White death

TWO

Carlisle Royal Infirmary

March 2007

‘Dan? It’s Keith, he’s been taken ill. He’s really bad. Can you come?’ Marion Taylor’s voice broke and she gave in to sobs.

‘I’ll be there in thirty minutes, love. Hang on.’

Dan Taylor descended from the scaffolding he had been working on like a man possessed. He ran across the building site to his van, shouting to his foreman on the way. ‘The lad’s poorly; got to go.’ He threw his hard hat in the back of the van and cursed as it took him three attempts to start the engine. When it finally caught, the wheels sent up a cloud of sand and gravel as they scrabbled to find grip on the loose surface, causing workmen crossing the site to seek protection for their faces behind hands and elbows.

‘Bloody loony,’ mouthed one.

‘It’s Dan Taylor. His kid’s been taken bad.’

‘No reason to have my bloody eye out.’

True to his word, Taylor was at the hospital in thirty minutes having contravened most of the Highway Code on the way and collected the flashes of at least two speed cameras to mark his passing. He compounded his list of offences by parking on a double yellow line outside A amp;E and rushing inside to ask where his son was, drumming his fingers impatiently on the desk while he waited for the answer.

He found his wife sitting in the corridor just inside the door of the ward. She was holding a wad of tissues to her face. He sat down beside her and put his arm around her shoulders. ‘So, what happened, love?’

‘He came home from school at lunchtime, saying that he wasn’t feeling well.

‘I thought he was having me on at first and I half expected him to say he was feeling better after half an hour and asking if he could go down to the arcade but I was wrong. He was sick a couple of times and his temperature seemed way up so I put him to bed. Things just seemed to get worse though. He was sick again and then he started talking nonsense. I was frightened. I couldn’t get any sense out of him, then he tried to go to the bathroom but he fell flat on the floor when he came out and I had to help him back into bed. I called the doctor and some silly cow in Reception told me I should bring him in. Can you believe it? I gave her a piece of my mind and told her I’d be writing to my MP if she didn’t pull her finger out and tell the doctor it was an emergency. When he got to the house, he just took one look at him and called for an ambulance. I phoned you as soon as we got to the hospital.’

‘So what’s wrong with him?’

‘The doctor didn’t say, just that the hospital would have to carry out tests.’

‘Was this our doctor or the hospital one?’

‘Ours. No one here’s come to speak to me yet.’

Taylor shook his head. ‘Surely it can’t be rejection after all this time. He’s been right as rain for the past year.’

Keith Taylor had been the recipient of a bone marrow transplant nearly a year before after contracting leukaemia. It had been touch and go at the time but he had made a good recovery and seemed to be in every sense a normal thirteen-year-old. He was perhaps more susceptible to minor ailments than his peers — because of the immuno-suppressant drugs he had to take to stop his body rejecting the transplant — but his energy levels were more than a match for his pals and he was a willing participant in the scrapes they got themselves into.

‘The doctor didn’t think it was rejection either. He thought it looked like some kind of an infection.’

A young doctor appeared in front of them, white coat flapping open, stethoscope slung round his neck and pushing a wayward flop of fair hair back from his forehead. ‘Mr and Mrs Taylor? I’m Dr Tidyman. I’m afraid your son’s very ill. We’ve had to put him on a ventilator and transfer him to intensive care while we try to establish just what’s wrong.’

Marion Taylor found this too much. She broke down in tears. ‘Oh dear God.’

‘Have you no idea at all what’s wrong with him?’ asked Dan.

‘I’m afraid not at the moment. We’re waiting for information and data to come back from the lab.’

‘You know he had a bone marrow transplant last year?’

‘We’re aware of that but, if it’s any comfort, we don’t think that’s anything to do with his current problem.’

‘The leukaemia’s not come back?’

‘No, nothing like that. He seems to have picked up some kind of infection that appears to be coursing through his body. Hopefully the lab’ll be able to tell us just what’s causing it and we can start fighting it.’

Taylor felt a strange conflict of emotions inside him — relief that the leukaemia hadn’t returned but quickly followed by fear about the infection. ‘This ventilator thing you mentioned…?’

‘It’s a machine that’s doing Keith’s breathing for him. We’ll keep him on it until he is strong enough to take over again for himself.’

‘Can we see him?’

‘Of course, but I have to warn you that people often find it distressing to see wires and tubes seemingly coming out of just about everywhere in their loved ones but try to remember that it’s for Keith’s own good. We have to know what’s going on inside his body. This is why we monitor everything we can electronically.’

Dan Taylor nodded and helped his wife to her feet. He kept his arm round her shoulders as they followed the doctor to a small room with a large viewing window into the Intensive Care suite. He gave her a squeeze as they looked at their son lying motionless and unaware while the ventilator clicked and hissed and the monitors beeped their messages. Green spikes chased each other across an oscilloscope, encouraging Dan to think positive thoughts. He’d seen enough TV medical dramas to know that spikes were good. Flat lines were not.

‘I want to hold his hand,’ murmured Marion.

Dan Taylor looked at the doctor who shook his head apologetically. ‘It’s for Keith’s own good that we keep everyone outside right now. We don’t want him having to cope with any more infection.’

‘When will you get the lab results, Doctor?’

‘We should start getting the first within the hour.’

‘We’ll wait… Can we stay here?’

‘Of course. I’ll get you a couple of chairs.’

Dan and Marion sat, holding hands in silent vigil, on moulded plastic chairs for at least thirty minutes before either spoke. Marion said, ‘Look at the skin on his face… It looks… strange.’

‘I suppose it’s the infection, love,’ said Dan, but he saw what she meant. The skin on what they could see of Keith’s face behind the mask and tubes seemed to have an unhealthy pallor.

The doctor returned with a clipboard in his hand. ‘Good news and bad news I’m afraid.’

‘For God’s sake, tell us the good,’ said Marion as if approaching the end of her tether.

‘There’s no suggestion that the leukaemia has returned and we’ve ruled out meningitis which was a major concern at the outset.’

‘And the bad?’ asked Dan.

‘We still don’t know what’s causing the infection. The lab has drawn a blank so far but let me say quickly that that’s just from examination of direct specimens. The chances are that they’ll have a much better idea in the morning when the overnight cultures have grown up.’

‘Sorry?’

‘Sometimes there are too few bacteria to find when we look at samples directly under the microscope,’ explained Tidyman. ‘So we spread them on artificial culture media and leave the bugs to grow and divide overnight in an incubator.’

‘So we wait,’ said Dan with a sigh in his voice.

‘I’m afraid so,’ said Tidyman sympathetically.

‘Doctor, have you seen his skin?’ asked Marion.

Tidyman took a deep breath as if contemplating a question he’d rather not have had put to him. ‘Yes,’ he said. ‘It’s giving us cause for concern and the nurses have been asked to keep an eye on the problem. It’s probably just some kind of reaction to the infection but they’ll apply moisturiser at intervals throughout the night… I know the suggestion won’t be welcome but there really is nothing you can do here. Why don’t you both go home and try to get some rest. We’ll call you if there’s any change and be assured, our nurses will take great care of your son.’

‘Thank you, Doctor,’ said Dan, ‘I think we will.’ He steered Marion towards the door. ‘Mind and call us if anything changes?… We won’t be sleeping.’

Dan and Marion were back at hospital before nine next morning leaving a sleepless night behind them and half-eaten sandwiches and half-drunk cups of tea all over the house. It had seemed that making tea and sandwiches for each other was therapeutic but eating and drinking them wasn’t. They were met by a new doctor when they got to the IC suite.

‘You’ve just missed Dr Tidyman; he’s just gone off duty. I’m Dr Merry.’

Dan looked at the slip of a girl in front of him with Dr Jane Merry on her name badge, dark hair tied back with a lilac ribbon, tight matching sweater emphasising young breasts and a pencil slim skirt and dark stockings worn in deference to the notion of power dressing. Christ, thought Dan, she looks fourteen years old. Her gaze and confident voice however assured him that she wasn’t. ‘How is he this morning, Doctor?’ he asked.

‘Not much change I’m afraid. We’re expecting the lab culture reports within the next thirty minutes,’ she said. ‘Why don’t you both go along to the machine and grab some coffee and I’ll come and find you. I’m sure you didn’t get much sleep last night.’

Marion warmed to the solicitous comment and smiled. ‘Thank you, Doctor, C’mon Dan. Let’s do that.’

They were on their second coffee, sitting by the machine, when Dan saw the young doctor coming towards them. There was something in her walk that suggested immediately to him that all was not well — that and the fact that she wasn’t alone.

‘Hello again,’ said Jane Merry. ‘This is Dr Trevor Sands, my boss,’ she said with a weak attempt at humour. ‘We’ve got the lab results. Dr Sands thought we’d be more comfortable in his office.’

Dan and Marion nodded to Sands and got up to follow the other two without comment although alarm bells were ringing in their heads.

At least, he looks like a doctor, thought Dan, appraising the middle-aged man across the desk from them who was smartly dressed and wearing a college tie. He also found the wedding ring, short conventional haircut, and golf club calendar on the desk reassuring. ‘Any further forward, Doctor?’

Sands folded his hands on the desk in front of him and said, ‘I’m afraid the lab has failed to find the cause of your son’s infection. Their tests for bacteria and viruses have all proved negative… so far.’

‘But how can that be?’ protested Dan. ‘If he’s clearly got an infection how come the lab says he hasn’t?’

‘I have to say it comes as a bit of a surprise to us too,’ said Sands. ‘We felt sure that they’d find the cause if for no other reason than because the infection is at an advanced stage and has spread throughout Keith’s body. But, having said that, there’s still time for them to come up with the answer. Some bugs take a longer time to grow up in culture than others.’

‘And in the meantime?’ said Dan, a hint of exasperation creeping into his voice.

Sands made a defensive gesture with the palm of his hand and said, ‘Rest assured it’s not a case of us doing nothing until we hear back from the lab. Your son is being given a course of broad spectrum antibiotics as we speak.’ He saw the blank look on Dan’s and Marion’s faces and added, ‘Broad spectrum in the sense that these antibiotics are capable of killing a wide range of bacteria. There’s a good chance that one of them will be the culprit causing Keith’s infection.’

‘So we wait.’

‘There’s nothing else for it, I’m afraid. I promise you we’ll call you if there’s any change in your son’s condition.’

Dan and Marion got up to leave. ‘Could I just see him once more before we go?’ asked Marion.

Dan and Marion stood looking through the viewing window with Jane Merry standing between them. ‘His skin,’ said Marion. ‘It’s getting worse.’

‘I’ll mention it to the nurses again,’ said Jane Merry.

Night Nurse Evelyn Holmes glanced up at the clock and saw that it was time to sponge down Keith Taylor. She had all the other information about his condition on the monitors in front of her on the desk nicknamed ‘The Enterprise’ by the staff due to its similarity to the flight deck of the famous starship. Sponging a patient’s skin and applying lanolin required the human touch.

‘There we are, my lovely,’ she cooed as she gently cleaned the skin of her unconscious patient, thinking to herself that Keith Taylor was round about the same age as her eldest boy who, at three in the morning, would be sound asleep in his bedroom and completely oblivious of the fight that her charge, Keith Taylor, was engaged in.

‘You are in a bit of a mess… aren’t you,’ she whispered as she patted Keith’s neck and face dry before starting to apply the cream. ‘But you’re young… you can fight this thing… In a few months’ time… you won’t even remember any of this… Oh, Jesus Christ!’

The nurse recoiled in horror and felt her blood run cold as part of Keith Taylor’s cheek started to come away in her hand as she applied the cream. One minute she was making gentle circling motions with the tips of her gloved fingers, the next a hollow furrow had opened up under Keith Taylor’s left eye and blood welled up in the trough as the skin gave way and a portion of flesh doubled over to hang limply on Keith’s lower cheek like some giant, hellish, teardrop.

Trevor Sands, called from his bed by an anxious duty doctor, had lost all semblance of urbanity. Sweat was trickling down his nose as he listened to Evelyn Holmes’ account of what had happened while he examined Keith Taylor for himself. ‘Ye gods, his skin is like tissue paper,’ he complained as his gloved hands probed gently. He took the bridge of Keith’s nose between his thumb and left forefinger while he tried to restore the loose flap of flesh to its rightful place but felt a hollow appear in his stomach when he felt movement between his fingertips.

‘Something wrong?’ asked the duty doctor.

Sands looked at him, his eyes filled with disbelief. ‘The bridge of his nose… it’s collapsed…’

Evelyn Holmes put her gloved hands to her mouth. She was unable to stop herself from saying, ‘He’s falling to bits.’

The corner of Keith’s mouth was next to go causing the ventilator tube to hang at a crazy angle and deepening the living nightmare of all those around him. No one wanted to touch the patient so it was left to Sands, as the senior medic present, to try to reposition the tube but what he feared might happen did happen as Keith Taylor’s insides proved as fragile as the rest of him and his trachea collapsed. ‘It’s hopeless,’ he said.

Keith Taylor died shortly after 4 a.m., before his parents could be summoned. Sands was waiting for them when they did arrive and invited them into his office. ‘I’m so sorry,’ he said. ‘I’m afraid it was all very sudden. It took us completely by surprise.’

Dan Taylor looked at the man sitting behind the desk and thought how different he looked from the last time he’d seen him. This man was wearing a sweat-stained T-shirt and needed a shave. He was wringing his hands in front of him as he spoke. Taylor closed his eyes as Sands said, ‘We did everything we could.’ He’d somehow known the man was going to say that and it left him cold. ‘What happened?’ he asked in a voice he scarcely recognised himself.

‘We won’t know for sure until…’ Sands paused as he realised he was about to mention the post mortem that would have to take place and changed his mind. This wasn’t the time… ‘We don’t have all the lab results back yet but it now seems pretty certain at this stage that your son died of something we call necrotising fasciitis.’

Marion Taylor looked blankly over the top of the wad of tissues she held to her mouth, Dan shook his head slightly.

‘The papers often refer to it as the flesh-eating bug,’ said Sands, letting his voice fall to a whisper in deference to the images he knew he was conjuring up and causing Dan to close his eyes again.

‘And what causes that?’ asked Dan, clearing his throat and trying to sound controlled when, in reality, his heart was breaking.

‘It’s a rare condition, usually caused by a bacterium called streptococcus,’ said Sands. ‘It’s a strange bug because it can cause so many different conditions, ranging from sore throats to scarlet fever and unfortunately, on rare occasions, to necrotising fasciitis. We really don’t know why its behaviour can change so dramatically. But other bugs can also cause the condition, staphylococcus, clostridium, vibrio and a number of others. We’re not at all sure what triggers it off.’

‘And these drugs you were giving Keith…?’

‘In theory, they should have dealt with streptococcus, and I would have thought most of the others,’ said Sands. ‘But obviously, on this occasion, they didn’t. Hopefully the lab will be able to tell us why not.’

‘I want to see my son,’ said Marion Taylor in an unexpectedly firm voice.

Sands moved uncomfortably in his chair. ‘Mrs Taylor… I really don’t think that’s a good idea…’

‘I want to see him.’

Sands looked to Dan Taylor for support before saying, ‘Keith underwent a great deal of trauma before he died although I can assure you he felt no pain. He never regained consciousness. I honestly think it would be better if you just remembered Keith the way he was.’

Dan Taylor got up and put his arms round his wife while maintaining eye contact with Sands. ‘The doctor’s right, love. Let’s just remember our lad the way he was, not as the victim of some…’ He searched for inspiration. ‘Bastard disease.’

The words ‘flesh-eating’ were still going round and round inside his head. He was praying that Marion wouldn’t stick to her guns. She looked up at him and finally acquiesced with a small nod.

‘Bloody bizarre,’ muttered pathologist Simon Monkton. ‘How come the lab can’t grow anything when he’s absolutely riddled?’

‘I think they’re quite embarrassed about that too,’ replied Sands, who had chosen to be present at the post mortem on Keith Taylor. ‘I spoke to the consultant bacteriologist earlier. He was very apologetic.’

Monkton gave Sands a look that suggested apologies were less than useful.

‘You are sure it was necrotising fasciitis?’ asked Sands.

‘What else could it be?’ replied Monkton. ‘It’s practically eaten the poor kid alive.’

‘So that’s what you will be putting down as cause of death on the death certificate?’

Monkton paused in what he was doing and looked at Sands over his half-moon specs. ‘Of course. Why do you ask?’

‘The boy’s GP told me that Keith Taylor was part of a monitoring study being carried out by the Department of Health. He is obliged to inform them immediately about any health issues that crop up.’

‘Health issues?’ snorted Monkton. ‘I suppose you could say dying of necrotising fasciitis was a health issue that cropped up… poor kid. I take it you are absolutely sure he wasn’t taking any antibiotics when he became ill?’

‘That was the first thing I thought of when the lab failed to grow anything from his specimens but his GP and his family assure me that he was taking nothing apart from his usual immuno-suppressant drugs.’

‘Ironically, I suppose that’s probably why the infection ripped through him so fast,’ said Monkton. ‘The drugs would severely compromise his natural defences. I take it the suppressants were stopped as soon as he was admitted?’

‘Of course.’

‘Well, that’s it then,’ said Monkton, stripping off his gloves and dropping them in a pedal bin he opened with his foot. ‘When God throws a curve ball… you’re out.’

‘His parents are coming in later to be told the findings of the PM.’

‘Something no parents should ever have to do,’ said Monkton. ‘I don’t envy you dealing with the living.’

‘Horses for courses,’ said Sands. ‘I can’t say I envy you your job either.’ He was looking down at the open cadaver of Keith Taylor.