Chameleon

right ovary. We fear it may be malignant and today we are going to have a look and decide with the aid of the pathology department just what to do.'

Jamieson had been watching the theatre sister lay out the instruments in order. She knew what Thelwell would ask for first and held it in readiness while a more junior nurse waited behind her ready to replace instruments as they were used.

Once again Jamieson saw what he expected to see. Thelwell was a competent surgeon. He could not be faulted on anything as he performed what was a delicate though fairly routine operation. The discipline in the theatre was excellent and the team functioned with the efficiency of a group who knew each other well.

'How is she?' Thelwell asked the anaesthetist as the entire theatre waited for the pathology lab's verdict on the tissue that Thelwell had removed from the woman's ovary.

'Quite stable. No problems,' answered the man sitting at the head of the patient.

Thelwell looked at the clock again and tutted. 'They seem to take longer each time,' he muttered.

No one spoke for they knew that Thelwell always said that at this point in the proceedings. It was never true. The pathology lab was always efficient when it came to emergency sections.

The swing doors opened and a green clad figure came in to join them. 'I'm sorry, it's malignant,' she said.

'Thank you,' said Thelwell matter of factly then turning to the anaesthetist. 'Is she still all right?'

'No problems.'

'Might as well get on with it then.'

Thelwell detailed the extent of the tissue he would have to cut away for the benefit of the houseman and students and then proceeded to do it while Phillip Morton assisted. Jamieson admired the business-like way Thelwell went about the remainder of the operation. There was no hesitation, no pause for second thoughts or discussion of alternatives. He made his decisions as soon as they were required and then acted on them. The operation was over with laudable speed and Phillip Morton was left to carry out the final stages before the patient was allowed to begin a controlled ascent to consciousness.

'Thank you everyone,' said Thelwell, stripping off his gloves and leaving the theatre. Jamieson joined him outside for gown and mask removal.

'Well, what did you see Jamieson?' asked Thelwell.

'I saw an excellent surgeon doing his job assisted by a first class theatre team,' replied Jamieson.

Thelwell grunted and Jamieson sensed that the man had difficulty in coping with compliments. His paranoia would not let him. 'How kind of you to say so Doctor,' he said sarcastically.

For the moment Jamieson could not think of the right word to describe Thelwell. He decided that 'shit' would have to do for the moment.

'And have you solved our infection problem?' asked Thelwell with an air of amused superiority.

'Not yet,' replied Jamieson keeping his temper. 'But I will.' He turned to face Thelwell and look directly at him. He knew that it was a challenging gesture that Thelwell would not experience too often in his own little world where he was king and no one dared question him. A flicker of uncertainty appeared in Thelwell's eyes and Jamieson was satisfied. That was what he had hoped for. 'You will remember to submit a nasal swab to the lab won't you?' he said as he put on his jacket to leave. 'One without the antiseptic.' Thelwell turned crimson and Jamieson said, 'Good day Mr Thelwell.'

Jamieson walked back to Microbiology and met Clive Evans en route; he was on his way to a late lunch at the hospital restaurant. Jamieson said that he would join him. It was nearly two o'clock and what was left in the heated metal trays at the food counter looked even less appetising than usual. Jamieson examined the congealed stodge and opted for a salad. Evans risked the steak pie. They found a clean table but found it hard to talk over the noise of the domestic staff who were clearing other tables nearby and scraping waste food from plates into large metal receptacles.

'How did the op go this morning?' asked Evans.

'Smoothly but the woman's tumour turned out to be malignant as they had feared.'

'Bad luck,' said Evans.

'By the way, I asked Mr Thelwell to submit another nasal swab to the lab when he has a moment. He was using antiseptic cream at the time of the last test.'

'Was he now?' said Evans raising his eyebrows.

Jamieson wondered what was going through Evans' mind but when the microbiologist realised that Jamieson was watching him he quickly snapped out of his preoccupation and asked, 'Was that the case with the nurse too?'

'No,' replied Jamieson. 'She was being treated with antibiotics.'

'Moira tells me you want to run some of your own tests on the Pseudomonas?'

'Just a case of 'know your enemy'. I need to have a feel for the bug. If you are objecting to me diverting Miss Lippman from other work, I can carry out the tests myself.'

'Moira tells me she can fit your stuff in with her routine work so there's no problem.'

'Good. I like Miss Lippman. She seems very knowledgeable and efficient.'

'She is,' agreed Evans.

Jamieson became aware of the kitchen staff looking at their watches and exchanging muttered comments behind the food counter. He said to Evans, 'I think we've outstayed our welcome.'

Evans looked round balefully then shrugged. He got to his feet and said, 'We'd better go.'

Jamieson finished setting up his biochemical tests on the Pseudomonas by four o'clock and called in on John Richardson to discuss the results of the latest staff screening tests.

'They were all negative for what we are looking for,' confessed Richardson with a weary sigh.

'And the theatre and recovery room tests before the disinfection last night?'

'Negative.'

'So you are no further forward,' said Jamieson.

''Fraid not. Evans tells me you sent the bug to your labs for special tests?'

'I want to know why it's so resistant to antibiotic therapy.'

'Will that help?'

Jamieson took the point that Richardson was making. It would not help the patients to know why the bug was immune to so many antibiotics. 'I agree, it's academic,' he said. 'But it might give us some insight into the environment that spawned the bug in the first place. I particularly want to know how much of the problem is chromosomal and how much is due to the bug having picked up extra plasmid DNA.'

Richardson rubbed his eyes as if he were very tired and asked, 'Supposing the damned thing is not carrying extra plasmid DNA, what could you conclude?'

'I would be very surprised. It would mean that the bug was resistant to all these drugs in its own right,' said Jamieson. 'It would have to have undergone multiple mutations.'

'It could have acquired the resistances one at a time,' said Richardson.

'It could,' agreed Jamieson. 'But it would have to have been over a very long course of time and the chances are that it would have caused trouble before now.'

'I suppose it would,' agreed Richardson, 'But somehow I'd go for that or something like that…'

'I don't quite understand…' said Jamieson. He could sense that Richardson was holding something back.

Richardson looked troubled and shook his head slightly as if to dismiss a thought as being of no importance. He said, 'Evans tells me that you were carrying out some tests of your own?'

'Routine biochemistry.' said Jamieson. 'I'm a great believer in accumulating as much information about a problem as possible and then stepping back to take a look at it all.'

Richardson nodded and asked, ‘Are you running tests for carbon source utilisation?'

'Yes. Why do you ask?'

Richardson remained silent for a moment as though deep in thought again and then shrugged. He made a dismissive gesture with his right hand and said, 'I'd be interested to hear your results, that's all.'

Jamieson was intrigued by Richardson's preoccupied manner. He said, 'Doctor I wish you would tell me exactly what's on your mind.'

'Not yet,' said Richardson. 'It's too soon. It may be nothing.'

The lab receptionist put her head round the door and said to Richardson. 'Mr Thelwell has sent down his