by Ken McClure
‘We won’t know for sure until…’ Sands paused as he realised he was about to mention the post mortem that would have to take place and changed his mind. This wasn’t the time… ‘We don’t have all the lab results back yet but it now seems pretty certain at this stage that your son died of something we call necrotising fasciitis.’
Marion Taylor looked blankly over the top of the wad of tissues she held to her mouth, Dan shook his head slightly.
‘The papers often refer to it as the flesh-eating bug,’ said Sands, letting his voice fall to a whisper in deference to the images he knew he was conjuring up and causing Dan to close his eyes again.
‘And what causes that?’ asked Dan, clearing his throat and trying to sound controlled when, in reality, his heart was breaking.
‘It’s a rare condition, usually caused by a bacterium called streptococcus,’ said Sands. ‘It’s a strange bug because it can cause so many different conditions, ranging from sore throats to scarlet fever and unfortunately, on rare occasions, to necrotising fasciitis. We really don’t know why its behaviour can change so dramatically. But other bugs can also cause the condition, staphylococcus, clostridium, vibrio and a number of others. We’re not at all sure what triggers it off.’
‘And these drugs you were giving Keith…?’
‘In theory, they should have dealt with streptococcus, and I would have thought most of the others,’ said Sands. ‘But obviously, on this occasion, they didn’t. Hopefully the lab will be able to tell us why not.’
‘I want to see my son,’ said Marion Taylor in an unexpectedly firm voice.
Sands moved uncomfortably in his chair. ‘Mrs Taylor… I really don’t think that’s a good idea…’
‘I want to see him.’
Sands looked to Dan Taylor for support before saying, ‘Keith underwent a great deal of trauma before he died although I can assure you he felt no pain. He never regained consciousness. I honestly think it would be better if you just remembered Keith the way he was.’
Dan Taylor got up and put his arms round his wife while maintaining eye contact with Sands. ‘The doctor’s right, love. Let’s just remember our lad the way he was, not as the victim of some…’ He searched for inspiration. ‘Bastard disease.’
The words ‘flesh-eating’ were still going round and round inside his head. He was praying that Marion wouldn’t stick to her guns. She looked up at him and finally acquiesced with a small nod.
‘Bloody bizarre,’ muttered pathologist Simon Monkton. ‘How come the lab can’t grow anything when he’s absolutely riddled?’
‘I think they’re quite embarrassed about that too,’ replied Sands, who had chosen to be present at the post mortem on Keith Taylor. ‘I spoke to the consultant bacteriologist earlier. He was very apologetic.’
Monkton gave Sands a look that suggested apologies were less than useful.
‘You are sure it was necrotising fasciitis?’ asked Sands.
‘What else could it be?’ replied Monkton. ‘It’s practically eaten the poor kid alive.’
‘So that’s what you will be putting down as cause of death on the death certificate?’
Monkton paused in what he was doing and looked at Sands over his half-moon specs. ‘Of course. Why do you ask?’
‘The boy’s GP told me that Keith Taylor was part of a monitoring study being carried out by the Department of Health. He is obliged to inform them immediately about any health issues that crop up.’
‘Health issues?’ snorted Monkton. ‘I suppose you could say dying of necrotising fasciitis was a health issue that cropped up… poor kid. I take it you are absolutely sure he wasn’t taking any antibiotics when he became ill?’
‘That was the first thing I thought of when the lab failed to grow anything from his specimens but his GP and his family assure me that he was taking nothing apart from his usual immuno-suppressant drugs.’
‘Ironically, I suppose that’s probably why the infection ripped through him so fast,’ said Monkton. ‘The drugs would severely compromise his natural defences. I take it the suppressants were stopped as soon as he was admitted?’
‘Of course.’
‘Well, that’s it then,’ said Monkton, stripping off his gloves and dropping them in a pedal bin he opened with his foot. ‘When God throws a curve ball… you’re out.’
‘His parents are coming in later to be told the findings of the PM.’
‘Something no parents should ever have to do,’ said Monkton. ‘I don’t envy you dealing with the living.’
‘Horses for courses,’ said Sands. ‘I can’t say I envy you your job either.’ He was looking down at the open cadaver of Keith Taylor.
THREE
Edinburgh
March 2007
‘I don’t want to go to school.’
Virginia Lyons glanced at the kitchen clock on the wall. ‘Look, Trish, you have to go. There’s nothing wrong with you. Why have you started doing this to me? You’ve always liked school, you know you have.’
‘Don’t want to go,’ mumbled her daughter, looking down at the floor.
‘Forget the “don’t want to go” nonsense. There has to be a reason. Tell me.’
‘Just don’t want to, all right?’
Virginia stayed silent for a moment to let the spark of anger in her daughter die down. ‘Are you being bullied?’ she asked. ‘Is that it? Just tell me if you are because I’m not having that. I’ll go straight to the head teacher about it. We’ll nip this in the bud.’
Trish shook her head silently, still staring studiously down at the floor.
‘Then what?’
Silence.
Virginia looked at the clock again and felt her stomach tighten. She was going to be late for work again and, as a divorced single mother, she needed the job even if it was only as a filing clerk in an estate agent’s office. It was a busy office. ‘Please Trish, tell me.’ She tried to make eye contact by taking Trish’s hands in hers and pulling her to her feet.
‘They’ve started calling me Patch in the gym class.’
‘Patch? And this is what this is all about?’ exclaimed Virginia. ‘Some silly children calling you some silly nickname?’
‘I don’t like it. I want it to go away.’
Virginia back-pedalled on derision when she saw the tears start to run down her daughter’s face. In recent months Trish had developed a patch of white skin on her right shoulder which ran nearly all the way down her right arm. Since she was dark haired and sallow skinned, it was very noticeable. The doctor had said it was really nothing to worry about and probably the result of hormonal changes in her body — she had just turned thirteen. He was confident that, given time, the discolouration would disappear of its own accord but it had been three months now without much change if any.
‘Look, if it will make you any happier, we’ll go back to the doctor and tell him there’s been no improvement.’
Trish nodded. ‘Yes please, Mum.’
‘You go off to school now and ignore these ignorant people. I’ll call the doctor before I leave for work and try for an evening appointment. Okay?’
Trish nodded and kissed her mother goodbye.
‘I’m not sure what you want me to do,’ said Dr James Gault when Trish and her mother told him the rash wasn’t getting any better. He sounded irritable. ‘It’s not technically a rash,’ he corrected. ‘It’s just an area of skin discolouration and most probably psychological in origin.’
‘Whatever it is, it’s showing no signs of going away and some of her class-mates have started calling her names and it’s very upsetting.’
Gault shrugged. ‘It’s absolutely harmless and what’s a little name calling. Sticks and stones, eh Trish?’
Trish stared resolutely at the floor.
Virginia felt a wave of exasperation sweep over her at what she felt was Gault’s lack of sensitivity. ‘It’s not harmless if it’s making her so unhappy,’ she pointed out. ‘It’s only a matter of time before it begins to
affect her school work. School kids can be very cruel.’
‘I’m reluctant to refer her to a skin clinic when it’s clearly just a harmless and almost certainly temporary loss of pigment. Frankly it would be a waste of time and resources.’
‘Then I’d like a second opinion,’ said Virginia.
Gault looked as if he might be thinking about arguing but then he changed his mind and conceded. ‘Very well,’ he sighed. ‘I’ll see if one of my colleagues will take a look at her but I’m sure they’ll tell you the exact same thing. It’s impossible to predict how long these things will take to go away. The more you make of them the more likely they are to persist.’
‘Tell that to her class-mates,’ countered Virginia.
Gault excused himself, leaving Virginia and Trish alone in his surgery. Although he was probably gone for less than two minutes, Virginia found the seconds passing like hours as she and Trish sat in silence. Both were unhappy, Virginia because she hated coming into any kind of conflict with authority and Trish because it seemed that nothing could be done to help her.
Gault returned and said, ‘Our Dr Haldane will see you after his next patient… if you’d care to wait in the waiting room…’
Virginia found Gault’s manner was now even more curt and decidedly distant but this was not unexpected. He was clearly taking her request as a personal slur. Gault held the door while she ushered Trish out first. She neither made eye contact with him nor said anything.
Scott Haldane beamed broadly when Virginia and Trish entered and Trish took to him immediately. He was young, broad-shouldered and wearing a smile that suggested openness. ‘Hi, how are you doing?’ he asked Trish.
‘All right,’ she mumbled.
‘All right apart from the patch on your arm, eh? Let’s have a look at it, shall we?’
Trish managed a nod and the suggestion of a smile. She took off her blazer and cardigan before slipping off one sleeve of her blouse and holding out her arm for inspection.
‘How long have you had this, Trish?’ asked Haldane, closely examining the area of white skin running up Trish’s arm.
‘Just over three months,’ said Virginia.
‘Thirteen weeks,’ said Trish.
Haldane smiled. ‘You’re the one counting the days,’ he said to Trish as if it was a secret between them. ‘Any pain or tenderness?’
Trish shook her head.
‘Good. How about itching, scaliness?’
Another shake of the head.
‘Good show. So it’s just that it’s a bit of a nuisance that’s a bit slow to go away eh?’
‘A bit?’ exclaimed Trish with such vehemence that both Haldane and Virginia smiled.
‘Have you been abroad in the last year, Trish?’
‘I’ve never been abroad,’ said Trish.
‘That’s not strictly true,’ said Virginia. ‘Although you were too young to remember, your dad and I took you with us to Greece when you were two.’
‘Before you broke up,’ said Trish.
‘And when was that?’ asked Haldane cautiously.
‘The break-up or the holiday?’
‘The break-up.’
‘Three years ago.’
‘And three months,’ added Trish.
Haldane looked thoughtful.
‘She still sees her dad regularly,’ said Virginia, figuring out which road the doctor was about to travel down. ‘We all get on.’
Haldane nodded.
‘Why did you ask if Trish had been abroad?’
‘Just a routine question.’
Virginia seemed unconvinced and didn’t hide the fact. The question lingered in her eyes. Haldane, however, diverted his gaze and got up from his seat. He brought out a sterile stylet from a small chest of shallow drawers sitting by the wash-hand basin and removed its wrapping. ‘Trish, I’m going to give your skin a little prick here and there. I want you to tell me what you feel.’
‘Dr Gault didn’t do this,’ said Virginia, a comment that Haldane ignored as he moved the sharp point around the area of discolouration on Trish’s arm.
‘Not sore,’ said Trish. ‘Not sore… not sore… not sore.’
‘Good. Let’s try your other arm.’
Trish removed her blouse completely and placed her other arm on the table while Haldane fetched a new stylet. ‘Here we go again. Tell me what you feel.’
‘A bit sore… Ouch!.. Ouch!’
‘Sorry, Trish,’ said Haldane, ‘I was a bit too heavy handed there. Sorry. Okay, you can put your blouse back on. I think maybe we should refer you to a specialist skin clinic, just to see what they say.’
‘What do you think it is?’ asked Virginia anxiously.
‘In all probability the chances are that it’s exactly what Dr Gault thinks it is — just one of these unfortunate reactions we see now and then resulting from some kind of emotional stress — but there’s no harm in being absolutely sure and, as it’s clearly causing Trish some anxiety, the clinic may be able to suggest some treatment to speed up things — UV light or something like that. I’ll have a chat with Dr Gault after surgery’s over and we’ll get things moving on the referral front.’
‘Thank you so much, Doctor,’ said Virginia. ‘I didn’t mean to cause trouble. I just want the best for Trish.’
‘Nothing wrong with that, Mrs Lyons.’
‘How did you get on with the over-protective mother?’ asked James Gault, putting his head round the door of Haldane’s office when the last patient from evening surgery had gone.
Haldane smiled. ‘She’s not so bad,’ he said. ‘Her kid’s having a hard time at school and she feels helpless. Perfectly understandable.’
‘Fine, but you have to remember we’re not social workers,’ said Gault. ‘What did you think of the child’s skin problem?’
‘I think you’re probably right but all the same I’d like to refer her to the skin clinic just to be on the safe side. There were certain unusual aspects that I’d like checked out.’
‘What aspects?’
‘It’s probably just an over-active imagination on my part,’ smiled Haldane, getting up from his chair and giving his colleague a reassuring touch on his upper arm.
‘Well, if you really feel you must,’ said Gault, sounding slightly miffed. ‘Perhaps in the circumstances you’d care to do the paperwork?’
‘Of course. Remind me, who’s the main man at the skin clinic?’
‘Ray McFarlane. He’s the kind of chap who won’t thank you for wasting his time.’
April 2007
‘Look, I’m sorry, Trish, I just don’t know what more we can do,’ said Virginia Lyons as they came out from morning surgery after getting the results from the skin clinic. ‘The specialist agrees with the other doctors. He says it’s something called vitiligo. It’s nothing serious and it’ll go away in its own good time. Unfortunately, there’s nothing they can do to speed it up so you’ll just have to persevere until it does. I know you hate it, sweetie, but hang on in there, huh? Let’s just be grateful it isn’t something more serious.’
‘You don’t know what it’s like,’ mumbled Trish.
Virginia looked at her daughter with a lump in her throat. She hated seeing her so unhappy. ‘I could write and ask Miss Neilson if you could be excused gym classes until it clears up?’
Trish nodded.
‘When’s your next class?’
‘Tomorrow.’
‘I’ll do it tonight. You can take the letter with you in the morning.’
Virginia came home next evening to find Trish sitting at the kitchen table in tears. Her shoulders were heaving, her head resting on folded arms. Wrapping her arms round her made matters worse for a few moments until cuddles and soothing words finally did their job and she was able to get some sense from her daughter.
‘They made me do gym.’
‘What?’ exclaimed Virginia. ‘But what about the letter I gave you?’
‘Miss Neilson said there was nothing physically wrong w
ith me so I’d need a letter from a doctor before I could be excused. Everyone was laughing at me.’
‘Give me strength,’ murmured Virginia, entertaining notions of flattening Miss Neilson with a hockey stick. ‘All right,’ she said. ‘If it’s a letter from a doctor they want, a letter from a doctor is what they’ll get. I’ll go round to the surgery first thing in the morning. When’s your next gym class?’
‘Friday.’
‘Plenty of time.’
‘Frankly, Mrs Lyons, I’m inclined to agree with the school. There is no physical reason why your daughter shouldn’t take part in gym classes,’ said James Gault in response to Virginia’s request. ‘I’m very reluctant to take sides in this sort of thing.’
Virginia took a deep breath. ‘It’s not really a physical reason we’re discussing here, Doctor.’
‘Ah, we’re moving into the realms of popular psychiatry, are we? Underlying psychological issues and all that?’
‘No, we are bloody not,’ replied Virginia, her patience coming to an abrupt end. ‘We are attempting to move into the realms of common sense but obviously failing. Kids don’t see things the way adults do.’
Gault seemed shaken at the outburst. He paled and swallowed before digging in and saying, ‘I have no intention of referring your daughter to a child psychiatrist over a little bit of skin discolouration.’
‘But that’s the whole point. Trish doesn’t see it as a little bit of skin discolouration. It’s making her whole life a misery. I’m not asking you to refer her anywhere. I’m asking you to write a simple bloody letter which anyone with a modicum of imagination would understand the need for… but not, apparently, you.’
Gault swallowed again. ‘I think we may have come to the point where a change of doctor…’
‘Would be most welcome,’ completed Virginia.
‘I’ll get the forms,’ said Gault, getting up.
‘That’s going to take time. Trish needs help now. I’d like to transfer within the practice to Dr Haldane; Trish seemed to like him.’