The Road to Hell (27 page)

‘Should I go on?’ he asked the Sheriff.

‘Yes, of course,’ she replied blithely, seemingly baffled by his query, as if he had been talking about a recipe for rice pudding instead of describing chewed human tissue.

After he had left the stand, the Sheriff closed her notebook and hooked the clip of her fountain pen over its cover. ‘We’ll start again tomorrow. Can you tell me who you intend to
lead first, Mr Brand?’

‘I can, my Lady,’ the Procurator Fiscal replied, looking down at his open blue notebook, then leafing feverishly through its pages before adding, in a relieved tone,
‘we’ll start with Doctor Alton. It’s the only time he can come. He was the one who saw Ms Fyfe at the Accident and Emergency Department.’

‘Very good,’ the Sheriff replied, and as she adjusted her wig, getting ready to stand up, the Macer suddenly got unsteadily to his feet and boomed out, ‘Court rise.’

The next morning, the young doctor raised his right hand as he had been requested by the Sheriff to do. Then, sounding like an impatient echo, he repeated the words of the oath
after her. Looking down at the medical records from the Royal Infirmary as instructed, he said to the Procurator Fiscal, ‘Yes, I’ve found page 42. I saw Ms Fyfe. I don’t remember
seeing her, but these are my notes, initialled by me.’

‘Can you explain your note to us, please, doctor – explain what it says?’ Mr Brand said, looking at the photocopies in his own ring binder.

‘Yes,’ the doctor began confidently, ‘“Attendance following a fall in the hostel” . . . that’s largely self-explanatory, I suppose. That’s the history
that she must have given me at the time. “Alcohol plus, plus, plus”, that’s an observation. “C/O of a head injury” . . .’

‘Sorry, sorry,’ the Procurator Fiscal said, raising his hand like a policeman, ‘if I could just stop you there. We need to unpack this a little. The observation about the
alcohol – what was that based on? For example, did she tell you that she had been drinking, or was she obviously drunk or did she simply smell of alcohol, or what?’

‘I’m afraid at this distance in time I can’t be sure,’ the doctor said apologetically, adding, ‘I suspect that it means the smell, maybe her manner too. Whatever it
was, by noting “plus, plus, plus” it means that I thought she’d drunk to excess. Taken a lot of drink. Probably that she was obviously drunk at the time.’

‘Very well,’ Mr Brand said, nodding reassuringly, ‘would you continue?’

‘Right. “C/O” . . . that’s “complaining of”, a head injury on the left temple. Again that must have been what she told me, the area she pointed to, in all
probability. O/E . . . ah, “on examination”, yellowish, external bruising on the right temple. So, apart from anything else, that means I saw nothing on the left temple. “Fairly
bright” . . .’

‘Sorry, I need to stop you again. You say that you saw no bruising on the left temple but some on the right. What conclusion did you reach about the bruising on the right
temple?’

‘That it was old. It had nothing to do with her fall.’

‘If there had been bruising, or any signs of injury, apparent elsewhere on her head, would you have made a note of that?’

‘Yes. Given her state and the history, I would have examined the whole of her head, I expect.’

‘You don’t know whether you did or not?’

‘As I said, I can’t remember the patient at all in amongst the thousands I have seen, but that would be my normal practice if I’d been given the history of a fall and a head
injury by a person clearly under the influence of alcohol.’

The sound of coughing echoed around the courtroom, and after it had continued for over a minute, building to a crescendo, a bent figure stumbled his way to the end of the bench at the back and
scurried towards the exit. Once silence had returned, the Procurator Fiscal, who had been momentarily distracted, turned his attention back to the witness.

‘If you could continue?’ he said, returning his gaze to the photocopied pages before him and trying to find his place.

‘“Feeling bright and alert” – well, I suppose I’d be looking at her demeanour, her state of mind, her memory, checking that she wasn’t confused,
disorientated, sleepy, vomiting and so on – those sorts of things. In short, checking that there were no signs consistent with a serious head injury, concussion.’

When there was no immediate follow-up question, the young physician looked across at his interrogator expectantly. The lawyer said nothing, his eyes still scanning the page for an elusive entry.
After a few seconds, Mr Brand resumed his questioning. ‘Very good, very good. Next, you have written “PERLA” – could you tell us what that means?’

‘With head injuries, you check the patient’s pupils,’ Dr Alton replied. ‘You look to see if they are equal, react equally to light and accommodation. It’s an
acronym. You shine a torch into each eye to check both of the pupils’ reactions, and then make them focus on a close object to see if each one constricts and constricts equally.’

‘Did you X-ray her skull, give her a CT scan or an MRI scan?’

‘No.’

‘Why on earth not? She might surely have had a hidden injury, a skull fracture or a bleed?’ The tone the lawyer adopted was one of mild incredulity but, being a bit of a ham, he
overdid it.

‘There wasn’t time. I don’t remember her but I do now remember that night. We were inundated. There’d been a pile-up on the bypass and we were run off our feet. A bus had
been involved and it was all hands on deck.’

‘When did you first recall this rather important detail – about the crash, I mean?’ Mr Brand asked, looking genuinely stunned by the news.

‘Last night. I was looking at my diary and I’d recorded it in there.’

‘And you’re sure that the pile-up was on the same night that you saw Ms Fyfe? You’ve never mentioned it before.’

‘Positive. It’ll have been in all the papers. You could check it there.’

‘In any event, going back to that particular night, you didn’t even assess her on the GCS, did you?’

‘Yes, I did!’ the doctor said hotly.

‘Before you go on,’ the Sheriff cut in, shaking her head to make her exasperation with the Procurator plain but addressing her remarks to the witness, ‘perhaps you had better
tell us what the GCS is, exactly?’

‘The GCS is the Glasgow Coma Scale. It’s a neurological scale devised to produce an objective way of recording the conscious state of an individual. They’re tests – can
the patient respond verbally? Do the eyes open responsively? There are scores for each exercise, and the total, in a healthy individual, is 15.’

‘Fine. On you go, Mr Brand,’ the Sheriff said, pointing at him.

‘Doctor Alton, there is no reference to the GCS in the notes, is there?’ the Procurator Fiscal said. He looked paler than before, and was scanning his file closely, his eyes darting
all over the page as he tried to make sure he hadn’t missed anything.

‘Not in the copy notes you showed me a month or so ago, no, but in the principal records that I’ve now got in front of me there is. I can show you. It’s in my writing.
I’ve given her a score of 15. That means she was normal, drunk or not drunk.’

The doctor held out the principal records, pointing at the relevant page as if to display the entry to the court.

The Procurator Fiscal looked hard at his photocopied notes and then in an agitated tone asked the Macer to take the principal records from the witness and pass them to him. After an interval of
about a minute, during which the remaining colour drained from his cheeks, he found the entry and said slowly, ‘Right enough, I see that.’

Once the witness had the records in front of him again, the Procurator Fiscal continued his examination-in-chief, but he sounded less fluent, less confident than before. It was as if he was now
feeling his way, aware that the ground beneath his feet was no longer solid.

‘What about advice – did you advise her to return if she experienced any of the classic head injury symptoms? There seems to be no reference to that in your notes . . .’

‘I’m afraid there is,’ the doctor said, looking almost disappointed for the lawyer. ‘It just didn’t appear in the photocopies. I think someone must have cut it off
in some way in your notes. In the principal records it says, “Usual advice, to return tomorrow”.’

‘You asked her to return the next day?’ the Procurator Fiscal said, his tone one of undisguised dismay and amazement. He glanced quickly across at the Sheriff. In return, she flashed
him a slightly annoyed, quizzical look and said, ‘You’ll appreciate, Mr Brand, that none of these entries are in my copies either. It looks as if whoever copied them did not do a very
thorough job.’

‘I’m sorry, M’lady. I’ll ensure that full copies are supplied to you for tomorrow.’

Swallowing hard, the Procurator Fiscal turned his attention back to the witness.

‘You were saying, Dr Alton?’

‘I did tell her to return. I told you, because of the pile-up the place was in pandemonium, and I wanted to be one hundred per cent sure of the woman. After all, I hadn’t been able
to have her X-rayed, scanned or whatever, and she was drunk. I couldn’t rely on her reading the head injury advice card I gave her.’

‘Where do we see that?’

‘The notes say “HIAG” . . . see, near the bottom of the page. “Head Injury Advice Given”.’

‘Go on,’ the Procurator Fiscal said.

‘That’s it, really. The examination at that time showed nothing to suggest any kind of focal or diffuse head injury, but I wanted to be sure. There could have been, for example, a
slow bleed, and if so the clinical signs would only appear later. That’s why I will have wanted to see her the next day.’

‘Would you like to sit down?’ the Sheriff asked Professor McConnachie. She had noticed the elderly witness starting to tilt forwards slightly as he gave his
evidence, a hand resting on the base of his spine. He had declined her earlier invitation to take a seat, but she risked asking him once more. It was obvious that an hour of non-stop standing had
taken its toll on the old pathologist.

‘Thank you, M’lady,’ he replied, grateful for the Sheriff’s keen eye and no longer too proud to accept. Resting his bony buttocks on the chair, he tried not to grimace as
another twinge of sciatic pain shot down his left leg.

‘To continue. In your view, did the fall that Moira Fyfe suffered on the thirteenth of January 2010 cause the subdural bleed?’ Mr Brand asked.

‘Yes, I think that was the most likely cause. It appears that when she fell she struck her left temple on the edge of the wing chair, the padded chair, and the left temple was the location
of the bleed.’

‘The bleed – the collection of blood between the dura mater and the arachnoid mater that you mentioned – could that have been responsible for Ms Fyfe’s death?’ the
Procurator Fiscal continued.

‘There was sufficient blood, certainly. However, I can’t say for sure, because, as I explained earlier, I have little doubt that Moira Fyfe also suffered from hypothermia. At post
mortem I found multiple erosions of the gastric mucosa, Wischnewsky ulcers, plus lipid accumulations in the epithelial cells of the proximal renal tubules in her kidneys, and frostbite
lesions.’

‘Professor, there is one thing I am having difficulty with,’ the Sheriff interrupted. ‘If the woman was cold, was suffering from frostbite, then what were her clothes doing all
over the place? Why on earth would she take them off? You’d think it would be the last thing she’d do!’

The Professor nodded his head before answering her. ‘It’s a well-known phenomenon, M’lady, known as “Paradoxical Undressing”. In the moderate to severe stages of
hypothermia, the victim usually becomes disorientated, confused. Sometimes they become fearful; they can even suffer from hallucinations or become combative. In her case, the alcohol she had
already consumed will have, obviously, accelerated the effects of the hypothermia, including the confusion. In such circumstances, the victim discards their own clothing – usually that
covering their lower body first, as in this case . . .’

‘But why,’ the Sheriff asked, brow furrowed in puzzlement, ‘if they are feeling the cold, do they undress? Surely they’d be desperate to keep their clothes on?’