When he eventually reached the hospital he found George Byars alone in his office, sitting in shirtsleeves, juggling with columns of figures. ‘It’s been a while,’ said Byars.
‘I felt there was a danger of too many cooks,’ said Steven. ‘I’ve been trying to focus on my own job for a bit.’
‘You weren’t entirely successful if what I hear from St Jude’s is correct.’
Steven shrugged and said, ‘Some things you just can’t walk away from.’
‘I’m glad you think that way,’ said Byars. ‘I sometimes wonder about certain members of my profession.’
Steven decided not to push him on the subject. Instead, he asked, ‘How are things at the sharp end?’
‘Sharper than we’d like. I sometimes think I’m standing on the bridge of the Titanic, feeling the temperature fall. We’ve got an enormous problem with a shortage of nurses and another over accommodation for the victims. Three churches and two schools have been pressed into use so far, and all of them are just about full. The next step will be to close the city’s secondary schools and bring them into the equation.’
‘Why secondary schools?’ asked Steven.
‘Times have changed,’ said Byars. ‘It’s the norm for both parents to go out to work these days. Suddenly dumping hundreds of young children back home would cause big social problems. Secondary-school kids are old enough to look after themselves till the folks come home.’
Steven nodded. ‘What about the nursing volunteers who were supposed to come?’ he asked.
‘Slowed to a trickle.’ Byars shrugged. ‘Can’t blame them. Watching people die without being able to do anything about it isn’t exactly glamorous or uplifting. Apart from that, we’ve lost two nurses to the virus.’
‘Two?’ exclaimed Steven.
‘It’s not common knowledge, like a lot of things in the city these days,’ said Byars.
‘Then you’re managing to keep things out of the press?’ asked Steven.
‘Someone is,’ corrected Byars. ‘Don’t ask me who, but I suspect government pressure’s being brought to bear.’
‘It certainly wouldn’t be an appeal to the hacks’ better nature,’ said Steven.
‘And you? Any progress?’
‘Let’s say I’m more optimistic than I was a few days ago, but there’s still a lot to work out. That’s really why I’m here. I need to talk to a cardiac surgeon — please don’t ask why. Can you help?’
Byars picked up the phone and dialled an internal extension. After a short conversation he replaced the receiver, said, ‘Our Mr Giles will be glad to give you all the help he can,’ and told Steven how to get to the cardio-thoracic unit.
Steven smiled and thanked him. He’d come to like and respect Byars over the past few weeks, and was relieved that the crisis-management team had recognised his abilities and kept him on as crisis co-ordinator.
At the cardio unit, Steven was met by a formidable-looking woman who introduced herself as Martin Giles’s secretary. ‘He’s expecting you,’ she said brusquely. ‘Go straight in.’
Steven’s immediate impression was that Giles looked more like a heavyweight boxer than a surgeon but when he spoke it was as an educated, articulate man. ‘How can I help?’ he asked, hunching muscular shoulders as he folded his arms on his desk. What neck he had seemed to disappear, making his head look like a cannonball perched on a castle wall.
‘I need to know something about modern heart surgery,’ said Steven. ‘What’s on offer and what you do exactly.’
‘Depends what the problem is,’ said Giles. ‘Anything from a couple of stitches in the right place to a complete heart-lung transplant.’
‘Sorry to be so vague,’ said Steven, ‘but I’ve got no idea how common heart surgery is these days or how many people benefit from it.’
‘Every cardiac unit in the country has a waiting list a mile long,’ said Giles. ‘Cardiac surgery has become commonplace.’
‘Supposing a man is referred to you with a history of rheumatic fever in childhood, and this has led to current heart problems. Talk me through it.’
‘That used to be very common,’ said Giles. ‘Rheumatic fever isn’t as prevalent as it used to be but it often resulted in a bacteraemia which in turn caused a build-up of bacteria on one or more of the heart valves with resultant stenosis. We would take a look at the problem with a range of options in mind. If the damage weren’t too bad we might attempt a physical repair to the damaged tissue — we’d stitch the damaged portions together if at all possible. If a valve was irreparably damaged, however, we’d have to consider replacing it, either with a mechanical valve — a plastic one — or a tissue one should one be available.’
‘Supposing the heart damage was age-related?’ asked Steven, remembering Frank McDougal’s medical records.
‘The same options would apply. Age defects are usually associated with the left side of the heart, the mitral and aortic valves, while infection usually affects the ones on the right, but either way we would repair or replace as appropriate, with repair being the preferred option.’
‘And you say this is quite common?’
‘I read recently in one of the journals that 225,000 heart-valve operations are performed every year in the developed world and 60,000 patients receive replacement valves.’
‘How about post-op problems?’
‘All surgery carries risks, of course, but heart-valve surgery has an excellent success rate. The vast majority of patients make a good recovery and generally feel like new people into the bargain.’
‘And the ones who don’t?’ asked Steven.
‘There’s always a slight risk of stroke, bleeding, infection, kidney failure and, on occasion, heart attack and death; but they’re the exceptions.’
‘Heart-surgery patients haven’t shown up as being susceptible to secondary illness in any way, have they?’ asked Steven cautiously.
‘Secondary illness?’ queried Giles.
‘Viral infections, that sort of thing.’
Giles said, ‘Not in my experience, although it may be true of transplant patients if they’re immuno-compromised because of the anti-rejection measures. I haven’t noticed increased susceptibility in valve-surgery cases and I haven’t heard that from anyone else in the business. We did have a major problem back in the eighties with mechanical failure of one make of replacement valve, the Bjork-Shiley CCHV, which was prone to fracture, but that model was withdrawn way back in 1986, if my memory serves me right.’
‘No, that’s not the sort of thing I was thinking of.’
‘Then I’m sorry, I can’t help,’ said Giles. ‘Valve replacement is one of the most satisfying and rewarding surgeries we perform in terms of improving the quality of patients’ lives.’
Steven nodded and got up to go. ‘Thanks for seeing me at such short notice,’ he said. ‘I appreciate it.’
‘Any time,’ said Giles.
Steven smiled and said, ‘I rather hoped you’d say that. I may have to call on you again.’
When he got back to his hotel, Steven called Sue in Dumfriesshire and told her that it was looking extremely unlikely that he would be able to be there for Christmas.
‘I half expected it,’ said Sue. ‘It sounds as though things are getting worse down there. I’ve been warning Jenny that those poor people may need to hang on to her daddy for a little bit longer.’
‘Thanks, Sue. How do you think she’ll take it?’
‘Your daughter is a remarkably mature young lady for her age. But if you aren’t going to make it, I think you should tell her yourself.’
‘Will do,’ said Steven. He had scarcely put down the phone when it rang. It was the duty officer at Sci-Med. ‘Dr Dunbar? Mr Macmillan would like you back in London at your earliest convenience’ — that being a euphemism for ‘now’.
Steven drove over to Caroline’s house and left her car outside with a note in it saying that he’d had to go to London. He hailed a cab and asked to be taken to the airport. He was in London four hours after receiving the call and in John Macmillan’s office at a quarter to five.