He got back after the weekend to find that Olive Spencer had died of pneumonia on Sunday. She’d been another “faller”, admitted with a broken hip. She was 73 and had MS, but it was under control and she’d been an intelligent woman, alert and impatient with herself for being so clumsy.
Fraser checked her notes. Chest infection Friday night, ampicillin prescribed by Becca Lake. It had developed into pneumonia on Saturday and by the time anyone thought to add another antibiotic, it was too late.
Exactly the same pattern as the others. He drummed his fingers on his desk for a moment, then started going through the patient files on the computer.
In the four weeks he’d been there, six patients had died from pneumonia despite treatment. Six had been treated and survived. He went through Singh’s patients and found a further five deaths.
Eleven patients in a month. A lot.
Sure, pneumonia was common in older people, but this common? With this high a death rate?
He took down David’s
Principles
of
Medicine
from the shelf and leafed through it, but could find nothing about epidemics of pneumonia.
He wondered about discussing it with Ranjid since both Philip and Edwina were away that day, but his attitude to Fraser had been so offhand since the incident in the canteen that he decided not to. Instead, he went over to the hospital library, but couldn’t find anything there either, except that the speed of the infections meant they were almost certainly pneumococcal.
On the way back, he found himself passing Pathology and on impulse, went in and asked to speak to the microbiologist. The receptionist phoned through and, after a couple of minutes, took him up.
“Dr Callan? I’m Roderick Stones.” He was a small, slender man with thinning grey hair and a rather abrupt manner. “Have a seat. How can I help?”
Fraser explained. “What I wanted to ask you is whether this could be some kind of epidemic?”
“Is this something Dr Tate has asked you to look into?”
“Well, not as such, no – she’s away today. To tell you the truth, I came in more or less on a whim because I couldn’t find anything in the library.” As he said this, he was aware of Stones’ pale blue eyes watching him.
“I see. I have to say I’m rather surprised you should have come here without telling her.”
Thinking this more than a little pedantic, but not wanting trouble, Fraser said, “I take your point, Dr Stones. Edwina’s due back tomorrow, so I’ll raise it with her then.” He made to get up.
“Oh, sit down – now that you’re here. D’you have any names?”
Fraser sat down again and showed him the list he’d made. “Only one actually had samples sent to the lab.”
“But they’re all patients of Dr Tate?”
“Er - no, five of them are Dr Singh’s.”
“I see. So he’s away too, is he?”
Resisting the urge to squirm, Fraser said, “No, he isn’t. As I explained just now, I came in on a whim. But you’re right, perhaps I should have spoken to them first.”
“Eleven in four weeks,” Stones mused. “It may seem like a lot, but it’s not what I’d call exceptional, bearing in mind their ages and the time of year.”
Fraser swallowed, said, “I accept that, Dr Stones, but what about the fact that they’re resistant to ampicillin? I didn’t think that was common in pneumococci.”
“Oh, we don’t use so
passe
a term as resistance with pneumococci anymore. True resistance
is
rare, but not insensitivity. Let me show you …”
He turned to the computer terminal on his desk and rattled the keys.
“Here’s your patient, and look – the organism isn’t sensitive to ampicillin, but nor is it truly resistant. By the time you started treatment, the infection was consolidated. He was an old man, the organism was insensitive … I’m afraid it happens. Let’s see go back a little and find one who recovered …”
Fraser watched, feeling more foolish by the minute.
“Ah, here we are - this one, you see, has a completely different sensitivity pattern, which knocks any idea of an epidemic on the head.” He swivelled round in his chair. “Let me tell you something about the pneumococcus. Did you know it used to be called ‘The Old Man’s Friend’?”
“No, I didn’t.”
“It’s a term not used so much now. It acquired the name before the widespread use of antibiotics, because it was probably the most common cause of death in the elderly then.”
“Why ‘Friend’?”
“I was just coming to that,” he said testily. “Because it seemed to target those people whose life had come to a natural end, and also because, before diamorphine, it was probably the kindest way to die there was. The patient becomes drowsy, then slips easily into a deep sleep followed by coma. There’s no pain or discomfort, just peace and rest. In some cases, it’s positively cruel to treat with antibiotics.”
Fraser apologised for bothering him and saw himself out.
*
Ranjid summoned him to his office immediately after lunch.
“Shut the door, please and sit down. How
dare
you go behind my back, discussing my patients with Dr Stones?” He was actually shaking with rage.
Fraser tried to explain how it had come about ... “And when I noticed how you seemed to have as many cases as Edwina, I thought – “
“You told him we have an epidemic … “
“I
asked
him, Rancid. It seemed to me – “
“
What
did
you
call
me
?”
“I – “
“You just called me Rancid – I heard you. You find that amusing, a racist pun on my name?”
Oh
God
,
how
could
he
have
… “No, of course not, I – “
“Get out. Get out of my sight. There is no place for you here.”
“Ranjid, I – “
“I’m not interested in your excuses - save them for Dr Armitage.”
*
Fraser agonised through the afternoon whether to try ringing Philip in the evening; in the end he left a note on his desk explaining what had happened.
The next morning, after clinic, Philip called him to his office.
“You know what this is about, of course?”
“Yes, and I’m very sorry it should have occurred.”
“So am I, Fraser.” He sighed. “What
possessed
you to call him Rancid?”
“I don’t know, Philip, it just slipped out. It was quite unintentional.”
“I’m sure it was. Unfortunate, though.” He paused for a moment, then continued, “Ranjid is in rather a fragile emotional state at the moment, and these days, any charge of racism has to be taken seriously.”
“It wasn’t meant to be racist.
I’m
not racist.”
“I’m sure you’re not. However, taken with the other business … “
“D’you want my resignation?”
“Oh, hopefully it shouldn’t come to that.” He looked at him. “Unless it’s what you want. Is it?”
“No.”
“Well, let’s look for a way round it. What made you go to Roderick Stones in the first place?”
Fraser explained and Philip let out a sigh.
“If you’d come to me with this, I’d have praised your observation and initiative. However, going to Dr Stones was a mistake.”
“I do see that.”
“Not entirely, you don’t – he and Ranjid go back a long way and it was inevitable Dr Stones would tell him.”
Fraser groaned.
“Why didn’t you go to Ranjid first, since he was here?”
Fraser hesitated. “To be honest, because I didn’t think our relationship was very good.”
“Professionalism should come before personal feelings, Fraser.”
“Yes, it should.”
Another pause. “Are you still worried about the number of pneumonia cases here?”
“Aye, I am, a bit.”
Philip steepled his fingers, pressed them against his lips. “Pneumonia’s probably the most common causes of death here, especially at this time of year – April isn’t called the cruellest month for nothing.”
Fraser nodded. “I realise that, but what’s bothering me is that so many of them seem to be resistant to ampicillin – or insensitive, perhaps I should say. Is there not a case for using a different antibiotic?”
“Which would you suggest?”
“Well …” Fraser hesitated, realising he’d been put on the spot.
“Tetracycline?”
“A lot of pneumococci and Haemophilus are resistant to it now.”
“Erythromycin, then?”
“Same problem, besides which, it’s not as efficacious as ampicillin.”
“How about cefataxin?”
“Fine for pneumococci, not so good for Haemophilus.”
“Vancomycin? Gentamycin? Chloramphenicol?”
“All rather toxic. The fact is, ampicillin does remain the drug of choice, even though we are seeing some insensitivity to it. It’s good that you’re thinking about these things though, which is why I don’t want to lose you. Unfortunately,” he continued, “Ranjid wants his pound of flesh. I suggest we try and get him to accept an ounce. Would you be prepared to apologise to him in front of me and assure him it won’t happen again. After which, so far as I’m concerned, it would be forgotten.”
What had he to lose? “All right,” he said.
“Good. I’ll go and put it to him now.”
But as they shook hands on it shortly afterwards, it was obvious to Fraser that Ranjid was neither going to forget nor forgive.
He went and found Edwina to apologise to her as well, but she gazed at him blankly and said she didn’t know what he was talking about. He explained.
She said, “So you’re happy now with what Philip told you about the pneumonia cases?”
“Yes.”
She shrugged. “OK then, fine. You’ve apologised and it’s over. Forget it.”
He’d been expecting worse. She must live her life in compartments, he thought as he walked away; if something didn’t directly concern her, she wasn’t interested. OK then, fine.
“Wow,” Fraser said. He was looking down the face of a scarp that dropped 500 feet into a broad valley below.
“That’s Patrick’s village there,” Helen said pointing, although all he could make out was a church tower poking up through the blanket of trees.
He’d forgotten about Fitzpatrick’s orgy and hadn’t understood what Helen was talking about at first when she’d told him she’d like to accept his offer of a lift.
“If you’ve changed your mind about going, don’t worry,” she’d said.
“No, I’d like to take you,” he’d said.
He’d picked her up at her house and she’d directed him south to a narrow road that threaded its way up through the downs. Spring had sprung at last and it was warm enough to drop the hood. The trees and hedges were dusty green, lambs bleated and blackbirds warbled throatily as they reached the summit - and the scarp …
“I wouldn’t like to come off the road here,” he said now as the MG’s snout pointed down. The exhaust burbled gently in protest as he switched round a series of hairpins, then the road levelled out and after a mile, they ran into a village square.
“That way,” Helen said, and a few minutes later, they pulled up in the gravel outside a long, low cottage.
Fitzpatrick came out to meet them.
“You look ravishing, my dear – or should that be ravishable?”
“Hello Patrick,” she said as he kissed her cheek.
She did look good, Fraser thought, she was wearing a primrose shift as airy as a flower over designer jeans.
Patrick led them down a stone passage and into a long living room split by a fireplace – the house was much bigger than it had seemed from the outside. A score or so of people generated a low buzz.
“Come and have some punch,” Patrick said, taking them over to a drinks table. “Don’t worry, it’s not strong.”
Philip, who was talking with Edwina and a couple of others nodded and smiled. A woman got up and came over to them.
“My wife, Marie,” Patrick said.
She was about thirty, startlingly pretty with red hair and milky skin. “Hello, pleased to meet you,” she said. “Love your dress, Helen … ”
Fraser had been expecting an Irish accent, but it was English, with more than a hint of estuary.
As Patrick ladled punch, Fraser became aware of another figure beside them .
Patrick said, “Ah … Fraser, may I – er - introduce you to Nigel Fleming, Chief Executive and also my boss …”
The
head
baboon
, thought Fraser as they shook hands.
The nerviness he’d noticed in Patrick before had suddenly erupted again …
And
not
a
lot
of
love
lost
…
“So how long have you been with us now, Fraser?” Fleming asked him as Patrick smartly faded away.
“A wee bit over a month.”
“Are you enjoying it here … ?”
He might not look like a baboon, Fraser thought as they exchanged half a dozen meaningless sentences – he was about six foot tall, fleshy pale, with a dark widow’s peak – but he was without any doubt the tribe’s dominant male, powerful enough to simply not care about what others thought of him.
“Well, I hope you enjoy your time with us,” he said, the shutters coming down as he judged Fraser, found him wanting and turned away to look for someone more interesting.
Helen was with Philip. Fraser was about to go over to them, but the intimate way they were talking made him hesitate. He mingled rather unsatisfactorily for a while – then a bell rang in the hall and Patrick hurried out. A moment later, a fantastic figure appeared in the doorway. It wore full evening dress with cloak, cane and top hat. The entire room was stunned to silence.
“Good evening everyone,” the figure said in fruity tones, and resolved itself into George Woodvine, whom Fraser had last seen in Edwina’s office with the local MP … what was her name? She was with him now - did they go everywhere together, he wondered? Matlock, that was it, Patricia Matlock – he remembered her now, with her short blonde hair and blue eyes ...
“Are we to see the infant?” Woodvine enquired, “Or is this a celebration in absentia?”
“As usual, your timing’s impeccable,” said Patrick. “Marie’s feeding him now and he’ll be down in a couple of minutes. Let me take your cloak.”
Woodvine handed him his accoutrements, then turned to greet Fleming, who’d walked over to him.
“Good evening, Nigel.”
“Good evening, George.”
Not a huge amount of affection there either, Fraser reflected.
Philip and someone else came in with trays of Champagne. Patrick returned with Marie, who was holding a baby.
“Would you do the honours, George?”
“Delighted.” He turned to the guests – “Are your glasses charged?
Excellent
– “ He turned back to the baby and solemnly addressed it – “May you be blessed with the health, humour and comeliness of both your parents.” He raised his glass, and his voice - “I give you Patrick Fitzpatrick the second.”
As this echoed round the room, the baby let out an outraged howl and everyone laughed as Marie took him out again. Fraser found himself next to Philip Armitage.
“You decided to come, then Fraser?”
“Patrick made it difficult to refuse.”
Philip grinned at him, his expression saying it was good to see him socialising rather than sulking.
They exchanged a few words, then he said, “I think Nigel’s going, I’d better go and say goodbye to him.”
Fraser looked round for Helen and saw her with Woodvine by the drinks table. He made his way over.
“George,” she said, “this is Fraser Callan, our new staff grade.”
“We’ve already met,” Woodvine said with a smile, his white teeth and thick white hair accentuating the ruddy tan of his face. Holding up the whisky bottle, he continued, “Will ye take a wee dram wi’ me Fraser?” The accent was perfect and Fraser and Helen both burst out laughing.
“I’ll take that as a yes,” Woodvine said.
“Noo,” said Fraser. “I’d love to, but I’m driving.”
“My commiserations.”
“I enjoyed your speech,” Fraser said.
“For its brevity, I imagine.”
“And its felicity.”
Woodvine looked at him, his eyes grey and very clear. “Now that is a compliment,” he said. “Thank you.”
“George…” a voice called softly.
They looked round – it was Patrick, who’d come back into the room.
“I’ll speak to you both later,” George said, and went over to him.
“I think you made an impression there,” Helen said quietly. “It’s usually George who does the impressing.”
“Oh, he did that fine well,” Fraser said. “His entrance was something to behold.”
By common accord, they drifted over to the room’s perimeter.
“Glad you came?” she asked.
“I wasn’t at first.” He told her in a low voice about his time with the head baboon. “He seemed to have a pretty negative effect on Patrick too,” he said.
“I know,” she said. “It’ll change now he’s gone.”
“Why?”
She lowered her voice. “He and Patrick don’t get on … well, actually, they loathe and detest the sight of each other, but Patrick had to invite him and Fleming had to come. Patrick always goes a bit flaky when he’s around.”
“Why do they loathe and detest each other?”
“Ancient history. I’ll tell you later.”
“Tell me now, no one can hear us here.”
She glanced round, bent her head closer. “Remember what I was telling you the other day about St James’?”
He nodded, breathing in her musky perfume.
“Well, Fleming blames Patrick for not foreseeing it.”
“With any justification?”
“Patrick’s Director of Community medicine, so in theory it was his responsibility.”
“Sounds to me more like Fleming trying to duck the buck.”
She grinned. “Ah, but you like Patrick, don’t you?”
“Don’t you?”
“Very much, but …”
“But what?”
She smiled, but shook her head.
Something had changed, he thought. She seemed … more alive towards him? Was it Ranjid’s absence, he wondered? He was at a meeting in Wolverhampton for the day.
He said, “Where does George Woodvine fit into all this?”
“He’s the Trust’s Chairman.”
“So in theory,
he’s
the boss?”
She shook her head again. “Not even in theory. He’s the non-exec Chairman. Fleming has all the real power.”
“Then what’s the point of him – George, I mean. Other than entertainment value.”
She smiled, said, “He chairs the meetings and keeps an eye on things. Remember I told you how Patricia Matlock set up a committee to deal with the St James’ scandal? Well, he, Patrick and Fleming were the other members. They were the ones with the most to lose.”
“So they’re all bound together whether they like it or not?”
“Something like that ... ”
“Ladies and gentlemen … “
They turned as, with a flourish, Patrick pulled a cloth away to reveal a table of food. People oohed and aahed, formed an orderly queue, ate, and then drank some more. Patrick circulated, chatting with everyone, a happier man.
Helen said, “What will you do when you’ve finished here, Fraser?”
“No idea. I’ve been wondering about going abroad again.“
“Again?” she asked, and he told her about his time in Africa.
“Yes,” she said, looking at him. “I can see you burnt as a berry somewhere in shorts and a pith helmet.”
He laughed. “Why d’you say that?”
“There’s something restless about you.”
There was a roar of laughter from the other side of the room by the drinks table where a crowd of people surrounded George Woodvine.
“You’re right about things changing,” he said, wanting to change the subject. “Is it because Fleming’s gone or Woodvine’s arrived?”
“Both, I expect – plus the alcohol effect.”
“Speaking of which,” he pointed to her glass, ”Can I get you another?”
“Mm … some more punch please. White wine if there isn’t any.”
He’d just scraped enough from the bottom of the punch bowl to fill two glasses when Woodvine caught sight of him.
“Ah, Dr Callan, I presume – the very man.”
Fraser smiled, wondering what was coming.
“I’ve been telling all these good people here of the vicissitudes Patricia and I have undergone on our tours of the nation’s hospitals.”
His ruddy face was certainly showing the alcohol effect, Fraser thought, although his diction was perfect. He listened along with the others.
“Last week we had to visit a hospital in – er - Warwickshire, I think it was. Anyway, the manager showed us in and I said to the patient in the first bed, who was swathed in bandages, poor fellow.
How
are
you
feeling
,
my
good
man
? I asked, and he said:
O
wad
some
Pow’r
the
giftie
gie
us
To
see
ourselves
as
others
see
us
.”
His accent, as before, was perfect.
“Well, I stepped back, wondering if this was some kind of subtle insult and Patricia said to the next man, who was also covered in bandages:
Are
you
happy
with
your
treatment
here
? and he said:
Wee
sleekit
,
cow’rin’
,
timorous
beastie
O
what
panic’s
in
they
breastie
?
“Well, she wasn’t too pleased about
that
, I can tell you, so I spoke very firmly to the next man, also well wrapped:
We’d
like
to
know
what
you
think
about
this
place
and he said:
The
best
laid
schemes
o’
mice
an’
men
Gang
aft
a
-
gley
.
“Well, that did it. I turned to the manager.
What
is
going
on
here
? I demanded. And d’you know what he said to me?”