Chameleon

'The post-operative ward in Gynaecology.'

'Thank you,' said Jamieson and put down the phone. So they had changed the theatres and that had made no difference, thought Jamieson. That left the theatre staff themselves as a possible source of infection or possibly the post-op ward in Gynae. The patient had been brought back there after her operation. Jamieson made a mental list of the questions he wanted to ask at the meeting.

There was a general air of gloom about the men who had assembled in Hugh Crichton's office to discuss the latest problem case. Crichton said to a serious looking, thin-lipped man, 'I don't think you’ve met Dr Jamieson yet have you?… Dr Jamieson, this is Mr Thelwell, consultant surgeon in Gynaecology.'

Jamieson smiled across the table and Thelwell gave a barely perceptible nod in reply. Jamieson was then introduced to Phillip Morton, Thelwell's registrar and then to Clive Evans whom he admitted he had already met.

'First of all gentlemen, how is the patient this morning?' asked Crichton.

'She's very ill,' said Thelwell. 'Chemotherapy is having no effect.'

'So it's the same strain as the others?'

'Looks like it,' said John Richardson. 'We'll know for sure when the antibiogram is ready.'

'Has there been any progress in determining the source of the outbreak?' asked Carew.

Richardson shook his head and Thelwell gave an audible snort which caused the others to move uncomfortably in their seats. Richardson carried on as if he had not heard. 'All the swabs we took from the theatres and the recovery wards were negative for the organism in question. In fact the standard of cleanliness was rather high.' Thelwell gave another snort and Carew shot him an angry glance but still said nothing.

'Where were the swabs taken from?' asked Jamieson.

'All flat surfaces including the walls. All wet areas including sink and sluice drains and flower vases in the wards.' replied Richardson.

'And no Pseudomonas?'

'We found Pseudomonas all right but not the strain in question,' said Clive Evans. Jamieson noted that the acne scarring on Evans' face became more livid when he was under stress.

'How about air sampling?'

'We've done that too,' said Richardson. 'Negative for Pseudomonas in all tests.'

'Am I right in thinking that the fact that this latest case was operated on in Orthopaedics means that the theatres in Gynaecology are now cleared of suspicion?' asked Hugh Crichton.

'I think we can assume that,' replied Richardson.

'So what does that leave us with?'

'Nursing and medical staff as possible carriers or something in the recovery wards that we haven't thought of.'

'Presumable you have already swabbed the staff?' asked Jamieson.

Richardson nodded. 'All of them. Nasal and axillary swabs in duplicate on two separate days. We found one nurse carrying haemolytic streptococci but no Pseudomonas carrier.'

'What about instruments and dressings?'

'They are sterilised in our Central Sterile Supply Department and taken directly to theatres in sterile packs.'

'How often are the sterilisers checked?'

'The autoclaves are fitted with a wide range of safe-guards against malfunction.

'Anything else?' asked Jamieson.

'Dr Evans is in charge of bio-safety in the CSSD,' said Richardson looking towards his junior colleague.

'The main steriliser is thermo-couple tested every week,' said Evans. 'I personally carry out the test. It's in perfect condition. Someone from Microbiology, usually myself, checks the chart recorders on the others every day. We have the records of every single autoclave run. They're kept in the lab office if you would like to examine them.'

'I think at this stage I would like to see everything including the air sampling reports and the swab results.' said Jamieson.

Evans looked a little surprised but Richardson simply said, 'Of course. When would you like to come?'

'Immediately after this meeting if that's convenient?'

'Of course.'

Carew cleared his throat and said, 'Now gentlemen we come to the big question. Can we allow surgery to continue in Kerr Memorial's Gynaecology Department?'

Gordon Thelwell looked as if there had never been any suggestion of doing otherwise. 'We have to,' he said firmly. 'My waiting list is already as long as a bank holiday traffic jam. Any suspension would only make matters worse.'

'We have to consider that two women have died after surgery and a third is seriously ill,' said Carew.

'The number has to be viewed in the context of the number of surgical cases passing through my Department.' replied Thelwell.

The coldness of Thelwell's statement made Jamieson a little uneasy and he saw that it had much the same effect on the others.

'The dead women's husbands don't view the deaths in the context of any numbers,' snapped Richardson.

Thelwell, wasp-like in his response snapped back, 'Then perhaps Doctor if your department did its job we would not be faced with the problem and neither would they.'

Richardson leaned forward angrily in his chair but managed to control his temper in time. He took a deep breath and said, 'We are doing everything humanly possible to identify the source of the infection and will continue to do so starting with another swab check of the surgical team and the nurses in the post-op wards.'

'Maybe we should send the swabs directly to the Public Health Laboratory Service this time,' said Thelwell. 'Perhaps they can find this damned bug.'

Jamieson saw the flash of anger in Richardson's eyes and noted Carew's impotence in intervening in the hostilities. He himself interrupted. 'They will go to the hospital lab in the usual manner.'

Thelwell reacted as if Jamieson had struck him. He said slowly, 'And who might I ask are you to make that sort of decision?'

Jamieson replied evenly, 'I think you will find that I have the authority.' He looked to Crichton and Carew.

Crichton said, 'Dr Jamieson does have the authority Mr Thelwell.'

Thelwell's smile was dipped in sarcasm. He said, 'So a civil servant is now in charge of surgery at Kerr Memorial.'

'Actually I'm a surgeon,' said Jamieson. 'And my involvement with Kerr Memorial will cease the moment people stop dying unnecessarily in your department. And talking about your department Mr Thelwell, I would like to be shown round it… today.'

Jamieson held Thelwell's gaze without flinching. It was Thelwell who broke eye contact first. He said, 'I'll have Mr Morton accompany you.'

'I'd rather you did it personally,' said Jamieson determined to establish his authority at the beginning in the hope that done once it would not be necessary to do it again.'

Once again Thelwell hovered on the brink of argument and Jamieson could see the anger swim in his eyes as he considered his reply. The thin lips quivered before they said curtly and to everyone's relief, 'Very well. Contact my secretary and she will fit you in to my schedule.'

Carew reminded them, 'We have still not decided what to do about the surgical lists.'

'I thought we had,' said Thelwell coldly.

'You expressed an opinion Mr Thelwell,' said Carew. 'But we did not decide. We must consider the options.'

'Which are?'

'Basically, there are three. One, we suspend surgery temporarily. Two, we start diverting patients to other hospitals. Three, we continue operating in the hope that, with extra vigilance on all our parts, the problem will not re-occur.'

'The second option is a non-starter I'm afraid,' said Crichton. 'I've been in touch with all the other hospitals and there is no possibility of their accepting any of our patients outside of dire emergency cases. Their lists are just as long as ours.'

'So we suspend or carry on with greater care.'

'I resent the implications of that remark Carew,' said Thelwell icily.

'There was no personal element in what I said Thelwell. If we decide that surgery is to continue in Gynaecology, aseptic procedure must be tightened up in all areas.'