Death Watch

Shaw was standing by the Land Rover, a polystyrene cup of coffee balanced on the roof, when his mobile buzzed; he looked at the incoming ID – it was Tom Hadden, calling on the landline from the Ark. He picked up the call, watching Valentine in the distance briefing the door-to-door teams on what they’d discovered at the Sacred Heart.

‘Peter. Look, I’ve got some tests back on the waste bag found under Judd’s body.’

Shaw didn’t speak, trying to refocus his mind on the scene in the Queen Victoria’s incinerator room, the blackened corpse shivering as it trundled out of the furnace.

‘It’s a human kidney, Peter – or at least what’s left of one.’

Shaw’s hand moved involuntarily to his back.

‘But the real conundrum is that, as far as Justina and I can be sure, this kidney is in no way diseased. It should be working away keeping someone alive. But it isn’t. It’s been discarded – and I don’t think that makes much sense.’

‘Unless…’

‘Well. Let’s take it step by step, backwards. Someone has deliberately falsified the documentation on the waste bag to slip this organ into the incinerator. Either that or they opened a bag on the belt and switched the contents.

The words echoed in Shaw’s head. Organ transplant. He felt they’d crossed a Rubicon; but the image was in colour, the river red.

‘Bryan Judd died with this thing under his body,’ said Shaw. ‘He was either holding it, and didn’t let go, or it was deliberately put with the body.’ It was a statement, not a question, and Hadden greeted it in silence.

Even in the noonday sun Shaw shivered, the hairs on his neck bristling, because his mind had only just made the big leap. He thought about the stifling smoke in the upstairs bedroom at number 6 Erebus Street, the fumes pouring through the gaps in the bare floorboards, the figure of Pete Hendre, curled in a foetal ball under the window ledge, and his whispered plea to make sure his face stayed hidden; hidden for ever, from the Organ Grinder.

He thanked Hadden, briefed him on what they’d found in the church, and asked if he could get a team on the scene as soon as resources allowed.

Twenty minutes later he was in a lift rising to the eighth floor of the main block of the Queen Victoria. He stepped out when a bell pinged, escaping the piped-in Bach and a trolley on which lay a man heading for theatre, his face mirroring the helpless fear he must have been feeling within. Shaw thought just how trusting you had to be to lie on a stretcher, to let strangers decide where to take you, and then to let them put you to sleep – the definition,

Mrs Jofranka Phillips, head of surgical services, had an office in the executive suite. The whole floor was air-conditioned, and the sudden chill made Shaw feel uneasy. The door was open, the office an uncluttered glass box empty but for a desk, a filing cabinet, and a full-sized skeleton hanging from an aluminium stand. Phillips stood five foot two in – Shaw noticed – her stockinged feet. She shook his hand and he thought that surgeons always had hands like that – the fingers preternaturally long, slender. And that stillness, an ability to remain calm at the very moment when ordinary people would begin to shake, as they made the first incision.

Shaw took a seat, noticing the skeleton had hands like that too.

‘Thanks for seeing me so quickly,’ he said. ‘My CSI team have passed on the details…?’

She nodded. ‘I thought we should talk,’ she said. She looked him squarely in the face and saw the dead eye for the first time, her familiarity with trauma reducing her reaction to the merest flicker of her eyelids.

‘I’m sorry.’ Shaw raised a hand. ‘I realize you have responsibilities in the hospital but we’re dealing with a murder scene here – and now with the discovery of a human organ without the relevant documentation. I’ve talked to my superior at St James’s – Superintendent Warren – and to the chairman of the primary care trust…’

He flipped through his notes but she didn’t have the patience for that.

‘Right. Him. And we’re all agreed that these two issues are now inextricably entwined.’

Phillips looked shocked, and she couldn’t stop a hand rising to cover her mouth.

‘So I’m going to investigate all of these issues in the round, as it were – with your help. I can rely on your assistance?’

He’d been brutal, but it was the only way. There was no point pretending anyone was in charge of this inquiry except him. What he hadn’t said was that Sir John Falcon had made it clear that any inquiry within the hospital would have to involve clinical experts brought in from other hospitals. Phillips would be answering questions, not asking them – although he’d added an encomium to the effect that she was one of the finest surgeons in the NHS and that they were very lucky to have her on the staff. Don’t be fooled by the ‘Mrs’, he’d added – it didn’t mean she was married, it meant she was a surgeon. ‘So don’t call her doctor,’ he’d warned, laughing, ‘because that is an insult.’

‘Of course,’ said Phillips. She touched the phone on her desk and Shaw guessed she’d thought about arguing the toss with Falcon, but decided it was a lost cause. ‘I’ll do anything I can.’ Her accent was heavy – Cypriot, perhaps. Luxuriant black hair was swept back off her face, a contrast to the white clinical coat and pale-olive skin. Her jewellery was black too, a jet stone bracelet, and a black pendant necklace. Black and white, light and darkness – Shaw sensed this was a person who dealt in certainties, or sought them out. But the eyes, an extraordinary luminous

‘What have you done already?’ he asked.

‘I’ve notified the Human Tissue Authority, Lynn Primary Care Trust, and the Department of Health. A team from HTA will undertake an audit of our tissue and organ bank within the next forty-eight hours. In the meantime I’ve had it closed. The locks are sealed. No one is to enter without my written approval. The press office have prepared a release, but it won’t go out until I say so.’

Any note of resentment at Shaw’s hijacking of the inquiry had disappeared from her voice. He sensed a woman whose self-confidence was robust, and anything but fragile.

‘Good. That’s prompt. Thank you. I’m sorry – two points. I need to sign that approval as well – for entry to the organ banks. Can you make that change? And the press office needs to sit on the news until I say so. I don’t want this aspect of the inquiry made public.’

She nodded.

‘Now, please,’ said Shaw. She flicked through a plastic internal telephone directory and made the calls.

When she’d finished she held the directory in her hand, shaking her head. Then she sat with it on her lap. ‘I’m sorry,’ she said, running a hand into her black hair until it stuck, the fingers lost in the thick plush locks. ‘This is really stupid of me. Stupid of all of us. One of your officers was asking if any of us recognized the initials – MVR.’ She put an unvarnished fingernail on one of the telephone entries, stood, and showed Shaw. Motor

‘It’s OK,’ said Shaw. But it wasn’t, and sorry was the most overrated word in the language. They could have had a forensic team in the garage while Judd’s body was still smouldering; now the chances of finding relevant evidence were slim. He stood, walked to the glass wall of the office, and rang Valentine on his mobile, telling him to get over to MVR with back-up. Then he took his seat again.

‘The kidney that we’ve found on the incinerator belt,’ he said. ‘To what degree can we be sure a crime has been committed here? What’s the best-case scenario, and the worst?’

Without knocking, Dr Gavin Peploe joined them. He let a smile begin on one side of his lopsided face and slide to the other, shaking Shaw’s hand. A crumpled figure, in a £500 suit, he folded himself easily into a chair, the crossed legs and folded arms revealing not a trace of anxiety.

‘Gavin, thanks,’ Mrs Phillips said, adroitly reinforcing her authority by making it clear she’d summoned him. ‘DI Shaw’s first question is a good one, if he doesn’t mind me saying so. Could this be nothing – a one-off?’

Peploe’s small feet did a little shuffle. ‘I’ve been thinking about that,’ he said. ‘At this moment we don’t have any other evidence of illegal traffic, unauthorized procedures, or organ or tissue retention against anyone’s wishes. Our records are complete for the disposal of tissue and organs from both live patients and cadaveric supplies.’

‘So. Here’s a scenario. What if the kidney is diseased – I think the pathologist is still doing tests – it could be something very difficult to detect in an organ which has been partly incinerated. Glomerulosclerosis, for example. What if an earlier bureaucratic error left such a kidney in the system which could not – retrospectively – be matched to documentation? All the NHS theatres run at near full capacity – everyone makes mistakes. We’ve completed nearly two hundred kidney transplants within the trust this year. Organ and tissue disposal is a priority, but it’s only human nature if people spend a bit more time on caring for the living patient. So – an error. Someone panicked, forged the tag, or switched a bag, and tried to slip it onto the incinerator belt.’

‘And what are the chances that actually happened?’ asked Shaw.

‘Nil,’ said Peploe, smiling, his teeth very white against the expensive tan. ‘One in a billion. Organ tracking is the surgeon’s responsibility, then the theatre manager’s. Senior professionals in both cases. If there’d been an earlier error they could just have reported it. It’s a misdemeanour. Why risk a career by trying to cover it up? It doesn’t make sense unless it’s a panic reaction. The one thing experienced theatre staff don’t do, Inspector, is panic.’

‘Worst case?’

Phillips stood and walked to her filing cabinet, leaving Peploe to answer. Shaw noticed for the first time there was a picture on the top in a gilded baroque wooden

‘The world,’ said Peploe, spreading his hands, ‘is divided into the rich and poor. The poor supply human organs, and the rich receive.’ He tossed a thick file onto the floor beside Shaw. ‘In 2002 the Washington Post reported from a small village in Moldova that fourteen of the forty men had sold body parts. We’re talking liver parts, kidneys, lung, pancreas, colon, corneas, skin, bones, and tissue such as Achilles tendons – even marrow.

‘This is a worldwide trade. The poor selling to the rich. A Turkish peasant can get two thousand seven hundred dollars for a kidney he doesn’t need. Someone who does need one will pay a hundred and fifty thousand. Note the profit margin. In 2000 eBay auctioned a kidney and reached one hundred thousand dollars before the FBI stepped in. There is also plenty of evidence that children were sold for body-part harvesting out of eastern Europe and Russia – largely through orphanages set up to feed a burgeoning black market.

‘There are darker corners of this market,’ he added, laughing again. ‘An entire human body is worth about a quarter of a million dollars. It did not take the market long to realize that if people wouldn’t donate parts, or sell them, then systematic murder would provide one source of supply. Tissue brokers, who supply the major bio-med companies, may not be as punctilious as they should be when checking the provenance of body parts.’

‘And one other sophistication…’ added Peploe. ‘The Chinese government uses prisoners on death row as a source for harvesting tissue and organs. Prisoners may undergo several operations before they are deemed of no more use. Until that point they are effectively kept alive to provide fresh body parts. They’re farmed, with regular harvests. Then they are executed. This happens. There is fragmentary – anecdotal – evidence it happens elsewhere, too.’

Somewhere, a hundred feet below, they heard a car alarm sound.

‘I need to read about this,’ said Shaw, picking up the file.

‘That’s all I could download this morning,’ said Peploe. ‘UN report, some background stuff from the HTA, and a few case studies from Organ Watch – a pressure group. If you want any more, let me know. It’s my specialist subject – at least, it’s going to be.’

‘If we’re talking illegal operations, could they be taking place here? At the Queen Vic?’ asked Shaw.

‘It’s unthinkable,’ said Phillips, leaning against the filing cabinet.

Her voice had been sharp, too sharp, and she knew it. She took a deep breath. ‘It is not possible for an illegal organ transplant to be completed in an NHS hospital without being detected.’ She gave Shaw a list. ‘This is a roll call of all surgeons working within the trust. There are twenty-eight names here. Any one of them could perform this operation. But, as I say, I find it impossible to believe it happened here.’

Peploe steepled his fingers. ‘Well, a lot easier than it was. New drugs mean you don’t need a blood match, or a tissue match for that matter. And the chances of organ rejection are significantly lower. Plus, you’ve got keyhole surgery for the removal now, so the donor can be up and about in hours. By the way – so you know – when you give someone a new kidney you don’t take out the old one. So if this is a transplant, we’re not missing the diseased organ. The new organ goes in here…’ He indicated a spot in his groin. ‘Joined to the urethra.’

‘Well, we have to begin somewhere,’ said Shaw, holding up the paper Phillips had given him. ‘We’ll start by interviewing everyone on this list.’

Shaw stood. ‘For the record, I am going to have to ask both of you this question. Do either of you have anything to do with illegal organ removal in this hospital, or with the death of Bryan Judd?’

There ensued what might have been a stunned silence. ‘I’m sorry, but I need an answer,’ said Shaw.

‘Nothing.’ They said it together, in perfect unison.