Murder and Malpractice

by Mairi Chong

  ‘Cathy,’ he said, and when words failed him, he shook his head once more. ‘We thought perhaps a bit more time off. I know we’re struggling for staff but –’

  ‘What, so you have discussed this already? Together? Without me?’ Cathy spat. ‘You’ve been talking about this while I’ve been tripping over dead bodies and being questioned by the bloody police?’

  James looked wretched. ‘Cathy. Just a few days off until –’

  ‘No,’ she said with finality. ‘I have patients to see. Get out of my room, both of you. I will have a full surgery tomorrow morning.’ She turned to her senior partner. ‘James, if you seriously think that I’m not capable of doing my job, then call the bloody GMC. Get me struck off for bad language, or malpractice, or whatever. All for shouting at a manipulative drug addict. I stuck up for you when Mark was making your life a misery, and this is how you repay me? Jesus.’ Brenda still hovered by the door, but she was not to be spared. Cathy met her gaze and saw a pathetic figure of a woman, but still, she went on. ‘Brenda, I can’t believe you. You of all people. You and I have kept things going together with all this going on and this is what you do? I thought you had more sense. We were meant to be a team.’ Cathy was now openly sobbing, and her words came out in heaves. ‘Get out. Leave me alone, both of you.’

  35

  Cathy stewed in her room for the rest of the morning. She worked solidly through the lab results, making rapid decisions about her patient’s health. Over one-hundred-and-five decisions made in thirty-nine minutes.

  At three o’clock the police arrived.

  ‘Sorry to interrupt your surgery, Doctor,’ DCI Rodgers said as he sat down in the chair offered. ‘We’ll try to be as quick as we can. We just had a couple of questions about the drug clinic you and Mr Edwards were planning to set up.’

  DS Milne sat down next to his colleague, his pen and notepad ready.

  Cathy frowned. ‘Yes,’ she said, ‘I heard you had been asking about the methadone prescription plans.’

  The two policemen watched her closely and Cathy felt herself flush. She was normally in control of the consultation and was annoyed to find she was nervous talking to the police in her own room. Her mouth was dry, and her tongue stuck to the roof with certain syllables.

  ‘As you know, we currently have Mr Edwards in for questioning with regard to the unexplained deaths of Dr Hope and Ms Steele,’ DCI Rodgers said with gravity. ‘Clearly, we have looked a little into Mr Edwards’s past movements before coming to your practice. He has been here for how long now?’

  Cathy tried to think. ‘A month or so, maybe? Brenda would know exactly,’ she said.

  ‘Of course,’ the police officer said.

  Cathy caught the patronising edge to his voice. She leaned forward and rested her elbows on the desk as he continued to speak.

  ‘And what was the process for employing the practice pharmacist? Did you put out an advert and then interview?’

  Cathy’s eyebrows knotted in confusion.

  ‘To be honest, Doctor,’ the policeman went on, ‘I had never heard of a practice having a pharmacist working in-house so to speak.’

  Cathy smiled. ‘Sure,’ she said. ‘It’s something the Health Board are actively encouraging. The idea is to have a highly trained pharmacist in individual practices as part of the multidisciplinary team. Their job is to oversee the general prescribing and to make recommendations and changes to the systems we have in place.’ Cathy looked from one officer to the other. DS Milne paused with his pen hovering and then looking up, met her gaze. ‘Really they’re there to keep the GPs up to date with the new drugs and educated in the best possible practice,’ Cathy continued. ‘Of course, each practice can choose what they ask their attached pharmacist to do. Fraser has been helping tidy up some of the chronic disease management prescriptions. Repeat prescriptions that haven’t been updated in years.’

  ‘And you interviewed a list of candidates?’ the detective asked.

  Cathy nodded. ‘Fraser put in his application and we shortlisted him for an interview. No-one else came close. He was local and presented himself very well. We asked Brenda to do a couple of referee checks. We heard that he was a bit of a loner but otherwise, he seemed faultless. He was very impressive when he came to interview, as it happens. It was a unanimous decision. As far as I’m aware, since appointing him he has only continued to prove his worth,’ she said glancing across at the computer screen as an alert came up saying a patient was waiting to be seen.

  ‘I take it you had heard about the death of a local drug addict about six months ago? The man in question belonged to your practice and I assume that you had heard of Fraser’s involvement in dispensing methadone to the man?’ asked DCI Rodgers.

  Cathy nodded. ‘Of course,’ she said. ‘It wasn’t a deal-breaker for us. Fraser had been essentially exonerated of any blame. Has something further come out?’

  DCI Rodgers turned to his colleague and after a silent exchange, returned to Cathy. ‘No,’ he said. ‘But Mr Edwards does seem to have gotten himself into somewhat of a muddle. When we took him in, he was convinced that he had killed Dr Hope, although, to be quite honest, his story doesn’t seem to add up at all with the facts as we know them. He denied having anything whatsoever to do with the death of your practice nurse, though. The man is in a fragile state, to say the least. Fraser admitted to a whole host of other crimes alongside Dr Hope’s murder, some of which date back many years and seem quite petty, but he appears determined to make a clean break of things.’

  Cathy sat back in her seat, shocked at this new information.

  ‘I assume that you had no concerns regarding Mr Edwards’s mental health at any time while he was working for you?’

  Cathy shook her head. ‘None at all. He seemed very distressed by the death of Dr Hope, as we all were.’

  ‘No that’s fine. He will, of course, be assessed by our own police surgeon and if it comes to it, a psychiatrist in due course, but I have to tell you that currently, we have little to go on. As I say, his story does not add up at all. Now to clear up a final point, Dr Moreland, as I can see that you’re very busy. Brenda – Ms Ingram, told us that you and Fraser were planning to start up a clinic for drug users. Can you briefly tell me a bit about that, please?’

  Cathy looked down at her fingers as she answered. She still had that ink on her fingertips despite scrubbing at them in the shower and her hands trembled slightly.

  ‘Of course,’ she said, ‘but I have no idea why you want to know. The psychiatric services in the area are stretched to breaking point right now and general practices are being encouraged to take on some of the more stable drug misuse patients.’ She glanced from one to the other and they both waited expectantly. ‘Currently, the drug misusers have to go to a psychiatric outpatient clinic to get simple weekly methadone prescriptions. We, as a practice, have been discussing taking on a limited number of patients for a trial period for a weekly methadone clinic. Fraser and I had begun to think it through, but what with everything going on, it fell by the wayside somewhat.’ Cathy smiled sardonically. ‘Anyway,’ she continued, ’I’m sure you know that drug misusers don’t have a great reputation for engaging in mainstream services, so we have had to think carefully about how we might run the clinic. Our idea was to have it on a single afternoon using a two-hour slot when no other patients would be in the building to limit any difficulties.’

  The detective nodded. ‘And you were planning on prescribing the methadone yourself? Pharmacists aren’t able to prescribe, are they?’

  ‘Yes,’ Cathy said. ‘I would prescribe, and no they can’t. Pharmacists don’t have that power. I have a bit of experience in dealing with drug and alcohol misuse patients. It is a special interest of mine. Fraser, though, has a wealth of experience from his shop pharmacy days and he was to work alongside me to advise me regarding reducing methadone doses or increasing if we had to.’

  ‘So, he would have had some control over the doses himself?’

/>   Cathy couldn’t understand where this was going. ‘Well, I would be writing the prescriptions,’ she reiterated. ‘but I would have taken his advice on board, of course. I’d have been stupid not to.’

  DCI Rodgers shifted in his chair, uncrossing his legs and then re-crossing them. Cathy looked at DS Milne and wished this would end.

  ‘Look,’ she said. ‘I don’t know what you want me to say.’ There was silence. ‘I have patients waiting,’ she went on desperately. ‘I’m sorry to be rude but you still haven’t even told me what this line of inquiry is all about. Why are you asking me all these questions about the methadone clinic?’

  DCI Rodgers got up and rebuttoned his suit jacket. ‘As I said, Doctor, we’re looking into Mr Edwards’s background. We’ve spoken to him regarding the deaths at this practice and another drug-related issue that has arisen. I’m sure you can understand that I can’t say any more for now.’

  Cathy sat for some minutes alone in her room when they had gone. What on earth did it all mean? When she finally roused herself enough to continue consulting, her mind was only half on the job. She knew she gave her patients a poor service that afternoon and by the time her last appointment came and went, she felt very relieved to have survived the day. She had three messages on her computer screen saying that a Dr Bhat had been trying to call her. She would have to deal with Suzalinna’s wrath later. No doubt her friend would be furious that she had come into work at all that day. A danger to herself and her patients she would tell her, when she was so over-wrought. Thankfully, neither James or Brenda had spoken with her again, and it seemed that they had not decided to report her to the GMC just yet anyway.

  She listened to the rest of the practice packing up for the day once more. In James’s room next to her, she could hear the movement of a chair and then the light being switched off and his door locked. She knew that he paused outside her own room, but clearly thinking better of it, continued out of the building. What a bloody mess. Perhaps there really was no going back with James. But despite all of this, she felt determined to get to the bottom of things.

  36

  Suzalinna shook her head. ‘I can’t actually believe what you’re telling me, Cathy,’ she said as she sat on the floor beside Cathy’s chair.

  ‘I know,’ Cathy replied. ‘It’s like some horror story, isn’t it? They’ve released him though. Said they were continuing to pursue enquiries regarding minor drug offences from years back, but that there was no concrete evidence to link him with the deaths.’ Cathy leaned back against the wicker chair in her friend’s conservatory and sighed. ‘That’s not the worst of it though,’ she continued. ‘They said that they needed to speak frankly with me, and that they were taking my own account of things at face value for now. They said that they had no reason to believe that I knew about Fraser’s past, but that it would be imprudent to continue with my plans to take on those methadone patients. Can you believe it? They suggested strongly that I should leave the whole thing.’

  Suzalinna’s forefinger traced a pattern in the woodwork. Round and round a notch in the floorboard her hand moved. Cathy watched her, but Suzalinna didn’t look up.

  ‘Listen, I’m sorry for not answering your calls earlier,’ Cathy said. ‘I know you only have my best interests at heart, but you do understand that I had to go into work.’

  Suzalinna scrunched up her face and sniffed.

  ‘Well?’ Cathy said, knowing that there was more to this than her friend was saying.

  Suzalinna sighed. ‘Darling,’ she began and stopped. She looked up into Cathy’s eyes and Cathy found it hard to maintain her stare.

  ‘Darling, you know yourself it’s wrong. This whole methadone prescribing nonsense,’ Suzalinna sighed again as if waiting for a response, but when none came, she continued. ‘After what you’ve been through, I’m surprised that you’re even suggesting it. I thought James would have quashed the whole thing by now. You’ve been very lucky, Cathy.’ Suzalinna touched her arm and Cathy froze. ‘No, darling, but you have been. You’ve been diagnosed with a serious mental illness. Bipolar disorder is no laughing matter. But before that, you were so unwell that you did self-medicate. Oh, please, don’t look like that Cath. If I can’t say it to you, then no-one can.’ Suzalinna shook her head. ‘As a doctor, you have a duty of care to your patients. You also must be of sound enough mind, to recognise your own weaknesses. You took drugs from the store at your own work. You did, darling. You took them and you self-medicated. You became, perhaps not physically, but certainly mentally, addicted to them. Now then. Tell me how you would be strong enough, or detached enough, to deal with other addicts having been in that position yourself. Tell me darling. I know you can offer them empathy, but that’s not enough.’

  Cathy couldn’t speak. She knew what her friend said was true.

  ‘Can’t you leave all of this to the police now?’ Suzalinna asked. ‘This investigating nonsense is all well and good, but you’re making yourself ill. You’d only want me to be honest, and at the moment you’re lurching from one lead to the next.’ Suzalinna smiled. ‘I know you hate me saying it, but it’s true. You’ve hardly noticed how you look yourself, but as your friend, and as a doctor, I have to say it.’

  Cathy shook her head. She felt exhausted. It was true, that since this business had begun, she had lost even more weight. She had always been slim, but her joints now seemed oversized compared to her limbs.

  ‘Just leave it,’ Suzalinna repeated. ‘The police are doing their job just fine without you butting in. Have a bit of faith. They’ll find out who did it eventually. Your job is to stay safe and healthy. You know what they told us back at med school? Look after number one and practise self-care, because if you become ill, it impacts a lot of other people.’

  Cathy groaned.

  ‘I know it sounds corny,’ Suzalinna agreed. ‘But it is true.’

  That had been the previous evening and Cathy had thought of little else. For a time, she did consider jacking the whole thing in and leaving it to the police, but it was hard when she had already come so far.

  Cathy drummed her fingers on the desk between patients or strode about the room, going over the conversation with the police the day before. She found herself standing on the scales, not bothering to look at her weight, then fidgeting with the blinds on her window. How was Mark killed that day? How did he drink the poison and what of Tracy? Did someone else run down the stairs following Tracy’s death, someone who Bert failed to notice?

  After finishing with a particularly simple prescription review and seeing that she had twelve minutes until her next patient was due in, she got up and quietly went to Mark’s room. The door was still locked but she had her own key, one which opened all the doors on the corridor. They had been told by the police that they were now finished examining the room, so she knew she would not be in trouble. She heard James’s voice as she passed, barely a muffled sound, but unmistakably him; slow and methodical. No-one was in the passageway, so she opened the door and slipped in, closing it silently behind her.

  There had been something they’d all missed. There had to be. She wished she had been more attentive that morning. She had been so caught up in her own worries, what with only just coming back to work. Surely if she had been more observant, she would have seen. Cathy did, however, recall with at least some clarity, the afternoon before Tracy’s death. She could picture the young nurse, standing in the front reception area, her bottom lip petulant and pouting. What had Tracy noticed that no-one else had? Cathy had considered this to be a wild exaggeration on the silly girl’s part at the time, but had what she said, scared the murderer into acting again? It certainly seemed likely now.

  Cathy looked around. She wondered what Mark had done that morning. Perhaps by reviewing his movements, she might come to some new conclusion. She sat at his desk and considered the facts. That morning, having been brought his coffee by James, they had spoken briefly, with the senior partner announcing his planned early retirement. James
had mentioned that he had seen Mark drink at least some of his coffee. Cathy got up and went to the sink, as he must have done that day. She turned on the tap and allowed the water to swirl, eddying round and into the plughole. He must have washed his mug out having drunk the coffee as he always did. It had been found at the side of the sink by the police. He had then taken in his next patient. She turned off the tap, half afraid that someone might hear and discover her sneaking around. She had no reason to feel this way, she told herself. She was committing no crime in simply looking. The answer must surely lie in Mark’s room, but aware that she should still be seeing patients, she gave it up for the time being. Frustrated, she left, glancing around one last time before relocking the door behind her.

  Cathy ushered her final patient out having completed her list. Her mind had been preoccupied. Still, she felt she had been stupid somehow and had missed something obvious. Someone had said something to her, and she had missed the significance. As she turned to go back into her room, she looked up the corridor and saw Bert’s cupboard door slightly ajar.

  ‘Bert, can I come in?’ she said as she stood outside, almost afraid to intrude. She didn’t want to go in at all. In fact, she hoped he would come out and talk to her.

  There was a shuffling from inside and Cathy heard something clang. When he opened the door, she realised that he must have dropped his metal thermos on the floor. He now held the lid in his hand.

  ‘Wait a bit,’ he said, and he shuffled back inside, tidying something or other, before fully opening the door.

  ‘What’s up Doc?’ he asked and smiled at his unintentional joke.

  ‘I need to speak to you,’ Cathy said. It had taken her far too long to come to Bert. He must surely be the only person who might know the truth. Who was better placed than he, to have seen what happened that day? Who else could have heard or seen the comings and goings in the corridor the morning of Mark’s death? How could she have been so slow? Cathy smiled at the handyman. She had always liked him. ‘You seem to be the only person round here who knows what’s going on,’ she said. ‘Do you want to come to my room? It’s maybe a bit cramped in there to talk.’