The Visitor (#3 - The Craig Modern Thriller Series) (4 page)

“Others?”

“I’ll get to that in a moment, Marc. But you need to proceed as if this is a murder now.” He paused. “Possibly three murders.”

“What!”

John opened the two thin files. Each one contained a single sheet of post-mortem paper.

“You know that I took over as Director last year from Dr Alan Davis?” They all nodded. “Well, he came back to cover me when I was in the States. And when I returned last week, Stormont asked me to review his cases. This is all hush-hush, so please keep it confidential.”

Annette stared hard at Liam, until he buckled. “God, why does everyone always look at me like that?”

“Experience.”

“Apparently they’d had concerns about his work for some time, hence his early retirement at fifty. But from what I’ve seen now, I’m amazed they allowed him to keep practicing at all. And I’m furious they didn’t discuss their concerns with me before they let him step in as my locum. The P.M. reports since January were the worst that I’ve ever read.”

He pointed to the files. “All of them were thin, but not as thin as these two. So I needed to find out why.” He paused. “They’re post-mortems on two other mothers who’ve died at the Maternity Unit since January.”

“Died of what?”

“I’ll answer that in a second, but let me give you some background. Statistically, Northern Ireland should have no more than one or two deaths per year across
all
of its Maternity Units. But we’re already looking at nearly twice that number in three months, just from one Unit. If this was a trend we’d be looking at almost a hundred per year across the province.

There are also very strong similarities between these two cases and Evie Murray-Hill’s. All the mothers died, all had Caesarean sections, and all the babies survived.”

“But Dr Winter, maternity’s a high-risk specialty. I worked there and I remember there was a lot of litigation..”

“That’s a fair point, Annette, but these women weren’t particularly high-risk. And the relatives didn’t litigate or complain any more than expected. There were just tears and the usual enquiries made at the time. Bear with me and you’ll see that there are more similarities.” Craig could see where John was heading.

“Both P.M.s were summarised as ‘natural death’, which makes me very nervous. They were completely unexpected and yet Davis called them both natural. The first lady was a forty-three-year-old. Mrs Deborah McCance, a multip from the Demesne Estate in north Belfast. Her death occurred in January. It was her fifth baby, all perfectly normal. But this time she needed a Caesarean. The operation went well and she had a healthy baby girl.”

“What’s a multip, John?”

“A multiple times Mum.” Craig nodded. At least that made sense, most medical terminology didn’t seem to.

“Mrs McCance was well after the operation, apart from a bit of diabetes, which settled on Insulin. Her only other medication was some Pethidine for pain. Everything was normal, and she was due to go home on day five post-op. Then on day three she just didn’t wake up. The P.M. revealed nothing to explain it.”

“What about the tox-screen?”

“Just Pethidine and Insulin as expected, high levels but nothing lethal. The last time she was seen alive was 2am. But she was in a side room and wasn’t found until eight the next morning. Her estimated time of death was 3am. ”

“Who was the consultant?”

Winter rolled his eyes. “The dreadful Nigel Murdock, again.” Craig glanced up sharply.

“That’s the second time I’ve heard that today. Why so dreadful?”

“Because he’s a total ass, Marc. He’s the sort of surgeon who caused the old joke. ‘What’s the difference between God and a surgeon? ‘God doesn’t think he’s a surgeon!’ ”

Liam laughed loudly. “Here, I’ll have to remember that one, it’s not bad.”

“He delivered our Jordan when he was a junior, sir. And he thought he walked on water even then. He must be shocking now he’s a consultant.”

“It’s even worse than that, Marc. You might possibly forgive some arrogance if he was a good surgeon, but his statistics are dreadful. But every time someone tried to start an investigation, he did the old-boys thing with Robert Moore, the old Chief Exec. And any complaints were hushed up. Until the next time.”

John shook his head resignedly. He knew the medical hierarchy too well to be surprised at the ranks closing. He lifted the other file.

“The second death occurred in mid-February. A thirty-year-old called Linda Bryson, from Holywood. She was one of Murdock’s private patients and was due for a normal delivery with her first baby. But she died during labour and the baby was delivered by emergency Caesarean after she died. Just as Evie’s baby was. She was in a side-room as well.”

“Privacy for the killer?”

“Possibly, but there are a lot of side-rooms on new units. Most wards are built that way now. Anyway, again it’s Mr Murdock. And worryingly, the midwife was also the same on both cases. Beth Walker. And, here’s a bit of hospital grapevine stuff for you. There’s real animosity between those two, much more than the odd midwife/surgeon disagreement. Some nasty stuff apparently.”

“They were Evie’s team as well, boss.”

“How many consultants work on Maternity, Annette?”

“Eight. And a similar number of midwives. But they aren’t paired - they’re allocated by the mothers post-code. Except the private patient. She must have chosen Murdock herself?”

“God help her wit.”

Craig nodded. Three deaths in three months. Same place, same consultant, and same midwife. What were the odds? He could see why John had called him.

“Moving on. Mrs Bryson was in the side-room for twenty-four-hours but the baby wasn’t progressing, so a drip was put up to help.” Craig glanced at him questioningly

“It’s quite normal procedure and she was fine. Nurse Walker recorded that she was chatting to her husband when she left the room to check on another patient. Murdock was due to call in when she was out. Except Murdock said that when he arrived the room was empty, and Mrs Bryson was already dead.

Her husband came back just as she was being rushed to theatre. He’d been getting himself a coffee. So although Mrs Bryson wasn’t scheduled to have one, we have another emergency Caesarean.”

“What about the post-mortem?”

“The same, nothing abnormal recorded. A healthy Mum on a little Pethidine for the difficult labour. And her Insulin level was non-lethal.”

“Why was she on Insulin?”

“Sorry, I should have said. She’d been diabetic since she was fourteen, so it was just her usual dose. Both drugs levels were high but in the normal range. ”

“What was the baby, Dr Winter?”

“Glad you asked, Annette. It was another little girl.” Annette gasped, and even Liam shuddered.

“OK, John. So we have three women dead in three months. Same location, same consultant and same midwife. Three female babies delivered alive by Caesarean-section, and all three mothers on high but non-lethal levels of Pethidine and Insulin. Two of them in side rooms. But nothing abnormal reported on the first two P.Ms.”

“Three in side-rooms, boss ...Evie was in one too, near the Unit door.”

“That about sums it up, Marc. Plus, these P.M. reports are much too brief, so you can see why I’m uneasy. And we can be certain that Evie’s death was suspicious, because of the totally un-prescribed Pethidine. So, given the similarities...”

Craig finished his sentence. “We’re looking at the two earlier deaths being suspicious as well.”

Winter nodded. “Yes. It would have been easy to give the first two women higher doses of drugs that were already prescribed for them. To subdue them, before they were killed, by whatever means. But Pethidine wasn’t even prescribed for Evie. And drugs definitely weren’t her cause of death.”

Craig interrupted him urgently. “What was, John?”

“It’s not obvious, so we’re doing more tests. But I’d say that she knew her attacker. They managed to get close enough to inject her without any signs of being fought off. Perhaps someone working in health? Or impersonating a health worker? And I’m uncomfortable about the two earlier P.Ms. Davis’ incompetence seems almost deliberate.”

He took a deep breath. “There’s one more thing, Marc.”

Craig sipped at his coffee, making a mental list of queries. “What is it?”

“Evie had a deep cut on her right cheek. It happened around the time of death and it was made with a very sharp implement. The clinical staff said it was there before they resuscitated her, so it could have been deliberate.”

A cut. An anomaly or a signature?

“What I don’t understand is why they added Pethidine for Evie, Marc. It’s such an obvious clue that it was murder. Very careless of them.”

Craig shook his head. “Evie’s Pethidine is window-dressing, John. Either they wanted us to know that she was murdered, or the killer is deliberately trying to confuse us. I don’t think they were being careless or trying to confuse us. I think that they wanted us to know they’d murdered Evie. They deliberately gave her un-prescribed Pethidine, knowing that we would detect it.

The question is
why
do they want us to know? And why kill all three women? Something must link them. We need to find out if Davis was involved in the killings, or just covering them up. Let’s get him in, Liam.”

Liam reached for his mobile and John shook his head. “Davis can’t be a suspect in Evie’s case.”

“Why not?”

“He died a week ago from a massive heart attack. It was totally unexpected. He was only fifty and kept himself fit.”

“Here, that’s a big coincidence, boss.”

“I agree. Let’s check it out. But it doesn’t stop him being involved in the first two cases, if only to cover them up. OK, no-one needs told about the sensitivity of all this, so it’s a press blackout, please. The C.S.I’s are at the Unit now and we’ve sealed the scene, so all that’s in hand. Liam, anything else that we need to know?”

“Nope. All under control as far as the scene goes. Uniform has started interviewing the junior players.”

“Fine. I’ll see the others myself tomorrow afternoon. We’re in court on Warwick all morning. Give us a steer here, John. What things should we be looking for, on the ward and with the staff? Anything that we need to do now to protect people, and before we lose evidence? You and Annette know hospitals, we don’t.”

“Get Evie’s ward and theatre notes, and drug charts. There’ll be things on paper that aren’t on the computer, and vice versa. Check the Rota for who was covering last night, even for an hour – the personnel department will have copies. You should try the junior doctor’s lounge at lunchtime as well. Juniors often swop their on-call nights between them and that won’t be written down anywhere.

If you concentrate on Evie, I’ll see what I can find on the other two. It all started in the past three months so ask if any staff have changed since Christmas, including admin and managers. Although whoever’s responsible could have been in post for a while before they started all of this of course. Or they might have moved to another ward and come back. But thankfully I haven’t P.M’d any other deaths like this in the past year, although I’ll check with the other pathologists. Make sure the C.S.I.s get all Evie’s needles, dressings and giving-sets for me please Liam. I need to have a good look at them.”

“What’s a giving-set, Doc?”

“The drip lines, fluid bags and the needle that was in her arm. And any dressings and tubes as well. We need to know what she was eating and drinking too. In fact, anything that came into contact with her in any way.”

“How’s Pethidine given, John?”

“Injection in the muscles by the nurses, but it can be in the veins and that would normally be a doctor. If they were trying to subdue her quickly they’d have given it in the veins in a higher dose. Its maximum time to clear from the body is forty-eight hours, so go back at least two days on everything.”

“What about the insulin?”

“Insulin’s given by injection or added to the drip bag. It’s lethal in high doses but much harder to detect. But remember...none of the blood levels were reported as lethal, and Evie’s were definitely too low to have killed her. I don’t believe we’re looking at a drug death here Marc, so I really don’t understand the Pethidine. The first two victims were already on both drugs, but Evie wasn’t.”

“If they’re clever enough to kill in such a complex way, John, they’re clever enough to know that the Pethidine would be spotted. Either they deliberately wanted to draw attention to her murder, or they added the Pethidine desperately, to complete a particular scenario. I really hope that it’s the former, because if they did it desperately then that’s bad news. It would indicate that they couldn’t wait to find someone who was
already
on the Insulin/Pethidine mix and fitted exactly. Which means escalation. And that means they’ll soon start looking for another victim. So far we have an average six week’s gap between deaths, and I want it to stay that way.”

“But why Evie, sir?”

“Exactly, Annette. Why Evie? First of all, they want us to know that they’re murdering. But they could have shown us that by just
overdosing
any woman who was already on the Insulin/Pethidine drug combination. They can’t be that uncommon, John?”