Death Before Time
Death Before Time
Andrew Puckett
UK (2014)
known as St. James’, the hospital has made a miraculous recovery from a
scandalous history, when it was described as “Death Wards” for the
elderly by the national press. But history sometimes comes back to haunt us…
first, the hospital seems a model of excellence, but then Fraser
realises that more patients are dying of pneumonia than should be the
case. When he raises the matter, he is ridiculed, threatened with the sack and finally beaten up by gangs of thugs. Then, after the suspicious death of an old man with terminal cancer, Fraser realises he must act. He reports his suspicions and is persuaded by Marcus Evans, a mysterious civil servant, to work undercover to find the killer.
© Andrew Puckett 2014
Andrew Puckett has asserted his rights under the Copyright, Design and Patents Act, 1988, to be identified as the author of this work.
First published 2008 by Robert Hale Ltd as The Old Man’s Friend.
This edition published by Endeavour Press Ltd in 2014.
As Fraser gazed down at the old man’s body, tiny as a London sparrow beneath the hospital sheets, he was swept by a wave of desolation, and then by a fury so intense that he could feel the blood pricking at his eyeballs …
Pneumonia –
again
. They were wrong –
again
…
“’Scuse me, Doc –” Wally the Trolley, the mortuary technician, come to collect the body.
He turned and walked quickly away, out of the brightly lit ward, out of the hospital. He found a bench, sat down and breathed deeply as the breeze rustled the leaves of the young tree beside it.
Somebody had deliberately killed the old man. Not just let him die, but quite deliberately put him to death, murdered him. And he was not the first. All the others, they’d been murdered too and now he, Dr Fraser Callan, was going to have to do something about it.
But what? Tell someone? Philip? He wouldn’t believe it. The police? They’d ask a lot of questions, find nothing and leave him to stew in the resulting acrimony.
It came to him that there was only one thing he could do. He didn’t like it, but he’d have to.
He stayed there on the bench until he’d calmed down enough to control himself, then went back inside, hoping that no one had noticed him. He went to his room, shut the door and looked up the old man’s medical record on the computer.
Friday
:
Chest
infection
,
put
on
ampicillin
…
Saturday
:
Stable
…
Sunday
:
Developed
into
pneumonia
,
erythromycin
added
…
But too late, all too late. He’d died early this morning.
He sat back in his chair and thought, his mind icy calm now.
To know that murder had been done wasn’t enough, you had to be able to prove it, or at least show evidence for it.
Aye, gey and easy – when he hadn’t the least idea who was doing it, never mind how it was being done …
Figures. It would come down to figures.
He spent the next two days gathering them, and then keyed in the phone number he’d never thought to need again. If Marcus was surprised to hear from him, he didn’t show it and told him to come up the day after tomorrow, Friday.
He begged the day off from Edwina, saying his sick mother needed him again, and caught the early train to London on Friday morning.
As the fields of Wilts and Berks slid by, he thought about Marcus, and Tom …
Marcus Evans was a civil servant with a difference. He ran a small section in the Department of Health whose purpose was to investigate allegations, or even rumours, of wrongdoing in the NHS that couldn’t be looked into in any other way. Not many people knew about it. Fraser only did because he’d been on the receiving end of its attentions the year before.
He was shown into Marcus’ office in Whitehall at 9.30. Tom was there as well. They both stood and Marcus came across and shook hands.
“Fraser, come and sit down. Would you like some coffee?”
“Aye, I would please.”
As Marcus busied himself pouring it, Fraser glanced round the room … It somehow managed to be both light and formal at the same time, the lightness accentuated by the cream carpet and pale walls, the formality by the dark furnishings and prints of old London.
“Before anything else,” Marcus said as he handed him a cup and saucer, “May I say how sorry we were to hear about your wife.” Tom nodded and murmured his agreement.
Fraser had to clear his throat before he could reply. “Thanks.”
Frances had died six months earlier of leukaemia. He knew they’d both been at the funeral, but they’d left without speaking to him.
“Now, how can we help you?” Marcus said.
No point in pussy-footing around it … “I’ve been working as a locum staff grade at a hospital for older people in Wansborough for the last couple of months, and I think…” he broke off, then continued, “I know fine well that someone’s systematically bumping them off.” His accent, noticeably Glaswegian, became more pronounced as he finished.
In the silence that followed, the curious thought went through his head that Marcus had been held in a time machine since he’d last seen him; he seemed to be wearing exactly the same dark suit and tie, with the same shine to the bald dome of his head above the heavy walrus moustache.
“I see,” Marcus said at last. “You say you
know
– d’you mean you have evidence?” He spoke softly as always, with a faint London twang to his voice.
“Statistical evidence,” Fraser said.
“You know what they say about statistics?” said Tom, speaking for the first time. He hadn’t changed much either, Fraser thought – leather jacketed, sharp featured and hard – and there was nothing faint about his London accent.
“Lies and damned lies, you mean? I’ve no reason for either.”
Tom didn’t reply and he continued, “I’ve compared the death rate at Wansborough with other community hospitals and it’s higher, significantly higher.” He reached down to undo his briefcase. “If you’ll just take a look …”
“We’ll look at your figures in a minute,” said Marcus. “You say patients are being killed – any patients, or a particular type or category?”
“Aye. Those whose lives some might say were not worth living.”
“That’s subjective, to say the least.”
“I don’t mean vegetative cases being allowed to die naturally – that happens, of course – I mean mentally alert people with two or three or more months left to live being deliberately killed.”
“So you’re talking about involuntary euthanasia.”
“I am.”
“How’s it being done?”
“I don’t know. I only know that it
is
being done, and that it’s being made to look natural. The one’s I’ve noticed seem to be dying of pneumonia.”
“Any idea who’s doing it?” Tom again.
“No, I don’t know that, either.”
Marcus regarded him for a moment ...
Fraser
had
changed; even with his beard, he could see that his face was thinner, darker, the dark brown eyes deeper in their sockets, giving him a mien even more intense than before. “Perhaps you’d better tell us from the beginning,” he said. “How did you come to be working there? It’s not really your line, is it?”
“No,” Fraser agreed. He began haltingly: “After Frances died, I didna know what I wanted to do …”
*
Although he’d been expecting it, even almost willing it at times, her death had shaken him more than he could have imagined.
He’d been formally cleared of any wrongdoing and was thus officially available for work again. Unofficially however, his erstwhile colleagues still blamed him for their misfortunes and let him know that his return would be deemed “inappropriate”. They’d offered him three months pay while he looked for another job and, dazed by grief, he’d accepted ...
“You should never have agreed to that,” said Marcus.
“You were shafted,” said Tom.
“Aye, I know that –
now
,” Fraser said ...
He tried to lose himself walking over Dartmoor and Exmoor. He dreamed strange dreams in which Frances spoke to him, then woke up crying because he couldn’t remember what she’d said. Guilt rode him like a vulture: he was alive, she was dead, it was his fault and he had to atone in some way. Which is why he’d volunteered to go and work in Africa for a year for a charity.
It hadn’t worked.
It wasn’t the heat, or the flies or the disease, and he liked the people, whom he thought the happiest he’d ever met, despite their poverty. What he couldn’t stand was the corruption of some of the indigenous petty officials and one day, he’d told one of them exactly what he thought of him.
It hadn’t been well received and his head was the price of peace.
“I told you so,” Mary, his mother in law, said when he got back. She had, too. “So what are you going to do now?”
“I don’t know,” he confessed.
Fortunately, his house had only been let on a short lease and was empty, but he needed money to pay the mortgage.
She said, “Wait there a minute.“ She left the room, came back a few minutes later with a sheaf of newspaper cuttings. “I’ve been meaning to show you these for a long time, but then what with Frances and everything else … “ She tailed off … ”Anyway, look at them now while I make some tea.”
It was a series of articles, mostly from the Telegraph, on the state of care for older people in NHS hospitals. There were case studies of elderly, but relatively healthy people going into hospital for trivial complains, then dying from the treatment they received there. Being found by relatives in urine-soaked bedclothes that hadn’t been changed for days. Food put out of reach so that they couldn’t eat, bedsores you could put your fist into, instructions such as
Not
For
Resuscitation
and
Nil
By
Mouth
surreptitiously attached to their notes.
“If you want to help suffering humanity,” Mary said, “why don’t you go and work in one of those places?”
He looked at her. “I do remember hearing about this, but I thought they’d sorted it out now ... ”
“I thought so too, but then last week, I saw this – “ She handed him another cutting.
The headline was
Why
did
Mabel
have
to
die
like
this
? Mabel Fisher, a healthy woman in her seventies, had gone into hospital for a minor operation and died there from malnutrition. This was followed by a report from the charity Age Alert claiming that six out of ten older patients in hospital were at risk of malnutrition and dehydration because the nursing staff were simply too busy to feed them properly. This meant that not only were they taking longer to get better and thus exacerbating the bed shortage, but some, like Mabel, were actually dying.
“Six out of ten,“ he repeated to himself … “I knew there was a nursing shortage, but I never thought it was that bad.“
“Well, why don’t you go and find out for yourself?”
So, a couple of days later, when he saw the advert for a locum staff grade to cover maternity leave at Wansborough Community Hospital in Wilts, he rang the consultant in change, Dr Armitage, and arranged to go and see him the following afternoon.
Philip Armitage was a smallish man of about fifty with sandy hair, a goatee and mild grey eyes behind glasses.
“I’ll show you round, then we’ll have a talk,” he said. He was gently spoken with a faint Midlands accent.
The hospital, which was in the grounds of the Royal Infirmary, was in the form of a misshapen T, with beds in the long stroke and admin in the short. It looked as though it had been built that way to fit into a left over piece of land (which he found later was the case). It appeared very cramped from the outside, and yet inside seemed airy and spacious – a bit like an NHS Tardis, Fraser thought with a smile.
“How many patients?” he asked.
“Forty-five altogether, thirty women and fifteen men.”
It was freshly painted in blue and yellow, clean, well equipped and, so far was he could see, well run. There was also very little smell.
Many of the old hospital wards he remembered, especially those for older patients, had held what he’d thought of as the miasma of the infirm. It’s a smell that hits you straight between the nostrils and when you stop noticing it, then it’s time to worry, because it’s impregnated your clothes.
Fraser commented on it.
“Having a new purpose-built unit helps of course,” Armitage told him. “Although good nursing and cleaning staff may have something to do with it.”
They walked back to his office. “Not quite what you were expecting?” he enquired of Fraser with a twinkle.
Fraser had to admit that it wasn’t.
“Perhaps you shouldn’t believe everything you read in the papers.” His steady gaze and faint smile seemed to be mocking him.
“Perhaps not,” Fraser agreed, reluctantly smiling.
“Oh, I know there were some places that were frankly vile,” Armitage continued, serious now, “This hospital replaced one of them in fact. There are still some which – er - leave something to be desired, shall we say? But this isn’t one of them.”
“Obviously not,” Fraser said.
There was a knock on the door and a secretary brought in some tea. While Armitage poured, he glanced round the room. It was austere almost to the point of starkness – no photos, no pictures or plants. The only thing of interest was a bookcase that seemed to contain old medical books and Fraser wondered if he was a collector –
“Sugar?”
“Oh – no thanks.”
He handed Fraser his tea and then questioned him about his medical experience. He asked him why he wanted the job.
