Wildcard

EIGHTEEN

He was relieved to have put the constraints of so-called logic behind him. The real question he should be asking was: what was wrong with the heart valves those patients had been given? A few moments’ consideration told him that there was only one way to find out for sure. He’d have to recover one of the transplanted valves from a wildcard victim and subject it to a whole range of tests.

This was going to be not only risky — a post mortem on a filovirus victim was a dangerous procedure — but difficult, because filovirus victims were cremated as soon as possible. He would have to move fast. He called Sci-Med back, asked them about the current condition of the wildcard patients, and told them why he wanted to know.

‘All dead and burned except two,’ said the duty officer.

‘How come the exceptions?’ Steven asked.

‘One’s a success story; it looks as if she might be one of the few who’ll recover.’

Steven closed his eyes for a moment and wished it could have been Caroline. He forced the thought from his mind.

‘The other one’s the nun, Sister Mary Xavier. She wasn’t cremated.’

‘What?’ exclaimed Steven.

‘They came up with a special dispensation for her — apparently, her order has severe religious objections to cremation. Because of the special circumstances and because the convent’s so isolated, the sisters were allowed to bury her in the grounds.’

‘I didn’t realise they made concessions over something like a filovirus,’ said Steven acidly.

‘A local decision in Hull,’ said the duty man. ‘I think they had to comply with strict conditions: sealed body bag, lead-lined coffin and all that. It’s a possibility, don’t you think?’

‘A good one,’ agreed Steven. He thanked the man for his help and rang off, already deep in thought. Requesting the exhumation of Sister Mary Xavier would be certain to meet with a lot of opposition on the grounds of insensitivity, but the only alternative was to wait until another wildcard case got ill and died. That could take another week or two, maybe even longer, and he needed to examine one of the heart valves as soon as possible. He decided to put in the request and get Sci-Med to fix the permissions and paperwork. He would deal with the flak as and when it came.

There was one other thing he’d have to get Sci-Med to set in motion: a thorough examination of Greg Allan’s financial position at the time of his death. In particular, Steven wanted to know if any unaccounted-for sums of money had been paid into his account. If so, pressure must be put on Allan’s wife, to find out how much she knew about her husband’s alternative source of income.

By five in the evening, an exhumation order had been obtained, in the face of considerable opposition from the local council and senior representatives of the Roman Catholic Church, who saw it as sacrilege. The Church’s opposition was heightened even more when they learned that, rather than risk moving Mary Xavier’s body, the mobile containment facility used after the diagnosis of her illness would be put back and used for the post mortem and the recovery of her replacement heart valve. The only problem still unresolved was finding a pathologist willing to carry out the autopsy.

‘It’s proving difficult,’ said Macmillan.

‘All right, I’ll do it myself,’ said Steven.

‘But you’re not a pathologist.’

‘I don’t have to be,’ said Steven. ‘All that’s required is for someone to open up her body and recover the mitral valve. I’m a doctor and I’m perfectly capable of doing that. In fact it might be unfair to ask anyone else to do it in the circumstances.’

‘Well, if you’re sure…’ said Macmillan doubtfully.

‘I take it Porton will be willing to carry out a full analysis of the valve?’

‘No problem there. And the Swedish team will take responsibility for its safe transport.’

‘Then it’s settled,’ said Steven. ‘I’d better get up there.’

‘When will you do it?’

‘Tonight, if you can get the mobile unit back in position,’ replied Steven.

‘Will do,’ said Macmillan. ‘Oh, one other thing. The PM report on Greg Allan came in half an hour ago. Asphyxiation due to a ligature round his neck.’

‘Not the best way to die,’ said Steven. ‘He must have got the jump wrong.’

‘The police have talked to his wife. It wasn’t a good time to do it, but their opinion is that she doesn’t know anything about him being mixed up in anything illegal. She was aware of them having more money in the last year or so, but he told her that it was down to his shares performing well.’

‘His must have been the only ones,’ said Steven sourly.

‘Quite.’

Steven decided to make one more call before he left for Hull. He rang Fred Cummings and asked if he could spare a few minutes to talk.

‘Sure,’ said Cummings. ‘What can I do for you?’

‘I’m sure we’ve spoken about this before, but I have to ask you again. Is there no conceivable way that a virus can lie dormant for a time before causing infection?’

‘Not in the normal way of things,’ replied Cummings. ‘Viruses have to replicate in order to live. Take away their cellular host and they die.’

‘How about inside a cellular host?’ asked Steven.

‘You mean, lie dormant within cells without replicating?’

‘I suppose I do.’

‘There’s a state called lysogeny in bacteria,’ said Cummings thoughtfully. ‘Even bacteria have problems with viruses. Certain bacterial viruses can enter the bacterial cell and interpolate themselves into their host’s DNA. That way, when the bug’s DNA replicates normally the virus is replicated, too, but in a controlled way, so no harm’s done. Occasionally, when something out of the ordinary happens to stimulate the virus, it goes into uncontrolled replication and kills its host.’

‘That’s the sort of situation I’ve been looking for,’ said Steven. ‘What did you call it?’

‘Lysogeny,’ said Cummings. ‘But it happens only in bacteria and only with certain bacterial viruses.’

‘Maybe we’re about to learn something new,’ said Steven.

‘Come to think of it,’ said Cummings, ‘maybe a similar situation actually can exist in human beings.’

‘Go on,’ said Steven.

‘I was thinking about the Herpes simplex virus,’ said Cummings. ‘You know, the bug that gives you cold sores. It seems to lie dormant in the mucosa around your lips until something like sunlight or stress triggers it off. No one has ever satisfactorily explained that.’

‘Food for thought,’ said Steven.

Steven drove up to Hull, suspecting in his heart of hearts that he had been too hasty in volunteering to carry out the pathology on Mary Xavier. Not for the first time, he reminded himself — albeit too late — that he wasn’t the single man with no responsibilities that he imagined himself to be when the bugle sounded. In reality, he was a single parent with a daughter’s welfare to consider. Jenny needed a live father, not a dead hero, but here he was once again courting danger and getting the buzz that he’d sought all his life. He was on his way to carry out a procedure that even experienced pathologists of many years’ standing might baulk at. ‘Oh, Jenny, love,’ he muttered to himself. ‘You’ve got an idiot for a father.’

Pulling out now was not an option, though, so he’d do the next best thing and think through the dangers ahead in order to try to minimise them. In theory, it was simple; he just had to avoid coming into contact with the reservoir of filovirus particles that was Mary Xavier’s body. It was the minute size of the virus that constituted the real danger. The particles were invisible not only to the naked eye but to the 1000? probing of an ordinary light microscope; it would take the power of an electron-beam microscope to determine their presence. Their sheer lack of physical substance meant that they were barely subject to the constraints of gravity and friction, and therefore had little or no positional stability. Millions of them could be carried on a droplet of moisture so light that it would remain airborne for hours. The slightest movement in the air could send clouds of them scattering off in all directions.

The only comfort Steven could find was in the fact that knowledge of the enemy was perhaps the most effective defence against it. He understood just how deadly a filovirus could be; there was no way that he would ever underestimate it. He would be wearing full protective gear with hood, visor and respirator, and have everything checked thoroughly beforehand for leaks. He would double-glove and, as an extra precaution, would use a chain-mail gauntlet on his left hand to give him protection against accidental cuts arising from a knife or scalpel slipping.

In his mind’s eye, he went through the exact procedure he would use in the removal of Mary Xavier’s heart. First, the central incision to open up the chest cavity, then the rib resection to give access to the heart, the freeing of the heart itself from associated tissues, and finally the removal of the organ itself. He would place it in a steel dish, and rinse it through with clean, sterile saline before dissecting out the mitral valve with fresh instruments. He would seal the valve inside an airtight container for transport to the lab at Porton, and the job would be done. Easy peasy. If only he could convince his stomach of that.

Steven had gone through the pathology in his mind several times by the time he reached the convent. Parked outside it were two police cars, a mechanical digger and two transporters associated with the Swedish mobile lab, which he could see had already been re-erected. He got out and walked over to the group of men standing by the vehicles.

‘I’m Inspector Jordan,’ said one of the policemen. ‘Are you the pathologist?’

‘Yes,’ replied Steven. ‘Everything ready?’

‘The sisters have decided to show their disapproval by distancing themselves from the whole affair.’

‘Understandable, I suppose,’ said Steven. ‘Will that affect anything?’

‘Apart from no one getting a cup of tea, I don’t think so,’ said Jordan. He looked round the group. ‘It’s important we agree beforehand who does what, so I’ll run through the plan of action. Mr Frost here from the council will operate the digger to excavate the grave and expose the casket. Dr Laarsen and his colleagues will then be responsible for its actual removal, but of course they’ll have Mr Frost’s help with the digger to lift it out, in view of the weight of the leadlined casket. Dr Laarsen’s people will oversee the transport of the casket to the mobile lab, where Mr Grieve from the undertakers who’s an expert on the sealing of high-risk coffins will advise on the opening of the security lid. He will then retire and Dr Laarsen’s people will remove the body. Dr Dunbar will then take over and carry out the post-mortem examination. When he has completed his work we’ll go through the whole process in reverse. Everyone happy?’

‘Happy’ was perhaps the wrong word, thought Steven. In fact, it was definitely the wrong word; but he, like everyone else, nodded agreement.

‘Right then, Mr Frost, if you please.’

The digger started up and diesel fumes filled the night air as the little yellow machine started to trundle slowly on twin metal tracks towards the graveyard at the back of the convent, where arc lights illuminated screens erected round Sister Mary Xavier’s grave. One of Laarsen’s people was detailed to provide Steven with protective gear, which he donned outside the mobile lab while the others trooped solemnly off behind the digger like members of a cathedral choir on their way to Mass.

Although there was no sign of the nuns, Steven felt the eyes of the Reverend Mother on him as he crossed the graveyard to join the others behind the screens. It might be his imagination, but he had a strong sense of her standing there in the darkness behind one of the upper convent windows, the dark birthmark on her face providing unwitting camouflage as she silently deplored and condemned that which he had instigated. It was almost a relief to step behind the screens and be shielded from view.

The digger bucked and scraped at the earth as Frost manipulated twin levers in the cab like a TV-series puppet, the spastic movement of its small shovel building up a growing pile of earth at the side of the trench. Nerves jangled as, with a sudden change in sound, the blade struck the coffin lid. The digger’s work was done for the moment and its engine died away. Two of Laarsen’s people lowered themselves into the grave to clear away the remaining earth by hand and to loop lifting cables under the casket.

As the minutes passed, Laarsen leaned over the grave to ask his men what the hold-up was. One of them reported that he was having difficulty getting the cable at his end far enough under the casket to make sure that it didn’t slip.

‘How far in is it?’ asked Laarsen impatiently.

‘Ten centimetres, not more,’ replied the man.

‘That’ll do,’ said Laarsen. ‘Up you come.’

The two men clambered out of the grave and secured the top ends of the cables to the digger’s shovel.

‘As smoothly as you can please, Mr Frost,’ said Inspector Jordan, but there was no way that the hydraulics of the small digger would permit completely smooth movement. There was a sharp intake of breath all round when the casket was jerked off the bottom of the grave. ‘Steady, steady!’ cautioned Jordan as it rose slowly from the grave. ‘Let’s have some help here.’

He put his hands on the lid of the casket to minimise the swing as it cleared the lip of the grave, and Laarsen’s men stepped forward to provide stability at either end. ‘It’s clear,’ said Jordan.

The digger driver took this as his cue to start swinging the casket round with a view to lowering it to the ground beside the grave. Suddenly a jerk in the hydraulics made the cable at the less-secured end slip free, and the casket slipped out of the loop and crashed down on the leg of the man at that end. The snap of bones sounded clearly above the noise of the machinery; as did the scream that followed.

There followed an anxious few minutes, which must have seemed like hours to the injured man, while the cable was once more looped under the casket by nervous helpers. Their fingers turned to thumbs in their haste and unease at having to use the small space between the base of the coffin and the ground, created by its resting on the man’s broken limb. The cable was at last secured and the digger lifted the casket off the trapped leg. Steven tended to him and made him as comfortable as possible while they waited for the ambulance the inspector had called. He could not help but think that this was the last sort of thing any of them wanted at the start of an operation like this. It was going to put everyone on edge.

Laarsen was clearly upset and guilty about his error over the cable’s security. Jordan felt bad about being ultimately responsible for the whole mishap. The digger driver felt guilty about his handling of the controls, and everyone else felt bad by association. There was a general surge of relief when the ambulance arrived and removed the accusing presence of the injured man.

The casket was secured to the digger’s shovel and transported slowly over the ground at a height of only a few inches to the mobile lab, where it was manhandled with some difficulty into the facility. Steven decided not to involve himself in the opening of the casket and removal of the body. Instead, he used the time to walk up and down outside, calming himself and once again running through in his mind what he was going to do.

‘All yours,’ said Laarsen, emerging from the lab. ‘We’ve put her on the table but we didn’t take her out of the bag. Maybe you won’t want to do that, either?’

‘Maybe not,’ agreed Steven. There was no need to have the corpse totally exposed as if for full post-mortem examination. Exposing the chest area should be sufficient, and the less handling of a filovirus-infected body the better. Steven did up the seals on his suit and lowered his hood and visor. Laarsen himself checked him over thoroughly, giving his approval with a tap on the shoulder.

Steven entered the lab through the plastic-walled airlock and sealed himself inside. He was suddenly very aware of the silence. The digger’s engine had stopped and even the generator for the lights could not be heard in the inner compartment. Mary Xavier’s body lay in its sealed bag on the examination table.

Steven removed the seal over the zip and started to undo it. It stuck after the first inch and refused to budge. He cursed as he struggled with it, thinking that this might have been an ill-fated venture from the outset. He recognised the danger of such a negative train of thought and took a moment to compose himself before looking around for some mechanical assistance. He found a pair of Spencer Wells forceps and slipped them through the loop on the zip so that he could apply strong downward pressure with both hands. He managed to move the zip down a few more inches but it was a struggle; and so it continued until it was at last fully open. Inside his helmet his breathing sounded as though he was running a marathon.

Steven checked his gloves and cuffs yet again, making sure no cuts had arisen during the struggle with the zip, then donned the chain-mail gauntlet before opening the bag to expose the body. The weather had been cold so decomposition was minimal but the blue/grey skin was distended around the chest area, which started alarm bells ringing in his head. It was almost certainly due to an accumulation of body gases which had failed to dissipate. They would escape when he made the first incision, bringing with them a cloud of filovirus particles.

‘Shit,’ he murmured, wondering what to do. He could feel the pulse beating in his temples as he sought inspiration. He removed the chain-mail gauntlet and looked through the equipment cupboards. What he found there sparked off an idea of how to divert the gases. He rigged up a two-way plastic syringe to a length of clear plastic tubing, one end of which he immersed in a beaker full of Virkon disinfectant. He fitted a large-bore needle to the barrel of the syringe and checked all the joints. The plan was to insert the needle into Mary Xavier’s chest cavity and release the gas. It would flow through the tubing into the disinfectant, which would kill the virus but allow the gas to bubble to the surface.

There was a moment when Steven experienced for the first time in his life what he thought afterwards must have been stage fright. He found himself unable to do anything but stand there motionless for a few moments. He was imagining what would happen if the condition of Sister Mary’s skin turned out to be so bad that the needle had the same effect as on an inflated balloon.

The seconds passed until, calling on every reserve of courage he could muster, he pushed the needle into the grey skin. To his enormous relief, the puncture site held its integrity and the disinfectant in the beaker started to bubble violently as the escaping gas passed through it. For an awful moment he thought the beaker might up-end and spill over, allowing the gas to escape directly into the atmosphere, but, as he stared at the shuddering beaker, the flow lessened and eventually the bubbles stopped coming.

He removed the needle, put the chain-mail gauntlet back on and selected a suitable knife for the first incision. He murmured an apology to Sister Mary as he opened her up, and got on with the business of removing her heart without further incident. When he had dissected out the mitral valve and it was safely stored in the high-security container, he sewed up the chest incision with large stitches and sluiced disinfectant liberally over the area before re-zipping the bag. He had just as much trouble with the zip as before and was sweating with the effort before the seal was complete and he could wipe down the outside of the bag with yet more disinfectant. He placed all the instruments and equipment he had used in steel security containers for autoclave sterilisation later, and proceeded to sluice down the entire lab.

One of Laarsen’s men was waiting for him when he emerged from the lab, and he stood still while the man sprayed his suit with disinfectant. When he’d finished, Steven removed his hood and visor and took deep breaths of the night air. It didn’t matter that it was cold and damp. It tasted oh so sweet.

‘How did it go?’ asked Laarsen.

‘I got it,’ said Steven.

‘Can we put her back?’ asked Jordon.

Steven nodded and gave a simple, ‘Yes.’ He didn’t feel communicative. He was no longer running on adrenalin and all he could think about was writing to Jenny. He wanted to tell her that he was thinking about her and that he hoped she would have a lovely Christmas.