Pandora's Helix

Three

Neef did not sleep well. The day’s events threw up a montage of images that haunted the margins between sleep and wakefulness making sure that complete rest did not come. Mrs Torrance’s gimlet eyes accused him; “Going to let her die,” said her husband over and over again. “Just a bairn,” said Frank MacSween as his face materialised from Melanie Simpson’s empty chest cavity.

It wasn’t until the first reassuring grey light of morning sneaked in through the vee in the curtains that Neef fell soundly asleep. Little more than an hour later, Dolly woke him with her paw on his cheek. She had decided that it was breakfast time.

“You look tired,” said Kate Morse when Neef came into the duty room.

“Didn’t sleep well,” said Neef picking up the night report.

“Lisa died at three this morning,” said Kate. “Her parents and Lawrence were with her.”

Neef nodded.

“A solicitor employed by the Evening Citizen called to say that arrangements had been made to transfer Tracy Torrance to the Randolf Clinic this afternoon.”

Neef nodded again.

“Did you see the TV report last night?” asked Kate.

“I did,” said Neef. “I also had a call from Ms Sayers.”

“Who?”

“Eve Sayers, the Citizen reporter who’s doing the story.”

“Hasn’t she done enough damage?” exclaimed Kate. “These people are beyond the pale!”

“Actually, she phoned to apologise.”

“She what?” exclaimed Kate.

“She wanted to apologise for what she was doing to us.”

“Do you think she was genuine?” asked Kate.

“I was suspicious at first but I think maybe she was. I couldn’t figure out an alternative angle.”

“A reporter apologising? Whatever brought that on?”

“I think Neil may have had something to do with it,” said Neef. “She met him during the course of a somewhat forced guided tour I subjected her to yesterday. The pair of them hit it off. She wants to come and visit him.”

“And what did you say?” asked Kate in tones that left Neef in no doubt what she thought of the idea.

“I said that I didn’t think it was a good idea.”

“It isn’t.”

“She was persistent. I said I’d think about it.”

Kate Morse’s look said what she thought.

“I know, I know,” said Neef. “But Neil doesn’t have anyone and he obviously took a shine to her yesterday.”

“You’re the boss,” said Kate. “But have you thought how having a journalist like her around the place is going to affect the staff? Everyone is going to be on their guard in case they make some little mistake and find themselves on the front page of the Citizen.”

“I must confess I hadn’t considered that. I was assuming that she would be coming here in a strictly non-professional capacity.”

“At the very least, I think we’d have to be assured of that,” said Kate. “And another thing.”

“What?”

“If she visits Neil and they do hit it off, she has to keep coming back. She doesn’t visit a couple of times and then disappear when the novelty has worn off.”

“Absolutely.”

“Even when the going gets tough,” added Kate with a meaningful look.

“That goes without saying.”

“I still think you should make sure she understands all the implications.”

“It may not come to that,” said Neef. “I won’t decide anything until I’ve seen the story in the Citizen this evening. She said she was going to do her best to back-pedal on it.”

“I think you have to consider...”

“What?”

“Ms Sayers may have decided to get herself a story about a child oncology unit. She may be using Neil to get on the inside, so to speak.”

Neef nodded and said, “To my shame, I thought of that too. I even considered that the whole apology scenario was part of some con.”

“The safe course...”

“Is to say, no. I know, Kate. “It’s just that I’m not sure. She may be entirely genuine and to dismiss her intentions unfairly...”

“Would be unforgivable and not you at all,” smiled Kate. “Up to you.”

“Let’s forget it for the moment. I am sure there are more pressing things to consider?”

Kate Morse nodded, adjusted her spectacles and opened her day folder. “Lawrence suggested we have the meeting you wanted at four this afternoon when he comes back on duty?”

“Fine.”

“We have an admission at eleven this morning, a twelve year old boy with a brain tumour, referred to us by Dr Sleigh at the Infirmary.”

“Yes, I remember. He phoned me. There’s some indecision about whether surgery is possible or not.”

“That’s the one,” said Kate. “Thomas Downy. And of course, Tracy Torrance. Will you be here for the hand-over?”

“Yes,” said Neef, without hesitation. “I think I’d better be.”

“They’re coming at two. We can expect a media circus outside, I suppose.”

“I don’t doubt it. Do we have Thomas Downy’s notes?”

“I put them on your desk.”

Neef walked round the unit before going to his office. He preferred this informal approach to ward rounds, rather than the traditional scenario of consultant followed by entourage of juniors, still favoured by many of his colleagues. Or maybe that was being unfair to them. The special nature of his own unit permitted a different approach. In a high turn-over general ward it was probably necessary for consultants to be continually briefed on who they were seeing and what was wrong with them. The population in his own unit was more stable. He knew all his patients well and liked wandering round on his own.

By ten thirty, Neef had made a thorough examination of Thomas Downy’s case notes, his X-rays and CT scans. He understood the problem. Here was a borderline case for surgery with a cerebellar tumour in such an awkward position that attempts to remove it might well cause irreparable damage or even death on the table. He would have to pass the buck entirely to the neuro-surgeon. In the meantime, he would assess the boy’s physical condition when he was admitted and get some MRI scans done just in case the surgeon decided to take the chance. He called Ann Miles on the desk intercom and asked her to contact Norman Beavis, the neuro-surgeon contracted to the Trust.

There weren’t enough neurosurgical cases in St George’s to warrant the full time services of a neuro-surgeon so the Trust had contracted for the part time services of Norman Beavis FRCS. Ann Miles called back to say that Beavis’ secretary had been informed. Mr Beavis was operating this morning but would return his call this afternoon.

The Downy boy was admitted at eleven and made welcome and comfortable by the nurses before the two housemen examined him and ran preliminary tests. Neef was in attendance but took a back seat. He was pleased with the way the new housemen were shaping up. They both chatted to the boy, disguising the clinical nature of their task with talk of football. On finding out that Thomas Downy was an Arsenal supporter, good natured rubbishing of his allegiance broke out with Samuels favouring Manchester United and John Duncan, who came from Glasgow, rooting for Celtic. Neef noticed the boy smile for the first time as Samuels and Duncan argued with each other in true pantomime fashion.

Neef ate lunch in the hospital restaurant. He was feeling slightly nervous about the afternoon encounter with the Torrances and this had dulled his appetite. He opted for a cellophane wrapped salad from the self service counter and a cup of tea. He was joined at the table by Frank MacSween.

“I called University College about the Simpson lassie,” said MacSween.

“You told them about the tumours?”

MacSween smiled wryly and said, “I think at first they thought I was complaining about the patient not being sent here in the first place. They were at great pains to assure me that no one had realised she had cancer. She was admitted as an ID case with pneumonia.”

The University College Hospital Trust and the St George’s Trust had a set of agreements about what kind of patients they could deal with. Infectious diseases went to University College, child cancer cases came to St George’s”

“Probably your Scots accent,” said Neef. “They’ll be expecting a bill.”

“I shall treat that with the contempt it deserves,” said MacSween. “Anyway I explained that the Public Health people would have to be informed as the cause of the cancer would have to be identified quickly. They said they’d be quite happy about that so I did, this morning.”

“Good.”

“Public Health are sending someone over this afternoon to take a look at the pathological material and then they’ll get on to it. University College also sent Melanie Simpson’s notes over this morning just in case the PH people want them.”

“Anything interesting?”

MacSween shook his head. “Not a thing. Bairn’s hardly had a day’s illness in her life and then, zap, she’s dead.”

Neef played with his fork thoughtfully. “You said the bugs lab failed to find any evidence of bacterial pneumonia so they were assuming it was a virus?”

“That’s right.”

“Are you happy with that?”

“I think so; it’s always a bit iffy when a diagnosis has to be made through a process of elimination but the bilateral consolidation was classic so I wouldn’t argue against it. Why do you ask?”

Neef shook his head as if dismissing some vague notion he had no wish to expand on and said, “Just a thought.”

“Well, we’ll see what the virology lab has to say and then we’ll get a clearer picture,” said MacSween.

Neef and MacSween looked at each other and broke into grins. “No, we won’t,” they both intoned together.

“They’ll find half a dozen everyday viruses of the cold and flu variety and invite us to pick one as the cause,” said Neef.

MacSween nodded. Viruses were always much more difficult to pinpoint than bacteria.

Neef looked at his watch and rose from the table. “They’re coming for Tracy Torrance this afternoon,” he explained. “She’s going to the Randolf Clinic.”

MacSween nodded. “The show must go on,” he said.

“Keep me informed about the Simpson case will you?”

“I will. Betty wants you to lunch on Sunday. Bring a friend, if you have any left when the newspapers are finished with you.”

“And with that happy thought...” said Neef, getting up. He smiled his good bye.

At five minutes to two, Neef straightened his tie and put on his jacket. He went over to his office window and saw activity around the front gate. A television camera crew were in place and technicians were milling around with their hands in their pockets. He saw a woman holding a microphone look at her watch and then primp at her hair with her free hand. A few minutes later a black Ford Granada swept into view and turned in through the gates. It stopped outside the front door and Mr and Mrs Torrance got out, accompanied by a tall, fat man with thinning hair which he kept plastered across his scalp with the palm of one hand. In the other, he carried a brief case. He shepherded the Torrances inside and turned to face reporters alone. He was standing on the second step leading up to the front entrance. The reporters below him looked like seals waiting to be fed, Neef thought.

As the brief interview ended and the fat man disappeared inside, Neef checked with Ann Miles that Tracy was ready.

“All ready,” she affirmed. “Shall I show them straight in when they arrive?”

“Please.”

A few moments later, the door opened and the Torrances were ushered in, accompanied by the fat man who introduced himself as Lewis Milligan.

“I represent the Evening Citizen,” announced Milligan. “In this instance, I’m also acting on behalf of Mr and Mrs Torrance.”

“Tracy is all ready for you,” said Neef. “We’re all sorry to see her go. We hope everything goes well for her at the Randolf Clinic.”

“Thank you Doctor,” said Milligan. “I’m sure it will.”

The Torrances seemed content to leave everything to Milligan. They stood in the background with a barely suppressed look of smugness on their faces.

A knock came to the door. Kate Morse came in holding Tracy in her arms. Another nurse stood behind her with a plastic bag containing Tracy’s belongings.

Mrs Torrance made a great show of taking Tracy into her arms and smothering her with affection. Tracy seemed unimpressed, preferring instead to chew a corner of Mr Raggins. As she was hoisted over to her mother’s other shoulder, Tracy dropped the doll and stretched out her arm in silent anguish. Milligan picked it up and eyed it distastefully. “You’re going to have lots of new dollies at the Randolf,” he said in what he imagined were child-friendly tones. Tracy did not respond. When it began to look as if he wasn’t going to return the doll, Kate Morse stepped in and took it from him. She gave it back to Tracy and said to Milligan in tones that threatened to freeze him, “Mr Raggins goes.”

As the party started to troop out of Neef’s office, Mrs Torrance handed Tracy over to her husband, who seemed equally determined to mount a display of affection for the onlookers. Mrs Torrance was the last to leave the room in front of Neef. She paused for a moment to let the others get ahead then turned round to face him. He saw the gimlet eyes that had haunted his dreams the previous night.

“You must really hope she dies,” she hissed.

“You can’t believe that, Mrs Torrance,” said Neef, trying to appear calm when he felt as if he’d been kneed in the groin.

“Stands to reason. If she dies, you were right. If she lives, you were wrong.”

“No one’s infallible, Mrs Torrance. I certainly don’t pretend to be. I would be absolutely delighted to be proved wrong over your daughter. Please believe me.”

Mrs Torrance gave a sneering look of disbelief then left to catch up with the rest.

Neef closed the door of his office and went over to the small wash basin in the corner. He splashed water up into his face for a few moments then rested his hands on the edge of the basin. He saw that they were shaking slightly.

He heard the door open quietly behind him but didn’t turn round. He knew it was Ann Miles.

“Are you all right?” she asked.

“With water dripping from his face, he looked at Ann in the mirror and said, “That bloody woman really believes I want her daughter to die.”

“She’s distraught,” said Ann. “She doesn’t know what she’s saying. You have to make allowances. You know that.”

Neef nodded, still with his back to her. He patted his face dry and said, “Sometimes I think my capacity for ‘making allowances’ has been stretched to its limit.”

Ann Miles said, “My husband’s an accountant. He thinks his job is stressful. He doesn’t know the half of it.” With that, she backed out of the door.

Neef’s phone rang. It was Norman Beavis. He would come in to see the Downy boy on the following morning if that was convenient. “I’ve pencilled him into the theatre schedule for Thursday,” said Beavis.

“Good,” said Neef. “I think he’s borderline but see what you think.”

Kate Morse and Lawrence Fielding arrived promptly at four. Lawrence, a sallow skinned, serious looking man, good at his job but lacking in humour, stood aside to let Kate enter first then closed the door behind him with meticulous care before sitting down beside her. He always reminded Neef of a deferential butler but he was a clever man and a good doctor.

“I just wanted to have a word with you both about a proposed trial that would involve our patients.” said Neef.

“Kate said something about Gene Therapy,” said Lawrence.

“That’s right. A company called, Menogen Research have developed a genetically based strategy for tumour treatment. They have satisfied the relevant control bodies and safety committees and obtained permission for human trials to commence. They still have to present their strategy to our own safety and ethics committee but, assuming they cross that hurdle, what do you think?”

“I’m not at all sure what it would involve,” said Kate.

“Nor me,” agreed Lawrence.

“Then we’re all agreed on that,” smiled Neef. “It’s a brand new area for all of us. I’ll know more when I meet the people from Menogen. I think the best we can do in the meantime is agree in principle if we can?”

“I’m all in favour of trying new things, providing they have a reasonable chance of success and aren’t just being used to provide data for some boffin’s pet project,” said Kate.

“There’s the parents to consider too,” said Lawrence. “It’s so easy to give people false hope as soon as you start talking about ‘new treatments’. The words immediately translate into ‘miracle cure’.”

“And our parents are particularly vulnerable,” added Kate. “They’re on a hair trigger to clutch at any straw.”

“Good points,” said Neef. “So we can agree that unless there is a real chance of our patients” condition being significantly improved, I should say, no?”

Both Kate and Fielding nodded.

“Is the treatment itself distressing?” asked Kate.

“I believe not, but that’s something I will verify. The kids have enough on their plate with chemotherapy and radiotherapy. There would have to be a terribly good reason to ask them to cope with anything more.”

Lawrence Fielding said, “I’ve been doing some general reading about Gene Therapy since Kate told me about our possible involvement.”

“Me too,” smiled Neef.

“There seems to be an element of danger involved in it. People keep stressing that it’s an unknown quantity.”

“That’s true,” agreed Neef. “But the major concern seems to centre on the possibility of actually causing cancer in patients undergoing therapy.”

“And ours already have it,” said Kate.

“A strange comfort to take, I admit,” said Neef. “But I do think that the fact that the kids who might be involved in any such trial would probably be the ones with the worst prognoses must play a part in our thinking.”

“Nothing left to lose,” said Fielding.

“Yes,” said Neef.

“As long as that’s not the only consideration,” said Kate. “They are not laboratory animals to be as used as such by these Menogen people.”

“Absolutely not,” said Neef.

Fielding nodded.

“Can I take it then that we’re all in favour of the trial, providing that there is a real chance of tumour regression and that the new treatment does not put our children under unreasonable stress or have any horrendous side effects?”

“Yes,” said Fielding.

“Good. I’ll let you know when I have more details.”

As soon as Kate and Lawrence Fielding had left, Ann Miles came in to report that Andrew D’Arcy had called to say that the people from Menogen Research would be coming the following day. “He wanted to know if you could be free at ten a.m. I told them you could,” said Ann. “I’ve marked it in your diary.”

“Thanks Ann. By the way, Mr Beavis has pencilled Thomas Downy in for surgery on Thursday; I’d better see his parents beforehand. Could you have them come in tomorrow afternoon?”

“Will do.”

Ann Miles had scarcely left the room when she was back in again. She closed the door behind her before saying, “There’s a Doctor Lennon from the Public Health service outside. He’s come on the off chance of having a word with you?”

“Send him in,” said Neef. “I think I know what it’s about.”

A short, bald man in his late fifties, wearing a dark suit and carrying a briefcase with combination locks on it came into the room and held out his hand. “I’m Lennon,” he said in a West Country accent that belied his appearance. He spoke like a farmer but looked like a bank manager, thought Neef.

“I’m an epidemiologist. I’ve just been having a word with your Dr MacSween.”

“About Melanie Simpson?”

Lennon nodded. “A disturbing case. I understand from Dr MacSween that you were present at the post-mortem. You saw the girl’s lungs for yourself?”

“That’s right. Frank called me down when he came across the tumours.” said Neef.

“As you’re a cancer specialist, Doctor, I thought I would ask if you have had any thoughts on what might have caused Melanie’s condition?”

Neef shook his head slowly, “I’m afraid not,” he said. “As you know, it’s practically unheard of for a child to develop bronchial carcinoma. Apart from that, the tumours were present in such numbers that it couldn’t have been spontaneous. There must have been some highly carcinogenic agent involved.”

Lennon nodded his agreement. “No doubt about it,” he said. “The puzzle is that the cancer was confined to the lungs,” he added thoughtfully. “If a powerful carcinogen was involved one might have expected tumours throughout the body.”

“A good point,” conceded Neef. “And if it had been a radiation source we might reasonably have expected to see some signs of epidermal damage but as far as I could see, the girl’s skin was unblemished.”

“A puzzle,” agreed Lennon. “That leaves us looking for some powerful carcinogen that Melanie must have inhaled,” he said.

“Like a gas, or fumes of some sort,” said Neef. “Or maybe dust particles.” He remembered MacSween’s comments about asbestos.

“The lab didn’t find any evidence of fibrous material in her lungs,” said Lennon. “So I think we can rule out particulate matter. That just leaves chemical fumes.”

“So where will you begin to look?” asked Neef.

Lennon smiled and said, “Good question. Where would a perfectly ordinary little girl, living with her mum and dad in a semi on Langholm Crescent come across a highly toxic gas?”

“These days you hear so much about poisonous chemicals being dumped here, there and everywhere that I suppose we shouldn’t be too surprised when this sort of thing happens,” said Neef.

“Sad but true,” agreed Lennon, getting up. “Well, it’s my job is to find and identify the damned source before anyone else is harmed.”

“Are you working alone?” asked Neef.

“There will be three of us. My colleagues are interviewing Melanie’s parents at this very minute. With the information they collect, we’ll try to build up a picture of her movements over the past few weeks and from that we may get some clue as to where she might have contaminated herself.”

“I sincerely wish you luck,” said Neef.

“Thanks,” said Lennon. “I’ll keep in touch.”

Kate Morse appeared, holding the first edition of the Evening Citizen.

“How bad is it?” Neef asked her.

“Well they ran the story but it’s not nearly as awful as it might have been. She’s toned it down quite a lot.”

“Good,” said Neef.

“They’ve also included an interview with the director of the Randolf. He more or less says that it’s a chance in a million that Tracy is going to benefit from the treatment but of course, the paper has to point out that even a chance in a million must be taken if a child’s life is at stake. What price life?” she added in a deliberately pompous, self-righteous tone of voice.

“We can probably tell them that, right down to the last penny,” said Neef wryly.

“Anyway, I don’t think the nurses will lynch Ms Sayers if you decide to let her visit Neil,” said Kate. “It could have been a whole lot worse.” She put the paper down on Neef’s desk.

“I haven’t decided finally,” said Neef, “but thanks for the assurance. I’m meeting with the people from Menogen Research tomorrow morning so I should have some more gen about the trial.”

“Good,” said Kate. “I was just saying to Charlie last night, it would be a wonderful boost to morale if something good came out of this.”

“Wouldn’t it just,” smiled Neef.

Neef read the article for himself when Kate had left and agreed with her interpretation, it could have been worse. He drove home feeling much more relaxed than he had on the previous night.

Dolly was nowhere to be seen when he got inside the cottage but this in itself was not unusual. She had a number of favourite hiding places. He looked in each in turn. Third time lucky. She was in the linen cupboard, snuggled up on the highest shelf, peering down at him.

“Hi Dolls, how was your day?” he asked. He heard Dolly’s paws hit the floor gently behind him as he walked away. She had dropped from six feet with hardly a sound. He filled her bowl then had a drink while his microwave dinner cooked. He turned on the television, reassured by the thought that this evening no one he knew was going to be on the News. “A better day, all round, Dolls,” he said as he drained his glass and got up to open his brief case. He had a lot of paperwork to catch up on.

Neef arrived early for the meeting with Menogen next morning. He had been late for the last three management meetings and didn’t want to develop a reputation for it. Andrew D’Arcy arrived shortly afterwards and then Tim Heaton, immaculate as ever, being lobbied on the move by Carol Martin over nursing budgets. “Have a word with Phillip,” said Heaton, adeptly detaching himself from the nursing director and wishing the others good morning. The hospital press officer arrived with two strangers in tow. They were introduced as Steven Thomas, managing director of Menogen Research and Dr Max Pereira, research director.

Thomas looked like a businessman; he was conventionally dressed in suit and tie and sounded English but Pereira wore jeans, a striped tee shirt, leather jacket and a beret. He sounded New York American. Phillip Danziger arrived last and apologised for being late.

Tim Heaton took easy charge of the meeting, welcoming the men from Menogen and saying how pleased he was that St George’s had been approached. He hoped that everyone would benefit from the association. Neef wore a neutral expression. He was thinking that Heaton would have made an excellent diplomat, an ambassador even. He could hear him saying, “The ties that bind our two great countries... Valdovia has always had a special place in our hearts...”

“This is Dr Michael Neef, consultant in paediatric oncology,” said Heaton, breaking Neef’s train of thought. “It is his unit of course, you would be working with.”

Neef smiled at Pereira and got a nod in reply. Thomas was more effusive.

With the introductions over, Heaton said, “I suggest the following schedule. First, Mr Thomas outlines in broad general terms what he has in mind and what he would like from us. This should be in non technical terms as at least half of us here are neither medical nor scientific, then Doctors Neef and Pereira consult over medical matters while Mr Thomas and Mr Danziger discuss figures. We can then reconvene over lunch. If we’ve made progress we can go ahead with a meeting with the ethics and safety committee. The members have been warned about this possibility and would be ready to convene this afternoon if called upon.” Heaton looked at Thomas and Pereira and explained, “We are subject to scrutiny by a local ethics committee that oversees both St George’s and University College hospitals. It comprises lay people as well as selected medical staff from both hospitals. You will be expected to provide evidence of approval by the relevant safety bodies.”

“All here,” said Thomas, touching his briefcase.

“Good,” said Heaton.

“Can I ask which medical staff University College have on the committee for this application?” asked Neef.

Heaton looked at the paper in front of him and said, “The Dean of the medical school, Dr Alan Brooks and the head of their molecular biology section, Dr Farro-Jones.”

“David Farro-Jones?” exclaimed Pereira.

“Yes, do you know him?” asked Heaton.

“We were post-docs together at Johns Hopkins in Baltimore.”

“Then you’ll obviously speak the same language this afternoon,” said Heaton.

Ostensibly, Heaton had been referring to technical language but Neef wondered if Heaton hadn’t said what he had as an in-joke for those present who knew David Farro-Jones. Although he and Pereira spoke English, there was a world of difference between Farro-Jones’ Oxbridge accent and Pereira’s New York patois. He also wondered about the expression on Pereira’s face when he heard Farro-Jones’ name mentioned. Maybe it had been surprise or maybe there had been more to it.

“Is that all right then?” asked Heaton, looking round the table at everyone in turn. “Good. Over to you, Mr Thomas.”

Steven Thomas gave everyone a potted history of Menogen Research along the lines which Andrew D’Arcy had already reported to Heaton and Neef two days before.

“It has been our good fortune over the last three years to have had the services of Max Pereira here and several of his colleagues whom he brought with him from the world of academia. These brilliant researchers have designed a range of vectors and strategies which we believe will be successful in delivering functional genetic material to where it’s most needed in the body. Testing in lab animals has given encouraging results and now the time has come to use the technology for real. We have obtained all the relevant safety certificates and ethical approval at national level. What we need now is the collaboration and cooperation of a first rate hospital like St George’s and its staff — in particular, Dr Neef and the paediatric oncology unit. I think it is not outside the bounds of possibility that here, together, we might make significant strides forward in medical science.”

“Thank you, Mr Thomas,” said Tim Heaton getting to his feet as Thomas sat down to polite applause. “I think we all echo these sentiments.”

Neef smiled at Pereira and said, “If you’d care to come with me, Doctor. I’ll show you round the unit and you can meet the patients.”

“Sure,” replied Pereira.