On the morning of the first murder Miss Muriel Beale, Inspector of Nurse Training Schools to the General Nursing Council, stirred into wakefulness soon after 6 o'clock and into a sluggish early morning awareness that it was Monday, 12th January, and the day of the John Carpendar Hospital inspection. Already she had half-registered the first familiar sounds of a new day: Angela's alarm silenced almost before she was conscious of hearing it; Angela herself padding and snuffling about the flat like a clumsy but benevolent animal; the agreeably anticipatory tinklings of early tea in preparation. She forced open her eyelids, resisting an insidious urge to wriggle down into the enveloping warmth of the bed and let her mind drift again into blessed unconsciousness. What on earth had prompted her to tell Matron Taylor that she would arrive shortly after 9 A.M. in time to join the third-year students' first teaching session of the day? It was ridiculously, unnecessarily early. The hospital was in Heatheringfield on the Sussex/Hampshire border, a drive of nearly fifty miles, some of which would have to be done before daybreak. And it was raining, as it had rained with dreary insistence for the past week. She could hear the faint hiss of car tyres on the Cromwell Road and an occasional spatter against the window-pane. Thank God she had taken the trouble to check the map of Heatheringfield to find out exactly where the hospital lay. A developing market town, particularly if it were unfamiliar, could be a time-wasting maze to the motorist in the snarl of commuter traffic on a wet Monday morning. She felt instinctively that it was going to be a difficult day and stretched out under the bedclothes as if bracing herself to meet it. Extending her cramped fingers, she half-relished the sharp momentary ache of her stretched joints. A touch of arthritis there. Well, it was to be expected. She was forty-nine after all. It was time she took life a little more gently. What on earth had led her to think she could get to Heatheringfield before half past nine?
The door opened, letting in a shaft of light from the passage. Miss Angela Burrows jerked back the curtains, surveyed the black January sky and the rain-spattered window and jerked them together again. "It's raining," she said with the gloomy relish of one who has prophesied rain and who cannot be held responsible for the ignoring of her warning. Miss Beale propped herself on her elbow, turned on the bedside lamp, and waited. In a few seconds her friend returned and set down the early morning tray. The tray cloth was of starched embroidered linen, the flowered cups were arranged with their handles aligned, the four biscuits on the matching plate were precisely placed, two of a kind, the teapot gave forth a delicate smell of freshly made Indian tea. The two women had a strong love of comfort and an addiction to tidiness and order. The standards which they had once enforced in the private ward of their teaching hospital were applied to their own comfort, so that life in the flat was not unlike that in an expensive and permissive nursing home.
Miss Beale had shared a flat with her friend since they had both left the same training school twenty-five years ago. Miss Angela Burrows was the Principal Tutor at a London teaching hospital. Miss Beale had thought her the paradigm of nurse tutors and, in all her inspections, subconsciously set her standard by her friend's frequent pronouncements on the principle of sound nurse teaching. Miss Burrows, for her part, wondered how the General Nursing Council would manage when the time came for Miss Beale to retire. The happiest marriages are sustained by such comforting illusions and Miss Beale's and Miss Burrow's very different, but essentially innocent, relationship was similarly founded. Except in this capacity for mutual but unstated admiration they were very different. Miss Burrows was sturdy, thick-set and formidable, hiding a vulnerable sensitivity under an air of blunt common sense. Miss Beale was small and birdlike, precise in speech and movement and threatened with an out-of-date gentility which sometimes brought her close to being thought ridiculous. Even their physiological habits were different. The heavy Miss Burrows awoke to instantaneous life at the first sound of her alarm, was positively energetic until teatime, then sank into sleepy lethargy as the evening advanced. Miss Beale daily opened her gummed eyelids with reluctance, had to force herself into early morning activity and became more brightly cheerful as the day wore on. They had managed to reconcile even this incompatibility. Miss Burrows was happy to brew the early morning tea and prepare breakfast and Miss Beale washed up after dinner and made the nightly cocoa.
Miss Burrows poured out both cups of tea, dropped two lumps of sugar in her friend's cup and took her own to the chair by the window. Early training forbade Miss Burrows to sit on the bed. She said: "You need to be off early. I'd better run your bath. When does it start?"
Miss Beale muttered feebly that she had told Matron that she would arrive as soon as possible after nine o'clock. The tea was blessedly sweet and reviving. The promise to start out so early was a mistake but she began to think that she might after all make it by 9:15.
"That's Mary Taylor, isn't it? She's got quite a reputation considering she's only a provincial matron. Extraordinary that she's never come to London. She didn't even apply for our job when Miss Montrose retired." Miss Beale muttered incomprehensibly which, since they had had this conversation before, her friend correctly interpreted as a protest that London wasn't everybody's choice and that people were too apt to assume that nothing remarkable ever came out of the provinces.
"There's that, of course," conceded her friend. "And the John Carpendar's in a very pleasant part of the world. I like that country on the Hampshire border. It's a pity you're not visiting it in summer. Still, it's not as if she's matron of a major teaching hospital. With her ability she easily could be; she might have become one of the Great Matrons." In their student days she and Miss Beale had suffered at the hands of one of the Great Matrons but they never ceased to lament the passing of that terrifying breed.
"By the way, you'd better start in good time. The road's up just before you strike the Guildford by-pass."
Miss Beale did not inquire how she knew that the road was up. It was the sort of thing Miss Burrows invariably did know. The hearty voice went on:
"I saw Hilda Rolfe, their Principal Tutor, in the Westminster Library this week. Extraordinary woman! Intelligent, of course, and reputedly a first-class teacher, but I imagine she terrified the students."
Miss Burrows frequently terrified her own students, not to mention most of her colleagues on the teaching staff, but would have been amazed to be told it. Miss Beale asked:
"Did she say anything about the inspection?"
"Just mentioned it. She was only returning a book and was in a hurry so we didn't talk long. Apparently they've got a bad attack of influenza in the school and half her staff are off with it."
Miss Beale thought it odd that the Principal Tutor should find time to visit London to return a library book if staffing problems were so difficult, but she didn't say so. Before breakfast Miss Beale reserved her energy for thought rather than speech. Miss Burrows came round the bed to pour out the second cups. She said:
"What with this weather and with half the training staff off sick, it looks as if you're in for a pretty dull day."
As the two friends were to tell each other for years to come, with that cosy predilection for re-stating the obvious which is one of the pleasures of long intimacy, she could hardly have been more wrong. Miss Beale, expecting nothing worse of the day than a tedious drive, an arduous inspection, and a possible tussle with those members of the Hospital Nurse Education Committee who took the trouble to attend, dragged her dressing-gown around her shoulders, stubbed her feet into her bedroom slippers and shuffled off into the bathroom. She had taken the first steps on her way to witness a murder.
Despite the rain, the drive was less difficult than Miss Beale had feared. She made good time and was in Heatheringfield just before 9 o'clock in time to meet the last surge of the morning rush to work. The wide Georgian High Street was blocked with vehicles. Women were driving their commuter husbands to the station or their children to school, vans were delivering goods, buses were discharging and loading their passengers. At the three sets of traffic lights the pedestrians streamed across the road, umbrellas slanted against the soft drizzle. The young had the spruce, over-uniformed look of the private-school child; the men were mostly bowler-hatted and carrying briefcases; the women were casually dressed with that nice compromise between town smartness and country informality, typical of their kind. Watching for the lights, the pedestrian crossings and the signpost to the hospital, Miss Beale had only a brief chance to notice the elegant eighteenth-century guildhall, the carefully preserved row of timber-fronted houses and the splendid crocketed spire of Holy Trinity church, but she gained an impression of a prosperous community which cared about preserving its architectural heritage even if the row of modern chain stores at the end of the High Street suggested that the caring might well have begun thirty years earlier.
But here at last was the signpost. The road to the John Carpendar Hospital led upward from the High Street between a broad avenue of trees. To the left was a high stone wall which bounded the hospital grounds.
Miss Beale had done her homework. Her briefcase, plump on the back seat of the car, contained a comprehensive note on the hospital's history as well as a copy of the last General Nursing Council Inspector's report and the comments of the Hospital Management Committee on how far it had been possible to implement the inspector's optimistic recommendations. As she knew from her researches, the hospital had a long history. It had been founded in 1791 by a wealthy merchant who had been born in the town, had left it in youthful penury to seek his fortune in London, and had returned there in his retirement to enjoy patronizing and impressing his neighbours. He could have purchased fame and ensured his salvation by succouring the widows and fatherless or by rebuilding the church. But the age of science and reason was succeeding the age of faith and it had become fashionable to endow a hospital for the sick poor. And so, with the almost obligatory meeting in a local coffee house, the John Carpendar Hospital was born. The original house, of some architectural interest, had long since been replaced, first by a solid Victorian monument to ostentatious piety and then by the more functional gracelessness of the twentieth century.
The hospital had always flourished. The local community was predominantly middle-class and prosperous, with a well-developed charitable sense and too few objects on which to indulge it. Just before the Second World War a well-equipped private patients' wing had been added. Both before and after the advent of the National Health Service it had attracted wealthy patients, and consequently eminent consultants, from London and further afield. Miss Beale reflected that it was all very well for Angela to talk about the prestige of a London teaching hospital, but the John Carpendar had its own reputation. A woman might well think there were worse jobs than being Matron of a developing district general hospital, well thought of by the community it served, agreeably placed and fortified by its own local traditions.
She was at the main gates now. There was a porter's lodge on the left, an ornate doll's house in tessellated brick, a relic of the Victorian hospital, and -- on the right -- the doctor's car park. Already a third of the marked plots were occupied by the Daimlers and the Rolls. It had stopped raining and the dawn had given way to the grey normality of a January day. The lights were full on in the hospital. It lay before her like a great ship at anchor, brightly lit, latent with activity and power. To the left stretched the low glass-fronted buildings of the new out-patient department. Already a thin stream of patients was making its dispirited way to the entrance.
Miss Beale drew up alongside the inquiry hatch of the lodge, wound down the car window, and announced herself. The porter, ponderous and uniformed in self-importance, deigned to come out to present himself.
"You'll be the General Nursing Council, Miss," he stated grandiloquently. "What a pity you decided to come in this gate. The Nurse Training School is in Nightingale House, only 100 yards or so from the Winchester Road entrance.
We always use the back entrance for Nightingale House."
He spoke with reproachful resignation, as if deploring a singular lack of judgement which would cost him dear in extra work.
"But presumably I can get to the school this way?"
Miss Beale had no stomach for a return to the confusion of the High Street or intention of circling the hospital grounds in search of an elusive back entrance.
"Well you can, Miss." The porter's tone implied that only the wilfully obstinate would try, and he settled himself against the car door as if to deliver confidential and complicated directions. They proved, however, remarkably simple. Nightingale House was in the hospital grounds at the rear of the new out-patient department.
"Just take this road to the left, Miss, and keep straight on past the mortuary till you get to the resident medical quarters. Then turn to the right. There's a signpost where the road forks. You can't miss it."
For once this notoriously unpropitious assertion seemed justified. The grounds of the hospital were extensive and well wooded, a mixture of formal garden, grass, and clumped unkempt trees which reminded Miss Beale of the grounds of an old mental hospital. It was rare to find a general hospital so well endowed with space. But the several roads were well signposted and only one led to the left of the new out-patient department. The mortuary was easily identified, a squat, ugly little building tactfully sited among the trees and made more sinister by its strategic isolation. The medical officers' residence was new and unmistakable. Miss Beale had time to indulge her usual, frequently quite unjustified, resentment that Hospital Management Committees were always more ready to rehouse their doctors than to provide adequate accommodation for the nurse training school, before noting the promised sign. A white painted board pointed to the right and read "Nightingale House, Nurse Training School."
She changed gear and turned carefully. The new road was narrow and winding, banked high on each side with sodden leaves so that there was barely room for the single car. Everywhere was dampness and desolation. The trees grew close to the path and knitted themselves above it, ribbing the dark tunnel with their strong black boughs. From time to time a gust of wind brought down a spatter of raindrops on the car roof or flattened a falling leaf against the windscreen. The grass verge was scarred with flower beds, regular and oblong as graves and spiked with stunted bushes. It was so dark under the trees that Miss Beale switched on her side lamps. The road shone before her like an oiled ribbon. She had left the car window down and could smell, even above the inevitable car smell of petrol and warm vinyl, a sweet fungoid stench of decay. She felt strangely isolated in the dim quietness and suddenly she was touched with an irrational unease, a bizarre sensation of journeying out of time into some new dimension, borne onwards towards an uncomprehended and inescapable horror. It was only a second's folly and she quickly shook it off, reminding herself of the cheerful bustle of the High Street less than a mile away and the nearness of life and activity. But it had been an odd and disconcerting experience. Angry at herself at this lapse into morbid folly, she wound up the car window and stepped on the accelerator. The little car leaped forward.
Suddenly she found she had turned the last corner and Nightingale House was before her. She nearly stood on the brakes in surprise. It was an extraordinary house, an immense Victorian edifice of red brick, castellated and ornate to the point of fancy, and crowned with four immense turrets. It was brightly lit in the dark January morning and after the gloom of the road it blazed at her like the castle from some childhood mythology. An immense conservatory was grafted onto the right side of the house, looking, thought Miss Beale, more appropriate to Kew Gardens than to what had obviously once been a private residence. It was less brightly lit than the house but through the faintly luminous glass she could discern the sleek green leaves of aspidistras, the harsh red of poinsettias and the yellow and bronze blobs of chrysanthemums.
Miss Beale's recent moment of panic under the trees was completely forgotten in her amazement at Nightingale House. Despite her normal confidence in her own taste, she was not entirely immune to the vagaries of fashion and she wondered uneasily whether in certain company it might not be proper to admire it. But it had become a habit with her to look at every building with an eye to its suitability as a nurse training school -- she had once, on a Paris holiday, found herself to her horror rejecting the Elysée Palace as unworthy of further notice -- and as a nurse training school Nightingale House was obviously quite impossible. She had only to look at it for the objections to spring to mind. Most of the rooms would be far too large. Where, for instance, would one find cosy offices for the principal tutor, clinical instructor or school secretary? Then the building would be extremely difficult to heat adequately and those oriel windows, picturesque no doubt if one liked that sort of thing, would keep out a great deal of light. Worse still, there was something forbidding, even frightening, about the house. When the Profession (Miss Beale, in defiance of an unfortunate comparison, always thought of it with a capital P) was climbing so painfully into the twentieth century, kicking away the stones of outworn attitudes and methods -- Miss Beale was frequently required to make speeches and certain pet phrases tended to stick in her mind -- it really was a pity to house young students in this Victorian pile. It would do no harm to incorporate a strong comment about the need for a new school in her report. Nightingale House was rejected even before she set foot in it.
But there was nothing to criticize in her welcome. As she reached the top step, the heavy door swung open letting out a gust of warm air and a smell of fresh coffee. A uniformed maid stood deferentially aside and behind her down the wide oak staircase, gleaming against the dark panelling like a Renaissance portrait in grey and gold, came the figure of Matron Mary Taylor, hand out-stretched. Miss Beale assumed her bright professional smile, compounded of happy expectation and general reassurance, and stepped forward to meet her. The ill-fated inspection of the John Carpendar Training School had begun.
Fifteen minutes later, four people made their way down the main staircase to the demonstration room on the ground floor where they were to watch the first teaching session of the day. Coffee had been served in Matron's sitting room in one of the turret blocks where Miss Beale had been introduced to the principal tutor, Miss Hilda Rolfe, and to a senior consultant surgeon, Mr. Stephen Courtney-Briggs. She knew both by reputation. Miss Rolfe's presence was necessary and expected, but Miss Beale was a little surprised that Mr. Courtney-Briggs was prepared to devote so much of his morning to the inspection. He had been introduced as Vice-Chairman of the Hospital Nurse Education Committee and she would normally have expected to meet him with other members of the committee for the summing-up discussion at the end of the day. It was unusual for a senior surgeon to sit in at a teaching session and it was gratifying that he took such a personal interest in the school.
There was room for three to walk abreast in the wide wood-panelled corridors and Miss Beale found herself escorted by the tall figures of Matron and Mr. Courtney-Briggs rather, she felt, like a diminutive delinquent. Mr. Courtney-Briggs, stoutly impressive in the formal striped trousers of a consultant, walked on her left. He smelt of after-shave lotion. Miss Beale could discern it even above the pervading smell of disinfectant, coffee and furniture cream. She thought it surprising but not disagreeable. The Matron, tallest of the three, walked in serene silence. Her formal dress of grey gaberdine was buttoned high to the neck with a thin band of white linen around the throat and cuffs. Her corn-gold hair, almost indistinguishable in colour from her skin, was combed back from the high forehead and bound tight by an immense triangle of muslin, its apex reaching nearly to the small of her back. The cap reminded Miss Beale of those worn during the last war by Sisters of the Army Nursing Service. She had seldom seen it since. But its simplicity suited Miss Taylor. That face, with its high cheekbones and large, slightly protuberant eyes -- they reminded Miss Beale irreverently of pale veined gooseberries -- could have looked grotesque under the fripperies of a more orthodox head-dress. Behind the three of them Miss Beale could sense the disturbing presence of Sister Rolfe, uncomfortably close on their heels.
Mr. Courtney-Briggs was talking:
"This influenza epidemic has been a thorough nuisance. We've had to defer taking the next set off the wards and we thought at one time that this set would have to go back. It was a close thing."
"It would be," thought Miss Beale. Whenever there was a crisis in the hospital the first people to be sacrificed were the student nurses. Their training programme could always be interrupted. It was a sore point with her, but now was hardly the time to protest. She made a vaguely acquiescent noise. They started down the last staircase. Mr. Courtney-Briggs continued his monologue:
"Some of the training staff have gone down with it too. The demonstration this morning is being taken by our clinical instructor, Mavis Gearing. We've had to recall her to the school. Normally, of course, she would be doing nothing but ward teaching. It's a comparatively new idea that there should be a trained instructor to teach the girls on the wards, using the patients as clinical material. Ward sisters just haven't the time these days. Of course the whole idea of the block system of training is relatively new. When I was a medical student the probationers, as we called them then, were taught entirely on the wards with occasional lectures in their own free time from the medical staff. There was little formal teaching and certainly no taking them off the wards each year for a period in the nurse training school. The whole concept of nurse training has altered."
Miss Beale was the last person to require an explanation of the function and duties of a clinical instructor or the development of nurse training methods. She wondered whether Mr. Courtney-Briggs had forgotten who she was. This elementary instruction was more suitable for new members of a Hospital Management Committee, who were generally as ignorant of nurse training as they were of anything else to do with hospitals. She had the feeling that the surgeon had something on his mind. Or was this merely the aimless chatter, unrelated to its hearer, of an egotist who could not tolerate even a moment without the comforting resonance of his own voice? If so, the sooner he got back to his out-patient session or ward round and let the inspection proceed without the benefit of his presence, the better for all concerned.
The little procession passed across the tessellated hall to a room at the front of the building. Miss Rolfe slipped forward to open the door and stood aside as the others entered. Mr. Courtney-Briggs ushered Miss Beale in before him. Immediately she was at home. Despite the anomalies of the room itself -- the two great windows with their spatter of coloured panes, the immense fireplace of carved marble with its draped figures supporting the chimney-piece, the high moulded ceiling desecrated with the three tubes of fluorescent light -- it was happily evocative of her own student days, an utterly acceptable and familiar world. Here was all the paraphernalia of her profession; the rows of glass-fronted cabinets, with their instruments placed in shining precision; the wall charts showing in lurid diagram the circulation of the blood and the improbable processes of digestion; the wall-mounted blackboard smeared with the dust of past lecture notes imperfectly erased; the demonstration trolleys with their linen-covered trays; the two demonstration beds, one containing a life-sized doll propped among the pillows; the inevitable skeleton hanging from its gibbet in forlorn decrepitude. Pervading all was the astringent and potent smell of disinfectant. Miss Beale breathed it in like an addict. Whatever faults she might later find with the room itself, the adequacy of the teaching equipment, the lighting or the furniture, she never felt other than at home in this intimidating atmosphere.
She bestowed on students and teacher her brief smile of reassurance and encouragement and perched herself on one of the four chairs placed ready at the side of the room. Matron Taylor and Miss Rolfe seated themselves on each side of her as quietly and unobtrusively as possible in the face of Mr. Courtney-Briggs's determination to be fussily gallant over pulling out the ladies' chairs. The arrival of the little party, however tactfully arranged, seemed temporarily to have disconcerted the nurse tutor. An inspection was hardly a natural teaching situation, but it was always interesting to see how long it took a tutor to re-establish rapport with her class. A first-class teacher, as Miss Beale knew from personal experience, could hold a class's interest even through a heavy bombing raid let alone the visit of a General Nursing Council Inspector; but she did not feel that Mavis Gearing was likely to prove one of that rare and dedicated band. The girl -- or woman rather -- lacked authority. She had a propitiatory air; she looked as though she might easily simper. And she was a great deal too heavily made up for a woman who should have her mind on less ephemeral arts. But she was, after all, merely the clinical instructor, not a qualified nurse tutor. She was taking the session at short notice and under difficulties. Miss Beale made a mental resolution not to judge her too harshly.
The class, she saw, were to practise feeding a patient by intra-gastric tube. The student who was to act as patient was already in one of the demonstration beds, her check dress protected by a mackintosh bib, her head supported by the back rest and a bank of pillows. She was a plain girl with a strong, obstinate and oddly mature face, her dull hair drawn back unbecomingly from a high nobbly forehead. She lay there immobile under the harsh strip lighting, looking a little ridiculous but strangely dignified as if concentrating on some private world and dissociating herself from the whole procedure by an effort of will. Suddenly it occurred to Miss Beale that the girl might be frightened. The thought was ridiculous but it persisted. She found herself suddenly unwilling to watch that resolute face. Irritated by her own unreasonable sensitivity, she turned her attention to the nurse tutor.
Sister Gearing cast an apprehensive and interrogative glance at the Matron, received a confirmatory nod and resumed her lesson.
"Nurse Pearce is acting the part of our patient this morning. We have just been going through her history. She is Mrs. Stokes, the fifty-year-old mother of four children, wife of a council refuse collector. She has had a laryngectomy for the treatment of cancer." She turned to a student sitting on her right.
"Nurse Dakers, will you please describe Mrs. Stokes's treatment so far."
Nurse Dakers dutifully began. She was a pale, thin girl who blushed unbecomingly as she spoke. It was difficult to hear her but she knew her facts and presented them well. A conscientious little thing, thought Miss Beale, not outstandingly intelligent, perhaps, but hard working and reliable. It was a pity that no one had done anything about her acne. She retained her air of bright professional interest whilst Nurse Dakers propounded the fictional medical history of Mrs. Stokes and took the opportunity of a close look at the remaining students in the class, making her customary private assessment of their characters and ability.
The influenza epidemic had certainly taken its toll. There was a total of seven girls only in the demonstration room. The two who were standing one on each side of the demonstration bed made an immediate impression. They were obviously identical twins, strong, ruddy-faced girls, with copper-coloured hair clumped in a thick fringe above remarkable blue eyes. Their caps, the pleated crowns as small as saucers, were perched well forward, the two immense wings of white linen jutting behind. Miss Beale, who knew from her own student days what could be done with a couple of white-tipped hat pins, was nevertheless intrigued by the art which could so firmly attach such a bizarre and unsubstantial edifice on such a springing bush of hair. The John Carpendar uniform struck her as interestingly out of date. Nearly every hospital she visited had replaced these old-fashioned winged caps with the smaller American-type which were easier to wear, quicker to make up, and cheaper to buy and launder. Some hospitals, to Miss Beale's regret, were even issuing disposable paper caps. But a hospital's nurse uniform was always jealously defended and changed with reluctance and the John Carpendar was obviously wedded to tradition. Even the uniform dresses were slightly old fashioned. The twins' plump and speckled arms bulged from sleeves of check pink gingham which reminded Miss Beale of her own student days. Their skirt lengths paid no concession to modern fashion and their sturdy feet were planted in low-heeled black lace-up shoes.
She glanced quickly at the remaining students. There was a calm, bespectacled girl with a plain intelligent face. Miss Beale's immediate reaction was that she would be glad to have her on any ward. Next to her sat a dark, sulky-looking girl, rather over-made-up and assuming an air of careful disinterest in the demonstration. Rather common, thought Miss Beale. Miss Beale, to her superiors' occasional embarrassment, was fond of such unfashionable adjectives, used them unashamedly and knew precisely what she meant by them. Her dictum "Matron recruits a very nice type of girl" meant that they came of respectable middle-class families, had received the benefit of grammar school education, wore their skirts knee length or longer, and were properly aware of the privilege and responsibilities of being a student nurse. The last student in the class was a very pretty girl, her blonde hair worn in a fringe as low as her eyebrows above a pert, contemporary face. She was attractive enough for a recruiting poster, thought Miss Beale, but somehow it was the last face one would choose. While she was wondering why, Nurse Dakers came to the end of her recital.
"Right, Nurse," said Sister Gearing. "So we are faced with the problem of a post-operative patient, already seriously under-nourished and now unable to take food by mouth. That means what? Yes, Nurse?"
"Intra-gastric or rectal feeding, Sister."
It was the dark sulky-looking girl who answered, her voice carefully repressing any note of enthusiasm or even interest. Certainly not an agreeable girl, thought Miss Beale.
There was a murmur from the class. Sister Gearing raised an interrogative eyebrow. The spectacled student said:
"Not rectal feeding, Sister. The rectum can't absorb sufficient nourishment. Intra-gastric feeding by the mouth or nose."
"Right, Nurse Goodale, and that's what the surgeon has ordered for Mrs. Stokes. Will you carry on please, Nurse. Explain what you are doing at each step."
One of the twins drew the trolley forward and demonstrated her tray of requirements: the gallipot containing sodium bicarbonate mixture for cleaning mouth or nostrils; the polythene funnel and eight inches of tubing to fit it; the connector; the lubricant; the kidney bowl with the tongue spatula, tongue forceps and gag. She held up the Jacques oesophageal tube. It dangled from her freckled hand obscenely like a yellow snake.
"Right, Nurse," encouraged Sister Gearing. "Now the feed. What are you giving her?"
"Actually, it's just warm milk, Sister."
"But if we were dealing with a real patient?"
The twin hesitated. The spectacled student said with calm authority: "We could add soluble protein, eggs, vitamin preparations and sugar."
"Right. If tube feeding is to continue for more than forty-eight hours we must ensure that the diet is adequate in calories, protein and vitamins. At what temperature are you giving the feed, Nurse?"
"Body temperature, Sister, 38° C."
"Correct. And as our patient is conscious and able to swallow we are giving her this feed by mouth. Don't forget to reassure your patient, Nurse. Explain simply to her what you are going to do and why. Remember this, girls, never begin any nursing procedure without telling your patient what is to happen."
They were third-year students, thought Miss Beale. They should know this by now. But the twin, who no doubt would have coped easily enough with a real patient, found it embarrassingly difficult to explain her procedure to a fellow student. Suppressing a giggle she muttered a few words at the rigid figure in the bed and almost thrust the oesophageal tube at her. Nurse Pearce, still gazing fixedly ahead, felt for the tube with her left hand and guided it into her mouth. Then shutting her eyes she swallowed. There was a convulsive spasm of the throat muscles. She paused to take breath, and then swallowed again. The tube shortened. It was very silent in the demonstration room. Miss Beale was aware that she felt unhappy but was unsure why. It was a little unusual perhaps for gastric feeding to be practised on a student in this way but it was not unknown. In a hospital it might be more usual for a doctor to pass the tube but a nurse might well have to take the responsibility; it was better to learn on each other than on a seriously ill patient and the demonstration doll wasn't really a satisfactory substitute for a living subject. She had once acted as the patient in her own training school and had found swallowing the tube unexpectedly easy. Watching the convulsive movements of Nurse Pearce's throat and swallowing in an unconscious sympathy she could almost recall, after thirty years, the sudden chill as the tube slid over the soft palate and the faint shock of surprise at the ease of it all. But there was something pathetic and disturbing about that rigid white-faced figure on the bed, eyes tight closed, bibbed like a baby, the thin tube dragging and wriggling like a worm from the corner of her mouth. Miss Beale felt that she was watching gratuitous suffering, that the whole demonstration was an outrage. For a second she had to fight an urge to protest.
One of the twins was now attaching a 20-ml. syringe to the end of the tube, ready to aspirate some of the gastric juices to test that the end of the tube had reached the stomach. The girl's hands were quite steady. Perhaps it was just Miss Beale's imagination that the room was preternaturally silent. She glanced across at Miss Taylor. The Matron had her eyes fixed on Nurse Pearce. She was frowning slightly. Her lips moved and she shifted in her seat. Miss Beale wondered if she were about to expostulate. But the Matron made no sound. Mr. Courtney-Briggs was leaning forward in his chair, his hands clasping his knees. He was gazing intently, not at Nurse Pearce, but at the drip as if mesmerized by the gentle swing of the tubing. Miss Beale could hear the heavy rasp of his breathing. Miss Rolfe sat bolt upright, her hands folded loosely in her lap, her black eyes expressionless. But Miss Beale saw that they were fixed, not on the girl in the bed, but on the fair and pretty student. And for a fleeting second the girl looked back at her, equally expressionless.
The twin who was administering the feed, obviously satisfied that the end of the oesophageal tube was safely in the stomach, lifted the funnel high over Nurse Pearce's head and began slowly to pour the milky mixture down the tube. The class seemed to be holding its breath. And then it happened. There was a squeal, high-pitched, horribly inhuman, and Nurse Pearce precipitated herself from the bed as if propelled by an irresistible force. One second she was lying, immobile, propped against her mound of pillows, the next she was out of bed, teetering forward on arched feet in a parody of a ballet dancer, and clutching ineffectually at the air as if in frantic search of the tubing. And all the time she screamed, perpetually screamed, like a stuck whistle. Miss Beale, aghast, had hardly time to register the contorted face, the foaming lips, before the girl thudded to the floor and writhed there, doubled like a hoop, her forehead touching the ground, her whole body twitching in agony.
One of the students screamed. For a second no one moved. Then there was a rush forward. Sister Gearing tugged at the tube and tore it from the girl's mouth. Mr. Courtney-Briggs moved resolutely into the mêlée, his arms wide. Matron and Sister Rolfe bent over the twitching figure hiding her from view. Then Miss Taylor rose and looked round at Miss Beale.
"The students...could you look after them please? There's an empty room next door. Keep them together."
She was trying to keep calm but urgency made her voice sharp. "Quickly please."
Miss Beale nodded. The Matron bent again over the convulsed figure. The screaming had stopped now. It was succeeded by a piteous moaning and a dreadful staccato drumming of heels on the wooden floor. Mr. Courtney-Briggs took off his coat, threw it to one side, and began to roll up his sleeves.
Muttering gentle encouragement, Miss Beale shepherded the little group of students across the hall. One of them, she was not sure which, said in a high-pitched voice: "What happened to her? What happened? What went wrong?" But no one replied. They moved in a shocked daze into the room next door. It was at the back of the house, a small, odd-shaped room which had obviously been partitioned from the original high-ceilinged drawing-room and which now served as the Principal Tutor's office. Miss Beale's first glance took in a business-like desk, a bank of green steel filing cabinets, a crowded notice board, a small pegboard fitted with hooks from which hung a variety of keys, and a chart along the whole of one wall showing the teaching programme and the progress of each individual student. The partition wall cut the mullioned window in half so that the office, unpleasing in its proportions, was also inconveniently dark. One of the students clicked down the switch and the central bar of fluorescence began to flicker into light. Really, thought Miss Beale, her mind clutching desperately at the comfort of its normal preoccupations, it was a most unsuitable room for a Principal Tutor, or for any other tutor, come to that.
This brief remembrance of the purpose of her visit brought a second's comfort. But almost immediately the awful reality of the moment reasserted itself. The students -- a pathetic and disorganized little bunch -- had crowded together in the middle of the room as if incapable of action. Glancing quickly around Miss Beale saw that there were only three chairs. For a moment she felt as embarrassed and nonplussed as a hostess who is not sure how she is going to seat all her guests. The concern wasn't altogether irrelevant. She would have to get the girls comfortable and relaxed if there were to be any chance of keeping their minds off what was happening next door; and they might be incarcerated for a long time.
"Come along," she said brightly. "Let's move Sister's desk back against the wall, then four of you can perch there. I'll take the desk chair and two of you can have the easy chairs."
At least it was activity. Miss Beale saw that the thin, fair student was shaking. She helped her into one of the easy chairs and the dark, sulky-looking girl promptly took the other. Trust her to look after number one, thought Miss Beale. She busied herself helping the other students to clear the desk and push it back against the wall. If only she could send one of them to make some tea! Despite her intellectual assent to more modern methods of combating shock, Miss Beale still put her faith in warm strong sweet tea. But there wasn't a chance of any. It wouldn't do to upset and alert the kitchen staff.
"Now suppose we introduce ourselves," she said encouragingly. "My name is Miss Muriel Beale. There's no need to tell you I'm a G.N.C. Inspector. I know some of your names but I am not really sure who is who."
Five pairs of eyes gazed at her with startled incomprehension. But the efficient student -- as Miss Beale still thought of her -- quietly identified them.
"The twins are Maureen and Shirley Burt. Maureen is the elder by about two minutes and has the most freckles. Otherwise we don't find it easy to tell them apart. Next to Maureen is Julia Pardoe. Christine Dakers is in one armchair and Diane Harper in the other. I'm Madeleine Goodale."
Miss Beale, never good at remembering names, made her customary mental recapitulation. The Burt twins. Bonny and bouncing. It would be easy enough to remember their name, although impossible to decide which was which. Julia Pardoe. An attractive name for an attractive girl. Very attractive if one liked that blonde, rather feline prettiness. Smiling into the unresponsive violet-blue eyes, Miss Beale decided that some people, and not all of them men, might like it very much indeed. Madeleine Goodale. A good sensible name for a good sensible girl. She thought she would have no difficulty in remembering Goodale. Christine Dakers. Something very wrong there. The girl had looked ill throughout the brief demonstration and now seemed close to collapse. She had a poor skin, unusually so for a nurse. It was now drained of colour so that the spots around the mouth and over the forehead stood out in an angry rash. She was huddled deep into the armchair, her thin hands alternately smoothing and plucking at her apron. Nurse Dakers was certainly the most affected of all the group. Perhaps she had been a particular friend of Nurse Pearce. Miss Beale superstitiously made a quick mental amendment of tense. Perhaps she was a particular friend. If only they could get the girl some hot reviving tea!
Nurse Harper, her lipstick and eye shadow garish on the whitened face, said suddenly: "There must have been something in the feed."
The Burt twins turned to her simultaneously. Maureen said:
"Of course there was! Milk."
"I mean something beside the milk." She hesitated. "Poison."
"But there couldn't be! Shirley and I took a fresh bottle of milk out of the kitchen fridge first thing this morning. Miss Collins was there and saw us. We left it in the demo room and didn't pour it into the measuring jug until just before the demonstration, did we, Shirley?"
"That's right. It was a fresh bottle. We took it at about 7 o'clock."
"And you didn't add anything by mistake?"
"Like what? Of course we didn't."
The twins spoke in unison, sounding sturdily confident, almost unworried. They knew exactly what they had done and when, and no one, Miss Beale saw, was likely to shake them. They weren't the type to be tormented by unnecessary guilt or fretted by those irrational doubts which afflict less stolid, more imaginative personalities. Miss Beale thought that she understood them very well.
0 Julia Pardoe said: "Perhaps someone else mucked about with the feed."
She looked round at her fellow students from under lowered lids, provocative, a little amused.
Madeleine Goodale said calmly: "Why should they?"
Nurse Pardoe shrugged and pursed her lips into a little secret smile. She said: "By accident. Or it might have been a practical joke. Or perhaps it was done on purpose."
"But that would be attempted murder!" It was Diane Harper who spoke. She sounded incredulous. Maureen Burt laughed.
"Don't be daft, Julia. Who would want to murder Pearce?"
No one replied. The logic was apparently unassailable. It was impossible to imagine anyone wanting to murder Pearce. Pearce, Miss Beale realized, was either of the company of the naturally inoffensive or was too negative a personality to inspire the tormenting hatred which can lead to murder. Then Nurse Goodale said drily: "Pearce wasn't everyone's cup of tea."
Miss Beale glanced at the girl, surprised. It was an odd remark to come from Nurse Goodale, a little insensitive in the circumstances, disconcertingly out of character. She noted, too, the use of the past tense. Here was one student who didn't expect to see Nurse Pearce alive again.
Nurse Harper reiterated stoutly: "It's daft to talk about murder. No one would want to kill Pearce."
Nurse Pardoe shrugged: "Perhaps it wasn't meant for Pearce. Jo Fallon was supposed to act as patient today, wasn't she? It was Fallon's name next on the list. If she hadn't been taken ill last night, it would have been Fallon in that bed this morning."
They were silent. Nurse Goodale turned to Miss Beale.
"She's right. We take it in strict turn to act as patient; it wasn't really Pearce's turn this morning. But Josephine Fallon was taken into the sick bay last night -- you've probably heard that we have an influenza epidemic -- and Pearce was next on the list. Pearce was taking Fallon's place."
Miss Beale was momentarily at a loss. She felt that she ought to put a stop to the conversation, that it was her responsibility to keep their minds off the accident, and surely it could only have been an accident. But she didn't know how. Besides, there was a dreadful fascination in getting at the facts. For her, there always had been. Perhaps, too, it was better that the girls should indulge this detached, investigatory interest, rather than sit there making unnatural and ineffective conversation. Already she saw that shock was giving way to that half-ashamed excitement which can follow tragedy, so long, of course, as it is someone else's tragedy.
Julia Pardoe's composed, rather childish voice went on: "So if the victim was really meant to be Fallon, it couldn't have been one of us, could it? We all knew that Fallon wouldn't be acting the patient this morning."
Madeleine Goodale said: "I should think that everyone knew. Everyone at Nightingale House anyway. There was enough talk about it at breakfast."
They were silent again, considering this new development. Miss Beale noted with interest that there were no protestations that no one would want to murder Fallon. Then Maureen Burt said:
"Fallon can't be all that sick. She was back here in Nightingale House this morning, just after eight-forty. Shirley and I saw her slipping out of the side door just before we went into the demo room after breakfast."
Nurse Goodale asked sharply: "What was she wearing?" Maureen was unsurprised at this apparently irrelevant question.
"Slacks. Her top coat. That red headscarf she wears. Why?"
Nurse Goodale, obviously shaken and surprised, made an attempt to conceal it. She said:
"She slipped those on before we took her to the sick bay last night. I suppose she came back to fetch something she wanted from her room. But she shouldn't have left the ward. It was stupid. She had a temperature of 103.8 when she was warded. Lucky for her that Sister Brumfett didn't see her."
Nurse Pardoe said maliciously: "Funny though, isn't it?" No one replied. It was indeed funny, thought Miss Beale. She recalled her long damp drive from the hospital to the nurse training school. The road was a winding one; obviously there would be a short cut through the trees. But it was a strange journey for a sick girl to make on an early January morning. There must have been some compelling reason to bring her back to Nightingale House. After all, if she did want something from her room there was nothing to prevent her asking for it. Any of the students would gladly have taken it across to the sick bay. And this was the girl who should have played the patient that morning, who should, logically, be lying next door among the tangle of tubes and linen.
Nurse Pardoe said: "Well, there's one person who knew that Fallon wouldn't be acting patient this morning. Fallon herself."
Nurse Goodale, white-faced, looked across at her.
"If you want to be stupid and malicious I suppose I can't stop you. But, if I were you, I would stop short of slander."
Nurse Pardoe looked unconcerned, even a little pleased. Catching sight of her sly, gratified smile, Miss Beale decided that it was time this talking stopped. She was searching for a change of topic when Nurse Dakers said faintly from the depths of her chair: "I feel sick."
There was immediate concern. Only Nurse Harper made no move to help. The rest gathered around the girl, glad of the chance to be doing something. Nurse Goodale said: "I'll take her to the downstairs cloakroom."
She supported the girl out of the room. To Miss Beale's surprise Nurse Pardoe went with her, their recent antagonism apparently forgotten as they supported Nurse Dakers between them. Miss Beale was left with the Burt twins and Nurse Harper. Another silence fell. But Miss Beale had learned her lesson. She had been unforgivably irresponsible. There was to be no more talk of death or murder. While they were here and in her charge they might as well work. She gazed sternly at Nurse Harper and invited her to describe the signs, symptoms and treatment of pulmonary collapse.
Ten minutes later the absent three returned. Nurse Dakers still looked pale but was composed. It was Nurse Goodale who looked worried. As if unable to keep it to herself, she said:
"The bottle of disinfectant is missing from the lavatory. You know the one I mean. It's always kept there on the little shelf. Pardoe and I couldn't find it."
Nurse Harper interrupted her bored but suprisingly competent recital and said:
"You mean that bottle of milky-looking mixture? It was there after supper last night."
"That's a long time ago. Has anyone been in that loo this morning?"
Apparently no one had. They looked at each other in silence.
It was then that the door opened. Matron came quietly in and shut it behind her. There was a creak of starched linen as the twins slipped from the desk and stood to attention. Nurse Harper rose gracelessly from her chair. All of them turned towards Miss Taylor.
"Children," she said, and the unexpected and gentle word told them the truth before she spoke.
"Children, Nurse Pearce died a few minutes ago. We don't yet know how or why, but when something inexplicable like this happens we have to call the police. The Hospital Secretary is doing that now. I want you to be brave and sensible as I know you will be. Until the police arrive, I think it would be better if we don't talk about what has happened. You will collect your textbooks and Nurse Goodale will take you to wait in my sitting-room. I shall be ordering some strong hot coffee and it will be brought up to you soon. Is that understood?"
There was a subdued murmur of, "Yes, Matron."
Miss Taylor turned to Miss Beale.
"I'm so very sorry, but it will mean your waiting here too."
"Of course, Matron, I quite understand."
Across the heads of the students their eyes met in bewildered speculation and wordless sympathy.
But Miss Beale was a little horrified to remember afterwards the banality and irrelevance of her first conscious thought.
"This must be the shortest inspection on record. What on earth will I say to the General Nursing Council?"
A few minutes earlier the four people in the demonstration room had straightened up and looked at each other, white-faced, utterly exhausted. Heather Pearce was dead. She was dead by any criteria, legal or medical. They had known it for the last five minutes but had worked on, doggedly and without speaking, as if there were still a chance that the flabby heart would pulse again into life. Mr. Courtney-Briggs had taken off his coat to work on the girl and the front of his waistcoat was heavily stained with blood. He started at the thickening stain, brow creased, nose fastidiously wrinkled, almost as if blood were an alien substance to him. The heart massage had been messy as well as ineffectual. Surprisingly messy for Mr. Courtney-Briggs, the Matron thought. But surely the attempt had been justified? There hadn't been time to get her over to the theatre. It was a pity that Sister Gearing had pulled out the oesophageal tube. It had, perhaps, been a natural reaction but it might have cost Pearce her only chance. While the tube was in place they could at least have tried an immediate stomach wash-out. But an attempt to pass another tube by the nostril had been frustrated by the girl's agonized spasms and, by the time these had ceased, it was too late and Mr. Courtney-Briggs had been forced to open the chest wall and try the only measure left to him. Mr. Courtney-Briggs's heroic efforts were well known. It was only a pity that they left the body looking so pathetically mangled and the demonstration room stinking like an abattoir. These things were better conducted in an operating theatre, shrouded and dignified by the paraphernalia of ritual surgery.
He was the first to speak.
"This wasn't a natural death. There was something other than milk in that feed. Well, that's obvious to all of us I should have thought. We'd better call the police. I'll get on to the Yard. I know someone there, as it happens. One of the Assistant Commissioners."
He always did know someone, thought the Matron. She felt the need to oppose him. Shock had left an aftermath of irritation and, irrationally, it focused on him. She said calmly:
"The local police are the ones to call and I think that the Hospital Secretary should do it. I'll get Mr. Hudson on the house telephone now. They'll call in the Yard if they think it necessary. I can't think why it should be. But that decision is for the Chief Constable, not for us."
She moved over to the wall telephone, carefully walking round the crouched figure of Miss Rolfe. The Principal Tutor was still on her knees. She looked, thought the Matron, rather like a character from a Victorian melodrama with her smouldering eyes in a deathly white face, her black hair a little dishevelled under the frilly cap, and those reeking hands. She was turning them over slowly and studying the red mass with a detached, speculative interest as if she, too, found it difficult to believe that the blood was real. She said:
"If there's a suspicion of foul play ought we to move the body?" Mr. Courtney-Briggs said sharply: "I have no intention of moving the body."
"But we can't leave her here, not like this!" Miss Gearing was almost weeping in protest. The surgeon glared at her.
"My dear woman, this girl's dead! Dead! What does it matter where we leave the body? She can't feel. She can't know. For God's sake don't start being sentimental about death. The indignity is that we die at all, not what happens to our bodies."
He turned brusquely and went over to the window. Sister Gearing made a movement as if to follow him, and then sank into the nearest chair and began to cry softly like a snuffling animal. No one took any notice of her. Sister Rolfe got stiffly to her feet. Holding her hands raised in front of her in the ritual gesture of an operating theatre nurse she walked over to a sink in the corner, nudged on the tap with her elbow, and began to wash her hands. At the wall-mounted telephone the Matron was dialling a five-digit number. They heard her calm voice.
"Is that the Hospital Secretary's office? Is Mr. Hudson there? It's Matron." There was a pause. "Good morning, Mr. Hudson. I am speaking from the ground floor demonstration room in Nightingale House. Could you please come over immediately? Yes. Very urgent. I'm afraid something tragic and horrible has happened and it will be necessary for you to telephone the police. No, I'd rather not tell you on the telephone. Thank you." She replaced the receiver and said quietly: "He's coming at once. He'll have to put the Vice-Chairman in the picture, too -- it's unfortunate that Sir Marcus is in Israel -- but the first thing is to get the police. And now I had better tell the other students."
Sister Gearing was making an attempt to control herself. She blew loudly into her handkerchief, replaced it in her uniform pocket, and raised a blotched face.
"I'm sorry. It's the shock, I suppose. It's just that it was all so horrible. Such an appalling thing to happen. And the first time I've taken a class too! And everyone sitting and watching it like that. The other students as well. Such a horrible accident."
"Accident, Sister?" Mr. Courtney-Briggs turned from the window. He strode over to her and bent his bull-like head close to hers. His voice was harsh, contemptuous as he almost spat the words into her face. "Accident? Are you suggesting that a corrosive poison found its way into that feed by accident? Or that a girl in her right mind would choose to kill herself in that particularly horrible way? Come, come, Sister, why not be honest for once? What we've just witnessed was murder!"
Copyright © 1971 by P. D. James
Copyright renewed © 1999 by P. D. James
Shroud for a Nightingale
The young women of Nightingale House are there to learn to nurse and comfort the suffering. But when one of the students plays patient in a demonstration of nursing skills, she is horribly, brutally killed. Another student dies equally mysteriously, and it is up to Adam Dalgliesh of Scotland Yard to unmask a killer who has decided to prescribe murder as the cure for all ills.
- Touchstone |
- 368 pages |
- ISBN 9780743219600 |
- September 2001