Chameleon

THREE

Outside in the courtyard between the block where Jamieson was sleeping and the old stone building that housed the Obstetrics and Gynaecology Department the rain continued to fall. Sally Jenkins heard it pattering down on the cobble stones. She had been unable to get to sleep for the pain in her stomach. 'Perfectly natural after any operation, the nurse had assured her. They would give her a pill and she would feel much better in the morning.

Keith, her husband had been equally reassuring. He had spoken to Mr Thelwell and everything had gone well in theatre. The surgeon had located a blockage in her fallopian tubes that had been preventing her from falling pregnant. The big fear that her tubes might have been too damaged to be repaired had been shown to be groundless. Mr Thelwell had successfully cleared away the obstruction and now there was no reason why she should not have children.

She would have a son for Keith, a boy he could take fishing on the canal on Saturdays while she and their daughter — yes she would like a daughter too — while she and Alice would have a nice day at home. They would call her Alice after Keith's mother. Keith's mother would like that. There had always been a frostiness between them, nothing serious, but Sally knew that old Alice blamed her for the fact that she still did not have any grand children after five years of marriage.

Alice would have preferred Keith to have married Stella Gorman, the girl he had been going out with when Sally had first met him. Stella Gorman's father owned a garage business in Trafalgar Street and Alice had already started to pencil in plans for Keith's future when it had all gone wrong for her. As it turned out, Keith had married her and as her father did not own a garage business, or any other kind for that matter, Keith was consequently still working as a mechanic in the council bus depot.

Sally managed a smile in the darkness despite the fact that her pain seemed to be getting worse not better. She did not want to bother the nurses again but it was becoming really bad. Perhaps if she thought some more about children it would take her mind off the pain or maybe even if she concentrated on the sound of the rain outside.

Sally liked the sound of rain. For some reason it always made her think of a time many years ago when she had gone camping with the Girl Guides. They had gone to the Forest of Dean and it had rained non stop for the entire week. They had spent hour after hour lying in their tents just listening to the sound of the rain on the canvas while their leader thought up endless variations on word games to keep them amused.

Sally had been glad to escape the games by being sent each morning to collect fresh milk from the nearby farm. Her wellingtons had squelched through the mud and the rain had pattered on the hood of her anorak just like it was pattering on the awning below her window.

A new stab of pain shot through her and wiped out all thoughts of rain and children. It made her gasp and reach out for the buzzer. Her fingers closed round it like a claw as the pain seemed to seek out the most sensitive nerve ending in her body. Her back arched in a sub conscious attempt to escape it but this only put unfair pressure on the stitches in her lower abdomen. Sally Jenkins added to the call of the buzzer with a scream.

The night staff-nurse in charge of Princess Mary ward called out the duty houseman who was reluctant to come at first for what he felt sure was probably normal post-operative discomfort but the nurse insisted. She won with a veiled threat to call Mr Thelwell directly. 'I think it might be another problem case,' she said.

'But it can't be,' insisted the houseman. 'Mr Thelwell used one of the orthopaedic theatres today. There's never been any trouble with infection in orthopaedics.'

'Well maybe there is now,' said the nurse, putting down the phone as another scream tore the air and wakened the rest of the ward. Sleepy voices were seeking reassurance as she hurried to Sally Jenkins' assistance. 'Nothing to worry about Mrs Elms… It's all right, Mrs Cartwright, we're dealing with it… Go back to sleep Mrs Brown, Nothing to worry about…'

The houseman, white coat pulled on over a hastily donned shirt which still had three buttons undone, arrived within five minutes and ran his fingers through tousled hair while the nurse briefed him. A cursory examination, established that Sally Jenkins' temperature was touching one hundred and two and she was showing all the classic signs of bacterial septicaemia. If this had been an isolated incident, he might have prescribed the normal front-line antibiotics and felt confident of their efficacy but with the current problem-infection in the unit he was reluctant to do this.

If there was a chance that the Pseudomonas was responsible for the infection then penicillin, always the safest drug to prescribe because of its safety and lack of side-effects, would have no effect. On the other hand, none of the other drugs at his disposal had had much effect on the bug in the previous cases. The houseman swithered for a moment, weighing up the pros and cons of seeking assistance. It was now after midnight but the desire to pass the buck on this one was overwhelming. He called Thelwell at home. Thelwell's wife answered.

'I'm sorry to disturb you at this hour Mrs Thelwell but could I possibly speak to your husband. It's Graham Dean at the hospital. I've got a bit of a problem.'

'I'm sorry Graham, Gordon isn't home yet. He's been attending a dinner this evening. Would you like me to give him a message?'

Dean gave Marion Thelwell a brief outline of Sally Jenkins' condition to relay to her husband when he came home and said that he would try to contact Thelwell's number two. After reading the number from the chart on the wall behind the phone, Dean called Thelwell's senior registrar, Phillip Morton and had more luck. He explained the situation to Morton and the buck passed to him. Morton said that he would be there within fifteen minutes. In the meantime, Dean was instructed to start chemotherapy immediately on the assumption that it was a Pseudomonas infection like the others. 'Start her on Pyopen.'

'And the pain?' asked the houseman.

'Omnipon, usual dose,' said Morton.

The door to the basement apartment opened and heavy curtains were drawn across rain splashed windows before it was closed again and locked twice from the inside. The man inside stood still for a moment in the darkness with his back against the door, listening to the sound of his own breathing and feeling the cold and damp surround him. A slight smile crossed his face for to him it felt good, it felt right. He clicked on the light, not that a forty watt bulb made much inroads into the gloom, and walked slowly through to the bathroom where a rubber apron hung over the bath and a row of surgical instruments were lined up along the back of the sink where he had left them. They were clean and dry and ready to be used again.

He took down the apron and folded it neatly before packing it into a briefcase. The inside of the case was protected by a polythene lining because the man prided himself on detail. There were to be no tell-tale blood stains, no blood anywhere there did not have to be.

In a separate compartment in the case he had a number of plastic bags. He counted them and decided to add a few more. There was still plenty of adhesive tape. He put down the case for a moment and went to the fridge in the kitchen to open the door. There, lying in two plastic bags was what he had removed from the Spooner woman. The man gave a satisfied grunt. There was one less bitch to spread her filth, one less to snare and entrap the unwary with her silks and perfumes. What fools men were not to realise what vile creatures lay hidden behind the smiling faces and the pretty clothes. But they were not entirely to blame. Nature had equipped the bitches well. It was so easy to succumb to their wiles. He knew that only too well.

The man closed his eyes and shook as he relived a private agony. His mother, God bless her, had always brought him up to be aware of the deceit and artfulness of women and he in turn had always believed her but on that one night in the town when the bitch had come out at him from the doorway he had suddenly become weak. He had wanted to push her away but something inside had prevented him. He remembered standing there, breathing in her sweet smelling scent, feeling her body brush against him, feeling the hardness start and the yearning to squeeze the breasts that were thrusting up at him from the half-open blouse.

The bitch had taken him by the hand, giggling and smiling, and pulled him into the darkness of the alley where she had gripped him between the legs and complemented him on what she felt there. 'You want me don't you,' she had crooned and the more she spoke the more he had wanted her.

He had paid her what she had asked and she had taken him to a filthy room in a crumbling tenement where the bed had smelled of sweat and the sheets had hard stains on them. But at the time it hadn't mattered. Nothing had mattered. In the midst of all that squalor, he had still wanted her. He had been on fire. He had lost all self control in the desire to possess her. The whore had egged him on until he had taken her quickly and urgently like an animal in heat.

Afterwards, he had lain there, with her laughter ringing in his ears. With passion spent, he had been able to see clearly that the bitch had trapped him. She had tricked him into doing something entirely against his will. All at once he had been able to see everything with crystal clarity. He had felt ashamed, dirty and very angry.

He had beaten up the whore. He felt he had duty to. He had smashed her face with his fists and kicked her senseless. It would be a long time before she trapped anyone else with her looks. But, for him, it had all been too late. The whore had given him an infection. She had given him a terrible infection.

At first it was just a burning pain when he urinated. He couldn't bring himself to believe that it was anything more than a slight urethritis but then the chancre appeared. It had disappeared on its own but he knew that this was just one of the symptoms, one of Treponema pallidum’s tricks for it would be sure to come back and next time it would bring the secondary phase of the disease, the rash, the invasion of his entire system, lesions in his bones, his joints, maybe even his central nervous system. He would go blind and maybe mad. The whore had given him syphilis.

Modern antibiotic treatment should have dealt with the problem. God knows, it was embarrassing enough to be on the treatment at all and to have to attend that damned awful clinic where you were given numbers in a pathetic attempt to preserve anonymity, but fate had something else in store for him. The strain of syphilis he had succumbed to proved not to be amenable to such treatment. It stubbornly refused to die. There was a war going on inside his body and Treponema was winning. The clinic staff kept up an unending stream of platitudes and reassuring pap in order to convince him that things were under control and but he knew better. They were doing their best to treat him but they were failing. His condition was untreatable.

All of us have within us, a mental threshold that decrees how much pain and anguish we can endure before we lose control and mentally start to fall to pieces. Fortunately, in times of peace, few of us ever approach this borderline. But for a man who had been a loner all his life, the oddball at school, the one the girls laughed at and the boys taunted, the one who had been unable to risk leaving the security of his mother's love, the disease within him was the last straw.

He had first approached the threshold when his mother collapsed and died just over a year before. There had been no warning, no time for him to prepare. He had simply gone into her bedroom one morning and found her lying there, icy cold and with her eyes open. When that happened he had felt so betrayed and alone that he had been unable to speak for weeks. They had taken him to the clinic on the hill where he had sat in a wickerwork chair and stared at the wall for days on end, totally withdrawn and unwilling to communicate with the world for fear of what else life in might have in store for him.

He had been given pills which allowed him to sleep and others which took the edge off reality during the day. He was artificially released from stress until, in time, he recovered enough to give life one more chance. He saw the disease as the result of his misplaced trust.

This time he did not lapse into a trance. He did not capitulate to the overwhelming forces of fate and bow his head in anguished acceptance. There was no flirtation at the threshold between reality and madness. He sailed way over it and there was no going back. This time he was filled with anger. A deep, burning anger that knew no bounds. What he wanted now was not pills or kind words. It was revenge.

He would have to protect himself against the evil charms of the whores for he was not yet immune. He had known this last night when the bitch had been tied up and he had felt the hardness come on. The hardness was even coming on now when he thought about it. He pulled down his fly and reached inside his trousers to grip himself while he thought about the wiles the bitch would use. The stockings, the underwear, the perfume, the laughing red lips. He had to protect himself. He turned out the light and in the darkness of the basement he relieved himself of the desire that would be such a weakness in the job ahead of him.

With the surgical instruments wrapped in cloth so that they would not rattle and the blades in foil sheaths so that they would not be dulled he snapped shut the case and put out the light before opening the door. He paused in the basement area for a moment to listen for footsteps but all was quiet. The rain was still falling. That was good. There would not be many people on the streets. But the whores would be there. They were always there, whatever the weather. If all went well he would be back within two hours.

Gordon Thelwell called the hospital at a quarter to one to say that he had just arrived home and understood that his houseman, Dean, had been trying to contact him earlier in the evening. He spoke to the night staff-nurse in charge of the ward where Sally Jenkins lay and was given a report on her current condition and an outline of the treatment prescribed for her by Phillip Morton.

'Appalling!' exclaimed Thelwell. 'This whole hospital is a cesspit of infection.'

The nurse remained silent and waited for Thelwell to continue. He asked her what specimens had been sent to the lab and she told him after referring to the ward lab records book.

'I hope they're not just lying in the collection basket,' said Thelwell.

'They were marked urgent and the duty microbiologist was called out to deal with them sir,' replied the nurse.

Thelwell grunted and asked if Dean was still in the ward.

'No sir,' replied the nurse. 'Mrs Jenkins seems to be stable at the moment sir. Dr Deans left about fifteen minutes ago.'

Thelwell grunted and asked to be informed if there was any change in the patient's condition.

'Of course sir,' said the nurse.

'We'll see how she is in the morning.'

'Yes sir.'

'Trouble dear?' asked Marion Thelwell, sitting up in bed and blinking against the light which her husband had switched on.

'One of my patients. She may have a wound site infection,' replied Thelwell distantly.

Marion Thelwell stopped blinking and looked concerned. 'Not another problem case,' she sighed. I thought you were going to use the Orthopaedic Theatre today?' she said.

'I did use the Orthopaedic theatre,' snapped Thelwell.

'Yes dear.'

Thelwell regretted his sharpness and apologised saying, 'I'm afraid I'm a bit on edge. This business is getting me down.'

'I understand dear. Come to bed.'

'Later.'

'Yes dear.'

Scott Jamieson woke at three in the morning. He usually did when something was troubling him. It was no comfort to know that he was one of thousands in the country who woke regularly at this time. Nature had decreed that three in the morning was the hour when people with problems ranging from the unmanageable size of their mortgage to true manic depression would wake to face their personal hell. Optimism required daylight. Despair thrived in the dark.

He felt alone as he lay in the subdued night-light of the strange ward listening to the sounds of the night. He missed not having Sue next to him. He missed not being able to stretch his arm over her sleeping body to cuddle in to her. He resolved to oppose any possible suggestion in the years to come that they change to single beds. It irked him that he had got off to such a bad start in his new job. Almost subconsciously he flexed the fingers of both hands beneath the bandages to assess how painful they were. It was academic really for he had already decided to start his investigation in the morning however badly he felt. As it happened, they did not feel too bad at all.

His impatience to get on with the job was not entirely due to his inability to come to terms with imposed idleness. It was reinforced with the belief that if he did not get on with the investigation Sci-Med might well feel obliged to send in someone else and that would mean that he had failed, a completely unacceptable state of affairs for Scott Jamieson whatever extenuating circumstance there might be.

As Jamieson closed his eyes and tried to get back to sleep in the ward, the telephone rang beside John Richardson's bed and woke him from a deep sleep. He took a few moments to clear his head and then held the receiver to his ear.

'I'm sorry to trouble you at this hour,' said Clive Evans's voice but I was called out a couple of hours ago for a patient in post-op, one of Mr Thelwell's patients, a Mrs Sally Jenkins. She's being showing signs of wound infection and Mr Thelwell's registrar took swabs for testing.'

'And?'

'Gram-negative bacilli and a positive oxidase test. It looks like it's the Pseudomonas again. I thought you would want to know.'

'Yes, thank-you,' said Richardson putting down the phone. His wife who was awake beside him asked about the call.

'Another post-operative infection in Gynaecology.'

'But I thought Thelwell had closed the Gynae theatre?'

'He did,' replied Richardson thoughtfully. He insisted on moving his scheduled operations to the Orthopaedic suite until we had traced the source of the outbreak.'

'Then it looks like he took the infection with him.'

Richardson looked at his wife and said, 'This is exactly what I have been saying all along. If we can't find the source of infection in the theatre itself then the fault must lie with the staff. It's time we swabbed the whole surgical team again; we must have a carrier among them. It's the only logical explanation. For some unknown reason we must have missed him…'

'Or her.'

'Or her, the first time around.'

Jamieson awoke to the sound of two nurses talking. They were standing in the doorway of his room, one with her hand on the door knob and the other standing in the corridor outside with a steel tray in her hand. As he became fully awake Jamieson could make out some of their conversation.

'They say he cut her to pieces,' said one of the girls.

'That's what I heard too,' agreed the other. I don't understand how no one heard her screams.'

'Maybe they did,' said the other girl. 'They just pretended not to, a sign of the times, I'm afraid. People just don't want to get involved.'

The nurse with her hand on the door handle noticed that Jamieson was awake and cut short the conversation to come into the room and close the door behind her.

'What was that all about?' asked Jamieson.

'A prostitute was murdered in the city last night,' replied the girl.

'I heard about that,' said Jamieson.

'No, this is another one. It happened last night. You're thinking of the first one.'

'Two in two days,' exclaimed Jamieson.

'He cuts them up,' said the girl.

Jamieson grimaced.

'Just like Jack the Ripper, they say.'

Jamieson guessed that 'they' would be the morning papers.

'How are you feeling?'

'Right as rain. I want to leave as soon as I can get the dressings changed.

'I think you should wait till Dr Carew has seen you. You're an important patient.'

Jamieson smiled at the girl's frankness and said, 'I'll take the responsibility.'

'If you say so doctor.'

Jamieson was back in his room in the doctors' residency shortly after breakfast and was pleased to see that the wall behind the bath had been repaired and the heater was back on its mounting. All the same he could not see himself using it again however cold the room might feel. He telephoned the hospital secretary's office and informed him that he was ready to start talking to people.

Crichton was surprised that Jamieson was back in action again so soon and expressed concern over the wisdom of leaving the ward so quickly. Jamieson bore it patiently then asked for help in organising his day.

'Fate has taken a hand Doctor, ' said Crichton. 'A patient that Mr Thelwell operated on yesterday has developed an infection despite the fact that the operation was carried out in a different theatre in a different part of the hospital. We are holding a meeting at ten to discuss the situation. Perhaps you would like to attend?'

'I would indeed,' agreed Jamieson. 'Just one question. Where was the patient taken after her operation?'

'The post-operative ward in Gynaecology.'

'Thank you,' said Jamieson and put down the phone. So they had changed the theatres and that had made no difference, thought Jamieson. That left the theatre staff themselves as a possible source of infection or possibly the post-op ward in Gynae. The patient had been brought back there after her operation. Jamieson made a mental list of the questions he wanted to ask at the meeting.

There was a general air of gloom about the men who had assembled in Hugh Crichton's office to discuss the latest problem case. Crichton said to a serious looking, thin-lipped man, 'I don't think you’ve met Dr Jamieson yet have you?… Dr Jamieson, this is Mr Thelwell, consultant surgeon in Gynaecology.'

Jamieson smiled across the table and Thelwell gave a barely perceptible nod in reply. Jamieson was then introduced to Phillip Morton, Thelwell's registrar and then to Clive Evans whom he admitted he had already met.

'First of all gentlemen, how is the patient this morning?' asked Crichton.

'She's very ill,' said Thelwell. 'Chemotherapy is having no effect.'

'So it's the same strain as the others?'

'Looks like it,' said John Richardson. 'We'll know for sure when the antibiogram is ready.'

'Has there been any progress in determining the source of the outbreak?' asked Carew.

Richardson shook his head and Thelwell gave an audible snort which caused the others to move uncomfortably in their seats. Richardson carried on as if he had not heard. 'All the swabs we took from the theatres and the recovery wards were negative for the organism in question. In fact the standard of cleanliness was rather high.' Thelwell gave another snort and Carew shot him an angry glance but still said nothing.

'Where were the swabs taken from?' asked Jamieson.

'All flat surfaces including the walls. All wet areas including sink and sluice drains and flower vases in the wards.' replied Richardson.

'And no Pseudomonas?'

'We found Pseudomonas all right but not the strain in question,' said Clive Evans. Jamieson noted that the acne scarring on Evans' face became more livid when he was under stress.

'How about air sampling?'

'We've done that too,' said Richardson. 'Negative for Pseudomonas in all tests.'

'Am I right in thinking that the fact that this latest case was operated on in Orthopaedics means that the theatres in Gynaecology are now cleared of suspicion?' asked Hugh Crichton.

'I think we can assume that,' replied Richardson.

'So what does that leave us with?'

'Nursing and medical staff as possible carriers or something in the recovery wards that we haven't thought of.'

'Presumable you have already swabbed the staff?' asked Jamieson.

Richardson nodded. 'All of them. Nasal and axillary swabs in duplicate on two separate days. We found one nurse carrying haemolytic streptococci but no Pseudomonas carrier.'

'What about instruments and dressings?'

'They are sterilised in our Central Sterile Supply Department and taken directly to theatres in sterile packs.'

'How often are the sterilisers checked?'

'The autoclaves are fitted with a wide range of safe-guards against malfunction.

'Anything else?' asked Jamieson.

'Dr Evans is in charge of bio-safety in the CSSD,' said Richardson looking towards his junior colleague.

'The main steriliser is thermo-couple tested every week,' said Evans. 'I personally carry out the test. It's in perfect condition. Someone from Microbiology, usually myself, checks the chart recorders on the others every day. We have the records of every single autoclave run. They're kept in the lab office if you would like to examine them.'

'I think at this stage I would like to see everything including the air sampling reports and the swab results.' said Jamieson.

Evans looked a little surprised but Richardson simply said, 'Of course. When would you like to come?'

'Immediately after this meeting if that's convenient?'

'Of course.'

Carew cleared his throat and said, 'Now gentlemen we come to the big question. Can we allow surgery to continue in Kerr Memorial's Gynaecology Department?'

Gordon Thelwell looked as if there had never been any suggestion of doing otherwise. 'We have to,' he said firmly. 'My waiting list is already as long as a bank holiday traffic jam. Any suspension would only make matters worse.'

'We have to consider that two women have died after surgery and a third is seriously ill,' said Carew.

'The number has to be viewed in the context of the number of surgical cases passing through my Department.' replied Thelwell.

The coldness of Thelwell's statement made Jamieson a little uneasy and he saw that it had much the same effect on the others.

'The dead women's husbands don't view the deaths in the context of any numbers,' snapped Richardson.

Thelwell, wasp-like in his response snapped back, 'Then perhaps Doctor if your department did its job we would not be faced with the problem and neither would they.'

Richardson leaned forward angrily in his chair but managed to control his temper in time. He took a deep breath and said, 'We are doing everything humanly possible to identify the source of the infection and will continue to do so starting with another swab check of the surgical team and the nurses in the post-op wards.'

'Maybe we should send the swabs directly to the Public Health Laboratory Service this time,' said Thelwell. 'Perhaps they can find this damned bug.'

Jamieson saw the flash of anger in Richardson's eyes and noted Carew's impotence in intervening in the hostilities. He himself interrupted. 'They will go to the hospital lab in the usual manner.'

Thelwell reacted as if Jamieson had struck him. He said slowly, 'And who might I ask are you to make that sort of decision?'

Jamieson replied evenly, 'I think you will find that I have the authority.' He looked to Crichton and Carew.

Crichton said, 'Dr Jamieson does have the authority Mr Thelwell.'

Thelwell's smile was dipped in sarcasm. He said, 'So a civil servant is now in charge of surgery at Kerr Memorial.'

'Actually I'm a surgeon,' said Jamieson. 'And my involvement with Kerr Memorial will cease the moment people stop dying unnecessarily in your department. And talking about your department Mr Thelwell, I would like to be shown round it… today.'

Jamieson held Thelwell's gaze without flinching. It was Thelwell who broke eye contact first. He said, 'I'll have Mr Morton accompany you.'

'I'd rather you did it personally,' said Jamieson determined to establish his authority at the beginning in the hope that done once it would not be necessary to do it again.'

Once again Thelwell hovered on the brink of argument and Jamieson could see the anger swim in his eyes as he considered his reply. The thin lips quivered before they said curtly and to everyone's relief, 'Very well. Contact my secretary and she will fit you in to my schedule.'

Carew reminded them, 'We have still not decided what to do about the surgical lists.'

'I thought we had,' said Thelwell coldly.

'You expressed an opinion Mr Thelwell,' said Carew. 'But we did not decide. We must consider the options.'

'Which are?'

'Basically, there are three. One, we suspend surgery temporarily. Two, we start diverting patients to other hospitals. Three, we continue operating in the hope that, with extra vigilance on all our parts, the problem will not re-occur.'

'The second option is a non-starter I'm afraid,' said Crichton. 'I've been in touch with all the other hospitals and there is no possibility of their accepting any of our patients outside of dire emergency cases. Their lists are just as long as ours.'

'So we suspend or carry on with greater care.'

'I resent the implications of that remark Carew,' said Thelwell icily.

'There was no personal element in what I said Thelwell. If we decide that surgery is to continue in Gynaecology, aseptic procedure must be tightened up in all areas.'

It was unanimously decided that, for the present, surgery would continue in Gynaecology at Kerr Memorial.

'There is one change that I would like to see,' said Jamieson.

'Yes Doctor?' asked Carew.

''You are still using the same recovery ward for gynaecology patients. I think it would be a good idea to change to another one for the time being. Is that possible?'

After some deliberation, Crichton said that it was. Alexandra ward had been closed for some months due to shortage of nurses or, more correctly due to the shortage of money to pay for them. It could be re-opened and used for post-operative cases after suitable cleaning and preparation.

'How long?' asked Jamieson.

'Two days,' said Crichton.

'Then I suggest that surgery recommences when the new ward is ready.'

There were nods of agreement round the table.

'We'll see to the fumigation of the old ward once it's empty,' said Richardson.'

'Good,' said Crichton.

'If there is nothing else gentlemen?' Carew looked around him. No one spoke. 'Very well then. Shall we be about our business?'