Crisis Page 2

  Bannerman changed the slide and altered the focus slightly with his thumb. ‘This is a photograph of a patient who contracted CJ disease after corneal graft treatment. Note the vacant expression in the eyes and the lack of facial muscle tone.’

  A voice from the darkness said, ‘Are you suggesting that the patient got the disease from the graft?’

  ‘Almost certainly,’ said Bannerman.

  ‘Then this is an infectious condition?’

  ‘Yes, but not conventionally so.’

  There was a murmur of amusement as the student body began to believe that they had caught Bannerman about to prevaricate at last.

  ‘Yes or no?’ demanded the cocky student voice.

  ‘Officially the diseases are said to be caused by unconventional slow viruses.’

  ‘How unconventional?’

  The truth is that no virus has ever been isolated from an infected brain but in all other respects the material behaves as if an infectious agent is present.

  ‘Then the disease can be transmitted?’

  Yes.’

  ‘Are there any other diseases like these?’

  ‘Several, in animals.’

  ‘Such as?’ asked the student, determined to catch Bannerman out if he could.

  ‘Scrapie in sheep; Bovine spongioform encephalopathy in cattle.’

  ‘Mad cow disease?’ asked the student.

  ‘Yes, also transmissible encephalopathy in mink.’

  ‘But surely a bit of research would determine the cause of these conditions?’ said the student.

  For a moment Bannerman was taken aback at the arrogance of the proposition then he said, ‘Mister …?’

  ‘Marsh,’ replied the student.

  ‘Mr Marsh, there is a small but significant graveyard containing the careers of several top flight researchers who insisted they had discovered the cause of these diseases. Perhaps you would care to do “a bit of research” and give me your written submission on where you think they went wrong? Shall we say by next Wednesday?’

  ‘Yes sir,’ mumbled the student, all trace of youthful arrogance gone.

  ‘Is there a species barrier?’ asked a female student voice.

  ‘Good question Miss ‘…?’ said Bannerman.

  ‘Lindsay.’

  ‘Good question Miss Lindsay. Everyone thought there was a barrier until Mad cow disease caught us on the hop. Recent research suggests that the cattle got it from eating foodstuffs containing Scrapie-infected sheep brains.’

  Then it’s not inconceivable that man could contract brain disease from eating infected animals?’

  ‘It’s not inconceivable, but there’s no evidence to support such a view.’

  ‘At the moment,’ added the student.

  ‘At the moment,’ conceded Bannerman.

  ‘It could be that Creutzfeld Jakob Disease in man is actually derived from eating infected meat?’

  ‘I repeat, there’s no evidence to support such a view.’

  ‘But you would advocate a vegetarian lifestyle anyway,’ said a student at the back.

  There was general laughter and Bannerman joined in. ‘I have no intention of becoming vegetarian,’ he said.

  ‘At the moment,’ added Miss Lindsay and there was more laughter.

  ‘What about Alzheimer’s. Is it related to slow virus disease?

  ‘There are distinct differences in pathology.’

  ‘Is it known what causes Alzheimer’s?’

  ‘There is a genetic form of the disease but no clear proof about the more common type apart from the suggestion of some chemical involvement.’

  ‘Aluminium?’

  ‘There is some published evidence about the involvement of aluminium,’ agreed Bannerman.

  ‘Would it be true to say that research on dementia is woefully inadequate, Doctor?’ asked a confident voice.

  Bannerman looked at the student who held his gaze from beneath a mop of red hair which clashed with the colours of his medical school scarf. There was almost an air of insolence about him but Bannerman had seen it too often before to be upset by it. It was simply the holier-than-thou righteousness of the young. ‘Yes I think it would,’ he said evenly.

  ‘Why?’ demanded the red-haired young man.

  ‘Every society has a limited amount it can spend on research,’ said Bannerman. ‘Dementia is primarily a disease of the old. There are enough diseases of the young to occupy our resources. It’s as simple as that.’

  ‘Personally I think it’s disgraceful,’ said the student.

  Bannerman could feel that the sympathy of the class was not with him. ‘Perhaps you should be reading social sciences, not medicine,’ he said.

  ‘Or politics,’ suggested another student voice to a murmur of laughter.

  ‘Medicine is a practical business,’ said Bannerman. ‘You work with the resources you have and make decisions accordingly. If you are faced with two patients in kidney failure and you have only one kidney machine it’s no good shouting about how disgraceful it is. You have to decide which one lives and which one doesn’t.’

  Bannerman gave the class a moment to think about what he had said before saying, ‘Perhaps the class would care to compare the pathology of the more common forms of dementia and we can discuss it next time.’

  Bannerman returned to his office in the hospital and lit a cigarette. His secretary, Olive Meldrum, appeared a few moments later with strong, black coffee without being asked.

  ‘How did it go?’

  ‘Not bad,’ replied Bannerman. ‘Not bad at all. They’re quite a bright lot. Any messages?’

  ‘Stella phoned. She’s operating this afternoon but she still expects you for dinner at eight and would you bring the wine?’

  ‘Did she

  ‘She said chicken,’ said Olive, anticipating the question.

  ‘Anyone else?’

  ‘Dr Vernon asked that you call him if you have a spare moment. That was all.’

  Thanks Olive, get me Vernon would you?’

  Olive closed the door behind her and a few moments later the buzzer on Bannerman’s phone announced his call.

  ‘Hello George, what can I do for you?’

  After a few pleasantries Vernon got down to business. ‘I’ve had a forty-seven-year-old man in for treatment on his arm. He burned it badly in an accident with a kettle of boiling water.’

  ‘Not exactly my area of expertise,’ said Bannerman.

  ‘It’s not the burn I’m concerned about,’ said Vernon. ‘I think he may have other problems.’

  ‘What makes you think that?’

  ‘I’ve noticed that in several conversations I’ve had with him he appears to have forgotten what I said to him only a few moments before. The first time I thought nothing of it but it’s happened more than once. Brain disease is your thing; I wondered if you might take a look at him?’

  ‘Of course,’ said Bannerman, looking at his watch. ‘How about now?’

  ‘Absolutely,’ answered Vernon, saying that he was obliged. He would meet Bannerman at ward seventeen in five minutes.

  Bannerman rinsed his mouth with the antiseptic wash he kept by the basin in his office; he didn’t want the patients to smell the cigarette smoke on his breath. He put on a fresh white coat and started out for the ward. The pathology lab was in the hospital’s basement so his journey took him up two flights of stairs and along a corridor which was busy with lunch trolleys and nurses in transit between their wards and the dining-hall. Vernon met him at the entrance to ward seventeen; they entered together.

  ‘I rang Sister to say we were coming,’ said Vernon.

  As if on cue, a stout woman dressed in navy blue with a white frilly cap on her grey hair emerged from a door to their left and smiled at them. ‘Mr Green is all ready for you,’ she said. ‘Nurse will screen him off.’

  Vernon and Bannerman were accompanied down the ward by a student nurse who pulled green, cotton screens round the patient’s bed, corralling the three of the
m inside. The ward had a meal-time smell, a mixture of food and antiseptic.

  ‘Mr Green, this is Doctor Bannerman. He would like to ask you a few questions.’

  The patient, a well-built man with a tanned face and good teeth smiled and said, ‘What can I tell you Doctor? My arm is coming along well thanks to Doctor Vernon here and they tell me I’ll be getting home soon.’

  ‘I’m glad to hear it,’ said Bannerman. ‘What happened exactly?’

  The patient smiled and said, ‘You chaps are like the police. You keep asking the same questions over and over again.’

  ‘I hope that’s not from personal experience,’ smiled Bannerman.

  ‘Indeed it is,’ replied Green.

  Bannerman was taken aback and Green noticed. ‘I’m a policeman Doctor, a sergeant in CID.’

  ‘Oh I see,’ said Bannerman with a smile. ‘I didn’t know. So what happened?’

  ‘Happened?’ asked Green.

  Bannerman noted that Green appeared to have forgotten the original question and exchanged a quick glance with Vernon who nodded. ‘Your accident,’ said Bannerman.

  ‘It was just carelessness really. I grabbed at a kettle thinking it was empty. I was going to fill it to make some tea and it turned out to be full of boiling water. It went all over my arm.’

  ‘Nasty,’ said Bannerman with a grimace. ‘Who else was in the house at the time?’

  ‘Nobody,’ replied Green.

  Bannerman looked at Green wondering whether or not he would realize anything from his own reply but he didn’t appear to. ‘What happened then?’ he asked.

  ‘I tried to get my shirt off to hold my arm under the cold tap for a bit but the pain was something else. I could see the damage was pretty extensive so I called the ambulance and waited.’

  ‘Did the ambulance take long to come?’

  ‘Eight minutes,’ replied Green. ‘I watched them all pass on the clock.’

  ‘Do you know how long it took to get to the hospital?’ asked Bannerman.

  ‘Ten minutes,’ replied Green. ‘It would have been quicker but there was a big snarl-up of traffic in Graham Road where they are laying new gas pipes. We got held up there for a couple of minutes despite the siren and flashing lights.’

  ‘What day is it today?’ asked Bannerman.

  Green smiled as if he hadn’t heard properly but Bannerman’s expression assured him that he had. ‘Why it’s … it’s …’

  ‘Tuesday,’ said Bannerman, Tuesday the 23rd of January.’

  ‘Of course,’ smiled Green. ‘I couldn’t think for a moment there. That’s the trouble with being in hospital, the days just come and go and they all seem the same.’

  Bannerman nodded sympathetically and said, ‘I want you to start counting backwards from three hundred taking away seven at a time.’

  Green shrugged his shoulders and began. Three hundred, two hundred and ninety-three, two hundred and eighty-six, two hundred and seventy-nine, two hundred and eighty-six, two hundred and eighty-six …’

  That’s fine,’ said Bannerman.

  ‘How did I do?’ asked Green with a smile.

  ‘Just fine,’ said Bannerman. He looked to Vernon and nodded.

  Vernon thanked Green for his cooperation and he and Bannerman left to walk back up the ward to the ward duty-room while a nurse pulled back the screens on Green’s bed.

  ‘What do you think?’ asked Vernon.

  ‘I think you were right to be suspicious,’ said Bannerman. ‘He’s showing all the signs of early Alzheimer’s.’

  ‘I feared as much,’ said Vernon.

  ‘His long term memory is fine but short-term is practically lost. I suspect that was the cause of his accident. I think he put the kettle on to boil then forgot that he’d done it. He went to do it again and poured the scalding water over his arm. He said there was no one else in the house. It must have been him who boiled the kettle in the first place.’

  ‘He’s only in his forties,’ said Vernon shaking his head.

  ‘He can only get worse,’ said Bannerman softly. To all intents and purposes his useful life is over.’

  ‘He has a wife and two teenage sons; one of them is a black kid they adopted when he was three. Sometimes I wonder if there’s a God at all.’

  ‘I came to my own conclusion on that one some time ago,’ said Bannerman without elaborating. He said goodbye to Vernon and returned to the Pathology Department.

  Olive Meldrum had gone to lunch; the outer office was empty. Bannerman made himself some more coffee and took it through to sit down at his desk and light up a cigarette. There would be no lunch for him today he decided. The bathroom scales this morning accused him of being twelve and a half stone and he had not been able to offer any defence. The band of thickening flesh round his middle, a legacy of over-indulgence at Christmas, was conclusive and could not be denied. Something had to be done.

  Bannerman looked at the date on his desk diary and remembered that in eight days time it would be his thirty-eighth birthday. Thirty-eight and still unmarried! he could hear his mother declare. He had been up to see his parents at Christmas and had suffered the annual accusations along these lines. Luckily he had a sister Kate who had provided, with the aid of her husband, two grandsons to take the pressure off a little. ‘When are you and Stella going to get together properly?’ his mother had wanted to know.

  Bannerman had countered by declaring, as he had so often in the past, that he and Stella were just old friends. It was true but then Stella was the only woman he ever mentioned at home. Some five years before there had been a romantic element to their friendship but it had not come to anything and had been abandoned in the cause of their continuing friendship. Occasional liaisons with members of the nursing staff were usually short-lived and seldom mentioned at home for fear of maternal probings worthy of the Spanish Inquisition.

  Bannerman took a deep lungful of smoke and rested his head on the back of his chair to wonder why he had never married. He liked women and they seemed to like him well enough. But there had always come a point in relationships when he had backed off, unable to make a final commitment. He closed his eyes for a few seconds reflecting on the irony of never being able to make clear decisions about his own life when he made so many about other people’s with no apparent trouble at all.

  If he were to be honest with himself he would have to admit that there had been a string of women in his life with whom he had formed affectionate relationships but nothing more. Stella had once pointed out that there was a difference between wanting someone and needing them. A woman liked to feel needed. Was that it, he wondered. Was he so self-contained that he didn’t need anyone? An island?

  Bannerman stubbed out his cigarette and decided that he had had enough of self-analysis for the moment. He checked his schedule for the afternoon and saw that he had a post-mortem to perform on a patient who had died of a brain tumour. He had also promised to be on call for any emergency analysis that theatre required during a breast operation that was being carried out by John Thorn, a surgeon colleague of Stella’s for whom she had particular regard. ‘The lump is in an awkward place,’ Thorn had said. ‘If I get it wrong the patient won’t have a second chance.’

  The operation was due to begin at three-thirty. It was five minutes to two. Bannerman decided that he would start on the PM and leave a message that he was to be called if any section analysis was required by the theatre team. He clipped his bleeper to his top pocket and started out for the mortuary.

  His prompt arrival at two o’clock took the mortuary attendant by surprise. The man was sitting at a small wooden table in his office with a newspaper in front of him. A sandwich with a bite taken out of it lay on some greaseproof paper and a thermos flask with its lid off stood beside it.

  ‘I was a bit late in getting off for my lunch,’ explained the man. ‘Doctor Leeman took longer than he thought this morning.’

  ‘Just when you’re ready,’ said Bannerman.

  ‘Who is it y
ou’re doing Doctor?’ asked the man, getting up from the table and wrapping the paper round his half-eaten sandwich.

  ‘Thomas George Baines from ward eight; he died on Sunday night.’

  The attendant checked a wall chart which depicted the refrigerated body vault. The names on it were written in pencil so it could be used indefinitely with the aid of a dirty eraser that lay on the table below. ‘Baines, number five,’ he said to himself.

  Bannerman moved back to allow the attendant to exit from the room and then followed him to the body vault. This was located in a long, white-painted room, one side of which was entirely taken up with a series of tall doors, each secured with a heavy metal clasp. The doors were numbered from one to eight. The attendant opened one and revealed three sliding trays, one on top of the other. He checked a label on the middle one and said, ‘Here we are, Thomas Baines.’

  The man pulled an adjustable trolley into position and locked it in position before winding up the platform to match the height of the middle cadaver. With a practised tug he slid the body of Thomas Baines out onto it and unlocked the trolley to swing it round in a semi-circle before slamming shut the door of the vault. ‘Table one all right?’ he asked.

  ‘Fine,’ said Bannerman.

  The man manoeuvred the body on to the post-mortem table and removed the shroud. He turned on the cold water supply to the slab and water started to gurgle down the gulleys. Bannerman himself turned on the overhead light and switched on the extractor fans.

  ‘Do you want the air freshener on?’ asked the attendant.

  Bannerman shook his head. ‘It’s a head job,’ he said. Bannerman loathed the smells of pathology as much as the next man but found the scent of the air freshener almost as bad in terms of pervasiveness. It would cling to him. There would be no need to open up the chest cavity of Thomas Baines. The examination would be confined to the head so he would do without the air freshener.