by Ken McClure
Steven put the phone down and let out his breath in a long sigh of relief as the tension he had been feeling over Jenny left him. He felt in a good mood as he set out for Great Ormond Street Hospital. He wanted to have a word with an old friend before he went in to the Home Office. Jim Brewer and he had gone through medical school together. Brewer had pursued a more traditional career path and was now a consultant physician, married to Linda, a radiologist who worked at another London hospital. Steven had last seen them both at the christening of Gerald, their third child, some two years ago. He noticed that his friend’s reddish fair hair had become thinner in the interim and his waistline thicker as he headed for his forties but he seemed relaxed and at ease with the world. A round peg in a round hole, thought Steven. Can’t ask for better than that.
With the pleasantries over, Brewer asked, ‘Well, Action Man, what can I do for you?’
‘I need some advice,’ said Steven. ‘I’d like you to imagine that you have a hundred or so children living together at a school camp and one of them is confirmed as having tuberculosis… what happens next?’
Brewer rested his elbows on his desk and made a steeple with his fingers. ‘Well, let’s see. The child would have to be admitted to hospital for assessment and the start of treatment. Assuming that it wasn’t a problem strain — resistant to one or more of the front-line drugs — he or she would be started on triple chemotherapy — streptomycin, PAS and isoniazid. They’d be kept on that regime for at least six months but they could be released from hospital once their sputum had gone negative and they weren’t infectious any more. Does that answer your question?’
‘What about the other children?’
‘Close contacts would be screened for the disease, as would family members of course. Depending on the outcome of the tests they would be vaccinated or even put on treatment themselves if they were showing signs of infection.’
‘How about non-close contacts, say, children at the camp but from another school group?’
‘Skin tests.’
‘I take it it’s still the Mantoux test we’re talking about?’ asked Steven.
Brewer nodded. ‘Nothing much has changed in the last fifty years.’
‘What would you think to the idea of vaccinating the whole camp immediately?’
‘With BCG?’
Steven nodded.
‘Without skin testing first?’
Another nod.
‘Sounds way over the top,’ said Brewer. ‘Unless of course there was some good reason for doing it.’
‘Like what?’
‘Like it wasn’t a straightforward strain of TB. The World Health Organisation has been reporting multi-resistant strains appearing in Africa and Asia, some of them resistant to all known drugs. If they were to get a grip in this country we could find ourselves back in the nineteenth century with people dropping down with “consumption” all over the place.’
‘The affected child was an immigrant.’
Brewer shrugged. ‘That could be your answer. The problem cases are coming from the third world. Desperate times, desperate measures and all that.’
‘Thanks, Jim, you’ve been a big help,’ said Steven, getting up to go.
‘You’re welcome. You’ll have to come down and see us all soon.’
‘I’d like that,’ said Steven. ‘I’ll give you a call.’
It was raining quite heavily when Steven left the hospital but he found a cab that was just turning around to leave and got in, asking to be taken to the Home Office.
‘Bit of a mess your place these days,’ said the driver.
‘Really? I hadn’t heard.’
‘Yeah, they’re going to cut it up into smaller bits. Good idea if you ask me. It’s too bloody big the way it is, far too much for one bloke to run.’
‘Right,’ said Steven. ‘Well, another bloke’s always welcome…’
Steven had coffee and leafed through the current copies of a range of medical and scientific journals while he waited to see John Macmillan. He found a report about what Jim Brewer had mentioned regarding the appearance of drug-resistant strains of TB. It didn’t make for happy reading.
‘He’s off the phone,’ said Jean Roberts and Steven nodded that he was ready. She clicked the intercom and told Macmillan he was waiting.
‘He isn’t going to like this,’ murmured Steven as he passed Jean’s desk.
Macmillan was standing at the window with his back to Steven. He seemed deep in thought. ‘I trust you’ve brought some sunshine to brighten up a rainy day?’
‘Not exactly.’
Macmillan turned round. ‘Well, they do say it never rains but it pours. What’s the problem?’
‘I do need to know more about the child who contracted TB at Pinetops camp — the one they were reluctant to give you information about.’
Macmillan’s look suggested that he’d need to hear more than that to comply. He invited Steven to continue.
‘There’s something they’re not telling us. It’s not just a case of keeping a low profile for reasons of racial harmony. There’s a real chance the kid was suffering from one of the drug-resistant strains that’s been reported in the journals of late.’
‘Need that concern us?’
‘Not directly,’ agreed Steven. ‘But Scott Haldane was very upset about something that was going on with the green sticker business and I’d like to know what it was.’
‘It sounds like you’ve entirely abandoned the possibility that Haldane committed suicide?’
‘The girl herself says her scalding was an accident so there was no reason for him to feel guilty and certainly no other reason for him to take his own life.’
‘And the possibility of murder?’
‘I haven’t been able to rule it out completely and I won’t be until I know what upset him about the Trish Lyons case. I need to know more.’
Macmillan sighed and said, ‘Well, your instincts are usually spot on. I’ll let you know when I get the information. Anything else?’
‘Jean got me a list of all the green sticker kids. I’d like to know how many of them have had occasion to visit a doctor since their time at the camp and for what reason.’
‘You’re not asking for the medical records of over a hundred children, are you?’ asked Macmillan, appalled at the thought.
‘No, just the ones who’ve had their records updated since being at the camp — the records submitted to the TB monitoring group.’
‘Do you think some of them may have contracted TB?’
‘It would be as well to know.’
‘All right, you can ask Jean to deal with it on your way out.’
‘Thanks,’ said Steven, noticing the presence of a red folder on Macmillan’s desk. He always used red folders for new Sci-Med cases when they came in. ‘Anything I should know about?’
Macmillan looked thoughtful. ‘Our computer search picked up on the death of a medical scientist in Cambridge, young chap, hit and run, driver didn’t stop.’
The Sci-Med computer was programmed to scan news stories from all over the UK, looking for possible criminal activity related to science and medicine.
‘Sounds like a police matter,’ said Steven.
‘That’s my feeling too,’ agreed Macmillan. ‘But I’m going to keep an eye on how things develop.’
‘A university don?’
‘No, he worked for a biotech company, St Clair Genomics.’
EIGHT
Steven spent the weekend up in Glenvane. He took Jenny and Sue and Richard’s two children swimming on Saturday morning in Dumfries and then for a pizza lunch followed by ice-cream and a telling-off from Sue when they got back for being so indulgent with them. The children enjoyed seeing Steven being scolded, suppressing giggles behind their hands while he did his best to appear contrite, exchanging secret glances with them.
Things between him and Jenny were not as they’d been — the ghost of her outburst on the last occasion still hung in the air — but
she seemed more relaxed and even happy again, and that pleased him. There would, however, be no going back. The one sure thing he had to face was the fact that Jenny was growing up.
Steven flew back to London on the Sunday night shuttle from Glasgow rather than wait for the packed flight first thing on Monday morning. He had some paperwork to take care of and some shopping to do. The fridge in his flat was nearly empty as was the freezer and ready meals played a big part in his diet. Cooking did not interest him. He’d had to look after himself at university but student cuisine was no basis for success in the kitchen. Apart from that, his mother had done all the cooking at home and the army had taken care of such matters throughout his time in the military. When he felt like eating ‘properly’ he would go out to one of a number of restaurants he visited regularly. Tonight, when he’d finished his shopping, it would be Chinese food at the Jade Garden.
‘The child’s name is Anwar Mubarak,’ announced John Macmillan on Monday morning. ‘He’s thirteen years old and he’s currently in the children’s hospital in Leicester. He’s been diagnosed with pulmonary tuberculosis, affecting both lungs, but the lab reports no problems with the strain. It’s sensitive to all front-line antibiotics.’
‘Really?’ exclaimed Steven. ‘That’s a surprise.’
‘Why?’
Steven told Macmillan about Jim Brewer’s assertion that the medical response at the camp had been over the top if there was no reason to believe a ‘difficult’ strain of TB was involved.
‘They wouldn’t know at the time if it was difficult or not,’ pointed out Macmillan. ‘Maybe they were just being ultra-cautious.’
‘I suppose,’ agreed Steven. ‘But it still doesn’t explain why Scott Haldane was so pissed off.’
‘You don’t let go, do you?’ smiled Macmillan.
Steven shrugged.
‘I need hardly remind you that HMG still wants the identity of the boy to remain a secret.’
‘Understood.’
‘Jean has the other stuff you asked for. Let me know when you want to lay this to rest.’
Steven smiled as he left Macmillan’s office. This was the nearest Macmillan would come to suggesting that he might be chasing rainbows. He collected the file from Jean and went to the unit library to read it, collecting a cup of coffee from the machine in the corridor on the way.
Steven learned that fourteen of the children who’d been present at Pinetops camp when Mubarak had been diagnosed with TB had subsequently sought treatment from their GPs. He read with some alarm that one had actually died. Keith Taylor, a thirteen-year-old boy, had succumbed to the ravages of necrotising fasciitis after having been admitted to hospital in Carlisle. Steven screwed up his face as he read the report, thinking how cruel fate could be and what his parents must have gone through, watching their son die a terrible death.
Patricia Lyons was on the list too, reported as suffering from vitiligo and currently recovering from a scalding accident. Two more children had been treated in hospital for burns. Three had been treated for broken bones — two with arm fractures, one with compound leg fractures after falling off his bike. Four of the children were being treated for impetigo…
Impetigo was a skin complaint. Steven had been looking for any early warning signs of TB among the green sticker children but now the four cases of impetigo leapt out at him. Trish Lyons had been suffering from vitiligo, another skin condition. That made five reports of skin complaints out of one hundred and eight children, six if the boy who’d died of necrotising fasciitis was included. Maybe not significant but… Steven read on and alarm bells started to ring when he read that three more children had been referred to their GPs suffering from unspecified ‘loss of pigment’ in their skin. Nine.
What the hell was going on? There was no sign of TB in the children but the incidence of skin complaints must be well above what could be expected in previously healthy twelve-to thirteen-year-old children. Four with impetigo, three with unspecified ‘loss of pigment’, Patricia Lyons with vitiligo and a boy who’d died of necrotising fasciitis — the flesh-eating disease… Surely this couldn’t be coincidence but if not, what was he suggesting? That there was some common cause of their ailments? That they had all contracted a skin condition through being at Pinetops camp?
Steven rubbed his forehead nervously as he tried to decide what to do next. The only thing the children had in common, apart from their age, was that fact that they had attended Pinetops camp at the same time and had been given BCG vaccine after a TB scare. BCG vaccine was something that had been used for fifty years so it was hardly likely to be that causing the trouble. According to Jim Brewer, it wasn’t the most effective vaccine in the world but it was certainly safe. This left the possibility that something the kids had been exposed to at Pinetops had been the cause of the problem although, he reminded himself, it did not seem to be a single problem. Vitiligo, impetigo, loss of pigment were all vague terms. Even necrotising fasciitis could have a number of causes. Maybe he had been precipitate in lumping them all together as ‘skin problems’ but he would certainly investigate further and he would start with the one that had caused Keith Taylor’s death.
The pathology report wasn’t included in the file Jean had given him — the cause of death had simply been put down as necrotising fasciitis. He needed to know more about the bacterium that had caused it. He wanted to know the exact cause of death.
Two days later, Steven finally got access to the PM report on Keith Taylor. His physician had made the original diagnosis of necrotising fasciitis after flesh ‘instability’ had been noted in several areas of Keith’s body. The Carlisle hospital pathologist had confirmed the diagnosis at post mortem but no cause had been given. The lab reports had all been negative.
Negative? Steven shook his head in frustration. The boy had an infection that was eating him alive and the lab had come up with nothing? What the hell did they imagine caused it, pixie dust? This was beyond… He stopped himself in mid-thought and cautioned himself to calm down. There had to be a rational explanation some where. It was just a question of finding it. He phoned the hospital in Carlisle and asked to speak to the consultant microbiologist. He turned out to be an Irishman by the name of O’Connor.
‘It was most unusual,’ conceded O’Connor. ‘We simply failed to grow any bacterium or virus from the boy’s tissues.’
‘But according to the medical report, his flesh was so infected it was falling off him,’ said Steven.
‘I know,’ said O’Connor. ‘But the fact remains, the cultures were all negative and so was the serology.’
‘What did you test for?’
‘Just about everything we could think of.’
Steven put the phone down, feeling far from happy but not quite sure what to do about it… or rather, he was sure but was unwilling to contemplate it unless he could convince himself and John Macmillan that it was absolutely necessary. It would involve the exhumation of Keith Taylor’s body.
Steven made his request to Macmillan the following morning having agonised about it long and hard and Macmillan had reluctantly agreed after unsuccessfully reminding Steven, unnecessarily, just how much upset and stress this was going to cause to the boy’s parents.
‘I know,’ agreed Steven. ‘But there’s something very wrong here. I have to find out why Keith Taylor died. I want a Home Office pathologist to carry out a second post mortem and a top lab to analyse the samples.’
Keith Taylor had been buried in a cemetery about half a mile from his home. A new granite headstone recorded his untimely death and the undying love of his parents. Bunches of fresh flowers marked the grave and cards spoke of his youth and all too premature demise. They appeared unreal under the lights from the rig set up by the police to illuminate the scene, an operation which started at midnight behind a canvas awning to avoid prying eyes.
‘I hope you’ve got a damned good reason for this,’ said the police superintendent who was overseeing the operation. The disapproval was plain
in his voice. ‘As if losing their son wasn’t enough…’
Steven resisted the temptation to snap back: Of course I’ve got a good reason. Do you think I do this as a bloody hobby? Instead he remained silent, eyes fixed on the digging, aware of the patter of rain on the shoulders of his waxed cotton jacket. He saw the coffin hoisted from the ground and loaded into the back of an unlettered black van for transport to the city mortuary where the second post mortem was to be carried out. He left the scene and returned to his hotel to grab a few hours’ sleep before joining the Home Office pathologist who was due at nine.
The post mortem was carried out with full bio-precautions being observed. The danger associated with bugs causing necrotising fasciitis was not to be underestimated and the pathologist, Steven and two assistants were fully gowned and masked with full-face visors being employed.
‘All right?’ asked Mark Porter, the pathologist detailed by the Home Office to carry out the examination. Steven nodded.
‘Bloody hell,’ were Porter’s first words as he began his work. ‘I’ve seen a few cases of Nec Fash in my time but never one as bad as this… he’s absolutely riddled… the flesh is like… Jesus, what a mess…’
‘You’re absolutely sure about it being necrotising fasciitis?’ asked Steven.
‘What else could it be?’
‘But the hospital lab couldn’t grow anything.’
‘Crazy,’ said Porter. ‘His flesh must be hoaching with bacteria.’
‘Can you take lots of samples, please? It’s important we find out exactly what caused this. I don’t suppose you’d care to hazard a guess about the bug’s identity?’
Porter gazed down at the corpse. ‘I’d rather not. Like I say, I’ve never come across anything as bad as this although…’
‘Yes?’
‘It might be a one-off. I mean, the boy might have been ultra-susceptible to the bug. It happens. I’ve seen AIDS victims succumb to infections that rip through them like a tsunami hitting a beach simply because they have no body defences left when the HIV virus is finished with them. On the other hand of course, it could be the bacterium itself that’s ultra-virulent; in which case, we could all be up a certain creek without a paddle.’