Seven years later—Day One
THERE WAS NOTHING especially urgent about the manner in which the phone rang, but context was everything. Not many people called at seven o’clock on a Monday morning for an idle chat. And it was one of the laws of the universe that you could come into work early, hoping for a couple of quiet hours before the switchboard opened at nine, and something would happen.
Thea reached for the phone. ‘Dr Coleman.’
‘Good. Glad you’re here …’
‘What is it, Jake?’ She surveyed the carefully ordered pile of paperwork in front of her. In comparison to the sometimes chaotic disorder of the Central London A and E department downstairs, it suddenly seemed like a poor shadow of reality.
‘I’ve got a thirty-four-year-old male that I want a second opinion on. Will you come and have a look?’
‘I’ll be right down.’ Paperwork might be a necessity, but it didn’t put a smile on her face when she got out of bed in the morning. And Thea was smiling as she put the phone down.
‘Where is everybody?’
Jake Turner was a great guy and a good doctor, but he generally didn’t have much of an appreciation of time. A busy shift in A and E could do that to you.
‘It’s seven in the morning, Jake. Anyone with any sense is still thinking about getting out of bed.’
‘Ah. No wonder I had to ring around.’
‘You mean you didn’t call me first? I’m devastated.’
Jake snorted with laughter. ‘I tried Michael Freeman. I thought he’d want to know about this.’
Michael was Head of Respiratory Medicine at the hospital. ‘So what have you got that warranted the attention of our beloved leader? I don’t see any holes in the walls or visiting dignitaries.’
‘Thirty-four-year-old male, persistent cough, congested lungs and recent weight loss. I’ve had some X-rays done and I think it might be tuberculosis.’
‘What’s his history?’
‘He’s been sick for a while. His GP put him on antibiotics and he improved a bit then deteriorated again after he finished them. He came in last night with chest pains and difficulty breathing.’
Thea flipped through the A and E notes that Jake had handed her. ‘Any travel overseas lately?’
‘Nope, nothing. And this guy’s a teacher.’
‘From …’
‘The big secondary school up the road.’
Something pricked at the back of Thea’s neck. A couple of thousand pupils, aged eleven to eighteen, all crammed into an overcrowded inner-city school. Along with a suspected case of TB. ‘Great. You’d better be wrong, Jake.’
Unlikely. Jake was far too good a doctor for that.
‘Yeah. Let’s hope so.’
Mr Michael Freeman, Head of Respiratory Medicine, leaned back in his leather chair, rubbing his neck as if it hurt. ‘You’re sure?’
‘Sure as I can be. I’ve put a rush on the initial tests and we should have them back within twenty-four hours. But the patient has all the symptoms of active pulmonary TB.’ Thea slipped the X-rays out of their sleeve and clipped them into the light box on the wall.
Michael studied them carefully. ‘I agree. You’re admitting him?’
‘Yes, I want to keep him under observation for a few days.’ Thea pointed to the areas on the X-ray that indicated fluid in the patient’s pleural cavity. ‘The pleural effusion might well resolve once we start medication, but if it gets any worse I’ll need to do a thoracentesis.’
‘I agree. I want you to supervise the isolation procedures yourself, along with the notifications. If we have a situation where the infection’s already spread, then I want you dealing with it.’
‘I hope it hasn’t.’
Michael fell back into his chair. ‘So do I. What do you think, though? Worst-case scenario.’
This was Michael’s preferred modus operandi. He knew the answers already and, as the head of department, it was his job to make the decisions. But he always listened to his staff, and let them come up with the solutions he already had in mind.
‘Given that TB’s not that infectious …’ Thea let out a sigh. False optimism wasn’t going to help the situation. ‘Worst-case scenario is that we have an unknown number of pupils infected. The patient’s not been abroad in the last five years so the source of his infection is probably in this area. The contact tracing’s going to be a big job and we’ll have to do it carefully. We don’t want wide-scale panic, but we do want to provide prompt testing where it’s appropriate.’
Michael nodded. ‘Agreed. And what do you recommend for resourcing?’
‘We can’t do it all ourselves. We’ll need consultancy from Public Health England, and probably a couple of extra TB nurses to support the staff here.’
‘Any ideas about who might be leading the hospital team?’
‘I’d thought that you would be