Pepsi at Midnight by Dr Pranab Kumar Sen

7/28/2019 Pepsi at Midnight by Dr Pranab Kumar Sen

1/25

PEPSI AT MIDNIGHT

By Dr Pranab Kumar Sen

I would like to dedicate this story

to my son, Avinash, who told me that my half baked idea sounded like an interesting story,

to my wife, Madhumita, who corrected the factual mistakes I kept making

but mostly to all professionals who can only express their creative talents by moving out of the box.

1. A CAN OF PEPSIWith you in a jiff! Ashok said into the phone, trying to sound as enthusiastic as one can at being woken up from sleep. He

glanced at his watch 23:50 and noted that at least he had enough time to get to the ward before the clock struck 12.

Dr. Ashok Ghosh was a young Indian doctor who had graduated from Kolkata 2 years ago. He had come to the U.K. for

postgraduate training in Surgery and was doing a 6 months posting in Orthopaedics at Hull Royal Infirmary as part of this training. Tonight

he was on call and, therefore, had to stay in the hospital rather than at home. He had learnt over the years that, contrary to what many

people think, being on call did not mean the same thing as dealing with emergencies. Sure, when you were on call, you dealt with

emergencies; but most of the time you were doing exactly the same things that you did during regular working hours like writing case

notes, giving intravenous drugs, organising tests and so on.

Some of the tasks were rather exasperating. In Kolkata, all intravenous injections were given by the nurses and some of them

were experts. Doctors were too busy with other jobs to bother about such mundane things. In the U.K., however, the law demanded

that allintravenous injections be given by a qualified doctor. As a result, intravenous injections were given by doctors, most of whom were

absolute novices. If anything went wrong, they would be clueless as to what to do, presuming, of course, that they could recognise a

mistake when they made one. This, as Ashok often said, wasnt Kolkata, it was Hull; and when in Hull do as.......

The British National Health Service, Ashok thought, was considered by many to be the one thing that the British could be really

proud of. It ensured that health care of the highest international standards is delivered, at no cost at the point of delivery, to the needy.

That may be perfectly true, he admitted, but if you are one of the privileged few who are chosen to deliver said health care of said high

international standards, then you are more likely to appreciate that the rose had its thorns. All that idealistic mush involved making a lot of

people work long hours, running from pillar to post with a professional smile plastered on their face behind which lurked an unspoken

curse. Personally, he felt that many nurses in N.H.S. hospitals took sadistic pleasure in waking up doctors who were on call. It was probably

their way of seeking revenge for the way theirseniors rubbed theirnoses in the mud. One thing he knew, for sure; it didnt pay to ignore

them. Hence his affected gleeful, enthusiastic response when he was woken up and told that four patients were waiting for him to give

them their next dose of intravenous antibiotics.

The call had come from the childrens, or paediatric, ward, which was on the 13th

floor. The room where Ashok was lying down

was on the third floor. Reluctantly, he pushed the blanket aside, swung his legs onto the floor and sat up. He put on his spectacles, slipped

on his shoes, grabbed his apron and left the room. He deliberately did not comb his hair. If I were to ever have an emergency myself, his

consultant used to say, I would rather be treated by a doctor who came to me immediately, even if he looked unkempt and dish evelled,

rather than be treated by a smartly dressed, clean-shaven doctor who took several minutes t o get to the Casualty. Of course, this was a

call to give intravenous drugs not an emergency, but if the nurses complained that he was late then there would be no end to the

trouble.

He walked to the landing, called the lift, went to the nurses station in the ward and said, Yes nurse, you called me.As

expected, all the intravenous injections were lined up on the counter. One by one, Ashok gave each one and filled in the charts and signed

them where necessary. Important, yes; interesting, no. When he had finished, he wished the nurse and walked out.

As he got to the landing, he started thinking. He needed to study for his exams. In fact, he had brought a book to the duty

doctors room, so that he could read something if he could find time. He was feeling wide awake. Maybe he could take a soft drink to wake

him up fully and then read up something. On the landing was a drinks dispensing machine. He pressed the Pepsi button, put in some

coins and pressed the button again. When the can came tumbling out, he flipped it open, took a sip and waited. His gaze shifted to the

large floor-to-ceiling window on the front of the landing. All the streetlights of the city could be seen spread out like a glowing carpet.

There was something that always struck him about being on call; if any patient in this entire city to as far as he could see were to

develop an orthopaedic emergency, then he would be the one to deal with it. Of course, he was not the only doctor on call for

orthopaedics, but he was the first responder for the department. That was quite an awesome responsibility. Once he passed h is exam,

he would even be expected to give definitive treatment to most cases; that was an even bigger responsibility. He marvelled at the system

that turned ordinary people into doctors capable of shouldering such a lot.....


2/25

All of a sudden he snapped out of his reverie. Something out there caught his attention. At this time of the night, everything

was usually still and silent. Once in a while a car would zoom by, but otherwise the streets were empty, all the buildings, houses or offices

were closed. There seemed to be something going on in one of the roads next to the hospital. He looked to the right and, sure enough, it

seemed as if there was a group of people having a row. On the opposite side of the road that ran by the side of the hospital was a pub.

Ashok had often noticed it when he went down that road for a jog early in the morning. Between the actual building of the pub-house and

the road was an open space with a few open-air tables and a small car-park. The pub was closed, the car-park was empty, but a group of

men were sitting at the open air tables. From where Ashok was, things looked very small, but it was obvious that there were two groups of

men, two at one table and four at another. They were all wearing jackets and hats, except one who had a scarf wrapped around his head.

They seemed to have bottles in front of them. They were obviously having some sort of argument, because every now and then they

would gesticulate wildly, or point at something or the other.

Ashok looked on, his curiosity aroused. It was quite cold outside and even if these guys had drunk enough alcoho l to warm

them up,it wasnt the sort of weather where people would choose to stay outside and talk. Was a fight brewing? It didnt take long to

figure that out. After a few minutes, the man with the scarf joined the group of four. A moment later the solitary man crossed over and

punched the man in the scarf in his face. After that a brawl broke out and it was impossible to make out who was fighting whom. All the

men stood up and the table fell over. One of the men fell. The others seemed to kick him repeatedly. Then one of them picked up a fallen

bottle and smashed it on the tables edge. He then knelt down beside the fallen man. Raising his arm with the broken bottle in it, he

brought it down as if he was stabbing the fallen man. He did this thrice. The man on the ground struggled and tried to catch the bottle. He

seemed to grasp it and lunge at his attacker, who fell back, clutching his right forearm. The others pulled the two men apart. One of them

took something out of his pocket. He unfolded it like opening a pen-knife. He went up to the prostrate man, knelt down and lunged the

knife into him. The man struggled a bit and then stopped moving.

The five men stood up and stepped back. For a few moments everyone stood still, looking at the prostrate man to see if he

would move again. Then the man in the scarf raised his right hand and started gesticulating with his other hand. He seemed to be urging

the others to hurry up and do something. For a couple of moments, the others stood still and then they started moving quickly. One of

them took something out of his pocket and unfolded it. It was a handkerchief, and he wrapped it around the hand of the man with the

scarf. Another man picked up the legs of the prostrate man who seemed to be dead as if he intended to drag him away somewhere.

However, after moving a couple of steps he stopped and let the feet down. The last man ran out of the car-park, down the road to where a

car was parked by the roadside. He jumped in, started the car and started to drive. He quickly turned the car so that it was heading

towards the pub and he drove it into the car-park. He stopped, opened the door, jumped out, went to the back of the car and opened the

boot. Now the four men in hats went to the place where the stricken man was lying, picked him up and got him into the car boot. They

folded his arms and legs so that he fitted in and then closed the boot and locked it. Next, all five men got into the car and closed the doors.

Ashok looked on aghast. He had seen plenty of street fights in Kolkata and knew that they usually ended as quickly as theystarted. One or two quick blows and that was it. Almost immediately someone would step in and try to stop the fight by separating the

people who were fighting. He had even been involved in a couple of fights himself: usually as a peace -maker. This row didnt seem any

different at least to start with. In a few seconds, however, the entire scene had changed. The coming-to- blows bit didnt surprise him in

the least. That was probably the whole point of the row in the first place. However, when one of the group started stabbing the fallen

man, he suddenly felt a slight sense of panic. Was this a drunken brawl that had gone over the top, or an execution? The way in which the

men rapidly brought a car to the scene and stuffed the body into the boot suggested that this was a planned move. The car had probably

been kept where it was on purpose. Almost involuntarily, as if to protect himself, Ashok stepped back from the glass window; he felt as if

someone down there might actually notice him from below, an unintended spectator to a grisly crime which was none of his concern.

A couple of moments later, he stepped forward and took another look.

The car had driven out of the car park and was driving southwards to the main road. At the corner, it turned left approaching

the main entrance of the hospital. At the hospital entrance, it turned in and drove straight to the porch at the entrance of the Accident &

Emergency department. Ashok could no longer see it, but he could imagine what was happening. A few seconds later, the car drove out

from under the porch and entered the hospital car park, which was nearly empty. It found a convenient space and parked. A man jumped

out of the drivers door, locked it and ran to the Casualty entrance. At the same time, Ashoks pager buzzed. He pulled it ou t of his apron

pocket and looked at it. The four digit number it showed was one of the phone numbers of the Casualty.

In the landing, beside the lifts was a wall phone. Ashok lifted the receiver and punched the four digits on his pager into the

telephone. After two rings, someone picked up on the other side.

Hello! he said, Orthopaedic SHO on call. Did you page me?

Hi! a female voice said. Dr. Atkinson from Casualty. Weve just got a man who has a penetrating injury of his left wrist. Could

you come down and take a look, please?

With you in a jiff! Ashok said, putting the receiver back as he pressed the button for the lift.


3/25

2. THE RED SCARFAs he waited for the lift, Ashok quickly ran through the study schedule he intended to follow in the next few days. He ought to

be able to complete two chapters this week if he didnt overstrain; but to attempt more than that would be biting more than he could

chew. Fine. Which two chapters should he cover?

The lift arrived. He stepped in, pressed the button for the ground floor and waited.

He should probably take one major and one minor chapter. Breast and Thyroid were two major chapters. You couldnt

cut corners with either. Nerves and Skin were minor chapters. The problem with skin was that there were so many Latin names you

had to remember: granuloma pyogenicum or dermatoliposclerosis if you please! There were so many different names in breast diseases

too, but many of them were English and the names were more systematic. O.K. He could pair off Skin with Thyroid and Breast with Nerves.

Done.

The lift stopped and the doors opened. He stepped out, took the corridor to the left and walked into the Casualty.

As always, the Accident and Emergency department presented a scene of organised chaos. There were several cubicles with

partitions and screens and curtains on one side and a waiting area for patients or relatives on the other. The waiting area had large

windows, with rows of chairs and a few tables with magazines on them. (If you were wheezing and puffing with asthma, but had to wait

your turn you could always catch up with the news by reading The Telegraph or find out what was coming on the T.V. this weekend in

Radio Times.) That was the organised bit. However there was a constant scurrying to-and-fro of nurses, doctors, ambulance men and otherpeople in between which clearly indicated the frenetic activity which was so diplomatically kept hidden from view.

He went straight to the Reception counter. A nurse with a smile which was obviously plastered on her face sat on a chair

behind the ledge. She had a pile of papers in front of her.

Dr. Ghosh, please, orthopaedic SHO on call. Dr. Atkinson called me about a penetrating wrist injury?

The nurse rummaged through the pile, and picked up one. Oh yes! she exclaimed, I think hes in cubicle 5.

Thanks. Ashok said as he turned and walked away. Cubicle 5 was on the right. He walked there with quick steps. Outside the

cubicle there were four men. One was wearing a brown jacket with the collar turned up. Another had a dark blue parka. The remaining

two men were in black jackets. They were talking among themselves with rather subdued voices.

One of them said, I better contact Helen; to which another said, Hey! Why dont you just keep that stupid gob of yoursbloody shut till the bloody docs seen him? Then well sort Helen out!

O.K., O.K, keep your damned shirt on! I was only makin a suggestion.

Ashok walked into the cubicle. On the bed was a man wearing a dark brown jacket and black denim jeans. He had a blood

stained dressing on his left hand and wrist. Two nurses were bandaging him. He noticed all this from the corner of his eye. What

immediately caught his attention was the patients face. He couldnt see it. All he could see was that it was covered with a red Manchester

United Football Club scarf. He was quite sure who these five men were.

3. A TENDON INJURYHe felt his tongue go dry and a feeling of warmth in his back. He realised that he was developing a sense of mild panic. He

needed to stay cool and level headed. He didnt know what to do, but he definitely did not want his emotions to show. On the one hand,

he needed to treat the patient without wasting time; on the other hand, he needed to find time to organise the thoughts and feelings that

were racing through his mind. One thing was certain - there was a patient lying on a trolley in front of him; he could notignore that. The

last thing he wanted was for the men waiting outside to think that he was wasting time, or that he didnt know what to do. He stepped

determinedly up to the trolley, bent slightly to see the dressing and asked,

How did this happen?

Er the lads had come over to me place for a drink. Weve just finished work on a building in Scunthorpe today and we were

celebratin. The man had a very pronounced Yorkshire accent, but Ashok had got used to that by now and could follow it.

No, no, no. I mean how did you get this injury? Ashok couldnt help noticing that the men had a story already worked out;

obviously they had anticipated that they would need one; maybe it was for a subsequent occasion. Was it with a sharp blade, or broken

glass, or something else?

Oh, you mean that? Er, I cut it on a glass which broke.


4/25

Did you bleed a lot? Did you hurt yourself anywhere else?

Er, not that I know of. One cuts more than enough innit? the man gave a flippant smile.

At the back of his mind, Ashok was grateful for the fabrication. If the injury was caused by glass, there was a slight possibility

that small fragments of glass may be in the wound. That would show up on an x-ray. Legally, an x-ray was mandatory; and that gave Ashok

the time he needed to collect his thoughts.

In that case, Im going to have to get an x-ray of your wrist to rule out any glass fragments that may have been driven in.

Wot! Cant you jus stitch it up an I can go home?

Im afraid not, sir. If theres a fragment of dirty glass inside and I stitch it up, the glass could not only cut something, but you

could also get a nasty infection.

Oh whatever! Go long then.

Can you open and close your hand for me a few times please. The man clenched his fist. His little finger did not bend and

stuck out from the rest. Cant you close that finger properly?

Er no, I cant. Whats happened? Have I broken something? he asked anxiously.

Ashok touched the finger gently. Realising that this did not hurt, he moved it back and forth, satisfying himself that no bones

were broken. There were a couple of gauze pieces on the steel locker beside the trolley, probably left over from the dressing. He picked

one up and touched the finger with it. Can you feel that? he asked.

Sure I can. Please tell me whats happened, doctor.

And does it feel the same when I touch this finger? Ashok went on, ignoring the question.

Yeah, yeah. Please tell me, whats the matter?

Well, Ill put it like this. It looks like youve cut one of the tendons in the front of the forearm. Thats why you cant bend your

little finger. You dont seem to have fractured any bones or cut any nerve or anything else. Once weve got the x -ray, Ill have a word with

my senior and tell you what well do. Please dont worry. Whatevers happened, its nothing we cant fix. Ashok used his professionaltone of voice and his best bedside manner.

O.K., then, the man said, looking up at the others.

Ashok stepped out of the cubicle and walked to the counter where all the forms were kept. Two doctors, both women, were

sitting there. Leaning over one of them, he said, Excuse me, Dr. Atkinson.

Its Trish. Help yourself. Queens property.

Although he was getting used to it, Ashok still found it awkward that doctors in England used first names by choice. In fact,

nicknames were preferred. If he called a lady doctor by her nickname in public in Kolkata, it would be presumed that they were going

steady. It was o.k. to be informal when you were alone, but not at work.

Dr. Patricia Atkinson. It was strange, he thought, that by adding a couple of letters to a mans name, the gender changed.Patrick and Patricia; Paul and Paula; Michael and Michela; Robert and Roberta, George and Georgina. He wondered whether the same was

true of Hindu names. Well, he could probably think of a few: Krishna and Krishnaa; Supriyo and Supriya; Jay and Jaya. Had the parents

expected a boy and chosen the name as a means of covering up their disappointment? What would he do? His wife, Mala, was expecting.

Nowadays, sex determination was both possible and accurate. Should he try to find out the babys sex? He would have to talk t his over

with Mala.

I figure hes cut a tendon, Trish said. He cant flex his little finger. No sensory loss, though.

That, surprise, surprise, I noticed too. Hes not going to like it when I tell him that hes going to be in a plaster for a while,

Ashok said, basically talking shop.

What do you mean hes not going to like it? Would you?

Point taken. Better than having a nerve repair too.


5/25

Look at whos in a good mood today!

Well, lets hope this x-ray doesnt take too long. He hastily filled up the form and handed it to the nurse on the other side of

the counter. Hes in cubicle 5, thanks, he told the nurse, putting on his professional smile.

The nurse glanced down at the form and turned her head to talk to a man sitting at a table behind her, sipping a cup of tea.

Andrew, Cubicle 5 to x-ray, please.

At your service, luv.Just finish this cuppa. He raised the cup and drained it with one gulp. It must have been cold. He got up,

walked to a sink, rinsed the cup out and put it down. He walked to a corner where several gurneys were lined up against the wall. He

pulled one out and took it to Cubicle 5. A few moments later, he emerged, with the patient lying on the trolley and walked off, pushing it

skilfully. He did not bump into anything but moved quickly. The four men moved back to the waiting area and sat down, talking to each

other in low voices.

4. AMPLE ENOUGH?At the back of his mind, Ashok thought that he had dealt with things neatly. By telling the men that the patient had cut a

tendon, he had made it reasonably obvious that an operation would probably be needed. By mentioning that he would inform a senior, he

had ensured that the men would not hastily run away. If they asked any questions, he would just have to say that he would ask the boss

and then let them know.

He made his way to the nearest telephone and called his immediate senior, a registrar. When someone lifted the phone, he

said, Hi Neil, its me, Ashok. Sorry to disturb you, but weve got a guy with a tendon injury. He explained the details of the case

maintaining the story about the broken glass but not mentioning anything that he had seen from the top floor.

Ill come down and have a look, the man replied. You might as well book the O.T. and call the anaesthetist. When did he last

eat or drink?

Sorry, I havent asked. Ill find out r ight away. But he does smell of alcohol.

If I werent on bloody call tonight, I would smell of alcohol too! Now just get on with it!

Ashok felt stung. How on earth had he forgotten something so basic? Everyone was taught that when an accident occurred,

you asked the patient about five things: details of any allergies, what medications the patient was on, what significant medical events had

occurred to the patient in the past, timing of last meal and details about events leading to the accident. These were so important, thatthere was a mnemonic for them: you took an AMPLE history A for allergies, M for medications, P for past medical history, L for last meal

and E for events leading to the accident. To top it all, the patient had now been wheeled away for x-ray!

Was there anyway he could find out the additional information before his registrar turned up? The four accompanying men

were sitting in the waiting area, busy talking. He was reasonably sure what they were talking about. If he asked one of them, there wasnt

much chance they would know. Even if they did, they may easily feign ignorance, so that they could continue talking to each other. No

point asking them. If he asked Patricia, she would probably give him a supercilious look and claim not to have asked. After all, she was

busy with other things. Also, he would be exposing his error to someone he wasnt particularly well acquainted with; there was no

knowing whom she might tell; definitely no point in asking her. After working hours, the Casualty did not get the old records unless

specifically asked for. If the man had been to this hospital earlier, he would have previous medical records in the Medical Records

Department, or MRD, for short. He mightbe able to get something from there. On the other hand, if the man actually lived somewhere far

off, his old medical records might be in a different hospital, in which case he would have to wait till next morning. Suddenly, the obvious

solution struck him. He walked to the registration counter, leaned over the ledge and grabbed a blank sheet of paper. He looked at thenurse and said, Nurse, Ill be right back! and walked as rapidly as he could without looking undignified behind the trolley.

The Radiology Department was just beside the Casualty. When Ashok got there, there were three patients waiting to have their

x-rays taken. Fortunately, his patient had not been wheeled in yet. He stepped up to the gurney on which his patient was lying and looked

at the mans face, trying to note any distinguishing identification marks.

Excuse me, please, he saidsuddenly realising that he had never bothered to ask the patient his name. There are a few more

things I need to ask, if you dont mind.

Yeah. Sure. Go ahead. Roger Drummond at your service.

That got one problem out of the way, at least.

Are you allergic to anything that you know of, Mr. Drummond?

Naaaaa, he said. Then he gave a wink and added, if you dont include the wife, that is.


6/25

Ashok decided to ignore the joke. Although a bit of humour helped to break the ice, in this case, familiarity could imply that he

was from a working class background. Doctors were upper class and if he, a foreigner, did not conform, his colleagues would look

down on him. It didnt help your social image to be a close friend of someone from the working class. He certainly didnt want this man

to act friendly with him if they met in the ward.

A technician came out of the x-ray room and called the next patient in.

Are you taking any medications at present? Ashok continued.

No. The man had obviously got the message.

Have you ever been admitted to hospital before?

Yeah, actually. When I was a kid at school, I had a fracture of me elbow. Supra konderor something, they call it.

Supracondylar, you mean.

Right, thats the one. Had me arm in a plaster for nearly a month!

And which side would that be?

The right side.

And they put you to sleep when they set it?

Isnt that obvious?

O.K. shouldnt have asked, Ashok agreed. It would be unreasonable to expect him to remember any technical details,

particularly when his sobriety was in doubt. You said that you and the others were celebrating. How much had you drunk?

I was into my fourth.

Beer, wine or spirits?

I was having beer. Not sure bout thothers.

And did you eat anything, too?

Sure. Liz, thats Simons lass, cooked up a real feast.

Again, Ashok noted the fabrication. However, it would probably be wise to presume that the man was on a full stomach. In

Yorkshire, Ashok was surprised to hear people refer to their wife as a lass. He remembered the look on a nurses face when he showed

her the dictionary where it said that the word was derived from the Old Norse word laskurameaning unmarried.

In that casewell have to wait for at least four hours before we can take you up for surgery under general anesthesia.

Four hours! Why that long?

Well, theres a small possibility that you could vomit when you are unconscious. If that happened and things went into the

lungs, I mean, it could be. er, fatal.Its safer to wait till your stomach is completely empty. Experience had taught Ashok that there

were times when it paid to be melodramatic.

Oh no! the man said, exactly as Ashok had expected him to. O.K., then.He seemed to be thinking about it. Four bloomin

hours, for chrissake!

Would you like us to inform anyone about the accident?

Er no, no. I mean, just tell mfriends out there and theyll tell everyone oo needs to know.

O.K., have you ever had any other procedure done? Like, maybe, a tooth pulled out?

As a kid, yeah, been to a dentis couple a times. Cant remember for sure, though if I had a tooth pulled out or not... His

voice wandered off as if he were trying to remember. Wait a minute Yeah, yeah. I have had a tooth pulled out, come to think of it. Itwas the day after I finished me O levels in school.


7/25

Fine, Ashok said. What year would that be?

Er, 1984, that would be; God! 10 years back, that was. My! How time flies!

Did they put you to sleep for that, too?

Yeah, they did.

Nothing else?Ashok asked, rapidly writing dental extraction GA 1984 as he spoke.

Naaa..

O.K., then; and have you ever had a prolonged course of medication?

What? Whats that?

I mean, have you ever had to take medicines for several days?

Naaaa

And have you ever been absent from work for a long time due to illness, or poor health? Ashok hoped the man understood

the question.

No way. Ive been withoutwork for a long time more than once, but never due to il l health. Bloody recession, more likely. He

sounded both bitter andsarcastic. And the guvmint dont bloody help none either, he carried on. Putting on a high pitched voice,

obviously mimicking a woman, he said Doyou have documentary evidence that yourapplication for work has been turned down?, she

says, when I goes to the Job Centre. What the bloody hell do you think Im doin, standin in this goddam queue for?I felt like askin er, to

stare at that horses mug of yours?I tells you one thing, mate. Dont evervote for the bloody Tories; ever.

The technician came out of the x-ray room again and called for the next patient.

That Thatcher woman. The man carried on. I mean, shes workin class herself, aint she? Like, her dad was a shopkeeper, for

cryin out loud! Surely you would expect her to think of the working classes? But no! No way! She snatches everythin she can from us folk.

Free meals in schools? Gone! Whatre they gonna get rid of nex? The bloody N.H.S.? Betcha guys like youwouldnt like thatwould you?

and he pointed at Ashok. An this nex generation of sods aint no better, I tells you. All theyre ever bothered about is to be able to afforda detached house right there in bloody Westminster. He was almost ranting by now. The other patient, a woman, was glaring at them.

Ashok wondered which political party she was affiliated to.

Sorry for all the troubles youve been through, Ashok cut in, but in order to treat you there are several things Im going to

have to sort out. Id better get on with it. Excuse me, please. He rushed off, hoping he wouldnt have to spend more time listening to this

cathartic monologue. At least he had an excuse to get away. He got back to the Casualty, walking briskly.

5. PAPERWORKAshok decided that he would need to organise some baseline investigations and to inform the anaesthetist on call and the operation

theatre. He got to the nurses station, grabbed the necessary forms and quickly started filling them up. He had devised a system to fill up

forms quickly. Firstly, he filled the patients name in each form. That was Roger Drummond, five times. Next he did the sam e with the

date. 03/03/1994, again five times. He did the same for the other details. By the time he had finished, the patient was being wheeled

back into the Casualty. He picked up a needle and some disposable syringes and went to the patient.

I need to take a blood sample, please, he said.

Sure. Go on.

Fortunately, Roger had large veins not uncommon in hard labourers and sportsmen. Ashok, like most junior doctors, kept a

tourniquet in his lab coat pocket. He tied this around the patients left forearm, turned his wrist so that the palm faced down, and quickly

inserted the cannula in. Blood started flowing back into the syringe.

Can I start some normal saline on this patient, nurse? The nurse already had things ready, so that by the time the syringe was

full, the intravenous drip was by his side. He took off the tourniquet, disconnected the syringe and connected the drip set to it.

Thanks, he said, fixing the cannula in place with strips of plaster.

Welcome, doctor, the nurse said with a professional smile.


8/25

Ashok couldnt help remembering the day he and Mala first arrived in England. His friend and college mate, Shantanu, had

come to Heathrow to fetch them. Shantanu worked at Hammersmith hospital and started giving Ashok friendly advice as soon as they

reached his flat.

The British,he started, are very polite. They may or may not have anything to say, but they will say it politely. If you want to

get along with them, remember the saying, when in London, do as the Romans do .

Dont you mean Londoners?

O.K. as the Romans did. For example, learn to breathe politely. He put on an affected accent and said Excuse me, and

breathed in sharply. Then he said Thank you, and breathed out.

Maybe Shantanu was exaggerating, but Ashok soon learnt that there was no denying the value of this advice. It didnt pay to be

informal with anyone but your closest friends. The British could say thank you and make it sound insulting.

And always wear a tie. Even if youre going to the loo. Especiallyif youre going to the loo.

Thatbit, Ashok presumed, was said for effect. His reverie was interrupted.

Hi, Ive stuck his x-ray up on the viewing box. It was Trish. I think you definitely want to see it.

Ashok went over to the viewing box and looked at the x-ray. There were two splinters of glass in the wound which showed up

in white. The x-ray technician had marked them with arrow s in ink. I saw the foreign bodies, but thought it better not to tell you within

the patients hearing.

Thanks.Ill leave it to my registrar to break the good news. Better inform the gasmen.

I think Alans on call for anesthesia tonight. We had an arrest a short while ago and Alan answered the crash bleep, Trish told

him, obviously trying to be helpful.

If he came down to give CPR, its unlikely hes covering the Emergency OT, Ashok said.Doesnt matter, really; Ill go through

the switchboard.He picked up the receiver of a phone on top of the doctors table and punched in four numbers as he spoke. After a few

rings, somebody picked up at the other end. Hello, Hospital Reception a cheerful, female voice said.

Hi! Dr. Ghosh, Orthopedic SHO oncall. I need to contact whoevers on call for anesthesia, please.

Lets see.. just a mo..er..that would be Dr. Alan Melvin, it says here.

Thanks. Could you get him to ring me back at this number, please?

Sure. Be right back.

Thank you, Ashok replied, putting down the phone. He thought that usually two doctors were on call for anesthesia; one for

the ICU and one for the OR. Something must have happened. Surprising that Trish knew. She wasnt known to be friendly with Alan; in fact

she was engaged to some computer nerd, as far as he knew. Oh well, wonders never ceased.

The phone rang; Ashok hastily picked it up. Dr. Melvin, SHO on call for anesthesia.

Hi, Alan. Its me, Ghosh from Ortho. Weve got a tendon injury, left wrist. We need to explore and repair the wound.

How long ago did he eat or drink? the question sounded rhetorical.

He was eating and drinking less than an hour ago, so I know we cant do it for another four hours at least. However, I was just

booking my place in the queue.

Well, actually Im holding Marks bleep, too. He just heard that his grandfathers passed away. O.K., Ill be down in a flash and

look at him. Have you booked the O.T. yet?

Er, no. I thought youd better see him first.

O.K. Sure, but youd better book the O.T. too.

Will do. Ashok heard the other phone being put down, so he waited for the dial tone and dialled for the operation theatre.After a few rings, someone lifted the phone.


9/25

Emergency O.T. Staff nurse Claire Fraser. The Scottish accent was obvious.

Oh hello. Im Dr. Ghosh, SHO, Orthopedics. Wed like to book the O.T. please.Theres a case of tendon injury, left wrist and we

need to explore it under GA.

Has your registrar seen the case yet?

Ashok felt a bit annoyed at the question. He remembered Shantanus warning, To be on the safe side, presume that every

white man is a racist until proven otherwise. Would she have asked this to a white doctor?

No, actually. But when I called him, he asked me to book the O.T. He resisted the temptation to say anything sarcastic. He

knew very well that an emergency operation could only be done by, or at least under the supervision of, a registrar or someone more

senior. However, he knew that nurses had a way of sounding superior when talking to foreign junior doctors. It came with the territory, so

to speak. If he pointed out the remark to anyone as discriminatory, most consultants would side with the nurse, claiming that she was

merely being thorough and just because Ashok had been painstaking did not obviate the need of a nurse to check.

Well, theres an emergency laparotomy for peritonitis, which is being started as we speak. After that, there is a below -knee

amputation for gangrene, by the vascular surgeons. Itll easily be four hours by the time theyre finished if not more.

Could you tell me who the vascular surgeon on call is?

Mr. Jacobson booked the case. Im not sure which consultant is on call. The case may be from the other vascular unit, for all I

know.

O.K., Please book the case.Its an injury to the flexor tendon of the left little finger. Theres a deep cut just above the wrist and

the x-ray shows glass fragments inside. Well definitely be using a tourniquet and well need to put on a plaster splint. Thanks, Ashok said.

After a very short pause to make sure that the nurse wasnt going to say anything more, he put the phone down. At the back of his mind,

he realised that the nurse had made a slip. He hoped that he could persuade his registrar to complain and at least threaten to kick up a

row. On the other hand, if the patient had a full stomach, they would have to wait for four hours anyway.

From the corner of his eye, Ashok saw his registrar approaching. He turned and said,

Hi! Hes in cubicle 5. Ive just spoken to the O.T. and the anesthetists about the case.

Hi! Where are the notes? Neil said, getting straight down to business. As soon as Ashok handed them to him, he startedskimming through them. Right. Lets take a look.

They went into the cubicle. Seeing the dressing, Neil said, Do me a favour, get his x -ray. The nurse scurried off; he turned to

the patient. Hello, Im Mr. White and Im the registrar in Orthopaedics. Mind if I take a look?

Sure. Go head.

Could you open and close your fist for me, please.

Again, the man made a fist and again the little finger did not bend. Neil moved the little finger to check the range of movement.

The nurse came back with the x-ray. Neil held it to the light and looked at it for a few moments.

O.K., then, he said, two things are obvious. Firstly, youve cut a tendon, which will need to be stitched back and secondly

there are two glass fragments in there which need to come out. We might have to make an incision in the forearm, because chances are

the muscle has contracted and the cut end of the tendon would have moved up into the forearm. Also, to ensure that the tendon heals

well, well have to put your arm in a plaster cast from above the elbow to the back of your hand so that you cant move it. This will have to

stay for 4 weeks, Im afraid. He paused to let the information sink in.

Oh God! You mean Ill be off work for a month! Roger said, in dismay.

Sorry, but its your hand. You dont want anything going wrong with it. Is there anything else you would like to know?

The patient stayed silent. The other men looked at each other.

In that case, Ill leave Dr. Ghosh to do the paperwork. He pronounced it Gosh. Meanwhile,Ill get the other things sorted

out.

Nobody spoke.


10/25

O.K., then, see you in the operation theatre.

He left and Ashok followed him. When I spoke to the O.T., they said that they are doing a laparotomy for peritonitis right now.

After that theres a below knee amputation for gangrene.

What?Neil said; the annoyance in his voice unmistakeable. You mean theyre giving priority to a bloody BK amputation over

a handinjury? Who the hell said that?

Er. The nurse in the O.T.

She can jolly well take her nursing degree and shoveit! Whos the surgeon?

Mr. Jacobson, she said.

Ill have a word with Paddy. He ought to have more sense than that pea-brained twit! and he hurried off.

Mentally, Ashok heaved a sigh of relief. An amputation for gangrene was definitelynot as urgent as a laceration. In fact, the

first 4-6 hours after an injury were called the golden window. If the injury was treated during this window, the likelihood of woun d

infection was low. After 6 hours, the risk of infection rose sharply. The fact that Neil was annoyed meant that he would probably complain

to the higher-ups. This spared Ashok the need to do so instead. If a British doctor lodged a complaint it was more likely to be acted on

promptly than if a complaint was lodged by a foreigner, particularly an Asian. It was one thing to say that the patient had eaten recently

and that therefore the case would have to wait. It was a totally different thing to say that the patient would have to wait for some other

case. Medical emergencies were not necessarily dealt with on a first-come-first -served basis. A patient who had a blocked airway and was

dying of asphyxia got priority over a case of a dislocated thumb, because the former could be immediately fatal, whereas the latter wasnt.

If a patient had gangrene and was scheduled for an amputation, delay was unlikely to seriously affect the ultimate outcome. The

gangrenous leg was dead; it wouldnt get worse. However, if a cut tendon got infected before it was repaired, the subsequent scarring

could ruin the repair and the patient would be physically challenged for life. A tendon repair definitelydeserved more priority than an

amputation for gangrene. Ashok hoped that the theatre nurse was made to eat humble pie. Serve her and her kind right! Ashok decided to

leave the matter of booking the OT to Neil. He would find out from Alan about the exact time in a few minutes. Right now, he wanted to

think about what he had witnessed.

6. A SILENT SOLILOQUYWhat if he didnt tell anyone? Would it reallymake a world of difference? Sooner or later, someone would report the missing

person. In fact, if the man didnt turn up at home by the next morning, chances were his family would start making enquiries and report

him missing in less than 24 hours. Then again, the murdered victim might not be someone local and he may be single. In that case, his

absence would not be noticed for several days. Roger had said that the men had completed a building contract in Scunthorpe and were

celebrating. There may be a germ of truth in that. If these men were day labourers and did not have a steady income, they may work all

over the country, wherever they could find employment. Lots of people travelled long distances as part of their job. In that case, was it

possible that the police would neveractually get to know? Could these men literally get away with murder? There was a lot of difference

between a person reported missing and a person reported murdered. Surely the latter was more serious. The police would definitely find

out that a man was missing, but they may not give it much importance.

Ashok suddenly remembered a sentence from the Bhagavad Gita. If it is a sin to commit a crime, it is also a sin to tolerate a

crime. This was a very forceful argument. In fact, if, by chance, the police found out that he hadwitnessed the crime and had chosen to

remain silent, there would be a lot of embarrassing questions. Was it worthwhile staying silent? No! Definitely not!

At the same time, it was equally true that if he told the police and they revealed his identity to the media, the men could findout and seek revenge. That could be directed at him, or maybe even Mala. He would have to make sure that he remained anonymous. But

how? If he refused to reveal his name, the police may not heed his 999 call. He would have to state that he didnt want his name

publicised at any stage. Surely the police would understand that. If he said that he wanted to report a possible homicide and stated who

he was, he could then add that he did not want his identity to be made public. That was the best way to go about things.

The next problem was where to phone from. There were many phones all over the hospital and it was a simple thing to first

dial 0, which would get him to the switchboard and then ask for 999. However, this meant two problems. Firstly, the switchboard would

know that he had called Emergency Services and might suspect that something was amiss. Secondly, nearly all of the telephones were in

very public places like the walls of a corridor, or the nurses station. Chances were that he would be overheard. Suddenly a thought struck

him. At the back entrance to the Casualty, there was a public payphone just beside the door. This entrance was used mainly by staff

entering or leaving the hospital. It was at the end of a corridor; at this time of the night, it was highly unlikely that anyone would be

around. He could be seen from the Casualty, but not heard; and he wouldnt be far from the Casualty. Calls for 999 were free.

The next thing was what exactly to tell the police, once he got through. He couldnt afford to waste time; he needed to be

precise and clear; he also needed to sound convincing. He decided to spend a couple of minutes composing exactly what he would say.


11/25

Hello! I am Dr. Ashok Ghosh from the Casualty at Hull Royal Infirmary. This was how doctors phoning the Poison Centre usual ly

introduced themselves. A few minutes ago I was in the Paediatrics ward on the top floor of the hospital. No, that would not do. Why

should a doctor from the Casualty go to the Paediatrics ward? If he was working in the Casualty, he should stay put in the Casualty. O.K.,

then. Hello! I am Dr. Ashok Ghosh from Hull Royal Infirmary. A few minutes ago I was in the Paediatrics ward on the top floor of the

hospital. That was better. I was standing on the landing outside the ward and through the window I saw a group of six men in the car

park of the pub on Argyle Street, just opposite the hospital. A fist fight broke out. That ought to arouse their interest; but was that the

best way to put it? Maybe it would be better to say, They started fighting. Yes. That sounded more natural. One of them broke a

bottle Should he waste time with details on the phone? He didnt gain anything by doing that. Five of them overpowered one man and

I think they stabbed him to death. In the process, one of them also injured his forearm. They stuffed the body into the boot of a car and

came to the hospital. I am tending to the man with the forearm injury in the Casualty, but as far as I can make out, there is a corpse

stuffed in the boot of a car in the hospital car park. That probably summed it up. If they wanted more details, he could always say that he

had to tend to the patient and had to rush.

Having made up his mind what to say, he thought it would be best to check on the patient once. It was quite possible that some

of the test results were ready. Also, he would have to get the patient to sign the consent form.

7. THE GETAWAYAshok went back to the nurses station. Excuseme, please, he asked the nurse sitting at the table, I want to talk to the people

who came with the patient in cubicle 5. Er... Roger Drummond. Any idea where they are?

In the waiting area, doctor, she answered without looking up. The unspoken snub was obvious.

Thanks, Ashok answered, in a tone that was over-polite. The nurse looked up and Ashok gave her a professional, anything-you-

can-do-I-can-do-better smile. He turned to look at the waiting area. The four men were standing in a corner, together. They were talking

to each other, but obviously did not want to be overheard. Ashok wondered what he should do; if he told them that there would be a four

hours delay, he would be giving them an excuse to go away, dispose of the body and come back. On the other hand i f he didnt tell them,

it was possible that they would leave anyway, leaving one man behind, dispose of the corpse and come back or even get away. He made a

quick decision and approached them.

Excuse me please, youre with Mr. Drummond, right?

Yes, one of them said.

Could I have a word with you, please?

Sure! Go `head.

Mr. Drummond has cut one of his tendons and this needs to be repaired. He has fragments of glass in the wound and these

have to come out. My senior, the registrar, has seen him, too. Hes going to need emergency surgery. Ive fixed things with t he operation

theatre, but he told me to let you know. He said that you would know whom to inform.

Sure, Ill tell his wife Helen, if thats what you mean.

That would be very kind of you. Should I leave that to you, then?

Yeah, yeah, sure.

Thanks, then.

Doc, How serious do you think it is?

Well, he has cut a tendon but it should be possible to repair that. It may take a few weeks of rehabilitation and exercises, but if

all goes well, he should be back to normal after that. The most important thing is that he hasnt damaged a nerve anywhere. He will not

have any loss of sensation. I suppose he should be grateful for small mercies.

Is è goin tbe off work for that long? another man asked.

Im afraid so.

Oh no! You dont say! the man said, with obvious concern. But è willbe alright after that, wont è?

I certainly think so, Ashok replied, trying to sound optimistic, without committing himself. An òw long is è gonna be

in ospikle?


12/25

When the operation is over, his arm will be immobilised in a plaster slab. This will stay till all the pain and swelling settles

down. Then it will be replaced by a plaster cast that surrounds the limb. After that he can go home. I dont think that would take more

than three days.

Ta! the man said in acknowledgement.

O.K, then. Ill get him to sign the papers.

Ashok returned to the nurses station and sat down. He opened the patients file and quickly wrote a brief account of the

accident and the injuries, making it a point to mention that the patient was unable to move the little finger and that there was no loss of

sensation. He was drawing a sketch to show the injuries, when Patricia leaned over his shoulder and said,

Thats a pretty good drawing certainly more accurate than the one Idrew.

Thanks for the compliment, Trish. When I was reading anatomy for my postgrad exam, I worked out a system by which, with a

few strategic lines, I could get a reasonable image ofanypart of the body.

I got one of the nurses to fill in the forms for the investigations. Just check that you dont need anything else.

Oh certainly. Im sureyou wouldnt have missed anything.

With a boss like mine you need to be damned sure. The Yanks call it the CYA principle; we Brits call it the CYB principle.

I dont think Ive heard that one, Ashok said inquisitively.

Cover your arse, or cover your backside. Youre neither a Yank nor a Brit, so take your pick.

Ashok laughed. Ill prefer the Kings English, thank you very much. He glanced through the forms as he spoke. Youre covered

alright.

How boring, she said, in an affected voice,when will I ever learn to err like ordinary human beings? and she walked away.

Ashok handed the forms to one of the nurses. These are for the patient in cubicle 5. Ive already drawn the blood and kept it

beside the patient. Could I have a consent form, please?

Here, doctor, the nurse said, handing him a printed sheet of paper.

Thanks, Ashok said, standing up as he took it. He turned towards cubicle 5. Maybe, he thought, he should tell the police first

and finish the paperwork next. If Roger started asking all sorts of questions before signing the consent form, he would get bogged down at

the patients bedside and the others might drive off. On the other hand, if the police started cross questioning him on the phone, the

other men could get away while he was still on the line. That was probably the better evil. At the back entrance to the Casualty there was

a public payphone. Here, he could ring 999 for free. Ashok put the consent form down and headed for the phone at the back of the

Casualty.

He picked up the receiver and dialled 999. He glanced back to look at the five men. He noticed to his dismay that they were

walking out of the Casualty.

After two rings, someone picked up and a female voice said This is 999, Emergency services. Whichservice do you want?

Could I have the police, please.

Just a moment. Again there was a click as the line was transferred and a phone rang. From the corner of his eye he could see

that four men left the Casualty and one stayed inside. They ran to the car, hurriedly got in and started to drive out. The phone still rang.

The car drove past him; he desperately tried to see the number. From what little he could make out, it was H672 NVM. He took his pen out

and scribbled this number down on the wall.

Ferensway Police station; may I help you? the mans voice was neutral, devoid of all interest, but perfectly polite. Probably

the police had to deal with the public as often as doctors did and spoke accordingly.

Er yes. I am Dr. Ashok Ghosh and I am on call at Hull Royal Infirmary. I would like to report a crime.

Sorry to interrupt, doctor, but could I get your name right. Could you spell it for me, please.

Ashok. Thats A-S-H-O-K. And Ghosh. Thats G-H-O-S-H.


13/25

O.K., doctor, and what did you see?

8. A THUMBNAIL SKETCHAshok looked at his shoes. It helped him concentrate.

A few minutes ago I was in the Paediatrics ward on the top floor of the hospital. I was standing on the landing outside the

ward and through the window I saw a group of six men in the car park of the pub on Argyle Street, just opposite the hospital. A fist fight

broke out. One of them smashed an empty bottle on a table. They started fighting. Five of them overpowered one man and I think they

stabbed him to death. In the process, one of them also injured his forearm. They stuffed the body into the boot of a car and came to the

hospital. I am tending to the man who injured his forearm in the Casualty. Just now, the others drove away. I think they want to get rid of

the body. I got a glimpse of the licence plate as they drove out. I think the registration number of the car was H672 NVM.

Could you repeat that number, please, doctor?

Er H-6-7-2- N-V-M. Ashok repeated, looking at what he had scribbled on the wall.

O.K. H672 NVM. Is that right?

Yes. As far as I can make out, they are on Anlaby Road and they are headed towards the Humber Bridge.

And you said one of them is inthe hospital?

Actually, there are two. One is the injured man and one of the others stayed back in case anything was needed.

Could you by any chance give me a name?

The name of the injured man is Roger Drummond. I didnt check his address, but it must be there in the patients record.

Rog.erDrum.mond. O.K. got that. We can send someone down there right away.

Thanks, but wouldnt it be more important to catch the men who are getting away? I mean, if you want evidence of a crime,

its in the car, not here in the hospital.

Sure thing. Ill inform my colleagues at Hessle and Humberside headquarters too. What are you planning to do with this Roger

Drummond fellow? Are you admitting him?

Yes, certainly. He has severed a tendon to his left little finger and he needs emergency surgery. The only reason we havent

taken him up yet is that the theatre is occupied with another emergency.

And what happens after that?

Hell have to stay in for a day or two, till the swelling settles.

You mean he wont be going home tonight?

Definitely not.

O.K., then. If there was a fight as you say, then we can consider it a medicolegal case and Ill send the lads down.

Actually, I was called to see the patient as the doctor on call for orthopaedics. Im not the doctor who first saw him in the A&E.

I dont know what account he gave to the attending doctors there. As I said, I sawthe men fighting, though Ill admit that I was on the

thirteenth floor.

What did he tell you?

He said he cut it on a glass that broke. He smells of alcohol. That sounds plausible even if I happen to know its a fabrication.

He probably said the same thing to the doctors who saw him before I did. As far as I can tell, he made it sound like a simple domestic

accident, not a fight. Thats part of the problem. Without actually admitting that I witnessed the event, I have no grounds for calling the

police.

I get you. You can do one thing, then. Just look up his file; if he has a phone number at home, just note it down and tell it to

me. Im holding the line.Meanwhile Ill organise a squad to chase the car the other men got away in.


14/25

O.K., Ill be right back. Ashok balanced the receiver on top of the phone and dashed back into the Casualty. He went to the

nurses station and quickly found Rogers file. He opened it and found a phone number, which he wrote down on the back of his hand. He

raced back to the phone and lifted it again, hoping that no one had noticed his scurrying to and fro.

Hello, Dr. Ghosh here.

Yes, doctor.

Theres a phone number. 01757-5877. That doesnt sound like Hull.

No. Its Selby. O.K., Have you told anyone else what you witnessed?

No; most certainly not!

Can you make sure that the other man doesnt go anywhere?

I dont think hell leave, but I cant guarantee that I wont be called away to tend to some other patient.

O.K., then. My colleague is on the line to Hessle police station. Oh! Hes just put down the receiver. I imagine theyll chase

them from there. O.K, now, do me a favour. Tell this other man that you want someone to be in the hospital .

What reason should I give?

Just tell him that in an emergency like this, its always safer if one of the victims acquaintances is available. I t may be useful if

any further enquiries have to be made.

Ashok realised that the policeman was using technical jargon which might be applicable to a police scenario, but was unlikely to

apply to a medical one. He would have to think of something himself.

Alright. Anything else?

Yes. See if you can note down his name and maybe his address and phone number. Leave it with the receptionist in the

Casualty. Well pick it up from there.

O.K. Consider it done.

Thanks, doctor. I wont hold you any longer.

Just one thing, please. Could you possibly keep this conversation confidential? I mean, these guys seem to be pretty

dangerous and I most certainly wouldnt want them to find out anything about me.

I get what you mean, doctor. Dont worry; we know how to keep our sources ofinformation a secret.

Thank you very much.

Youre welcome. The line went dead and Ashok put down the phone.

9. BACK TO THE GRINDAshok went back to the Casualty. In the waiting area, the man who had stayed back was sitting with a magazine. He didnt seem to

be reading it; every now and then he lifted his eyes and glanced around quickly. Ashok went up to him and asked,

Are you with Mr. Roger Drummond?

Yeah. The other guys who were with im have gone to get his wife.

Any idea how long theyll take?

Shouldnt be long. `Elives in `essle.

See. I have to leave now. Im needed in one of the wards. Could I know your name, please?

Simon. Simon Rowbotham.

Is there any chance that you could be called away before your friends get back?


15/25

At this time of the night? I wouldnt think so.

All the same, just in case you do, could you write your address and phone number on this piece of paper for me.

Er... I dont have a phone, so I cant give you one.I lives in Blackpool, but Im stayin with me aunt as long as this job lasts. I can give

you her address, but I dont think shell fancy you if you wakes er up in the middle of the night. Be ready for some pure Yorkshire

English if you do.

Fair enough. Im just being thorough. He handed the blank paper and his pen to Simon, who scribbled something on it and handed

it back.

Thanks. I certainly hope it wont be necessary to disturb her. He walked briskly to the receptionist, took the paper out of his

pocket, wrote the name Simon Rowbotham on it and handed it to the receptionist.

Could you keep that name and address for me please? Hes with the patient in cubicle 5. He did not mention anything about

the police.

Sure thing, doctor, the nurse said cheerily, glancing at the note. Her expression changed a bit. Excuse me, doctor, but could I

ask you something? she beckoned him to come closer as she spoke.

Yes, nurse? Ashok asked, coming towards her. She waited till he was quite near and then said, in a hoarse whisper

Is this somebodys address? I mean, I dont want to sound nosey, but Ive never heard of a Daleham Drive in Hull in all my life.

And Ive lived here for more than twenty years. I thought I knew this town like the back of me `and!

Ashok realised that the mistake was deliberate, but it wouldnt be much use trying to rectify it. In fact, if he questioned Simon,he would probably end up giving him a warning.

O.K., leave that to me, just keep the slip. Oh, I need a consent form, please.

Here! the nurse said, handing him one. She stared at the slip again.

Thanks, Ashok said and went to cubicle 5. Roger was lying on his back, staring at the ceiling with a faraway look on his face.

Excuse me. Please. I explained to you that you have to undergo an emergency operation. Your friends have gone to call your

wife....

What! All of them? Roger asked, a bit startled.

No, no, no. One man has stayed back and is waiting outside. His name is Simon, I think.

Thats O.K. For a moment I thought they had all left, leaving me stranded.

Oh no. Actually, I came because I need you to sign a consent form for the operation. Let me explain what will happen and if

theres anything you want to ask, feel free to. O.K.?

Yeah, yeah, go `head. Ill sign it. Hope I can write properly without holdin the paper.

Basically what we plan is this. You will be operated on under general anaesthesia....... and Ashok started to tell his patient allthe relevant details.

10.THE CHASE

Why the bloody hell dont you take the main road? Youd be doing 60 anyway an at this time of night you could easily go at 90.

Here you cant cross 30 and you keep slowin down for curves an crossings an sorts

How many times do I have to tell you, moron? I told you las night. A car speeding down a main road at night will get caught on

speed cameras. These roads dont ave `em and were less likely to be seen by the police.

The three men were driving in the car. After leaving the hospital, they had sped down Anlaby road, but after a short distance they

turned left into a smaller street. They kept driving on roads lined with single or double storied houses, the residential areas of this old

town. Two men were in front and one behind.

Just shut up, you two an concentrate on the work. Fred, you just keep your eyes an ears peeled an let Paul do the driving. Youre

supposed to be a bloody lookout, not a pain in the arse. Paul, stop faffing around with Fred and get to the bloody docks.

Whos idea was this anyway? Fred asked.

Rogers,and its a damn good one. Now just shut your bloody gob.

Look, Dave, Paul said. I know we agreed on the docks las night an all, but I stillsays, the further we are from town, the better. I

says we should go beyond the bridge to Ferriby and dump this there.

Whos being the moron now, eh? Dave asked. Have you ever been to the riverside from Ferriby? There are houses right upto the

waterfront. Want to risk wakin up the whole neighbourhood? And anywhere beyond that, the road is too far from the river. Youd have to

carry the damn thing for God knows how far till you got to the river and I havent a clue how far youd have to walk into the river before

you get to water which is deep enough. At the docks, the water is deep at the quayside, and the river flows reasonably swift. Theres

buildings alright, but theyre all storehouses an all. Nobodys gonna be around at night. Now jus shut up and get onwith it.


16/25

Oh well, Paulaccepted. I agreed las night so I aint backin out.

They drove in silence. After a while, they came to a T-junction and turned right. They were on a road which was parallel to the river

and it flowed to their left.

Well be at Andrews Quay pretty soon, Paul said. Tell me when to stop.

O.K., just slow down a bit. Dave said, pointing ahead. Now, go down that road to the left. Paul turned onto the left fork and

slowed down. They were on a dock at the riverside. He looked in the rear-view and side mirrors. They were completely alone.

Right. Here. Dave said and they came to a stop. Fred opened the front door and put one foot out. Just then, they heard a siren.

What the hells that? Fred asked, An ambulance?

Shut up and get back in, bloody idiot! Paul, get the hell out of here! Dave cried out. His voice was a bit high pitched and showed a

hint of panic. Fred got back in and slammed the door shut as Paul started the engine. Neither Fred nor Paul seemed to understand why an

ambulance siren should cause alarm.

Whats the matter, Dave? Paul asked. An ambulance going to Hessle or Ferriby. Why should we stop?

Get onto the A63 and when you reach the bridge, turn right to Beverley. That aint no ambulance. Its the bloody police! If an

ambulance was going to pick up a patient in Ferriby, it would be on the main road, not some bloody side road like this. There are no

houses here, or didnt you notice? Why the hell do you think I chose this spot to get rid of the guy?

Holy shit! was all that Fred could come up with, but the message had sunk in. What the hell, man! We werent drivin over the

limit or somethin like that! Why should they follow us?

If youre that damned desperate to find out, why dont you stay back and askthem? You think Iknow? Whats wrong with you,

Fred? Are you even more stupid than you look?

O.K., O.K. Jus wonderin. By now, they were moving. They turned to the right and were soon back on the main road.

Step on the gas, Paul. You dont want them catchin up on us! Dave said peremptorily.

Paul speeded up; the road was empty. In the rear view mirror, Paul could see the headlights of the police car as it got onto the road.They were probably a hundred yards behind. He accelerated, and the gap grew. However, very soon it started to decrease. The siren was

clearly audible.

Faster, bugger, faster! Dave rasped, gnashing his teeth.

Cant dammit! This aint no top-of-the-range Jag.

Shit, man! Theyre gaining on us.

Ahead of them, over the river, the lights on the Humber Bridge could be seen; the suspending cables reflected the lights and looked

like an intricate design of threads. The image rapidly grew larger and it was soon large enough to make out individual cables. The road

curved gently to the right.

Damn! The lights are red! Fred muttered.

Dont be stupid, for chrissake! Dave shouted. Just skip them!

Paul sped through the red light, but had to slow down a bit as he turned right. The road the men were on crossed under the north

pillar of the bridge. Paul entered a slip road and got onto the northbound road. The signposts read Beverley. Paul accelerated, looking in

the rear view mirror every now and then to see how far behind the police were. To his dismay, the police car came round onto the road

almost instantly, implying that either they had gone through the red light too, or the lights had changed just in time for them.

Oh God! Paul exclaimed, They skipped the light too. We aint gonna make it.

O.K. Heres the plan. Fred and I are piss drunk. Youre not, Paul. Were drivin back from Hull where we were at Simons place

celebratin. Weve jus finished a buidin projec in Scunthorpe. Paul, you didnt drink anythin.

Yeah, yeah. I know. He was a teetotaller.


17/25

Behind them, the car was gaining on them. In a few moments, it was alongside them. It over took them and flashed its hazard lights,

slowing down in front of them, forcing them to slow down too. Both cars ground to a halt. Both front doors of the police car opened and

two policemen stepped out. They approached the car and each one went to one of the front doors of the car.

Could I see your licence and registration, please, the man on the drivers side said.

Paul rolled the window down, opened the glove compartment and, after a bit of searching, found the papers. He took his wallet out

of his trouser pocket, opened it and took out something else, which he unfolded. He handed them both to the policeman.

These seem to be in order. Hugh, write down the registration number for me, please.

The second policeman went to the back of the car. Perfect match, Don. Mus say, that bloke had good eyes. He pulled out a

notepad and copied the number.

Which one of you gentlemen does this car belong to? Hugh asked

Me. Its mine, Paul said.

And where were you driving to, sir?

Er. To Beverley, officer, where I live.

You were doing 84 miles an hour and you drove through a red light. Would you explain that, sir?

Sorry, officer, I wasnt looking. We were talking to each other and the road was empty.

Right, then. Please stay in the car. We have information, he said, moving so that he stood closer to the door, that a car, matching

yours in description and with the exact same registration number was seen speeding eastwards along Anlaby Road a few minutes ago.

There is a lot of smuggling going on and so we need to examine your car. I suggest you cooperate. Without asking for permission, the

police reached into the car, turned the ignition off and pulled out the key. He walked to the back of the car and inserted the key in the

latch of the boot.

YOU CANT DO THAT, Officer!Dave shouted, opening the door as he said so. He put his foot out and moved as if he were going to

get out. Hugh grabbed his collar and shoved him back into the car.

STOP THAT! I SAID STAY IN THE CAR! he shouted. Both men glared at each other; Hugh slammed the door shut.

Don opened the car boot and swung the back up.

Holy CHRIST! he ejaculated.

11. A TENDON REPAIRThats fine, Ashok. Just hold the hand and forearm in that position for a short while and the plaster will set. Neil, the on -call

orthopaedic registrar, stepped back from the operating table and took off his gloves. They were in the emergency operation theatre

and the case had just finished. He nodded to the anaesthetist, Thanks Alan, looked at the nurse at the other side of the table and

added, Thanks, staff nurse.

Pleasure, Alan said.

Welcome, the nurse said and sighed with relief now that the case was over.

One of the theatre assistants came and helped Neil take off his gown. Thanks Neil acknowledged. Ill write the notes while

youre waiting for that cast to set. By the way, Ashok, your exams coming up soon isnt it?

Yes. Its in three months.

Care to answer a few questions?

About the case or about the subject?

A bit of both, I suppose.


18/25

O.K., Why not?

Neil wrote a sentence in the notes. This guy had an injury close to the wrist and so he injured his tendon. Imagine that the

injury was higher up in the forearm. What structures would he have injured then?

He would probably injure the belly of the muscle. In this case that would be the flexor digitorum superficialis.

That answer is one hundred percent correct. Is it possible to differentiate between an injury to the deep tendon and the other

one clinically?

I think that if the deep tendon is preserved, the patient can bend all the joints of one finger. If the deep tendon is divided, the

last joint wont flex.

Again one hundred percent correct. O.K., this guy had a tendon injury. That was repaired by suturing the two ends of the cut

tendon together. What treatment would you recommend if the muscle itself was cut?

A tendon transfer? Wait a sec.. No, no. If the deep tendon is intact, he has a full range of movements. That means he will

have some weakness, but this should be dealt with by exercises. Having said that, however, I would still recommend surgery to

debride the wound and clearly identify the structures injured.

Absolutely! Not bad! Keep going at this rate and youll have no problem! Which college have you applied for?

Edinburgh.

Any particular reason?

The boss told me to when I sat the first part. He said they boast that they are the College with the maximum number of

foreign fellows and I should try there first .

Cant say I disagree.

One of the nurses came up to them and said, Excuse me, please. Sorry to interrupt Dr. Ghosh, but there was a phone call for

you from Dr. Ashish Roy in Casualty. You were still scrubbed at the time, so I said youd call back.

Run along, then, Neil said. That cast seems reasonably dry. Put it on a pillow.

Ashok did this and hurried out of the O.T. He entered the men s changing room, picked up the phone and dialled the number

for Casualty. When someone picked up, he said, Casualty? This is Dr. Ghosh from Orthopedics. Could I speak to Dr. Ashish Roy,

please?

Just a minute, doctor. Ill call him.

A moment later, someone picked up the phone and asked, Ashok?

Yes.

Aami Ashish. Baar baar bolechhee tokay (This is Ashish. Ive told you again and again) the avuncular tone was

unmistakeable. Crime doesnt pay, Ashok. Now youve got three policemen here asking for you.

Arre, choop kor, bokaa.(Hey, shut up, you moron.) Just cut the crap and hand the phone to one of them.

Yes, your majesty. Your wish is my command. Here, and he handed the phone over.

Good morning, doctor. Constable Beresford, from Ferensway police station here. Is that Dr. Ashok Ghosh, please?

Yes, constable. How can I help you?

At about 1 a.m. this morning you phoned the Ferensway police station to report an incident you had witnessed. Is that

correct?

Ashok was surprised at how deftly the policeman avoided any mention of murder, or even a crime. Yes, certainly, he said, I

did.

Well, I was told that one of the persons involved was admitted in this hospital and is currently being treated by you. His name

is Roger Drummond.


19/25

Well, he was admitted byme, but he was admitted under Mr. Brockman, a consultant in Orthopaedics.

Whatever the policeman interrupted, Can I speak to Mr. Drummond, please?

Actually, he has just been operated on as an emergency and is still recovering from the anaesthetic. He should be awake in ten

to fifteen minutes. Once hes awake, Im sure you can talk to him.

And which ward is he in?

Hes still in the Emergency Operation Theatre at the moment. He will be taken to the recovery room for an hour or so, after

which he will go to the orthopaedic ward on the fourth floor. Both the O.T. and the Recovery Room are on the first floor.

Can I come up there? Id like to have a word with you, if I may.

They wouldnt allow you inside the O.T., Im afraid. But if you come outside and ring the bell beside the entrance, I can co me

out and talk.

Thanks doctor, Ill be with you straightaway. He put down the phone and Ashok did likewise. A minute later, he heard the

doorbell outside the O.T. ring and he went out.

12. THE ARRESTA policeman was standing at the door, with his hat in his hands. He was breathing heavily, because he had just dashed up the

stairs. He was quite tall and had an athletic build.

`Morning, officer, I am Dr. Ashok Ghosh. How can I help you? Ashok asked. Again he felt his tongue go dry and a warm feeling

in his back, similar to the one he had felt on the top floor when he witnessed the crime. He found the obsequious attitude of the

policeman a bit discomfiting.

`Morning, doctor, the policeman said. Im Police Constable Beresford. Are you the doctor who reported a homicide earlier

on this morning?

Yes.

My colleagues downstairs would like to have a word with you. Ive come to place Mr. Drummond in custody.

Well. I certainly dont want to come in the way, officer, but he has just undergone surgery and is still unconscious. I did say

that he would wake up in a few minutes, but he will still be a bit sedated. I mean, he may be awake enough to understand simple

instructions, but for him to be awake enough to be er I think the term is compos mentis it means in his full senses. could

take longer.

I understand that well enough, doctor. Would it be possible for me to be on gua rd beside him while he is waking up? I assure

you I will not interfere with his treatment in any way, but the police must ensure that no one tries to abduct him from the hospital;

or worse stillattack him.

I suppose you could, but it might be a good idea to inform the Medical Superintendent of the hospital first. You can use any of

the hospital phones and dial 0 to get the switchboard. Theyll get you in touch with him.

I most certainly will, doctor. He took out his walkie talkie and pressed a button. Loud static could be heard. P.C. Beresford,

here. Could I speak to Harry? Over.

The reply was unintelligible to Ashok through the crackling. After a moment someone spoke, but, again, Ashok couldnt make

out what was said.

Harry. Gerald here. The blokes still in surgery. We need clearance from the hospital medical superintendent if Im to stay with

him in the ward. Can you sort that out? Over.

The crackling seemed to change in pitch, but some sort of reply must have been made.

Consider it done, then. Over and out. He switched off the device and turned to Ashok.

That was my superintendent, doctor. He is contacting the hospital authorities and has asked me to proceed with the arrestunless I hear from him to the contrary.

Sure. You can either wait here, or go to the Recovery room and wait there.

Id prefer here, if you dont mind.

No problem. There are some chairs over there.

Thanks. By the way, can you contact my colleague in Casualty, please? His name is Peter Fitzsimmons.

As soon as I can. Ashok realised that he would need to give some explanation to Neil. He did some quick thinking as he looked

back at the O.T. Just then the doors of the operating room swung open and a trolley was wheeled out. The patient couldnt be seen

and there were three nurses alongside the trolley. Neil came out after them, carrying the patients file.

Neil, theres something I need to tell you about the case, Ashok said as Neil turned into the mens changing room.

What? Neil asked, pausing at the rooms entrance.

Oh, go in, Ashok continued, following Neil into the room. There was a desk beside the wall and Neil put the papers on it. He

drew up a chair and sat down.

This is a medico-legal case, it seems. Some police are waiting outside. They want to arrest this man.This is not the first time thats happened, you know? Neil said casually.


20/25

Yes, but they are calling me out for questioning. I was the doctor who saw him in the Casualty. I think they want to ask me

about his injuries.

You mean all those police who were in the Casualty when I came in were for this guy?

Probably.

Well, mark m words, boy. Dont tell them anything technical. You are an SHO and a senior house officer does notpontificate.

You examined the patient, wrote down your findings and contacted me. If they want any details about what injuries the bloke

sustained, or what was done, tell them to talk to a consultant. I operated on this case after talking to Mr. Brockman. Hes the

consultant in charge of the case and hes the one carrying the can, not you. Get that?

Certainly.

O.K. Remember, dont tell them anything that hasnt been written down.Believe me, boy you dontwant to get caught up in

a court case.

True, Ashok said and started to change back into his working clothes.

When he stepped out of the theatre, the corridor was empty. He went to the recovery room and looked in. The policeman was

wearing a disposable gown, a mask and a cap. He had shoe covers on his feet and looked completely out of place. He sat beside the

patient, who was snoring. Ashok noticed that the left leg of the patient was chained to the bed with a pair of handcuffs.

You said your colleagues name was Mr. Fitzsimmons, right?

Yes, doctor.

O.K. Ill go down and meet him.

13. THE POLICE.Ashok was feeling a bit tired now. He had been up all night; there had been a case to do and more than the usual amount of

excitement. He had noticed that whenever he was doing or assisting in an operation, he never noticed how time flew. Once it was over,

however, his body tended to remind him of the strain.

Operating could be quite a strain on the eyes. You had to keep your eyes focussed for minutes on end. You couldnt look away except

now and then. When you were looking at the operating field, you had to stay focussed at exactly one distance for as long as it took. If you

placed a stitch at a depth, then you had to keep looking at that depth till the stitch was tied and cut. Only then could you afford to look

away at something else. During all that time, your body also had to maintain the same posture, and this could tire the muscles out,

particularly if you were looking at an awkward angle. When the operation was over you had a feeling of fatigue in these muscles and later

on it could feel awkward.

As he hurried down the stairs, Ashok felt a feeling of fatigue in his left little finger and forearm. This was something unique to surgical

specialities. Only a surgeon experienced this. It wasnt pleasant, but it was special. Maybe he was being vain. How did it feel aft er

hitting the ball for a six in cricket? Would it be right to call that special? Wouldnt it? Oh well, maybe not. But there was nothing wrong in

feeling good after a case, was there?

He entered the Casualty again. There seemed to be more people in the waiting room. One group of nurses were going from cubicle

to cubicle. Obviously, the nurses on the new shift had turned up and this was the handing over ceremony. One of the nurses who had

been in the Casualty at night was taking the nurses who would man the Casualty during the next shift from cubicle to cubicle, giving a brief

summary of each case.

Miss Victoria Morgan 22 years. Prefers to be called Viki, does not want to be called by any other name. Right iliac fossa pain for 3

hours, possibly acute appendicitis; seen by Surgery SHO. Investigations sent. Transfer to Surgery ward with results. Nil by mouth; consent

for surgery taken. Parts prepared. The nurse was quite senior and her uniform looked crumpled, compared to the nurses who had just

turned up. They moved on. Ashok walked to the reception counter. Two policemen were seated in front, looking at what was happening,

silently.

Good morning, officers. I am Dr. Ashok Ghosh. I was told that a Mr. Fitzsimmons wantedto talk to me?

Yes, doctor, one of them said. I am Constable Fitzsimmons. Could I ask you a few questions in private, please?

Certainly, officer. We can sit in the duty doctors room; we wont be disturbed there. Come with me, please. He led the way to a

corridor and opened a door. The room had a bed which had not been slept in, two chairs and a table with a phone on it. He sat on the bedand signalled to the two policemen to sit down. Have a seat, please.

The two men drew the chairs and sat down and put their helmets on the table. I am Police Constable Fitzsimmons and this is my

colleague Constable Mc Latchie. I take it that you are the doctor who phoned us early this morning to report a crime?

Thats right, Ashok acknowledged.

Im sorry to take your time, but if you could just run over what you saw with me, then Mr. Mc Latchie will take down what we say.

He knows shorthand, so you wont have to wait. Is that O.K.?

Certainly, Ashok said. The other policeman took out a flip pad and ball point pen.

Im ready, doctor, Mc Latchie declared.

Could you please describe what you saw, Dr. Ghosh, Fitzsimmons asked; Mc Latchie started writing.

Shortly after midnight, I was in the Paediatrics ward on the top floor of the hospital tending to patients. I came out of the ward and

was standing on the landing outsid

Date post:	03-Apr-2018
Category:	Documents
Upload:	madhumita-sen
View:	216 times
Download:	0 times

Pepsi at Midnight by Dr Pranab Kumar Sen

Documents