Donor (9 page)

Dunbar nodded. It didn’t seem likely that he would be getting any tittle-tattle or scandal from Ingrid Landes. He decided to press her a little to see how strong her loyalty was.

‘It’s a very artificial environment,’ he said.

She took the bait. ‘How so?’

‘The very fact that it’s a private hospital means you can pick and choose your clientele. That makes things a lot easier, don’t you think?’

‘I don’t think we pick and choose. We take anyone who wants to come here and—’

‘Can afford to.’

‘That’s unfair. Many of our patients are covered by health insurance, something they elect to pay for. It’s their choice. I see nothing wrong in that.’

‘That still doesn’t make you a proper hospital.’

‘I don’t see how you can say that,’ said Ingrid, annoyance creeping into her voice.

‘You’re not obliged to provide services you don’t want to. You don’t have an A&E department, you don’t treat VD, you’re not interested in AIDS, TB, or any infectious disease come to that, and as for Alzheimer’s or any kind of mental disorder, forget it. Médic Ecosse wouldn’t want to know.’

‘It’s true we don’t handle everything,’ she agreed defensively, ‘but we do have one of the best transplant units in the country.’

‘Indeed you do,’ said Dunbar with a grin, ‘and one of the most loyal staff members.’

Her eyes widened. ‘You were testing me!’ she exclaimed.

Dunbar raised his eyebrows slightly and pursed his lips in a display of innocence. Ingrid broke into a smile. ‘What a thing to do,’ she said.

‘Are all the staff as loyal as you?’

‘I should think so. The working conditions here are very good, the pay’s well above the going rate and the holidays generous. Maybe I shouldn’t be saying this to you. You’ll probably put all that into reverse,’ laughed Ingrid.

‘Fear not,’ smiled Dunbar. ‘I don’t have any such powers and I do appreciate that if you want the best you have to pay for it. So you never have staff problems or problems with disgruntled employees?’

Ingrid frowned as she thought. ‘Not that I can recall,’ she said.

Dunbar maintained an encouraging silence.

‘Well, there was one, come to think of it,’ said Ingrid, ‘quite recently, as a matter of fact. A staff nurse in the transplant unit – I’ve forgotten her name. She started making wild allegations after the death of a patient, poor woman.’

‘What sort of allegations?’

‘One of the patients in the unit, a young girl who had been very ill for a long time, died after an unsuccessful kidney transplant, one of the few deaths in that unit, I have to say. I think that’s maybe the only death they’ve had.’

Dunbar managed to stop himself pointing out that there had been another.

‘I think the nurse had been very attached to the patient. She was very upset and started saying all sorts of ridiculous things, making wild accusations about the negligence of the medical staff and things like that.’

‘What happened to her?’

‘In the circumstances, Dr Ross and Mr Giordano were very understanding about it. They arranged for her to have professional counselling and lots of time off but she persisted with her claims, and in the end I’m afraid they had to let her go.’

‘Poor woman,’ said Dunbar, deciding to let the subject drop. ‘How about showing me around?’

‘What in particular would you like to see?’

‘Absolutely everything.’

Dunbar was impressed by what he saw on his guided tour. He wasn’t allowed to enter any of the rooms currently occupied, as that would have been regarded as an invasion of patient privacy, but he did see from the empty ones the type of accommodation on offer. The rooms would have done justice to a top hotel, each being equipped with telephone, radio, satellite television and space-age communications systems. Wherever possible, medical equipment was hidden from view, much of it secreted behind sliding wall panels. Cardiac monitoring equipment, oxygen supply points and drip-feed equipment were all within easy reach of the bed but out of sight until required. It was hard to tell that this was a hospital room. Even the air smelled fresh and free from antiseptic odour. Dunbar looked up at the ceiling and saw grilles for air-conditioning.

The X-ray suite was state-of-the-art, as was the physiology lab with its gleaming respiratory function equipment. The operating theatres were fitted with the latest in lighting and table technology. Anaesthetics were available through a colour-coded bank of regulators, each gas with its own gauge and flow monitor and not a cylinder in sight. Endoscopy monitors were mounted on swinging arm platforms that could be adjusted to any height and angle required by the surgeon.

As they waited for a lift to take them up to the transplant unit, Ingrid asked, ‘What do you think so far?’

‘It’s hard to believe I’m in a hospital,’ said Dunbar. ‘Apart from anything else, it’s so quiet. There just don’t seem to be any people about. I always associate hospitals with bustle and activity.’

‘Company policy,’ said Ingrid. ‘They don’t just hide the equipment, they hide the nurses too! But whenever you need one, one will materialize at your shoulder.’

The lift doors slid back and three people got out, a man in pristine white Arab clothes and two others whom Dunbar recognized as the driver and bodyguard he’d seen getting out the limo earlier. Ingrid smiled and said something to them in Arabic. She sounded fluent.

‘I’m impressed,’ said Dunbar as they got into the lift and the doors slid shut.

‘Omega patients expect no less,’ Ingrid replied.

As they stepped out into the reception area for the transplant unit, Ingrid said, ‘I’ll have to check with Dr Ross first to see if it’s all right to show you round.’

Dunbar nodded.

Ingrid leaned over the reception desk and asked the nurse sitting there if she would tell Dr Ross they were here. The woman smiled, nodded and picked up a telephone. Ross appeared in the foyer a few moments later. He acknowledged Ingrid with a nod, then turned to Dunbar, stretching out his hand. ‘Big Brother is watching us,’ he said with a smile.

‘It’s not that bad,’ smiled Dunbar in reply. ‘As long as you’re not carrying out operations for nothing.’

‘As a matter of fact we will be tomorrow,’ said Ross conspiratorially. ‘One of my colleagues is carrying out facial reconstruction work on one of the NHS patients we agreed to take on for free as part of the funding agreement.’

‘A laudable exception,’ said Dunbar. ‘Actually, I was rather hoping I might be able to see round your unit? Meet the staff?’

‘Of course,’ replied Ross. ‘That is, the bits that are empty. Ingrid has probably told you that patient privacy is paramount.’

‘It’s what I keep hearing,’ agreed Dunbar.

‘The plain truth is that many of our clients don’t want anyone even to know they’re in hospital, let alone what they’re having done. And if they pay the piper …’

‘They call the tune.’

‘You can see the transplant theatres, of course, and one of the intensive-care suites for post-operative use. The individual rooms are pretty standard throughout the hospital.’

‘Even for Omega patients?’ asked Dunbar.

Ross exchanged an uncertain glance with Ingrid before smiling and saying, ‘Perhaps a few more little goodies for them.’

There were smiles all round. Ross said, ‘Come and meet the staff.’ He led the way to a room where a man dressed in surgical greens was standing in front of a blackboard addressing several medical and nursing colleagues. He paused as the newcomers entered but Ross indicated that he should continue and ushered Dunbar and Ingrid to seats at the side of the room.

‘Staff briefing,’ he whispered. ‘We have one every morning. I’ll let John finish.’

Dunbar nodded and listened with interest to the briefing. There were seven patients in the unit. The current condition of each was discussed in turn and staff were asked for any observations they might have. Updates were made to all their charts and all staff were made aware of plans for each patient for the day. Again, Dunbar was impressed. This was a well-run unit.

‘Any questions?’ asked the man Ross had called John. There were none.

Ross stood up and said, ‘Just before you go everyone, I’d like you to meet Dr Steven Dunbar. He’s been assigned to the hospital by the Scottish Office to keep an eye on us, but he tells me he’s not such a monster once you get to know him.’

There was polite laughter. Dunbar saw that Ross was popular with his staff. He was introduced to each member of staff in turn, starting with the theatre sister, Trudy Sinclair, and ending with John Hatfull, who had been giving the briefing.

‘John is my surgical registrar,’ explained Ross. ‘Also my right-hand man.’

Hatfull was slightly shorter than Ross, brown-haired and hazel-eyed. He had an air of intensity that Dunbar often associated with highly intelligent people. It was as if they radiated energy. It was hard to imagine them relaxing. He shook hands with Hatfull.

‘Did I hear James say you were a doctor yourself?’ Hatfull asked.

Dunbar nodded.

‘What speciality?’

‘Field medicine,’ Dunbar replied.

Hatfull looked surprised then amused. ‘From field medicine to accountancy? Quite a change. I suppose you were looking for more excitement.’

The others laughed. Dunbar smiled dutifully, but offered no explanation. He didn’t want anyone thinking too much about the unlikelihood of such a switch.

‘Well,’ said Ross, ‘I’ll show you round. Or maybe you’d care to do that, John, if you have the time?’

‘My pleasure,’ replied Hatfull. ‘Anything in particular you’d like to see?’

‘Anything and everything,’ said Dunbar. ‘I just need to get a general feel for the unit. I need to relate its size and facilities to the figures I see on the balance sheets.’

‘Of course.’

As they started the tour Dunbar sensed that Hatfull was on his guard. He thought he’d try a little flattery to see if he could soften him up. ‘Dr Ross seems to rely on you a lot.’

‘He’s a very busy man,’ replied Hatfull.

‘Of course,’ said Dunbar. ‘He has research interests too. Are you involved at all in that?’

‘No, I’m just a work-horse. I leave research to the clever people.’

‘As a transplant surgeon in this unit, you’re not exactly among the intellectually challenged of the world,’ countered Dunbar with a smile.

‘One does what one can.’

‘The withdrawal of research funding must have been quite a blow to Dr Ross?’

‘Must have been.’

Dunbar didn’t ask any more. He accepted he wasn’t going to get anywhere with Hatfull.

The tour of the transplant unit took about thirty minutes, including the time taken by Hatfull to answer questions as monosyllabically as possible. Dunbar reverted to asking the kind of questions he thought he should be asking. They related to length of patients’ stay in the unit, numbers of staff involved in preoperative and post-operative care, in fact, anything he thought an accountant might be interested in. He made notes in a small leather-bound book he took from his inside pocket. There was very little to ask about the equipment and accommodation. The facilities were simply the best. When he’d asked everything he thought he should, they were re-joined by Ross, who asked if he’d enjoyed his tour.

‘Very interesting,’ replied Dunbar. He thought he’d risk trying a different tack and asked, ‘What actually happens when you hear that an organ has become available for one of your patients, Doctor?’

‘Quite a lot,’ smiled Ross. ‘And all at the same time! The procedure usually starts with a computer alert that a matching organ is available. We first double-check that this is the case and then contact the hospital or clinic holding the organ to establish personal contact and agree terms of transfer. A lot depends on where the donor organ is and how long it’s going to take to get here. At the same time, we alert our patient to the possibility of an operation and arrange for him or her to be admitted if they aren’t already in hospital. The operating teams are put on stand-by, round the clock if necessary. Time is always of the essence where live tissue is concerned.’

‘Of course.’

‘Apart from the actual theatre teams, we also need lab support and a supply of blood from the transfusion service available at exactly the right time. A lot of people are involved in a successful transplant. It’s a team effort and there are so many things that can go wrong. A flight gets delayed, a traffic jam, a driver takes the wrong turning. So many things, so many links in the chain, and all of them important.’

Dunbar nodded and pushed his luck. ‘And do they?’ he asked.

‘I’m sorry?’

‘Do they go wrong?’

‘Very rarely,’ said Ross with a smile and a touch-wood gesture. ‘There have been a few close calls as regards time but we’ve always managed to get the job done.’

‘That’s interesting,’ said Dunbar. ‘I suppose the clock starts ticking as soon as the donor organ is removed?’

‘Absolutely. There’s only a finite time before it becomes useless for transplant purposes.’

‘I suppose the ideal thing would be to keep the donor on a life-support system until everything was ready?’

‘In a cold, clinical sense, yes,’ agreed Ross. ‘But of course the moral implications of such a procedure dictate that hospitals can’t actually do this – well, not overtly. There’d be a public outcry.’

‘Of course. So with time ticking away, and traffic jams and airline delays all playing their part, you must have to get the organ into your patient almost as soon as it comes through the door?’

‘Almost,’ agreed Ross. ‘The theatre staff are usually prepped and ready.’

‘No time for any last-minute checks on the organ itself?’ said Dunbar, feeling as if he’d just jumped into water without knowing the depth.

There was a tense pause before Ross said, ‘I don’t think I’m quite with you. What sort of checks are you referring to?’

‘Oh, I don’t know,’ said Dunbar, trying to appear off-hand and casual. ‘The usual things, blood group, tissue-typing, AIDS, Hep.B screening, that sort of thing.’ He had slipped his real question in at number two in the list, hoping it would nestle there without arousing suspicion. A glance at Ross as they proceeded along the corridor made him doubt whether he had succeeded: the smile had gone from his face.