Sisters of Mercy by Andrew Puckett Page B

latter, you bring about symptoms in those under your care. She had both. Also, she was inadequate.’
    ‘ Is there anyone like that on ITU?’
    ‘ Not that I can think of at the moment.’
    ‘ We’ll bear it in mind.’ He made another note. ‘What other drugs are there which affect the heart?’
    ‘ Well, there’s digitalin, or digoxin, which is used to reduce blood pressure. Reduce it enough, and you’ve got heart failure. Although it’s usually given by mouth rather than by injection.’
    ‘ But it can be injected?’
    ‘ Yes.’
    ‘ Is it easily available?’
    ‘ We keep it locked away, although nothing like so securely as we do controlled drugs.’
    ‘ So a nurse or a doctor could lay their hands on some if they wanted to?’
    ‘ Yes, although not as easily as insulin.’
    ‘ D’you know how long it takes to work?’
    ‘ I’ll check when we get back.’
    ‘ Is there anything else?’
    ‘ The other heart regulators we use are tenoret and propanolol, but they’re administered orally.’
    He stopped writing and looked at me. ‘We’ve been assuming up till now that the agent was injected, but there’s no reason it couldn’t have been given orally, is there?’
    I thought for a moment. ‘Not in the case of digoxin, no. But with the others, tenoret and propanolol, you’d have to get the patient to swallow a hell of a lot of tablets.’
    ‘ So, not really practical?’
    ‘ I wouldn’t have thought so.’
    ‘ Good,’ he said, scribbling again. ‘But would orally administered digoxin result in a high blood level?’
    ‘ I’m sure it would, yes.’
    ‘ I’ll mention it to the lab. What about an overdose of sleeping drug — nembutal and seconol, stuff like that?’
    ‘ You could certainly use them, but they are controlled drugs. They’re kept in a double-locked cupboard in my office.’
    ‘ OK. So potassium chloride, insulin and digoxin are the clear favourites. I’ll ring Guy’s now and let them know.’
    When he’d finished the call, he said, ‘They’ll try those, but they’re going to have to dilute the sample, so we probably won’t get a result until tomorrow.’
    I said, ‘We’d better get back if we’re not going to be late for Miss Shenstone.’
    *
    She was a small, dried-up woman with a wrinkled face — I think she was about sixty, but she looked older. Until you saw her eyes, that is. They were a bright, clear blue, and when she smiled, they took ten years from her.
    She was smiling now as she stood up and reached across her desk to take Tom’s hand.
    ‘ It’s very good of you to see me at such short notice, Miss Shenstone,’ he was saying. ‘I appreciate it.’
    ‘ Not at all. I happened to have these few minutes free, and I always like to help the staff of ITU if I can.’ She had a brisk, clear voice, slightly deep for a woman, with an attractive Irish lilt. ‘Won’t you sit down?’
    ‘ I’ll leave you, then —’ I began.
    ‘ I’d as soon you didn’t, Sister,’ Tom interrupted quickly. ‘So long as you don’t mind, Miss Shenstone?’
    ‘ Not at all. Now, time is short, so how can I help you?’
    ‘ My department is looking into ways in which costs might be cut in units such as Intensive Therapy —’
    ‘ When are they not?’ Miss Shenstone inserted drily.
    He smiled. ‘I’m looking at several ITUs throughout the country, particularly with regard to their relationships with other departments, which is why I’m here.’
    ‘ We do indeed have a relationship with ITU, and a close one, but I confess I can’t imagine where savings could be made …’
    ‘ Nor I, at this moment,’ he said. ‘But you’d be surprised how often, when we collate all our results, that ways of economizing do emerge.’ He wasn’t playing the silly ass so much, I noticed.
    ‘ I’ll take your word for that,’ said Miss Shenstone, glancing up at her clock.
    ‘ Perhaps I could ask you some direct questions? To save time.’
    ‘ Of course.’
    He took out his