dim, ghost-green glow of the two VDUs at the desk. Beyond the receptionists’ windows, the waiting area itself seemed over-lit and very empty, a long room filled with rows of standard-issue seating – moulded plastic chairs which, as Mike insisted on pointing out, came in the tasteful NHS colour choice of bile green, puke orange, pus yellow and brain grey. Some were still strewn with old magazines from the reading rack: creased Bellas and dog-eared Cosmos. At the far end, the night pressed cold against the closed double doors.
I was still trying to kid myself that I was just killing time as I went into the office and took a seat in front of the nearer VDU. I didn’t bother with the light; I could almost feel my face soaking up the green-screen glow. And for a long moment I just sat there, staring, as if mesmerized by the endlessly blinking cursor. Then I leaned forward and typed in a name, watching it spell itself out across the screen.
KAUFMANN, JOSEPH
The computer beeped, and flashed up a request for further information. I had it ready, knew it now by heart.
D.O.B. – 29/07/32.
ADDRESS – NFA
DATE ADMITTED – 14/06/93
The drive whirred quietly, and in another moment the patient admission data was unscrolling before me. Joseph Karol Kaufmann, age 60, no fixed address, no GP. Admitted by ambulance 21:54. Died in department 22:16.
There was other info too, and various coding references; but that was the gist. Somehow it didn’t quite convey the impact of the event. It had all seemed a routine admission to start with, to be sure. But it wasn’t. Oh no.
Ambulance Control had – given advance warning: collapse coming in, severe chest pains. I’d finished taking the details of pulse and b/p over the phone, and handed the scribbled note to Kathy Jones, who was the doctor on for that night, as we made our way to Resus. From the way she squinted at it, running her free hand back into her dark, tangled hair, I got a hint of just how tired she was; normally she never let it show.
‘Is he conscious?’
I nodded. ‘Bit delirious, apparently. Look like an MI to you?’
‘Um. Probably. We’ll get him wired up as soon as he’s in.’
The ambulance arrived a couple of minutes later, and I went out to meet it, hugging myself in the chill night air as I watched the crew unload. The man on the trolley looked wasted and gaunt, his face almost paler than the pillow. We wheeled him in through the ambulance doors, bypassing the waiting area’s walking wounded; one or two people glimpsed us, and stood up to gawp.
On into Resus, where the routine began to unfold around him with the quiet confidence of endless practice. We transferred him across to our own trolley, and Karen and I sat him up and helped him off with his coat and shirt – from the state and smell of them, the bloke was in off the streets – while Mike and Kathy set about preparing the ECG. I spoke to the ambulancemen as I worked, checking details; Karen kept talking to the patient, softly and calmly, trying to ease the panic that shone in his frantic eyes.
Helen Wright was at my elbow, less the wide-eyed student by now and anxious to help. I gave her the clothes to bag up, calling goodbye over my shoulder to the ambulance crew as they left. See you again, lads … The electrodes were already pasted to our patient’s scarred and bony chest, and Kathy was studying the readout. ‘How’re we doing?’ I asked.
I got the impression she wasn’t quite sure. But after fingering her way through the length of readout tape, and listening to his heart sounds again, she nodded to herself, and glanced across.
‘MI. We’ll make sure he’s stable, then get him upstairs to Coronary Care. Will you let them know, Rachel?’
I was already on my way over to the phone, handing my drug keys to Mike as I passed. ‘Diamorph?’ he asked, and I nodded.
‘We think you’ve had a myocardial infarction,’ Kathy was telling the patient, speaking slowly and clearly. ‘A minor heart attack. We’re going to have to admit you for …’
The man looked at her then, and that look left even Kathy lost for words. In the midst of that pale, sweating face, his eyes were glazed and staring – and the despair in them was almost frightening. Deep in his throat, he gurgled.
Here comes the vomit, I thought resignedly, and wondered if Karen would move quickly enough to avoid getting it all over herself this time. Kathy drew back prudently, and I was already reaching for the plastic bowl when I noticed something that made me hesitate … and frown.
A thin trickle of blood had started from the corner of his mouth.
My poised hand wavered. For an unreal second we were all of us still as he began bloodily to drool.
I’d seen it all before, of course. Haematemesis and haemoptysis; patients vomiting blood or coughing it up. But suddenly, as I watched that slowly lengthening dribble, strung out with saliva, I felt my stomach go cold and tight inside me. Somehow I’d known that things were about to go horribly wrong.
Kathy turned to me, still awaiting the bowl, and our patient managed one dry heave before coughing a splash of scarlet down her pristine white coat. She swore tiredly, and motioned to Karen to help her support the man as he retched again, convulsing. His mouth yawned open.
And the blood came bursting out.
It was sudden, incredible, horrifying: a niagara of gore that just came and came, dousing him, drenching Kathy and Karen, even spattering me. His body jerked, and jerked again, spraying liquid crimson halfway across the room. For a frozen moment I watched with the numb lightheadedness of sheer panic; then lunged forward, jostling with the others as we struggled to stem the flow. Infection-control procedures went out the window: there’s no point gloving-up when you’re in blood to your elbows, when it’s splashing in your face. And all to no avail; the stuff kept geysering out. Nothing we did could stop him spewing up most of his bloodstream on to our Resus room floor – a spreading crimson lake that threatened to escape under the doors. And as our frantic efforts began finally to slacken, some cold, detached part of me still found time to picture the reaction of the bored line of patients sitting outside the plaster room opposite, as that creeping bloody tide began to emerge.
So there you go. Joseph Kaufmann, vagrant; died very spectacularly in our department some eight months back. My eyes still on the readout screen, I took a sip of tepid coffee.
Just the basics were outlined here of course; his file contained the gorier detail. Kath had written up the summary: if her usual hieroglyphics were indicative of tiredness, then the scrawl she’d used on this occasion suggested a state of near-clinical shock. I knew: I’d looked through the notes often enough since. Not everything had been recorded for posterity, of course. No mention of Dr Kessler, our consultant, bursting in to demand what the fuck we were doing in there; nor of Mike skidding in the mess and spraining his knee. Nor yet of Helen, pale and shaken, finally crying it all out in the duty room, as Karen and I held her tight. One thing, however, did come over clearly: the fact that none of us knew what the hell had gone wrong.
There’d been a post-mortem, of course. It confirmed that death had resulted from massive internal haemorrhage – as if we hadn’t guessed. As to a reason for the bloodbath, the pathologist had been less forthcoming; but his findings had both puzzled and disturbed him. Not that I’ve actually seen a copy of his report to the Coroner, of course; but we get to hear these things. And maybe the tale had been distorted slightly in the telling – but the version that reached us said that friend Kaufmann had recently undergone major surgery. Abdominal and thoracic. Maybe he’d had cancer, because great chunks of his intestines had been cut away completely. Organs had been crudely trimmed and grafted. The strain on his ruined system had given him an infarct; and the whole bloody lot had gone together. Like a failed experiment. That was the rumour I heard.
Records had dutifully been checked, and backs covered; but no record had been found, either here in our hospital or anywhere else. If someone really had been attempting to broaden the frontiers of medical science, it hadn’t been on NHS time. The police had also