Chameleon

'Mr Thelwell insists on picking up the instruments that go to his theatre himself.'

'Has he always done this?'

'Just for the past couple of months.'

'He just comes down here and takes away his instrument packs?' asked Jamieson.

'He does more than that,' replied Blaney. 'He likes to monitor the sterilising process.'

'What exactly does he do?' asked Jamieson.

'He checks the temperature and pressure gauges during the autoclave cycle, monitors the graph recorder, waits till the instrument packs come out then takes them up to his theatre.'

'Did Mr Thelwell say why he does this?' asked Jamieson.

'A safety precaution,' replied Blaney.

'A safety precaution,' repeated Jamieson thoughtfully.

'That's right,' said Blaney. 'Is something wrong?'

'No… nothing,' said Jamieson but his mind was turning cartwheels. The revelation that Thelwell was an intermediate in the chain of events that brought sterile instruments from the supply department to the theatres was something that he hadn't reckoned on.

'Mr Thelwell is a very conscientious man. He leaves nothing to chance,' said Blaney. 'Even though Dr Evans puts these machines through their paces every week and the graph recorders are always spot on, he likes to see things for himself.'

'Does Mr Thelwell just collect his own instruments?' asked Jamieson, trying to make it sound like a casual inquiry.

'No, he takes all the packs for gynaecology,' replied Blaney. 'There's nothing wrong in that is there?' he added in a slightly aggressive response to the frown on Jamieson's face.

Jamieson said that there wasn't but his mind was working overtime.

'Perhaps you would like to see the routine?' asked Blaney.

Jamieson looked at Blaney, smiled and then said, 'Why not.'

Blaney gave Jamieson a conducted tour of the sterilising hall, stopping at intervals to explain things when he thought it necessary.

'Do you always use the same steriliser for the instruments?' asked Jamieson.

Blaney nodded and pointed to one of the autoclaves. 'That one,' he said. 'All sterile supplies for Gynaecology go through that one.'

Jamieson looked at the dials on the front. He said, 'What would happen if the steam supply should fail?'

'The machine would reset itself and refuse to proceed with the cycle.'

'What if it should fail half way through a cycle?'

'Same thing. It would reset itself and the graph recorder would show the failure.'

'Is there a manual over-ride?' asked Jamieson.

'I don't understand,' said Blaney.

'Can you convince the machine that it has completed its sterilising cycle when it actually hasn't?'

'But who would ever want to do that?' asked Blaney.

'Can it be done?'

'No,' said Blaney. 'The automatic timer will not start until the temperature has climbed to a pre-set value and if at any time during the cycle the temperature should fall below that value, the timer would reset itself and refuse to start until the temperature had climbed again.'

Jamieson looked at the chart recorder on the front of the machine and said, 'Do you keep these charts?'

'Every one,' said Blaney.

'So if I were to ask you for the chart from the run Mr Thelwell has just been watching you could show it to me?'

'Of course.'

'I'd like to see it,' said Jamieson.

Blaney shrugged and asked Jamieson to wait while he fetched it from his office. He returned with a circular piece of graph paper. 'This is it,' said Blaney. 'Dated and initialled.' He traced the blue line on the paper with his forefinger and said, 'As you can see, it was a normal run. The temperature climbed steadily as the steam entered the machine and at 131 degrees centigrade the timer was triggered.' The finger traced a plateau on the graph. 'The temperature held steady until the timer cut out and here…' Blaney's finger began to drop with the blue line. 'is where the steam was shut off and the temperature started to fall.'

'Thank you,' said Jamieson. He made a mental note of the reference number on the graph before asking, 'How often is the machine checked?'

'Dr Evans checks it out every week, sometimes twice.'

'You couldn't ask for more than that,' said Jamieson.

Blaney smiled modestly and said, 'We do our best.'

Jamieson returned to the Microbiology department to pursue his original intention of going to see Clive Evans but his mind was now almost totally preoccupied with the fact that Thelwell was removing surgical instruments from CSSD and holding them in his personal possession before they were used. Why? Why? Why?

He found Evans in what had been John Richardson's office. He was sifting through some papers.

'Just checking up on some overdue lab reports,' said Evans by way of explanation when he saw Jamieson.

'Did you find them?' asked Jamieson.

'Not yet. What can I do for you?'

'I wanted to talk to you about correlating your efforts with the Public Health people so that you don't start getting in each other's way,’ said Jamieson.

'When will they come?' asked Evans.

'Tomorrow morning.'

'Perhaps I could have a word with their chap before they start and we can agree on not duplicating each other's work.'

'Good idea. I'll bring their people across to the lab when they arrive,' said Jamieson.

'Was there something else?' asked Evans seeing that Jamieson was lingering on.

'When did you last check the surgical steriliser in CSSD?' asked Jamieson.

Evans looked surprised. 'This morning. Why do you ask?'

'Was it all right?'

'Perfect. It always is. I don't see what you are getting at.'

'This lab has so far failed to find the contaminating organism in the theatres, the wards, the air samples or anything else for that matter. Correct?'

'I'm afraid so,' said Evans.

'As I see it there are only a limited number of ways this infection problem can come about. One is that some person is carrying the infection and passing it on to the patients undetected.'

'Like Thelwell.'

'Like a carrier,' agreed Jamieson. 'Another way would be for the instruments or dressings in theatre to be contaminated.'

'That's impossible,' said Evans. 'They are autoclaved in sealed packs.'

'So the lab never bothers to check them, right?'

'There's no need.'

'You check the machines but you don't check what comes out of them.'

'There's no need,' repeated Evans.

'I want you to carry out a spot check on an instrument pack from the gynaecology theatre.'

'When?'

'I'll tell you when.'

'You're the boss,' said Evans but he said it in a way that made it plain that he thought what he was being asked to do was a waste of time.

Jamieson understood his point of view but did not tell him about Thelwell having collected the instruments from CSSD. It would have been too easy for Evans to read his mind and know what he was thinking. For the moment that was too terrible to be voiced out loud. If the instruments were at fault, the contamination must be occurring after they had been sterilised. That meant that it was not accidental. The contamination had been deliberate! Women were not dying of an unfortunate, accidental infection at Kerr Memorial. They were being murdered.

NINE

The possibility that Gordon Thomas Thelwell might actually be interfering with the sterility of surgical instruments before they were used in theatre was an idea so horrendous that Jamieson had great difficulty in even considering it without his sub-conscious sending up a stream of objections and telling him that there must be some mistake. Such a thing just could not be. This was the stuff of surreal nightmares, the province of the lunatic asylum. It had to be some wild figment of his imagination born out of his intense dislike of the man but still the thought would not go away.