‘Hospitals hate that worse than anything,’ said Sandy. ‘They prefer complete ignorance in their patients and relatives, followed by unquestioning acceptance of anything they care to tell you.’
‘Well, if you don’t want to ask them, why not ask Clive Turner? Maybe he knows why they did the tests again. He’s always been very nice to us and you wouldn’t question anything he’s done.’
‘Now that’s a good idea,’ he agreed, brightening. ‘I might just do that. In fact,’ — he looked at his watch — ‘I’ll try to catch him right now.’
‘Paging Dr Turner for you,’ said the hospital voice.
‘Dr Turner.’
‘Clive, it’s Sandy Chapman here.’
‘Hello there. I was just thinking about you folks this morning. How’s Amanda doing?’
‘That’s really why I’m calling. She was quite ill when we went to see her yesterday and a nurse told me that she’d had her dialysis withheld while they did some tests on her, including a marrow puncture.’
‘A marrow puncture?’
‘That’s what I thought,’ said Sandy, acknowledging the surprise in Turner’s voice. ‘The nurse there said it wasn’t unusual for transplant patients. I pointed out that Amanda has already had all these tests done, but I don’t think I got through to her. I didn’t like to request a meeting with the doctors over it because I didn’t want to make a fuss but, on the other hand, I’d still like to know why they put her through that. I thought you might have some idea?’
‘I’m embarrassed to say that I haven’t,’ replied Turner. ‘Amanda’s immunological data is all known and recorded on the register.’
‘That’s what I thought.’
‘I can’t imagine why they’d want to repeat it all, although I suppose there must have been a reason… I’m trying to think if there’s any way I could find out for you without stepping on sensitive toes.’
‘I don’t want to make waves, but it’s something that’s been niggling away at me.’
‘I can understand that,’ said Turner. ‘There’s a chap I know over there called Steven Dunbar. He’s a doctor but he’s not actually on the medical staff so he won’t be inclined to take offence. Maybe I’ll ask him if he can find out for us discreetly. I know him through the negotiations to have Amanda admitted there.’
‘I think I know him too,’ said Sandy, recognizing the name. ‘He helped me push-start the car one night when it played up. He’s some kind of government official, isn’t he?’
‘That’s right. Truth to tell, you have him to thank for Amanda’s referral to Medic Ecosse being successful. He had the final say over it and didn’t question it at all. Simply gave it his seal of approval. He seemed like a good bloke.’
‘I didn’t know that,’ exclaimed Sandy. ‘He never said. I owe him one.’
‘An unusual civil servant,’ said Turner. ‘Anyway, I’ll see if he can shed any light on Amanda’s marrow puncture.’
‘I’m obliged to you again,’ said Sandy.
Turner called Dunbar the following morning. They exchanged pleasantries, then Turner said, ‘I know this is not strictly up your street but I wonder if you can help me out with something?’
‘Not another free transplant, I hope,’ joked Dunbar.
‘Nothing like that,’ laughed Turner. ‘I do realize your resources are finite. I have a question I hoped you might be able to answer for me… discreetly.’
‘Try me.’
‘I’ve had Amanda Chapman’s father on the phone. He was a bit worried about why his daughter had to go through the unpleasantness of a marrow puncture when all her immunological data is already known. He didn’t want to make a fuss and appear ungrateful up there, so he asked me and, frankly, I couldn’t think of a reason either. I thought I’d try to find out quietly. That’s what made me think of you.’
‘I see,’ said Dunbar. ‘You don’t want to ruffle any professional feathers in this neck of the woods.’
‘Exactly. I thought you might conceivably have access to relevant files and might take a little look for me?’
Dunbar smiled to himself and said, ‘I can’t promise anything but I’ll see what I can do. If I come up with anything I’ll get back to you.’
Dunbar put down the phone and thought. He waited until Ingrid had left the room before requesting a current-costs listing for Amanda Chapman from the computer. It was hospital policy that reasons had to be given for all tests and procedures carried out, to avoid possible later accusations of performing unnecessary ones just to inflate the bill. Although Amanda’s parents were not paying, the computerized listing procedure was routine and would therefore apply in her case too. It would be too much trouble to change it all for an individual patient.
But the listing that came up on the screen made no mention of any marrow puncture having been carried out on Amanda Chapman. None at all. He checked the date on the file. It had last been updated that morning. Dialysis charges and standard daily fees were given, but there was nothing about any special tests or minor surgical procedures.
Dunbar sucked the end of his pen and considered. It could simply be that the staff had been tardy in keeping Amanda’s file up to date, knowing that in the end there would be no bill to settle, but that seemed unlikely in a hospital that ran like clockwork. The only alternative was that someone had taken a conscious decision not to enter the marrow puncture in the notes. Why? Because they didn’t want a record of it? Maybe that was being too melodramatic. A marrow puncture was not that uncommon a procedure. It was simply the fact that all her immunology stats were already known that made it seem questionable.
Some kind of mistake? Unnecessary duplication? Had one of the more junior staff, through ignorance of Amanda’s case, written her up for a procedure she didn’t need? It seemed plausible. Dunbar wondered how he could check. He supposed there must be a record of the test somewhere, even if it hadn’t been entered in the patient’s notes. He would call up the record of theatre usage for the past few days and find out where the marrow puncture had taken place and who had carried it out. He didn’t want to make a big thing out of it; he just wanted to know.
The computer obediently showed the schedules for each theatre in turn. There was no record of Amanda being treated in any of them. There was, of course, a theatre in the Obstetrics wing being used by the Omega patient. No information was available on its use, in keeping with the total confidentiality rule for these patients, but that didn’t seem a very likely choice… or did it? Dunbar suddenly remembered the little girl being taken into the lift leading to the Omega wing on the night he’d raided the Radiology Department. Now it made sense. The girl must have been Amanda Chapman.
Ingrid returned and said, ‘I’ve done the costings you asked for on transplant patients.’
‘Well done.’
‘I think you’re in for a bit of a shock,’ she said, putting the file in front of him.
Dunbar looked at the final figure and let out his breath in a low whistle. ‘That much!’ he exclaimed.
‘I’m afraid so,’ said Ingrid. ‘It’s an expensive business.’
Dunbar nodded and she smiled. ‘You’ll be regretting having agreed to the free NHS referral case,’ she joked.
‘Money isn’t everything,’ he replied.
‘I don’t think the Scottish Office would be too keen on hearing you say that,’ said Ingrid.
‘Perhaps not. But maybe a good part of the cost will be offset by the money coming in from the Omega patient?’
‘I’m sorry, I don’t think I understand.’
‘I just thought that Omega patient fees might subsidize the hospital’s generosity when it came to free transplant cases.’
‘Oh I see,’ said Ingrid.
‘Amanda Chapman isn’t the first transplant patient the hospital has taken on for nothing,’ said Dunbar. ‘I noticed there were two others in the past. They were on the list of free referrals you prepared for me. I just wondered if the cost of their operations had been offset against Omega patients too?’
‘I’m not sure.’ She sounded a little uncertain, but soon recovered and said, ‘I suppose you may be right.’
Dunbar was puzzled. There was so much money involved that he felt sure Ingrid ought to know how the free
