At Grant’s insistence, I remained in bed for most of Tuesday. I think he believed it was the right thing for me but it just gave my mind the time and space to worry about every conceivable minor family problem, as well as some of the world’s major ones.
I was actually better when I was doing something.
Grant had taken a second day off work even though I’d told him it was unnecessary.
‘I need to look after you,’ he said.
Keep an eye on me more like, I thought, in case I decided to disappear off to Bristol once more. But the aching desire to harm myself had subsided during that long night at the bridge, at least for the time being, so I didn’t put up a fight. I simply stayed in bed as he requested.
However, on Wednesday morning, with some trepidation, Grant went back to work.
‘You stay here all day,’ he instructed before he left. ‘I’m taking your car keys with me.’
‘But I need the car. I have an appointment with Stephen Butler.’
Stephen Butler was my psychiatrist and Grant had given an assurance to the Bristol doctors that he would get me to see him as soon as possible.
‘Can’t you get a taxi?’
‘Grant, don’t be ridiculous. I’m quite capable of driving.’
I held my hand out for the keys and, reluctantly, he handed them over.
‘Please, be careful,’ he said. ‘Don’t do anything stupid.’
As if I would.
I don’t think Jeremy Cook was pleased to hear from me when I called him at eleven. After all, it had been he who had spilled the beans to the Medical Director that I’d been hiding in the linen cupboard.
‘Ah, hello, Chris,’ he said when I called him, the embarrassment thick in his voice. ‘How are you doing?’
‘Fine, thank you, Jeremy.’
‘How can I help?’ he asked.
Help? I thought. That’s a laugh. He’d hardly been much help so far.
‘I need some information for the police,’ I said.
‘The police?’
‘Yes, a policeman came to my home on Monday and asked me to get him the blood-test results and a copy of the medical file for the man who died in the department on Saturday evening. Do you remember?’
‘Yes,’ Jeremy replied. ‘The man with no name.’
‘Exactly. Normally I would come in and get the results myself but, as you must know, I have been barred from entering the hospital.’
That did nothing to lower the level of Jeremy’s awkwardness.
‘Why don’t the police go direct to the hospital admin?’ he asked.
‘I have no idea,’ I said. ‘But they’ve asked me to get them instead. You’re on ten till six today, right?’
‘Yes.’
‘Good. Make copies and I’ll collect them from you in an hour. I can’t come in so bring them out to me.’ I wasn’t giving him a chance to refuse. ‘I’ll be outside the main entrance in a light-blue Mini.’
‘OK,’ he said unsurely. ‘If I’m not too busy.’
‘If you are, send somebody else out. I’ve told the police that I’ll get everything to them by half past twelve today.’
‘OK,’ he said again. ‘In an hour, you say?’
‘Yes. Can you make the copies straight away?’ I asked.
‘I suppose so,’ he replied.
‘Good. See you in a bit.’
I hung up before he had a chance to change his mind.
It wasn’t only the police who wanted to see those blood results. I was pretty interested in them too.
Jeremy Cook appeared right on cue dressed, as always, in consultant’s purple scrubs. He looked around, saw me, and rushed over and thrust a buff folder through the open car window.
‘Must dash,’ he said. ‘There’s a suspected myocardial infarction arriving in two minutes.’
He hurried back inside without another word – and no awkward questions. Never before have I been pleased that someone was having a heart attack. As I drove out onto College Road an ambulance came the other way, lights flashing and siren blaring. Jeremy Cook was welcome to it.
I parked in a side street in Montpelier near the Queens Hotel and picked up the folder. My hands were shaking.
Jeremy had been busy. The folder contained not just the blood-test results and the medical file for the time when the man was alive, but also the preliminary report of the post-mortem examination of his body.
I had told Jeremy I’d promised to get everything to the police by twelve-thirty but that had been just a little white lie to encourage him to make the copies. I had all the time I needed to study them.
It was the blood results I was most interested in.
I stared at the paper with my heart racing and there it was in black and white.
Cocaine.
The blood-plasma concentration was 0.7 milligrams of cocaine per litre. Normally a minimum reading of at least 1.4 was required to be considered a lethal dose but, assuming the man had been several hours in the lavatory cubicle before being found, the initial dose would have been much higher. Cocaine has a blood metabolic half-life of about ninety minutes. So, in a three-hour period, the level would have dropped to only one quarter of the original. In four and a half hours it would only be one eighth.
However, it was the level of benzoylecgonine, or BZG, in the blood that was the real clincher. BZG is the primary metabolite of cocaine and it has a much greater half-life, remaining in the system long after the drug itself has ceased to be detectable. It is BZG excreted in urine that is used by the police or employers to give a positive test for cocaine. Scientists even monitor the concentration of BZG in the River Thames as a means of estimating the amount of cocaine consumed by the population of London.
In this particular case, the BZG in the man’s blood was over 8 milligrams per litre, indicating an initial cocaine dose several times greater than that required to kill him.
The junior doctor had been right: there was nothing we could have done to save him. The only surprising thing was that, given the levels, he had been still alive when he’d arrived at the hospital.
So I hadn’t killed him. Giving the adenosine had made no difference to the outcome.
I suppose I should have been elated but, in truth, I just felt empty.
I looked up from the papers and watched as a young mother walked along the pavement with a tiny newborn strapped to her chest. It gave me an enormous pang of regret. Our baby would have been a few months old by now – if only I had managed to get pregnant.
I forced my eyes back down and glanced through the post-mortem report.
It only showed preliminary results but did reveal that no puncture marks had been found in the man’s skin, other than the one we had made in his elbow to take blood and administer the adenosine. A dip test of urine found in the bladder had confirmed the presence of a high concentration of benzoylecgonine, confirming the existence of a large dose of cocaine in the man’s system.
The pathologist suggested that, most probably, the cocaine had been ingested orally as he found no evidence of powder in the nasal passages, and no residues in the lungs as might be expected if that much of the drug had been smoked. He had sent samples for analysis taken from the lungs and stomach to confirm this opinion, along with other specimens from the man’s liver, kidneys, heart and brain. A sample of hair had also been acquired to establish if there was a history of prolonged illegal drug use.
As DS Merryweather had indicated, there was no definitive cause of death recorded in the report even though the pathologist did hint that the urine dip test made it likely that a cocaine overdose was the culprit. His final conclusions would only be made on completion of the toxicology tests.
I put the papers back in the folder and placed it down on the passenger seat. For some considerable time I simply stared out the windscreen, drops of fine rain periodically marking the outside of the glass.
Why did I worry so much about this man?
Sadly, death in hospital was not uncommon. Dealing with the dying was one of the pitfalls of being an emergency-care doctor. Strokes and heart attacks were the most common causes. Accident victims who arrived alive mostly stayed that way, at least until they had passed through to specialist surgical teams. Nevertheless, I had witnessed hundreds, if not thousands, of my patients as they took their last breath and their lives literally slipped away through my fingers.
Not that I had become immune and unaffected by the process of death, especially if the victim was a young adult or, worse, a child. Over the years, I had shed more than my share of grief-driven tears for those I had never known before they had arrived in front of me with non-survivable injuries or untreatable disease.
Some of my colleagues tried to grow a thicker skin or build a shell of indifference around themselves, anything to allow them to continue to function when the natural instinct was to simply close one’s eyes and run away.
But there was something about the death of this particular man that troubled me.
Maybe it was because no one knew who he was – his wife and family would still be unaware that their husband and father had ceased to exist nearly four days ago. Or perhaps it was that, in my experience, smartly groomed men in sober suits rarely presented at hospital with massive cocaine overdoses.
Had he overdosed on purpose in order to kill himself, or had it been an accident? A cubicle in a gentlemen’s toilet seemed a strange place to commit suicide, but who was I to talk? Was it really any more strange than the rocks below Clifton Suspension Bridge? Was shattering one’s body with a high-speed fall in a public place somehow preferable to privately swallowing a cocaine-laced sandwich in a locked lavatory?
If one was so desperate to die, did the manner or the venue matter?
But, if the man had killed himself, why did he dispose of any form of identification beforehand? I knew that many suicides go to great lengths to ensure that their loved ones are not the first to stumble across their lifeless corpse. Did this man simply want to die without his family ever finding out?
It sounded like a sensible idea to me.
I read through all the papers twice more before driving to Cheltenham police station and parking in one of the visitor spaces round the back.
DS Merryweather had asked me to phone him when I had the blood-test results but I had no real desire to speak to him again. I decided I would just hand in the folder at the reception desk, marked for his attention, and then leave. But it didn’t quite work out like that.
‘Dr Rankin,’ called out a voice behind me as I climbed the three steps up to the back door of the police station. I turned around.
‘PC Filippos,’ said a young uniformed officer. ‘We met at the hospital last Saturday.’
‘Yes,’ I said, nodding. ‘You’re half Greek.’
He smiled broadly at me, clearly pleased I’d remembered. ‘Can I help you?’
‘I have a folder for DS Merryweather.’ I held it out. ‘Could you please give it to him?’
‘Sure,’ he said, taking it. ‘Are these the blood-test results for the nameless man?’
I nodded again. ‘Have you still not found out who he is?’
‘Not yet but I’m sure we will eventually.’
‘Did you find anything at the racecourse?’
He looked at me quizzically.
‘On Saturday night, after the man died, you told me you were going back to the racecourse to search the Gents where he was found.’
‘Ah, yes,’ he said. ‘So I did.’
‘So what did you find?’ I asked again.
‘Not a lot. There was nothing in the cubicle and mostly just paper towels in the rubbish bin by the washbasins.’
‘Mostly?’
‘There was also some other general waste, you know, a few newspapers, a couple of discarded racecards, some torn-up betting slips and one of those small flat quarter-bottles of whisky.’
I thought back to the slight smell of alcohol that had been present on the man’s breath at the hospital. It could have been whisky.
‘The man had definitely had a drink of alcohol at some stage. Have you checked the bottle for his fingerprints?’
It was clear from his expression that he hadn’t.
‘And did you test the contents?’
‘It was empty.’
‘There must have been some residue left,’ I said. ‘According to his report, the pathologist thinks the cocaine was probably ingested orally. I wonder if it was in the whisky.’
‘Can you put cocaine in whisky?’ he asked.
‘Sure,’ I said. ‘It will dissolve in almost any liquid. I remember a case a few years back when someone drank rum laced with cocaine. It killed him.’
‘Are you serious?’
‘Deadly serious,’ I said. ‘A man dissolved a large quantity of cocaine into a bottle of rum to smuggle it into the UK. His girlfriend carried it because he claimed he was over the duty-free limit but the man was stopped by customs and the girlfriend gave up waiting. She gave the bottle to a taxi driver without realising its contents were lethal and he died after drinking a single shot.’
‘Couldn’t he taste it?’
‘Obviously not. Probably knocked it back in one go. And that’s not the only time. Someone else died drinking pear juice laced with cocaine, again after it was smuggled into the country.’
‘But how can you get it back out of the liquid?’
‘Simple,’ I said. ‘Gently evaporate it in a saucepan and you’ll be left with the cocaine powder at the bottom.’
‘So you think our nameless man was a smuggler?’
‘No,’ I said. ‘I didn’t say that. I’m simply asking whether you’ve tested the whisky bottle as the possible source. Have you still got it?’
‘Yes,’ he said with certainty. ‘Everything was bagged up.’
I suddenly felt dreadfully light-headed and rocked slightly, grabbing hold of the handrail.
‘Are you all right, Dr Rankin?’ PC Filippos asked. ‘You’ve gone very pale.’
‘I’m fine,’ I said automatically.
I was always fine.
But in truth, this time, I was far from feeling fine. I was dizzy, shaky and I couldn’t focus my eyes properly. In fact, I was very close to passing out altogether. I slumped further against the handrail and only the policeman’s strong arms of the law stopped me falling over completely.
‘I’m sorry,’ I mumbled. ‘Must be something I ate.’ Even though I doubted that. I hadn’t eaten anything at all since the previous evening and, even then, I had only consumed a reduced-calorie cup of vegetable soup.
‘Come on,’ he said, holding me tightly round my waist, ‘let’s get you inside and sat down.’
He all but carried me through the door of the police station. One of his colleagues rushed to help and, between them, they lifted me onto an upright chair in the reception area.
‘I’ll call an ambulance,’ said the colleague.
‘No,’ I said, trying but failing to be forceful. ‘No ambulance.’
I’d have had more chance of holding back the tide.