Murder and Malpractice

by Mairi Chong

  Irene slid from her chair, her face a deep, mottled red.

  ‘Some of us have a life outside this practice,’ Mark said in defiance, seeing both Cathy’s and James’s raised eyebrows.

  Fortunately, poor Irene was spared the indignity of finding the practice manager as the door was opened. It was clear that Brenda had overheard Mark’s final comment.

  ‘Sorry to keep you waiting, folks. I got caught up downstairs,’ the practice manager said apologetically, entering the room and immediately going to the seat she always took at the far end of the table. She quickly opened her notebook and finding what she was after, smiled around at the group. ‘Finally, we’re all in one place,’ Brenda said. ‘I just have a few points to go through that involve the whole team.’

  Brenda spoke about an age-old issue of staff forgetting to turn off lights when they left, and their apparent thoughtlessness over the heating in their rooms.

  ‘All I ask is you think to switch your radiators off at the end of the day. I’ve said it time and again. Linda, you don’t come in on a Wednesday or Thursday some weeks, and your heating came on with the rest of the building for two full days unnecessarily.’

  Linda nodded, but Mark was clearly growing bored and Brenda moved on. She discussed a problem that all the practices in the area were having in trying to obtain locums. ‘This means we’re relying on residual staff to mop up any short-fall, I’m afraid,’ she said. ‘I hate to ask it when your holidays are sacred, but if either doctors or nurses feel that they want to pick up extra sessions having not booked anything already in the way of trips away, then please let me know. It’s a blow to all of us, but a real problem all the same. You’d be paid locum fees of course if that helps.’ This suggestion was met with the expected response. Cathy looked around having heard the murmur of concern, but from beside her, James spoke.

  ‘Put me down for my week off Brenda if it helps. I’ll take the Monday, Tuesday off and come in the rest of the week. That’ll do me fine.’

  Dr Mark snorted rudely and Cathy saw Tracy smile across at him. ‘Short on cash at the moment, James?’ he asked. ‘I’m sure we’d cope without you, wouldn’t we Cathy?’

  Cathy glared at Mark and Brenda held up a hand. ‘We’ll talk about details later. Mark, you know we need a certain number of doctors in the building. James, come into my office in the morning after you’ve had a think. I hate putting people on the spot and I know everyone needs some sort of a break. Now,’ Brenda sighed, ‘onto the significant event. James is going to present. Can I remind everyone,’ Brenda paused and looked at Mark, ‘that this is a no-blame culture and our significant event analysis meetings are a learning opportunity for all, not just the person directly involved. As always, we allow the full presentation without interruption and then we can discuss. Agreed? Excellent. Thank you, James, if you’re ready?’

  While James got up and struggled with the computer, Mark turned to Brenda. ‘I suppose you’ve seen they’ve been at the sign again, bloody vandals?’

  Brenda looked concerned. ‘The sign?’ she asked.

  ‘Yes, the bloody metal plaque at the front of the building with our names on it,’ Mark said in exasperation. ‘“Dr Hope – less’’ it reads. Get it sorted, Brenda. It’s a damn liberty. If I catch who’s been doing it, I’ll skin them alive.’

  Cathy was sure she saw a smile twitch on Irene’s lips.

  Ignoring this exchange, James pressed a key repeatedly. He looked up from the screen over which he had been bent and smiled around the room.

  ‘I’d like to discuss the matter of a simple prescribing error that could have had very real consequences had it not be dealt with rapidly,’ he said.

  James was a likeable and gentle figure. As he spoke about the mistake and the actions that he had taken to correct it, Cathy sat in respectful silence. In many ways, her senior partner was the reason that Cathy enjoyed working at the practice. He held the place together with his high standards, warmth of character and steady wisdom. Thinking back, although initially drawn to Mark’s charismatic self-assurance and wit, Cathy had always felt safer in James’s company. It had been he who she had gone to first when she had a problem.

  The presentation lasted approximately ten minutes. Rather than coming over as a fool or a careless prescriber, James highlighted the need for honesty in owning up to a mistake. It was something that impressed Cathy greatly. The team discussed the case in-depth, with Mark making some good and well-judged points without apparently feeling the need to make a snide comment or jibe at James, at least for the time being. When finished, they were clear on the safe-guards required to prevent a further error occurring, and Brenda was tasked with transcribing the case and sending a copy out to all of the GPs for their approval before submitting it for the re-evaluation team in a month’s time.

  ‘Well James, on behalf of everyone, thank you very much,’ Brenda concluded. ‘Everyone happy?’

  ‘Oh, quick query about the coils and Implanon list,’ Irene said. ‘I know you need to get on, but I couldn’t catch you all together. Linda’s been doing the list for the last few months.’ Irene smiled at Linda.

  ‘Yes,’ said Linda, taking over. ‘I don’t know what your plans are now that Dr Moreland’s back,’ she said apologetically. ‘I’m happy to continue with them, of course, but I wasn’t sure about booking folk in.’

  ‘I’ll re-start the contraceptives and minor surgeries,’ Cathy said firmly.

  ‘Perhaps we will discuss this at the business meeting?’ James cut in.

  ‘She’s not a bloody child, James,’ said Mark, clearly forgetting his good form, ‘and we can’t treat her like an invalid either. If she’s fit to come back to work, then she should be allowed to get on with it. Jesus.’

  Suddenly, his face a deep red, James slapped the table with the palm of his hand, making them all jump.

  The rest of the practice staff looked at him, dismayed. But ever the professional, Brenda stepped in.

  ‘Now folks, I think we should begin the business side of the meeting,’ she said.

  The nurses and remaining non-partner GP, Linda, looked relieved.

  ‘Thank you for coming everyone,’ Brenda concluded.

  Cathy and Mark still stared at James in astonishment. The rest of the clinical team left. As she passed his chair, Cathy saw Tracy reach out a hand and touch the back of Mark’s neck. Linda was the last to leave and as she did so, she rolled her eyes and mouthed ‘sorry’. Cathy hoped that she fell down the bloody stairs on the way out.

  Brenda, choosing to ignore the awkwardness, moved on as if nothing had happened. She smiled around at the remaining three partners. ‘Right, on to business. First, I’d like to say how delighted we are to have Cathy back.’

  5

  After a blissful hiatus, the monotony soon began to kick-in. Like so many before him who had achieved their dream employment, Fraser found only disillusionment. Glainkirk was not what he had expected and if truth be told, he was unutterably bored. He certainly didn’t miss the atrocious situation he had found himself in at the hospital, but he longed for the faster pace of labour and the mental stimulation of working within a busy team. It seemed that having lived on adrenaline for over a year, he was dependent on the rush. Ruefully, he looked at the methadone-users who came in and found that he envied their quick fix. But he knew that he must rapidly stop with that kind of madness. He must knuckle down and make the best of what he had. His situation was enviable. He had security and reasonable wealth, not to mention, the respect of his two assistants.

  No, excitement, was an unnecessary and overrated commodity. He reminded himself of what he had left behind; the sleepless nights, lying in the narrow hospital bed in the staff accommodation wing, listening as the junior doctors returned from their shifts. Sometimes they would tap quietly on his door and wake him, simply out of devilment. When he did go to answer the door, breathless and shaken from his fitful sleep, there would be nobody there. Minutes later, on returning to bed, he would lie
his head on the creased pillows and hear their laughter echoing along the corridor.

  It was madness really to feel anything other than happiness now that he had escaped. His pay as a supervisory dispenser was not bad at all. He had finally signed the papers to secure a property on the Langholm Road this last week. Although it was a busy stretch leading out of town, the house, a three-bedroom, detached, was set far back due to its large garden, and there was ample parking to accommodate his new car also. Things were certainly on the up, so why then, Fraser asked himself, wasn’t it enough?

  He continued on for a number of weeks, pushing the feelings of discontent to the back of his mind and making polite comments to the shop girls, Anna and Sarah. Day-in-day-out, he would dole out the tablets and tonics as everyone expected. He moved into his new house and began to slowly do it up, spending his weekends in builders’ merchants and homeware department stores. He toyed with the idea of writing a research paper. Perhaps he should get in touch with one of his classmates and see if there were any study projects requiring assistance at the nearest university. Maybe if he applied his talent in this direction, it might satiate his restlessness. On one evening, he even sat down at his laptop and opening up a blank document, began thinking of titles for a novel he might write. A murder perhaps, with the perpetrator being a fiendishly intelligent organic chemist. Fraser closed his computer screen in self-disgust. Had it really come to this after all? He considered how things might have been if had listened to his father and followed in the family tradition of law. Perhaps if he had, his attention might have been kept, and his head steadied.

  Throughout this disappointing time, Fraser continued to see Kiean every other day, such were the man’s requirements for his prescription. He had given the matter a good deal of thought, having been shocked at the desperate man’s half-hearted suggestion of Fraser giving him an ‘extra’ dose on the side. In spite of all that had happened, Fraser found himself actually momentarily considering helping the poor soul out in some small way. Offering him an additional measure to tide him over when times were tough. But when he thought of it, it was an utterly absurd idea and would end in much the same manner as the previous predicament he had found himself.

  All the same, late one Friday evening after work, cosseted in his immaculate house, jaded beyond belief and slightly dazed on whisky, Fraser keyed in the question on his computer. It took only a matter of minutes to find that the illicit trade in prescription drugs was buoyant, to say the least, particularly in the green, sickly tincture which he was considering. Fraser closed the computer screen in horror at what he had contemplated and then opening it up again, he rapidly deleted his search history. What if someone was to find his computer and see what he had been researching? Dear God, what was he considering? And why would he? He didn’t need the money. He was settled and content. The tablets in the hospital had been bad enough, but methadone was quite a different thing altogether.

  That night, Fraser struggled to sleep, and when he did finally manage, he awoke confused and frightened, convinced that he had heard a knock at the front door. Too afraid to get up, he lay still and listened for what seemed like hours. But he had been mistaken. It was because of the whisky he had drunk earlier, of course. His father always said the amber liquid only led to madness. Fraser settled himself down again, resting back in his bed, and eventually drifted off. That night, he dreamt of terrifying masked figures pinning him down whilst holding syringes of poison to his veins.

  But despite his dreadful night, going into work the following morning, Fraser walked with a bounce to his step. He had parked by the old tweed mill, long since converted to flats, down by the river so that he could enjoy the longer walk into the centre of town. The crumbling high street took on a new energised atmosphere and the huddles of leisurely, ancient shoppers that spilt from the pavements in absentminded conversation, no longer riled him as they had done the previous day. Side-stepping out into the road to pass, he raised a hand to a regular customer. Yes, things, after all, might be quite alright, for he had awoken knowing finally what the problem really was. He was lonely of course, and needed to find himself a good woman. And she had been there in front of him all this time. If only he had bothered to do something about it.

  By the time Fraser had reached the pharmacy shop, he had all but made up his mind. He would ask her out that day. Sweet, gentle, innocent Sarah. Now he thought of it, he had known from the start that she was for him. Her mild, friendly banter while assisting him to measure out the liquid medications. Her studious accuracy in checking the dosette boxes. Indeed, it was obvious that they were perfectly matched.

  But ever professional, Fraser knew that his love-life must wait. He set to work as always, dealing with the mountain of repeat prescription requests, and discussing over the telephone several minor prescribing errors with the GPs who had written them. The morning passed quickly and it was soon eleven o’clock and time for the methadone-users to arrive at his door. Fraser set aside what he was doing and collecting the control drug register notebook, he went through to the back room where he saw all of the clients who required a confidential consultation. Kiean was first, as he always seemed to be, and smiling at Sarah as he passed her, he led the man through.

  ‘Come through Kiean, you know the drill,’ Fraser said, barely looking at the man.

  The addict followed him, and before the door was shut, Kiean, to Fraser’s utter amazement, began to shudder, as if gasping for air.

  Initially, Fraser thought he was having some kind of a fit and made towards the door to shout for help. Only then, on properly observing the man, did he realise that the methadone-user was sobbing uncontrollably.

  ‘Oh goodness,’ Fraser said, quite unsure what he was meant to do. ‘Sit down Kiean. I’ll get a box of tissues if you wait a minute.’ He left the room, glad to have some space to think. Re-entering, he found Kiean more composed. ‘Now then,’ Fraser said. ‘What’s it all about?’

  ‘I shouldn’t make such a fuss,’ the addict said and rubbing a grubby hand across his face. He seemed to pull himself together a little and grasping the tissue offered to him, blew his nose noisily. ‘Bad news today. I just heard a good friend of mine passed.’

  Fraser, who was still standing, lowered himself to the chair opposite. ‘I’m sorry to hear that Kiean. Was it unexpected then?’

  ‘Cancer,’ Kiean said and blew his nose again. ‘Too young, but God, I’m sorry to carry on in front of you, Mr Edwards, really I am.’

  Fraser smiled. ‘It’s fine. Honestly. I lost my father a couple of years ago and even that, all this time on, still gets me occasionally. Now, if you have your prescription, we’ll get you sorted in that way at least this morning.’

  Kiean fished in his jacket pocket and then began patting himself down. Fraser’s heart sank. Please don’t let him say he’s lost the prescription, Fraser prayed. Suspiciously, he wondered as he watched the drug addict go through the motions, if the story had been a ruse all along. Fraser watched distantly as the man removed his coat and jumper and then began rooting through his pockets, all the while muttering that it must be somewhere. He didn’t have the prescription, of that Fraser was sure and he doubted that Kiean’s friend with cancer had existed either. Fraser felt as if he had been taken for a fool.

  ‘Well, Kiean?’ he finally asked as the man stood before him, repeatedly apologising and reiterating that he didn’t know what had happened to the damn thing. ‘It should have been a triple dose as well Kiean, because it’s Friday.’

  Kiean nodded. ‘I know. I honestly don’t know what I’ve done, Mr Edwards. You can phone the clinic and ask them. They left the prescription for me to collect this morning at nine as they always do. It hasn’t changed. My dose, I mean. It’s the same as it’s always been. I must have dropped it at home before I came back out, I had to go back to get my fags. I’ll bring the script in on Monday and you’ll see.’

  Fraser shook his head. ‘You know I can’t dispense without it, Kiean. Give me a
minute and I’ll call through to the clinic and see.’

  Fraser left the man and did just that. To his surprise, it all seemed above board. Kiean had collected his prescription at nine-fifteen that morning and his dosage hadn’t been altered. The doctor suggested that he fax across a duplicate prescription to cover him for the weekend, as withdrawing from the quantity he was on, would undoubtedly be dangerous.

  Fraser returned to the room and told Kiean that he would indeed be receiving his medication after all. The drug addict seemed pitifully grateful and must have thanked Fraser a good six or seven times before he left.

  As Fraser closed the door, he had a dreadful, sinking feeling in his stomach, but he dismissed this. He had checked with the clinic and it was as the man had said. As far as Fraser was concerned, he had the faxed prescription which was undoubtedly legitimate and all was well.

  ‘I heard you ringing the clinic,’ Sarah said as Fraser came through to the front of the shop. ‘I hope Kiean wasn’t any trouble.’

  Fraser pulled himself together and nodded. ‘Just part and parcel of the job, I’m afraid. He lost his prescription, but it’s sorted now. I got the clinic to fax another through and the old one, if it is found in the street, will be invalid if another pharmacy takes it. I’ve put out an email to warn the dispensing chemists in the area. Sadly, you can’t be too careful with these drug dependants. As long as you and Anna keep well out of their way when they come in, I’ll be happy. I don’t like them coming in at all really. It intimidates the other customers. I hope not you though, Sarah?’ Fraser held the girl’s gaze and then looked down at his feet. ‘I was going to ask if you’d be free perhaps for a drink maybe next week, even this evening. I thought a meal out? I had been meaning to ask for a while now, but …’

  Sarah smiled. ‘But what? I wish you had asked before. Yes of course. I’d love to.’