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Houseman & Sounderajah – Junk: Part I

December 28, 2012

Houseman woke slowly, as if surfacing from far underwater. He felt confused…but he didn’t know why. He opened his eyes and saw a chessboard of ceiling tiles. There was a beeping sound, somewhere.

“Where am I?” As first conscious words went, they were a pretty decent attempt.

“You’re in hospital, doctor Houseman.” Came the reply. Houseman blinked and tried to focus on the room ahead of him. There was a white coat at the foot of the bed, and a man wearing it. Handsome, if that was your thing. But between him and Houseman were too immobile casts. Together, they covered Houseman’s entire lower half. “There was an accident.”

In another part of the hospital, or maybe a different hospital altogether, Viknesh Sounderajah was going about his daily duties of filling in paperwork, drawing blood and just generally being the ward bitch. It wasn’t all bad, he told himself. The job had to have its good points; otherwise, why would he do it? He just had a bit of trouble thinking what those good points were. Stop thinking, Viknesh, no good will come of that.

“Doctor?” the F1’s ears picked up on instinct and he turned on his heels towards the voice.

“Yes, Mrs. Harding?” he chimed chirpily, “What seems to be the matter?”

“My hip hurts something awful, doctor.” The patient replied, that dying breed of unfaltering deference to the man in the white coat, regardless of his age, ethnicity…or gender. “Is there something you can give me for it?”

“Let’s have a look.” Viknesh said as he retrieved her drug chart from its folder at the end of her bed. Mrs. Harding had had a total hip replacement two days ago, an operation associated with barbaric amounts of pain and discomfort, but despite this, Mrs. Harding was only on paracetamol for analgesia, at near-homeopathic doses at that. She should be screaming in agony.

“How long have you been in pain, Mrs. Harding?” he asked.

“Oh, since this morning but I didn’t want to make a fuss.”

“Well, I’m going to write you up for some morphine so that should take the pain away.” Viknesh explained calmly, marvelling inside at the woman’s resolve to handle pain simply because it was inconvenient. “A lot of people find it makes them constipated so to stop that happening, I’m going to ask the nurses to give you lactulose as well.”

“Thank you, doctor.”

Viknesh gave a quite nod and exited the bay. As he strolled along the ward, looking purposeful so no one would ask him to do anything, he began to wonder about the Mad Hatter, otherwise known as Jack Houseman. He hadn’t seen his fellow F1 and amateur private detective for a few days now. At first, he had relished the peace and quiet (relative terms for a junior doctor) but now he was beginning to worry.

“Have any of you seen Houseman recently?” he asked the gaggle of doctors, of various ranks, loosely gathered in the doctor’s mess. He was met with blank stares from all sides, from the kitchen, over the newspaper, over the shoulder on the amorphous sofa.

“If anyone would know where he was, we’d thought it’d be you,” Katherine, an F2, answered. “What happened? Did he skip out on your date?”

“For the last time, he is not my boyfriend. I’m not gay!” Sounderajah protested, in vain. Denial in these matters was as good as an admission of guilt. Pretty much nothing would change that state of affairs. He sighed and left, “Fat lot of good you guys are.”

On the off-chance that Houseman was laid up in bed with the deadliest of man-flu and in dire need of some heckling, Viknesh decided to make a house-call. Flat-call would be more accurate. Houseman’s apartment block was some way away from the hospital but within walking distance. Given the decrepit state of the rusted machinery that Houseman called a car, that was very fortunate. Viknesh saw it parked in the resident’s car park on his way in. It was hard to miss. No one answered when he buzzed Houseman’s flat so he picked another button at random and pretended to be delivering a take-away. With a hammed-up Indian accent, who would question that?

The door to Houseman’s flat was unlocked so Sounderajah let himself in. By Houseman’s own estimation, there was nothing of value in the flat so there was no real risk. As he shut the door behind him, he called out but got no reply. The place was small but the volume of crap compensated for its limited area. There didn’t even seem to be any kind of order to things either. Take-away boxes competed with papers, journals and textbooks in towering piles across the floor, whose bases may have been discarded clothes. In addition to these monoliths of mess, the floor was littered with detritus of differing varieties. Viknesh noted that this included more than occasionally medical supplies. Needles, cannulas, catheters; stuff that would not be readily missed.

After moving carefully through the compact living room, Sounderajah examined the kitchen. Despite the abundance of take-away cartons, Houseman had a keen grasp on home cooking. A more elusive concept for him was washing up. A quick inspection of the cupboards confirmed that all of Houseman’s cutlery and crockery was currently in the sink. There was also a distinct lack of food, apart from a few tins of baked beans in reserve. The fridge, though nearly empty, assaulted him with nausea. Wrinkling his nose in disgust, Viknesh moved the forlorn milk carton at arm’s length to the bin.

He moved on to the bedroom, in a desperate need to clear his sinuses. The general trend of slovenliness persisted. Picking his way through the waves of debris, Viknesh inspected the wardrobe. Several neatly pressed blue-and-white striped shirts hung in a uniform line. On the shelf above them, there were a series of hats, including a few trilbies. The precision in this one cupboard felt oddly out of place with the rest of the apartment. Shaking his head to clear it of the juxtaposition, Sounderajah crashed on the worn sofa in the living room.

The place was a bomb-site but nothing was out of place. Houseman was always a scatterbrained slob. Viknesh sighed. If he wasn’t at work, and he wasn’t at home, he must be out somewhere, causing trouble no doubt. But if that were the case, why hadn’t he involved Viknesh? He always insisted on his company, whether it was convenient for him or not. Viknesh surmised he needed validation for his little adventures, or perhaps an audience?

The junior doctor sighed again and put his feet up on the already over-burdened cover table. In doing so, he knocked some papers off onto the floor. As he leant over to pick them up, something clicked. He had kicked the TV guide onto the floor. Hardly significant in itself but Viknesh noticed that it was open to the schedule for five days ago. Houseman paid far more attention to television than general cleanliness. Whether at work or at home, he tried never to miss the news, in particular the local news. Also, Doctor Who. Strange set of choices but nevermind. The TV guide didn’t prove anything but it suddenly gave him the motivation to look around the flat a second time.

There was a rubbish bin in the corner of the room. He had ignored it on his first sweep because, amidst so much rubbish, it was effectively invisible. As Viknesh got closer to it, he became aware of a stale burnt smell. Picking up the bin, he could see why. It was nearly empty but at the bottom there was a collection of ash, and some burnt-up matches. Sounderajah glanced over his shoulder at the rest of the apartment. Houseman clearly didn’t believe in throwing things away idly. The milk was proof enough of that. But here was something that not only did he want to be rid of, he wanted to be rid of its entire existence.

That didn’t make any sense. It was completely out of character for Houseman. But, what if it were evidence? Viknesh poked at the ash experimentally. Incriminating documents, a photograph maybe? There was nothing left. He put the bin down. It was like he thought. Houseman was up to trouble again.

Wandering through the rest of the flat didn’t reveal anything new. He learned that Houseman kept notes, in bits and pieces, on nearly all their cases, but there was nothing relevant. In the bedroom again, next to the unmade bed and a copy of The Adventures of Sherlock Holmes (cliché much, Jack, Viknesh couldn’t help thinking), he came across Houseman’s planner.

Flipping through it, he was surprised how Spartan it was. Instead of deep musings on their ongoing work (that was scattered elsewhere), it was simply a record of his shifts and other important events. It was filled in in advance up to the end of the month but the shifts for the previous two weeks had been erased and re-written as ‘A&E.’ Houseman had plenty of reasons to visit Accident and Emergency, usually as a doctor, often as a patient, but why would he change his rota to spend more time there? It was involving, intensive work with long hours – Houseman typically preferred the lighter shifts where he wouldn’t be missed for a few hours at a time.

Viknesh snapped the planner shut, wondering what could have drawn his friend to A&E.

For most people, the Accident and Emergency department was their first experience of the hospital. As first impressions go, it could try harder. Noisy and crowded, understaffed and overworked, it did nothing for those who passed through the sliding doors bleeding, broken or not breathing. However, sooner or later, most people left alive and usually grateful. Working there as a doctor or a nurse could be a mixed blessing. The hours were atrocious, and packed with more than their fair share of stress and confusion. However, A&E doctors were never short of amusing stories to tell about their job. They got to see the true face of humanity, or one of them at least. Beyond the frustration, the anger, even the violence, most people were just afraid.

Sounderajah could see the appeal in it for Houseman’s sake. The fallout of many crimes and mysteries washed through those doors and they were to his friend what a ball of yarn was to a very odd cat. Finding information about him was proving difficult though. A lot of people remembered him – he tended to make an impression – but very few of them had enough time or patience to talk about him at any length. Eventually, he cornered a pair of nurses who were having a tea break in one of the empty assessment rooms.

“I’m looking for Jack Houseman, he’s one of the F1s here. I heard he was working in A&E.” Viknesh explained. The nurses looked at him with expressions that were either sullen or non-plussed. “He’s the one with the eyes…” he added weakly, attempting to mime, “And the hat.”

“Oh, that one.” One of the nurses nodded, dunking her biscuit in the weak excuse for tea.

“When did you last see him?” Sounderajah asked, when it became apparent that there was no more information forthcoming.

“A few days ago.” She replied, “Why? Has he gone missing or something?”

“Hey, maybe he was the one who was swiping the co-codamol?” the other nurse, shorter, stouter, more matronly, piped up. The first nurse nodded at the idea and they proceeded to natter between themselves, freezing out Viknesh momentarily.

“Wait. What was that about co-codamol?”

“Yeah, it’s been going missing for a few weeks now. We’ve had to replace it with other painkillers but it’s just not the same.” The second nurse explained happily. She frowned and took a sip from her tea. “Or was it the morphine? I get those two confused a lot. Ngh!”

The last exclamation was in response to a subtle jab to the ribs from her colleague. Not subtle enough for her to clam up and not subtle enough for Viknesh not to see it. Something wasn’t quite right in A&E. He wasn’t sure what it was yet but was certain that was what had drawn Houseman here. Where he had gone afterwards still remained a mystery but now Viknesh had his own ball of yarn to play with.

Next morning, Viknesh was back on his usual ward and decided to call on a familiar face.

“Hello Mrs Harding. How are you feeling today?” he asked, wandering purposefully over to his favourite patient. Of course, all patients were his favourite patient but they didn’t need to know about the others.

“Wonderful, doctor.” The little old lady replied, “That drug you gave me really did the trick.”

“That’s good to hear.” Viknesh nodded taking up her drug chart from the end of the bed. He frowned. The morphine he had prescribed had not been given. It was noted that paracetamol had been given instead but that was akin to using a bicycle with a flat tyre in place of a freight train. Mrs Harding had gone another day without adequate pain relief. Somehow, he seriously doubted that she was feeling wonderful. “Are you sure you’re alright, Mrs Harding?”

“Well, to be honest,” the patient confessed, sucking her gummy lips, “My hip is still giving me a bit of bother.”

Viknesh nodded again. Acquiescent and eager to please, Mrs Harding was the best and worst kind of patient. It broke the F1’s heart to see her in pain, moreso to see her soldiering on like nothing was wrong. “I’m going to have a little chat with the nurses and see if we can straighten out your pain medication.”

“Thank you, doctor.”

Viknesh left Mrs Harding but took her drug chart with him. In an unusual lull in the normally busy ward, finding a nurse proved facile. There were a few loitering around in the nurses’ station. He thought he saw a box of Quality Street vanish under the desk.

“I wrote up Mrs Harding in bed seven for morphine and lactulose. Why hasn’t she had it? Why has she just been given paracetamol instead?” he inquired, not angrily but firmly.

“I would’ve given it to her if we had any.” One of the nurses replied, surreptitiously pocketing a silvery sweet wrapper. “We’ve got eight more orthopaedic patients on this ward and no morphine for any of them. We’re running on triage medicine here.”

“Wait. No morphine at all?” the junior doctor blinked. He had never heard of such a thing. “Why?”

“Beats me,” the nurse shrugged disinterestedly, “You’d have to ask Pharmacy.”

“Viknesh!” Houseman jerked up in his bed.

“What’s wrong?” a nurse burst into his room, noticing his sudden movement. Houseman struggled to see past her into the ward beyond her. If he had seen Sounderajah, he was gone now.

“Nothing.” He said, relaxing back into his pillow, “I thought I saw someone I knew. A doctor.”

“You mustn’t strain yourself.” The nurse chided, calming the bedsheets, a surrogate for calming the patient. She leaned across him to plump his pillow. Houseman felt like a ragdoll, limp useless. She took his arm and injected something through his cannula. He felt a cold sensation rush up his arm. “You’re still very weak from the accident.”

Yes, the accident, Houseman wondered. That still remained hazy in his memory. It had been dark and then…something. What had happened exactly? What lay inside that ellipsis? And did he now have two broken legs? He wanted to rack his mind further over the issue but he could feel himself slowing, like thinking through treacle. The nurse must have given him morphine or some other sedative. He yawned reflexively. What was the fuss in staying awake all of a sudden.

There would be time to think about things when he woke up.

In Sounderajah’s mind, the pharmacy was a quiet and cavernous place, populated by people who much preferred chemicals to human beings. In reality, he was not far off. The stores were surprisingly spacious. He didn’t think the hospital could accommodate such dimensions. Rows of shelves stretched on into the distance, each neatly stacked with boxes and vials. Absently, Viknesh ran his hand over some of the labels. Aspirin, adrenaline, atenolol…

“Can I help you?” a pharmacist appeared from behind a row of shelves, dressed in the iconic white coat that Houseman missed so acutely. He wore glasses, though they were currently pushed up on his high forehead, made even higher by his unfortunately receding hairline. He did not appear pleased to find an interloper within his fiefdom.

“No, thank you. I’m just window shopping.” Viknesh quipped lightly and smiled.

“Haha.” The pharmacist said, without any trace of humour.

“Actually, I was hoping you could help me.” The junior doctor continued, “I work down on Chapman ward, where we have several orthopaedic patients. They’ve been prescribed morphine but they’re not getting it. I want to know why that is.”

“Not again with the morphine.” The pharmacist groaned and rolled his eyes, “Every day, I have scores of ignorant doctors coming in here asking where their morphine is. I’ll tell you what I told everyone else. There’s a shortage in the hospital.”

“That sounds like a lapse in judgement.” Viknesh said, “Did someone miss a zero off the order form?”

“It’s nothing like that.” The pharmacist shook his head. He began sorting through the drugs, checking their expiry dates, simply as something to do that wasn’t talking to the F1. “I’ve been ordering more opiates than usual but A&E keeps burning through them. The General Pharmaceutical Council is going to have my arse.”

“Something odd is happening in A&E,” Sounderajah mused, following in the mental footsteps of his friend, “As well as stocks of co-codamol going missing, they’re using up morphine like it’s going out of style. They must be connected somehow.”

The chemist, who had been trying to ignore him, started at the news, “What? Someone’s been stealing co-codamol? Why wasn’t I told about this?”

“That’s something else I’d like to find out.”

After his talk with the pharmacist, what he found in A&E only confused Sounderajah further. The drugs cabinet, a poor shadow of the pharmacopeia he had seen earlier, was replete with both co-codamol and morphine. Neither one had been stolen. Apparently, the only thing to go missing from A&E was Jack Houseman.

After that, he decided to flip through some of the recent patient files. Of any given  twenty patients that visited A&E, five should have seen their GP instead, six would be drunk, four would have the flu or some other malady that might actually need medical attention, two would have a broken bone sticking out of them, another two would queue patiently while their heart muscle infarcted and one patient would have accidentally, albeit hilariously, ‘fallen on’ something that would invariably make the doctors smile when they saw the X-ray. Other than a bolus of common sense, some of these patients have little need for analgesia. Yet, Viknesh found that without exception, they were all being prescribed morphine, even when there was no clinical indication for it. Further, hardly anyone was being prescribed co-codamol. He was beginning to suspect that whatever was going on in A&E, it was more than a simple case of pinching pills. Morphine was in too high a demand for some to just go missing. Likewise, with co-codamol just sitting on the shelf, it would be apparent if it disappeared. Something was going on but he wasn’t sure what exactly.

While he tried to muddle it out in his head, he occupied himself by clerking patients. Most were minor affairs, assorted lumps and aches that were no more serious than a case of hypochondria. A few patients were those delightful individuals who were an insipid shade of green with nausea, and carried a laden, aromatous bucket of stomach contents. He put their unenviable state down to a kebab of bad chicken (or whatever eldritch beast passed for chicken in the city centre takeaways).

Viknesh’s next patient was a bit more serious. Despite the chill of the rattling air-conditioning unit, he could see the man glisten from a thin film of sweat. Further dark patches were spreading from under his arms and threatening to unite across his broad checked shirt. He was also breathing heavily, deep wheezing sighs, and his face was screwed up in patiently ill-concealed pain. Viknesh took him aside to a clinical assessment room for what he hoped would be the shortest clerking in history.

“So, Mr Randall, what seems to be the matter?” Sounderajah asked, infusing his voice with empathy and understanding.

“I’ve got this pain in my chest.” Mr Randall grimaced, laying a fist over his ribcage. A classic sign.

“Just there, in the centre?” Viknesh indicated, “And what does it feel like?”

“Like my wife is sitting on my chest.”

“And did it come on suddenly? What were you doing?

“Like that.” Mr Randall tried snapping his fingers and failed, “While I was at work.”

“Construction site?”

“Lumber yard.”

“My mistake. Any other symptoms?”

“Yeah, I feel sick to my stomach.” Viknesh couldn’t argue with that. Those ladettes with the food poisoning looked a little peaky but he looked positively ashen.

“One last question, Mr Randall. What do you think this could be?”

“I’m worried this is a bloody heart attack.” The patient replied, with a slight look of incredulity underneath all the pain.

“So am I, Mr Randall, and I plan to do something about it,” the doctor agreed seriously. He crossed the room to the patient and took down an oxygen mask connected by tubing to the wall. Passing the mark to Mr Randall, he opened the tap as far as it would go and the room filled with the hiss of oxygen. “Breath on this. It should make you feel a little better.”

Viknesh worked quickly. Physical examination revealed a panicky thread pulse and a tanking blood pressure while the ECG, a confusing snakes’ nest of wires, demonstrated a rising ST segment, which was never a good sign. Viknesh left the wires attached to Mr Randall’s chest, hairy and corpulent, while he set about saving the man’s life.

Firstly, he wrote down a recipe for a cocktail of drugs and passed it on to a nurse to fill. He sent a round of vials for various blood tests. He bleeped for the registrar on call and started scrolling through the hospital extension numbers, looking for someone interested in a patient’s dying heart muscle. He looked up just as the nurse was bringing Mr Randall his Tombstoner cocktail, so named for the shape of T waves in acute myocardial infarction. Aspirin, morphine, metoclopramide and glyceryl trinitrite, drizzled over ice, served with a lime wedge.

“I hope you brought the morphine because Mr Randall is in some serious pain in there.” He remarked casually. It wasn’t even a formality. You didn’t get to work in A&E if you were sloppy with life-saving medications.

“Oh, no.” the nurse replied breezily, “I replaced that with co-codamol, as per the guidelines.” Before Viknesh could say anything, she was already through the door with the virgin Tombstoner. Nothing took away pain like morphine – not surprising since it was basically heroin. Comparing co-codamol to that was like comparing a Ford Fiesta to a Ferrari. The guidelines? To conserve morphine use? But that couldn’t be right. The pharmacist had said that A&E was going through the stuff at a rate of knots, and all the patient notes recorded morphine being prescribed and given. It didn’t make any sense.

While the junior doctor was struggling with this, the nurse exited Mr Randall’s room, made a brief scribble in the notes and left. Viknesh rose and retrieved Mr Randall’s drug chart. All the drugs he had prescribed had been marked as given, including the morphine. No mention was made co-codamol.

That was it! Morphine was being smuggled out of A&E under the guise of over-enthusiastic prescribing. That was what was draining the pharmacy and the other wards. Every time it was prescribed, co-codamol was given instead. On the books, it would look like co-codamol was going missing. A crime, yes, but not as serious as stealing morphine, heroin’s respectable brother. This must be what Houseman had found out.

As if in sympathy, his phone buzzed in his pocket. A text from Jack Houseman. Talk of the devil.

-Where are you?

-A+E. Where have you been?

-At a conference in Edinburgh. Home now.

-I’m coming over. We need to talk.

Once he has made sure that Mr Randall was in the safe hands of the thromboplasty unit, Sounderajah made his way to Houseman’s apartment. If he has been investigating the morphine in A&E, and discovered the same irregularities as Viknesh, it would be most unusual for Houseman to leave for a conference. He had a stubborn single-mindedness that bordered on the pathological. He would probably make an interesting case study for a psychiatrist one day.

He knocked on the door but received no reply, so let himself in. The door was still unlocked. There didn’t seem to be any recent changes to the disaster zone that was Houseman’s living room but Viknesh dismissed it. It would take several hours concerted effort to make it anything less than a mess. He looked around. The flat was as quiet as before.

“Jack? You in?”

Now that its host had returned, Viknesh felt less comfortable about simply taking a seat on the sofa. What’s more, he felt restless. Idly, he paced around the small area near the door where there was space for casual movement. Houseman had found something in A&E. He was eager to compare notes with his investigative partner to see what each other had found. He eyed the small bin in the corner, the one with the burnt papers. Burnt notes!

He rushed over and sank to his knees but the bin didn’t reveal anything new. Still ash and stale smoke. There was no telling what it had been previously. But suppose, Viknesh mused, Houseman had found something in A&E. To keep their plot hidden, whoever was responsible seek to destroy any evidence he had. They would also seek to disappear the nosy junior doctor, to a conference in Edinburgh, say? Then why would Houseman suddenly reappear?

To get to me, obviously.

Viknesh was proved right almost immediately when something solid thwacked him in the back of the head. He keeled sideways in pain and for a fleeting moment, he was surrounded by twice as much mess as before. He felt someone clamber onto him, pinning him between their legs and forcing him onto his back. He saw his attacker for the first time. A young guy, dressed smartly like him, but with the physical build of a rugger. Bugger.

Trapped under the bulk of his assailant and possible sodomist, Viknesh looked around desperately for something to fight back with. Pizza boxes mostly. At the same time, his attacker beat him with a series of heavy blows, mostly to the face. In between the spare seconds of stars and space, Viknesh spotted a hefty-looking medical textbook within arm’s reach. He tried grabbing for it but, sensing his intentions, the other man pinned his arm down, while continuing to beat him with his free hand.

Forced to lie there and take the pummelling, Sounderajah realised he recognised his attacker. Not by name but the face was familiar. He was a junior doctor, same as him, in the hospital. He must be on a surgical speciality because of that college rugby club tie he wore, in blatant disregard for infection control measures. Those things were dangerous. Idea!

Viknesh leaned forward and with his free hand, yanked on the rugger’s precious tie as hard as he could. The knot slid up until it lodged tightly against the other doctor’s adam’s apple, pressing conveniently on his windpipe. The one-armed assault ceased and he released Viknesh’s arm as he scrabbled at his neck, desperate to breath. Seizing his chance, Sounderajah grabbed the textbook with both hands and with one almighty swing, clocked his assailant around the head with it.

This time, it was the rugger’s turn to fall onto the floor. Released, Viknesh stood up and rubbed his head which was feeling universally sore. Nothing felt broken however. He looked at his unlikely saviour. Robbin’s Basic Pathology. For the first time ever, pathology had been useful for something. He weighed it in his hands. Hardback, it probably hurt a great deal. At his feet, the other doctor was groaning not entirely sensibly. After a brief consideration of the book’s weight, Viknesh dropped it on his head. The groaning stopped.

He moved to the kitchen. On his last visit, he had spied a bag of peas in the freezer. Withdrawing them, he wrapped them in a tea-towel and resisted the urge to simply bury his face in the healing coolness. Applying it to the worst of the bruises and necking down a convenient paracetamol, he sat down on the sofa to take stock.

Houseman had uncovered something rotten in A&E, most likely to do with embezzling morphine, covered by co-codamol. He had then disappeared, about a week ago, judging from the TV guide on the coffee table. Now that he was also on the trail, someone was trying to disappearing him as well. He doubted it was just his surgical friend, currently in the oblivious bosom of unconsciousness.

They really should be introduced properly. Putting the bag of peas down, Viknesh knelt down next to the rugger. He loosened his tie off first before patting down his pockets, which proved very informative. A hospital ID card confirmed John Peter Williams as an FY1 doctor in orthopaedic surgery at the same hospital as Viknesh and Houseman. Keys and loose change. Viknesh pocketed his mobile phone – it might come in handy later. The wallet turned up a return train ticket, purchased less than an hour ago.

Sounderajah knew where he was heading next.

Part II Here

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