by Rob McCarthy
Harry switched to the main screen for Solomon Idris, where it showed all his hospital visits, which totalled three: the present one, July 2011, and March 2009. Harry brought up the 2009 record, which was summarised by a brief report from a doctor who’d treated Idris in A&E for a cracked rib and superficial cuts and bruises, gained in a gang brawl.
‘What a start in life,’ Noble said.
‘Here’s the interesting part,’ Harry said, reading out the last sentences of the A&E doctor’s report. ‘Patient reports that the injuries were gained as part of a gang initiation and refuses to give consent for police involvement. Saviour Project referral accepted.’
‘2009, he’d have been fourteen,’ said Noble. ‘Jesus.’
The Saviour Project was the scheme run out of Lahiri’s GP surgery, over in Camberwell. Harry opened his mouth to comment, but was interrupted by a knock on the door, which Gladys Lane rushed past them to open.
‘Dr Kent, the surgical team are here to see the patient,’ she said. Harry and Noble made their excuses, threw their gloves and aprons into one of the clinical waste bins, and moved to leave, replaced by Abe Gunther and the rest of his team. Gunther nodded solemnly to Harry as he entered.
‘How is he?’ the surgeon asked.
‘Stable,’ said Harry. ‘His platelets are running low but there’s a bag going in now. And the serology’s back. He’s HIV-positive.’
‘That’s confirmed, is it?’
Harry nodded.
‘We’ll go back in this afternoon to repair his vasculature,’ Gunther said. ‘But his spleen took a tough hit. We might have to take it out. I’ll do my best to avoid it, but sometimes there’s no choice.’
Most people could live without a spleen, but if you had HIV it was much harder. Harry looked at the floor and shrugged his shoulders.
‘Let’s just get him out of the woods, and we can let the immunologists worry about the future.’
‘Very good,’ Gunther said, and finished washing his hands. Harry left the isolation room and joined Noble, who was checking her phone in the corridor.
‘Anything else I can help with?’ he said.
‘Not that I can think of,’ she replied, sliding her phone back into her dark jeans. ‘I encounter so many people like this. Every single thing I find out about them just tells me their lives were even shittier.’
The copper who’d been assigned guard duty for Idris emerged from the stairwell opposite them, holding two cups of coffee.
‘How many of those do you drink a day?’ Harry asked.
‘Twelve,’ she said. ‘Jack used to say that a detective was a machine for converting caffeine into paperwork. Can I ask you a straight question, and you give me no bullshit?’
‘Sure,’ said Harry. He had a bad feeling about where this was going.
‘Is Idris going to live?’
‘I don’t know. He’s young. He’s got that going for him. But when people with severe systemic illness get critically injured, and have to undergo multiple operations . . . it doesn’t usually end well, that’s all I’m saying.’
‘Well, I’m sure you’ll do your best,’ Noble said, sipping her coffee and briskly changing the subject. ‘Would you like to know who I just spoke to on the phone?’
‘Fairweather?’ Harry guessed.
‘No, thankfully,’ said Noble. ‘The duty inspector who went to Peckham Rye station on 14 November and watched Keisha Best being scraped off the tracks. It was a straight suicide, apparently. CCTV and a dozen witness saw her waiting on the platform for half an hour, smoking a joint to calm her nerves, and then just climbing down onto the track and standing in front of the 5.38 to Dartford. A right tragedy, he said.’
Harry nodded. The phrasing struck a chord inside him – he suspected Noble was quoting, and that it bothered her, too. She’d not simply jumped in front of the train, but climbed down onto the track and stood waiting for it to hit her. That took a certain something. Perhaps the same something he’d seen in Solomon Idris’s eyes.
‘Right, let me know if anything changes,’ Noble said. ‘You’ve got my number. I’ve got a day’s work to be getting on with.’
‘You’re leaving?’
‘It’s a Monday morning, I’ve got to sift through all the crap CID has been given over the weekend.’ Noble gestured towards the ward. ‘And our mate’s not going anywhere, is he?’
He understood where she was coming from: the Met had their man, comatose under police guard, and nobody cared about what had driven him to do what he’d done. He was a criminal, a nobody from the estates, who probably would have ended up in prison eventually even if he hadn’t started waving his gun about.
‘And anyway, it looks like you’ve got a visitor,’ Noble said, before she turned and left. He moved to return to the ward round, grunting, angry, before he spotted the visitor that Noble had referred to. He was leaning against the wall, and looked serene. There was an NHS ID badge on a lanyard around his neck, but Harry couldn’t make out the writing.
‘Harry Kent?’ the man said.
He wore a chequered shirt, at least an eighteen-inch collar, and a dark burgundy tie that exploded out of his neck fat, disguised by a full, black beard flecked with white and grey. Harry approached him and nodded.
‘I’m Duncan Whitacre. I’m a GP over at Burgess Park.’
Harry nodded. He knew the practice – it was the one Lahiri worked at. In common with many inner-city surgeries, it had several partners, but Harry got the impression that Whitacre was fairly senior. He’d heard the name quite a bit. Youth work. Making a difference.
‘Harry Kent.’
‘Ah. You know James.’
Harry took a deep breath. Nothing Whitacre had said implied any particular preconception. So he just nodded.
‘I believe one of my patients is here. Solomon Idris.’
Once again, it wasn’t a question.
‘Yeah. The surgeons are with him right now. It’s a bit of a circus, as you can imagine.’
Whitacre nodded slowly.
‘How is he?’
Harry started shuffling slowly down the ICU’s main corridor as he explained Idris’s condition. He stopped outside a quiet, empty bay, where a technician was fiddling with a haemofiltration machine.
‘So it’s a real possibility he won’t make it?’ Whitacre said.
‘I’m afraid so,’ said Harry. Whitacre looked solemn again and focused on the machine. Behind them, Abe Gunther and the surgical team retired to view some images on a computer.
‘We can—’ Harry began.
‘No bother,’ said Whitacre.
‘Can I ask you a few things, while you’re here?’
Whitacre nodded.
‘He’s HIV-positive, and James didn’t know,’ Harry said. ‘Did you treat him for that? You wouldn’t have any idea of the story there?’
‘I treated him, yes,’ said Whitacre. ‘But as part of the Saviour Project, not as his GP.’
‘You run the Saviour Project, do you?’
‘Yes. I helped set it up.’
‘Where’d you get the name?’ Harry said. He had always wondered, but had never got around to asking.
‘It’s an acronym,’ said Whitacre. ‘Southwark Against Violence and Unrest. Started off as a charity based here in A&E. And we still do a lot of that. Assemblies in schools and the like. But we took it formal and got it NHS-funded. The whole philosophy is that we treat youth violence like any other disease. If you have someone come in with a mini-stroke, you reduce their risk factors. You refer them to their GP who puts them on statins, anti-hypertensives, you screen for arrhythmias. You have someone come in who’s had ten Stellas and fallen into the road, you make sure their GP gives them a chat about alcohol intake. It’s the same story.’
‘How does it work?’
‘We have a team of youth workers located in A&E who screen for any gang-related injuries. If it’s minor, we see them then and there in the department. Anything serious, we take the name and go to see t
hem on the ward once they’re better. If they’re between twelve and nineteen and they’re from Lambeth or Southwark they get referred to me. And my team works with them, four introductory sessions at the very least, to try and get them out of the wretched lifestyles many of them are leading. We’re just in the process of publishing data, but I can tell you, this project changes lives. And it probably saves them, too.’
Whitacre spoke with heady words and impassioned eyes. His accent was a mirror of Harry’s own, dropped H’s and consonants, but mellowed out by years of the medical establishment. Harry suspected he was local, definitely a Londoner.
‘Who mentored Idris?’ Harry asked.
‘I did, at first,’ said Whitacre. ‘I do all the preliminary interviews, along with the youth workers. Me and one of the shrinks from the Maudsley developed a screening questionnaire. But later it was James. We’ve got five or six registrars attached to the project, and they do a lot of the longer-term patients.’
Lahiri. Harry pictured him, broken-eyed in the ICU on his midnight lunch break. Idris had got himself shot, and Lahiri probably saw that as a personal failure. Maybe it was, Harry thought. He had no idea.
‘Are the family around?’ Whitacre said.
‘They were, this morning,’ said Harry. ‘Joy and the brother, Junior.’
‘That’s another tragedy. The mother has ME, the poor woman, but the bastards won’t give her disability benefit. She can barely work, but she does.’
Harry didn’t ask about the boys’ father because he knew what the response would be. Whitacre’s phone rang loudly and he apologised, before checking it and killing the call. Searching in his pocket, Whitacre found a business card and handed it over.
‘Any change in his condition, I’d appreciate a call,’ he said. ‘And likewise, if there’s anything else you need.’
Harry thanked him, and Whitacre moved over to Idris’s room, arching his head through the doorway to take a peek before shaking his head and moving to the exit. Harry wondered whether he should have asked more questions, about Keisha Best, but by then he was gone. Perhaps Noble was right, anyway. In the hospital, under police guard, Idris was safe. What had motivated him to do what he’d done could wait until he was better, and Harry should concentrate on making that happen as soon as possible. He slunk back toward the ward round, catching Dr Saltis typing into one of the bedside computers.
‘Sorry about that, Maria. What do you need me to do?’
Saltis was already speaking rapidly, the stress of the day evidently already getting to her. ‘Beds two and six need tracheotomies placing. Bed six has a BMI of thirty-eight so she might be tricky – I’ve called ENT to let them know. And fourteen needs a central line, but none of them are urgent.’
‘What are their names?’ Harry said.
‘Oh,’ Saltis said, fumbling for the list, ‘Mr Archer in two, Mrs Singathawaran in six. And Mrs Kufeji in fourteen.’
‘OK,’ said Harry. ‘Who have we got waiting for us?’
The referrals from A&E and the wards were usually seen by the registrars first, who would then sort the wheat from the chaff and feed back to the consultants. Saltis flipped the list over to read off the list of patients she’d scrawled since the morning had begun.
‘Brenda Collingwood’s a seventy-three-year-old woman in Resus, COPD. Wraclav Kaminski, fifty-four, over on Owens ward, he’s a GI bleeder, encephalopathic.’
‘We’ll take one each?’ Harry suggested. Saltis nodded, said she’d head over to Owens, and he could take the woman in A&E. As he headed out of the unit, he noticed Duncan Whitacre at the central computer station, deep in conversation with Abe Gunther, a worried look across his face, and remembered his words. This project changes lives, and it probably saves them, too. It was a shame that the benefits hadn’t extended to Solomon Idris, Harry thought as he worked alcohol gel into his hands, the doors closing behind him.
Brenda Collingwood should have quit smoking forty years before she did, and she wished she had, but it was hard when you’d been hooked early. Her Alfie had gone through sixty a day since he’d been a lad, and it hadn’t done him any harm, until the stroke which had effectively widowed her four years ago. At first, she’d tried to care for him herself, but now she had three carers a day, all of them foreign, not that she minded, but Alfie would’ve done had he been able to talk. She’d worked behind the bar of the Kings Arms on Penge Common for forty of her seventy-three years, where Alfie had been the landlord, until his illness, when they’d sold up and bought a bungalow. Their only son, Eddie, was on his way over from Essex, having been told his mother was very ill in hospital. Brenda wasn’t worried about herself, but she was worried about Alfie and the garden and Geraldine, the ninety-two-year-old demented woman in the house next to her who she checked on every evening to make sure she hadn’t left the gas on.
Harry knew none of that, but he knew Mrs Collingwood was pretty damn sick from her posture, upright on the bed, too weak to prop herself forward, recruiting all of her upper-body muscles in the battle for each breath. The notes said she’d been diagnosed with COPD last year, the combination of emphysema and bronchitis having built up over fifty-five years of tobacco-induced damage. Now it was winter, and it only took a mild infection to bring an already fragile body to the brink of death.
‘Have you got the latest gas?’ Harry asked Dr Maitland, the on-call medical registrar who’d asked the ICU team to come and see Mrs Collingwood. Normally the high-dependency unit would have come down to take the referral, but HDU was full, and so Maitland had called Harry.
‘CO2 was nine point five; we’ll get another one done in five minutes,’ Maitland said, passing Harry the readout so he could see for himself. He’d worked with Dr Maitland several times before, and liked her. The on-take medical registrar had probably the hardest job in a hospital, with responsibility for seeing and admitting all medical patients who came through the front door. On a busy day that could be as many as thirty in a twelve-hour shift.
In the case of Brenda Collingwood, Harry couldn’t fault Maitland’s management. She’d had intravenous antibiotics started to battle the infection that was the cause of her respiratory failure, and once it had become apparent that Mrs Collingwood’s condition had deteriorated further still, she’d called ICU and asked A&E to set her up on a non-invasive ventilator. The machine was connected up to a wide mask strapped tightly to her face, using alternating air pressure to help force air in and out of her lungs. It was a horrible feeling, and Harry could see that Mrs Collingwood was in considerable distress, but the machine was keeping her alive.
Harry went up to her, told her she was doing well and he knew how uncomfortable it was, but she had to keep going. Mrs Collingwood nodded quietly and kept fighting to breathe. Harry listened to her chest and felt her pulse. Then he looked at Maitland and nodded towards outside the cubicle.
‘I think you’re right,’ Harry said. ‘She needs to be in a critical care bed.’
Maitland nodded. There wasn’t really any disputing that. The problem, as usual, was beds. The HDU, which was the ideal place for their patient, was full; the ICU was split in two, ten beds for medical patients, like Mrs Collingwood, and ten for surgical and trauma cases, like Solomon Idris. The ten beds set up for medical patients were all occupied, and there were only two free on the surgical side. To an outsider, it was probably amusing: centuries of medical advancement, and yet a spell of cold weather still brought the system to its knees.
‘I’ll do my best,’ Harry said. ‘Can you do another gas while I go and ring my boss?’
He was hoping that things would improve, but he knew that was wishful thinking. He stepped up to the central station in Resus, looking across at bed six, where yesterday they’d resuscitated Solomon Idris. Now it was occupied by a man in overalls with a painful-looking injury to his arm.
Harry called the surgical ICU and reached Dr Rashid quickly enough.
‘Make me happy, Harry.’
‘I might not do that, I’m
afraid,’ Harry said. ‘I’ve got a Mrs Brenda Collingwood down here, seventy-three-year-old with an infective exacerbation of COPD, she’s haemodynamically stable, gas shows Type II failure, A&E have established her on BiPAP and referred to medics, but she’s running a pH of around seven point two five and she really needs to be upstairs.’
In this case, upstairs meant in a critical care bed, with monitors and nurses checking every five or ten minutes, and access to ventilators or dialysis if they became necessary.
‘I’m sure she does, but that bleeder from Owens ward is having a TIPSS and then he’s coming to us. If I take her that’s our last bed gone.’
Harry swore silently and hoped no one had seen. Getting a patient into the last available ICU bed in a hospital was harder than getting into medical school, and with good reason. If a trauma call or a cardiac arrest came in, they’d have nowhere to put them. If the crisis persisted, they’d have to shut down operating theatres and use them as beds instead, which cost the trust thousands of pounds a day in cancelled operations.
‘I’d put her in HDU if they had a bed, but the med reg has checked and none of their patients are anywhere close to discharge.’
‘Ha,’ said Rashid. ‘Two or three on the medical side are well enough to step down, but there’s no room in HDU to take them, and they’re not ready for the wards yet.’
Harry sat hunched over the phone, listening to the static and ward noise on the other end and the frantic sounds of Mrs Collingwood trying to breathe, waiting for Rashid to make a decision. ‘I’m not keen to block our last bed,’ said Rashid. ‘She won’t die if we leave it another half-hour, will she?’
Harry looked over through the half-pulled curtain at Mrs Collingwood, who seemed more relaxed, not fighting the mask any more. A&E had a nurse with her constantly, which was good.
‘Probably not, no.’
After that, Rashid said the words Harry had been dreading.
‘OK. Call Dr Traubert, it’s his decision.’