Burns thought. Court appearance at ten thirty. Formal remand. He would have to leave it to Skinner.
‘Eleven o’clock? You know the Dover Street station? Just ask for me at the front desk.’
‘Not often you meet that sort,’ said Skinner as they crossed the road to their car.
‘I like him,’ said Burns. ‘When we get those bastards, I think we might have a result.’
On the drive back to Dover Street DI Burns discovered by radio where the injured man had been taken and which constable was watching over him. Five minutes later they were in contact.
‘I want everything he possessed – clothes, effects, the lot – bagged and brought to the nick,’ he told the young officer. ‘And an ID. We still don’t know who he is. When you’ve got it all, call up and we’ll send a replacement for you.’
Mr Carl Bateman was not concerned either for the name and address of the man on the trolley, or yet who had done these things to him. His concern was keeping him alive. From the docking bay, the trolley had come straight through to the resuscitation room where the A and E team went to work. Mr Bateman was sure there were multiple injuries inflicted here, but the rules were clear: life-threatening first, the rest can wait. So he went through the ABCD procedure.
A is for airway. The paramedic had done a good job. Airway was clear, despite a slight wheezing. The neck was immobilized.
B is for breathing. The consultant had the jacket and shirt torn open, then went over the chest area both front and back with a stethoscope.
He detected a couple of cracked ribs but they, like the mashed knuckles of the left hand and the broken teeth in the mouth, were not life-threatening and could wait. Despite the ribs, the patient was still breathing regularly. There is little point in performing spectacular orthopaedic surgery if the patient decides to stop breathing. The pulse worried him; it had left the normal 80 mark and climbed above 100. Too fast: a probable sign of inner trauma.
C is for circulation. In less than a minute, Mr Bateman had two intravenous catheters in place. One drained off 20 millilitres of blood for immediate analysis; then, while the rest of the examination proceeded, a litre of crystalloid fluid went into each arm.
D is for disability. This was not good. The face and head were hardly recognizable as belonging to a human being and the Glasgow Scale showed the man was now 6 over 15 and fading dangerously. There was serious cerebral damage here, and not for the first time Carl Bateman thanked the unknown paramedic who had spent a few extra minutes getting the man to the Royal and its neuro unit.
He called up the scanner unit and told them he would have his patient there in five minutes. Then the consultant called his colleague Mr Paul Willis, the senior neurosurgeon.
‘I think I must have a major intra-cranial haematoma here, Paul. Glasgow is now at five and still dropping.’
‘Get him in as soon as you have a scan for me,’ said the neurosurgeon.
When he was knocked down the man had been wearing socks and shoes, underpants, shirt – open at the neck, trousers held up by a belt, jacket and a light raincoat. Everything below the waist was not a problem and had simply been pulled down. To prevent jolting of the neck and head, the raincoat, jacket and shirt were just cut off. Then everything was bagged, pocket contents still in place, and given to the delighted constable waiting outside. He was soon replaced and able to take his trophies back to Dover Street and an expectant Jack Burns.
The scanner confirmed Carl Bateman’s worst fears. The man was haemorrhaging into the brain cavity. The blood was pressing upon the brain itself with a force that would soon prove lethal or irreversible.
At eight fifteen the patient entered brain surgery. Mr Willis, guided by the scans that showed exactly where the intra-cranial pressure was being exerted, could reach the haematoma with a single insertion. Three small holes were drilled in the skull, then linked with saw-cuts to create a perfect triangle, the standard operation.
With this triangle of bone removed, the haematoma was drained of the blood causing the pressure, and the damaged arteries leaking into the brain cavity were tied off. With the blood sacs gone, the pressure was eased and the brain was able to expand back into the full space that had been its natural area.
The triangle of bone was replaced and the flap of scalp stitched over it. Heavy bandaging would keep both in place until nature could take its course and heal. Despite the damage, Mr Willis was hopeful that he had been in time.
The body is a weird contraption. It can die from bee stings or recover from massive trauma. When a haematoma is removed and the brain allowed to expand back to its full cavity size, patients can simply recover consciousness and perform quite lucidly within days. No-one would know for twenty-four hours, until the anaesthesia wore off. By day two, without recovery, there would be cause for concern. Mr Willis scrubbed off, changed and went home to St John’s Wood.
‘Bugger all,’ said Jack Burns, staring at the clothes and personal effects. The latter included a half-smoked pack of cigarettes, half a box of matches, assorted coins, a soiled handkerchief and a single key on a ribbon, apparently for a house door somewhere. These had come from the trousers. From the jacket, nothing. Whatever else the man had carried, the wallet must have contained it all.
‘A neat man,’ said Skinner, who had been examining the clothes. ‘Shoes, cheap and patched, but an effort has been made at a shine. Trousers, cheap, worn, but a crease down each front leg, made by an iron. Shirt, frayed at neck and cuffs, but also ironed. A man with no money, but trying to keep up appearances.’
‘Well, I wish he’d kept a credit card or a letter addressed to himself in a back trouser pocket,’ said Burns, who was still plodding through the endless form-filling required of today’s policeman. ‘I’ll have to log him as a UAM for the moment.’
The Americans would call him a John Doe. The London Met refers to an Unidentified Adult Male. It was still warm, but the night was pitch-black when the two detectives locked away the paperwork and saw they had time for a quick pint before going home.
A mileaway, the neat man lay face up in the intensive care unit of the Royal London, breathing shallow but regular, pulse still too high, checked every now and then by the night sister.
Jack Burns took a long draught of his beer.
‘Who the h
ell is he?’ he complained to no-one in particular.
‘Don’t worry, guv, we’ll find out soon enough,’ said Luke Skinner. But he was wrong.