Chameleon

'On what?'

'On an agreed procedure for sterilising and storing instruments and dressings,' said Jamieson.

'What do you have in mind?'

'I suggest that instruments are not stored in the theatres at all. I suggest that they are collected fresh from CSSD immediately before they are required.'

Thelwell thought for a moment and then said, 'Agreed.'

'I'll take these back down with me,' said Jamieson nodding to the packs from Thelwell's desk. Thelwell handed them over.

Jamieson returned to his room in the lab after setting up the new procedure for instruments with CSSD and the administration people. Moira Lippman asked if he had a moment to speak. He said that he had but then his phone rang. It was Macmillan from Sci Med.

'Time of death on the murder in Leeds last night has been set at some time between ten thirty and eleven.'

Jamieson thanked him and put down the phone. He had been hoping for a time of death after eleven thirty when Thelwell had returned home but that comfort had been denied to him. He tapped the end of his pen on the desk while he thought. Behind him, Moira Lippman cleared her throat to remind him of her presence.

'Sorry,' he said. 'I was miles away.'

'I repeated your tests on the Pseudomonas,' she said.

Jamieson smiled. 'What happened?'

'You were quite right. There were three significant differences in terms of biochemistry. In fact I did some extra tests and found two more.'

'Five?' exclaimed Jamieson.

Moira Lippman nodded. 'Very strange,' she said. 'In fact one might almost think that… No, it's silly.'

'What is?'

'No, really. It isn't worth mentioning.' With that Moira Lippman turned on her heel and left Jamieson alone again.

Jamieson reflected for a moment on how much he hated when people did that.

The first indication that all was not well in the post-surgical care ward in the Gynaecology department, came at three thirty when Hugh Crichton called Jamieson and said, 'You did ask to be kept informed of any other surgical infections breaking out in the hospital?'

'Yes.'

'It's beginning to look as if several women in surgical gynaecology who had their operations within the last ten days have developed fever and signs of wound infection.'

Jamieson closed his eyes for a moment then said, 'Go on.'

'There's not much more to report really. Samples are on their way down to the lab for bacteriology. I just thought you should know.'

'How are the women?' asked Jamieson.

Crichton cleared his throat nervously before replying, 'They are rather ill actually. It all happened very suddenly and their condition has been worsening all the time.'

'Thanks for telling me.'

Jamieson put the phone down and cradled his head in his hands for a moment while he thought. More infection and again in Thelwell's unit. If the damned Pseudomonas strain was responsible again the whole place would have to be closed down. There was no alternative. He went to talk to Clive Evans.

'I've just heard,' said Evans when Jamieson entered. 'The specimens will be here at any moment.

'So you will know by tomorrow morning if it's the Pseudomonas to blame?'

'Tomorrow for sure but we can do a few microscope slides on the specimens directly. We should be able to get an idea from them.'

'How long?'

'Half an hour.'

'Let me know as soon as you have a result, will you?'

'Of course.'

Jamieson was trying to call Sue for the fourth time that day and still without success when Clive Evans came into the room. Jamieson could see that he had the results of the primary tests. He replaced the receiver.

'I've just had a look at the stained slides,' said Evans.

'And?' asked Jamieson anxiously.

'I don't think it's the Pseudomonas.

'You don't?' exclaimed Jamieson.

'They're Gram positive cocci rather than Gram negative rods.'

'So what do you think?'

'All the indications at the moment are that it's a Staphylococcus infection,' said Evans.

'A different infection?' said Jamieson sounding bemused.

'It seems to be, but we won't know for sure until the morning when the cultures have had time to grow up.'

Jamieson turned away, wresting inside his head with the implications of what Evans had said. 'Another outbreak of post-operative infection in the same unit but caused by a completely different bug?' he murmured.

'That's how it looks,' said Evans. He could see that Jamieson was deep in thought so he said, 'If you'll excuse me, I've got things to do.'

'Thanks,' said Jamieson absently.

Jamieson walked over to Gynaecology at six thirty. The condition of the infected women in had worsened and there had been speculation that some of them might actually die before morning if the right antibiotic was not found. The choice of antibiotic treatment had already caused disharmony between Thelwell and his team. They were all agreed that penicillin was proving ineffectual. This was not too surprising because most hospital strains of Staphylococcus had become resistant to the drug over the years but Thelwell's insistence that Cephalosporin should continue to be used and Morton's insistence that it was having not having an effect either was causing tight lipped anger all round. Jamieson intervened to suggest that they treat the women with more than one antibiotic at the same time. After a brief discussion they agreed on a regime of three drugs with close monitoring of the patients' condition so that the regime could be altered if it was proving ineffectual.

Jamieson took the ward sister to one side and asked her about the infected patients. 'How many patients do you have in the ward Sister?'

'Seventeen.'

'And of these only eight have become infected?'

'So far,' said the sister.

'Do the eight have anything in common?' asked Jamieson.

'I don't understand.'

'I'm looking for the reason why eight of the seventeen patients have developed wound infections and the other nine didn't. Did they all have their operation on the same day? In the same theatre? Were the operations performed by the same surgeon? That sort of thing.'

'I'll check for you.'

Jamieson followed the woman to the ward duty room and waited while she checked the records. He became aware that his presence at her shoulder was making her uncomfortable so he turned away and looked at some post-cards pinned up on the wall until she had finished. Two were views of sun-splashed beaches in the Mediterranean; the rest were saucy sea-side cards almost invariably featuring large bosomed nurses and captions of the 'Blimey Nurse!' sort.

'Only two had their operations on the same day,' said the sister. 'Some operations were carried out by Mr Thelwell others by Mr Morton. Some were done in Gynae; three were done in the Orthopaedic theatre. No obvious common factor.'

'There must be one,' maintained Jamieson. 'If they all became infected at the same time there must be one.'

'I can't think,' said the sister.

'Nor can I at the moment,' agreed Jamieson, racking his brain. 'But there has to be a common link. There are just too many for it to be chance wound infection with an airborne bug.'

A nurse came into the duty room and apologised for interrupting before saying, 'Sister, it's Mrs Galbraith. She's very ill.'

The ward sister left the room. Jamieson could hear cries of pain coming from the ward. He left and returned to the residency.

As he climbed the stairs Jamieson thought he heard a slight sound on the first landing as if someone were standing there. He paused but now could hear nothing. Normally this would not have merited any consideration at all but his nerves were taut. There was something strange going on in this hospital, maybe even something evil. The knowledge brought fear and suspicion with it. He continued up to the head of the stairs but was cautious about turning the corner. The thought that someone was lurking there had become almost unbearably strong. He made noise with his feet to suggest that his next step would bring him round the corner and then drew back his right fist. An arm emerged from the shadow and Jamieson prepared to let fly. He only just managed to stop himself in time when he caught a glimpse of the wrist and realised that it was a woman's.