Pestilence

Chapter Ten

Saracen returned to A and E and told Alan Tremaine what had been going on.

“I trust we can all sleep safely in our beds now that a committee has been formed,” said Tremaine, tongue in cheek.

“You certainly can,” said Saracen. “The County Medical Officer says so.”

“Then maybe I’ll emigrate,” said Tremaine.

“No respect the younger generation, none at all. Now if you want to give me the report you can go home and get some sleep.”

“Are you serious?” exclaimed Tremaine.

“I’m serious.”

“Then I’m not going to argue,” said a delighted Tremaine. He picked up a clip-board and started to read out facts and figures. “Road accident, two admitted, man with skull fracture, three broken ribs and broken left femur. He’s in ward twelve. Woman, severe facial lacerations, broken left wrist, admitted to ward thirteen. Kid knocked off his bike, cuts and bruises, bad sprain to left ankle. He’s presently at X-Ray but I don’t think it’s broken. One drunk with a four inch cut on his face from a beer glass. Singh is stitching him up in Cubicle four. Lastly a woman with a rash all over her body. It came out while she was eating in a restaurant with her husband. I think it’s an allergy rash, maybe something she ate. She’s responding well to antihistamines.”

“That’s it?”

“That’s it.”

“See you in the morning,” said Saracen. “By the way have all the staff had their tetracycline?”

“To a man. How about you?”

“I’m just about to.”

“Don’t forget,” said Tremaine and with that he left.

Saracen took his tetracycline and then started looking for the day-book. He failed to find it and went to ask Sister Lindeman.

“I put it on Dr Garten’s desk I thought you would be using that room from now on.”

“Of course, thank you Sister,” said Saracen who had overlooked that side of things. He found that Lindeman had moved some of his other books and papers into Garten’s old room and it made him think about her. He had often tried to define what made a good nurse but had never fully succeeded. Whatever it was, Moira Lindeman had it in abundance. She was quite simply the best. Quiet, unobtrusive, competent and smoothly efficient. But there was more to it than that. She had the capacity not only to act but to anticipate what would be required in any given situation. In many other professions she would have been highly rewarded for that quality but here in A amp;E she was taken for granted.

Saracen finished scanning through the day book and closed it as a knock came to the door and a nurse put her head round. “Dr Saracen? The pubs are coming out. We need you.”

Saracen joined the rest of the team in the treatment room as the first casualties of ‘The Happy Hour’ as Tremaine termed it arrived in A amp;E. The hour referred to was the hour immediately after closing time when arguments fuelled by booze were settled by violence.

“What happened?” Saracen asked a burly man with blood pouring from a head wound. He was holding a dirty handkerchief against it.

“It were this other bastard see, it were all his fault. There I was, mindin’ me own business when this…”

Saracen switched off. He had heard it all so many times before. He concentrated on stitching the cut but just before he started the man put a hand on his arm and asked thickly, “Is this gonna hurt?”

“Hope so,” said Saracen.

There was a welcome lull between one and two in the morning when the town had settled its differences and settled to sleep. Saracen grabbed the chance to drink tea and eat digestive biscuits that had gone soft through lying too long on the plate. In the quiet of the small hours he started doing the Guardian crossword and was pencilling in the word ARCHIMEDES when the phone rang; it was Dave Moss.

“The woman died and we’ve had four more admissions.”

“From where?” asked Saracen.

“From the Maxton estate. A woman and three kids.”

“Known contacts?”

“Don’t know yet. Braithwaite’s people are investigating but there’s more to worry about at the moment; I’ve got the lab results back.”

“And?”

“It’s plague all right. They’ve isolated Yersinia pestis but there’s some kind of problem with the drug tests.”

“What kind of a problem? MacQuillan assured us that the treatment was cut and dried,” said Saracen.

“Well, the lab think so too but they are not too happy with the readings they’ve been getting. They’d like Porton Down to check them out.”

“What’s to check? The strain is either sensitive or resistant to tetracycline and plague is always sensitive. MacQuillan said so.”

“I know that’s what MacQuillan said and that’s what the book says too but the lab found that, although tetracycline slowed the bug down, it didn’t kill it.”

“Maybe some problem with the potency of the drug used in the test,” suggested Saracen.

“Maybe,” said Moss hesitantly

“So what drug do we use meantime until they check it out?” asked Saracen.

There was an uneasy pause before Moss said, “Trouble is…all the drugs the lab tested behaved in the same way. They slowed the bug down but they didn’t kill it.”

Saracen’s head reeled with the implications of what Moss was saying. “But that means we can’t treat it,” he said finally.

“Yes it does,” agreed Moss.

“If tetracycline slows it down what are the chances of the patient’s own body defences coping?” asked Saracen.

“That’s the big money question,” agreed Moss. “We won’t know until we’ve tried it. So far all the patients have been well into fever before we’ve seen them; they probably would have died anyway. The only people treated with tetracycline have been the staff and the known contacts and they seem all right so far, touch wood.”

“When will we hear from Porton Down?” asked Saracen.

“Two days they reckon. It has top priority.”

“So we just sit tight and hope,” said Saracen.

“Nothing else for it,” agreed Moss.

Saracen put down the phone and sat staring into space for a moment. Sister Lindeman interrupted him. “I’m sorry. We’ve got a right mess coming in,” she said.

“Tell me,” said Saracen wearily.

“Glue sniffers. Four kids. The Police found them on a building site.”

Saracen could smell the solvent on the breath of the children. Like a lot of other things, tar, petrol, disinfectant, it was not unpleasant in small doses but when you put the stuff in a polythene bag and clamped it over your nose and mouth as the four in front of him had been doing it was a different story. He looked at the blistered mouths and rolling eyes and shook his head as he examined each in turn.

One of the four, a street-wise youngster in grubby Tee shirt and jeans and with a mop of curls, seemed less affected than the others so when things were under control Saracen came back to him and asked some questions. He asked the boy his age.

“Twelve,” came the sullen reply.

“Why do you do it?”

“Nothing else to do around here.”

“Crap!” said Saracen.

The boy seemed taken aback. “It’s true,” he mumbled.

“And I’m telling you it’s crap! Don’t you think I’ve got enough to do without dealing with a bunch of cretins who stick plastic bags on their heads?”

“You can’t say that! You’re a Doctor!” protested the boy.

“I just did” said Saracen. Where did you buy the glue?”

“Ain’t sayin’”

Saracen looked at the police constable who had brought the boys in but the man shrugged his shoulders. “I asked you a question,” said Saracen turning back to the boy.

“And I said I ain’t sayin!” replied the boy aggressively.

Saracen eyed him up for a moment and then said, “In that case my son I think a nice enema is called for.”

“What’s that?” demanded the boy.

Saracen leaned over and whispered in the boy’s ear. “First the nice nurse will take this big tube and then…”

The explanation had the desired effect. The boy’s eyes opened wide and aggression changed to panic. “No one is gonna do that to me,” he spluttered.

Saracen nodded gravely. “Oh yes they are,” he said. “And with ice cold water too…”

The boy began to shrink away but was restrained by the constable’s hand.

“Now perhaps if you were to answer my question I might just be able to reconsider your treatment,” said Saracen calmly looking at his fingernails.

The truth dawned on the boy. “This is blackmail!” he stammered.

“I believe it is,” agreed Saracen.

The boy gave in. “Bartok’s in Weaver’s Lane,” he said. “He said we weren’t to tell anyone.

“I’ll bet,” said Saracen quietly. He looked at the policeman and asked, “Mean anything?”

The officer nodded and said, “We know old Bartok. Tight as a cat’s arse.” Realising too late what he had said the policeman began to colour and offer his apologies to Sister Lindeman. “We’ve heard worse,” said Lindeman.

“You’ll have a word with him?” asked Saracen.

“We’ll lean on him a bit but he’ll swear blind that he thought the kids were building model aeroplanes.”

“See what you can do anyway.”

The constable got to his feet and replaced his helmet. “Can I take it these four rogues are going to be all right?” he asked Saracen.

Saracen nodded and said, “This time.”

“Are you keeping them in?”

“These three better stay overnight, this one can go home,” said Saracen lightly shaking the shoulder of the boy who had provided the information.

“Right then. You come with me,” said the policeman to the boy. “I’ll take you home and have a word with your dad.”

“Don’t do that Mister. He’ll kill me!” said the boy.

“Where do you stay?” Saracen asked the boy.

The boy gave an address in the roughest part of the Maxton estate and Saracen looked at the constable. His shrug was a plea for mitigation. The policeman smiled and said, “Perhaps in view of the help this young man has given us and taking into account the fact that he is never going to do anything like it again…”

“Never, I promise Mister.”

“Right then. Wait here while I get some details from Reception.” The officer left the room.

“What were you doing on the building site anyway?” Saracen asked the boy.

“Playing.”

“You came all the way down from the Maxton to play?

The boy hung his head and Saracen played the waiting game. “A bloke at school said you could get treasure at the site.”

“Treasure?”

“That’s what he said.”

“What kind of treasure?”

“Gold.”

“Gold on a building site?” asked Saracen.

“It’s true!” said the boy defiantly. “Edwards had a chain, a gold chain; he got it on the site.”

“Where about on the site?”

“He wouldn’t tell us.”

“So you thought you would investigate on your own?”

The boy nodded.

“Find anything?”

“Not yet.”

Saracen smiled at the defiance. “Building sites are dangerous places. If Edwards found a chain there it probably belonged to one of the workmen; he should have handed it in.”

“No, it was different. It was treasure!”

“Treasure or no treasure you stay away in future. Understand?”

The boy said yes but avoided Saracen’s eyes when he said it. The constable returned.

Saracen was called to a special meeting of the emergency committee on Thursday morning and guessed rightly that this was to discus the results from Porton. The meeting was delayed while they waited for Dave Moss to arrive from the County Hospital but when ten minutes had passed with still no sign of Moss Saithe decided to start without him and handed over to MacQuillan immediately.

“Not to beat about the bush,” said MacQuillan, “Porton agrees with the findings of the local laboratory. There is, in fact, a problem.” MacQuillan paused to let the murmur die down. Saracen was only too aware of the inflection that MacQuillan had put on the word ‘problem’. It made him uneasy.

“The bacterium appears to have undergone some alteration to its outer membrane affecting both passive and active diffusion.”

Saithe said, “Perhaps for the benefit of those among us who are not scientists?”

“I’m sorry. Of course,” said MacQuillan. “The outer wall of the bacterium has changed, mutated in some way so that it has become impervious to certain agents.”

“Does ‘certain agents’ include antibiotics?” asked Saracen.

“Among other things yes,” replied MacQuillan quietly. The buzz in the room grew loud and Saithe had to ask for quiet.

“So there is no way of treating the disease?” said Saracen.

“Antibiotics do have some effect,” said MacQuillan. “Tetracycline in particular slows the growth rate of the organism markedly.”

“But in the end?” persisted Saracen.

“In the end the outcome is inevitable. The prognosis for treated cases will be the same as for untreated. One hundred percent fatality can be expected.”

Braithwaite interrupted. “This is all academic of course,” he said. “If my people have moved quickly enough to isolate the contacts, as I believe they have, there is nothing at all to worry about.”

“I disagree,” said Saracen flatly.

The room fell to awkward silence before Saithe said, “Perhaps you had better air your views Dr Saracen.”

Saracen stood up and said, “We must not be complacent. I suggest that steps be taken immediately to isolate Skelmore from the rest of the community.” Even before he had got the last word out Saracen was aware of the murmurs of disapproval. These murmurs spawned a small supercilious smile on Braithwaite’s lips. He said, “I am sure the good doctor should be commended for his caution but this is not mediaeval England. Isolating a modern day town is not a matter to be taken lightly. It would do untold damage to the economy of the town not to mention putting an end to Skelmore’s development hopes for the future. I think most of us here would agree that there is certainly no call for such a drastic measure at this juncture.” Sounds of agreement greeted Braithwaite’s words.

Saracen continued his losing battle and said, “This may not be mediaeval England but what we have here in the town is mediaeval plague and from what Dr MacQuillan has said we are no more equipped to deal with it in this time than we were then.”

Silence met Saracen’s comments until MacQuillan said, “I am afraid that there is a deal of truth in what Dr Saracen is saying.”

“But surely you don’t think that we should isolate the whole town too?” said Braithwaite.

MacQuillan adjusted his spectacles and said, “As always in these cases the crux of the matter lies in the source of the outbreak. In this case we know the source; it was the Archer woman and she brought it in with her from Africa. That being the case I see no need to quarantine the town.”

“There we have it then,” said Braithwaite, pleased that MacQuillan had backed him up.

“I take it that the relevant African medical authorities were informed about Myra Archer?” asked Saracen.

“Of course,” replied Braithwaite, content to leave it at that but Saracen persisted. “Have you heard back from them yet?”

“No, but then I really don’t expect to,” said Braithwaite with more than a trace of irritation. “The simple fact is that the disease is endemic in areas of that continent. I suggest you read the World Health Organisation’s report on the subject Doctor.”

“I don’t doubt it,” replied Saracen. “But I would like to know if any case of plague has been notified in the area relevant to Myra Archer in the past few months.”

“Africa isn’t England Doctor,” snapped Braithwaite. “People come and go, live and die without the state ever being aware of it let alone writing it all down. Official records are scanty if they exist at all.”

The meeting fell into thoughtful silence until Saithe said, “Is anyone other than Dr Saracen in favour of taking steps to isolate the town?”

No one spoke.

“Very well then,” said Saithe, “We carry on as we have been doing for the time being.”

Saracen phoned Moss at the County Hospital as soon as he got back to A amp;E. He wanted to find out why he had not attended the meeting.

“The anti-plague vaccine arrived this morning,” said Moss. “I thought it more important to start vaccinating the staff. Anything interesting come up?”

Saracen told Moss of the Porton findings.

“So the lab was right,” said Moss. “The bug is resistant to tetracycline.”

“Worse than that. MacQuillan says that its altered cell wall makes it immune to just about everything.”

“All things bright and beautiful…” intoned Moss.

Saracen had a chilling thought. He said, “I wonder if Porton checked the bug’s antigenic structure.”

“What do you mean?”

“If our bug has a different cell wall it may not be susceptible to antibodies produced against different strains.” said Saracen thoughtfully.

“Christ! You mean the vaccine we have may not be any good against the Skelmore strain?” said Moss.

“Just a thought,” said Saracen.

“That would be all we need,” groaned Moss.

“I better check with MacQuillan,” said Saracen. “Can you give me the batch number of the vaccine you are using?”

“Hang on.”

Saracen waited for Moss to return to the phone and used the time to uncap his pen and flick over his desk pad to a new page. He was absent mindedly drawing a clover leaf in the top right hand corner when Moss came back on the line. “It’s WHO 83 YP 761. Got it?” Saracen confirmed that he had and said that he would contact MacQuillan immediately.

As he was about to dial MacQuillan’s number Saracen saw Jill Rawlings pass the glass door panel. She was walking along the corridor with another nurse. Saracen opened the door and called her back. “Do you have a moment?” he asked.

“Of course,” replied Jill, indicating to her companion that she should carry on without her.

“I haven’t seen you for ages. I’m sorry,” said Saracen, closing the door.

“Don’t be. I know how things are but I’m here if you need me.”

“I need you,” said Saracen.

Jill seemed taken aback. She said, “Well Doctor, it took something for James Saracen to say that didn’t it.”

“Maybe,” conceded Saracen. “Can I see you tonight?”

“I’m on duty until eight thirty. I’m free after that.”

“Good, perhaps we can go out to dinner and…”

Jill put a finger on his lips. “No,” she said. “You were on call last night in A amp;E.”

“Yes but…”

“And the night before?”

“I’m fine, really I am,” insisted Saracen.

Jill would have none of it. “Stay home,” she said. “I’ll come round when I’ve finished and we’ll eat in, then we’ll relax with a drink and then we’ll make love and then, my dear Doctor, you will go to sleep. Understood?”

Saracen looked down at Jill’s smiling eyes and said, “You are a very special lady.”

“See you later,” said Jill backing out the door.

Saracen called MacQuillan and told him of his worries about the vaccine. “Could you ask Porton to check it?” he asked. “I’ve got the serial number of the batch.”

“The check is already being done,” said MacQuillan. “Our people thought of it as soon as they discovered the altered cell wall.”

“I should have realised,” said Saracen, feeling foolish.

“I’ll let you know when I hear the result,” said MacQuillan.

“There is one other thing,” said Saracen tentatively.

“Yes?”

“If the vaccine should turn out to be ineffectual, what then?”

“A new antiserum and vaccine would have to be prepared from the Skelmore strain.” replied MacQuillan.

“As simple as that?”

“Yes. It would take a little time of course but preparing a bacterial vaccine is no great problem. We can be grateful that plague is caused by a bacterium and not a virus. Viral vaccine are a different ball game.”

“You said antiserum as well as vaccine?”

“Now that we have a problem with antibiotics we can inoculate animals with the Skelmore strain and then use their serum to treat cases with. There’s always a risk of serum sickness of course, even anaphylaxis but it’s a lot better than nothing.”

“Quite.”

Saracen left A amp;E at six and despite a threatening sky decided to leave his car and walk home for he felt the need for fresh air. Jill would not arrive much before nine so there was no reason to hurry. He took a detour through Coronation Park and sat for a while beneath the trees feeling depressed. There was no specific reason for the feeling; he just had a sense of foreboding; it was almost as dark as the sky. Perhaps it was the weather, he reasoned, heavy, still air, trees absolutely motionless as if holding their breath while they waited for something to happen. The sky grew even darker; the clouds were almost black and the failing light made the grass seem a much richer green than usual. What few people there were in the park at that time started to scurry away as the first large drops of rain speckled the path.

Saracen was soaked to the skin by the time he got back to the apartment but showed no irritation for he had taken no steps to avoid it. True his first impulse had been to run for cover when the rain had started but tiredness in his limbs and the general feeling of depression had changed his mind. He had opted instead to walk through the rain, knowing that a warm bath and a change of clothes were to come. In the event he discovered that the timer on the water heater in the flat had failed to trigger and there was no hot water. He switched it on manually and towelled himself dry while he waited in front of the gas fire for it to heat up. After twenty minutes or so he settled for a lukewarm bath with a large whisky propped up on the soap bar.

At eight thirty Jill phoned; she seemed distraught. “It’s Mary Travers,” she said. “She collapsed on the ward.”

“What’s the matter?”

“They don’t know yet but I want to stay with her till they find out.”

“Of course,” said Saracen. “Is there anything I can do?”

“I don’t think so. I’ll still come round later if that’s all right?”

“Whenever,” said Saracen.

Saracen turned on the television and flicked through the channels until a programme about the Amazon River caught his attention but after a few minutes drowsiness began to compete with his interest and the soporific hiss of the fire colluded with the slow monotone of the narrator to induce in him an overwhelming desire to sleep.

He was rudely awoken by the telephone and the crick in his neck, when he sat up, told him that he had been asleep for some time. The clock confirmed it; it was a quarter to midnight.

“James? It’s Jill; I’m still at the hospital.

It took Saracen a few seconds to clear his head and gather his thoughts. “What’s the problem?” he asked.

“Mary is very ill and Dr MacQuillan thinks it would be a good idea if I didn’t leave the hospital right now.”

Saracen was suddenly wide awake. “What’s MacQuillan doing there?” he asked in alarm. He was aware of Jill breathing quickly as if she was very upset. “What’s going on?” he asked. “Take a deep breath and tell me.”

“They think Mary has plague.”

Saracen felt his stomach go hollow. His mind started to race but he kept a tight rein on his tongue while he considered the implications. Mary Travers had been the nurse on Medic Alpha on the night it had brought in Myra Archer. She, like the others, had been given tetracycline cover. It seemed that all the drug had done was slow down the development of the disease. An outbreak among the other contacts could be imminent.

“James are you still there?”

“Sorry. You say that you are staying on at the hospital?”

“Dr MacQuillan thinks it would be a good idea if those of us who have been in contact with Mary stay here for the moment. They’re opening up Ward Twenty as an isolation unit and asking for volunteers to staff it. I thought that as I was here anyway…”

“You volunteered.” Saracen closed his eyes for a moment. “Take care,” he said softly.

“You too,” said Jill.

“Can I speak to MacQuillan before you hang up?” asked Saracen.

“Hang on.”

After a few seconds MacQuillan’s voice came on the line. “Dr Saracen?”

“Staff Rawlings told me about Nurse Travers,” said Saracen. “It looks as if the contacts are beginning to go down.”

“I wish I could disagree,” said MacQuillan.

“That means that there could be half a dozen or more people scattered over Skelmore about to develop plague. It’s like having incendiary bombs in a wood-pile.”

“Braithwaite’s people are bringing them in and isolating their families.”

“But will they be in time?”

“It’s touch and go. It could go either way that’s why I’ve requested a government order.”

“Government order?”

“From 6a.m. tomorrow morning nothing moves in or out of Skelmore.”

“Can the Police cope?”

“It will be a military affair,” replied MacQuillan. The town will be under martial law.”

“Good God!” said Saracen. “That has an unpleasant ring.”

“There’s no other way.”

“Staff Rawlings said that ward twenty is being opened and staffed with volunteers.”

“And you are wondering about the volunteer angle?”

“Yes.”

“There’s a moral dilemma involved,” said MacQuillan. “We know that the patients admitted to twenty will almost certainly die but they have to be cared for. On the other hand there is some doubt about the efficacy of the vaccine offered to staff as protection. While that doubt persists I felt we had to make the job voluntary.”

“About protection for the staff…” Saracen began.

“I’ve placed an urgent request for respirator suits from the Ministry of Defence. They will be here by tomorrow morning. In the meantime we have isolated Nurse Travers in a plastic cocoon.”

“Is there anything I can do?” asked Saracen.

“Get some sleep while you can,” replied MacQuillan. “And if you’re a praying man now’s the time to do it.”

The sound of the National Anthem woke Saracen up. He got up from his chair rubbing his neck and turned the television set off before padding over to the window to look out at the rain. Something told him that he had just had all the sleep he was going to get.

The phone rang at two a.m.; it was Moss.

“Where are you?” asked Saracen.

“At home. The hospital just rang to say that four of the other Archer contacts have developed full blown plague.”

“Which ones?”

“The two ambulance men, the police constable who attended the incident and one of the porters.”

“How about their families?”

“The Public Health people are working at full stretch trying to reach them in time.”

“I don’t envy them.”

“Braithwaite is beginning to fray at the edges.”

“Have they established any link between the dead workman and the other three cases from the Maxton?” asked Saracen.

“The woman was having an affair with the dead man. Braithwaite isolated the man’s family but no one told him about the other woman. Just about everybody knew but no one liked to say. You know how it goes.”

“And the kids?”

“Two belonged to the woman; the other was a school friend who happened to be staying.”

“God, what a mess.”

“I believe ‘tangled web’ is the expression.”

“You’ve heard about the quarantine order?”

“From 6am. Yes.”

“Do you know when the public are being told?”

“In the morning when the road blocks are in place and it’s too late to decide on a snap visit to Auntie Mabel in Birmingham.”

“Makes sense.”

“The Police have had a meeting with the heads of local radio and television. It’s been decided to present the measure as a sensible precaution and a chance for Civil Defence bodies to have a major practice. Appeals will be made to British common sense etc.”

“It’s still hard to believe this is happening.” said Saracen.

Moss murmured his agreement.

Saracen lay back on the headboard with his hands behind his head and listened to the sound of the rain outside in the darkness. There was no way that he was going to be able to sleep. He swore softly and got out of bed.