The Hunt and the Kill

by Holly Watt

  There was another knock at the door. This time a doctor, neat in his scrubs.

  ‘Good afternoon, Flora,’ he smiled. ‘How are you feeling today?’

  He took Flora’s temperature and blood pressure with quick precision. His eyes – both concerned and calm – met Casey’s over Flora’s shoulder.

  ‘I’m Casey,’ she spoke quietly, making herself forgettable out of habit.

  ‘A friend,’ Flora added hastily, unnecessarily. ‘This is Dr Noah Hart, Casey.’

  ‘Hello.’ Noah barely registered Casey, tapping notes into a handheld tablet. His mouth tensed slightly as he read one line. ‘The old abscessus isn’t responding exactly as we’d like, is it?’

  ‘No.’ Flora sounded almost apologetic.

  ‘Have you coughed up any more blood?’

  Flora’s eyes went to Casey. ‘A bit.’

  ‘I’ll go,’ Casey said quickly.

  ‘No.’ Flora shook her head. ‘Don’t.’

  As he pondered his notes, Noah sat down in the uncomfortable chair next to Flora’s bed, the grey plastic creaking cheaply.

  ‘Noah specialises in antibiotic resistance,’ Flora told Casey. ‘Antibiotic resistance is a constant problem for CF patients. And everyone else, really.’

  Noah looked at Flora’s visitor, and explained simply. ‘When you give a patient antibiotics, you knock out most of the bacteria, but sometimes not all of them. Some of the original bacteria may have been resistant to that specific antibiotic, and the moment you stop the antibiotic, they start growing again. Only this time, the new bacteria population are all resistant to that antibiotic. It’s why it’s – ah – problematic when people don’t finish a course of antibiotics. Effectively, they’re just giving the bacteria a bit of a workout, and then they bounce back stronger than ever, having learned some fun new tricks.’

  Casey was nodding, uncertainly.

  ‘So for me,’ Flora said briskly, ‘who takes antibiotics all the time, it can get quite complicated.’

  An understatement, Casey saw. Noah turned back to Flora, his pale face lit up by the utilitarian bedside lamp.

  ‘As you know, we’re treating you with amikacin and imipenem.’ Noah spoke the drug names with the fluency of familiarity. ‘But the Adsero antibiotic, zentetra, isn’t working quite as we’d like it to.’

  Casey pictured the nurse’s trolley. The white packets with the prosaic writing on the side. There was no need for a hard sell with this audience.

  ‘Adsero are bringing out a new antibiotic soon,’ Flora said, in an aside to Casey. ‘Hopefully. They’re doing a last round of tests. But it might be a breakthrough.’

  ‘It’s provisionally called saepio,’ Noah said to Casey. ‘And it’ll be at least a year.’ And they all knew: there might not be a year.

  ‘And it only might be a breakthrough,’ Flora filled the short pause. ‘Drug companies are always talking up miracle drugs that never actually appear.’

  Noah stared at a crack in the wall. ‘We can start you on a different drug regime, Flora,’ he said. ‘I think … ’

  The doctor fell into silence, his eyes hazing with calculations.

  Casey watched him. Noah looked as if he rarely went outside: black under the eyes and a hospital-grey face. His pale blond hair was thinning, fading to cream at the temples already, although he was only in his early thirties. Casey sensed a blaze of intelligence beneath the despondent face, a mind whipping through a thousand possibilities. There was a sadness about him, too, as if the ward’s melancholy had seeped into him over the years.

  ‘Casey’s a journalist,’ Flora spoke into the stillness. ‘Sorry,’ she added to Casey, ‘I didn’t want him not to know.’

  Noah flinched, his eyes went sharply to Casey’s face.

  ‘Casey Benedict from the Post,’ she said smoothly, equably. ‘I may write a short feature next week. Just about life with CF, what it’s actually like for patients. I should have talked to the comms team first, but … ’

  Casey shrugged. Noah hesitated, eyes flickering to the window, and then he shrugged too, deliberately mimicking her, and forcing himself to relax.

  Noah didn’t care about the comms team, Casey saw. Like many doctors, he’d seen too much to care about a middle manager’s tantrum over a few words to the press. On her first day as health correspondent, at a rickety A&E in Bassetlaw, Casey had watched the staff turn away – ostentatiously – from the professional smile of a junior minister. And heard the rude, half-muffled comments as they’d proceeded on a ward round. The politician had beamed widely for the cameras throughout, just the same.

  But Noah’s concern ran deeper, and was covered up more carefully.

  ‘Why did you first get interested in antibiotic resistance?’ Casey asked, making conversation, changing the tone.

  He looked straight at her. ‘Because it’s going to kill you.’

  3

  He tried to lighten the mood afterwards, joking with Flora, and forcing a wide smile.

  ‘Bacteria are a truly worthy enemy.’ He turned the grin on Casey. ‘We can talk off the record, if you want. Then you can check in with the press officers for proper quotes later.’

  That was normal; interviewees often spoke openly – rambling freely, umming and ahhing – and then agreed the actual words for print with the journalist later.

  ‘All off the record,’ Casey promised.

  ‘It’s a numbers game with bacteria, then.’ Noah’s enthusiasm was abruptly real. ‘It’s Darwinian selection at a million miles an hour. Evolution on a scale that you would never normally think about. You’ve got 7 billion people on the planet and you can have 7 billion bacteria in a few millilitres of liquid, and they’re all multiplying as fast as they possibly can. You can start using any antibiotic, and they will immediately try and find a way to overcome it.’

  ‘You make it sound great.’ Casey matched his smile.

  ‘It’s not,’ he said brightly. ‘But it is fascinating.’

  ‘So how do you win?’

  ‘You don’t,’ he said. ‘Whatever we invent, whatever we find, the bacteria will defeat it in the end. AMR – that’s antimicrobial resistance – is expected to kill an extra 10 million people a year by 2050 if we don’t work something out. That’s more than cancer. It’ll be Covid, but all the time.’ There was a zeal in his eyes, a glitter of fervour, and then his face changed, sharply. He turned to Flora. ‘Don’t worry, Flora, we’ll work something out.’

  He moved quickly, making for the door.

  ‘See you tomorrow, Noah,’ Flora called after him.

  ‘See you tomorrow,’ he echoed, closing the door.

  ‘That’s odd,’ Flora said, when the sound of footsteps had receded down the corridor. ‘He seemed quite stressed out.’

  ‘Sorry,’ said Casey. ‘I should have got permission to come here. It just all takes time.’

  ‘No, he wasn’t worried about that. It was something else.’ Flora coughed, reached for a box of tissues. ‘You get to know the doctors here pretty well over the years. Well, never mind.’

  Casey smiled at her. ‘So tell me, how did CF affect your time at university?’

  ‘I’m studying journalism.’ Flora smiled shyly. ‘And it’s tricky anyway, of course, breaking into that world … ’

  ‘You’ll love it,’ Casey grinned. ‘And journalism is the best fun in the world. Some of the time, anyway.’

  ‘How did you get into the Post?’

  ‘Oh,’ Casey stared at her notepad. ‘One day, I just realised I was meant to be working at the Post. That I had to be there. They didn’t see it quite like that though, unfortunately.’

  ‘So how did you get started?’

  ‘Um.’ Casey felt the laugh bubble up. ‘I got a job at a call centre.’

  ‘A call centre?’

  ‘It was during an election.’

  A call centre set up during a general election, where dozens of students on zero-hour contracts read from scripts hour after hour. Can I ask you h
ow you are planning to vote, madam? And then …

  Push polling dressed up as market research: illegal.

  Casey – a student then, barely undercover – got a job at the call centre, photographed the scripts and called the Post. A minor scandal, a slapped wrist.

  ‘Oh, yes,’ Flora nodded. ‘I remember.’

  ‘And after that, the Post offered me work experience.’

  ‘And?’

  ‘Basically, I never left.’

  ‘How did you manage that?’ Flora’s eyes were keen.

  ‘After the work experience was over,’ Casey started to laugh, ‘I just kept coming in. They told me I couldn’t because it was someone else’s turn, but I managed to get to my desk every single morning.’

  ‘How?’

  ‘Oh, you know. There was a service entrance out the back, and that guard liked croissants. And the lavatory windows weren’t guarded twenty-four hours a day. All the usual stuff.’

  They were both laughing now, at the ludicrousness of it all.

  Once, Casey had slept under one of the boardroom tables, because it was easier to stay overnight than find her way back past the guard the next morning. And when an Italian bridge collapsed in the middle of the night, Ross was delighted to see her trot towards the newsdesk at 3 a.m.

  ‘Get me a fucking coffee’ – a warm greeting by his standards.

  At 4 a.m., taking a breather, Ross had given her some career advice.

  ‘How would you feel about knocking on someone’s door twenty minutes after they’ve been told their eight-year-old’s been killed by a drunk driver?’

  ‘Not great, but I’d do it.’

  ‘In journalism, you can be told to fuck off twenty times in one day. That bother you?’

  ‘No.’

  ‘Good, then.’

  When the managing editor finally barred her from the Post, Casey doorstepped Ross outside his Balham home at 5.30 a.m.

  ‘Fuck off.’ He hurried through the grey morning, carrying his stack of newspapers.

  ‘No.’

  ‘Fuck off.’

  ‘I need a job, Ross.’

  ‘Fine, I’ll talk to the fucking editor.’

  ‘I can do that,’ Flora’s eyes were gleaming. ‘That’s what I’ll do.’

  ‘No,’ said Casey hastily. ‘I’ll organise some work experience for you.’

  ‘Oh, thank you,’ Flora glowed.

  They talked for another hour, Casey making careful notes until her phone shrilled. Ross: Siamese twins about to be born in Cardiff. Get on it. We’re behind already FFS.

  Looking up, Casey realised it had got dark. Saying goodbye to Flora, she stepped out into the empty corridor. No one loitered here, gossiping away the hours. As she pulled her phone out of her pocket, Casey’s attention was caught by a painting hanging opposite Flora’s room. It was a gaudy burst of colour in the relentless magnolia. Someone had sketched an old-fashioned map with the ward as a fantastic archipelago. In this illustration, Debbie and Tony and Lauren and Marcella were grass-green islands, separated by oceans of disease. The careful script named the Gulf of N.T.M., the P. Aeruginosa Strait, the B. Cepacia Sea, and a galleon bobbed so bravely. Blue sea monsters, evil eyes glowing, skulked between the islands.

  Casey glanced around for the way out of the ward. The exit signs were bright, simple, designed for people in distress. She typed out a message to Ed as she headed towards the ward exit. Sorry, darling, have to go to Cardiff for the night. Won’t be back for dinner.

  She looked up as someone came through the swing doors. It was Noah, brisk in his scrubs.

  ‘I’m just off,’ Casey explained.

  ‘There is a quicker way out, just down that corridor,’ he pointed. ‘They’ve mothballed a ward, but you can nip through and then it’s straight down the stairs to reception.’

  ‘Thanks,’ said Casey. ‘Goodbye, Noah.’

  ‘Goodbye.’

  He disappeared through another set of double doors. Casey sent her message, and with a last glance at the jaunty sea monsters, she headed off.

  The corridor floor was filthy, builders’ footprints traipsing to and fro. They must be in the middle of a refurbishment. Casey hurried down the narrow passageway, thinking about the intro for her cystic fibrosis story. She had been a good interviewee, Flora. Articulate and thoughtful and sympathetic. They weren’t all like that.

  As the words flitted around her mind, Casey pushed open the ward door. It was a long, dark room, a few beds shrouded in plastic dust sheets. Almost everything had been stripped out, apart from the curtains around the beds. They drooped, pale as ghosts. Electric wires hung from deep-gouged walls, and the side rooms were taped off.

  The muddy footprints led across the floor. Casey felt along the wall for a switch, but no light flickered into life.

  You can nip through and then it’s straight down the stairs to reception …

  Casey followed the footprints. There were double doors at the end of the ward, and she pushed them open into another long room, an orange glow oozing in through the windows. The curtains dangled, gallows-heavy. Casey hurried along.

  This ward ended in a dusty reception area. Left or right or straight on? Casey muttered aloud, trying to remember Noah’s words. She checked her watch. Come on. She chose right randomly, scurrying through another ward, around an abandoned nurse’s station.

  There were double doors at the end of this ward. Nearly there, this must be it. She pushed at the doors.

  They were locked.

  Casey tugged at the doors irritably. I’ll miss my train.

  But the doors were impervious.

  She scuffed the grimy floor with her toe, and spun around crossly. Now she would have to go all the way back to Flora’s ward, and follow the maze back out again.

  Just then, Casey felt the air shift very slightly. It was almost unnoticeable except for a plastic dust sheet shivering, the curtains whispering quietly to themselves.

  Somewhere far in the distance, someone had opened a door.

  The ward now seemed very dark. There were more light switches by this set of double doors and she pressed them hard. Nothing happened.

  She shoved at the double doors again, but she was trapped, no way out.

  For a second, Casey stood, her back flat against the hospital doors, a ripple of fear in her spine.

  ‘Who’s there?’ She felt the words catch in her throat.

  Silence.

  In the distance, a door closed hiss-quiet. The curtains beside her shuddered, and stilled.

  Someone had come into the ward. A silence settled over the room, a waiting, watchful stillness.

  Casey’s eyes flickered around the room, searching for another way out. But there was nothing. Moving quickly, instinctively, she slid behind one of the curtains, a strange echo of the child’s game.

  Her breath was shortening, her hands clenching. But then she squared her shoulders and shook her head. You’re being pathetic. Come on.

  She took a deep breath and stepped out from behind the curtain, walked down the ward and peered into the next room.

  It was even darker in here. The bed curtains reached to the floor, and there were a dozen places a person might hide. The clutter and rattle of the rest of the hospital must be only a few dozen yards away, but it might have been a hundred miles. This ward felt abandoned to strange Victorian spirits, to dusty, fateful ghosts and watchful, dangerous eyes.

  ‘Who’s there?’ Casey could hear a shake in her voice. ‘Stop playing games.’

  Silence.

  She tried to peer around the drifting curtains, tried to see into the shadowy corners.

  Nothing.

  And then she lifted her chin and marched down the long room.

  She passed the first bed, with its spectral curtains, then the next and the next.

  And she was nearly at the doors, nearly back in the bright chaos of the hospital, nearly safe, when a curtain jerked aside, and a shape surged towards her.

  4

/>   Casey opened her mouth to scream.

  ‘Shut up.’ She realised it was Noah, still in his scrubs, his pale face smudged with grime.

  ‘What the hell are you doing?’ Casey spat. ‘Are you insane?’

  In the gloom of the ward, Noah was staring at her, eyes wide, hands shaking.

  ‘You have to … ’ Noah spun away, jaw gritted. ‘You need to … ’

  The doctor’s frustration took him across the room in a couple of strides, ending up by one of the windows, his hands gripping the sill.

  ‘What?’ Casey let herself sound angry. ‘You scared me.’

  ‘You need to … ’

  ‘What do I need to do, Noah? This is ridiculous.’

  ‘I looked you up.’ The words were staccato. ‘You don’t write features. You’re an investigative reporter. Casey Benedict. You did that story in Libya.’

  ‘I’m not on investigations.’ Even now, Casey resented saying the words. ‘I’ve stopped doing that. I’m covering Heather Webber, our health editor, while she’s on mat leave. You can check with the Post. Or just look up the last few bloody stories I’ve written.’

  ‘But you were … ’

  ‘Yes, I was,’ said Casey. ‘But now I’m just writing a piece on cystic fibrosis. Look me up properly, Noah. Yesterday, I wrote 900 unbelievably dreary words about tax breaks for pharmaceutical companies. I couldn’t be bothered to go through all the hoops with the wretched press team here, that’s all.’

  ‘That doesn’t matter.’

  ‘Well,’ she said. ‘What do you want then, Noah?’

  ‘It’s … ’ Casey waited. Noah pushed himself away from the windowsill, turned back towards the room. ‘Flora is very ill,’ he said.

  ‘I know,’ she said. ‘I can see that.’

  ‘No,’ he said. ‘It’s worse than you realise. It’s worse than she realises, even. Flora is going to die. And she’s going to die very soon, unless we can get the abscessus under control. She can’t fight it much longer.’

  ‘The Adsero antibiotic isn’t enough?’

  ‘No. Nowhere near. Even the new one, saepio, probably won’t help much. Flora will need a lung transplant, much sooner than she knows. And if you operate on someone with abscessus in their lungs, it gets into their bloodstream too, and then it really is the end. It makes it far too dangerous to do the operation. And because of that, they won’t give donor lungs to a patient with abscessus. It’s a waste of precious lungs.’