Pestilence

Chapter One

James Saracen carried a loaf of bread in one hand and a carton of milk in the other as he climbed the stairs to his apartment. When he got to the third floor he put the loaf under his left arm leaving his right hand free to search in his trouser pocket for the key. The pocket was empty. “God was it ever different,” he muttered, changing over the groceries. He found the key and opened the door; it swung back like a snowplough, clearing mail behind it. He closed it again with his heel and put down his things before clicking on the hall light and picking up the assorted pile of paper. A card to say that the electricity man had called, a circular from Safeways promising ten pence off washing powder, a brown envelope marked ‘Inland Revenue’ and a white one marked ‘Northampton’ which said it was a Visacard bill. Good, there was nothing to make him change his plans. It was Saturday, it was eight in the evening and he had promised himself something special. He was going to take off his clothes, get into bed and sleep until he woke up.

Saracen woke two hours later but not of his own accord. The bleeper in his jacket pocket had just gone off. “I don’t believe it…I just do not believe it,” he complained as he struggled to free an arm from the bedclothes. He lifted the telephone from the bedside table and balanced it on the edge of the bed while he dialled the hospital number.

“Skelmore General,” said the voice.

“Doctor Saracen, you were paging me.”

“One moment.”

Saracen scratched his head sleepily as the operator did whatever operators do with jackplugs.

“James? I know this is your first night off in God knows how long and I know you have just worked an eighteen hour shift…”

“But?”

“The fact is we need you. A amp;E is going like a fair and now there has been an accident up on the By-Pass. Someone will have to go up there. It’s a Fire Brigade affair.”

“So why don’t you go?”

“I’m the only one on.”

“What?” exclaimed Saracen. “Where is Garten? He is supposed to be on tonight.”

“You know how it goes. Something social cropped up at the last moment and our leader wriggled out of it. ‘Said he felt sure I would cope, had absolute confidence in me, the usual shit before it was Hi-Ho Silver Away.”

“I’ll come in. I’ll go out with Medic Alpha.”

As Saracen turned into Skelmore General he saw Medic Alpha standing outside A amp;E. The vehicle, a white Bedford with appropriate markings, was Skelmore’s latest acquisition and the nearest thing to a hospital on wheels. It was designed for attendance in situations where on the spot medical treatment might make the difference between life and death and had been donated to the hospital by a wealthy local man whose son had died after a road accident.

Saracen saw that the windscreen wipers on Medic Alpha were operating and that the driver was already aboard and waiting. He parked his own car alongside and shouted to the gate porter to park it before climbing into the back of the ambulance.

“Have a good sleep?” asked Jill Rawlings, the Staff nurse who was checking the vehicle’s inventory.

The question had been tongue in cheek. Saracen didn’t reply. He struggled into the jacket that Jill Rawlings handed to him as the vehicle gathered speed and cleared the way ahead with a siren that proclaimed its origins in the streets of San Francisco rather than the English midlands. He had both hands in the armholes behind him when the ambulance lurched to the right to avoid a car emerging from a side street. Saracen crashed against the side of the van, his head narrowly missing an Oxygen cylinder. The driver gave a quick glance back. “Sorry,” he said sheepishly.

Saracen grunted and did up the rest of his jacket.

“Now we all know who we are,” said Jill Rawlings, referring to the white, plastic jackets they all wore. Each carried a fluorescent strip with the designation, Doctor, Nurse or Ambulance according to its wearer.

“I always feel as if I’m part of one of these sets you get when you’re a child,” said Jill.

“Could be a money making idea,” said Saracen. “Any details on the accident?”

“An articulated lorry and two cars.”

Saracen screwed up his face. “Direction?”

“Head on then a rear shunt.”

Saracen gave a low whistle then asked, “Morphine shots?”

“All ready.”

“Cutting gear?”

“All ready.”

The rain lashed against the windscreen as Medic Alpha lost the protection of town buildings and sped out on to an exposed section of the ring road. From where Saracen sat in the back the lights outside merged into blobs of yellow and red in the rivers of water flowing down the glass. Somewhere up ahead blue blobs appeared and Medic Alpha slowed as they reached the scene of the accident. Two fire appliances were present, their arc lights already in position while three police cars sat angled across the carriageway.

Blue lights flashed asynchronously in the night sky as Saracen got out and bowed his head against the rain that was whipped into his face by a malevolent wind. The Firemaster led him into the lee of one of the police cars to brief him but still had to shout above the sound of the generators.

“First car nose-dived under the artic, decapitated the two in the front. There’s a kid in the back; we think it’s dead but we don’t know for sure.”

“And the other car?”

“Driver’s dead, steering wheel crushed his chest. His passenger, wife I think, is trapped by her feet. My lads are trying to free her right now.”

“Is she conscious?”

“No.”

“Staff Rawlings will see to the woman. I want to see if I can reach the child,” shouted Saracen through cupped hands.

The firemaster gave an exaggerated nod to signify that he had understood and indicated that Saracen should follow him. They picked their way through cables and hoses to reach the towering front of the truck, now deformed into a giant mouth that had half swallowed a Ford saloon.

“Your best bet is to go in from the left!” yelled the firemaster against the noise.

Saracen got down on the cold, wet tarmac and wriggled under the front bumper of the truck. He paused to reach out his hand behind him and accept the powerful torch that a fireman handed him then crawled in deeper to search for some breach in the car’s side where he could gain access. The wetness of the road changed to stickiness where blood had poured out from the floor pan to form a puddle. Somewhere behind him rainwater had found a path through the twisted metal to flow steadily on to the back of his legs.

Saracen finally managed to get his arm between the rear door of the Escort and its pillar which had bowed on impact. He levered himself against the inside of the truck’s front wheel to reach in deeper and felt his way along the rear seat until he touched something. It was a hand and it was cold and limp. He tried for a pulse but could feel nothing.

Saracen pulled the child’s wrist until its body flopped over on to his forearm then he drew back a little and felt for the head. He touched curly hair and moved his hand down to search for a carotid pulse. Still nothing. As he tried to remove his arm from the crack he brought the child tumbling forward to lie against the back of the gap. He brought up his torch and shone it through the opening. He could now see that it was a little girl. Her eyes were open but she was quite dead.

Saracen started to wriggle out backwards, for there was no room to turn round, when a woman started to scream. He looked out from under the truck and saw the yellow leggings of a fireman running towards him. A face squatted down to look under the truck. “Doctor! The trapped woman has come round. She’s in a lot of pain.”

Almost before he had had a chance to reply the screaming subsided and Saracen knew that Jill Rawlings had taken care of the situation. The strict who-does-what regime of hospital life did not always apply in the searing reality of Medic Alpha’s world.

Saracen was aware of a fireman recoiling as he got to his feet and looked down to see that the front of his jacket was covered in blood where he had been lying in the puddle. A policeman handed him some rags and he wet them at the trickling end of a hose on the ground that had been used to flush away spilt fuel before sponging away the sticky mess.

“How is she?” he asked Jill Rawlings.

“They can’t free her. Take a look.”

Jill Rawlings moved back and Saracen knelt down to peer into the crushed foot well of the car that had ploughed into the back of the Escort. He could see the problem for the woman’s foot had been snapped at the ankle and crushed between an engine support member and the bulkhead of the car. Her foot was a bloody, broken pulp sticking out at right angles from her ankle. There was no room for the firemen to use hydraulic jacks in such a confined area.

Saracen withdrew from the front of the car and said, “I’ll have to take her foot off.”

“I thought you’d say that.” said Jill. “I’ve prepared the instruments.”

“What did you give her?”

Jill told him and he nodded. “Ask the firemen if they can rig some kind of shelter to keep some of this bloody rain off will you.”

Saracen returned to examining the trapped woman’s foot with the aid of a better torch while Jill went to speak to the firemaster. Now satisfied that he knew exactly what he was going to do he began to assess his patient in more general terms. She was a woman in her early thirties, well dressed, slim, attractive and apparently in good health before the accident that was about to shatter her life. Probably the wife of a successful professional man, thought Saracen, considering the make and year of the car and the quality of her clothes. She was a woman with everything going for her who was going to waken up a widow with no left foot.

Saracen stood up and moved out of the way while two firemen rigged a makeshift shelter out of a tarpaulin. While he waited he asked one of the senior policemen about the contents of the woman’s handbag. “Anything I should know about? Any discs or medallions?”

The policeman shook his head. “She did have a kidney donor card though.”

“Did her husband carry one too?”

I put it in the ambulance with the body and alerted the hospital.”

Saracen nodded. That might be something else to tell the woman when she came round. “All right?” he asked Jill Rawlings.

“All ready.”

The firemen and policemen knew what was going on behind the screen but had only their imagination to fill in the details until the sound of Saracen using a saw painted too vivid a picture for one of them. A constable retched up the contents of his stomach on the wet road. He supported his head on his forearm as he leaned against one of the fire appliances.

“Clips!” said Saracen.

Jill Rawlings pressed them into his hand and knew that Saracen was now working on stemming the blood flow from the stump. She anticipated each request before it came. Swabs, pressure pads, tape. The seconds ticked past then Saracen sighed and said, “All right. She’ll do.” He got to his feet stiffly and rubbed at his legs to restore the circulation then he moved out of the way to allow the ambulance men to come in and lift the woman gently from the wreckage and carry her to the ambulance.

“What happened to the truck driver?” Saracen asked the senior policeman standing beside him as he cleaned his hands and watched Jill Rawlings gather together their equipment.

“Minor cuts and bruises. He went to hospital for a check-up in the first ambulance.

Saracen nodded and said, “That’s it then. I’ll leave the rest to you. He started to walk towards Medic Alpha with Jill Rawlings.

“Be seeing you,” said the policeman.

“All too soon,” replied Saracen.

As Saracen climbed into the back of Medic Alpha he paused to look over at the houses that bordered the ring road. Most of the people who had earlier been at their windows to see the excitement had returned to their television sets. Real life drama had begun to pall. Saracen had picked up some road grit in his mouth; he spat it out on the tarmac.

The rain had still not relented by the time Medic Alpha arrived back at Skelmore General and one of the ambulance men stepped in a puddle up to his ankles as he wheeled the trolley up to the doors. Saracen accompanied the trolley with the intention of handing over his patient to the surgical registrar on duty and then going home. He could hardly believe the sight that met his eyes. A amp;E resembled the Beggars’ Court of eighteenth century Paris.

“What’s going on?” he asked Tremaine, the houseman who had called him.

“Three things,” answered the flustered houseman. “It’s Saturday night, the weather is bringing in the drop-outs and City were playing United at home. There was trouble.”

Saracen looked around him and swore under his breath. The treatment room was full, the waiting room was full. Half a dozen policemen were talking to people and writing things in note-books. The sound of gagging and retching came from one of the side rooms. Saracen looked in and found Sister Lindeman cajoling a teenage girl into swallowing a gastric aspiration tube.

“OD?” Saracen asked.

“A hundred aspirin. Her boyfriend left her.”

In a corner of the main treatment room Saracen caught sight of a nurse sitting down. It was such an unusual thing that he knew something must be wrong. He went over and saw that the girl was holding the side of her face.

“What happened?”

“One of the drunks,” replied the girl.

Saracen lifted her hand away to assess the damage and saw the early signs of bruising. “Did you tell the police?” he asked.

“Jack Lane dealt with him,” replied the girl.

“Do your teeth feel all right?” asked Saracen.

The nurse smiled and said, “I’m all right, really I am. Just give me a moment.”

Saracen squeezed her shoulder and continued on a quick inspection tour. He looked in on the waiting room but the smell that met him made him wish that he had not. It was a mixture of vomit, urine and wet clothing. All the chairs were full and people were squatting on the floor. A woman was wandering up and down with tears flowing down her face and Saracen recognised her, she was regular in A amp;E when it rained. She was known to the Unit as Mary.

Mary was one of the people that the Sunday Supplements liked to call the ‘twilight people’ in their intermittent features on life’s unfortunates between advertisements for Porsche cars and Swedish furniture. She was alone in the world and had the IQ of a child although now in her early thirties. She had spent her entire adult life either sleeping rough or in a succession of hostels and assessment centres having fallen through one of the many gaps in the Welfare State. She could not be admitted to a regular hospital because there was nothing physically wrong with her and she could not be admitted to a mental establishment because, although retarded, she was not mentally ill. This left her alone in a world with very little sympathy for a thirty year old bed-wetter with the mind of a ten year old child.

On the occasions when being turned out of a hostel coincided with bad weather Mary would turn up in A amp;E in floods of tears and stinking of urine in the hope of a bed and a little kindness. She was rarely successful for the simple truth was that Mary was not alone. There were a lot of ‘Marys’ on the streets, out of sight and out of mind.

“Come on now Mary, you know the rules,” said Saracen gently.

“But Doctor I’m ill,” whined the woman.

A porter came up to Saracen and whispered in his ear, “We’ve been on the blower and the church hostel in Freer Street will take her for tonight.”

Saracen nodded, grateful that he was not going to have to turn Mary out on the street. “C’mon Mary,” he said, “We’ve found a nice warm bed for you.”

The sobbing subsided and Mary came towards Saracen with open arms. Saracen steeled himself for the embrace and held his breath. He patted her back and hoped that she would release him before the stench of ammonia overpowered him. “I’m sure one of these nice policemen will run you round to the hostel while they’re waiting.”

The nearest constable raised his eyes to the ceiling before saying, “Of course,” with less than marked enthusiasm. He whispered to Saracen as the porter led Mary out, “It took us three days to fumigate the Panda last time.”

Saracen returned to find Tremaine and said to him, “You’ll need some help, I’ll stay.”

“I wasn’t going to ask…honest.” said Tremaine.

Saracen smiled and put on his white coat.

Sister Lindeman had finished pumping out the stomach of the teenager. She left her in the care of another nurse while she returned to the main treatment room to see how things were going. She saw Saracen and grinned. “Couldn’t stay away huh?”

“That’s about it Sister. Who’s next?”

Saracen started working his way through the aftermath of a violent Saturday. Tiredness prevented any kind of small talk and limited him to asking only relevant questions before working in silence. He accepted the answers with no sign of emotion for exhaustion had brought on a detachment that shielded him from the boring, mindless monotony of the reasons given for the injuries he was treating. Bottle… beer glass… steel comb… bread knife.

Saracen was working on his fourth patient when reception alerted them to the arrival of an ambulance carrying victims of another road accident. A few minutes later a trolley was wheeled quickly into A amp;E with an entourage of police and ambulance men. A distraught woman with blood running down her face from a cut on her forehead ran alongside the trolley, unwilling to let go. Saracen guessed correctly that it was her husband lying on it.

“It was the rain…it was the rain…David has always been such a careful driver but it was the rain. The car just spun, there was nothing he could do…it was the rain…”

In the background Saracen saw one of the ambulance men shake his head. He said to one of the nurses, “Nurse, would you find a seat for Mrs?…”

“Lorrimer,” replied the woman. “With two ‘r’s,” she added nervously.

Saracen smiled reassuringly at her as she was led away to the waiting room then he turned to her husband.

“I think he’s had it,” said the ambulance man who had shaken his head. He filled Saracen in on the details of the accident while Saracen examined the man. Saracen stood up from the table and said, “You’re right. He’s dead, ‘ribs probably punctured his heart. The PM will say for sure.”

“Will you tell his wife?” asked one of the policemen.

Saracen said that he would and went to find the woman. She had been taken to one of the side rooms by a nurse. She got up as Saracen entered and smiled nervously before starting to speak quickly as if in the belief that she could make something true by saying it often enough.

“He is all right isn’t he? Just a bit of a bump. I thought so. This weather really is the limit. I was just saying to David before the accident…” Her voice trailed off as Saracen took both her hands in his. “I’m sorry,” he said, “Your husband is dead Mrs Lorrimer. There was nothing we could do.”

The woman’s eyes widened then filled with tears as the bottom fell out of her world. She began to sob uncontrollably and Saracen held against his shoulder, raising his hand to stop the nurse who made to move forward and take her away. He let the woman cry herself out before lifting her gently off his shoulder and asking if there was anyone they could contact to be with her. A relative? A friend? “Nurse will clean you up and get you some tea,” he said, ushering her into the waiting arms of the nurse. Saracen returned to the main treatment room as a heavily built man lurched in from the waiting room.

“I wanna see a doctor,” he demanded, his voice slurred with drink. He transferred his weight unsteadily from one foot to the other as he tried to focus on the scene in front of him.

“You’ll have to wait your turn,” said Saracen. “Go back to the waiting room please.”

“I wanna see a fuckin’ doctor now!” demanded the drunk. He brought his fist down on the edge of an instrument tray sending a shower of steel up into the air. He staggered back as if amazed at the consequence of his action.

“You’ll have to wait your turn like everyone else. Go back to the waiting room,” said Saracen.

“Who fuckin’ says so?”

“I fuckin’ do,” said Saracen evenly.

The drunk sniggered. “Are you gonna make me like?” he whispered hoarsely.

“No, he is,” said Saracen matter of factly. He nodded to the porter, Jack Lane who had just returned from taking a patient to X-Ray. He looked down at the drunk from six and a half feet and said quietly, “This way my son…there’s a clever boy.” He led the drunk out by the scruff of the neck.

Tremaine shrugged and said to Saracen, “Twenty minutes ago this place was full of policemen. Now, when you want one…”

Saracen stitched up another cut head then walked over to the sink to wash his hands. He levered on the taps with his elbows and took in the sights around him as he washed. The clock up on the wall said twenty past two and exhaustion was inducing a cynical numbness. How different it all was from his pre-medical school view of medicine when family and friends had encouraged him in the notion that he was about to become one of God’s chosen people, or at least, society’s. He smiled faintly as he recalled the image he had nurtured through his student years, the one where he, dressed in a neat grey suit, was standing on the steps of a bright, modern hospital waving good-bye to a grateful family who looked as if they had stepped out of the pages of Homes and Gardens. “How can we ever repay you Doctor?” they were saying.

“Oh, it’s nothing really…”

Saracen saw the symbolism in washing his hands as he looked at the last of a Saturday night’s clientele at Skelmore General. “Barabbas it is then,” he said softly, but not so softly that a passing nurse did not hear. “Did you say something Doctor Saracen?” she asked.

“No. nothing.”

The stream of patients dwindled to a trickle and the last one finally limped out through the swing doors at twenty minutes past three. Saracen sat down slowly on one of the tubular frame chairs and tilted it back to rest his head against the wall. Alan Tremaine joined him and read aloud from the clip board in his hand. “Forty three patients, fourteen admitted to the wards, four palmed off on to the County Hospital, one dead on arrival, the rest discharged.”

“Tea?” asked Sister Lindeman.

“Please”

Tremaine put down the clip board and stretched before putting his hands behind his head. “Only two more months of A amp;E to go,” he sighed. “How long have you been doing it James?”

“Six years.”

Tremaine expelled breath loudly and said, “You know, I can’t begin to tell you how grateful I am to you for helping out tonight.”

“Forget it,” said Saracen.

“Something should be done about Garten,” said Tremaine, “How does he keep getting away with it? I’ve got a damned good mind to complain to the authorities about him.”

“You will do no such thing,” said Saracen with an air of finality that took Tremaine aback, “You will keep your mouth shut, finish your residency and leave with a good reference. Understood?”

“If you say so…But it’s so unjust.”

“Don’t waste your time looking for justice. Keep your nose clean and get on with your career.” With that, Saracen got up and left through the swing doors.

Sister Lindeman returned with the tea and looked surprised. She looked around her and then asked, “Has Doctor Saracen gone?”

Tremaine replied that he had. He accepted the mug that Sister Lindeman held out and asked almost absent mindedly, “How come James is still only a registrar? He must be what, thirty five? thirty six? Come to that, why is he still working in A amp;E?”

“I’m sure I don’t know what you mean Doctor,” said Sister Lindeman. Her voice was cold enough to ensure that Tremaine knew not to pursue that line of conversation.

Tremaine sipped his tea, still deep in thought. “And as for Garten…”

“Drink your tea Doctor.”

Saracen pulled up his collar against the wind and walked up the hill to find the duty porter. The man emerged from his turreted gate-house when he saw Saracen approach.

“Where did you leave my car?” Saracen asked.

“It’s round the back, parked behind the bins.” The man dropped the keys into Saracen’s hand and said good-night. Saracen turned and walked back down the hill, taking care not to slip on the wet cobblestones. It had stopped raining but only recently for water still trickled down the hill through the joints and crevices of a surface that had been laid before the turn of the century.

Unlike the front of the building which had an array of neon signs and direction indicators the lighting was poor at the back for the rear boasted no public buildings save for a small chapel attached to the mortuary. The lighting was therefore minimal and comprised solely of electric conversions to the original gas mantle holders on the walls.

Saracen saw that a notice had been pinned to one of the two tall mortuary doors. He stopped to read it but had to manoeuvre himself till he achieved an angle where there was enough light to make it possible.

MORTUARY CLOSED DUE TO REFRIGERATION FAILURE

For transfer arrangements call ext. 2711.

His curiosity satisfied, Saracen walked on past the row of large bins that held the Hospital’s refuse. Each was mounted on a wheeled trolley and fitted with a grab ring to fit the hydraulic hoists of the collection vehicles that called every other day. He took in breath sharply as a cat leapt from the top of one of the bins in front of him and disappeared off into the shadows.

Saracen found his car squeezed into a small space behind the row for parking space was always a problem within the precincts of the hospital. He had to sidle between it and a wet stone wall to reach the driver’s door. As he fumbled for the lock in the gloom he dropped the keys and cursed softly as he found difficulty in bending down in the narrow space.

As he groped for his keys Saracen became aware of a faint hissing sound. At first he thought it must be coming from one of the tyres but as it grew louder he realised that it was coming from the other side of the bins. Intrigued, he stood up and squeezed out from behind the car to peer through a gap between two of the bins where he could see out into the courtyard.

The sound grew louder and Saracen recognised it as the noise car tyres made on wet cobblestones. A vehicle was freewheeling slowly down the hill from the gate. He waited for its headlights to illuminate the courtyard but nothing happened. Instead he saw the dim outline of a dark van come slowly round the corner without lights and stop outside the mortuary.

The light coming from the single bulb above the mortuary doors enabled Saracen to see that three men had got out. He watched spellbound as they donned some kind of protective clothing that they took from the back of the van. The unlikely possibility that they were refrigeration engineers was totally dispelled when Saracen saw them put on hoods and full face visors and then pull on gauntlets.

Looking like astronauts about to enter their space craft, the men approached the mortuary doors in single file. There was a brief pause while the lock was undone then they disappeared inside.

Saracen began to wonder if he was hallucinating. Perhaps it had all been a vision brought on by tiredness. He even screwed up his eyes before looking again and finding the van still there.

A few minutes later two of the men re-emerged carrying a long box that appeared to be wrapped in plastic sheeting. They loaded the box into the back of the van the turned to wait for the third man who was still inside. Through the open door Saracen saw the darkness of the mortuary become eerily light as if candles had been lit inside. The third man came out and closed the door. Saracen walked out into the open and approached the van. “What’s going on?” he demanded.

Three dark visors turned to look at him but no one spoke.

“I asked you what you were doing,” said Saracen as he got closer. Still no reply. Saracen suddenly felt apprehensive. The lack of response and the fact that he could not see the men’s faces made him feel that it might be unwise to get any closer. “Just stay where you are!” he ordered and turned on his heel to make for the gate- house. He only made it to the foot of the hill before something hit him on the back of the head and unconsciousness swept over him like a black fog.