have successful heart surgery, you feel like a new person, and suddenly you’re dead.’ Matilda Spicer had not been specific about the type of surgery Victor had undergone, and Steven didn’t feel like contacting her again in the circumstances. He did remember, however, the name of the hospital, so he asked Sci-Med to make contact and request details.

He was getting ready to leave for St Jude’s when medical details on Frank McDougal came through. Steven scanned the screen with a frisson of anticipation and found what he was looking for. McDougal, too, had suffered from a heart problem. He had been diagnosed in December 1999 as suffering from age-associated degeneration of the aortic heart valve. Surgery had been performed to correct the fault in April this year and had been successful, so much so that McDougal had taken up hill-walking and had already bagged fourteen Munros (Scottish mountains over three thousand feet) during the summer.

‘Jesus wept,’ muttered Steven. He didn’t pretend to understand what was going on, but the elation at making a connection between the wildcards was more than welcome and long overdue. Four wildcards, four heart problems, four operations, this was too much of a coincidence to be one at all.

Caroline looked more tired than ever when she emerged from the changing room with Kate Lineham. She was losing weight, thought Steven; hollows were appearing in her cheeks.

Kate was trying to persuade her to take the following day off. ‘Do something else,’ she advised. ‘It doesn’t matter what, just anything else for a change.’

‘I’ll be here. I haven’t seen you taking the day off.’

‘I’m more used to this sort of work than you.’

‘No one is used to this sort of work,’ retorted Caroline, holding her gaze for a long moment.

‘You have a point,’ conceded Kate, ‘but there’s no sense in making yourself ill.’ She turned to Steven and said, ‘I’m off. See that this one gets to bed early.’

Caroline had had to leave her car at home that morning because it had refused to start, so Steven drove her back. ‘Rough day?’ he asked, although the answer was plain in her face.

‘The worst. You know, I’m beginning to wonder what the point is. We’ve had only three people show signs of recovery since I started down at St Jude’s. All the rest have died. All we do is wipe up blood and vomit and urine and shit… all day, every day, over and over again

… And then they die.’

Steven glanced at her out of the corner of his eye and saw that tears were running down her cheeks although she was not sobbing and her face was impassive.

‘Kate’s right. You need some time off,’ he said gently.

‘No way,’ she said resolutely. ‘Not until we get some more volunteer nurses down there.’

‘Are you sure you’re not doing this out of some misplaced sense of guilt?’ said Steven as kindly as he could.

‘Maybe at the beginning,’ she agreed, without protest and to Steven’s surprise, ‘but not any more.’

‘Then why?’

‘You know, I think it’s simply because I hope someone might do the same for me if I ever need it,’ said Caroline. ‘That’s the best reason I’ve been able to come up with.’

‘I think you do yourself an injustice,’ said Steven. ‘But I won’t embarrass you by suggesting that you’re an exceptional human being, I’ll just feed you dinner.’

‘You’re serious?’

‘I am.’

They completed the journey in silence. Caroline leaned her head on the headrest and closed her eyes.

The food the hotel had provided was plentiful if, of necessity, cold. Since both of them were hungry but not particularly interested in food, it didn’t matter.

‘You haven’t said anything about your day,’ said Caroline as they sat in front of the fire nursing the last of the first bottle of wine.

Steven told her what he had discovered.

‘Heart surgery?’ she exclaimed. ‘What on earth can that have to do with the virus?’

‘I know it’s bizarre,’ agreed Steven, ‘but it’s also a fact and I think it’s too much of a coincidence to ignore.’

Caroline still looked doubtful. ‘Now, if they had all had surgery in the same hospital at the same time, I might have to agree that there was something fishy but they didn’t and even the timescale is all wrong. They had their surgery many months ago. The virus has an incubation time of around seven to ten days, so what exactly are you suggesting?’

‘I don’t know,’ confessed Steven. ‘I think I need to talk to a surgeon so I can get some feel for what’s going on.’

‘In the meantime, maybe we can open that other bottle of wine?’

‘Water of Lethe coming up.’

After a while, Caroline slipped off her chair and sat on the carpet in front of the fire at Steven’s feet. She rested her head on his knee. ‘How long till Christmas?’ she asked. ‘I’ve lost track.’

‘Ten days,’ he said. The question made him think of Jenny. It seemed unlikely that he would be with her. He would have to speak to Sue and find out how she was going to take it.

‘Where will you spend it?’ asked Caroline, as if reading his mind.

‘Here, I should think. You?’

‘St Jude’s,’ she said quietly, ‘piling up bodies for collection. Wonder how God will square that one.’

He stroked her hair gently and she made an appreciative sound. ‘God, it seems such a long time since anyone did that,’ she murmured.

The wine and the heat of the fire conspired to bring her eyelids together and it wasn’t long before she fell fast asleep. Steven slid slowly sideways to stand up. He picked her up and took her upstairs to her bedroom, where he removed her shoes and loosened her clothing before putting her to bed and tucking the covers in around her. The central heating had switched itself off and the room was chilly.

Caroline stirred sleepily and without opening her eyes said, ‘Are you putting me to bed, by any chance?’

‘I promised Kate Lineham I would,’ whispered Steven, and he clicked out the light.

He’d had too much to drink to consider driving back to the hotel, so he settled down on the couch in the living room. He awoke some four hours later with a crick in his neck. Rubbing it vigorously, he padded over to the window, opened a curtain, and cleared a patch in the condensation. He could see by the light from the street lamps that large flakes of snow were falling, laying a carpet of white over street and garden. He shivered and looked at his watch: it was 4 a.m. Not the best time of day to feel optimistic, but something about the way the snow was silently covering the city invited parallels with the virus and nurtured thoughts about the nature of good and evil.

‘You must be cold,’ said Caroline behind him. ‘I didn’t put out any blankets for you.’

Steven turned and saw her standing in the doorway. ‘I’m fine,’ he said. ‘Couldn’t you sleep?’

‘Too many bad dreams. I need coffee. You?’

He nodded and closed the curtain again. Caroline made the coffee and they sat on the couch, hands wrapped round their mugs, staring at the fire, which Caroline had turned on full.

‘I have such a bad feeling about the way things are going,’ said Caroline.

‘It’s always darkest before the dawn.’

‘Maybe there isn’t going to be a dawn. Did you know that the suicide rate in the city has gone up by a factor of eight in the past week?’

‘I didn’t,’ said Steven.

‘They reckon it’s guilt. Relatives of those going down with the disease feel helpless because they can’t do anything to help — they can’t even give their loved ones a proper funeral because of the restrictions.’

She shivered and Steven put his arm round her.

‘Would you think me awfully forward if I suggested that we should go up to bed together?’ she asked, still gazing at the fire.

‘No,’ replied Steven truthfully.

‘Somehow I feel that time is not on our side,’ she murmured.