27/10/07
8:10 AM
William Harvey Hospital, Ashford

"Right," A young A&E doctor in scrubs said to Rob as they took the gurney through the doors. "Let's have the handover."

"Okay, this is an unidentified male, early thirties, looks Middle Eastern to me. He was found unconscious, naked and tied up in a bag at a routine car search at this side of the Eurotunnel, trying to cross to France. He has not shown any sign of consciousness since we picked him up, or reported by the police who found him, his pupils are constricted. His heart rate has been sitting around the sixty mark, but his pressures are poor so I'd call that bradycardic, he's breathing badly so we've had him on oxygen, about four to six per minute. He's cold, was 35.2 when we picked him up, he's up to 35.4 now. He had vomit round his mouth when we found him and he's dehydrated. He's got an array of injuries… teeth missing, you can see the cuts on his face, he's bruised over a lot of his body, some black some fading." A look of alarm was spreading across the doctor's face. "He's missing fingernails and toenails, he's got broken digits, small circular burns on his face, forearms, chest, abdomen, thighs and feet, cuts in his groin that look cauterised, one of them looks infected."

"Okay," The doctor said, her jaw set. "What have you given him so far?"

"Two 500 mil fluid boluses, his vitals are improving, but he's not showing any sign of coming to. We thought about naloxone because of the breathing and the pupils, but given everything else…"

"Okay." The doctor leant over the man and pulled one of his eyes open. She shone a light in to the eye. "Well his pupils react, which is a good sign." She straightened up again. "Anything else?"

"Other than thinking that whoever did this needs to spend the next thirty years behind bars? No."

"Right then, thank you." Rob and Patrick walked away. The doctor and a nurse started to wheel the man down the corridor.

"He looks like he's under anaesthetic or over-sedated, doesn't he?" The nurse said.

"I know what you mean. Can you get a weight for him and set up three times maintenance fluids?" The doctor set a stethoscope to the man's chest. "Yeah, we can get away with that. Oh – Doctor Hatch, ambulance just brought this man in." Another man in scrubs, with white-blond hair stopped and turned to the first doctor. She repeated what the paramedics had told her.

"So what's your question?" Doctor Hatch asked.

"Do you think he looks drugged and do you think he looks like a torture case?"

Doctor Hatch looked pointedly at the man's hands. "Drawn nails and missing teeth, Doctor Mullin. Yes. Call the Truro Centre and see if they'll take him. As for whether he's drugged…" Doctor Hatch pulled the man's eye open again. "He does look a bit opioid-y, doesn't he? Let's give him a dose of naloxone and see if he perks up. What's your plan at the moment?"

"Oxygen, three times maintenance fluids and naloxone." Doctor Mullin said.

Doctor Hatch nodded. "Sounds good, don't leave him unattended and keep an eye on his pain. If he's doped with Torb the naloxone is going to make him hurt."

Doctor Mullin left the nurse to sort oxygen and fluids while she fetched the naloxone. She put it in the patient's fluid line and asked the nurse if she'd be OK with him while she went to call Truro for advice, since that was what you were meant to do if you suspected torture. She hadn't even made it to the door of observation when an alarm went off behind her, three beats in a run, a crash. She looked around quickly. That wasn't hers, was it? It shouldn't be hers!

"Here, here, here!" That was Doctor Cortellino, so tall his raised hand nearly brushed the ceiling as he called for help. "This one! This one!" He was down the far end of the ward, she hurried back towards him, past her own patient, over half the people in the room going with her. A Caucasian man in his forties lay in the bed next to Doctor Cortellino, a nurse was kneeling next to him, she'd already started CPR. Someone was dropping the bed, someone else had the Ambu bag, what could she do? Drugs. Doctor Mullin ran for the crash box.

Constricted pupils: Small pupils, less worrying than pupils that are too big, but potentially a sign of heroin or morphine overdose

Bradycardic: Having a heart rate that is too slow. If this man's blood pressure is poor, 64 is indeed too slow.

Torb: Medical slang for butorphanol, a morphine-like drug which is not a terribly effective painkiller, but is a very effective sedative.

Ambu bag: A bag used to force breath in to a person who is not breathing.