Plymouth serves as the critical medical destination beyond Combe Island: when Dr. Speidel becomes seriously ill, he is transferred there by helicopter, and a special isolation unit receives him after he is diagnosed with SARS. The city is not depicted through streets or landmarks; its significance lies in the hospital care unavailable on the island, the controlled conditions imposed on Speidel’s family, and the uncertainty his transfer brings to the murder investigation and island quarantine.

Medical destination beyond Combe Island

The contrast is practical and stark. Guy Staveley considers Dr. Speidel too ill to be nursed on Combe Island, which has no facilities for caring for a seriously ill patient. A helicopter is summoned, and Speidel is taken to a hospital in Plymouth. The rapid transfer marks the limit of what the island’s medical arrangements can provide: Staveley can recognize the danger and arrange urgent transport, but continued treatment requires a hospital on the mainland.

The journey is initially understood as an emergency medical evacuation, not a police operation. Kate Miskin observes the helicopter’s arrival and notes that it is normally reserved for emergencies; Adam Dalgliesh explains that Speidel’s worsening condition is the reason for it. After Speidel has been brought out, the investigators watch the helicopter rise and wheel away. His departure removes a person whose account of the time of death matters to the inquiry, even as his condition makes further questioning impossible for the time being.

SARS treatment and family access

The transfer carries consequences beyond Speidel’s individual care. After he reaches Plymouth, Guy Staveley reports that Speidel has SARS and is in a special isolation unit, where he is receiving care. Speidel remains seriously ill. His wife and some members of his family are arriving from Germany, but they will see him only under controlled conditions. The hospital’s isolation arrangements therefore shape both treatment and contact with his relatives: the family can come to Plymouth, but illness restricts the terms on which they can be with him.

The diagnosis also changes how the transfer is understood on Combe Island. Staveley says he had considered SARS a possibility when he sent Speidel to Plymouth; once it is confirmed, the island’s medical situation becomes more difficult. He identifies Adam Dalgliesh and Jo Staveley as especially at risk because they had close contact with Speidel: Dalgliesh helped him after he collapsed and accompanied him back to his cottage, while Jo nursed him. Plymouth is thus the place where Speidel receives specialist isolation, but the infection does not remain a problem confined to the hospital. Its consequences reach back to the island through the people who may have been exposed.

The limits and costs of transfer

The prospect of transfer is not straightforward for everyone who becomes ill. Guy Staveley warns that Adam Dalgliesh may also need to be taken by helicopter to Plymouth if his condition worsens. Meanwhile, he explains that close person-to-person contact is the principal known route of SARS transmission, while acknowledging uncertainty about other possible forms of spread. He recommends voluntary quarantine for everyone on Combe Island for about ten days, including those not known to have been in close contact with either patient. A hospital journey is therefore part of a larger public-health response: treatment for the sick must be balanced against the danger of carrying infection between the island and the mainland.

As Dalgliesh’s illness intensifies, the possibility of being moved becomes personally urgent. His disjointed memories of Tuesday morning include being helped into a buggy, taken across the island, and put to bed by a masked, white-coated figure. He remembers insisting that he must remain on Combe Island, partly because leaving would make it harder for Emma Lavenham to find him and partly because the lighthouse investigation remained unfinished. By Wednesday, he is weak, coughing painfully, and receiving oxygen under the care of Guy Staveley and Jo Staveley. Staveley has said that transfer to Plymouth may be necessary if Dalgliesh worsens, but the account of this period places him in the island sickroom. The possibility of the mainland hospital hangs over his treatment without becoming the described outcome.

Narrative significance

Plymouth is defined by what Combe Island cannot offer: hospital care for a seriously ill patient and a special isolation unit for someone diagnosed with SARS. The helicopter links the two settings, carrying Dr. Speidel away from the inquiry while making the risks of infection more immediate for those who remain. For the investigation, his absence matters because his evidence about the time of death is important; for the island community, the diagnosis prompts quarantine and complicates the possibility of outside assistance. The city remains offstage, but its medical role exposes the costs of the island’s remoteness and makes transfer, isolation, and remaining in place competing pressures rather than simple alternatives.