Hiding in Plain Sight.

I heard that it was easy to move about a hospital ward unreservedly, but I never actually believed it. I thought they must have measures in place to protect against this sort of thing, this kind of subtle infiltration. But here I am. A killer. Moving about freely and no one is taking any steps to prevent or at least limit, my access to the whole ward and the susceptible individuals on it.

I feel a small thrill as people, staff and patients in wheelchairs pass me by and I remain unnoticed, blending into the background. Hiding in plain site. My jacket protects me from feeling exposed to the environment. I feel safe.

As I move about, I see the patients who pass me by and the possibilities I am presented with almost break my focus. The whole ward is just ripe with poorly, immuno-compromised, fragile samples from the local population and I realise I am potentially faced with the prospect of not being able to decide who would be my most suitable victim.

I moved unnoticed past the nurses at the station in the middle of the ward and continue on around the corner, towards the isolation rooms at the opposite end. A few doctors walk past me, accompanied by nurses wheeling another patient on a bed. I catch a few lines of their conversation which causes me to shiver.

“…but I’m not sure if that’s the best treatment. She is already showing signs of deteriorating and I don’t think we need the results from the abdominal x ray to show us what we already suspect.”

“No, I agree with you. So, shall I just change it to Metronidazole then?”

“Yes, and add Vancomycin alongside that. Hopefully combined she should show some signs of improvement in the next forty eight hours.”

I feel a measure of gratitude that I lose track of the conversation as I move away, but I hear enough to know that whomever they were talking about is quite unwell. That must be why they are moving them off the ward.

But well or not, it doesn’t change what I have to do. I know that everyone from the nurses to the domestic staff doesn’t and wouldn’t understand. At the end of the day I am only doing what I have to. The only thing I know how to do.

They could stop me if they really wanted to, of course. Even if they didn’t stop me, they could certainly limit my ability to move around freely. But still they don’t seem to be taking these kinds of situations seriously enough, or at least as seriously as they should be.

I know they supply information about patient safety often enough to the staff, whether through leaflets or presentations. I know it’s up there with fire safety and de-escalation techniques, so they don’t have any excuse not to be paying attention to me. But still, here I am, outside the isolation room furthest from the ward entrance and I have not seen or sensed any kind of preventative measures.

I thought that after all the bad press hospitals had received over the last few years that my being here would have been made slightly more difficult. It was a memo from the Government which implied that the whole of the health service was at risk of being ‘institutionally polluted’ with my kind. My kind! The whole statement is positively offensive.

Either way, it seems in my opinion that society has turned into some sort of Darwinian nightmare in which the fittest, such as myself, prosper mightily whilst the old and weak are tossed aside as of no value. And that situation serves me and what I am about to do just fine.

I can see her lying on the bed, all manner of medical devices intrinsically intertwined over and around her body. Pumps for fluid, pumps for pain killers and pumps for nutrition. All blinking lights and quiet servo motors constantly aiding in the continued endeavour of supporting life. My thus far stealthy infiltration of the hospital ward still unnoticed, I loiter outside her side room door, taking in the environment in front of me.

Surprisingly for a hospital side room, it appears uncluttered. Other than the infusion devices, there is only the bed in the centre against the far wall, a locker to the right of the bed head and a table to the left. A small hand wash basin is present to the right of the door where I am, with a shelf just above it housing what appear to be various items for personal hygiene.

A patient call alarm buzzes in the background, breaking my perusal of the room and causing me to consider what my next move is going to be now that I am here. I thought that I would be able to complete my duty and do what I came here to do without hesitation. But now I am here, I find myself more wary of what I am about to do.

I though the infiltration of the ward would be the hardest part, not carrying out the duty I am here alone to do.

And then, it hits me. I am here alone. All alone. Suddenly I am no longer wary, but afraid.

I shouldn’t be here alone. That’s the whole point. I should have support all around me, encouraging me to carry out my duty and condemn this woman to varying degrees of suffering, discomfort and general unpleasantness.

It takes me a few moments to work out then why I am on my own. I didn’t notice anything when I entered the ward, but I realise now I was so full of petulant arrogance that I was convinced it wasn’t here.

But it is here. I see it to the left of me, through the small window on the doors which lead to another ward and the sight makes my calm façade finally begin to crack. It is coming for me. I thought I had made it disregarded and unseen, but that couldn’t be further from the truth.

Maybe it has just taken them a while to realise I am here. Maybe they have had other incidents elsewhere in the hospital which has increased their level of awareness and caution. But they wouldn’t be making a huge point to alerting patients of the potential risks to their safety whilst they are in hospital. They wouldn’t have signs up with my picture on, stating that I am a risk to them. I had been convinced by recent events in another hospital which my brothers’ were involved in, that the Government’s suggested Stalinist control of hospitals and my brothers conviction that a slowly occurring collapse of the ethic of caring that was first promulgated by that paragon of virtue, Florence Nightingale, had opened the doors up wide to this kind of orchestrated, co-ordinated attack.

But I am so very, very wrong. Not only can I see that they are prepared for the events I was so close to putting in motion, but they are resolute in their resolve that situations like this can never happen anymore.

I face it in horror as they walk through the doors. They have come fully prepared. It’s almost as if they knew I would be here.

I realise no matter where I move to now, they will catch me eventually. I’m trapped. This is the end of the line. I now see that they take me and my kind more seriously than I ever realised.

At one time, we were everywhere and we considered our propagation unstoppable. I now realise we are far from unstoppable. We are under threat of extinction.

The machine towers over me, blocking out any light. I see the domestics move around it to place their mops and buckets on the floor beside the door where I am present.

It is a clear, colorless and odorless liquid with a pH of 2.5-3.0. It is free from alkyl phenol.

And soon the air will soon be thick with it, thick with a peroxide-based fast-acting surface sporicide which is effective at killing spores, bacteria and viruses.
Within ten minutes, I will be inactive and unable to play my part. Once upon a time, we were resistant to most commercially available surface disinfectants but as we evolved, so did they and their methods of termination.

I realise now, the patient in the room in front of me is the last one on the ward. The others I passed on my way in on the updraft of breeze caused by the opening doors were on their way off the ward. You cannot have patients on the ward when you are about to use hydrogen peroxide. Its effects can be fatal.

Fatal to all of my brethren. Bacillus subtilis, Staphylococcus.aureus, Pseudomonas aeruginosa. And its effects will be fatal to me, Clostridium difficile. It will break down my protective jacket; my shell like coating which ordinarily protects me from disinfectant products and it will result in complete destruction of my sporicidal activity. It was something we weren’t prepared for in our eagerness to become the leading case of hospital acquired infection.

Yet as the odorless gas begins to pump into the air and I face my death, I know this will not be the end.

We are patient.

We have evolved over millennia. We will evolve again.

We are legion.