Chapter 24

Birmingham. August the same year.

The Chief Executive of Queen Elizabeth Hospital, Birmingham, looked up, startled, as two men entered his office unannounced.

“What?” he asked in surprise, before gathering himself. “Who are you and what do you want?” he asked, wondering slightly why his PA had not even tried to inform him.

“Mister Sturgeon? Mister Connor Sturgeon?” the taller, younger, of the two men asked.

“Yes. Who are you? You need to make an appointment. I’m a busy man, now please leave.” Sturgeon still wasn’t nervous or scared, but he was puzzled. He put his hand out to the intercom, but was startled when the other man grabbed his arm firmly, firmly enough that he found his arm completely immobile. Now he did start to get worried, but he wasn’t a chief executive, in this time of political insecurity and instability, for nothing. He just frowned, annoyed, successfully hiding his nervousness but not his annoyance.

“I understand you have said things against the Prime Minister?”

“What?” His heart leapt and his pulse began to race. Now he began to truly fear. Like all senior executives, whether in public service, or in private industry - and Connor Sturgeon had now been both in his time - Connor knew that anything he might say could and often would be taken out of context, blown up out of all proportion, or simply used against him. With a Prime Minister like Graham Thorn though, one tried to make doubly sure that anything one said was at worst completely harmless and innocuous, and at best actually complimentary. Connor Sturgeon despised Graham Thorn, and though he hid it well, his closest friends and associates knew that, at best, he wasn’t a ‘fan’ of Graham Thorn, but he was as sure as he could be that he had never said anything that could gain the attention of Thorn’s bully boys.

To the untutored eye, Connor looked of typical white Anglo-Saxon stock, though perhaps slightly darker of hair and skin then might normally be expected, but his maternal grandmother was a black African from Nigeria. Connor had never actually met his grandmother, she had died young, but he was proud of his African heritage, and now, with the likes of Graham Thorn around, even a little worried because of it. His wife had been brought up Jewish, though she had never been a practicing Jew, just as he had never been a practicing Christian. As a family though they observed some aspects of both their backgrounds, such as Christmas and Passover.

Connor Sturgeon had two reasons therefore to fear Graham Thorn’s Truth and Freedom, and the increasingly aggressive Safety Patrol: his own racial background, and his wife’s religious heritage.

“I don’t know who could have told you that,” Connor answered calmly, “but whoever it is, they’re lying. I have never spoken against Mister Thorn.”

“So you are a supporter of Graham Thorn?”

Sturgeon wasn’t, but he knew where his safety lay. “Of course,” he said simply, not embellishing his answer.

“And you have never spoken out against Graham Thorn? Never? Not even once?”

“No. Now if that’s all, you can leave my office. I have work to do, and a busy hospital to run.”

What Connor Sturgeon didn’t know, couldn’t know, was that the younger of the two men in front of him had developed a remarkable skill in the last few years, that of reading a persons body language and telling, with a better than average degree of accuracy, when an answer was a lie, the truth, or an evasion. It wasn’t perfect, and sometimes a half-lie was missed, but blatant lies and genuine heartfelt truths were usually recognised.

That man, Lieutenant-Colonel Carter, was slightly puzzled. He believed Sturgeon’s assertion that he’d said nothing against Thorn, yet there was a hint of evasion there. The previous answer Carter had been unable to ‘read’. The answer had been too simple and too short for accurate reading.

He interrupted his colleague. “We have never heard or seen you actively promote Graham Thorn. Why not?”

“Then you have simply not been looking or listening at the right place or time. I regularly extol the virtues of our glorious leader. Now please leave.”

Carter nodded. Their suspicions were confirmed. That whole last speech by Sturgeon had been a lie. He nodded to his colleague. “Okay. We’re good.”

For a moment Sturgeon thought his lies and evasions had been believed. His two visitors however quickly disabused him of that notion. Apart from the chair Sturgeon was using, there was only one other chair. Carter perched himself on the edge of a low table against the wall, while his colleague took the chair.

“You used to have a military wing... ?”

Carter made the statement sound like a question, and trailed it off in a way that made Sturgeon even more nervous than he already was.

“Yes. It was closed some two years ago.”

“Why?”

“Er, well, you ordered us to.”

“Us?” enquired the other, older, man gently.

“You. The government. A Patrol officer came in to see us and ordered us to close it.”

Both men nodded slightly. They already knew Sturgeon assumed they were either Patrol officers in mufti, or were Truth And Freedom party officials.

“And you had an issue with that?” he asked, almost off handedly.

Sturgeon shrugged. He had had an issue with it. A big one. The military wing had helped to train all the military’s doctors and nurses, but had also brought a large number of techniques learned in the heat of combat operations back into the general NHS, particularly for use with major trauma patients. It had been an excellent symbiosis as far as Sturgeon had been concerned.

At the time of its closure, the twenty-one bed ward had had twelve military in-patients. Before the Patrol had had the chance to find them, eight had been moved to other wards and one discharged early. But the remaining three had been too ill to easily or quickly move and the Patrol had taken them away before arrangements could be made to ensure their safety. Sturgeon strongly believed those men were now dead and it angered him. His older brother had been in the army in his twenties, and their grandfather, at eighteen, had been called up just before the D-Day Normandy invasion. Fortunately he had made it to the end of the war, though not without serious injury. Connor Sturgeon had always been a supporter of the military, though in the current climate he hid his support.

“Not really I suppose. It meant that the equipment could be used by the whole hospital instead of just a single ward.” In fact this happened anyway, but the anti-military politicians liked to put it about that somehow the army had better equipment that it denied to other parts of the general public. In reality, the army’s own equipment was often at least two, and often more, generations out of date.

“Hmm.” Again both men knew Sturgeon was just parroting the party line, though Carter now believed, with reasonable certainty, that Sturgeon would not be antagonistic to their requests.

“Hmm,” started Carter again. “Now we’ve got that all sorted out. We need you to do something for us.”

“I’m already cut to the bone. There’s no more cutbacks and savings we can make. Please don’t take away any more of our funding,” pleaded Sturgeon.

“That’s not what we’re here for,” the older man told him.

‘Here for anti-government staff?’ wondered Sturgeon. A good quarter of the hospital staff, he knew, were actively anti-Thorn, most of the rest were at least ambivalent about him. Few now truly liked or supported Thorn, though Neil Conway had been popular in the early days of the Earth First government. Sturgeon wasn’t going to mention any of this though, he had seen enough films, and read enough books, where someone had been caught out by confessing to the wrong crime. “What then?”

“I’m Llewelyn Carter,” stated the younger man, “this is my deputy, Simon Pierra. We need you to set something up for us. Something that as a patriot you should be more than happy to do.”

Sturgeon’s heart sank.

“What?” he asked hollowly.

Pierra was about to speak when Carter interrupted.

“What medical training do you have, Mister Sturgeon?”

Sturgeon looked at him. “None. You do not need doctors running hospitals. Quite reasonably, and understandably, they just want to spend money. You need businessmen. And women. But more than that you need good administrators. I am damn good at both.”

“And if you could help the doctors and nurses do their job better? More efficiently?”

Sturgeon shrugged, puzzled. “I would, but a hospital isn’t only about nurses and doctors. On the clinical side alone, there’s sociologists, psychologists, psychiatrists, physiotherapists, radiologers...”

“Yes yes,” interrupted Pierra impatiently, “and there’s also cooks and cleaners and porters and clerks and accountants and maintenance people and many others all equally necessary. We’re well aware of that. Assume we are talking about the hospital as a whole.”

“Well, yes, of course. Anything I can do to improve the working of the hospital I would do. That goes without saying. The issue is with the slowly reducing budget we have, plus the ever increasing cost of medicines and equipment. The drug companies and the medical equipment companies do not make my life easy. Even the costs of other equipment: cleaning and maintenance equipment, cooking and eating utensils, even basic foodstuffs are all going up as fast as our budget is going down.”

Sturgeon, almost forgetting who he was talking to, believed he was talking to, leaned forwards, urgency in his voice. “I understand that budgets are tight. I really do. But there are some things that we just cannot do without. We had one of your men in here last week, a young Patroller. He’d been injured in that damn rioting and we had already run out of dressings to cover his wounds.” This wasn’t strictly accurate, but Sturgeon believed he could make the two men understand and accept his need for more money. “We had to use old and out of date dressings. They were sterile as far as we can tell, but there is a use-by date on those dressings packs for a reason.”

Pierra nodded. “We are going to bring in six machines. You are going to install them in various parts of the hospital, and you are not going to mention them to anyone.”

Carter stood up and nodded at Pierra. “I’ll leave you to it.” He left the room, Sturgeon looking after him, startled.

“Er, er, yes, sure. What are these machines? How big? Where do they need to go?”

“All in good time. These machines are secret. No one, and I mean no one that we don’t specify, can know about them. Do you understand?”

“Er. No, not really, but that won’t prevent me from doing what has to be done.” Sturgeon still believed he was talking to someone from the government, and was paying lipservice only in his commitment. That would soon change.

“Good. Now listen carefully.”

The hospital receptionist looked up as two men walked up to the desk. The elder, a man in his forties, his hair just starting to go attractively grey, carried a clipboard. “‘ere luv, sign that,” he said in a broad Brummie accent, stuffing a delivery note in front of the receptionist. “We’ve got four big boxes for you. Where do you want them?”

The receptionist had had similar requests for years. She looked at the form in front of her. It looked like a standard delivery note, like many she had signed over the years. Oddly, the note did not say what was in the boxes, just ‘four boxes’, and the weight and dimensions. “What are they?” she asked, the pen in her hand hovering over the signature box.

“Dunno. Electrical I think.”

The receptionist nodded. “Clinical or administrative?”

“Dunno. Sorry luv. Not done a hospital delivery before. I just assumed you would know.”

The receptionist smiled slightly. “If it’s medical stuff, it needs to go to one place, if it’s for the admin block it needs to go elsewhere. Um. How big are they?”

The two delivery men looked at each other. “Large fridge-freezer,” the younger man, who looked to be still in his teens, with a shock of bright un-naturally orange hair and a face full of freckles and acne, suggested. The other nodded. “Yeah. About that. Say a bit bigger than a standard domestic fridge-freezer. Two metres high maybe a bit more, about one wide and one an’ a bit deep.”

She nodded. “Um. Okay.” She looked around. “For now, just bring them in here. Leave them over there.” She pointed to a corner before scribbling her signature on the docket and handing it back.

Twenty minutes later, the four boxes were standing neatly in a line, out of the way of most of the hospital users. The four boxes were identical, and the only markings on them were a strange logo that she’d never seen before, a long identification code, and the words “NOT TO BE OPENED EXCEPT BY QUALIFIED INSTALLERS” emblazoned across the front. The receptionist shrugged, not really interested. Hopefully someone would be along soon to sort them out. She turned and pushed them out of her mind as she got on with other work.

Queen Elizabeth Hospital was a large hospital, over a huge, multi-building site. About two months earlier and almost a mile from where Connor Sturgeon had his office, one of the emergency generators had shown signs of seizing up, and the on-site engineer, unable to even work out what the fault might be, had called in the manufacturers to investigate. The manufacturers’ engineer had taken one look, spent about five minutes poking ineffectually around, and declared it defunct. Just so much scrap metal. The hospital had, reluctantly, ordered a replacement.

Today the maintenance manager watched as a large low loader edged into the bay at the back of the hospital. On its back was the replacement generator, nearly three months earlier than expected. It was almost forty percent bigger, but, he’d been told, it was over five hundred percent more powerful, far more fuel efficient, and needed a lot less maintenance.

“I’ll believe that when I see it,” muttered the maintenance manager under his breath. “I hope you can take the old one with you when you go,” he told the vehicle’s driver.

“Nah mate. Been told to leave it here.”

“Fuck, there’s almost no room here now. When this one’s in...” he tailed off, irritation on his face. He pointed at the corner of the yard. “The new pilings and fixings have gone in over there, just get it in place. I don’t suppose you’re actually connecting it up are you?”

The driver shook his head.

“Nah, didn’t bloody think so,” grumbled the manager. “Life’s never that soddin’ easy.”

An hour later the new generator was in its final position, but it wasn’t fully fixed down, and it wasn’t wired in yet. The manager walked around it, frowning slightly. It looked like no generator he had ever seen. For one thing the built in fuel tank looked far too small, and there didn’t appear to be any way of plumbing in the main tank. He shrugged and stomped off to ring the manufacturer. He wanted to know when the engineer was coming to fit it, and what the hell he was supposed to do with the old generator. It was lucky, the manager reflected, that the builders who had come in and have the pilings done, had themselves turned up two months earlier than expected. At no point did he ever think it was all staged.

Connor Sturgeon’s face looked more alive than it had looked in years, it had a glow of excitement and pleasure about it. He looked happier, he was happier, than he’d been in a long time.

“I can do all that,” he said, nodding, typing furiously onto his old tablet computer. “When do you need it all done by?”

“The four replicators should have already been delivered. They’ll be in boxes in reception probably. The generator should be being delivered as we speak, and the engineers will be coming in to connect it all up this evening.”

“Okay, and the sixth box? The tube thingy?”

“That’s going to be more awkward. We need space, and we need privacy.”

“Well, if it’s big and awkward to move, I guess it’ll have to be in a room off the trunk...”

“No no no,” interrupted Pierra. “We will get it in using other technology. It’s a place to put it we need. In one sense it ought to be near A&E, otherwise in the same general areas as other scanners, CT, MRI, X-RAY, et-cetera, to take advantage of the high turnover of people going through.”

Sturgeon looked thoughtful. “Not sure of the best place, but I seem to remember there’s a room on the third floor of ‘B’ block, that was going to be used as a backup theatre. Then it was pointed out that it’s too far from the nearest recovery room, so now it’s just used as a store room. It’s still got all the ‘plumbing’ and fixings and stuff to be used as a theatre though.”

“Sounds ideal.”

“So who goes through it first?”

“Up to you, but it must be people you absolutely trust. You must be capable of trusting them with your life, because in effect that’s what you will be doing.”

“Can I call in a few people?”

“Who?”

“My assistant, two of the senior consultants, and the senior registrar.”

“Three medical, one not?”

Connor smiled slightly. “Actually my assistant was a senior nurse until she was forced to give it up due to an injury.”

“Okay. No current senior nurses?”

“Unfortunately most of the nursing staff I deal with directly are the union leaders, and I daren’t trust them with this. Not yet anyway. My band nine, whom I would trust, isn’t in today. The rest I don’t know enough about. Not for this anyway. Hopefully these people will though.”

Pierra nodded. “Uh huh, go ahead then. But carefully, mind.”

The argument had been raging for nearly an hour and there was still no sign that it would finish anytime soon. Three days after Sturgeon had accepted the Confederacy technology into his hospital, it had all been connected up. The four replicators had been installed in various parts of the hospital, the generator had been bolted down and wired in to the hospital’s mains, and the medical tube had been placed in the ‘spare’ operating theatre and wired in. Now they were arguing about who should use it first.

Two days earlier, Sturgeon had called a meeting of the few people he knew he could trust. Like him, they had become very excited, but all Sturgeon had really wanted, was more names, names of people who could be trusted.

Now, today, three days after that first contact, the twelve most important, influential and hopefully most trustworthy people in the hospital were sitting down to discuss how to use their new toys. The new people had initially been sceptical, then wondering, then excited, now furious.

One surgeon wanted all the senior staff to go through first, then the more junior staff. A senior registrar thought it should it should be medical staff, then nursing staff, then other clinical staff, and only then other staff. He hadn’t mentioned patients at all.

The senior nurse present, Connor’s band nine, had argued for putting patients through first. After all, she told them, wasn’t this a hospital? This had triggered arguments about priorities. Acute versus chronic. Quick fixes versus complicated fixes. And yes, staff versus patients. After all, the counter-argument went, if the staff were ill then they couldn’t look after patients, so should have at least some priority.

Sturgeon, in despair, slowly laid his forehead on the table in front of him and began banging it gently up and down. Thump. Thump. Thump. Thump. Thump. Thump.

It took nearly a minute before anyone else noticed, and then the arguments quickly stopped.

When there had been silence for a good twenty seconds, Sturgeon spoke.

“So. What we have decided,” he said, his head still on the table, “is that you all want your people to go through first.” He lifted his head and glared round the table balefully. “We have been given a wonderful gift here. We have protection, in a way, from Thorn. We don’t have to rely on the Department Of Health. We don’t have to worry about the cost of drugs, of dressings, of cleaning materials, of food, of paint, of water or electricity or gas. You don’t ever have to worry about whether or not you are going to lose a patient, because unless your patient is too bad, that box of tricks will fix him.” He paused and glared at them again. “And all you lot can do is say ‘I want to go first’?”

The one nurse who had said patients first started to speak, but Sturgeon turned on her. “I’ll make the decision. I’ve heard everything you’ve said, and since you can’t make a decision, I will.” He picked up a piece of paper and waved it at them. “I have a piece of paper here. You’ve all got copies in front of you. It tells you how long particular conditions should need in that damned box to get fixed. I think it fairly safe to say most of you haven’t read it. No more than a casual glance at best. I have been advised that war is coming, so we need beds. We only have one tube, so we need to use it in the most efficient way possible. To me that means emptying beds.” He turned sharply to one of the other nurses, a band seven, ward sister.

“You work on renal. How long is a typical dialysis session?”

“Typically four hours, three times a week.”

“That’s twelve hours a week per patient. And of course the patient will be with us longer than that, and for weeks and months on end. That box out there can fix a kidney in about twenty two minutes. It can fix a pancreas for a patient with type 1 diabetes in about the same time. Crohn’s disease and similar can take as little as twelve minutes to fix, depending upon the exact variety and severity of the disease. All of them will save us huge amounts money for the cost of drug therapy. Hearts and lungs take slightly longer, cancers take slightly longer again. Depending on the cancer. Think, people, think.”

He glared around the room. “Those replicators won’t be available for forty days. They are, apparently, working together to upgrade themselves to a bigger class. So until that time, we are going to have to watch our costs on drugs and dressings as per usual. I know I’ve just said beds, but for the next six weeks, it’s cost. We can start to alter that priority afterwards. So. Conditions that cost us a lot of money, particularly chronic conditions, or conditions that use expensive and rare drugs or equipment, get first priority. I happen to know we have a staff nurse who has to be dialysed twice a week. She has the first slot. After that it’s patients. No patient should be in for more than half an hour or so, but they’ll need recovery time. I’m told,” he had started to calm down a bit now, “that an extra hour in the tube to help recovery saves a day in a bed. Well they’re not gonna get it. Basic nursing care we can afford, so as far as I’m concerned, if all we are doing is general looking after, general nursing care, no drugs apart from basic pain relief and a few dressings, I can live with that for now. We can do that. We will do that. Pain relief is relatively cheap compared to other meds.

“So. All of you. Read the notes on what this tube thing can do, and work out on cost savings of drugs and dressing and other equipment, versus time in the tube plus time to recover in bed, the best priority. Then go through the patient lists and sort out a sequence. Add in staff medical history as well.”

One of the doctors gingerly raised a hand.

“Yes?”

“What happens if we get someone into A&E that...”

Sturgeon cut him off. “Emergency, acute, life threatening is always highest priority. Priorities can, and will, be changed as events change. As new patients come through the door. That’s no different from now. I would imagine that a high proportion of the patients that come here will never see the tube. There will be others with higher priority conditions, and we will treat these ones as we do now. The triage nurse in A&E will still control that. There is no ‘patients have priority over staff’, but nor is there a ‘staff has priority over patients’, except where the condition states that we would be, as a hospital, as an organisation, as a family, be better off. Better off financially. Better off clinically. Better off morally, ethically and morale wise.”

He stared around the room. Many of them were now reading down the list he had pointed out, some jotting notes onto notepads. In a way he had now lost their attention, but he believed they had gained his vision. Only two weren’t looking at the list, but they weren’t clinical or patient facing staff.

“I want to treat patients again,” his assistant said. “I want to go through that contraption as soon as convenient so that I can be a nurse again.”

Sturgeon smiled slightly at her. “Agreed, Jill. But only when your place in the priority comes up. Not before.” He knew she had kept her registration up to date, but they both knew she would have to do a lot of refresher and updates before she could actually work as a nurse again.

It had been pure chance that had brought Jill to work for her uncle, five years earlier. She had been a band six nurse, a deputy ward sister, on a very busy surgical ward, but a motorbike accident a couple of years before that, had caused injuries to her legs that meant she was unable to stand for very long, so was unable to actively nurse. After her recovery, rather than leave the NHS, she became a medical secretary, then personal assistant to one of the senior registrars. She had thought about going into the classroom and becoming a nurse trainer, but the thought of being away from the hospital environment had turned her off that idea. At the time Connor had been a senior executive in a commercial bank, but a year later he was getting bored. During his career he’d worked in banking, software, financial services, retail services and even, earlier in his career, in hotel management. All of them had been interesting at the time, but in every case, after about three years or so, he had decided to move onwards and upwards.

This time, when Connor was casting around and talking to people, a friend of a friend had mentioned in passing that the post of Chief Executive at a major hospital was about to be announced. It had been a chance remark, but Connor, knowing his niece was a nurse, decided to look into it, looking at it as a new and very different challenge.

He had got the role but it wasn’t until he actually started there that he found out that Jill was working in the same hospital. They kept their family relationship quiet in case of complaints of nepotism, but as he knew what she now did, offered her the option to become his PA. She had jumped at the chance.

Running a major hospital, especially one with such close links to the military, had been a very different experience for Connor, one that he came to absolutely love, and soon found he had a particular aptitude for it. This was despite having never worked with either health care or the military before. The loss of income hadn’t bothered him or his family even slightly, though as normal, many of the unions had complained that he, like all the other senior management, were a complete waste of money and massively overpaid. “Sturgeon’s salary will pay for twenty-five new nurses,” they grandly announced. Connor and Jill, between them, contrived to ‘accidentally’ let one of his monthly payslips fall into the hands of the unions. When they saw the hours he actually worked each week, over eighty, and the overtime pay, zero, and the fact that his pay was actually only slightly more than a senior registrar, the complaining quieted a little. But only a little. His salary would actually only pay for about eight staff nurses, and then only newly qualified nurses on the very basic rate of pay: no increments, no nighttime or weekend allowances and most definitely no overtime.

Jill nodded at his words, looking sad and resigned. “In that case it won’t happen. I’m not in real pain. I don’t need medication or dressings. I don’t need time off work. I just can’t use my left leg properly, it’s too weak, so I can’t stand for long so can’t nurse.

“Are we using this thing twenty-four-seven?” asked one of the senior registrars.

“I think so, if we have the patients to put through, and we have people to staff it.”

There was a slow nodding around the table.

The first fifty-eight patients had gone through without a hitch. Four had been staff, four had been severe life-threatening trauma patients brought into Accident and Emergency by ambulance, seven had been acute emergency medical conditions brought in the same way. All the rest had been chronic medical conditions, patients already in hospital with conditions varying from a chronic MRSA infection to lung problems, cancer patients on particularly expensive or harmful chemotherapy, some dialysis patients who needed longer or more frequent treatments, a couple of type 1 diabetes patients with severe complications and some with other heart, lung or cerebral problems, principally COPD, TIA and strokes, and CVA’s. All the patients had been in a serious condition, though some had not looked it.

Every single conscious patient had been told something different, about what the machine they were getting into was, and all had come out healed in body, even though, in most cases, still incredibly weak, in pain, and all still needing nursing care. A few even went in unconscious, never even knowing they had been in the machine.