Mistakes, omissions, instructions misheard...no system is perfect, and culpability cannot always be assigned. In hospital such errors lead to death. Peter Owens knows that. He practises euthanasia without causing suspicion.
Nina Charan, a young and idealistic doctor, investigates an unexplained death. Overcome by circumstances, her naivety torn away, she finds herself on the brink of collusion. More
Nina Charan, a junior doctor, takes charge during the resuscitation of an elderly man. It is her moment of glory. He dies four weeks later, due to the negligence of a locum.
She moves on, and three years later is inspired by Peter Owens, her new registrar. He becomes her mentor. William Waybridge, a cancer patient, dies after his bowel is perforated during a procedure. The X-ray that might have led to an early diagnosis is delayed, fatally; the request form was lost.
Nina investigates but cannot identify the culprit. Peter and Nina take over the care of a 19 year old man, Jason, who has been sick since the age of 9 and who now requires a bowel transplant. Peter is promoted to consultant, and takes charge of Jason’s case. When pressed, Jason admits that he is tired of fighting his illness; he submitted to surgery at the time of his last crisis only to spare his mother, Deborah, the pain of grief.
‘Next time,’ he says, ‘let me die’.
A new doctor, Diana, arrives from Jamaica. She begins to suspect that Peter is biased in his treatment of the elderly, and quietly accumulates data to prove this. Nina is asked by a dying Professor of Medicine to put him out of his misery by prescribing an overdose of morphine; Nina refuses but is affected by the emotional and intellectual force of his argument – only those who are close to the suffering can truly decide if assisted suicide is justified.
Before he dies, of natural causes, he begs Nina to open her mind to the possibility of physician-assisted death. She is swayed. Peter then reveals to Nina that he and the professor formed the nucleus of a network of doctors who advocate assisted suicide and euthanasia. Only the best doctors are chosen to join this network, and Nina impressed the professor. Before dying he instructed to Peter to induct her. Peter shows Nina the missing x-ray request form – he removed it – it is a symbol of his trust, and hope, in her. Better that William Waybridge died without surgery, it would have extended and complicated the passage of his inevitable death. By degrees Peter educates Nina in methods of killing that leave little or no trace – errors, oversights…
Diana is put on ‘gardening leave’ just two days before she is due to present her incriminating data – the reason, allowing a religious reference to slip into a discussion with a patient’s relatives. Diana wears a crucifix, and is not embarrassed to display her Christianity. Jason deteriorates, but his progress onto the transplant waiting list is hindered. Diana confronts Nina, fearing that her colleague has become blind to Peter’s unethical practise. Jason confides to Nina that he has changed his mind – he now wants to fight to the end. Peter tells Nina that Jason has refused transplantation. Nina notices some irregularities on Jason’s drug chart. Could he really be planning to kill Jason – one so young?
She deduces that Peter worked as a locum in the hospital where she began her career, in Bristol. Nina reconnects with her prior commitment, to save life, not end it.
Nina confronts Peter. He threatens her, referring to a dossier of medical errors that can be attributed to her. She accuses him of megalomania, of manufacturing the idea of a ‘network’ to rationalise his actions. Jason dies, without a transplant. His mother is grateful to the team. He had had enough, she could tell.
Peter attends a national conference. He is surprised to see Diana arrive at the podium. She presents her data, anonymised but transparent. All eyes turn to Peter. He is not seen again. As the novel ends, Nina learns that the network probably does exist, but even now she remains ambivalent. Peter is in exile. Nina moves on, and shares her knowledge with no-one.