Authors: Paul Carson
Tags: #Fiction, #General, #Mystery & Detective, #Thrillers, #Suspense, #Crime
© 1999 Paul Carson
To my wife, Jean, and my children, Emily and David, for
putting up with the stolen hours in the attic.
To my agent, Darley Anderson, in London, for his
To my editor, Lynne Drew, at William Heinemann, for
her astute and constructive criticisms.
To sales and marketing at Random House for their
Finally to my partner, Dr Conor O'Toole, for looking
after my health.
My thanks for technical advice to Professor 'Jack' Harbison, forensic pathologist to the Republic of Ireland; forensic psychiatrist Dr Art O'Connor; psychiatrist to the National Drugs Treatment Centre in Dublin, Dr John O'Connor; orthopaedic surgeon Paul McNamee and finally Dr Rory O'Donnell, haematologist.
I am also grateful to Dr James Donovan, founder and current head of Ireland's Forensic Science Department who still carries the scars of an attempt to assassinate him. Thanks also to the members of Garda Siochana, Ireland's largely unarmed police force, who provided background information.
8.15 am, Tuesday, 12 May
Mercy Hospital, Dublin.
Dr Frank Clancy, physician specialising in diseases of the blood, crooked a phone between right ear and shoulder as he scribbled notes on a patient chart in his office.
'Hi, Clancy here.'
A youngish female voice came back.
'Dr Clancy, this is the lab. We have a rather unusual blood film we'd like you to look at.'
Clancy flicked over a page and continued his hurried scrawl, glancing at his watch.
'What's so unusual?'
'There's no white cells. It's a full blood count and we're not finding any white cells.'
Clancy stopped scribbling.
'Full blood count?' he checked.
'No white cells?'
'At all?' Alarmed, incredulous.
Clancy slipped the chart onto the desk in front and sat down slowly, disturbed by what he was hearing. He shifted the phone into his right hand, thinking furiously. The absence of white cells was extremely serious, they were the body's vital defenders against infection. Without them no patient could survive. He ran a hand
through his hair, then glanced again at his watch. Behind time as usual.
'I'll be down when I can. Get the medical history and any other blood screens.'
'Right away,' the girl replied.
'Oh,' Clancy cut back, 'leave details and ward number. I'd like to examine the patient myself.' His voice suggested urgency.
'It'll all be here in fifteen minutes.' Calm and efficient.
Clancy forced a grin and stood up. 'Okay, I'll be down soon.'
'Thanks, Dr Clancy.'
Frank Clancy pulled on his white coat and hurried out from his office to the bustling wards. He steered past a group of students squinting at films on an X-ray viewing box and along to his medical team waiting at the middle of a row of beds.
'Hi, sorry I'm late,' he announced, avoiding the disapproving frown of the ward sister. 'Where do we start? Who's going to tell me about this patient?' He picked up a chart and skimmed the tattered, dog-eared pages until he found the most recent entry, then nodded to his second in command. 'Off you go.'
As the monologue began Clancy's thoughts were already elsewhere. The telephone call worried him. Yet another patient on the wards deficient in white cells. That's two, maybe three in as many months. What's going on?
CONCERN GROWS FOR MISSING US SURGEON'S DAUGHTER
Police are concerned for the safety of missing schoolgirl Jennifer Marks. The eighteen-year-old failed to return home yesterday and a search for her began late last night. Extensive inquiries failed to determine the teenager's movements after she left school yesterday afternoon. The search continued until after dark, when it was finally called off. Officers resumed door-to-door questioning at first light this morning. Jennifer Marks is the only daughter of Dan Marks, the top US cardiac surgeon appointed head of this city's recently established Heart Foundation. He was unavailable for comment this morning.
Tuesday, 12 May,
Dublin Evening Post
Tuesday, 12 May.
A gasp filled the lecture theatre.
'It is not my intention to disturb you this morning.' Declan Kelleher, trauma surgeon at the Mercy Hospital, Dublin, stood at a lectern studying the tiered rows of third-year medical students. There was no mistaking the shocked expressions on each young face. A few had momentarily averted their eyes from the image on the screen behind him. 'However in trauma you often see the worst side of medicine, the blood and guts.' He paused, then half turned to the colour transparency on display. In his right hand a light source directed a tiny red blip onto the screen.
'Let's try and make out what we are looking at.' The red blip stopped at a bend on a limb. 'That's the knee joint,' he explained, then moved the blip slowly along the image, 'that's what's left of the lower tibia and fibula and ankle joint.' Whispers spilled down from the middle rows. At the back a much older man shifted uneasily in his seat and eased out his right leg for comfort. He did not look towards the front, eyes firmly closed, lids flickering. He listened intently to every word. Kelleher turned to face the group again and pressed a button on the lectern.
'Before we go any further, maybe we should remind ourselves what a normal lower limb looks like on X-ray.'
As a silver-grey image slotted into place, Kelleher trained the red blip. 'That's the femur, the large, strong bone that connects hip and knee joints. That's the knee joint itself and underneath you can see normal tibia and fibula, ankle joint, metatarsal bones and phalanges, what we recognise as our toes.'
He turned back to the audience. Most eyes were on the screen, the rest on him. His tall frame, with head of grey hair that always seemed combed into permanent disorder, blocked one or two and they craned to see past him.
'Let's look at that first slide and see how much damage this patient sustained.'
The transparency glided onto the screen and all eyes turned to inspect. This time none of the heads turned away, the initial shock had abated. The trainee doctors were learning to steel their stomachs as much as their nerves. In the very back row a set of eyelids momentarily flickered open then closed just as quickly. In that split second he saw everything and shuddered involuntarily despite the uncomfortable warmth of the room. The image was overwhelming. Against a green background of theatre drapes rested a leg. The slide captured a little of above-knee and all of the below-knee structures. The knee was bent at a thirty degree angle. From about two hands'-breadth below the knee the skin surface abruptly ended and was replaced by a mass of bloodied and bulging muscle and the distinct whiteness of freshly exposed bone. The visible bone was clearly shattered and slivers stood out like tooth picks.
'To be completely honest,' confessed Kelleher, 'I'm not sure what I can identify here.'
The red blip picked out a white shard. 'That might be part of the tibia.' The blip settled on a reddened mass. 'That could be gastrocnemius muscle, possibly part of soleus. I'm not sure which is which though.'
Another silver-grey image slipped onto the screen. As it did someone in the middle rows groaned loudly. 'Yes, pretty ghastly, isn't it?' agreed Kelleher as he inspected the result. The red blip shot up and rested on a structure picked up on X-ray. 'That's femur,' the blip slowly traced a path from normality to utter chaos, 'that's normal knee joint, that's the upper third of the tibia and fibula and the rest is broken, smashed, crushed bone.'
He turned back to the audience and scanned the faces. Most were still riveted by the transparency, a few heads bent as hands scribbled notes, one or two stared directly at him. He noted the lowered head at the back.
'As I said, I'm not in the business of shocking you, but in accident and emergency, you deal with what comes through the door, no matter how bad it looks.' No one spoke, pens paused, all eyes now directed at him. 'However I thought you might like to see how this patient fared, what was the outcome of that bloody mess we saw a minute ago.'
Kelleher flicked a switch on the lectern and the theatre lights flashed on. Eyes were rubbed to adjust to the change, heads moved closer as comments were exchanged. Pens returned to paper and notes were made. In the back row the man shifted his leg again, using his left foot to drag the other back slightly. He massaged the lower part of his right leg through his trousers, grimacing as he felt a twinge of pain.
Kelleher raised a finger. 'I'd like to introduce the owner of that mangled limb. Can you come down to the front, superintendent?'
All heads swivelled.
A distinct Donegal accent answered. 'Yes, if you give me a minute.'
'I'd like to introduce you to Detective Superintendent Jim Clarke,' Kelleher said.
Clarke struggled out of the cramped seat and settled his single crutch carefully in front before swinging his right leg
into the aisle. It hit the floor with a thud. He took his weight on the left leg to stand up, then slipped his right arm through the crutch guide and grasped the hand rest before moving any further. Each step down the aisle seemed painfully slow. The students could not take their eyes off the slightly stooped figure. He was slim, almost thin, and one inch above a full six feet in height. He wore regulation police uniform. Those near the aisle could see the pain that flickered across his face with each step. Near the bottom he stopped and pulled a handkerchief from his side pocket to wipe his brow. Then he brushed fingers through the bit of straggling hair still left after fifty-two years of life, trying to present a better image.
'I'm sorry, I'm a bit slow on steps.'
'Take your time,' encouraged Kelleher as he pulled a chair closer to the lectern. He
the microphone from his jacket lapel and held it until the other man had settled again, then handed it to him.
'Superintendent Clarke,' Kelleher explained, 'is a senior member of the Serious Crime Squad.' Clarke looked at the rows in front and smiled awkwardly. He seemed embarrassed, like someone about to be given a medal at an awards' ceremony and not sure how to handle the occasion. 'On 25 July two years ago he was admitted to this hospital with the injuries you saw. I was on duty and involved in his immediate management.' Kelleher half turned. 'He's here to relate how those injuries came about.'
Clarke acknowledged his comments with a slight nod.
'Also with us,' continued Kelleher, 'is Dr Patrick Dillon.' A tall, heavily built man stood up from one end of the front row and faced the audience. He was wearing neatly pressed flannel trousers under a navy blazer with a white handkerchief in breast pocket. He unfolded a pair of glasses and slipped them on, then shielded his eyes against the theatre lights. His hair was dark and slicked back in a duck tail.
'Dr Dillon,' explained Kelleher, 'is a forensic psychiatrist, someone who deals with the criminally insane. He has trained in secure psychiatric units where staff are taught self-defence and carry Mace spray on the wards. He has also worked in Broadmoor, the main British hospital for such offenders. He has just been appointed head of the forensic psychiatric department at Rockdale Hospital in County Meath and can be called upon to assist police with their assessments of certain serious crimes.' Kelleher was reading from notes on the back of an envelope. 'As part of this series of early morning lectures,' he went on, 'I wanted you to consider trauma from angles other than medical management. Look behind the scenes, as it were.' He paused briefly. 'Often in casualty departments we see criminal violence. Rape, stabbing, shooting, bludgeoning. Severe, deliberate inflicted injuries. Frequently we ask ourselves "Who could do such a thing?" You're about to hear how one such event happened, then have the background explained.' Kelleher nodded towards Dillon and sat down in the front row to listen.
Patrick Dillon moved to the lectern and scanned the faces in front. 'Psychiatry,' he began, 'is the study and treatment of disorders of the mind.' His voice was quiet yet distinct, with a slight English accent. 'Most psychiatrists spend their working lives dealing with conditions such as depression, anxiety states or schizophrenia. The forensic psychiatrist deals with the criminal mind. More importantly he deals with the criminal but mentally abnormal, those whose acts of violence, often murderous, cannot be presented to the courts in the usual manner.' The audience was gripped, attention unwavering.
'My work,' continued Dillon, 'involves psychiatry and criminality, two of the most intriguing fields of human behaviour.' His voice became hard and deliberate. 'I look into the mind of the murderer.' The words chilled and Jim Clarke turned sharply.
'Occasionally,' Dillon went on, 'I am asked to provide a
psychological profile, a characterisation if you like, of the person most likely to be involved in specific crimes.' He slipped his glasses back into a side pocket. 'After we've heard the superintendent's story,' he finished, 'I will attempt to explain the mental status of the criminality involved in his case.' He stood down and moved to the side.
Clarke shifted slightly on the chair and eased out his right leg with the top of his left foot. He reached over and rested the crutch against the lectern, wiped his brow with his handkerchief, then paused to collect his thoughts. And control his emotions. He'd had to go over this so many times he could have recited it in his sleep. But each retelling was just as difficult, the pain almost as intense, the horror as real.
'I was on surveillance duty in Blackrock, south Dublin,' he began, 'in an unmarked squad car.' His voice sounded weak despite the microphone and students at the back leaned forward to hear. 'There was myself and one other officer. We'd been following a Dublin drug baron for months, watching collection and delivery patterns, mapping distribution networks.' He stopped and nodded towards the glass of water resting on the lectern, noticing a few sympathetic smiles flicker along the front row. The glass was passed over.
'We were parked outside a pub along the seafront,' he continued. 'A black transit van pulled in and drove very slowly to an empty corner, well away from the rest of the cars. It looked out of place immediately, as though the driver had chosen that exact spot for a reason. We checked with headquarters and learned the number plates were false. The driver left the van without locking it and walked towards the pub. My colleague waited three minutes, then followed on foot. I stayed in the car watching. I noticed a young couple sipping on beer cans a little way away but didn't pay much attention. They were laughing a lot, as if caught up in their own company.'
For a brief second he was back in the driver's seat, wondering whether to sit tight and wait or check the van. He could almost hear again the static on the radio, smell the sea, hear the waves crashing on rocks behind the high wall barely twenty yards away.
'I got fed up waiting. That was my only mistake, I got fed up waiting.'
The van was clean, only empty boxes, stacked one on top of the other in a neat pile and pushed against the driver's side panel. It had taken him less than ten minutes to open and check each one. As he made his way back he noticed the young couple had gone.
'I can't remember what I felt first. I do remember turning the key in the ignition, then there was a sudden bang and I felt pain in my legs, or maybe it was the bursting in my ears. I really can't remember.'
He stopped and looked up. The lecture theatre was silent, not a hand moved, not a pen scribbled. 'The next I remember was being dragged from the car and someone screaming, that and the noise of an ambulance siren. There was a mask over my face and a voice shouting to take deep breaths.' He wiped a handkerchief across his brow and took another sip of water.
Kelleher looked at the audience, noting their absorbed attention. He adjusted the sound on the microphone.
'A pound of explosive had been planted under my seat, wired to the ignition.' Clarke sipped on the water again, then took a deeper quaff, as if trying to drown his voice. He placed the glass down carefully at his feet, taking time so the audience wouldn't see the shake in his hands.
The emotional pain was palpable and Kelleher decided to interrupt.
'Superintendent Clarke's physical condition was very poor when he arrived in casualty. He'd lost a lot of blood, was hypotensive, lapsing in and out of consciousness. The right leg was in a poor state, the left leg relatively unscathed even though he'd sustained a fracture of the
tibia. Priority was to stabilise and get his blood pressure up. Then he was taken to theatre to have the right leg amputated, it wasn't considered viable.'
Kelleher dimmed the theatre lights and began flicking slide after slide onto the screen as he explained the surgical reconstruction of the right leg. One transparency picked up wires and screws where the decision to amputate had been changed and an orthopaedic team worked throughout the night, pulling shards and slivers and pieces of bone together. A vascular surgeon joined at the halfway stage to protect the blood vessels.
'Fortunately the nerve supply to the limb remained reasonably intact,' Kelleher continued, dropping medical labels that slipped over the head of the man sitting in the seat beside the lectern trying hard to remain detached from the discussion.
'Did you find out who did this?' a red-haired girl in the second row interrupted. Clarke's head dropped slightly and he massaged the damaged leg. He squinted at the questioner through the darkness, her face lit by the projector light.