Chameleon

Evans read his mind and said, 'I'm afraid there's no air conditioning. Dr Richardson has been asking for it for a long time I understand but with no success. Too many other priorities. It's not so bad when the steriliser isn't running.'

'But pretty awful when it is,' added Jamieson.

The two men moved on through the basement corridor with Jamieson having to duck his head to avoid hitting it on an array of pipes that ran along the underside of the low ceiling. Evans, a couple of inches shorter than Jamieson, did not have the same problem.

'This is my lab,' said Evans opening a door to a square room that was slightly bigger than any of the others Jamieson had seen with the exception of Richardson's room. 'And this, I am afraid, is yours for the duration.' Evans opened a door on the other side of the corridor and Jamieson looked in to a small, narrow room that reminded him of a walk-in wardrobe. It had a desk, a telephone and an anglepoise lamp and not much else. There was no room for anything else. There were two cardboard folders lying on the desk.

'These files contain the information you asked for,' said Evans. 'If there's anything else, I'm just across the corridor.'

Jamieson thanked him and took off his jacket to hang it over the back of his chair. He sat down and looked at the walls that enclosed him. If he reached out he could touch all of them. Above him there was a thick, glass grating that allowed the merest suspicion of daylight to enter, slightly less than the greyest of dawns, Jamieson reckoned. 'One hundred and five North Tower,' he whispered switching on the anglepoise lamp. He opened the folders and got to work.

After a good two hours study, Jamieson could find no fault in the procedures followed by the Microbiology Department in trying to trace the source of the infection. According to the records, all recommended, standard procedures had been carried out with meticulous care and all tests appeared to have been carried out more than once, often three or four times. But the result had always been the same. No sign of the bug that was plaguing the practice of surgery in the Gynaecology department.

Jamieson went through the results of the staff tests again, just looking for anything at all out of the ordinary. His finger stopped moving as he found something. One nurse and one member of the surgical team had proved to be completely negative on each of the two separate occasions they had been tested. He found that puzzling. Most people carried bacteria of some sort in their nose and throat and on their skin. Usually it comprised a variety of harmless bugs but in a few cases people carried organisms which could cause disease in others in certain circumstances. It was naturally unwise for these members of staff to be near patients with open wounds.

There were a number of possible explanations for a completely negative test and Jamieson considered them in turn. If the person was on some kind of anti-bacterial treatment then the normal bacterial flora of the body might have been destroyed. Alternatively, antiseptic creams might have been applied to the areas to be swabbed before the test but that would demand some explanation. Jamieson made a note of the two reference numbers from the result sheet and resolved to pursue the matter further when he had finished reading the paperwork. He finished going through the staff reports and changed to reading the lab report on the infecting organism.

The cultural characteristics of the bug were recorded and its identity had been established beyond doubt. It was only when he saw the results of the antibiotic tests against it that he saw where the real trouble lay. The organism seemed to be immune to every known antibiotic on the standard treatment list. There was simply no way of treating such an infection. 'No wonder they died,' he said quietly.

For bacteria to become resistant to antibiotics was nothing new. It happened all the time and, perversely, especially in hospitals. With so many drugs around it was merely a case of natural selection at work. Spontaneous mutations arose all the time in bacterial populations so when an antibiotic was injected into a patient the occasional mutant able to resist its action would survive and multiply. It would become the dominant form of the infection and if not detected and destroyed might survive long enough to affect other patients.

The Pseudomonas bug that was causing all the trouble started out with the advantage of being naturally immune to many antibiotics. The acquiring of a few more through living in a hospital environment could make it a very dangerous customer indeed. Despite that, Jamieson still found the virulence of the Kerr strain surprising.

Clive Evans put his head round the door and asked how things were going.

'I know a bit more now than I did earlier on,' replied Jamieson.

'Good. Can I show you where the staff restaurant is?'

Jamieson looked at his watch and was surprised to see that it was after one o'clock. He said. 'Can I ask a couple of questions first?'

'Of course.'

'There are two members of the surgical team who had two successive negative results from their swab tests. Was this followed up?'

'No, I don't think I noticed that,' confessed Evans.

'It might be an idea to check them out.'

'We've just done another swabbing this morning but you are right, we should have caught on to that. Who were the two?'

'I can't give you names. They were only numbers were on the sheet you gave me. These ones.' Jamieson handed Evans a sheet of paper with the reference numbers on it. Evans put it in his pocket and said he would check. 'What was the other question?' he asked.

'Have you had the Pseudomonas checked for the presence of Resistance Transfer Factors?'

'No we haven't,' replied Evans. 'Dr Richardson didn't think there was much point in it. If the bug is resistant to antibiotic treatment it's resistant. It was his view that it doesn't matter much to the patient why it's resistant.' Evans saw the look on Jamieson's face and quickly added, 'Well, that's what Dr Richardson said.'

Jamieson said flatly, 'It might help in establishing where the bug came from in the first place.'

'I see,' said Evans sheepishly. 'I suppose we didn't consider that. We've been concentrating on trying to find synergistic action between the antibiotics available to us. Dr Richardson thought that we might be able to find some combination of antibiotics which would be effective against the bug.

'The one plus one equals three effect,' smiled Jamieson. 'A good thought. Have you had any success?

'Not yet but we're still trying.'

'Maybe the London people could help with that too,' said Jamieson.

'Where would you like me to send the strain?'

'Send it to the Sci-Med labs in London and mark it Priority E,' said Jamieson using the code he had been given in order to attract quick and expert scientific help. He gave Evans the address of the labs.

'Anything else?' asked Evans.

'You said something about lunch?'

After a forgettable lunch in the hospital staff restaurant Jamieson returned to his 'cupboard' in the Microbiology lab and telephoned Thelwell's secretary to arrange a suitable time to visit. He was told that four o'clock would be best for the surgeon. Jamieson said he would come at four. He put down the phone and Evans came in to hand him a sheet of paper. 'The names of the two double negatives in the swab tests. I wish I'd noticed it earlier.'

Jamieson read the names out loud. Staff Nurse Marion Fantes and

… Mr Gordon Thomas Thelwell. 'Thank-you,' said Jamieson trying to keep emotion out of his voice. 'I'll mention this when I go up there later on.'

'Very good,' said Evans with just a trace of a smile in his voice, Jamieson thought. 'Is there anything else I can do for you?'

'I'd like some lab space,' said Jamieson.

'Lab space?' echoed Evans.

'Yes, lab space and a culture of the Pseudomonas. I want to see the thing for myself, do some of my own tests.'

The request seemed to trouble Evans for a moment. 'Actually we are a bit short of room as you probably noticed. I can't think where… Unless of course, you wouldn't mind sharing my lab?'

'That's very good of you,' smiled Jamieson. 'Any bit of bench will do.'

Evans took Jamieson across the corridor into his lab and introduced him to a serious looking girl. This impression was created in part by the fact that the girl's dark hair was tied back in a neat bun and she was wearing fashionably large spectacles. She seemed intent on what she was doing and did not look up at first.