by Hall, M. R.
It wasn’t so much the bacteria that had killed her, as her body’s attempts to stop their progress. Or viewed another way, Dr Kerr explained, the bacteria had learned to exploit the body’s responses to lethal effect. And unlike other bacteria that would colonize and coexist with a host indefinitely, once spurred into action, Neisseria meningitidis embarked on a rapid fight to the death. Its swiftness was perhaps its greatest weapon.
‘Did you send samples of infected tissue for analysis?’ Jenny asked.
‘Yes,’ Dr Kerr replied, but made no attempt to enlarge.
‘And what did the results show?’
Jenny saw his eyes flit to the hospital’s legal team in the uncertain pause before he gave his answer. ‘It seems the cultures grown in the lab proved resistant to the usual suite of antibiotics that would be used against them.’
‘Are you able to explain that in language we can understand?’
‘These are notoriously difficult organisms to treat. Like all bacteria, they’re constantly evolving and selecting for strains that resist anything that threatens them. When we take antibiotics for minor infections or consume them in our foods, they come into contact with bacteria in our bodies. Those that prove resistant are those that survive to reproduce. It’s just a part of the natural evolutionary process.’
Jenny was troubled by his neutral tone. When they last spoke he had seemed deeply concerned by what the results had revealed.
She pushed him harder. ‘Are you telling the court that Sophie Freeman was killed by a strain of bacteria that had evolved to become resistant to current antibiotic treatment?’
He shot another glance at the lawyers. ‘So it would seem.’
‘I’m no expert on these matters, Dr Kerr, but the little background reading I’ve done tells me that the vast majority of the world’s cases of Neisseria meningitidis occur in tropical countries.’
‘That’s correct.’
‘So does it then follow that any new strains of the bacteria are likely to have come from such countries?’
For the third time, Dr Kerr seemed to seek the approval of the hospital’s lawyers before he answered. He opened his mouth to speak, then paused, as if thinking again. ‘Statistically perhaps, but I have no knowledge whatever of the provenance of this particular strain.’
‘How is this infection passed from one person to another?’
‘Through saliva and throat secretions. The most usual methods are kissing, coughing, sneezing or touching infected fluids.’
‘So Sophie was most likely to have been infected by someone with whom she had been in close proximity – a school friend or family member?’
Martlett rose abruptly to his feet before Dr Kerr could answer. ‘Ma’am, Dr Verma will deal with this point. As you know, my clients have conducted tests on all those who have been in recent contact with Miss Freeman and found no evidence of infection.’
‘Thank you, Mr Martlett.’ She turned to Dr Kerr. ‘I would nevertheless like to hear your answer.’
‘Friends and family are clearly the most likely sources,’ Dr Kerr conceded, ‘but to assume that she was infected by someone in this group would be wrong, and,’ he added for certainty, ‘unscientific.’
‘I understand.’ There was no use pushing him any further. She addressed the lawyers. ‘Does anyone have any questions for this witness?’
Radstock and Martlett both shook their heads, leaving Catherine Dyer, who announced that she had only one point that she wished to clarify.
‘You are not a trained microbiologist, are you, Dr Kerr?’
‘No, I’m not.’
‘Do you possess a working knowledge of this organism’s genetic make-up?’
‘No.’
‘So you would agree, then, that you are not in any way qualified to comment on the reasons why this particular strain may have proved particularly stubborn in the face of appropriate medical treatment.’
‘You are correct in saying that is not my area of expertise.’ He hesitated. Jenny saw him glance over at Ed and Fiona Freeman. He was struggling.
‘Yes, Dr Kerr?’ Jenny coaxed.
‘Ma’am,’ Catherine Dyer pronounced, ‘I think we have established beyond all doubt that Dr Kerr has no knowledge worthy of being admitted as evidence in this area.’
Dr Kerr looked from Dyer to Jenny and back again.
‘Have we dispensed with this witness now?’ Catherine Dyer was determined to close the issue down. ‘I’m sure he has many pressing commitments awaiting him back at the hospital.’
‘Is there anything you wish to add to your evidence, Dr Kerr?’ Jenny said. ‘This is your final opportunity.’
‘Yes, ma’am . . .’
The lawyer’s cheeks hollowed in disapproval. Jenny gestured her to sit.
‘I may not be an immunologist, but I can’t say that I’m entirely happy with treating this case as an anomalous event.’
Martlett began to rise in objection but Jenny was having no interruptions. ‘Counsel will please let the witness finish. Go on, Dr Kerr.’
‘As a matter of principle, I’m afraid I don’t think the body should be released for burial until we are entirely satisfied that every conceivable test has been done. I do know enough microbiology to be aware that bacteria can undergo significant mutation within one incubating host. Neisseria meningitidis only incubates in human beings – there are no animal hosts. It’s a long shot, but there is a chance that this strain of bacteria evolved in this young woman’s body. If that is the case, subtly different strains may also be found within her tissue and we may learn something about the mechanisms involved.’
Martlett was now leaning back on his chair, receiving whispered instructions from Dr Verma and another of her colleagues from the Health Protection Agency. He nodded and rose swiftly, giving Jenny no opportunity to deflect him.
‘Ma’am, I am instructed this is simply nonsense. Numerous samples have been taken from the body, more than sufficient for my client’s exhaustive investigations. May we please receive your assurance that such uninformed speculation will form no part of the evidence?’
‘Dr Kerr’s misgivings are part of the evidence, Mr Martlett. I see no reason for them not to be.’
Martlett raised his rhetoric. ‘Ma’am, there is absolutely no evidence to support what Dr Kerr has just said. To suggest otherwise would be frankly irresponsible and, to use his word, unscientific.’
‘And I’m sure Dr Verma will explain why your clients hold that view.’ Jenny couldn’t resist landing a blow herself: ‘You really can’t hope to restrict the evidence to that which supports your client’s version of events, Mr Martlett.’
‘With respect, ma’am, restricting experts’ testimony to their fields of competence is a rudimentary rule of evidence.’
He was right, of course, and Jenny was more than aware that she had already nudged Dr Kerr far further than he had intended to go. She was also acutely aware that shrewd lawyers like Martlett knew how to push a coroner into outbursts which could be presented to the High Court as evidence of bias. Much as she would have liked to have given him a very public dressing-down, she had to be smarter.
‘Thank you for your observation, Mr Martlett. Subject to any of you having any further questions, I am prepared to end the witness’s evidence there.’
She was met with silence.
‘Thank you, Dr Kerr. You may go.’
Dr Verma was every bit as bumptious in the witness box as she had been during their meeting in Jenny’s office. Insisting that she could lay all of Dr Kerr’s lingering doubts to rest, she announced that none of Sophie Freeman’s family had been found to be carriers of the bacteria which had infected her, and neither had any of her school friends. Amongst the four hundred pupils tested they had found only two swabs positive for meningitis bacteria, and the positive samples were not a match for the strain that had infected Sophie. There was more good news: the fact that Sophie had been in close contact with so many young people, none of whom had develo
ped the illness, meant they were dealing with a strain which wasn’t proving particularly contagious.
‘Are you able to speculate with any accuracy on where she might have picked up this infection?’ Jenny asked.
‘No, ma’am. Having ruled out known contacts, we have to assume she was infected by a stranger – perhaps by something as commonplace as a sneeze on a bus or in a railway carriage. Your guess would be as good as mine.’
She went on to explain that the samples that had been cultured in the Health Protection Agency’s laboratories would in due course undergo detailed DNA analysis. The genetic code would then be compared with all other known strains, whose entire genomes were held on an international database. In all likelihood, in a matter of weeks, her colleagues would be able to identify the precise segments of DNA which had mutated to lend this strain its particular resilience to drug therapy. In the meantime, laboratory tests were being conducted to determine which combination of antibiotics might be most effective against it.
It was a polished and comprehensive performance, no doubt designed with the help of the lawyers to leave Jenny little room for manoeuvre, but she felt sure it fell a long way short of the whole truth. Dr Verma’s entire emphasis had been on Sophie Freeman’s particular case. There had been no mention that it might have been part of a wider pattern of exotic, untreatable infections that had been claiming lives at the Vale. But again, Jenny had to tread carefully. To raise issues that might be considered technically irrelevant would provide more ammunition against her. She had no choice but to stick to the case in hand.
‘Dr Verma, can you say with certainty that prior to Sophie Freeman falling ill, your agency has not encountered any infection or death from this particular strain?’
‘Absolutely.’
‘And you would know, because meningitis is a reportable disease?’
‘That’s correct. All cases are made known to us and kept on a register.’
‘Forgive me if there is an obvious flaw in my logic, but doesn’t that mean Dr Kerr may have had a point? If Sophie Freeman were the first to manifest this strain, doesn’t that mean the mutation may indeed have taken place in her body?’
‘It’s possible,’ Dr Verma said confidently, ‘but as has already been said, we have all the samples we need. We are quite happy for the body to be released for burial.’
At that, Radstock, the Freemans’ solicitor, intervened. ‘If I may, ma’am, my clients are most anxious to be able to bury their child as soon as possible. I’m sure you understand.’
‘Of course, Mr Radstock.’
Jenny saw Ed Freeman reach for his wife’s hand, and for the first time that morning she did not rebuff his affection. Jenny’s gaze lingered on them for a moment, and she asked herself if she truly had any reason to prolong their agony.
‘Does anyone have any questions for the witness?’
The legal teams consulted with their clients and decided that they had heard enough.
‘You may step down, Dr Verma.’
She left the witness box with an air of quiet triumph.
‘Is there any additional evidence to which any of the parties wish to draw my attention?’ Jenny asked.
The lawyers again responded in the negative. They were anxious for proceedings to end, and behind their immutable expressions, Jenny could tell they were relieved to have had such an easy passage. But behind them in the public seats, Jenny sensed the atmosphere was growing restive. Looks were being exchanged and comments whispered as those who had sucked up conspiracy theories on the Internet sensed another official cover-up in the making. Having heard nothing revelatory, Jenny could simply have declared that Sophie Freeman had died of natural causes and brought proceedings to an end, but her conscience told her she owed her family and the wider world a fuller explanation.
‘I’ll adjourn briefly to consider my verdict,’ she announced.
All stood in unison, and feeling the hostile gazes of the spectators like a hail of arrows, Jenny exited the courtroom.
Behind the door of her stuffy, claustrophobic office, she attempted to compose the few paragraphs that would stand for all time as the last word on the cause of Sophie Freeman’s death. But as she started to write, she became increasingly unsure. Something wasn’t sitting right. She cast her mind back over the evidence. None of the witnesses had entirely convinced. Dr Morley had looked harried and exhausted. Dr Kerr had been intimidated by his bosses into withholding his real concerns. Dr Verma had given a pre-prepared presentation, not testimony.
It was no good. She couldn’t deliver a verdict without an answer to a question Dr Kerr would never have answered directly in court. Breaking every rule of procedure, she dialled his mobile number.
‘Mrs Cooper?’ He sounded alarmed to hear her voice.
‘I’m about to give my verdict,’ Jenny said. ‘I just have one question.’
‘Is this permitted?’
‘No. But nor is not telling the whole truth. I need to know why don’t you want the body disposed of?’
He paused, then answered in a hurried whisper. ‘It just doesn’t seem like good practice, that’s all. While investigations are continuing it should be available for further samples.’
‘The HPA say they have all they need.’
‘They would, wouldn’t they? Sorry, I have to go now.’
No further forward than before she made the call, Jenny was switching off her phone again when it buzzed in her hand, indicating she had an unread message. She checked her texts and saw that David had sent one thirty minutes earlier: Call me.
‘Mr Tarlton’s in theatre all afternoon,’ the secretary to the cardiac team barked at her. ‘I can only page him if it’s an emergency.’
‘Can you get him a message that I called?’
‘I can’t guarantee when he’ll get it.’
Thanks for nothing, is what Jenny would like to have said, but was interrupted by a knock at the door.
She looked up to see Alison enter.
‘Sorry to disturb you, Mrs Cooper.’ She looked as if she had brought bad news.
‘What is it?’
Alison took out her own phone and handed it to Jenny. ‘I thought you might want to see this. I think it might be from Jim Connings at the path’ lab.’
On the screen was an email sent a little over an hour earlier from an address that gave no clue as to its sender. It read: Another neiss. men. this a.m. Female 23. Bristol. Dead.
The anger in the public benches was palpable. Reading the mood, and with an eye to avoiding the online slander that might be coming his way, Radstock had put some distance between himself and the two barristers, who sat as still and expressionless as sentries, waiting for their verdict and the large fees they would doubtless be receiving for a successful and painless morning’s work.
‘Before we conclude, I’ve one small matter to clear up with Dr Verma,’ Jenny said. She picked her out in the second row. ‘If you wouldn’t mind coming back to the witness box.’
Dr Verma seemed surprised, affronted even, by the request.
‘It won’t take a moment.’
She edged out from among her colleagues and returned to the witness box.
‘You are still on oath, Dr Verma – you do understand that?’
‘Yes.’ Caught unawares, she was suddenly less sure of herself.
‘And you do also understand that you have sworn on pain of prosecution to tell the whole truth?’
Her eyes travelled anxiously to Martlett, who had turned to consult with the other members of Dr Verma’s team, leaving her momentarily adrift. ‘I do,’ she answered uncertainly.
‘Then please take this opportunity to tell the court the whole truth.’
‘I don’t know what you mean, ma’am,’ she ventured cautiously.
Martlett cut short his conversation and shot to his feet. ‘Ma’am, may I request a brief adjournment?’
‘No, Mr Martlett, you may not.’ She turned to Dr Verma. ‘I want to know why you didn�
�t tell me that another patient was admitted to the Vale in the early hours of this morning also suffering from meningitis, and from which she has died.’
Martlett played the only card he had left. ‘Ma’am, may I remind Dr Verma that she does not have to answer any question which may incriminate her.’
Competing with the sudden excited eruption on the public benches, Jenny said, ‘I’m adjourning these proceedings until further notice. And when they resume, I expect answers.’
Fiona Freeman was already out of her chair and challenging Martlett and the grey-suited officials behind him, demanding to know what they were hiding from her. United in outrage, Ed Freeman followed her into the fray.
Jenny slipped out of the courtroom unnoticed. She knew now that this was only the beginning.
ELEVEN
JENNY SHARED A CAB BACK TO THE OFFICE with Alison, expecting at any moment to receive another call from Simon Moreton imploring her not to cause any further embarrassment. She could only imagine the panic that would now have gripped the Vale Hospital management and which would rapidly be spreading like a contagion into the corridors of Whitehall.
‘What amazes me is that Dr Morley must have known about this other patient,’ Alison said, ‘but he didn’t say a word.’