Donor

SIXTEEN

Dunbar sat at his desk and embraced the silence. He took slow, deep breaths as an aid to thinking clearly and rationally; mounting frustration had been preventing this. He knew exactly what he wanted to do. He wanted to put a stop to Amanda Chapman’s transplant operation, but he couldn’t. This was the unpalatable bottom line that was making him so uncomfortable. He couldn’t because he had no good reason to. If he tried, he would be seen by all and sundry as some kind of interfering lunatic, at best suffering from a sudden nervous breakdown, but more probably reviled as a madman of the sort who mowed down the innocent.

No one would listen and they couldn’t be blamed. There was really nothing of substance to consider. For that reason they would all be against him, the hospital, the transplant unit, Amanda’s parents, Sci-Med, everyone. Even if he were to succeed in stopping it, the chances were that Amanda would still die because she couldn’t get a transplant in time when — as others would not be slow to point out — one had been available. He would be seen as her murderer and all because he suspected things weren’t going to turn out well for her.

He knew that unless he worked out exactly what Ross was up to by the time the donor kidney arrived from Geneva, he was going to have to sit still and do nothing. If, as he suspected, Amanda should reject her transplant, like Amy Teasdale and Kenneth Lineham, it would still be his fault because he hadn’t done anything to stop it. Talk about the devil and the deep blue sea. Damned if you do, damned if you don’t. He cursed and got up to start pacing the room.

Once more he juggled the pieces of information in his head, trying to make a coherent picture, but they still wouldn’t fit. Maybe there weren’t enough or maybe there were too many and not all of them relevant.

He was distracted by the sound of a taxi’s diesel engine as it drew to a halt and idled noisily at the front door. He looked down to see another person carrying a medical bag had arrived. There was certainly lots of activity surrounding the Omega patient. Soon, he reflected, there would be lots of activity surrounding Amanda Chapman. He frowned and asked himself again: what’s the connection?

Amanda had been taken to the Omega wing for her unnecessary marrow puncture. He hadn’t been able to come up with a reason for it but at least he knew that the test itself wasn’t a simple mistake of duplication. Amy had been subjected to the same procedure. Ross had insisted on it. What was it that Turner had said? He must have wanted stem cells for his immuno-preparation work.

Dunbar suddenly saw the light. The tests hadn’t been performed for the benefit of the patients at all. Ross hadn’t wanted duplicate tests done. He’d needed stem cells from the patients for a purpose other than the obvious one of checking their immunotype. There was no repetition of unnecessary tests at all. There never had been.

He felt a frisson of excitement. He was getting somewhere at last. Immuno-preparation work? Where had he come across that term recently? Turner had used it but he had seen it somewhere else. If only he could remember… The phone rang and broke his train of thought. He cursed and answered it. It was nothing important.

Dunbar tried to recover his concentration but failed. The moment had gone. He decided to cut his losses and waste no more time wondering. He connected his notebook computer to the phone line to call up Sci-Med. He wanted the latest information they had about James Ross.

His interest quickened at once: they’d found out something about Ross’s Geneva connection. Their earlier problems had been due to an inability to trace a Medic International hospital or clinic in Geneva. The reason for this was simple. There was no such place and Medic International had no interests at all in Geneva. Ross had been going there for other reasons; he also owned a house there, a villa overlooking the lake. He had paid $2 million for it three years ago.

‘Jesus,’ muttered Dunbar. So money was involved after all. Big money. You didn’t buy a house like that on eighty grand a year. He saw that there was more information to come and scrolled down the screen. Ross had an interest in a Swiss medical recruitment agency called Roche Dubois. It specialized in the recruitment of high-grade staff for private clinics all over Europe. Doctors, nurses, technicians of all sorts, could find highly paid work if they were good enough. The agency was above-board and had a good reputation. It specialized in finding positions for American nursing and medical personnel wishing to work in Europe for whatever reason, although exchanges for European nationals were also arranged.

Dunbar wondered if this was relevant. Did Ross have reason to recruit medical staff on his own behalf? He thought about the American doctors being shown to the Omega wing. Could all the secrecy, stone-faced guards and strange medical people coming and going really be ascribed to a need for confidentiality? No, there had to be more to it.

The Omega patients were the key to the whole damned thing, Dunbar decided. It wasn’t that the money they brought in was being used to subsidize NHS charity patients. Quite the reverse. The NHS patients were being used in some way for the benefit of Omega ones. That must be why Ingrid had feigned ignorance when he had mooted a connection between them and Omega patients over funding. She knew what was going on. He had thrown her by making the connection but for the wrong reason.

This still didn’t help. The only connection he was aware of was the marrow puncture done on Amanda Chapman in the Omega wing and the fact that there had been Omega patients in the hospital when Amy Teasdale and Kenneth Lineham had been patients.

Just who the hell were these Omega patients? he wondered angrily. What were they really there for? He had the hollow feeling that he was running out of time. He needed information and he needed it fast. It was time to change tactics. No more pussy-footing around. He would cause a fuss by asking questions openly. Maybe he couldn’t stop Amanda’s operation, but he could certainly create the illusion that he knew much more than he did. That might scare someone in the know; it might scare them enough to achieve the same end. It was a dangerous game to play, though. Ignorance was never a position of strength.

He picked up the phone and called Ingrid’s extension. ‘Ingrid, would you come over, please?’

Ingrid arrived and smiled. ‘You have something for me?’

‘I want to know who the current Omega patient is. I want her name and I want to know why she’s here. I also want to know where she was before she came here and who referred her to Medic Ecosse.’

Her smile faded. ‘I’m not sure I can do that,’ she stammered. ‘The strict confidentiality surrounding-’

Dunbar interrupted her. ‘I need that information. I need it now, please.’

Ingrid tried to recover her composure. ‘Are you absolutely sure?’ she asked tentatively. ‘If you’ll forgive my saying, it doesn’t seem to be strictly relevant to the investigation and monitoring of accounts.’

Dunbar had anticipated such opposition. ‘On the contrary,’ he said, ‘I have reason to believe that the true income from Omega patients is not being declared.’

‘But you’ve seen the figures,’ said Ingrid, taken aback. ‘The profit for the hospital amounted to many thousands of pounds.’

‘I’ve seen the declared profit,’ agreed Dunbar. ‘I’d like to see for myself how the figures are arrived at. For that reason I want to know all about the current Omega patient, who she is, why she’s here, and I need verification of her condition from an outside source, preferably the hospital or clinic that referred her to you.’

‘I see,’ said Ingrid. ‘I very much doubt if Mr Giordano or Dr Kinscherf will agree to this.’

‘If they don’t, I will lodge a formal complaint of obstruction with my colleagues at the Scottish Office and suggest that an investigation be mounted immediately by the Serious Fraud Office.’

Ingrid tried to maintain eye contact with Dunbar, by way of a challenge, but she failed after a few moments. ‘I’ll see what I can do,’ she said quietly; she was obviously unnerved at seeing a side to Dunbar she hadn’t encountered before.

The door closed behind her and Dunbar remained in his chair, sitting perfectly still, wondering how well he’d played his hand. Would they give in and tell him what he wanted to know or would they try to delay as long as possible? He had to admit that the latter would be the bright thing to do. They were vulnerable only as long as the Omega patient was in the hospital. Once she’d gone they’d be safe. She’d be lost in the mists of secrecy. His only hope lay in Ingrid relaying his threat to call in the SFO as being imminent. They might just believe that his interest was still financial and gamble on giving him the information he asked for. After all, no figures had been declared for the current Omega patient. They had nothing to worry about on that account. He decided to help matters along by exploiting the fact that his computer screen was being monitored. He sat down at it and started drafting a letter requesting that the Scottish Office consider calling in the SFO on the grounds that he’d been denied access to files he thought might be concealing fraud.

After nearly half an hour, Ingrid returned, carrying a file. ‘Here are the notes you asked for, Doctor,’ she said without emotion. ‘I’m asked to remind you of their strictly confidential nature. Please inform me as soon as you’re finished with them.’

‘Of course.’

Dunbar felt a thrill of excitement as he flipped open the cover and started to read.

The patient was a thirty-year-old Saudi Arabian woman, the wife of a sheikh with extensive oil interests and an income to match. She was pregnant for the third time. Her first two babies had been stillborn from a congenital heart defect. The sheikh, who doted on his wife, was anxious that she be monitored every step of the way through her current pregnancy. The Mayo Clinic in Rochester, Minnesota, had been given the task but after it was diagnosed at an early stage, through the use of the latest foetal monitoring equipment, that the foetus was suffering from the same cardiac defect as the others, the woman had been removed from the Mayo and flown across the Atlantic to Medic Ecosse. Corrective surgery was planned immediately after a successful birth.

Dunbar noted the name of the attending physician at the Mayo Clinic, Dr Gordon Hasselhof, and closed the file. There was certainly more to it than just a difficult birth, but did it help him at all? It was difficult to see how little Amanda Chapman could be involved in the obstetric care of a thirty-year-old Middle Eastern woman. He phoned Ingrid and told her he was finished with the notes. They were collected within minutes and without comment.

There was one question that sprang to mind though — although it might not be relevant, thought Dunbar. Why had the woman been transferred to Medic Ecosse? The Mayo Clinic was one of the most famous medical institutions in the world. A transatlantic flight and the trauma of moving to yet another strange country and hospital could not have been the most restful experience for the patient. What had precipitated it? Had there been some kind of disagreement over her treatment at the Mayo? Some undisclosed problem?

It had not been Dunbar’s intention at the outset to contact the referring doctor or hospital; he had made his request for their identity purely as a safeguard against being fobbed off with anything Medic Ecosse cared to tell him. But now he decided he would make inquiries. In his present state of ignorance, no detail should be overlooked. He looked at his watch. Making adjustments for the time differential, it would be around 10 a.m. in Minnesota. He asked the switchboard to make the call.

‘Good morning. Mayo Clinic. How may I help you?’ said a robotic female voice.

‘I’d like to speak with Dr Gordon Hasselhof, please.’

‘May I ask who’s calling?’

‘Dr Steven Dunbar. I’m calling from Glasgow in Scotland.’

‘Please hold.’

For a few moments the line was left open and Dunbar could hear the everyday sounds of a hospital in the background; then music cut in as he was put on hold. ‘Greensleeves’ coming from the wrong side of the Atlantic seemed slightly bizarre.

‘Hello, caller.’

‘Yes?’

‘Dr Hasselhof is currently in conference. Would you care to leave a message or call back later?’

‘I’ll try later,’ said Dunbar.

‘Have a nice day, Doctor.’

‘You too,’ said Dunbar. He cautioned himself that it was better to be told to have a nice day by someone who didn’t mean it than to get lost by someone who did.

He put down the phone and started to tidy up the papers on his desk. He saw that his letter to the Scottish Office was still on the screen of his computer and decided to copy it to disk rather than cancel it. He picked up the disk he had initialled earlier and inserted it. He saw it come up as ‘Research Data One’, the title he’d given it when covering up the mistake of inserting one of Ross’s disks. Looking at it and thinking of Ross’s research reminded him where he’d seen the term ‘immuno-preparation’ before: in the title of one of Ross’s research papers, the one he had put aside while he read the others. He grabbed his jacket and briefcase and made for the car park. The paper was in the file in his hotel room.

There was a laundry bag sitting on his bed when he got there, with a note pinned to it. Dunbar feared it would be a complaint from the hotel about the state of the things he’d sent for cleaning, the clothing he’d used on the ill-starred expedition with Jimmy Douglas. He opened the envelope. It wasn’t a complaint. They were returning a set of car keys that had been left in one of the pockets. Dunbar looked at them. They were the keys to Jimmy’s Land-Rover. He’d have to find a way of returning them.

When he retrieved Ross’s paper from the Sci-Med file, Dunbar noticed that it was over three years old. This was not encouraging. Could what Ross had been working on over three years ago really be relevant to what was going on at the moment? If it had been a successful line of research, why had he not published any more about it in the intervening period? He sat down and started reading.

He had to struggle with the immunological jargon at the beginning but it soon began to make sense and he jotted down the major points as they emerged.

Fact number one was that the human foetus did not start out with an immune system of its own. If biological material from a foreign source were to be introduced to it before its own system developed, it would be accepted. More importantly, when the baby finally did develop its immune system, it would continue to accept material from that source throughout its life. Animal experiments using stem cells… Dunbar swallowed as he read the words… had shown this to be the case. Unborn mice, surgically infused with human stem cells before development of their immune system, had subsequently been born with a human immune system as well as their own.

Using this technique, it was possible to ‘prepare’ a foetus by surgically introducing stem cells from a putative donor into it while still in the womb, making a subsequent transplant after the baby’s birth problem-free. There was no need for steroids or any other kind of immuno-suppressants to overcome rejection problems. There simply wouldn’t be any. The tissue would be one hundred per cent compatible. The perfect transplant, in fact.

The limitations to this strategy, as Ross pointed out in his paper, were obvious. Such transplants would have to be restricted to organs that the donor could afford to lose, such as a half or whole kidney. If the foetus needed a heart or liver then, of course, there could be no human donor. It was suggested, therefore, that the development of this technique of ‘immunizing’ foetuses against rejection of a future transplant would best be pursued with animals in mind as the donors. Improvements in foetal surgery would also have to be achieved if stem cells were to be introduced without a high risk of premature labour induction.

Dunbar felt a chill down his spine as the picture became clear. He had discovered something so awful that his mind almost rejected it. He looked back over the text and picked out the the words ‘there could, of course, be no human donor’. He was mesmerized by them. In his head he started to modify the text: there could, of course, be no human donor unless… the stakes were high enough… to include murder as part of the procedure. And that’s what the ape experiments were all about. Ross was practising foetal surgery because he needed to introduce stem cells into unborn foetuses. Christ! It all fitted now. Kenneth Lineham, Amy Teasdale and now Amanda Chapman had not been admitted to Medic Ecosse as transplant recipients at all. They were the donors.

Dunbar rubbed his forehead as he struggled to come to terms with the discovery. Amanda’s marrow puncture had been carried out to obtain stem cells for surgical introduction into the unborn foetus of the Omega patient. That’s why she had been taken up to the Omega wing. In the intervening weeks, the Omega baby had been developing Amanda’s immune system and it must now be ready to accept Amanda’s tissue as its own. Dunbar guessed at an operation timed to coincide with a Caesarian delivery when the baby was large enough to receive a child’s heart.

It also seemed a fair guess that Ross had put out a request to the black market for a suitable kidney for Amanda, knowing that if the price were high enough one would be found. At some point before or during Amanda’s operation, he would substitute an incompatible kidney, an animal organ, knowing that she would reject it and die. He would then steal her heart for the Omega baby. At autopsy he would put the correct donor kidney into Amanda to make everything neat and tidy. Her death, like those of Amy and Kenneth before her, would be just another one of those things… unless two nurses said otherwise!

Dunbar thought back to McVay’s report on Amy Teasdale. He’d said that not only her kidney but also her heart had been removed; they had both assumed at the time that this had been part of a routine earlier autopsy. McVay had been asked to examine Amy’s transplanted kidney. If only he’d been asked to examine the heart too. He would almost certainly have discovered that it was not her own but the previous Omega patient’s baby’s heart. It was odds-on that Amy’s heart was currently beating inside the offspring of some unknown Omega patient in a foreign land. This could be proved with a second exhumation of Amy, but Dunbar prayed that that wouldn’t be necessary. In the meantime, the prime objective was to save Amanda Chapman’s life.

His immediate thought was to inform Sci-Med and call in the police. That would put an immediate stop to everything. The problem was that ‘everything’ included Amanda’s chances of a transplant in time. Despite everything, it was true that a real, compatible kidney had been found for her. It just wasn’t Ross’s intention to use it until after her death. There must be some way of allowing things to continue so that the kidney arrived safely and was given to Amanda. He’d contact Clive Turner at the Children’s Hospital but first he’d tie up a last loose end. He’d call Hasselhof at the Mayo Clinic again.

‘Who is this?’ asked an American voice after a short wait.

‘My name is Steven Dunbar. I’m calling from the Medic Ecosse Hospital in Glasgow, Scotland.’

‘You’ve got a nerve!’ retorted Hasselhof.

‘I’m sorry?’ said Dunbar, recoiling slightly from the earpiece.

‘The medical profession has enough problems without carpetbaggers like you in it.’

‘I’m sorry, there must be some kind of mistake. I really don’t understand what you’re talking about, Doctor. I’m calling about one of your patients who was transferred here from the Mayo Clinic.’

‘I figured that,’ said Hasselhof. ‘You people promised that man and woman something that can’t be done. There is no operation that could save that woman’s baby. The malformation is far too great for corrective cardiac surgery to be of any value, but you people obviously convinced them otherwise. That, sir, is fraud in my book. And you now have the nerve to call me for advice!’

Dunbar was about to explain to Hasselhof that he hadn’t called for advice and that he wasn’t part of the Medic Ecosse set-up, but he changed his mind. There wasn’t time. He simply asked one question. ‘What if the baby were to have a heart transplant, Doctor?’

‘A transplant? The child wouldn’t survive long enough for a donor to become available. Even if one did, the necessary steroid suppression of the immune system would lay the child open to every infection under the sun. It’s just not possible.’

‘Thank you, Doctor,’ said Dunbar. ‘I’m obliged.’

He put down the phone, muttering to himself, ‘Oh yes it is, Dr Hasselhof, if you know how to make sure the baby accepts the heart as its own flesh and blood so you don’t have to use steroids and if you’re prepared to murder the donor for her heart.’

Dunbar called the Children’s Hospital and asked to speak to Clive Turner.

‘Dr Turner’s in theatre at the moment,’ he was told.

‘Damn!’ said Dunbar as he put down the phone. A voice inside his head urged caution. ‘Take it easy. There’s no need to panic. Think it through. The first thing to establish is when they plan to operate on Amanda.’

He would simply go back to Medic Ecosse and inquire, which would be in keeping with his new up-front policy of asking things outright. As he prepared to leave his room, Dunbar wondered if there was anything he’d overlooked. He had the unpleasant feeling that there was but for the moment whatever it was eluded him. He had his briefcase and his computer. He had his notebook in his pocket. As soon as he’d established when the kidney from Geneva was going to arrive, he’d devise a plan of action to intercept it and inform Medic Ecosse. He closed the door with an air of finality and set off to play out the last act in a nightmare.

He got no further than the car park. As he inserted his key into the car door lock he felt a sharp pain in his thigh and the world started to swim. Nausea… a falling sensation. His last conscious thought was the realization that Medic Ecosse knew he’d contacted the Mayo Clinic. He’d phoned the first time from the hospital, and the call would have been logged. He’d given away that his interest in the Omega file was not confined to financial matters.

Dunbar woke up in complete darkness. He had a splitting headache and felt sick but this was partly due to the smell in the room, a strange mixture of excrement and… wet grain was the best he could come up with. It was the smell of harvest time in the fields, a throwback to his childhood. But no, it wasn’t that… It was the smell of animal feed. And animals.

Despite his muzziness it took him only a moment to figure out that he must be back at Vane Farm. He tried to sit up but the pain in his head soared to new heights so he slipped back down again. As long as he lay still he could think clearly. He ran his hands over his body. He had clothes on, shirt, trousers, shoes. One of the sleeves of his shirt, the left one, had been torn away and his upper arm ached. Oh God! They’d been giving him more injections. That meant there was no way of knowing how long he’d been unconscious. It could have been days or even weeks. Amanda Chapman could be dead by now.

His next thought was to wonder why he’d been allowed to regain consciousness at all. Was it deliberate or a mistake? The human body quickly developed a tolerance to narcotics, which meant dosage had to be increased to maintain the effect. Was that it? Had he come round before his next injection was due? If so he probably didn’t have much time. He rolled over on to his stomach and began to drag himself over the floor to explore his surroundings.

The first thing he came into contact with was a sack made of coarse hessian; it was full. He stretched up, put his hand inside the neck and pulled out a handful of small hard round pellets. He smelt them; it was animal feed. He also found a metal scoop inside the sack and put it in his pocket. It was a weapon of sorts, he supposed.

The room was a food store. The only thing other than sacks of feed-stuffs in the room was a floor-standing machine which, judging by feel, was some kind of processor. It had a large loading hopper on top and an exit pipe with a grille over its front lower down. There was a control panel on the front with two buttons on it, one raised and one recessed. The recessed one must be the On switch. It always was on industrial machines; a safety measure.

Dunbar froze as he heard voices. They were quite loud but he couldn’t make out what they were saying. He put this down to his wooziness until he realized that they were not speaking English. The throat-clearing sounds suggested Arabic. There were two of them and they were probably coming to give him his next injection — or worse. Feeling as ill as he did, and armed only with a pellet scoop, he could do little to stop them.

A mobile phone started to bleep and the men’s talk stopped, to be replaced by one side of a phone conversation, again in Arabic. When it ended it became apparent that one man had been called away. Both voices receded and Dunbar heard the front door open and close. He waited for returning footsteps and did not have long to wait. At least with only one opponent the odds were a little more even. He lay down again, hiding the metal scoop in his right hand behind the small of his back. He wished his head would clear. He felt as if he were in a drunken stupor.

He opened his eyes fractionally so he could see something when the door was opened. The lock turned, the door swung open and he saw the silhouette of a tall, well-built man with a syringe in his right hand. He seemed to stand still in the doorway for ages, like an executioner contemplating his victim’s neck on the block as some announcement ceremony went on around him.

Dunbar desperately wanted to swallow but did not dare. He closed his eyes completely as the light was clicked on. The next few moments were going to decide whether he lived or died. The light on his eyelids dimmed as the man’s shadow fell on them. Dunbar sensed him kneel down to his left. He could hear his breathing, smell a suggestion of foreign food on his clothes.

He felt his arm being grasped firmly but not with undue roughness. The man suspected nothing. Timing was all-important now. At the first touch of the needle point Dunbar rolled smartly away to stop it piercing his skin. He brought the metal scoop from behind his back and swung it at his assailant’s head. It connected with a dull clunk and threw the man off balance, but Dunbar knew the blow wasn’t heavy enough to knock him out. The man was already recovering and soon Dunbar was going to be in real trouble. He’d used up his adrenalin in fighting the effects of the drug.

Fuelled by panic, he struggled to his knees and swung his right fist at the Arab but his arm felt like lead and the punch carried no weight at all. The Arab evaded it with ease and grinned as Dunbar slumped back to the floor. There was no point in trying to throw any more punches; he hadn’t the strength to make them count. He backed away instinctively, now just hoping to survive as long as possible. The Arab recovered his syringe and checked it leisurely before coming after him.

As Dunbar retreated, he stumbled against the sack of animal feed, which spilled over. He grabbed a handful of pellets and flung them across the floor under the Arab’s feet. It seemed odds against, but for once he got the luck he needed. The Arab lost his footing and pitched forward, saving himself from falling by reaching into the hopper of the processing machine. Instinctively, Dunbar groped for the On switch on the control panel — it took only a second but seemed like an eternity — and pressed it.

The machine sprang to life and drew the Arab’s arm into the blades. Mercifully, he fell into unconsciousness as the scream died on his lips. The machine jammed. Dunbar hit the Off switch and was enveloped in silence.

‘Your kind of justice, I believe,’ he murmured. ‘An arm for an arm.’