The Hollow Men: A Novel

by Rob McCarthy

  ‘OK, boss. Thanks.’

  Harry cursed again and felt his stomach twist as he called the switchboard and asked to be put through to Traubert. After he’d usurped Traubert yesterday in A&E, he’d hoped not to have to encounter him for a couple of weeks, to let the dust settle.

  ‘George Traubert.’

  Harry exhaled, told him the situation.

  ‘Didn’t think you’d be at work today,’ Traubert said. Harry could picture him, working in his spartan office, the events of last night probably nowhere near the forefront of his mind. ‘Where are you? A&E?’

  ‘Yeah, Resus,’ said Harry.

  ‘I’ll be down in five minutes.’

  Harry had spent quite some time with George Traubert – he was his educational supervisor, and they’d met for appraisals, how-are-you-getting-on meetings and the like. But he’d hardly had the chance to see what he was like with patients. If Harry had seen one extreme with Solomon Idris, he was seeing the other one now. Genial, professional Dr Traubert sat on the edge of Mrs Collingwood’s bed, gently clasping her hand, asking how she was feeling and explaining what was going on.

  ‘The thing is, Mrs Collingwood,’ he said, nodding gently, ‘we need to make sure you’re in the right place. We’re doing all we can to make you better.’

  Mrs Collingwood nodded solemnly, still too weak to speak. Harry tapped his foot against the linoleum flooring, waiting for Traubert to hurry up and make a decision. Though he was primarily an anaesthetist, Traubert had wound up as the hospital’s Clinical Services Director for Critical & Emergency Care, responsible for A&E, the anaesthetics department and the intensive care and high-dependency units. As well as sitting on the board and reporting to the Medical Director, it was his job to sort out the kinds of problems which arose when the hospital ran out of intensive care beds. Such bureaucracy, in addition to his academic activities, meant he spent much less time actually seeing patients, with the consequences they had seen last night.

  ‘I’ll be back soon,’ Traubert said, patting Mrs Collingwood on the hand again. He reviewed the chart before joining Harry at the end of the bed.

  ‘She’s tolerating the BiPAP,’ he said. ‘I don’t think she’ll need intubating. We could admit her to Lawrence Ward.’

  Lawrence was the respiratory unit, and the nurses ought to be able to manage the ventilator there, but that wasn’t Harry’s concern. Mrs Collingwood needed continuous monitoring, not the hourly checks common on the acute wards.

  ‘What if she goes off?’ Harry protested. ‘They’re busy as hell up on Lawrence. If she deteriorates up there, it might not be picked up until too late.’

  ‘I know, but we’ve got one bed left on the surgical side now,’ Traubert said. ‘We get a single trauma call and we’re stuffed.’

  Harry felt his face begin to redden, realised he was still angry at Traubert for the previous night, tried to separate that out and think rationally, but it didn’t work.

  ‘You said she’s improving. She’ll be on the unit for a day, no more, and we can move her into HDU as soon as a bed is available. If it was my mother . . .’

  Traubert looked at him with dark eyes set into his tanned skin, and Harry waited for the cutting remark, the reminder that he was a registrar and when he was qualified enough to run four hospital departments, he could make comments like that. But it didn’t come.

  ‘Good point, Harry. Ring ICU and tell them she’s coming up. I’ll talk to theatres about opening up some beds in Recovery and get onto HDU about prioritising discharges.’

  Harry went and made the phone calls, and when he came back, Traubert was back on the edge of the bed, explaining.

  ‘. . . to our intensive care unit. I know that sounds scary, but it just means we can keep an eye on you a bit better. The nurses are fantastic, so you’ll be in good hands. OK?’

  He patted her hand a final time and stood up. With great difficulty, Mrs Collingwood raised her arms, lifted her mask off and rasped.

  ‘Thank. You. Doctor.’

  ‘Not at all,’ said Traubert, replacing the mask. ‘Now keep this on, we’ll soon have you better.’

  Traubert came out of the bay and started washing his hands. The porters would be down in five minutes, and the A&E junior doctors could watch her until then. He finished rolling his sleeves back down – unlike yesterday, he was dressed in suit trousers and a pinstriped shirt with ice-white collar, silk tie tucked between the third and fourth buttons. He turned to Harry and said, ‘Heading back upstairs?’

  Harry nodded, then regretted it.

  ‘I’ll walk with you,’ Traubert said. ‘I wanted to have a bit of a chat anyway.’

  I know exactly why, Harry thought. He had already decided to eat his words and apologise, live to fight another day, even though he’d been in the right.

  ‘How is the young man doing?’ Traubert asked as they headed towards the East Wing stairwell.

  ‘He’s stable. I expect the surgeons will go back in today, hopefully won’t have to take all of his spleen.’

  ‘Thank God,’ Traubert said, grimacing. ‘Good work on your part, from what I’ve heard.’

  Traubert held open the stairwell door for him, and as Harry passed through he caught a whiff of cologne. At work, he thought. Now they were alone, in the quiet of the stairwell, but Traubert lowered his voice anyway, stepping across two of the stairs, leaving Harry no place to go.

  ‘The thing I wanted to say was,’ Traubert said, inhaling deeply, ‘that I’m very sorry about last night. I let you, and the rest of the team, down. I let the patient down. And you did very well under difficult circumstances. You were unafraid to challenge the hierarchy because you felt that the patient’s safety was compromised, and that was the right thing to do.’

  Harry said nothing. He knew first-hand that all doctors were human, and those who made mistakes were often hard-working, decent people. But there was something, residual anger perhaps, that stopped him from speaking.

  ‘I didn’t see many shootings in Switzerland,’ Traubert said, smiling so hard Harry got the impression he was trying to force one in return. Traubert had worked in Toronto before moving to London, and there must have been a fair few shootings there, but Harry bit his tongue. That would have been a while ago, perhaps when venous cutdowns were still done.

  ‘All I’m trying to say is, I don’t hold anything against you, OK? Is there anything you want to say? I’d appreciate any feedback.’

  Harry looked Traubert in the eye and saw sincerity that could even be described as genuine.

  ‘With all due respect, Dr Traubert,’ he said, ‘I might not be there next time. And if the rest of us hadn’t been there, Solomon Idris might not have made it to theatre. Your registrars won’t always be around to cover for you.’

  ‘More’s the pity,’ Traubert said. ‘You guys get better every year. I’ve booked myself on the next ATLS course anyway, to refresh my memory. It’s in March. Thank you again, Harry. You were fantastic down there, in your element.’

  Harry immediately regretted his words. Traubert was charming, international, popular, cosmopolitan, the very epitome of the modern consultant in everything but medical acumen. It was only through his mastery of hospital politics that he held his senior position, and the sooner the stupid bastard ended up behind a desk as a glorified accountant, the better. It was a wonderful irony that the best way to get people like Traubert away from the wards, where they could do damage, was to promote them even farther up the hierarchy they clung to. He might even turn into a useful friend in a high place. God knows Harry needed them.

  ‘Just doing my job,’ Harry said. They had started climbing again.

  ‘Ah yes, the police work,’ said Traubert. ‘How is that going?’

  ‘It’s going great,’ Harry said, aware of how unconvincing he sounded. ‘Yesterday was a bad day.’

  ‘I see,’ said Traubert. ‘Do you know if the police have any leads about what made him do what he did?’

  ‘I don’t think
so,’ said Harry. ‘They think it might be gang-related.’

  ‘I see,’ said Traubert. By now they had arrived at the crossroads at the centre of the ICU block: to the left were the medical beds, to the right the surgical beds, and ahead the consultants’ offices. Traubert patted him on the back with a heavy hand. ‘I’ll let you get back to work, then. We’ll have another mentoring meeting some time next week.’

  Harry smiled, unsure what to reply, but was saved by the piercing chime of his bleep on his belt.

  ‘I’d better—’

  ‘Of course!’ Traubert said, already pacing away towards his office, the biggest of the lot. ‘Have a good day, Harry.’

  The rest of the morning passed with routine jobs and procedures, and by half past twelve, Harry had enough time free to grab lunch. He sat down in the junior doctors’ office, pulling open the cardboard wrapping on a sandwich from the Sainsbury’s in the main hospital atrium.

  He’d done his best to put Idris out of his mind: the porters had turned up an hour or so ago to take the kid to theatre, and when he’d come back, the anaesthetist had said it’d all gone to plan. The surgeons had removed a portion of the spleen and used endovascular stents to repair the larger damaged blood vessels. He munched on the sandwich and remembered the feeling of hunger from the chicken shop, heard Idris’s voice again, his breath spiralling out over the vinyl tables. They killed Keisha, and the feds didn’t give a shit.

  At his computer, Harry brought up the patient records system, found the main search engine and typed Keisha Best’s name in. The Ruskin was the closest hospital to Peckham Rye. Unsurprisingly, the admission was to the mortuary.

  14/11/2012. Admitting clinician: Dr Megan Wynn-Jones.

  Harry was in luck. Wynn-Jones was on the staff at the Ruskin, and also on the Home Office list. He’d learned in six and a half months with the police that when a suspicious death occurred, standard procedure was to summon whichever certified Home Office pathologist was on duty for the region, and then take the body to the closest suitably equipped hospital for the post-mortem examination. Out of hours this usually took a while as the pathologist had to come in from home. Often, Harry would be called to certify death in situations that initially appeared non-suspicious, only for the duty CID inspector to arrive, spot something which seemed out of place, and suggest that forensics get involved. He’d not yet encountered Dr Wynn-Jones, though he’d heard her name mentioned once or twice.

  Wynn-Jones picked up the phone when Harry dialled her extension. He pictured a mousy-looking middle-aged woman, hunched over a microscope with a white coat and a cup of tea.

  ‘Hi. My name’s Dr Kent, I’m one of the FMEs for Inner South-East.’

  ‘This is a hospital extension you’re calling from?’ said Wynn-Jones.

  ‘Yeah, sorry,’ said Harry. ‘I’m an ICU reg here in my day job.’

  ‘Ah, right. How can I help?’

  ‘Do you remember someone called Keisha Best?’ said Harry. ‘You’re down as admitting her for a post-mortem on 14 November last year.’

  ‘The suicide at Peckham Rye?’ said Wynn-Jones. ‘Yes. Very sad. There wasn’t much of her left.’

  The rush-hour trains from Victoria through to Kent didn’t stop at the smaller stations like Peckham Rye, so they’d come through at at least seventy. Energy delivered equals mass times velocity squared, equals not a lot left.

  ‘A straightforward suicide?’ said Harry, thinking of what Noble had told him earlier.

  ‘A suicide,’ said Wynn-Jones. ‘But not straightforward, no.’

  Harry felt his stomach twist again. He reached over and pushed the office door shut.

  ‘Did the police investigate it?’

  ‘To some degree. Why do you ask?’

  ‘The name’s come up in a case I’m involved with,’ said Harry. ‘What made you say it wasn’t straightforward?’

  ‘We found quite a few things wrong with Keisha Best,’ said Wynn-Jones, her own voice now quietened too. ‘CID couldn’t come up with anything tangible, though.’

  ‘Can we talk about this later?’ said Harry.

  ‘Sure. I finish at four, pending any drastic emergencies, but I have some academic work I ought to stay late for. What about a coffee? You can bring a large cappuccino from AMT down to my office, it’s by the cell path lab.’

  Harry laughed. He knew many consultants who’d trade caffeine for second opinions.

  ‘OK, that’s very—’

  He heard thumping on his office door and called, ‘Come in!’

  It was Dr Saltis, sweat on her face.

  Her expression told him everything he needed to know.

  ‘What is it?’ he said, getting to his feet.

  ‘Bed ten.’

  Idris. Harry started running.

  Hands washed, gloves on, apron on, hurry the fuck up, he’s crashing. Harry squinted to make out the readings on Idris’s vital signs monitor. Heart rate was fast, very fast. Blood pressure dropping, systolic in the low seventies.

  ‘What’s going on?’ Harry demanded.

  Vicky Faraway, the F2 junior doctor on the surgical ICU, was standing by the bed, listening to Idris’s chest. Harry stepped beside her and saw the issues immediately. Idris’s face, neck and hands were swelling up, his lips beginning to protrude from his face like a grotesque mask. It was an emergency Harry had seen once or twice before, full-blown anaphylactic shock, nothing to do with the infection in his lungs nor the damage to his abdomen. Until proved otherwise, it was an allergic reaction.

  ‘Get his oxygen up to a hundred per cent, now!’

  Faraway ran around to the ventilator to change the settings while Gladys Lane got a crash trolley to the end of the bed. There were drugs that could reverse it, but some of them had to go in centrally, rather than through the peripheral lines. Harry leant up to the central line running into the jugular vein in Idris’s neck and shouted for drugs.

  ‘IV adrenaline, fifty micrograms,’ he barked. ‘Change the Hartmann’s bag and give two-fifty.’

  Faraway started drawing up the drugs, powerful stimulants which would increase the blood pressure and oxygen delivery to Idris’s brain and kidneys, which was all Harry cared about. He didn’t need to worry too much about airway swelling, because the breathing tube would protect against that. Allergic reactions seldom killed people on the wards, but in ICU patients like Idris, the normal reserves of the human body to fight off such an insult were already depleted.

  Faraway finished drawing up the adrenaline and passed it to Harry, who injected it into the jugular line.

  ‘Is he on any new antibiotics?’ Harry said.

  ‘Co-amox. Started just now,’ Lane replied.

  ‘Stop the infusions!’ Harry ordered. ‘That’s the cause; he’s allergic to penicillin.’

  Before he had even finished speaking, Lane was disconnecting the two antibiotic infusions from the ports in Idris’s wrist, hanging the bags back up on the dripstands. Harry looked up at the vital signs monitor, waiting to see what Idris’s blood pressure was doing. Eighty over sixty, not brilliant. The daytime ICU charge nurse, Aoife Kelly, had arrived as well, and was setting up the fluids.

  ‘Another two-fifty of Hartmann’s, please,’ Harry ordered. The adrenaline he’d given was a huge dose, but the problem was the swelling in his tissues stopping the blood getting through. That could happen in his hands and feet and Idris would survive, maybe after an amputation or two. In his brain or his kidneys, it would kill him.

  Somewhere along the line, someone had fucked up, but that didn’t matter now. What mattered was making sure it didn’t kill the poor kid. They waited. Five minutes was the deadline for the adrenaline to work, and Harry was ready the moment it elapsed.

  ‘Another fifty of adrenaline, please,’ Harry ordered. Faraway drew up the dosage, her hands shaking, and injected it.

  ‘Do you want another bag of Hartmann’s in?’ Kelly said.

  ‘Please,’ said Harry. He looked up at Idris’s face. The swelli
ng hadn’t come down, but it hadn’t got worse, either, which was the normal state of affairs. In the interim, Saltis had run with a blood sample to the gas analyser and returned with the result.

  ‘O2 is nine point six, CO2 is four point five, pH is seven thirty-one, lactate of four and a half, bicarb of twenty.’

  The picture was confirmed. Thankfully, Idris’s oxygen levels were still holding up, despite his lower saturations. He was in shock, even with all the oxygen being pumped into his lungs and the fluid charging around his system. Blood pressure was up at ninety, the adrenaline beginning to take effect.

  ‘Harry, look at the ECG,’ said Saltis, as an alarm sounded on the monitor. Idris’s heart, weak and fast already, had hit a hundred and ninety beats a minute, dangerously high. The trace was saddle-shaped too, meaning the heart muscle was deprived of oxygen, the complexes of the trace so close together they were overlapping. Idris’s heart was beating so fast it could no longer pump blood. Harry dug his fingers into Idris’s neck, searching for a pulse that was so faint he couldn’t even be sure he felt it.

  ‘He’s in VT. Get me the pads, please! Has somebody called Rashid?’

  Harry looked up at the monitor. Blood pressure was perishingly low. Then Solomon Idris went grey and died, and the numbers disappeared.

  ‘CPR, now!’

  Aoife Kelly, leaning over, hands on Idris’s sternum, breaking ribs.

  ‘Do you want amiodarone?’ Saltis said.

  Harry opened up the defibrillator pads that Gladys Lane had thrust in front of him, sticking them onto Idris’s chest, looking up at the monitor, checking the rhythm.

  ‘No, we’ll shock him. Sync shock, two hundred.’

  A loud whine as the defibrillator started charging, and a chime as it finished.

  ‘Stand clear!

  Saltis recoiled away from Idris’s chest, and Harry stepped back, finger on the button.

  ‘Clear!’

  Idris’s body jerked weakly, his muscles flexing as the electricity pulsed through him. Harry interlocked his hands, ready to start CPR if the shock didn’t work, when the trace returned to the vital signs monitor, normal sinus rhythm, one hundred and ten beats a minute. Harry’s heart sank back down into his chest. The drugs Idris had needed to save him from the allergic reaction had sent his heart into overdrive and nearly killed him. His blood pressure was still in his boots.