Chameleon

by Ken McClure

  Thelwell, wasp-like in his response snapped back, 'Then perhaps Doctor if your department did its job we would not be faced with the problem and neither would they.'

  Richardson leaned forward angrily in his chair but managed to control his temper in time. He took a deep breath and said, 'We are doing everything humanly possible to identify the source of the infection and will continue to do so starting with another swab check of the surgical team and the nurses in the post-op wards.'

  'Maybe we should send the swabs directly to the Public Health Laboratory Service this time,' said Thelwell. 'Perhaps they can find this damned bug.'

  Jamieson saw the flash of anger in Richardson's eyes and noted Carew's impotence in intervening in the hostilities. He himself interrupted. 'They will go to the hospital lab in the usual manner.'

  Thelwell reacted as if Jamieson had struck him. He said slowly, 'And who might I ask are you to make that sort of decision?'

  Jamieson replied evenly, 'I think you will find that I have the authority.' He looked to Crichton and Carew.

  Crichton said, 'Dr Jamieson does have the authority Mr Thelwell.'

  Thelwell's smile was dipped in sarcasm. He said, 'So a civil servant is now in charge of surgery at Kerr Memorial.'

  'Actually I'm a surgeon,' said Jamieson. 'And my involvement with Kerr Memorial will cease the moment people stop dying unnecessarily in your department. And talking about your department Mr Thelwell, I would like to be shown round it… today.'

  Jamieson held Thelwell's gaze without flinching. It was Thelwell who broke eye contact first. He said, 'I'll have Mr Morton accompany you.'

  'I'd rather you did it personally,' said Jamieson determined to establish his authority at the beginning in the hope that done once it would not be necessary to do it again.'

  Once again Thelwell hovered on the brink of argument and Jamieson could see the anger swim in his eyes as he considered his reply. The thin lips quivered before they said curtly and to everyone's relief, 'Very well. Contact my secretary and she will fit you in to my schedule.'

  Carew reminded them, 'We have still not decided what to do about the surgical lists.'

  'I thought we had,' said Thelwell coldly.

  'You expressed an opinion Mr Thelwell,' said Carew. 'But we did not decide. We must consider the options.'

  'Which are?'

  'Basically, there are three. One, we suspend surgery temporarily. Two, we start diverting patients to other hospitals. Three, we continue operating in the hope that, with extra vigilance on all our parts, the problem will not re-occur.'

  'The second option is a non-starter I'm afraid,' said Crichton. 'I've been in touch with all the other hospitals and there is no possibility of their accepting any of our patients outside of dire emergency cases. Their lists are just as long as ours.'

  'So we suspend or carry on with greater care.'

  'I resent the implications of that remark Carew,' said Thelwell icily.

  'There was no personal element in what I said Thelwell. If we decide that surgery is to continue in Gynaecology, aseptic procedure must be tightened up in all areas.'

  It was unanimously decided that, for the present, surgery would continue in Gynaecology at Kerr Memorial.

  'There is one change that I would like to see,' said Jamieson.

  'Yes Doctor?' asked Carew.

  ''You are still using the same recovery ward for gynaecology patients. I think it would be a good idea to change to another one for the time being. Is that possible?'

  After some deliberation, Crichton said that it was. Alexandra ward had been closed for some months due to shortage of nurses or, more correctly due to the shortage of money to pay for them. It could be re-opened and used for post-operative cases after suitable cleaning and preparation.

  'How long?' asked Jamieson.

  'Two days,' said Crichton.

  'Then I suggest that surgery recommences when the new ward is ready.'

  There were nods of agreement round the table.

  'We'll see to the fumigation of the old ward once it's empty,' said Richardson.'

  'Good,' said Crichton.

  'If there is nothing else gentlemen?' Carew looked around him. No one spoke. 'Very well then. Shall we be about our business?'

  FOUR

  When they left the meeting, Jamieson told Clive Evans that he wanted to call in at the residency to pick up his briefcase before going on down to Microbiology. Evans said that he would accompany him and then show him the way.

  'I've never seen anyone stand up to Mr Thelwell that way before,' Evans confided seriously as they crossed the cobbled yard to the blackened, stone building that served as the doctors' residency. Jamieson had not relished his first meeting with Thelwell. He had to admit that it had turned out to be even worse that he had feared but he was reluctant to enter into any conversation about Thelwell with another member of staff. He chose to ignore the comment, and looked up at a series of stone busts on ledges at the side of the entrance to the residency. Corrosion of the sandstone had eaten away at the cornice of the ledges and also at some of the lettering. It made the names and dates difficult to read but he managed to make out the citation to the main one. It said, John Thurlow Kerr, Professor of Medicine, 1881–1888.

  'Our founder's bid for immortality,' said Evans.

  Jamieson wondered for a moment why all busts and statues looked pretty much the same to him. What was the point of it all? What was he meant to think when he looked at a crumbling stone bust? He supposed that Evans had hit the nail on the head with his 'bid for immortality' comment. Pathetic, really.

  He considered what the hospital must have been like in 1881 and how much pain and suffering these walls had seen and heard, how much human misery they had been witness to. If only they could talk, but maybe it was best not to hear. Had the public of the day had the same faith in their healers as they did today? The same blind faith. Had people looked on trustingly while leeches were applied to suck their blood under the 'learned' gaze of frock-coated sages, the medical gentlemen, the Thelwells of another age, men for whom self doubt was an alien concept?

  Jamieson reflected on the history of his profession with little pleasure. Was there any other professional body so conservative in its outlook, so fiercely insular, so determined that outsiders be kept at bay? He doubted it and took little pride in the conclusion.

  Jamieson looked at the stern, bearded face of John Thurlow Kerr and considered the state of medicine in the late nineteenth century. Surgery had meant the screams of the unanaesthetised and the near certainty of suppurating wound infection to follow. Childbirth had meant puerperal sepsis for so many women, a disease caused almost entirely by the medical profession itself who, in the ignorance of their age, had arrogantly strode between the post-mortem room and the maternity ward unwittingly spreading the infections that they subsequently sought to cure.

  How many doctors of a later day acknowledged that fact when the role of bacteria in infection was finally understood? Not many he concluded. Humility was not an outstanding characteristic of medical practitioners. This was true the world over whether they be Harley Street physicians or African witch doctors. In their own way both sought to keep their patients in ignorance of their own bodies and determined to keep it that way in their own interests. Both peddled pills and potions and did so with a mystique cultivated to preserve their position in society. 'What will the penicillin do Doctor?' 'Fight the infection Mrs Brown.' But how many GPs knew what penicillin really did do? How many would know that it inhibited the final step in peptidoglycan cross linking in bacterial call wall synthesis? At a rough guess none out of a hundred. Jamieson knew because Jamieson wanted to know everything. But then, that was why he had been recommended to Sci-Med in the first place.

  'Shan't be a moment,' Jamieson said to Evans and ran upstairs to collect his briefcase. He paused in the room for a moment to adjust the bandage on his left hand which was threatening to come adrift. As he re-tied it he reflected on what he h
ad learned at the meeting. 'Difficult' wasn't the word for a man like Thelwell. He was a twenty-four carat son of a bitch with no saving grace that he could determine.

  Carew was too weak to be effective as medical superintendent. He was all right for opening hospital fetes and talking to the ladies' luncheon club but no use against the steam-rollering of people like Thelwell. Crichton seemed to be a good man but, of course, as a pure administrator, he could not involve himself in matters medical. Phillip Morton seemed all right from what little he had said and Jamieson did not envy him his job under Thelwell. Richardson too, seemed a good man. Jamieson admired the way he had kept his temper under extreme provocation from Thelwell but was forced to wonder whether or not it was a case of real self control or perhaps a lack of stomach for a fight due to advancing years. Clive Evans seemed competent, loyal to Richardson and keen to help in any way he could. What was more, he was waiting downstairs.

  Jamieson followed Evans along a narrow lane between signs pointing to the skin clinic in one direction and the hospital laundry in the other. He was hoping for a modern microbiology department but when Evans took a left turn down some stone steps he feared the worst and was duly rewarded. The Microbiology Department at Kerr Memorial was located on the ground floor and in the basement of one of the oldest buildings in the hospital.

  'Dr Richardson's office is just along here,' said Evans, still leading the way. A girl technician at Specimen Reception looked up as Jamieson passed and smiled. Jamieson smiled back. Smiles were important when you were on your own. They were reassuring, like the sight of a navigational buoy to a mariner in strange oceans.

  Jamieson felt claustrophobia closing in on him as they progressed along a long corridor between rows of small laboratories, each scarcely big enough to warrant the term, 'room'. They were correctly, little more than cubicles. The corridor narrowed in places to almost less that the width of a human body where lack of space had forced refrigerators and other large items of equipment out into the hallway.

  Although Richardson's room was bigger and had a large window, Jamieson could see that it would never receive enough daylight to warrant turning off the artificial lighting. The building across the way was less that five feet away.

  'I've arranged for you to have a room downstairs,' said Richardson. 'It's not much I'm afraid but as you see we are a bit cramped.

  'I'm sure it will be fine,' said Jamieson.

  'If there's anything you need you only have to ask.'

  Clive Evans took off his jacket and donned a white lab coat. As he rolled back the cuffs of his shirt sleeves Jamieson again noticed the red burn marks on the back of his wrist and asked him about them.

  'Oh it's absolutely nothing,' insisted Evans, 'No problem at all.'

  'What happened?' asked Richardson.

  'Dr Evans burned himself while helping me escape electrocution yesterday,' Jamieson explained.

  'Really?' exclaimed Richardson, obviously concerned at his colleague's injury. 'Have you seen about it Clive?' he asked. 'Maybe you should have a dressing on that.' He leaned forward to examine it more closely but Evans again insisted that it was nothing and pulled down his sleeve. He turned to Jamieson and said, 'If you like I'll show you around the lab.'

  Jamieson followed Evans round the cubicles of the first floor while Evans explained what happened in each of them then he led the way downstairs to the cold, fluorescent light of the basement and a long low room. 'This is the Preparation Room,' he said. 'All our glassware and equipment is cleaned and sterilised here.

  Jamieson noted the three women working at large stainless steel sinks and noted the steam steriliser that was currently on an operating cycle. A relay clicked to allow more steam to enter and maintain its temperature.

  'As you see, we have one large autoclave, working on the hospital's direct steam supply. We use that to sterilise all specimens once we've finished with them. In addition we have three hot air ovens and several small pressure cookers for individuals to use if they have to sterilise something in a hurry.

  'Do you sterilise anything for other wards or departments?' Jamieson asked.

  'No. All general sterilising is done down in the central facility at CSSD.'

  'I see,' said Jamieson. He noticed that the sweat was running off the women as they worked at their sinks and looked up at the ceiling for an extractor fan.

  Evans read his mind and said, 'I'm afraid there's no air conditioning. Dr Richardson has been asking for it for a long time I understand but with no success. Too many other priorities. It's not so bad when the steriliser isn't running.'

  'But pretty awful when it is,' added Jamieson.

  The two men moved on through the basement corridor with Jamieson having to duck his head to avoid hitting it on an array of pipes that ran along the underside of the low ceiling. Evans, a couple of inches shorter than Jamieson, did not have the same problem.

  'This is my lab,' said Evans opening a door to a square room that was slightly bigger than any of the others Jamieson had seen with the exception of Richardson's room. 'And this, I am afraid, is yours for the duration.' Evans opened a door on the other side of the corridor and Jamieson looked in to a small, narrow room that reminded him of a walk-in wardrobe. It had a desk, a telephone and an anglepoise lamp and not much else. There was no room for anything else. There were two cardboard folders lying on the desk.

  'These files contain the information you asked for,' said Evans. 'If there's anything else, I'm just across the corridor.'

  Jamieson thanked him and took off his jacket to hang it over the back of his chair. He sat down and looked at the walls that enclosed him. If he reached out he could touch all of them. Above him there was a thick, glass grating that allowed the merest suspicion of daylight to enter, slightly less than the greyest of dawns, Jamieson reckoned. 'One hundred and five North Tower,' he whispered switching on the anglepoise lamp. He opened the folders and got to work.

  After a good two hours study, Jamieson could find no fault in the procedures followed by the Microbiology Department in trying to trace the source of the infection. According to the records, all recommended, standard procedures had been carried out with meticulous care and all tests appeared to have been carried out more than once, often three or four times. But the result had always been the same. No sign of the bug that was plaguing the practice of surgery in the Gynaecology department.

  Jamieson went through the results of the staff tests again, just looking for anything at all out of the ordinary. His finger stopped moving as he found something. One nurse and one member of the surgical team had proved to be completely negative on each of the two separate occasions they had been tested. He found that puzzling. Most people carried bacteria of some sort in their nose and throat and on their skin. Usually it comprised a variety of harmless bugs but in a few cases people carried organisms which could cause disease in others in certain circumstances. It was naturally unwise for these members of staff to be near patients with open wounds.

  There were a number of possible explanations for a completely negative test and Jamieson considered them in turn. If the person was on some kind of anti-bacterial treatment then the normal bacterial flora of the body might have been destroyed. Alternatively, antiseptic creams might have been applied to the areas to be swabbed before the test but that would demand some explanation. Jamieson made a note of the two reference numbers from the result sheet and resolved to pursue the matter further when he had finished reading the paperwork. He finished going through the staff reports and changed to reading the lab report on the infecting organism.

  The cultural characteristics of the bug were recorded and its identity had been established beyond doubt. It was only when he saw the results of the antibiotic tests against it that he saw where the real trouble lay. The organism seemed to be immune to every known antibiotic on the standard treatment list. There was simply no way of treating such an infection. 'No wonder they died,' he said quietly.

  For bacteria to become resis
tant to antibiotics was nothing new. It happened all the time and, perversely, especially in hospitals. With so many drugs around it was merely a case of natural selection at work. Spontaneous mutations arose all the time in bacterial populations so when an antibiotic was injected into a patient the occasional mutant able to resist its action would survive and multiply. It would become the dominant form of the infection and if not detected and destroyed might survive long enough to affect other patients.

  The Pseudomonas bug that was causing all the trouble started out with the advantage of being naturally immune to many antibiotics. The acquiring of a few more through living in a hospital environment could make it a very dangerous customer indeed. Despite that, Jamieson still found the virulence of the Kerr strain surprising.

  Clive Evans put his head round the door and asked how things were going.

  'I know a bit more now than I did earlier on,' replied Jamieson.

  'Good. Can I show you where the staff restaurant is?'

  Jamieson looked at his watch and was surprised to see that it was after one o'clock. He said. 'Can I ask a couple of questions first?'

  'Of course.'

  'There are two members of the surgical team who had two successive negative results from their swab tests. Was this followed up?'

  'No, I don't think I noticed that,' confessed Evans.

  'It might be an idea to check them out.'

  'We've just done another swabbing this morning but you are right, we should have caught on to that. Who were the two?'

  'I can't give you names. They were only numbers were on the sheet you gave me. These ones.' Jamieson handed Evans a sheet of paper with the reference numbers on it. Evans put it in his pocket and said he would check. 'What was the other question?' he asked.

  'Have you had the Pseudomonas checked for the presence of Resistance Transfer Factors?'

  'No we haven't,' replied Evans. 'Dr Richardson didn't think there was much point in it. If the bug is resistant to antibiotic treatment it's resistant. It was his view that it doesn't matter much to the patient why it's resistant.' Evans saw the look on Jamieson's face and quickly added, 'Well, that's what Dr Richardson said.'