Chapter 10: Dr Jordan’s Last Case

As Freddie and Ellie Clegg advance their plans to retire and transfer the human and digital assets of Canopus ImpEx to a safer location, Dr Pam Jordan, one of their most trusted and valuable colleagues begins to have problems of her own.

Bed Mates

Dr Pam Jordan rolls over in bed and feels the slim, beautifully muscled body of her slave, Sukie, lying asleep and still beside her. Sukie was originally abducted and trained by the American slaver, Steve Glennis. She accompanied him to the UK when he had business with Freddie Clegg’s subsidiary company, his slaving operation Canopus ImpEx and was bought by Larry Ross, who had originally met Sukie when he travelled to Steve Glennis’ island “colony” on behalf of Freddie. Larry now lives with another slave, Rachel, and Sukie was bought by Pam. At first, Pam merely wanted someone at home. A maid and a cleaner, some to keep house, but Sukie was intelligent, could use her initiative and was beautiful. In time Pam’s relationship with her changed. The slave and sexual muse became a companion and then a lover and presently a partner, a married relationship in every aspect except for the legalities.

Pam has never married and Sukie is an ideal companion for her. Elegant, charming, helpful, intelligent, and uncomplaining. For her part, Pam has bought Sukie a gym membership, arranged for her to extend her education, taken her out to restaurants, exhibitions and concerts. Sukie has been Pam’s holiday companion, has been abroad with Pam when she travelled to professional meetings or for foreign holidays. Pam especially enjoys the naturist resorts they have been to, so she can — throughout the day — admire Sukie’s taught “gymnastic” body, especially the rings in her nipples and the barbell which transfixes her clit and peeps out from between her labia.

Sukie has a new identity and United States passport to back it up, supplied by Steve Glennis. Steve has an “associate” in the US Passport Office who is able to deal with such formalities. After all, trusted slaves must sometimes accompany their owners on trips away from home, catch airline flights and book into hotels, so a robust identity is important. Sukie, for her part, knows that the identity is potentially fragile, that if abandoned by Pam or some other owner when she is abroad, she could easily be rendered stateless. She has no wish to become just another piece of human flotsam and jetsam and end up in detention for months, perhaps even years, as her ‘case’ is considered — so Sukie is careful to be always loyal to Pam.

Today when Pam awakes, she is vaguely aware of a slight ringing in her ear. At first, she thinks her Eustachian tube must be blocked, the tube which runs from the middle ear to the pharynx and which opens to equalise the pressure in the middle ear to atmospheric. Pam grasps her nose, closes her lips and blows gently. She can hear and feel the left and right tubes open but, when she releases the pressure, the ringing continues.

A Routine Induction

Dr Jordan is, in conventional life, a senior anaesthesiologist at St Thomas’ Hospital in London. (1) She occasionally allows herself a secret smile when she reflects on her personal involvement in a major enduring criminal enterprise whilst she simultaneously works at the particular London hospital which traditionally cares for officers in the Metropolitan Police. Ah, if only they knew!

By eight o’clock, she is in the theatre suite getting ready for her first case. Today she is working on an orthopaedic list which is timed to begin at nine thirty with the final patient at four in the afternoon.

Before the list begins proper, the surgical, anaesthetic and nursing teams meet to review the patients on the list, the operations planned for them, the medical complications they may encounter, and any special recovery procedures.

The first patient is a black teenager who has torn some of her knee ligaments in a sporting injury. She also has abnormally-shaped red blood cells. Pam must maintain her oxygenation levels as high as possible throughout the operation because the girl’s red cells are fragile and apt to break open if the oxygen saturation of her blood falls too low. Breakage would release the precious haemoglobin into her blood stream where it can cause serious mischief. The “sickle cell trait” offers some innate protection against the malaria parasite, and so the mutation has survived from generation to generation in West Africa and into the modern age, to complicate the working lives of anaesthesiologists.

The teenager was admitted to hospital the day before and arrives in theatre already drowsy from a pre-anaesthetic drug given to Dr Jordan’s prescription by the ward nurses. As the theatre nurses help the teenager onto the operating table, Pam checks her own armamentarium: the tourniquet to wrap around the girl’s forearm which will cause the veins just beneath her skin to inflate with blood and make it easier for Pam to site a venous cannula in her arm and administer the anaesthetic cocktail. She methodically checks the drugs she will give to induce anaesthesia. By the time she turns to greet her patient and speak well-rehearsed words of reassurance, the anaesthetic nurse has slipped a pulse oximeter over the girl’s finger to monitor her blood oxygen levels, placed ECG leads on her chest to monitor her heart, and wrapped a blood pressure monitoring cuff around her arm.

Pam’s cannula finds its way into a vein on the back of the girl’s hand easily and gently begins the infusion which will send her into anaesthesia. As Pam watches her patient, the girl’s conversation with the anaesthetic nurse slows, falters and ceases — and she is asleep. The nurse extends the girl’s neck and holds her chin to maintain an airway whilst Pam connects her to the anaesthetic respirator with a face mask. She opens the gas flow, administering oxygen and halothane, but notices that her patient is not breathing.

Pam suspects that the girl has developed a laryngospasm, where the vocal cords close to protect her lungs.

The pulse oximeter notices that the patient’s blood oxygen concentration is falling and the anaesthetic machine bleeps musical chimes as if to sing “ox ee gen,” “ox ee gen,” “ox ee gen” to remind her, as if she did not know, that all is not entirely well.

The anaesthetic machine has a monitor screen to provide a graphical account of the patient’s condition in a series of wiggling and snaking coloured lines. Blood oxygen continues to fall but the girl’s heartbeat remains strong and regular. The heartbeats march confidently across the monitor screen, each heartbeat forming the segments Q-R-S-T. Pam watches them, alert for any change in frequency or amplitude or shape, but they continue in soldierly procession ... QRST ... QRST ... QRST...

Anaesthesia is, par excellence, a “sharp end specialty.” Pam has been here many times before. She is at ease in tiger country.

Out of habit, she glances over to her emergency equipment. The tracheostomy tray. The cricothyroid membrane puncture needle. She catches the eye of her anaesthetic nurse assistant who raises an eyebrow as if to ask “It’s not that bad, is it?”

“No,” says Pam reassuringly in answer to the unspoken question. “Let’s try patience.”

The moments continue to slip by as the teenager’s blood oxygen continues to fall, slowly approaching the point when the girl’s red cells will begin to split — then the patient’s cords relax and her larynx opens. Her chest rises as she inhales deeply. Pam takes her laryngoscope, opens the girl’s mouth — careful not to damage her even white teeth nor trap the edge of her tongue — and passes the scope’s blade over the base of the girl’s tongue, sweeping it forward until she can peer down her throat and see the troublesome laryngeal cords. Pam takes the oro-tracheal tube and deftly introduces it past the tongue, between the cords and through the larynx and finally, into the trachea. She connects the airway to the oxygen supply from the anaesthetic machine. She inflates the tube cuff and the girl’s airway and her oxygen supply are protected. Now the initial difficulties have been surmounted, the monitor on her finger immediately begins to show the blood oxygenation is rising and the anaesthetic machine stops singing. Pam places a throat pack, sterile lubricated ribbon gauze, carefully around the airway to further seal the opening of the trachea from any oral debris or fluid which might be displaced into her trachea when it is time for the anaesthetic to be reversed and the oro-tracheal tube to be removed.

At last, the patient is in stable anaesthesia. She is in a safe place. Unconscious. Unaware. Paralysed. Ventilated. Anaesthetised. The drama has been played to its conclusion in just fifteen minutes.

Pam enjoys the absolute benign control she has over her patient and her life and death responsibility to care for her patient’s welfare. Occasionally as now, she muses on the similarities between her control over this patient and the control she has with others, over other girls, the ones abducted, enslaved, and exported to new lives by Freddie and Ellie and Canopus ImpEx.

As she bends her head forward to check that the saline is running gently through the intravenous cannula in the girls arm, Pam’s glasses slip off her nose. She pushes them back and completes her inspection. As she lifts her head, they slip out of position once more. Pam takes them off, wipes her nose and the skin over her ear with a paper handkerchief, but her skin is dry. She explores the skin above her right ear and finds the trouble. Her glasses will no longer sit properly in place because the bone beneath the skin has developed an irregular lump. The lump seems to come from behind and beneath her ear and to extend up the outside of her skull. It is smooth, irregular, slightly squashy and tender when pressed. She cannot move it over the bone of her skull, which must mean the swelling comes from within the skull itself and is not something contained within the skin of her scalp.

The Unexpected Patient

The day following, Pam seeks out a colleague, an Ear, Nose and Throat surgeon with a special interest in ear diseases and the temporal bone. (2)

“Pam, come in and sit down,” he says, welcoming her into his office. “How can I help?”

“Sydney, I will get to the point. I have had a ringing in my right ear for a week now, my glasses will not stay on properly, there is a bony lump behind my right ear, and, today, I feel my balance is not quite right.”

“Hmmm,” says Sydney Petersham, reflectively. “How’s your health in other ways?”

“Perfectly all right. Specifically, I do not have any respiratory tract symptoms or sinusitis and I do not think I have labrynthitis.”

“Anything in your medical history I should know about?”

“No, nothing. I have always enjoyed good health. I am sorry I have no useful ‘history’ to offer.”

“And you keep fit?”

“Yes, I keep fit.”

“Alcohol?”

“Enjoyed regularly over the period of my working life, like many of us, but not to excess. Drinking too much makes me feel sick.”

“Yes, well, I am sure many of us could say that. May I examine you?”

“Of course. I was hoping you would!”

Sydney Petersham rises and stands behind Pam. He puts his hands (Pam notices they are warm and soft and reassuring) on the sides of her head and palpates the area over both ears. He notices the lump Pam speaks of immediately. It is lobulated, smooth, and it is difficult to be sure of its full extent. He also finds what Pam found earlier. The lump has a rubbery consistence and it is not hard.

He takes an otoscope and gazes down her ear canals. First the left, to establish what the unaffected side looks like, and then the right.

At length he says, “You know, Pam, I would like to send you for a CT scan. What about this afternoon? Are you free?”

“I have a Gynaecology list to do, by rights.”

“Well, I think you should beg a favour from a suitable colleague and go have your CT scan. Can you do that?”

It feels strange to be a patient and Pam is slightly flattered by the attention but she agrees to make arrangements.

Pam arrives at the Radiology Department and reports to the Patient’s Reception. It is another odd feeling. Usually she would walk straight past the ordinary patients waiting for their X-rays or scans, and go straight to the “Viewing Room” to seek out whichever consultant colleague she needed to speak to. Today, she has to meekly introduce herself and report that she has been sent for a CT scan. The clerk looks at her, looks at her list of appointments on her computer screen, looks at an untidy collection of “Post-Its” and then says, “Ah, yes, I have found you. You have got to have an emergency CT. Just sit over there till they are ready for you.”

Pam joins the other patients. Suddenly, she feels herself very ordinary and vulnerable, embarrassed by her white coat as she sits beside people in their street clothes.

“Pam?”

She looks up and sees Simon Wienstock, one of the Radiologists. (3) He puts his hand on her shoulder. “Come on through...”

Pam is alone in the CT room. Just her and the x-ray scanner. The disembodied voice of the radiographer says, “We are just about to start. If there is any problem, or if you want us to stop for any reason, just call out. Now, you need to lay still, with your hands beside you, where I put them...”

Pam feels the machine come to life as the examination couch begins to move through the giant doughnut aperture of the scanner.

There is no sensation from the x-rays, but the machine whirrs and clicks as it does its work. Pam notices that she moves very slowly through the aperture as her skull is examined, taking image after image, slicing through her body, millimeter by millimeter.

She had expected that the scan would be confined to her head, but the machine carries on, but at a marginally faster pace, until it has surveyed her whole body, which now exists in parallel form, like so many slices of cold meat, in the computer memory — and then the radiographer is at her side, smiling.

“Well done,” she says, “not even a wriggle!”

As Pam exits the suite, she sees Simon Wienstock gazing carefully at images — her images — on a computer screen. She is tempted to look over his shoulder but something prompts her to resist, so she leaves Radiology to retreat to her office and the consolation of tea.

In the very late afternoon, she sees Sydney Petersham again. With him sits Daphne Wylie, the Oncologist. Pam notices that he has made a small circle with the chairs. One for her. One for him. One for Daphne. Then she knows, before a word is spoken, that the news is bad.

“Thank you for coming again, Pam,” begins Petersham. He glances down and then looks at her and says, “You have an osteolytic lesion in your petrous temporal bone. (4) The lesion involves your eighth cranial nerve, which explains the ringing in your ear, and it is close to your semi-circular canals, which explains why your sense of balance is disturbed. The scan shows similar lesions elsewhere, in your sternum and in your pelvis and the left femur. I am so very sorry to have to tell you this.”

Petersham’s assessment is bad — in the circumstances, it could hardly be any worse and yet, in one way, Pam is not surprised. Her own suspicions were raised by the appearance of the lump near her ear and the auditory symptoms she had.

“So, what’s your take on this, Daphne?” asks Pam.

“Pam, there is nothing very satisfactory I can offer. You are a candidate for chemo-radiotherapy, but I can’t say much about whether it will substantially alter the progress of the disease.”

“So, what do you think it is?”

“We have both looked at the scan results and also spoken to the people in radiology and pathology. We think you have an aggressive osteolytic osteosarcoma. Left to its own devices, the lesion will soon involve the internal carotid artery, so there is every chance that you will suffer from a catastrophic intra-cranial bleed. Treatment may buy you a few weeks. With no treatment — I am so sorry — you don’t have long.”

“So, not much to sleep on? It seems I should put my affairs in order?”

“I think ... I think, Pam, you are looking at the situation in the right way,” says Wylie.

Daphne is sitting very close and the contact of her body with Pam eases the pain of the news just broken. “With your permission, we will let your GP know. (5) We will also let the Clinical Director of Anaesthesia know. We think you should do more with your time than coming to work to do routine lists. Here is my mobile number. Just call as soon as you have decided what you would like to do...”

As Pam walks back through the hospital, she reflects on how many times she has made journeys like this, surrounded by suffering humanity. Herself, seemingly immortal. Seeing all the other sick people, knowing that she is now one of them — perhaps chief amongst them as the sarcoma erodes the walls of her internal carotid artery — she feels unexpectedly calm and serene. She knows what she must do. Her personal affairs are already in order. It is just a matter of informing her Solicitor. (6) Her family is only Sukie and her brother and sisters. But what of her own end, now at hand? That is easy. It is really a question of saying good-bye to the right people, in the right order.

A Conversation With Ellie

“Ellie? Oh, hello. Look, it’s Pam here. I’ve got some significant news...”

“Pam? Thank goodness I have caught you! I am afraid I have news, too. Bad, I am afraid.”

“Oh. Well, you go first.”

“This morning, Larry got a call from Cordingleys. They are the demolition people in Warwick. You know: the people dealing with the old training centre?”

“Yes?”

“A police inspector turned up yesterday afternoon out of the blue, asking to be shown round. By the time the workmen arrived this morning, the whole site had been cordoned off. The site manager was told they were taking samples from the training block, looking for blood and tissue.”

“It’s going to take some time to deal with those, Ellie. Extracting the DNA and matching it with any they have on file, but I agree that this is very serious.”

“Freddie thinks they will find out soon enough that it’s all female. If they have organised the sampling carefully, they will find out that the samples which come from the cells are all female. If the police suspect what’s been going on there, it must mean they are coming after us.”

“Ellie, what are you and Freddie going to do?”

“You know Freddie and I were thinking about retirement? We think the time has come for us, but I — we — are very worried about you and Harry — and Larry, for that matter.”

“I think Harry has a trip planned to see Steve? He is taking Sarah. Asked me to help with their travel arrangements. I think they, but I really mean Harry, was planning on going at the end of the week but he is bringing the trip forward. It’s a question of making arrangements for the perishable freight consignment.”

“Ah ... I am just so surprised at the way things have turned out. So much has gone wrong so quickly. I mean, the whole situation changed when Jennifer McEwan came back. I sometimes think that Kustensky did this on purpose. His final revenge on us for mistakenly lifting his daughter. Do you think? Anyway, it doesn’t really matter now, whatever the truth of it. So, what will you do, Pam? I am so worried about you...”

“Well, Ellie, I can set your mind at rest completely, as it happens. I will be fine and completely out of reach of the Police.”

“You will?”

“Yes. Erm, this was what I was calling to tell you about. Look, Ellie, there is no easy way to say it. I am dying. I have a very nasty tumour in the base of my skull. I have only a few weeks left and there is not much for treatment to offer, so I am not really bothered. I am de facto untouchable. I have things to attend to, Sukie, for example, but it’s all in hand so, really, I was ... erm ... I was calling to say good bye and to thank you for your friendship over all these years...”

“Oh, Pam ... Pam ... Oh, Pam, I am so dreadfully sorry ... I just do not know what to say. I never thought it would all end like this. I feel Freddie and I are running away and leaving you to face the Police on your own ... Do you need ... I mean, is there anything we can do?”

“No, Ellie, there is nothing you nor anyone else can do. This was going to happen anyway. It’s probably the result of my genetics as much as anything else. I have been around medicine long enough to know that bad and unexpected things happen to people out of the blue.”

“Are you still working? I mean, shouldn’t, you use your time better?”

“At work? No, I have been put on sick leave. I have a constant ringing in one ear and my balance is not what it was. I think the Clinical Director of Anaesthetics is worried about me collapsing in the operating theatre with a patient under anaesthesia. It would not look good if a famous hospital was to be seen working their consultants until they collapsed!”

“Oh, Pam, surely not?”

“No, only joking. But it’s probably appropriate that I am not at work and, when there is not much time left, you are quite right. There are better things to do.”

“What are you going to do with Sukie? She really belongs to the Company. I don’t suppose Harry or Larry will know of your news?”

“No, they don’t and, as far as Sukie is concerned, I don’t think she does belong to the company anymore. I bought her. Anyway, I have enjoyed her so much I want to leave her properly provided for. I have left her my flat in my will. I had the flat valued last year. On the market, and after all the bills are paid, it will fetch over three point five million, so Sukie will go from being a slave to being a millionairess, which provides a nice fairytale ending for her, don’t you think? The rest of my effects and resources are being divided amongst my sisters and brother. They are all pretty comfortably off themselves, so I hope they will not make a fuss about the Settlement.”

“Pam, you are being very brave about all this.”

“Remember Shakespeare, Ellie. Remember when Brutus hears about the death of Portia? What does he say? Something like ‘Ah, Portia, Portia. In meditating on this moment, now I can bear it, now the hour has come... ‘ So, Ellie, I need to know so I can rest easily, when are you and Freddie taking your leave?”

“We are going tomorrow, like Harry.”

“Not as Ellie and Freddie Clegg?”

“No, of course not. Freddie has had this planned for several years. We will be...”

“Don’t tell me, Ellie. I don’t want to know. If I don’t know, I can’t tell anyone, either in answer to a straight question or by mistake. So, the Gods are leaving Olympus?”

“I suppose we are leaving Olympus but, on the other hand, Olympus is not the only mountain.”

Dr Jordan’s Last Case

When Pam enters the Canopus building, the first person she sees is Harry. In fact, Harry is really the only person she expects to see because the security staff have been paid off as Canopus ImpEx relocates across the Atlantic.

“Did you give her the pre-med?” (7)

“As instructed, Doc. Actually, I enjoyed myself, sticking a hypodermic into a girl’s tight bum. Maybe nursing should have been my vocation?”

“Actually, Harry, a large number of the bums I sick hypodermics in are not smooth or tight or attractive, unlike Sarah’s which, of course, has all those advantages.”

“Ah, so reality does not live up to fantasy then?”

“Unfortunately, no. You injected her in the outer upper quadrant like I told you?”

“Yes, Doc. I followed Doctor’s Orders.”

“Very funny, Harry. Let’s go see the patient, shall we?”

When Dr Jordan and Harry enter Sarah’s cell, she is still asleep. Sarah would usually awaken immediately she was called, but not today.

Dr Jordan notices that Harry has also given Sarah a ‘number one’ buzz cut to leave her with a very short and easy to manage hair. It is another standard part of the Canopus transportation protocol.

“Good morning, Sarah. How are you?”

Sarah starts from sleep. She opens her eyes, tried to focus and then closes them, choosing for the moment, sleep to wakefulness. Pam grips her shoulder and shakes her. This rouses Sarah, but still not into full rational wakefulness.

“Dr Jordan! I was not expecting you, Ma’am. How can I help?”

“Has Mr Harry spoken to you?”

“No. You have just woken me up. Have I overslept? Dr Jordan, I am so sorry...”

Pam squeezes Sarah’s hand and says, “I don’t want you to worry, Sarah. We did not want you up early today. Today, you are going on holiday. You are going with Mr Harry. You are going to the West Indies.”

Sarah gazes uncomprehendingly at Pam, her eyes half-closed, drunk with the effects of the pre-med. “To the West Indies?” she manages to say, slurring her words. “Goodness. I have not been out of England for ever so long. I do not have a passport anymore,” and then she sinks back into sleep, like a child awoken too early.

Pam smiles at Sarah’s response. The drug had blunted her awareness but not abolished her capacity for logical thought completely.

Pam looks up at Harry. “Let’s get her into the container, then I will get into her veins to set up the intravenous infusion, and then I need your help with the crico-thyroid puncture — are you all right with that?”

“Quite frankly, Doc, I am a bit squeamish with medical things...”

“Harry! You will do-as-you-are-told, understand?”

“Yes, Ma’am. I am sorry, Doc. What am I going to have to do?”

“You will hand me instruments when I ask for them and you will wipe up a dribble of blood on a paper handkerchief when I tell you. That’s what you are going to do and no nonsense. Do you understand, Harry?”

In the privacy of her mind, Dr Jordan sighs. To think that the “Head of Acquisitions” is squeamish about “medical things!”

“Is the container ready?”

“Sure.”

“Let’s get her inside it. Sarah? I need you to go to the toilet, to pee and have a crap if you need to. Don’t be embarrassed.”

Sarah replies dreamily, “I only need to pee and I can stand up...” and then she giggles as she stands up uncertainly, supported by Harry on one side and by Dr Jordan on the other. “ ... but I feel,” continues Sarah, “... disconnected? ... my body is moving but the rest of me is taking time to catch up!”

When Sarah has performed, Dr Jordan wipes her clean, wraps an adult diaper around her, and finally dresses her in a track suit. The hold of the aircraft will be temperature-controlled, but Sarah will only be able to wriggle in her container, and so the track suit is an added precaution against hypothermia.

Harry wheels a stacker into Sarah’s room and, together, Dr Jordan and Harry help Sarah onto the base board of her container. The stacker is a piece of industrial equipment designed to handle heavy and awkward loads. A slave in a transport container is both of those. (8) The equipment also gives Harry and Dr Jordan all-round access to Sarah to prepare her for the journey.

The transport container is rectangular, not shaped like a coffin, which is encouraging for the Transportee. It is made from airframe aluminium for strength and is built up in sections: base, sides and lid.

The base of the container is covered with “memory foam” to take up the shape of Sarah’s body, for comfort and to prevent pressure sores from developing — the skin of a slave is always one of their important assets and must not be treated carelessly. Harry has noticed with amusement that the same product is now marketed quite widely as the mattress material of choice for those who suffer with a “bad back.” (9)

The insides are lined with foam rubber, quite firm but not rigid, so the sensation is actually very reassuring. Once Sarah is secure on the base, the sides are added and fixed and finally, the container lid will be located and secured. Sarah will have room to wriggle side to side, to flex her arms and legs, to arch her back a little, and to stretch, but not to climb back out because her wrists, forearms, lower limbs and ankles will be secured to the container with soft leather straps and there will be a strap across her waist and across her chest, just below her breasts. The leather might be soft but it will not “give.” Without help, there is no prospect of Sarah being able to climb out of her container. Sarah will also wear a hood which will close her eyes and ears and provide anchor points at the crown of her head and at each side and these will keep her in place very effectively. Finally and critically, the container has ventilation panels right around the sides to assure an air supply for the Transportee.

When Sarah is in place, Harry and Dr Jordan strap her down: around her ankles, her arms, her waist, across her chest and around her wrists.

As she secures the buckles and locks them closed with zip-ties, Pam recalls the various experiments they did in years past to get the design just right. In the circumstances, she had volunteered to be the “experimental animal” (much to the delight of Ellie) and Pam recalls how it was clear very quickly that straps had to be tight enough but not too tight. There had to be enough restraint to prevent significant movement but not so much that the Transportee was immobile, to avoid the risk of developing muscle cramps, joint pain, pressure sores — and lower limb thrombosis.