by John Macken
‘Go on,’ Reuben said.
Dressed in one of his trademark colourful shirts, Simon seemed to grow in confidence. ‘Right. The reason we found no link between Carl Everitt, who worked for Roche, and Ian Gillick, who worked as a research scientist at the Holloway, was that we hadn’t looked back far enough. Everitt worked for another pharmaceutical company, BioNovia, prior to Roche.’ Simon wrote BioNovia in small blue letters. ‘And, before taking a senior research position at the Holloway, Gillick worked at the medical school of University College London, which is closely affiliated with the Royal Free. The final piece of the jigsaw – and Leigh and I only found this out about forty-five minutes ago through talking to HR at the Hammersmith – is this: Philip Gower, who died last night, was previously a clinical trials coordinator at the Royal Free.’
Birgit Kasper frowned, her make-up-free face wrinkling into rows of fine lines. ‘The Royal Free is a teaching hospital. I applied for a Ph.D. there. So what you’re proposing is that Gillick and Gower could have encountered each other there?’
‘How does Everitt fit into this?’ Reuben asked.
‘At BioNovia, Everitt was very active in university-led research projects, particularly in the golden triangle – Oxford, Cambridge and London.’ Simon drew a series of arrows from the blue names of the three men to the red Royal Free.
‘Merely coincidence,’ Reuben said. ‘Prove to me otherwise.’
Simon grinned back at his boss. ‘Tough love. Just how I like it. For the final piece, it’s over to my special friend Paul.’
Paul Mackay shuffled in his chair, upright, adjusting his Dolce and Gabbana glasses. Reuben studied him for a second, eager for the next piece of information, wondering whether Paul put up with the jokey homophobia with quite as good grace as he seemed to. Reuben took the blunt management style that if no one complained there wasn’t a problem. But that had got him into a lot of trouble before.
‘Leigh and Simon forwarded their info around and asked if anyone could find anything else,’ Paul began. ‘And I think I have.’
‘What have you got?’ Reuben asked, leaning forward, his elbows digging into his desk.
‘A clinical trial at the Royal Free.’
Reuben felt a rush of affirmation. The cuttings in Riefield’s flat. The occupation of Gower. Without knowing any more, he realized his team was fast honing in on the truth. The forensics would come; for the time being links and associations were the next best thing. But still, Reuben held back. He had to be sure.
‘You’ve only had forty minutes at the most,’ he said. ‘Where’s this come from?’
‘Where all great discoveries are made these days. The internet.’
‘Are you sure it’s right?’
‘Absolutely. There are hundreds of web pages about it. And there, in among them all, are the names of all three of our victims.’
‘What was the trial for?’ Mina asked.
‘The drug was called Vasoprellin. BioNovia’s new wonder compound.’
‘That rings a vague bell.’
‘It should do. For a short period of time nearly four years ago it was front-page news.’ Paul opened a brown cardboard folder and pulled out several sheets of A4. ‘I just had time to run these off,’ he said.
Reuben slid his copy across the desk and spun it round. He scanned the news story, his head bowed down, his concentration absolute. Vasoprellin. A clinical trial gone wrong. And now three of the people involved in it were dead. He consumed the details, forming ideas about the man who was killing and mutilating, about the man who was holding his son. He absorbed the timelines, and also the names. Dion Morgan, Martin Randle, Syed Sanghera, Daniel Riefield, Michael Adebyo, Amanda Skeen.
His eyes flicked back to Daniel Riefield’s name, and then to an accompanying photograph, of Amanda Skeen.
Just what the hell had gone so badly wrong, he wondered?
10
Amanda Skeen monitored the second hand, which jerked around the white face of the observation room clock. It was 9.59 and thirty-two seconds. A few more stutters of the bold red hand and everything would begin.
She checked out the others. The usual mix of students and members of the public, all of them skint, most of them having been here before. Her fiancé smiled at her from the far side of the room, a brief flick of the eyebrows, an acknowledgement that it was nearly time. Amanda sighed quietly to herself. His idea. Three and a half thousand pounds each for a couple of days in hospital, and they would finally have enough money to tie the knot. Crippled by student living expenses, it wasn’t going to happen any other way for several years. This was their big chance, and Amanda was excited and scared in equal measure. Marrying as a student came with significant disadvantages. Quiet nights in rather than wild nights out. A shrinking social circle while everyone else’s expanded. Two sets of living expenses to worry about rather than just one. But the many advantages were encapsulated in the physical form of the wonderful man grinning across the room at her.
As a third-year medical student, Amanda was well aware that the test was not inherently dangerous. The trial coordinator and the chief scientist had been through the data with each of the ten trialists. In cell work, in mouse experiments, in chimpanzee testing, Vasoprellin had exerted mild vasoconstriction effects. It was a drug to complement anti-angiogenesis treatments in cancer, to locally restrict blood flow in tumours. Amanda had read up on it in the Medical School library. Deprive tumours of their thirst for blood and you could stop them growing, even regress them. And the local action of a drug like Vasoprellin could speed the process to the point where cancers that might otherwise have invaded and metastasized into blood capillaries could be intercepted before they got the chance. Truly, this could be a small step forward in the medical treatment of cancer.
The hand finally ticked round to the vertical position, and Amanda watched the trial coordinator, Dr Philip Gower, walk over to the chief scientist, Dr Ian Gillick. She sensed for the first time that they had a lot riding on the trial. Pass this phase, and the next step would be to perform Phase Two clinical testing on cancer patients, with higher doses and direct outcomes. A poor outcome and the drug would be shelved.
Amanda knew Dr Gower vaguely. She had seen him around the university, and he had lectured her two or three times in her first and second years. He was smart, quick in his actions, neatly turned out, with an aura of cleanliness about him. He smiled at one of the nurses, and Amanda imagined for a second there was more than just friendliness in the gesture. She had only met Dr Gillick once before, when she had signed up for the trial. He was slower, more considered, an old-fashioned academic despite only being, she guessed, mid thirties at most.
She watched them confer, Gower taller than Gillick, his head angled down slightly. They were at the far end of the room, between the two rows of beds. Most of the five female and five male trialists were lying propped up on their elbows, reading magazines, enjoying the rest. Her fiancé’s surgical gown made him appear older than he was, as if his casual clothes kept him young. He was a couple of years older anyway, in his final year, but not as ancient as he suddenly appeared.
Amanda wondered for a second whether she would get a placebo, or whether he might. It stood to reason that a clinical trial needed comparisons. Dr Gower had said as much. But neither he nor Dr Gillick had made any further comment. She briefly considered whether she would rather have the drug than her fiancé. This was surely a test of her love. If one of them had to have the treatment, would she rather have it herself, to spare her lover any potential danger? She thought about it, observing the nurse Dr Gower had smiled at as she prepared a series of cannulas on a blue plastic tray. And in that moment, Amanda realized that this was the right thing to do. She was ready to abandon her student freedoms and get married. She would gladly do anything for her fiancé, whatever the outcome.
Dr Gower strode towards the centre of the hospital observation room. For the Royal Free, a medical facility with a worldwide reputation, the room was
less than glamorous. Its decor seemed to have been hampered by 1980s budget restrictions, and never to have recovered. Off-white walls, bare windows, cheap patterned curtains around each bed, dull green floor tiles that squeaked under Dr Gower’s shoes. He stopped and addressed the room, swivelling his suited body round to direct his words at each of the ten test subjects.
‘OK,’ he said, ‘I think we’re ready to kick off. I hope you are too. If anyone has any problems, please make the nursing team aware of them as soon as I’ve finished talking. Now, as you’ve all been briefed, this is a tolerance test for the drug Vasoprellin, manufactured by BioNovia. So if you have any complaints, you should direct them to BioNovia’s sales executive, Mr Everitt.’
Dr Gower nodded in the direction of a dark-haired, tanned man standing at the far end of the suite. Everitt smiled warmly back, a corporate acknowledgement of a joke at his expense.
‘Now, animal tolerance tests have been extremely well received, with no reported ill effects. Dr Gillick and I aren’t expecting any issues, but there will be full medical monitoring over the whole trial period. You are, as they say, in good hands. Dr Gillick, would you care to outline the procedure?’
Amanda watched Dr Gillick’s body language. Hands in pockets, less confident than Gower, thoughtful in his words.
‘We’re going to set off at standard five-minute intervals, so that the drug is administered for all ten of you well within the space of an hour. In a moment, the nursing team will fit you each with a cannula on the back of the hand. Then, when everyone is ready, we’ll start the timed injections. Because we’re nice here, we’ll give you some anaesthetic gel to numb the injection.’ He glanced across at Dr Gower. ‘So really all we want you to do is lie back, relax and enjoy the flight.’
Amanda gave him the satisfaction of a small laugh. She was the only one to do so, and she felt bad that no one else had helped him out.
‘Right, the sooner we get started, the sooner you can be paid, and the sooner the rest of us can go home.’
Dr Gillick nodded to the nursing team, and Amanda quickly appreciated that she was going to be one of the first five. The beds were clearly set out in chronological order, a bold number in front of each, two males and two females to her right already having cannulas inserted. She felt that quick prick of adrenalin that occurs prior to an injection. The knowledge that a needle is soon going to be forced through your skin. A nurse approached and smiled, swabbing the back of Amanda’s left hand with an ethanol wipe, wordlessly pulling a butterfly needle from its plastic home.
At precisely twenty-five past ten, Amanda watched a small volume of clear fluid surge through the clear plastic tubing which led into her hand. The trial had officially begun at 10.05, and as she had predicted, she was fifth in line. She glanced away from the tubing and gazed over at her fiancé, who was chatting to the man on the bed next to him. Amanda hadn’t seen the man around before. She squinted at his name which was scribbled on a clipboard beside his bed. Martin Ramble or Randle, she guessed. Randle, probably. He was large and powerful, his musculature obvious even when he was lying down. Something about him spoke of military service, of a toughness that marked him out against the others. She watched for a couple more seconds. Randle would be sixth, her fiancé seventh.
The nurse removed the tube and closed the small plastic tap. Amanda sighed. The difficult bit was over. She swung her head to the right, checking on the first four. All were relaxed, chatting with Dr Gower and Dr Gillick, sharing the odd bland platitude to cover the lack of excitement.
Amanda decided she ought to get some rest and shuffled down under her thin hospital sheets. She watched the man next to her fiancé as his treatment was administered. Five minutes later, almost metronomically with the pronounced tick of the clock, her fiancé’s injection was carried out.
Amanda picked a magazine from a small stack next to her bed. It smelled of ink and perfume, and had a BioNovia sticker in the top right corner. They had all been provided with reading material – another sweetener to smooth the long hours of observation. She flicked through the pristine pages, savouring the glossy scent of promise and possibility, losing herself in a section on designer bridal outfits. She smiled across at her fiancé again. Fat chance. Most of the outfits cost more than a year’s tuition fees.
And then, from the far right, there was movement. The first subject was out of bed. He was starting to pace around with a nurse at his side. Dr Gower sauntered over, a deliberate lack of haste about his upright form, hospital code for ‘nothing to panic about’. Amanda sat up. The male who had received the first dose of the drug was shivering, walking quickly about, his head bowed. She checked across the room. The final patient was just being injected.
The first patient looked pale. His name was Daniel Riefield, Amanda recalled, a rugby-playing medic from the year below. Without warning he started to vomit. Thin watery fluid falling out of his mouth almost uncontrolled, dropping on to the dull green tiles. Amanda found the noise it made almost indescribably abhorrent.
She transferred her attention to the second trialist. People got sick. It happened. But if two went down . . . The second, a female in her early thirties with a dark red bob and black framed glasses, was fine. She had barely noticed, filling in a crossword or sudoku or something similar, white headphones buried deep in her hair.
Six minutes passed. Riefield was still out of bed, unable to relax. He was scratching at his arms and face, deep red grazes appearing on his white flesh. He was freaking out. But, Amanda reminded herself, these things happened in hospitals. She had seen it herself on her ward rounds. Patients confused, disorientated or scared, medications stirring the waters. It was life.
Number two continued regardless and unconcerned. Next to her, number three, a pretty blonde she didn’t recognize, was lying utterly still, the implications slowly eating into her. The blonde girl stared at her watch, seconds ticking by, barely breathing.
Another four minutes passed. If anything was wrong, systematically wrong, they would know about it by now. Dr Gower was conferring with a nurse, and didn’t look overly worried. Dr Gillick was talking to the guy from BioNovia, their bodies static, their reactions impossible to read.
Another couple of minutes. Twelve in total. Surely that was more than enough. But then a thought struck her. What if number two was a placebo? What if number three was a placebo too? It was possible.
Amanda turned to the man in the next bed, who had introduced himself in an African lilt as Michael. He shrugged back.
Fourteen minutes. This was good. Riefield had maybe reacted badly to the drug, or was a hypochondriac, or had already been ill. Amanda returned to her magazine, skimming articles for a couple of minutes. Then she turned to Michael to say something. He had gone quiet and was staring upwards. Glistening beads of sweat had appeared across his forehead. Amanda felt herself clench. ‘Please be nothing,’ she whispered under her breath. ‘Please be nothing.’
And then Michael began as well. Groaning under his breath, moving under his sheets. ‘I’m hot,’ he said out loud, ‘I’m hot.’ A nurse dashed over to him. She held his arm and felt his pulse at the wrist. Dr Gower appeared, standing close behind her. The nurse placed a digital thermometer into Michael’s ear and held it there. After a few seconds she removed it, checked the display and showed it to Dr Gower. Amanda tried to read his reaction, but he had spun round and was walking quickly over to Dr Gillick and Everitt, the pharmaceutical guy. Michael coughed and retched, then vomited over his sheets. Amanda turned away. The smell was unbearably sharp and pungent, a stench that tugged at her own stomach, encouraging its contents to travel up her throat. She swallowed the reflex and caught her fiancé’s eye. He was staring in horror.
Michael began to scratch at his skin. Amanda noted that it was almost black, long pink fingernails gouging out strips of red. In particular, he was scraping at his hands, one attacking the other, swapping almost continuously. She began to feel the first urgent heaves of panic. It was clear what wa
s happening. The first and fourth subjects had been given the drug, the second and third hadn’t. She wondered what the overall sequence was. Drug, placebo, placebo, drug . . . then what? She was next in line.
Amanda peered over at Daniel Riefield. He was being escorted back to his bed by two nurses. He was shaking uncontrollably, his head jerking from side to side as he was moved. He seemed to be losing consciousness, his legs barely supporting him. The rest of the patients were watching intently, no longer lounging around but sitting up straight. And then Amanda noticed it. Out of the corner of their eyes they were monitoring her as well. They were glancing at the clock, examining her, and looking back again. Everyone knew she was next. They lay there with the drug in their veins and waited to see if she succumbed as well. Amanda realized that Dr Gillick, too, was searching her face.
She did the maths. Nineteen minutes. If it was going to happen, it would come now. Five-minute intervals, give or take. A chain reaction passing around the room. She watched the pharmaceutical guy make a call on his mobile, saw Dr Gower pick up an internal phone. Each stutter of the clock was good, she told herself. Another second and no reaction. Several pairs of eyes tried to make it look like they weren’t watching. Her fiancé was staring at her, intent and focused, no longer smiling. He seemed scared. Amanda asked herself whether he was scared for her or for himself.
And then she felt it. She tried to dismiss it, but it was there. She ripped out the cannula, knowing it was too late but doing it anyway. A sick tightness in the base of her stomach, a clamping force in her intestines. ‘Please, no,’ she said to herself. There was a lull, a chance for her to convince herself that she was imagining it. But as quickly as it had subsided, something grabbed her insides and crushed them again. An uncontrollable surge squeezed her pyloric sphincter, propelling a gush of fluid out of her mouth and through her nose. Her skin erupted, feeling like it was burning and freezing at the same time. She dug deep into it with her nails, instantly wanting it off her, stripped away, torn apart. Her head began to squeeze, her ears pounding, her vision narrowing. She gouged deeper into her own flesh, her fingers frostbitten and on fire, unbearable and intolerable. Her whole body started to shake, her teeth crashing into one another, chipping small fragments that she swallowed. All she could hear was a voice that sounded as if it was coming from inside her, shrieking and shrieking.
