Chameleon

'Very good.'

Jamieson put down the phone. 'You were right,' he said to Sue. 'You're a genius. It was the dressings. An unsterile pack of dressings'

'But how did they get to be unsterile?' replied Sue.

Jamieson shook his head as a black cloud swirled around inside his head.

When they got back to the residency Jamieson went immediately up to the Gynaecology Department and spoke to Sister Roache. She handed him a dressing pack with only two remaining in it. Jamieson was careful not to touch either of them.

'Staff Nurse Telfer says that this was the pack that was used,' said the sister. 'She and student nurse Barnes applied them.' Jamieson said that he would take them to the lab and asked about the condition of the infected women.

'Not good. I've never known such a virulent outbreak of wound infection before.'

Jamieson didn't tell her that this was an entirely new infection but he thought about it on the way over to the Microbiology Department. That two completely different organisms had caused such havoc in the same department only reinforced his growing suspicion that the contamination was not due to a quirk of fate. Something much more sinister was behind it.

Jamieson saw a light on in the microbiology lab and found Moira Lippman there. 'I didn't know you were on call tonight. 'This is a bit of luck,' said Jamieson.

'What can I do for you?' asked Moira.

Jamieson thought the girl sounded a bit distant but let it pass. He asked her about setting up some microbiological tests on the dressings.

'Of course,' said Moira Lippman. 'Just leave them there. I'll do them in a moment.'

The girl turned back to the bench to continue with the specimen she was dealing with and Jamieson felt compelled to ask, 'Is something wrong Moira?'

Moira Lippman put down the tubes she had been holding and laid her hands flat on the bench in front of her. 'My sister in law is one of the infected women,' she said quietly.

'I'm sorry. I didn't realise,' said Jamieson softly. 'How is she?'

'Very ill. They all are.' Moira Lippman swung round in her chair and looked directly at Jamieson. 'There's something crazy going on here,' she said.

'Go on,' said Jamieson.

'It's a Staphylococcus infection this time yet it's behaving in exactly the same way as the Pseudomonas. None of the usual antibiotics are having any effect at all. We are having to run a race to find alternative drug combinations. Two highly drug resistant infections in a row. How can that be?

'Infections that are resistant to treatment are not unknown,' said Jamieson.

'But two in succession? In the same department? There's something not right about this whole affair.'

'If it's any comfort I share your disquiet,' said Jamieson. 'I can't say more than that at the moment.'

Moira nodded and shook her head slightly. She returned to what she was doing.

Jamieson left the lab to return to the residency. As he crossed the courtyard he saw two porters emerge from the side door of Gynaecology. They were wheeling a covered trolley in the direction of the mortuary.

'Can't you sleep?' whispered Sue.

'I'm sorry. Did I wake you?' replied Jamieson in the dark.

'It's all right. What's on your mind?'

'Something Moira Lippman said when I spoke to her earlier. She said that there was something 'not right', to use her expression, about there being two such virulent infections occurring in the same department.'

'You mean the possibility of deliberate contamination has occurred to her too?' asked Sue.

'No I don't think she was going that far,' said Jamieson. 'Moira was talking purely about the organisms involved.'

'I don't see what you are getting at,' said Sue.

'How would you go about contaminating surgical instruments if you had to?' asked Jamieson.

'What a question. I suppose I would just break the sterility seal and expose them to the atmosphere for a while. Maybe drop them on the floor. Spit on them? I don't know really. Something like that.'

'And then they would be unsterile?'

'Yes of course, wouldn’t they?'

'Indeed they would but just think for a moment. Take it a step further. What sort of organisms would they be liable to attract?'

'Oh, I think I see what you mean,' said Sue. 'Your chances of picking up something really nasty are pretty remote?'

'Exactly. I'm not saying it’s impossible but it's not all that likely. If it were, all of us would be sick all of the time. Nasty pathogens are few and far between, thank God.'

'So doing it twice and on two separate occasions would be even more unlikely.'

'Yes,' said Jamieson. 'I think that there's more to it than just breaking the sterile seal on the packs.'

'If the criminal were a carrier of a virulent organism it would be possible for him to contaminate the instruments or dressings from his own secretions,' said Sue.

Jamieson nodded but said, 'Again, the chances of him carrying two deadly organisms are so remote as to be ridiculous. And how would he separate them?'

'I see the problem,' agreed Sue. 'So how did he do it, assuming that there is a 'he'? Any ideas?'

'None,' admitted Jamieson.

'You said that you thought Dr Richardson had some notion about the first organism?' said Sue.

'But he never told me what it was,' said Jamieson.

'Maybe he told someone else?'

'Like who?'

'His wife maybe?'

Jamieson turned and kissed Sue on the cheek. 'Now I know why I love you,' he whispered. 'You're pure dead brilliant.'

Jamieson was surprised to find Moira Lippman in the lab again when he arrived at eight. 'You're back early!' he said.

'I didn't go home. It wasn't worthwhile. There was so much to do last night.'

'You must be exhausted,' said Jamieson.

'I'm OK. I couldn't have slept anyway knowing what Marion is going through.'

'How is your sister-in-law this morning?' asked Jamieson.

'She's very weak and the new drugs are not having much effect.'

'I'm sorry,' said Jamieson. 'Have you looked at the cultures yet?'

'Dr Evans was right. It's a Staphylococcus all right. It's immune to all the penicillins, even the pen'ase resistant versions. Erythromycin is out as well. But I have come up with something.'

'Really? What?'

'Some months ago the hospital took part in a clinical trial of a new antibiotic from Steadman Pharmaceuticals; it was called Loromycin. I carried out the lab work for the trial and I still had some of the drug sitting in the fridge. I tried it out on the Staphylococcus and it worked. The medics could use it if they can get some more from the company.'

'Well done,' said Jamieson. Have you told them?''

'I called the ward ten minutes ago. They still have a few dozen injection vials left over from the trial. Mr Morton has started the women on them while Mr Crichton gets in touch with Steadman for further supplies.'

'What a bit of luck,' said Jamieson. 'I only hope it's not too late.'

Moira nodded.

'Did you recover the organism from the dressings?'

Moira Lippman nodded. 'You were right about that. The dressings were heavily contaminated with the Staphylococcus. There's no doubt that they were to blame for the outbreak this time.'

Jamieson admitted that the idea had been his wife's.

'She's a doctor too?' asked Moira.

'A nurse.'

'Smart lady,' said Moira.

'She's here in the hospital,' said Jamieson. 'She arrived yesterday.'

'Not so smart,' said Moira.

Jamieson checked his watch, got up and said that he was going over to CSSD to check on the sterilisation record of the dressings. He met Clive Evans coming into the lab as he was going out and told him that he had been right about the infecting organism. Evans nodded and said that the microscope slides had been clear. Jamieson told him that Moira Lippman had been on duty all night and obviously needed some rest.