Chameleon

FOUR

When they left the meeting, Jamieson told Clive Evans that he wanted to call in at the residency to pick up his briefcase before going on down to Microbiology. Evans said that he would accompany him and then show him the way.

'I've never seen anyone stand up to Mr Thelwell that way before,' Evans confided seriously as they crossed the cobbled yard to the blackened, stone building that served as the doctors' residency. Jamieson had not relished his first meeting with Thelwell. He had to admit that it had turned out to be even worse that he had feared but he was reluctant to enter into any conversation about Thelwell with another member of staff. He chose to ignore the comment, and looked up at a series of stone busts on ledges at the side of the entrance to the residency. Corrosion of the sandstone had eaten away at the cornice of the ledges and also at some of the lettering. It made the names and dates difficult to read but he managed to make out the citation to the main one. It said, John Thurlow Kerr, Professor of Medicine, 1881–1888.

'Our founder's bid for immortality,' said Evans.

Jamieson wondered for a moment why all busts and statues looked pretty much the same to him. What was the point of it all? What was he meant to think when he looked at a crumbling stone bust? He supposed that Evans had hit the nail on the head with his 'bid for immortality' comment. Pathetic, really.

He considered what the hospital must have been like in 1881 and how much pain and suffering these walls had seen and heard, how much human misery they had been witness to. If only they could talk, but maybe it was best not to hear. Had the public of the day had the same faith in their healers as they did today? The same blind faith. Had people looked on trustingly while leeches were applied to suck their blood under the 'learned' gaze of frock-coated sages, the medical gentlemen, the Thelwells of another age, men for whom self doubt was an alien concept?

Jamieson reflected on the history of his profession with little pleasure. Was there any other professional body so conservative in its outlook, so fiercely insular, so determined that outsiders be kept at bay? He doubted it and took little pride in the conclusion.

Jamieson looked at the stern, bearded face of John Thurlow Kerr and considered the state of medicine in the late nineteenth century. Surgery had meant the screams of the unanaesthetised and the near certainty of suppurating wound infection to follow. Childbirth had meant puerperal sepsis for so many women, a disease caused almost entirely by the medical profession itself who, in the ignorance of their age, had arrogantly strode between the post-mortem room and the maternity ward unwittingly spreading the infections that they subsequently sought to cure.

How many doctors of a later day acknowledged that fact when the role of bacteria in infection was finally understood? Not many he concluded. Humility was not an outstanding characteristic of medical practitioners. This was true the world over whether they be Harley Street physicians or African witch doctors. In their own way both sought to keep their patients in ignorance of their own bodies and determined to keep it that way in their own interests. Both peddled pills and potions and did so with a mystique cultivated to preserve their position in society. 'What will the penicillin do Doctor?' 'Fight the infection Mrs Brown.' But how many GPs knew what penicillin really did do? How many would know that it inhibited the final step in peptidoglycan cross linking in bacterial call wall synthesis? At a rough guess none out of a hundred. Jamieson knew because Jamieson wanted to know everything. But then, that was why he had been recommended to Sci-Med in the first place.

'Shan't be a moment,' Jamieson said to Evans and ran upstairs to collect his briefcase. He paused in the room for a moment to adjust the bandage on his left hand which was threatening to come adrift. As he re-tied it he reflected on what he had learned at the meeting. 'Difficult' wasn't the word for a man like Thelwell. He was a twenty-four carat son of a bitch with no saving grace that he could determine.

Carew was too weak to be effective as medical superintendent. He was all right for opening hospital fetes and talking to the ladies' luncheon club but no use against the steam-rollering of people like Thelwell. Crichton seemed to be a good man but, of course, as a pure administrator, he could not involve himself in matters medical. Phillip Morton seemed all right from what little he had said and Jamieson did not envy him his job under Thelwell. Richardson too, seemed a good man. Jamieson admired the way he had kept his temper under extreme provocation from Thelwell but was forced to wonder whether or not it was a case of real self control or perhaps a lack of stomach for a fight due to advancing years. Clive Evans seemed competent, loyal to Richardson and keen to help in any way he could. What was more, he was waiting downstairs.

Jamieson followed Evans along a narrow lane between signs pointing to the skin clinic in one direction and the hospital laundry in the other. He was hoping for a modern microbiology department but when Evans took a left turn down some stone steps he feared the worst and was duly rewarded. The Microbiology Department at Kerr Memorial was located on the ground floor and in the basement of one of the oldest buildings in the hospital.

'Dr Richardson's office is just along here,' said Evans, still leading the way. A girl technician at Specimen Reception looked up as Jamieson passed and smiled. Jamieson smiled back. Smiles were important when you were on your own. They were reassuring, like the sight of a navigational buoy to a mariner in strange oceans.

Jamieson felt claustrophobia closing in on him as they progressed along a long corridor between rows of small laboratories, each scarcely big enough to warrant the term, 'room'. They were correctly, little more than cubicles. The corridor narrowed in places to almost less that the width of a human body where lack of space had forced refrigerators and other large items of equipment out into the hallway.

Although Richardson's room was bigger and had a large window, Jamieson could see that it would never receive enough daylight to warrant turning off the artificial lighting. The building across the way was less that five feet away.

'I've arranged for you to have a room downstairs,' said Richardson. 'It's not much I'm afraid but as you see we are a bit cramped.

'I'm sure it will be fine,' said Jamieson.

'If there's anything you need you only have to ask.'

Clive Evans took off his jacket and donned a white lab coat. As he rolled back the cuffs of his shirt sleeves Jamieson again noticed the red burn marks on the back of his wrist and asked him about them.

'Oh it's absolutely nothing,' insisted Evans, 'No problem at all.'

'What happened?' asked Richardson.

'Dr Evans burned himself while helping me escape electrocution yesterday,' Jamieson explained.

'Really?' exclaimed Richardson, obviously concerned at his colleague's injury. 'Have you seen about it Clive?' he asked. 'Maybe you should have a dressing on that.' He leaned forward to examine it more closely but Evans again insisted that it was nothing and pulled down his sleeve. He turned to Jamieson and said, 'If you like I'll show you around the lab.'

Jamieson followed Evans round the cubicles of the first floor while Evans explained what happened in each of them then he led the way downstairs to the cold, fluorescent light of the basement and a long low room. 'This is the Preparation Room,' he said. 'All our glassware and equipment is cleaned and sterilised here.

Jamieson noted the three women working at large stainless steel sinks and noted the steam steriliser that was currently on an operating cycle. A relay clicked to allow more steam to enter and maintain its temperature.

'As you see, we have one large autoclave, working on the hospital's direct steam supply. We use that to sterilise all specimens once we've finished with them. In addition we have three hot air ovens and several small pressure cookers for individuals to use if they have to sterilise something in a hurry.

'Do you sterilise anything for other wards or departments?' Jamieson asked.

'No. All general sterilising is done down in the central facility at CSSD.'

'I see,' said Jamieson. He noticed that the sweat was running off the women as they worked at their sinks and looked up at the ceiling for an extractor fan.

Evans read his mind and said, 'I'm afraid there's no air conditioning. Dr Richardson has been asking for it for a long time I understand but with no success. Too many other priorities. It's not so bad when the steriliser isn't running.'

'But pretty awful when it is,' added Jamieson.

The two men moved on through the basement corridor with Jamieson having to duck his head to avoid hitting it on an array of pipes that ran along the underside of the low ceiling. Evans, a couple of inches shorter than Jamieson, did not have the same problem.

'This is my lab,' said Evans opening a door to a square room that was slightly bigger than any of the others Jamieson had seen with the exception of Richardson's room. 'And this, I am afraid, is yours for the duration.' Evans opened a door on the other side of the corridor and Jamieson looked in to a small, narrow room that reminded him of a walk-in wardrobe. It had a desk, a telephone and an anglepoise lamp and not much else. There was no room for anything else. There were two cardboard folders lying on the desk.

'These files contain the information you asked for,' said Evans. 'If there's anything else, I'm just across the corridor.'

Jamieson thanked him and took off his jacket to hang it over the back of his chair. He sat down and looked at the walls that enclosed him. If he reached out he could touch all of them. Above him there was a thick, glass grating that allowed the merest suspicion of daylight to enter, slightly less than the greyest of dawns, Jamieson reckoned. 'One hundred and five North Tower,' he whispered switching on the anglepoise lamp. He opened the folders and got to work.

After a good two hours study, Jamieson could find no fault in the procedures followed by the Microbiology Department in trying to trace the source of the infection. According to the records, all recommended, standard procedures had been carried out with meticulous care and all tests appeared to have been carried out more than once, often three or four times. But the result had always been the same. No sign of the bug that was plaguing the practice of surgery in the Gynaecology department.

Jamieson went through the results of the staff tests again, just looking for anything at all out of the ordinary. His finger stopped moving as he found something. One nurse and one member of the surgical team had proved to be completely negative on each of the two separate occasions they had been tested. He found that puzzling. Most people carried bacteria of some sort in their nose and throat and on their skin. Usually it comprised a variety of harmless bugs but in a few cases people carried organisms which could cause disease in others in certain circumstances. It was naturally unwise for these members of staff to be near patients with open wounds.

There were a number of possible explanations for a completely negative test and Jamieson considered them in turn. If the person was on some kind of anti-bacterial treatment then the normal bacterial flora of the body might have been destroyed. Alternatively, antiseptic creams might have been applied to the areas to be swabbed before the test but that would demand some explanation. Jamieson made a note of the two reference numbers from the result sheet and resolved to pursue the matter further when he had finished reading the paperwork. He finished going through the staff reports and changed to reading the lab report on the infecting organism.

The cultural characteristics of the bug were recorded and its identity had been established beyond doubt. It was only when he saw the results of the antibiotic tests against it that he saw where the real trouble lay. The organism seemed to be immune to every known antibiotic on the standard treatment list. There was simply no way of treating such an infection. 'No wonder they died,' he said quietly.

For bacteria to become resistant to antibiotics was nothing new. It happened all the time and, perversely, especially in hospitals. With so many drugs around it was merely a case of natural selection at work. Spontaneous mutations arose all the time in bacterial populations so when an antibiotic was injected into a patient the occasional mutant able to resist its action would survive and multiply. It would become the dominant form of the infection and if not detected and destroyed might survive long enough to affect other patients.

The Pseudomonas bug that was causing all the trouble started out with the advantage of being naturally immune to many antibiotics. The acquiring of a few more through living in a hospital environment could make it a very dangerous customer indeed. Despite that, Jamieson still found the virulence of the Kerr strain surprising.

Clive Evans put his head round the door and asked how things were going.

'I know a bit more now than I did earlier on,' replied Jamieson.

'Good. Can I show you where the staff restaurant is?'

Jamieson looked at his watch and was surprised to see that it was after one o'clock. He said. 'Can I ask a couple of questions first?'

'Of course.'

'There are two members of the surgical team who had two successive negative results from their swab tests. Was this followed up?'

'No, I don't think I noticed that,' confessed Evans.

'It might be an idea to check them out.'

'We've just done another swabbing this morning but you are right, we should have caught on to that. Who were the two?'

'I can't give you names. They were only numbers were on the sheet you gave me. These ones.' Jamieson handed Evans a sheet of paper with the reference numbers on it. Evans put it in his pocket and said he would check. 'What was the other question?' he asked.

'Have you had the Pseudomonas checked for the presence of Resistance Transfer Factors?'

'No we haven't,' replied Evans. 'Dr Richardson didn't think there was much point in it. If the bug is resistant to antibiotic treatment it's resistant. It was his view that it doesn't matter much to the patient why it's resistant.' Evans saw the look on Jamieson's face and quickly added, 'Well, that's what Dr Richardson said.'

Jamieson said flatly, 'It might help in establishing where the bug came from in the first place.'

'I see,' said Evans sheepishly. 'I suppose we didn't consider that. We've been concentrating on trying to find synergistic action between the antibiotics available to us. Dr Richardson thought that we might be able to find some combination of antibiotics which would be effective against the bug.

'The one plus one equals three effect,' smiled Jamieson. 'A good thought. Have you had any success?

'Not yet but we're still trying.'

'Maybe the London people could help with that too,' said Jamieson.

'Where would you like me to send the strain?'

'Send it to the Sci-Med labs in London and mark it Priority E,' said Jamieson using the code he had been given in order to attract quick and expert scientific help. He gave Evans the address of the labs.

'Anything else?' asked Evans.

'You said something about lunch?'

After a forgettable lunch in the hospital staff restaurant Jamieson returned to his 'cupboard' in the Microbiology lab and telephoned Thelwell's secretary to arrange a suitable time to visit. He was told that four o'clock would be best for the surgeon. Jamieson said he would come at four. He put down the phone and Evans came in to hand him a sheet of paper. 'The names of the two double negatives in the swab tests. I wish I'd noticed it earlier.'

Jamieson read the names out loud. Staff Nurse Marion Fantes and

… Mr Gordon Thomas Thelwell. 'Thank-you,' said Jamieson trying to keep emotion out of his voice. 'I'll mention this when I go up there later on.'

'Very good,' said Evans with just a trace of a smile in his voice, Jamieson thought. 'Is there anything else I can do for you?'

'I'd like some lab space,' said Jamieson.

'Lab space?' echoed Evans.

'Yes, lab space and a culture of the Pseudomonas. I want to see the thing for myself, do some of my own tests.'

The request seemed to trouble Evans for a moment. 'Actually we are a bit short of room as you probably noticed. I can't think where… Unless of course, you wouldn't mind sharing my lab?'

'That's very good of you,' smiled Jamieson. 'Any bit of bench will do.'

Evans took Jamieson across the corridor into his lab and introduced him to a serious looking girl. This impression was created in part by the fact that the girl's dark hair was tied back in a neat bun and she was wearing fashionably large spectacles. She seemed intent on what she was doing and did not look up at first.

'This is Moira Lippman, one of our senior technicians,' said Evans. 'I'm sure she will help you with anything you want in the way of equipment and advice.'

The girl finally looked up and smiled. She held up her gloved hands to excuse herself from shaking Jamieson's hand.

'Of course,' said Jamieson, returning the smile.

'Moira, Dr Jamieson would like a culture of the Pseudomonas. Perhaps you could get him one as soon as you have a moment?'

The girl finished what she was doing and then walked over to a sink where she stripped off her contaminated gloves and dropped them into the open maw of a pedal bin before elbowing on the taps and washing her hands. As she dried them again she walked towards Jamieson and indicated to a row of cardboard boxes above the bench. 'You'll find gloves and masks up there,' she said. ‘Surgical gloves are not going to be any good for you with these bandages on your hands. You can use the large plastic inspection type; there's a box by the door. I'll try to find a lab coat for you.'

With Jamieson kitted out in mask, gloves, lab coat and plastic apron Moira said, 'We keep all the dangerous bacteria in the fridge with the red tape across the door.'

'I get the picture,' said Jamieson noting the skull and cross bones in the middle of the red band.

'Normally we would not classify Pseudomonas as deadly but this particular strain has made it on merit.' Moira opened the locked fridge with a key she took from a pin on the back of her lapel and took out a plastic dish containing a straw coloured jelly. The surface of the jelly was pock-marked with colonies of the organism and tinged with a slight blue-green colour. 'You can't mistake it,' said Moira. 'The pigment gives it away every time.'

'Pyocyanin,' said Jamieson.

'You've been doing your home-work,' smiled the girl. 'Someone told me you were a butch… a surgeon.'

Jamieson smiled at the near slip of the tongue and said. 'Jack of all trades.' He looked down at the culture dish and detected the vague smell of new-mown grass that he associated with pseudomonas from his time in microbiology. It seemed so innocuous when confined to the culture dish. The pigment was even a pretty colour. Its name, pyocyanin sounded mellifluous until you thought about the meaning. Blue pus producer.

Sally Jenkins' insides knew the reality of the Pseudomonas bug. She was dying of an infection that had turned her peritoneal cavity into a suppurating, festering mess. The organism had invaded her tissues at will starting from her operation scars and spreading into the surrounding area with complete immunity to the drugs that were pumped into her. It had now invaded her blood stream sending her into a delirium that separated her from her husband who sat by her bedside in his own private hell of helplessness. 'Is there nothing you can do,' he whispered hoarsely. 'God damn it, there must be something!'

Phillip Morton shook his head and swallowed his emotion. 'I'm sorry,' he said simply. 'Perhaps it would be better if you waited outside for a while?'

'No,' insisted Jenkins taking a new grip on his wife's hand. 'I want to be with her. I'm not leaving. Sally! Can you hear me?'

Morton exchanged glances with the ward sister. Both felt impotent in the circumstances. There was nothing worse than knowing there was nothing that could be done in the presence of relations who expected better.

Sally threw her head from side to side making it difficult for the nurse beside her to wipe away the sweat from her face. Her breathing was rapid and laboured and her fingers moved constantly and restlessly as if searching for an escape from pain. No one from the outside world could reach her across the intellectual deserts of delirium.

Quite suddenly she stopped moving. Her neck went rigid. For a brief moment she was absolutely silent then a long, gurgling sigh erupted from her throat and her body relaxed slowly into death.

The death restored a sense of order to Morton and the nurses but Jenkins' agony was just beginning. He flung himself across his wife's body and sobbed in long uneven spasms. His lips sought her dead fingers to kiss them as if in some desperate attempt to communicate with her and call her back. 'Don't leave me!' he sobbed. 'Don't leave me Sal.'

Morton ushered the nurses to the door and said softly to them, 'Give him a moment.'

Moira Lippman watched Jamieson sit down to inoculate a fresh culture dish with the Pseudomonas she had taken from the fridge. He flamed the inoculation wire to red heat in the Bunsen burner and allowed it to cool for a moment before touching it to the donor culture and then streaking the charged wire sequentially across the surface of the new culture.

'You can tell a lot about people from the way they do that,' said Moira.

'Really?' asked Jamieson, mildly amused at the thought.

'It's a bit like hand-writing. Quiet, timid people do lots of thin lines very close together. Extroverts make a few large streaks and finish the last one with a flourish, just as if they were making their signature.'

'How did I come out of it?' asked Jamieson.

Moira took the new culture and looked at the surface through the lid. 'Lines perfectly parallel, neat, well proportioned and perfectly angled. I would say a meticulous worker who shows great attention to detail.'

'I'm happy to settle for that,' smiled Jamieson.

Moira put the culture plate into the incubator and asked, 'What exactly is it that you want to do with the bug?'

'I want to do some routine biochemical tests, get a feel for the beast if you like. At the moment it's just a collection of facts and figures on paper. If I actually do the things myself I think I might have a better notion of what it's all about.'

'Standard range of tests?'

'Full range.'

'You won't be able to do them until your culture has grown up overnight. Would you like me to prepare the tubes for you in the morning?'

'That would be a big help,' agreed Jamieson. 'But I don't want to interfere with your other work.'

'No problem,' said Moira. 'I'll show where to find them in case I have to go up to the wards in the morning.

Jamieson called in at the administration block to inquire about Staff Nurse Marion Fantes only to be told that, according to the ward records, she was off duty until seven forty-five on the following morning. He was resigning himself to having to wait to talk to the nurse when the clerk added that she lived in the nurses' home in the hospital. There was a chance that she might currently be there. Jamieson thanked the man and asked where the home was situated. He followed the directions he was given and found himself in a square outside a broody, dark, three-storey building that stood next to the hospital kitchens.

A sign said, The Thelma Morrison Home for Nurses, and a stainglass window on the front of the building above the doorway depicted a nurse tending to the wounded of the Crimea. Was having a 'heritage' all that big a deal? The whole damned business seemed to him to consist of constant allusions to a history filled with the killing and maiming of others. A glorification of them, not a derogation. Sometimes he thought it might actually be quite nice to live in a country with very little 'heritage'. Somewhere where there was no bullshit. Somewhere where the buildings were new and everything worked. Was there such a place?

The square was noisy. It was filled with the clanging of food trolleys and hissing of steam from the kitchens whose three loading bays opened out on to a yard. A porter was singing an operatic aria badly as he manhandled a heavy container in opposition to the will of its castors on the cobbles. Jamieson thought the man might be hoping for 'discovery'. Someone from a television talent show would step out from behind one of the bins and lead him to overnight stardom. He had that air of ingenuous awfulness about him. He pitied the night nurses that had to sleep through the racket during the day.

He entered the nurses' home and was confronted with a staircase in front of him and corridors running to both sides but no indication of who lived there or of any room plan. There was a desk but it was unmanned and there seemed to be no one about. Jamieson found the place strange. It had the aura of a church, a property conferred on it by the light coming through the stainglass window which, as Jamieson could now see, filled the entire wall of the first landing on the stairs.

The dull, red carpet deadened his footsteps as he moved along the corridor to explore further. The air was still and musty and had a cold edge to it that only stone built buildings can impart to their interiors. He was looking at a perfectly formed spider's web on the reel of a fire hose when he heard the front door open and saw a man in an ill fitting navy-blue uniform shuffle across the corridor with cup and saucer in his hand. He planked himself behind the desk and reached underneath it for a newspaper. He had not seen Jamieson and so was startled when Jamieson walked towards him and coughed to attract his attention.

''Ere! What's your game!' exclaimed the man, obviously startled. 'You shouldn't be in here!'

'I'm looking for Staff-Nurse Fantes,' said Jamieson.

'Well, you're supposed to ask at the desk not wander about the bleedin' corridors.'

'You weren't at the desk,' said Jamieson evenly and eyeing the cup and saucer.

The man imagined he caught a whiff of management about Jamieson and decided to play safe. He changed his tone to a more ingratiating one and asked, 'And who might I enquire is wanting her?'

'Dr Jamieson and it's official not personal,' added Jamieson, anticipating the next question.

'I'll just see if she's in doctor,' said the man with what he imagined was a friendly grin but which made him look like a dachshund with tooth-ache. He put on a pair of spectacles one handedly and traced his finger down a list of residents before picking up an internal phone and tapping three digits. He shot Jamieson another grin while he waited for a response and seemed disappointed not to get one in return but his call was answered and he gave the message to the person at the other end.

'She'll be down in a moment Doctor,' said the man putting down the phone and missing the rest at the first attempt. 'You can wait in the day room. It's along here.'

Jamieson followed the hunched figure along the bottom corridor and was shown into a large, high-ceilinged room to wait for the nurse. There was a tall, elegant fireplace at one end with an embroidered fire screen standing in front of it and a brass log box beside it. Cold rooms and empty fire places, thought Jamieson. There was something very British about it. Faded oil paintings of English rural scenes hung on the white walls at regular intervals and a number of assorted arm chairs that had seen better days were dotted about the lino covered floor. Copies of, Nursing Standard and various women's magazines were stacked in neat piles on a small, black table.

Jamieson checked his watch; it was three-fifteen. The door opened and a small, dark girl in her late twenties, thin at the shoulder but broad at the hips came into the room and closed the door quietly behind her before announcing herself as Marion Fantes.

Jamieson said who he was and why he had come to Kerr Memorial.

'I see,' said the girl but her eyes betrayed the fact that she was trying to work out why Jamieson had come to see her.

'It's about the swabs that were taken as part of the surgical team screening.' said Jamieson.

'But they were negative,' said the girl quickly.

'Indeed, that's why I'm here.'

'I don't understand,' said the girl.

'They were too negative.'

The girl shook her head slightly in bewilderment. 'Too negative?'

'No bacteria at all,' said Jamieson.

'Is that bad?' asked the girl, obviously feeling that it wasn't.

'Not bad,' said Jamieson quietly. 'It's unusual, unless of course you were on treatment involving anti-bacterial drugs… but there is no mention of that on your medical record.'

The girl held Jamieson's gaze for a moment then dropped her head and looked at the floor. Her shoulders visibly drooped forward. 'What a fool,' she said softly. 'I should have thought of that. What a fool.'

Jamieson waited quietly until the girl had recovered her composure. Somewhere in the building a door slammed and the noise reverberated round the room challenging the length of the silence.

'You are quite right.' Marion Fantes said softly. 'I am on treatment.'

'What's the problem?'

'Cystitis. I'm taking ampicillin.'

For a moment Jamieson could not see what the girl was so upset about. Cystitis was a common enough complaint in young women, perhaps correlated with sexual activity and often attracting the adjective, 'honeymoon' but in this day and age this was hardly a matter for either secrecy or embarrassment. Then he realised what the problem must be. 'You didn't go to your doctor?' he said.

The girl shook her head.

'You took the drugs off the ward?'

Marion Fantes nodded.

Jamieson let out his breath in a long sigh then he said, 'You do realise that taking any drugs off the ward is an offence that renders you subject to instant dismissal?'

The girl nodded and said, 'Of course. It was a stupid thing to do. I suppose I just didn't think at the time. I quite often get cystitis and my doctor always gives me ampicillin. I suppose I just thought that this time wouldn't have been any different so I didn't bother with the trip across town and the forty minute wait in the waiting room. It's so depressing.'

'How long have you been a nurse?' asked Jamieson.

'Nine years.'

'Any thoughts of marriage?'

The girl gave a bitter laugh and said, 'It's ironic really. I got the cystitis after a week's holiday with my boy-friend in the Lake District. At the end of it we broke up for good and now this.' She looked at Jamieson with an air of resignation and asked, 'What happens now?'

Jamieson looked at the sorry figure in front of him and considered his options. The official line was easy to take. He should report the girl and she would be dismissed. End of matter. But there were more things to be considered in the circumstances. The girl was thirty-one? Thirty-two? She had lost her boy-friend and she wasn't the most attractive girl he had ever seen. What would happen to her if she lost her job as well, not only her job, but her career? He could see the threat of embittered spinsterhood looming large on her horizon. Her record said that she was an excellent nurse. Was it really right to destroy all that? The rules said that it didn't matter what drug was stolen or for whatever purpose.

Jamieson decided to disagree. Any girl who had spent eight years of her life working in institutions like Kerr Memorial and living in places like the Thelma Morrison Nurses' Home deserved personal consideration and it wasn't heroin she had taken, just ampicillin, an antibiotic that graced half the bathroom cabinets in the land. Jamieson took a deep breath and said, 'Nothing.'

'I don't understand,' said Marion Fantes looking puzzled.

'To-night you take a trip across town and you wait for forty minutes in the waiting room along with the screaming kids and the coughing bronchitics. You read old copies of Punch and What Car until the buzzer sounds for you and then you tell your GP that you've got cystitis. That is the way — the only way — you get ampicillin in future. You never ever take anything from the ward again. Understood?'

Marion Fantes looked as if she could not believe her ears. Her face lit up like a sunrise as she fought for words to express her gratitude. 'I'll never be able to thank you enough,' she said.

'Hop it,' said Jamieson. He looked at his watch again. It was time to go and see Thelwell. He wasn't looking forward to that. As he left the nurses' home, the singing porter was aiming for the top note of Nessun Dorma. He missed.