Wildcard

FIFTEEN

‘I thought I’d feel embarrassed, but I don’t,’ said Caroline as she dropped bread into the toaster.

‘Good,’ said Steven, wrapping his arms round her from behind and planting a kiss on the back of her neck. ‘Me neither.’

‘Must be that good old British wartime spirit you hear so much about,’ she said thoughtfully. ‘Normal rules of social engagement will be suspended for the duration of the hostilities.’

‘My regiment marches at dawn,’ said Steven.

‘Only this time the war has come to us.’

He kissed her hair but didn’t answer.

After breakfast he tried starting Caroline’s car but found that it had a flat battery. Having failed to persuade her to take the day off, he insisted that she take his car to get to St Jude’s. In the meantime, he would try to sort hers out.

‘Will I see you later?’ she asked.

‘If you want to.’

‘I’ll see you later, then.’

A neighbour who had noticed Steven trying to start Caroline’s car came out, still in his dressing gown, to volunteer the use of his battery charger. Steven was able to charge the dead unit and be mobile within half an hour. He stopped at a fast-fit service on the way over to the City General and had the battery checked. The technician declared it defunct — ‘Won’t hold a bloody charge, mate’ — so Steven bought a new one and had it installed.

When he eventually reached the hospital he found George Byars alone in his office, sitting in shirtsleeves, juggling with columns of figures. ‘It’s been a while,’ said Byars.

‘I felt there was a danger of too many cooks,’ said Steven. ‘I’ve been trying to focus on my own job for a bit.’

‘You weren’t entirely successful if what I hear from St Jude’s is correct.’

Steven shrugged and said, ‘Some things you just can’t walk away from.’

‘I’m glad you think that way,’ said Byars. ‘I sometimes wonder about certain members of my profession.’

Steven decided not to push him on the subject. Instead, he asked, ‘How are things at the sharp end?’

‘Sharper than we’d like. I sometimes think I’m standing on the bridge of the Titanic, feeling the temperature fall. We’ve got an enormous problem with a shortage of nurses and another over accommodation for the victims. Three churches and two schools have been pressed into use so far, and all of them are just about full. The next step will be to close the city’s secondary schools and bring them into the equation.’

‘Why secondary schools?’ asked Steven.

‘Times have changed,’ said Byars. ‘It’s the norm for both parents to go out to work these days. Suddenly dumping hundreds of young children back home would cause big social problems. Secondary-school kids are old enough to look after themselves till the folks come home.’

Steven nodded. ‘What about the nursing volunteers who were supposed to come?’ he asked.

‘Slowed to a trickle.’ Byars shrugged. ‘Can’t blame them. Watching people die without being able to do anything about it isn’t exactly glamorous or uplifting. Apart from that, we’ve lost two nurses to the virus.’

‘Two?’ exclaimed Steven.

‘It’s not common knowledge, like a lot of things in the city these days,’ said Byars.

‘Then you’re managing to keep things out of the press?’ asked Steven.

‘Someone is,’ corrected Byars. ‘Don’t ask me who, but I suspect government pressure’s being brought to bear.’

‘It certainly wouldn’t be an appeal to the hacks’ better nature,’ said Steven.

‘And you? Any progress?’

‘Let’s say I’m more optimistic than I was a few days ago, but there’s still a lot to work out. That’s really why I’m here. I need to talk to a cardiac surgeon — please don’t ask why. Can you help?’

Byars picked up the phone and dialled an internal extension. After a short conversation he replaced the receiver, said, ‘Our Mr Giles will be glad to give you all the help he can,’ and told Steven how to get to the cardio-thoracic unit.

Steven smiled and thanked him. He’d come to like and respect Byars over the past few weeks, and was relieved that the crisis-management team had recognised his abilities and kept him on as crisis co-ordinator.

At the cardio unit, Steven was met by a formidable-looking woman who introduced herself as Martin Giles’s secretary. ‘He’s expecting you,’ she said brusquely. ‘Go straight in.’

Steven’s immediate impression was that Giles looked more like a heavyweight boxer than a surgeon but when he spoke it was as an educated, articulate man. ‘How can I help?’ he asked, hunching muscular shoulders as he folded his arms on his desk. What neck he had seemed to disappear, making his head look like a cannonball perched on a castle wall.

‘I need to know something about modern heart surgery,’ said Steven. ‘What’s on offer and what you do exactly.’

‘Depends what the problem is,’ said Giles. ‘Anything from a couple of stitches in the right place to a complete heart-lung transplant.’

‘Sorry to be so vague,’ said Steven, ‘but I’ve got no idea how common heart surgery is these days or how many people benefit from it.’

‘Every cardiac unit in the country has a waiting list a mile long,’ said Giles. ‘Cardiac surgery has become commonplace.’

‘Supposing a man is referred to you with a history of rheumatic fever in childhood, and this has led to current heart problems. Talk me through it.’

‘That used to be very common,’ said Giles. ‘Rheumatic fever isn’t as prevalent as it used to be but it often resulted in a bacteraemia which in turn caused a build-up of bacteria on one or more of the heart valves with resultant stenosis. We would take a look at the problem with a range of options in mind. If the damage weren’t too bad we might attempt a physical repair to the damaged tissue — we’d stitch the damaged portions together if at all possible. If a valve was irreparably damaged, however, we’d have to consider replacing it, either with a mechanical valve — a plastic one — or a tissue one should one be available.’

‘Supposing the heart damage was age-related?’ asked Steven, remembering Frank McDougal’s medical records.

‘The same options would apply. Age defects are usually associated with the left side of the heart, the mitral and aortic valves, while infection usually affects the ones on the right, but either way we would repair or replace as appropriate, with repair being the preferred option.’

‘And you say this is quite common?’

‘I read recently in one of the journals that 225,000 heart-valve operations are performed every year in the developed world and 60,000 patients receive replacement valves.’

‘How about post-op problems?’

‘All surgery carries risks, of course, but heart-valve surgery has an excellent success rate. The vast majority of patients make a good recovery and generally feel like new people into the bargain.’

‘And the ones who don’t?’ asked Steven.

‘There’s always a slight risk of stroke, bleeding, infection, kidney failure and, on occasion, heart attack and death; but they’re the exceptions.’

‘Heart-surgery patients haven’t shown up as being susceptible to secondary illness in any way, have they?’ asked Steven cautiously.

‘Secondary illness?’ queried Giles.

‘Viral infections, that sort of thing.’

Giles said, ‘Not in my experience, although it may be true of transplant patients if they’re immuno-compromised because of the anti-rejection measures. I haven’t noticed increased susceptibility in valve-surgery cases and I haven’t heard that from anyone else in the business. We did have a major problem back in the eighties with mechanical failure of one make of replacement valve, the Bjork-Shiley CCHV, which was prone to fracture, but that model was withdrawn way back in 1986, if my memory serves me right.’

‘No, that’s not the sort of thing I was thinking of.’

‘Then I’m sorry, I can’t help,’ said Giles. ‘Valve replacement is one of the most satisfying and rewarding surgeries we perform in terms of improving the quality of patients’ lives.’

Steven nodded and got up to go. ‘Thanks for seeing me at such short notice,’ he said. ‘I appreciate it.’

‘Any time,’ said Giles.

Steven smiled and said, ‘I rather hoped you’d say that. I may have to call on you again.’

When he got back to his hotel, Steven called Sue in Dumfriesshire and told her that it was looking extremely unlikely that he would be able to be there for Christmas.

‘I half expected it,’ said Sue. ‘It sounds as though things are getting worse down there. I’ve been warning Jenny that those poor people may need to hang on to her daddy for a little bit longer.’

‘Thanks, Sue. How do you think she’ll take it?’

‘Your daughter is a remarkably mature young lady for her age. But if you aren’t going to make it, I think you should tell her yourself.’

‘Will do,’ said Steven. He had scarcely put down the phone when it rang. It was the duty officer at Sci-Med. ‘Dr Dunbar? Mr Macmillan would like you back in London at your earliest convenience’ — that being a euphemism for ‘now’.

Steven drove over to Caroline’s house and left her car outside with a note in it saying that he’d had to go to London. He hailed a cab and asked to be taken to the airport. He was in London four hours after receiving the call and in John Macmillan’s office at a quarter to five.

Macmillan smiled and said, ‘I underestimated you: I’d allowed another couple of hours. I’ve called a meeting for seven. Perhaps you’d like to…?’

Something about Macmillan’s demeanour suggested that Steven shouldn’t ask too many questions. He smiled and said that he’d be back for seven. He walked for a bit, enjoying the bustle of the early-evening crowds and the feel of Christmas in the air after the unnatural quiet of Manchester. He found a wine bar which was playing Christmas carols, and had a glass of Chardonnay. He’d have preferred a large gin but remaining alert for the meeting was a priority. Macmillan hadn’t said that Steven would be asked to report on his progress, or lack of it, but it seemed likely.

Back at Sci-Med he found Macmillan alone.

‘The meeting isn’t here,’ said Macmillan in response to his questioning look. ‘It’s in the Home Secretary’s office.’

When they got there Steven was surprised to find two other cabinet ministers in the room besides the Home Secretary himself, who looked a worried man. In all there were eight people present. Steven nodded to each in turn as they were introduced.

‘The truth is, we haven’t been quite frank with you, Dunbar,’ said Macmillan.

Steven remained impassive while he waited for Macmillan to continue, but his pulse rate rose.

‘In the past it’s always been Sci-Med’s policy to pass on every scrap of relevant information to our people as soon as it became available. In this instance, however, we’ve been forced to hold something back.’

‘Well, they say confession’s good for the soul,’ said Steven dryly.

‘The decision wasn’t taken lightly,’ said Macmillan. ‘It was taken at the very highest level and with the concurrence of the people present in this room. When Sister Mary Xavier caught the disease, a woman who had led a sheltered life in an enclosed order, it seemed to us that your search for a common linking factor could not possibly succeed. You don’t have to be an epidemiologist to see that there simply couldn’t be one. The implications of that conclusion were, of course, enormous: that our country is under attack from a lethal virus which can pop up anywhere and at any time, without the need for a continuous chain of infection.’

‘So what was it that you didn’t tell me?’ asked Steven.

‘We told you about Sister Mary but we didn’t tell you about the others. There have actually been fourteen new wildcard cases across the UK. All without a linking factor.’

Steven blanched at the figure.

‘Because of the medical authorities’ vigilance these people were quickly isolated, but if this is the tip of an iceberg we are facing national disaster on an unprecedented scale,’ said Macmillan.

‘And the steps we must take are draconian,’ said the Home Secretary. ‘We are on the verge of declaring a national state of emergency, with all that implies.’

‘Well, gentlemen, it seems to me that you’ve already made your minds up about the virus,’ said Steven.

‘We told you about Sister Mary because we thought you would investigate and reach the same conclusion before reporting back with your findings,’ said Macmillan. ‘That’s why I brought you here tonight. You do agree, I take it, that there is unlikely to be a traceable source of this virus?’

‘No, I don’t,’ said Steven, to the accompaniment of surprised looks around the room. ‘In fact, I think there is one.’

‘But the nun never left the convent.’

‘She did,’ said Steven. ‘She had heart surgery at a local hospital nine months ago.’

‘So she hasn’t been outside the convent in nine months,’ said a man from the British Medical Association testily. ‘Same difference as far as a viral infection is concerned.’

‘The other wildcards, at least the ones I was told about,’ said Steven with a glance at Macmillan, ‘had also had heart surgery recently.’

‘And you think this is relevant?’ asked the Home Secretary.

‘I don’t know exactly how at the moment, but yes, I do.’

The medical experts all travelled the road that Steven had travelled; they protested that there could be no logical connection between having heart surgery and falling victim to a deadly virus. Steven sat through it all patiently, nodding as people pointed out what he already knew about varying geographic locations, different hospitals and different surgeons, the operations having been performed at different times of the year and for different medical reasons.

‘It’s still a fact that all four had heart surgery,’ said Steven when the protests had died down. ‘And it’s the only thing they had in common.’

‘What d’you think, Macmillan?’ the Home Secretary asked.

‘In the circumstances, I think we should at least look at the medical history of the wildcards we didn’t inform Dr Dunbar about,’ said Macmillan.

‘So we delay bringing in the new emergency measures?’ asked the Home Secretary, looking to the others.

The meeting agreed with Macmillan, although with some reluctance since many still failed to see the relevance.

‘I don’t suppose anyone has done this already, by any chance?’ asked the Home Secretary.

‘As I understand it, the investigation of the patients’ backgrounds was confined to a period of forty-two days, that being twice the conceivable incubation time for such a virus,’ said the Health Secretary.

‘Very well, then, I will recommend to the PM that we delay declaring a national state of emergency for… how long?’

‘A week,’ suggested the hardest sceptics. Suggestions of two weeks and one of a month were whittled down to ten days.

‘What do you say, Dr Dunbar?’ asked the Home Secretary. ‘Can you come up with the source of this damned plague in ten days?’

‘I can but try,’ replied Steven.

‘Anything you need, from secretarial assistance to an aircraft carrier, you only have to ask.’

Steven’s first request when the meeting broke up was for food. He hadn’t eaten since breakfast and he planned to work through the night, using Sci-Med’s resources and computers to gather information about the undeclared wildcard cases. A small team of executive-grade civil servants was drafted in to help with fax and phone communications and by 9 p.m., when his Chinese takeaway arrived, the phone lines were buzzing.

He ate at a computer desk while setting up a new database to accommodate information on the new patients as it arrived. Macmillan came in and caught him with his mouth full. He just wanted to know if Steven had everything he needed and, when Steven nodded, said that there wasn’t much point in him hanging around. Steven agreed but sensed a reluctance in Macmillan to leave.

After an awkward pause, Macmillan cleared his throat and said, ‘I owe you an apology about the missing information. When it became apparent that a state of emergency might be declared, it was unanimously agreed that no further details about the crisis should leave these four walls. We just couldn’t risk it getting out and causing panic on the stock exchange and God knows where else.’

‘I understand,’ said Steven.

‘Call me if there’s any news.’

By midnight it was becoming clear that heart surgery was indeed the common factor. Nine of the fourteen wildcards had had heart surgery within the last year; information on the remaining five was still being sought. Steven called Caroline in Manchester to apologise for having had to rush away at such short notice and to tell her that he was finally making some progress, but there was no reply. He looked at his watch and hoped the reason was that she was fast asleep.

‘So what do we conclude?’ asked Macmillan when Steven phoned to tell him the news.

Steven took a deep breath and said, ‘I think we have to conclude that it was the surgery itself that gave them the virus.’

‘You mean they contracted a new filovirus as a post-operative infection?’ asked Macmillan incredulously.

‘Not in the conventional sense, but in a manner of speaking,’ replied Steven. ‘What we have to look for now is a common factor, something about the heart surgery that distinguishes these patients from the hundreds, if not thousands, of others who had heart surgery in the past year or so.’

By three in the morning Steven and the team had managed to obtain precise details of five of the operations, although they had had to deal with some pretty irascible people along the way at that time in the morning.

Steven rang Macmillan again as soon as he’d had time to appraise the information. He said, ‘It looks as if the common factor is going to be a prosthetic heart valve. So far, five patients have a record of having had replacement valves fitted. No cases of surgical repair so far.’

‘My God,’ said Macmillan. ‘Contaminated heart valves. Who would have believed it? You’ve done well.’

‘We’re not out of the woods yet,’ said Steven. ‘We still have to explain why there was a delay of many months before the infection took hold and how the valves came to be contaminated in the first place.’

‘And with a virus that no one’s ever come across before,’ added Macmillan.

‘Quite.’

‘Well, I’ll leave figuring that out in your capable hands,’ said Macmillan. ‘In the meantime, I’ll wake the PM with the news.’

Steven asked his team to put out immediate requests for the type and make of heart valve used in the surgery. In the meantime, details on three more patients came in: they, too, had had surgery to replace a damaged valve.

‘It’s looking good, folks,’ said Steven, accepting a mug of much-needed coffee from one of the civil servants. ‘We could be talking a champagne breakfast here.’

Shortly before first light the first fax sheet came in with technical details of the valve used in replacement surgery. A human-tissue valve had been used in the operation on Humphrey Barclay. It had been a pretty nigh perfect immunological match for him and anti-rejection measures had not been necessary. Steven swore bitterly under his breath.

At six-thirty, feeling thoroughly depressed, he called Macmillan and told him, ‘We’ve hit the wall. The first five results are in. They all had human-tissue valves fitted.’

‘But how can that be?’ asked Macmillan as if he were appealing to the gods for mercy.

‘I don’t know,’ confessed Steven.

‘One contaminated heart donor is a possibility, but there’s no way all those people could have received heart valves from the same person,’ said Macmillan.

‘My maths tells me that too,’ agreed Steven wearily. Tiredness was catching up with him.

‘Get some sleep. We’ll talk later.’