Donor

SEVEN

Dunbar looked back at The Beeches as he closed the gate behind him. The meeting had seemed strange but that was often the way with people who were very ill and under heavy analgesia. They had an air of detachment about them which suggested wooziness but they often still retained a clarity of thought that was as sharp as a razor and could take you by surprise. Despite the travails of her illness, Sheila Barnes had struck him as an intelligent, down-to-earth woman and, like Lisa Fairfax, not at all the type given to hysterical outbursts. Another nail in the coffin of the ‘neurotic nurse’ theory.

But, he wondered as he got back into the car, did that help? As far as he could see, eliminating one possibility left two others. Either both nurses had been mistaken in their conclusions or — the least attractive scenario of all — both were right and if that were the case… God knows where that was going to lead him. He decided he would go round to the Barneses’ house that evening and pick up Sheila’s journal. Maybe that would help him get a better feel for what had really gone on at the time.

Sheila and Cyril Barnes had lived in a neat, tidy, white-painted bungalow in the Glasgow suburb of Bearsden. It was in darkness when Dunbar arrived but a security light clicked on and illuminated the path as he approached the front door, keys in hand. The curtains of the neighbouring house to the left moved and a man looked out. Dunbar ignored him and concentrated on opening the door; it was well secured.

When he stepped cautiously inside, fearing a burglar alarm he had not been warned about, he paused in the darkness for a moment before running his palm down the wall to find the light switch. The place smelt musty, but he supposed it had been empty for some time now and the windows, of course, had been kept closed. Feeling very much like an intruder, he walked slowly through the hall and found the living room. The silence and emptiness were almost tangible as he clicked on the light.

It was a comfortable room with a cottage-style suite covered in light-coloured floral material positioned round a stone fireplace and various small tables handy for receiving cups and saucers. A large television set sat silently gathering dust in an alcove by the window. Photographs occupied most of the flat surfaces and souvenirs from past holidays sat easily with them. From these Dunbar deduced that the Barneses had one son. A wedding photograph of Sheila and her husband took pride of place on the writing bureau, a graduation photograph on the mantelshelf. It was old, so Dunbar assumed the man was Cyril.

He went in search of the main bedroom and found the dressing table where he’d been told he’d find the journal. It looked solid — a family heirloom perhaps. The tall mirrors had a number of chips round their edges, a legacy of many removals, he guessed. The make-up items lying on a coloured glass tray struck him as poignant as he thought of Sheila’s gaunt, pain-lined face. He opened the drawer and found the book where she had said it would be.

He had just sat down back in the living room to read it when the doorbell rang. It seemed uncommonly loud in the silence and made him jump. He answered it and found a short man with ginger hair and a moustache standing there. He was wearing a check shirt under a yellow cardigan, and brown flannels pulled well up over his midriff so that the belt nestled just below his chest. On his feet were sheepskin slippers, the kind you bought from craft centres on bus trips, and he was carrying a cardboard box.

‘Yes?’

‘Good evening. My name’s Proudfoot,’ said the stranger. ‘I live next door.’

‘Oh yes.’

‘I saw you arrive. I was wondering if there was any news of Cyril and Sheila?’

‘They’re very ill,’ replied Dunbar, suspecting that the man was really checking up on him. ‘Sheila asked me to pick something up for her.’

‘I see,’ said Proudfoot uncertainly. ‘Are you a relative, might I ask?’

‘No.’

‘I see, then that makes things a bit difficult…’

‘What’s on your mind, Mr Proudfoot?’ asked Dunbar. The man obviously wanted something more than information.

‘Actually, it’s my camera,’ said Proudfoot with some embarrassment.

‘Your camera?’

‘I hate being petty at a time like this, but Cyril was using my camera. His own was being repaired but it’s back now. In fact, I’ve got it here. The postman brought it this morning.’ He held up the cardboard box. ‘I rather hoped I might have mine back.’

‘I see,’ said Dunbar. ‘Why don’t you come in? I’m sure Cyril wouldn’t mind in the circumstances.’

‘Thank you very much,’ said Proudfoot, immediately relaxing and stepping inside.

‘Do you know where it is?’ asked Dunbar.

‘Oh yes. Cyril keeps his photographic equipment in this little cupboard here.’

Proudfoot bent down and pulled open a small cupboard door to the left of the hearth. ‘Here it is,’ he announced, pulling out a leather camera case. ‘I’ll just put his back, though I don’t know what he’s going to say when he hears they didn’t find anything wrong with it. He’s been having problems with spoilt film. Three have come back completely fogged. It’s been driving him up the wall.’

‘Probably a defective batch.’

‘I think he tried more than one,’ said Proudfoot.

‘You’re both keen photographers, then?’

‘It’s our hobby. Birds mainly, but Cyril liked atmospheric stuff too, you know, derelict cranes in the old shipyards along the river, girders against the sky, twilight of an industry, that sort of thing. Maybe it had something to do with his illness, sic transit gloria mundi and all that.’

Dunbar nodded.

‘We’re planning a trip down the Clyde to Arran in the spring.’

‘Sounds nice,’ said Dunbar, but somehow he didn’t think Cyril would be going.

Dunbar decided to take Sheila Barnes’s journal back to the hotel. That way he could photocopy anything he thought relevant, and return the journal later in the week. He stopped on the way and bought a bottle of gin and a litre of tonic water. He had no wish to go out or to spend the remainder of the evening in the shallow fraternity of the hotel bar, but he did need something to take the edge off the day.

After a long shower, he wrapped himself in a dark-blue towelling robe and poured himself a drink. He placed it on the bedside table while he got comfortable on the bed and opened Sheila Barnes’s journal. He had assumed that it would be a personal diary in which she mentioned the patient at the centre of her allegations but it proved to be much more comprehensive than that. She had kept notes about the progress of all the transplant patients she had nursed during her career. She had obviously been a dedicated, professional nurse, who cared deeply about the people in her charge, and they had played a major role in her life. There was genuine concern in the pages of her journal and it wasn’t specific to any one patient.

When he came to the time when Kenneth Lineham’s transplant had gone wrong, he could feel her involvement reach out to him from the page. The sudden rise in temperature leading to fever and delirium, the successive changes of immuno-suppression therapy which had proved ineffectual, the anguish of the boy’s parents, the consultations with colleagues and the growing belief that her patient had been given an incompatible organ. Her initial reluctance to voice her fears and then the relief when she finally did. It was there in black and white and there was nothing hysterical about it.

After the boy’s death, the journal recorded her bitter disappointment that her observations were not taken seriously and her anger at being considered neurotic. Her gradual disenchantment with the establishment became obvious as it closed ranks against her. There was a record of a subsequent meeting with a local journalist who seemed interested at first in what she had to say but then did not follow up with a story.

Dunbar was struck by the similarity between what Sheila Barnes had written and what Lisa Fairfax had told him the previous evening. It worried him; he couldn’t dismiss it as coincidence. It wasn’t just the end result that had been the same. The details struck him as being identical. He leaned his head back on the wall for a moment and looked up at the ceiling before continuing to read.

The operation on Kenneth Lineham had been performed by a Doctor Phillip Cunningham, James Ross’s senior registrar at the time. According to Sheila Barnes, he had taken the boy’s death badly, as had all the staff, and had even agreed with her privately that the severity of the rejection suggested that there was something wrong with the donor organ, but he had been reluctant to voice this openly at the time, preferring instead to accept the official view that it had just been one of those things. After all, the lab reports from both the donor’s hospital and Medic Ecosse agreed that the organ was compatible, so there was nothing more to be said. He had a career to consider.

Sheila’s journal went on to record her departure from Medic Ecosse, her fall into ill health, the subsequent diagnosis of her cancer and then her husband’s and the full hell of radiotherapy and chemotherapeutic treatment. Dunbar felt exhausted when he finished reading. He now knew Sheila Barnes to be a woman worthy of respect and a credit to her profession. Despite her shoddy treatment at the hands of the Medic Ecosse authorities there was surprisingly little anger or bitterness against those who had chosen to ignore her allegations and who had dismissed her as a misguided neurotic. The only time she showed any signs of spleen was when she thought an Omega patient was getting more attention than her dying transplant boy. She wrote of ‘mercenary toadies falling over themselves to chase the cheque-book’.

Dunbar closed the book and rubbed his fingers lightly over the cover for a few moments before getting up to pour himself another drink. He wondered what he was going to tell Sci-Med in his first report due at the end of the week. A couple of days ago, before he had met the two nurses, it would have been easy. He’d have reported that the nurses’ allegations were probably without foundation. His own inspection of the set-up at Medic Ecosse had shown it to be a centre of medical excellence, well organized, well managed and under no pressure. It was just an unfortunate coincidence that two transplant patients had experienced fatal but non-specific rejection problems.

Now things had changed. He couldn’t dismiss the nurses’ claims as being neurotic or malicious or even, more kindly, as the result of over-involvement with their patients. His computer search for other such cases, and its failure to come up with any, was also a factor that had come back into play. He wouldn’t be returning to London just yet. He would simply have to report that his investigations were continuing.

Ingrid was already in the office when Dunbar got in next morning. ‘How was your afternoon?’ she asked.

Dunbar looked at her inquiringly, then remembered telling her he was going to see the sights of Glasgow. ‘Very interesting,’ he replied.

‘I’m afraid I couldn’t get you an itemized costing for the Omega patients but I did manage to get some more information on what they were in for and when.’

‘That was good of you. I’m obliged.’ He took the file and slipped it into his briefcase.

‘What’s the plan for today?’

‘I thought we might take a look at the figures for the Radiology Department. I thought the running costs were a bit high in proportion to patient charges.’

‘You think patients should be charged more for their X-rays?’ asked Ingrid.

‘Or overheads should be cut. Maybe you could get a printout of staffing levels in Radiology and their rates of pay?’

‘Of course. Anything else?’

‘I’d like to take a look at the unit, get a feeling for the place, see what facilities they have. Would you contact the head of department and ask when would be a convenient time?’

‘Will do.’ She picked up the phone.

‘Dr Svensen says any time you like,’ she said a few minutes later. ‘They’ve got the service engineers in this morning, so they won’t be taking patients until this afternoon. You couldn’t have picked a better time.’

‘Good,’ replied Dunbar.

‘Want me to come with you?’

‘I don’t think so. Why don’t you concentrate on getting the figures and I’ll have a poke around on my own.’

Dunbar resolved to make the visit to Radiology take up most of the morning. He was running out of ideas to keep Ingrid occupied. There were several areas of the hospital he had not yet been to so he thought he would remedy this by taking a circuitous route to Radiology. He had wondered about a staircase leading down from the ground-floor corridor. There was no signboard nearby. As he walked along the ground-floor corridor on his way to Radiology, he decided to take the opportunity to find out where the stairs led.

Glancing over his shoulder to check that there was no one behind him, he turned off and ran lightly down the steps. He found himself facing double doors. He pushed one gently and it opened. There wasn’t much in the way of light down here below ground level, so it took a moment or two to accustom his eyes to the gloom which was only occasionally relieved by overhead bulbs protected by wire cages. Leading off the narrow corridor, which seemed to run the entire length of the building, there were a number of doors. Dunbar tried them in turn.

The first three led to store-rooms, all of similar design and furnished with rows of metal shelving coded with an alpha-numeric system and bearing a variety of spares for medical equipment, along with a variety of consumer items in large cardboard boxes. The fourth door opened into a dark room which immediately struck Dunbar as being cold and damp. He recoiled slightly as he felt cold air brush his cheek. It was the hospital mortuary. There was no outward sign but the plain white walls, the simple wooden cross on one of them and the solid fridge door told Dunbar immediately. The small size puzzled him until he reminded himself that this was a private hospital — selected procedures for selected patients. People weren’t supposed to die here. He released the clasp on the fridge door and swung it open. A waft of cold air chilled his face. There were only two body trays inside, a lower and an upper one, both unoccupied.

There was, however, an interesting-looking door to the right of the fridge. It didn’t have a handle. He investigated and found a button to the right of the frame. He pressed it and the door slid open to reveal a lift. It was narrow and deep, designed to accommodate a horizontal coffin, he concluded. He checked the buttons inside; the lift went to all floors. He tried to work out in his mind where the mortuary was in relation to the building above, and concluded that it was at the back about two-thirds of the way along. He remembered seeing an anonymous-looking green door in about that position on the ground floor when he’d parked his car round the back.

It made sense. If you were unfortunate enough to die in Medic Ecosse, your body could be taken directly to the mortuary, using the custom elevator, instead of being wheeled along main corridors. You would lie in the fridge until the appointed undertakers came with a coffin for you, and, using the back door, your body could be removed with the minimum of public display.

Dunbar closed the mortuary door and continued along the corridor. More store-rooms, including one for gas cylinders. They stood in rows, secured to the wall by chain-link guards. He tried to remember the colour code for them but couldn’t do better than a black body with a white top for oxygen. He supposed the others were anaesthetic gases. He had almost reached the far end of the corridor, hoping to find a way back up to the ground floor, when he came upon a closed set of double doors. He opened one and stepped into a small ante-room leading to an inner scrub room and another set of double doors. A number of plastic aprons were hanging on pegs and white Wellington boots stood in a row below. He pushed open one of the inner doors and found the light switch. Several fluorescent tubes stuttered into life. It was a post-mortem suite, tiled and smelling slightly of formalin and antiseptic.

Dunbar thought the table seemed unusually large. He approached it and ran his fingers along its smooth metallic surface and drainage channels leading down to the large stainless steel sink at the foot. There was a puzzling system of wheels and wires in the ceiling above it, but apart from that everything seemed normal. Trays of instruments sat on a long bench by the wall, gleaming knives and scalpels, saws and drills and a chain-mail glove used by pathologists to wear on their non-cutting hand to avoid accidental injury from the knife they were using. Dunbar shivered although it wasn’t cold.

He found he was wrong in his assumption that there would be a way up to the ground floor at the far end of the corridor. There wasn’t. He had to return the way he had come. He thought it odd but then supposed that having the PM suite at the far end meant that ‘passing traffic’ would hardly be welcome. As it was, very few people would have occasion to visit that end of the corridor. Dunbar was thinking about this when a door to his left suddenly opened and startled him. The orderly who emerged from the store-room pushing a trolley was equally surprised.

‘Who are you?’ stammered the man. ‘What are you doing down here?’

‘I was curious,’ replied Dunbar. He showed the man his ID.

‘Oh right, I heard about you. The government busybo — inspector, right?’

‘Something like that. And you are?’ said Dunbar.

‘Name’s Johnson. I’m one of the porters. I’ve been picking up some equipment.’

‘Like working here?’

‘Money’s better than what I was getting. It’ll do me.’

Dunbar noticed the symbol on the side of the cardboard boxes on Johnson’s trolley. It was a wine glass.

‘Wine glasses?’ he asked.

‘For the PR party tomorrow.’

‘What’s that all about?’

‘The press have been invited to see the little girl they operated on, the one they took on for free.’

‘Oh I see.’

‘I guess she can’t insist on confidentiality like the others,’ said Johnson.

‘I suppose not,’ agreed Dunbar. It was something he hadn’t considered. They had come to the parting of the ways. Johnson stopped outside the mortuary door. ‘I’m going to use the lift in here,’ he said. ‘How about you?’

‘I’ll take the stairs. You and the trolley will just about fill it.’

As soon as the words were out, Dunbar regretted them. He had just admitted to knowing about the lift and its size. That was tantamount to admitting he had been snooping around earlier. He thought he saw a questioning look in Johnson’s eyes but that could have been just his imagination. After all, he was known to be an inspector. He was expected to be nosey. The problem might come when people compared notes and wondered what he was doing in the basement when he had told Ingrid he was going to Radiology.

Dunbar paused for a moment at the head of the stairs, wondering whether or not he should go on with his plan to take a look at the second floor or go directly on to Radiology. ‘In for a penny,’ he decided and walked briskly along to the main stairs. He ran up the steps to the first floor and the signs announcing the transplant unit, then walked up the next flight.

‘ OBSTETRICS AND GYNAECOLOGY ’, said the sign at the head of the stairs. Dunbar suddenly had the feeling that this was as far as he was going to get. Two Arab gentlemen sitting on chairs outside the entrance doors rose to their feet and barred the way.

Dunbar showed his ID card and one of them examined it in some detail before handing it back with a shake of the head. Faced with the two unsmiling faces in front of him and the thought of what they might be carrying inside their jackets, he shrugged and retreated downstairs. It was obviously time to visit Radiology.

Erland Svensen was a man who took life seriously, as became painfully apparent to Dunbar over the course of the next hour. The tall, fair-haired, lantern-jawed Dane was completely devoid of anything resembling a sense of humour. When Dunbar attempted to lighten the atmosphere with a joke, he simply looked blank for a few seconds, then continued his monologue on his sole interest in life, radiology. Having been warned that Dunbar would be visiting his department he had assembled facts and figures on all items of equipment in his department and proceded to justify them in comparison with rival systems by subjecting Dunbar to an in-depth technical appraisal of their relative performance figures.

When Svensen finally had to stop for breath, Dunbar quickly interjected, ‘That all makes perfect sense to me, Doctor.’

The comment seemed to take the wind out of Svensen’s sails. He had obviously expected some kind of cost-cutting argument from Dunbar and was surprised when none materialized.

‘It does?’

‘Of course. You’re obviously a man who knows his job inside out. The patients expect the best and they’re getting it. As long as they’re being charged enough for your excellent services, I’ll be happy.’

‘I don’t work out the charges,’ said Svensen weakly. ‘Mr Giordano’s office deals with that.’

‘I thought that might be the case.’

‘Would you like to meet the staff while you’re here?’

‘I certainly would,’ replied Dunbar. Anything would be better than more technical details of X-ray machinery.

‘I have two radiographers and a dark-room assistant,’ said Svensen, leading the way out of his office.

Dunbar had a bet with himself that the radiographers would be glamorous young women.

‘Girls, I’d like you to meet Dr Steven Dunbar,’ said Svensen as they entered the main X-ray suite. ‘This is Melissa Timpson and Annabel Waters.’

Dunbar stepped forward to shake hands with two glamorous young women. His smile was as much about winning the bet as it was about social nicety. What was it, he wondered, that attracted women who looked as if they belonged on a yacht in the Med to become radiographers? Once before, when he had wondered this aloud, his girlfriend at the time had offered the cynical opinion, ‘The plan is to marry a doctor. It’s either that or become a trolley-dolly and hit on a pilot.’

Melissa and Annabel had been talking to the service engineer about some problem with one of the machines. Dunbar decided to let them get back to it, rather than do a bad impression of a member of the royal family asking questions for the sake of it. ‘What’s through here?’ he asked Svensen, moving towards an exit route.

‘This is my pride and joy,’ replied Svensen breaking into a smile that boded ill, thought Dunbar. He was about to get enthusiastic again.

‘A small tumour radiation facility,’ announced Svensen. ‘A brand-new development in the treatment of such tumours.’

‘What’s special about it?’ asked Dunbar with some trepidation.

‘I’ll show you,’ replied Svensen. ‘Come, put this on.’ He handed Dunbar a protective apron and put one on himself. ‘Not that we need it with this machine, but rules have to be obeyed.’

Svensen put an X-ray plate on the table beneath the front lens of the radiation head and then put a radiation-detection meter very close to it. He used a tungsten light source in the head to align the target and then said, ‘Do you see how close the light circle is to the meter?’

‘Yes.’

‘Watch the meter.’

Dunbar looked at the needle but it didn’t move when Svensen triggered the radiation source. ‘Nothing happened,’ he said.

‘Exactly,’ said Svensen triumphantly. ‘This machine is so well focused we can hit the tumour without fear of damaging the surrounding tissue. We can use higher doses than before and there’s much less risk to the patient.’

‘Oh, I see,’ said Dunbar, getting the point of such a negative display.

Svensen walked across the room to where an illuminated sign said, DARK ROOM KEEP OUT. He pressed the button of an intercom on the wall and said into it, ‘Run this one through for me, Colin, would you?’

There was a two-way wall safe next to the door. Svensen pulled the handle of the metal door and it opened a few inches at the top. He slipped the X-ray cassette into it and closed it firmly with a metallic clunk. ‘Won’t be long,’ he said to Dunbar.

A buzzer announced the return of the film and Svensen collected it from the wall safe. He held it up in triumph. ‘Now then, what d’you think of that?’

Dunbar took the film from him and saw an almost perfectly edged circle where the film had been exposed to the radiation. The area around it was totally unexposed. ‘Remarkable,’ he said, handing the film back. ‘I’m most impressed.’

Svensen held the film up again and marvelled at it. ‘Hot damn, this is a good machine,’ he enthused. ‘Here! Keep it as a souvenir.’

Dunbar accepted the film and smiled at the man’s total immersion in his job. He thanked him for showing him around.

‘Any time,’ smiled Svensen.

‘A good morning?’ asked Ingrid when Dunbar returned to his office.

‘Dr Svensen’s certainly very knowledgeable,’ he replied.

She signified her understanding with her superior little smile. ‘He’s certainly that,’ she agreed. ‘I’ve got the figures you asked for.’

‘Good.’

‘And an invitation too.’

Dunbar raised his eyebrows.

‘There’s going to be a press conference and photo opportunity followed by a reception for the NHS patient who had the jaw-realignment surgery with us.’

‘Before and after pictures,’ said Dunbar.

‘They’re quite dramatic, I believe,’ said Ingrid. ‘All good publicity for the hospital I think you’ll agree.’

‘It’s certainly that. I only hope she doesn’t mind being a circus animal for the afternoon.’

‘A small price to pay,’ said Ingrid. ‘Her whole life will be changed by the work of the surgeons here.’

‘You’re right,’ smiled Dunbar. But he suspected that the patient had been selected because she would provide dramatic publicity in return for some relatively simple surgery, and that she’d taken precedence over more difficult patients who wouldn’t have provided the same photo opportunity. He wondered just how much the scheme was going to benefit patients chosen for free referral and had the depressing thought that it might all be just window-dressing. There was no doubt that the specialist skills and equipment of Medic Ecosse could be used on occasion to great effect in the treatment of difficult NHS cases, but would that be how it worked? Or would Medic Ecosse go for the safe option every time? He wondered if there might be a way of investigating precedent and getting an indication from that.

‘Who has the final say in selecting patients for the free treatment scheme?’ he asked.

‘A committee of three. Dr Kinscherf, Mr Giordano and the head of the department concerned,’ replied Ingrid. ‘Why d’you ask?’

‘Just interested. As I understand it, the hospital has taken on a few NHS patients for free in the past. Do you think you could get me a list and information about what treatment they had?’

Ingrid obviously wondered how this could possibly interest someone employed to monitor financial dealings, but she merely said, ‘I’ll see what I can do.’

Dunbar knew well that he had no business asking for this information. It was plain curiosity on his part and perhaps the thought that even if his other inquiries came to nought he could at least bring the failings of the free referral scheme — if that’s what they turned out to be — to someone’s attention at the Scottish Office.