Sick to Death

by Douglas Clark

  ‘Yes.’

  ‘Because she injected herself with useless insulin?’

  ‘That is my belief.’

  ‘Even though these comas are slow to start?’

  ‘That’s the only thing that puzzles me. Why she didn’t get help while she was still capable of doing so.’

  ‘Even though she was sick? She vomited, you know.’

  ‘She would. That’s one of the symptoms. It’s caused by the accumulated poisons of excessive fat metabolism. They urinate a lot and they vomit. This dehydrates them. The body loses all its fluid. As much as ten or fifteen pints. With the fluid go the basic minerals. As a result, their circulation collapses, their pulse becomes feeble and god knows what else. They look like Belsen inmates and they are in immediate danger of death. Insulin alone won’t save them then. They’ve got to have the fluid they’ve lost put back straight away. And even when that’s done they can die from shock and heart failure. If there’s nobody to help them …’ He didn’t complete his sentence. The thought of Sally Bowker, ill and helpless, seemed to affect him more than Masters expected a doctor to be affected by the death of a patient. Without regarding doctors as in any way callous—any more than he was himself—he was of the opinion that they encountered death so often it inevitably began to have less effect on them as time went by—again, just like himself.

  ‘When did you last see her—before her death?’ he asked.

  ‘On Saturday morning. I like to reserve that surgery for permanent patients. Patients who have to come and see me at intervals for long periods or, as in the case of diabetics, for the rest of their lives.’

  ‘You examined her?’

  ‘Thoroughly. They bring charts of their urine tests, you know. I looked at Sally’s record pretty carefully, and tested the sample she brought. I do that. Just to make sure they’re not backsliding or making mistakes with their own tests. And I gave her an overhaul. Examined her feet pretty carefully …’

  ‘Why her feet?’

  ‘Because the extremities are a diabetic’s most vulnerable spot. Any cut or abrasion on the feet is liable to go wrong. I’ll not go into the medical reasons, but take my word for it, gangrene can set in very easily because their feet are poor healers.’

  ‘Are you in a position—ethically—to tell us the result of your examination?’ Masters asked.

  Sisson turned towards him. He said gruffly, ‘To hell with ethics in this case. Sally Bowker was one hundred per cent fit. Not a snuffle in her nose or chest. Not a flutter of her heart. One hundred per cent fit. That’s why, when she died in a coma shortly afterwards, I was suspicious. Insulin comas take time to come on—maybe up to forty-eight hours—as I’ve told you. If she’d been starting one that would render her helpless by Saturday night, I’d have spotted some of the symptoms twelve hours before.’

  ‘You’re sure?’

  Sisson glowered. ‘Of course I’m sure.’

  ‘Please don’t misunderstand me. I’m not doubting the thoroughness and skill of your examination. I’m wanting to establish without doubt that a coma which could knock a girl out by midnight would be showing some signs during the morning before. The first signs couldn’t have appeared, say, in the middle of the afternoon?’

  ‘Not a chance.’

  ‘Alternatively, could the coma have come on later than Saturday night?’

  ‘It could. But I’ll take my oath it didn’t.’

  ‘What makes you so sure?’

  ‘Lots of reasons. First of all, the body takes a long time to die, and Sally had been dead at least twenty-four hours when I saw her on Monday evening. That means she’d died no later than Sunday evening. A coma such as this doesn’t kill even the old and decrepit in a flash. If she became comatose by midnight on Saturday, it means that she was lying there less than twenty hours. A girl as fit and well as Sally would take at least that time to die.’

  ‘That sounds convincing.’

  ‘But there’s something else which makes me sure this coma came on fast. Sally was a very sensible, practical girl. She knew what the symptoms of coma were and how to combat them.’

  ‘Had you taught her?’

  ‘Thoroughly. She knew that at the first signs she was to take more insulin. This she had done. The dose taken from the bottle shows that.’

  ‘Does it? How?’

  Sisson accepted a cigarette from Green and sat back thinking for a moment. Masters watched him carefully. At last the doctor said, ‘Let’s go through my reasons from the beginning. Sally was on long-acting insulin. That means she only had to inject twice a day.’

  ‘At twelve-hour intervals?’

  ‘Not necessarily. Actually the times of injections are governed by the times of main meals. To get ready to counteract the food that the body is about to get, you need to inject about half an hour before the meal. So I’d given Sally a programme which meant an injection half an hour before breakfast and half an hour before supper.’

  ‘She ate breakfast?’ asked Green. ‘Not just a glass of orange juice?’

  ‘She ate hearty.’

  ‘Was she allowed to?’

  Sisson grinned. ‘These juvenile diabetics are put on a diet like everybody else. But because they’re so active they need more food, so as long as they don’t go too far over the score, they’re not restricted nearly as much as most people think. Certainly the first rule for diabetics is “Never go hungry”.’

  ‘I see. The little weighing-scales are completely out of fashion.’

  ‘Gone years ago. You can adjust insulin intake these days fairly easily to make up for minor indiscretions. It’s a good thing to take great care, of course, but the thought that they’re not in an absolute strait-jacket helps them mentally.’

  ‘I can understand that. But now to get back to Sally Bowker …’

  ‘Oh, yes. When she came to me on Saturday she’d already had her morning injection, and she told me she’d got just enough left for her before-supper dose. That was how it should be. I prescribed just enough to carry her through to the day of our next appointment.’

  ‘Isn’t that a bit risky?’

  ‘Not at all. She could always call at any time if the need arose. But I like to give them just what they need each time. Then they can get a nice, fresh supply for the next four weeks.’

  Masters tapped out his pipe on the palm of one hand and dropped the ash into the tray. ‘So you gave her a new prescription which we know she took to the chemist that morning. At seven in the evening—or just before supper time—she’d have taken the last dose of the old stock. The new should have been started at breakfast time on Sunday. Right?’

  ‘Quite right. But I’m positive that having died on Sunday evening, she could not possibly have been in a fit state to inject herself on Sunday morning. I’m positive that the latest time she would have been able to do this would have been midnight Saturday.’

  ‘I’ll accept that for the moment. Now can you explain why she didn’t get help.’

  Sisson leaned forward. ‘I’m certain she was taken by surprise. She must have suddenly become aware that the coma was on her. She acted quite properly in giving herself another dose of insulin. Thinking that would work she probably didn’t call anybody and then, by the time she realized the injection wasn’t going to reverse the symptoms, she was probably too ill to phone. State of collapse, I’d have thought. Flaked out on the bed and never came round.’

  ‘Then how do you account for her going to the lavatory to vomit, and clearing up afterwards?’

  ‘That was probably the first symptom. And you know yourself that if you have a good clear-out, you feel better, if only momentarily. At least until the next wave comes. You probably feel so much better you can pull the chain, clean your teeth … all sorts of things. Then you’re sick again. And so on. Until, as I see it in Sally’s case, you lie down virtually exhausted, waiting for recovery. Instead you become comatose.’

  Masters got to his feet. ‘Thank you, doctor. If nothing else you’ve g
iven us a basis for working on.’

  Sisson stood up and said, in a rather embarrassed tone, ‘I’m glad. I want to help.’

  ‘Because she was your patient?’

  ‘Yes.’ It was a snapped answer. Slightly too brusque.

  ‘Nothing more?’

  ‘How d’you mean?’

  ‘She was an extremely personable young woman.’

  Sisson reddened under his tan. ‘You’re not suggesting …’

  ‘I’m suggesting nothing. But I thought you did.’

  Sisson stared at him for a moment, and then said: ‘O.K. You might as well know. I thought she was everything a girl should be.’ Then he changed his tone. ‘But that doesn’t mean I ever …’

  ‘Of course not. I realize you would respect her too much ever to give her a hint of your feelings. But just off the record, had you hopes?’

  Sisson toed the carpet, uncomfortably. ‘You’re a nosey bastard, but yes, I suppose I had. After she’d been diagnosed as diabetic. I thought that there might be just a chance …’

  ‘Of Dent throwing her over?’

  ‘Not really. Brian wouldn’t dream of it. But he’s a bit under his parents’ thumb, and his mother’s a protecting old hen who wouldn’t want her boy tied up to an invalid. She was heard to use those very words. So I thought perhaps Brian might yield to pressure. And if he had!’

  Masters smiled. ‘I know.’

  Sisson said, a bit shamefacedly, ‘Well, I could have given her expert care.’

  ‘And more, I’ve no doubt. Thank you very much indeed. I expect we shall meet again. In fact, can I come running if I find something I don’t understand?’

  Sisson held out his hand. ‘It’ll be a pleasure. I’ll confess I wasn’t very keen on meeting you tonight. I thought you’d just ask a lot of tomfool questions I couldn’t answer—like the local lot. God, how they floundered! But you arrived and asked for information and advice. Your attitude was a revelation to me, I can tell you.’

  ‘That’s the way we work, doctor,’ Green said. ‘I’ve been telling Chief Inspector Masters all day that we were going to be up the creek unless we got our bearings about diabetes. So our very first job was to look up the expert and consult him.’

  Sisson grinned at Masters. Neither said anything. Green shook hands and the doctor showed them out.

  By now it was dark. A warm, soft darkness that felt pleasant after the heat of the day. Masters started to stroll slowly. ‘Come on. Step lively,’ Green said. ‘We’ve only got about ten minutes before the bar closes.’

  ‘We’re resident.’

  ‘Maybe we are, but they won’t send draught Worthington up to rooms. Only bottles.’

  Masters increased his pace. They reached the hotel in silence.

  They took the first drink quickly so as to get a refill before time was called. ‘Did you get all that the doc gabbled about?’ Green asked Masters.

  ‘I think so. Didn’t you?’

  ‘Oh I got it. I expect I could almost repeat it word for word.’

  ‘I expect you could.’ Green’s memory was phenomenally good.

  ‘But I’m just a bit puzzled by it.’

  ‘Sleep on it. It’ll sort itself out.’

  ‘Maybe. But it’s given us some leads hasn’t it?’

  ‘Such as?’

  ‘Why wasn’t she missed before Monday evening?’

  ‘That’s a good point. And tomorrow, being Saturday, we should be able to find out.’

  ‘You’ve got a plan?’

  ‘I’d like you to take on her two partners. I propose to see Dent. If you want Brant with you, take him. But if not, he and Hill can go over the block of flats where she lived …’

  ‘Wye House?’

  ‘That’s right. We might pick up a few reports from somebody who saw or heard her on Saturday night.’

  ‘I’ll go alone.’

  ‘Right. Brant can take you in the car before he starts on Wye House.’

  ‘That’s the lot?’

  ‘Not by any means. I want a word with Sisson’s receptionist and Dent’s parents. And I’ve no doubt a few others might occur to us before we’re through.’

  Green picked up his beer and drank deeply. He said, inconsequentially, ‘I wonder if diabetics are allowed to drink beer? If not, in spite of doctors saying they can lead normal lives, they’re missing one of God’s better inventions.’

  Masters put his empty tankard down. ‘We can discuss that tomorrow, too. I’m for bed now.’

  ‘Me, too.’

  3 |

  At breakfast time the next morning Green asked for sausage, bacon, eggs, tomatoes and sauté potatoes. ‘Don’t stint yourself,’ Hill said. ‘Have a few kidneys as well.’

  Green, who had appeared in a pale grey Palm Beach suit said, ‘I’m never going to eat offal again. I’ve been hearing things I don’t like.’

  ‘I’ve never seen that suit before,’ Brant said. ‘Where’ve you been keeping it?’

  ‘The government paid for it. Remember when I was sent out to Cyprus? Had to have something to wear in all that sunshine in the Med. This is it. I was fitted three times for it.’

  Masters was reading the Telegraph as he ate. Green didn’t enlighten the others that it was Masters who had suggested to the A.C. that the suit should be paid for out of public funds, had helped Green choose the material and had bullied his own tailor into doing a rush job for his subordinate. Green could never have done this for himself, but would never acknowledge the fact. Masters appeared to be paying no attention now. He was dressed in light grey himself—a check bookie suit, cut hacking-style and built to suit his huge figure. He smiled inwardly at what appeared to him a naive conversation: astute enough to realize that Green was slightly embarrassed at wearing this particular suit, because it was different in colour, weight and cut from his usual reach-me-downs, but ideal for the present heat-wave. He also realized that in his oblique way, by stating he had not paid for it himself, Green was acknowledging the help he had been given.

  When his plate was set before him, Green rubbed his hands in anticipation before beginning to eat. Masters lowered his paper, poured himself another cup of coffee, and said, ‘Seeing you enjoy yourself over that little lot reminds me of something you said last night.’

  ‘Wha’?’ Green said, with his mouth full.

  ‘About beer. Can diabetics take beer? We don’t know much about what they can and can’t eat. I was thinking about it before I went to sleep.’

  ‘I might have known you’d have some beer in your bonnet.’ Green laughed at his own joke. Getting no response from the others, he went on: ‘Everybody knows diabetics have to be bloody careful about what they eat and how much.’

  ‘Do they? Sisson last night said a diabetic should never go hungry. Probably they’re not allowed to tuck in, like you, to their hearts’ content, but exactly what can they eat?’

  ‘No sticking in till they stick out, but if they can never see green cheese but their een reels, then they’re allowed to have a bit. That what you mean?’

  ‘Something of the sort.’

  ‘How will it help us if we know?’

  ‘Just an idea I had.’

  ‘In other words you’re not talking.’

  ‘I can’t explain unformed theories.’

  Green sneered, ‘Theories!’ and got on with his breakfast.

  ‘We went for a jaunt round the town last night,’ Hill said.

  ‘And?’

  ‘We stopped and looked in a chemist’s window. They’ve got a series of little books on every disease there is. Things like bronchitis, arthritis, migraine and so on. For people who suffer from them to buy so they can understand what their complaint is all about and to cope with it. There’s a diabetic book among them. If it’s for use by the patients themselves it’s bound to have instructions on diet, I’d have thought.’

  ‘Excellent,’ Masters said. He looked at his watch. ‘I don’t know what time the shops open here, but it must be any minute
now. Buzz off and get me a copy. And while you’re at it, have a word with the pharmacist. He might have other leaflets he can let you have.’

  Hill put his napkin on the table and got to his feet. ‘Can you give me half an hour?’

  ‘Until ten if you like.’

  Green wiped his mouth with an air of satisfaction. ‘D’you want me to wait?’ he asked.

  ‘No. That’s why I told Hill he could have until ten o’clock. Brant can drive you to Cheltenham while I’m waiting. If you’re too long in getting there they may be out for the day before you arrive.’

  ‘Going to see the other two girls?’ Brant asked. ‘Now I know why he’s got his snazzy suit on.’

  Green lit a Kensitas and flicked the match at the sergeant. ‘Come on, Po-face, wheel out that old crate of yours while I have another drink of tea. I’ll expect you at the front door in five minutes.’

  Masters was smoking his first pipe of the day at the door of the Bristol when Hill returned, carrying a small handful of booklets. ‘I’ve got quite a bit here,’ he said. ‘The chemist gets all sorts of reprints of papers sent to him. The manufacturers use them to advertise their goods—diabetic tests and foods and what-have-you.’

  ‘Lovely. We’ve got a bit of time before Brant gets back. I want the two of you to question the occupants of Wye House, but you can drop me at the doctor’s surgery on the way. Until we go, we’ll comb these booklets. I want to find information about diabetic diets in young adults.’

  They turned through the foyer of the hotel and out of a door at the back. Here the garden was provided with green-painted iron tables and slatted, folding chairs. The dew had gone, but the sun was not yet high enough to be unpleasantly warm. Hill, however, took his jacket off before getting down to work. Masters put his feet up and started looking through the first of the pamphlets.

  They read for some minutes in silence. Then Hill said, ‘There’s an advert here for beer.’

  ‘Diabetic beer?’

  ‘No. Carlsberg. It says, “A more than fair exchange. Don’t deny yourself a glass of Carlsberg, but do remember that it has to be used by exchange as the carbohydrate content is not negligible.” What does “by exchange” mean?’