A Life for a Life

by Andrew Puckett

  ‘The school I went to in Glasgow was of the kind that regards a pupil who becomes a scientific officer as a major academic achievement. Once I was in lab work and studying for a degree, I realised I had a facility for academic study and that I could aim much higher.’

  ‘But what made you choose medicine? You had a first class honours degree, you could have done a PhD and gone into industry – and probably earned more than we do here.’

  Fraser took a breath. ‘I think it was a fascination with the human body, and also with what I saw going on around me… I watched the pathologists at work and realised that that was what I wanted to be – in both medicine and science.’

  Somersby nodded and Connie Flint leaned forward.

  ‘Do you regard your experience as a lab worker as an advantage or a disadvantage to your career now?’

  ‘Oh, very much an advantage.’

  ‘Why?’

  ‘I believe it enables me to see both sides of laboratory practice more clearly – the medical and the scientific.’

  She smiled at him. ‘Are you suggesting that the rest of us here can’t?’

  Fraser smiled back. In the beam of her ultramarine eyes, he realised she wasn’t just attractive, she was beautiful – and sexy. ‘No, I’m not suggesting that,’ he said, ‘although there are some who can’t, just as there are some lab workers who can’t, or won’t, understand the medical point of view.’

  ‘But of course they can’t – they’re not doctors.’

  Careful… ‘I used the word in the sense of sympathy. I do believe that a little more understanding on both sides would result in more effective pathology.’

  ‘Could you give us an example of that?’ Saunders asked.

  Somersby was listening attentively to everything and Fraser somehow wasn’t surprised when a week later he was offered the post.

  *

  The thing Fraser had liked most about working with John Somersby was his manner with his patients. No matter who they were, or what their medical condition, he seemed to have the right word or gesture for them. Once, he sat beside an elderly woman who was unconscious and clearly dying, just holding her hand and looking at her face. After a full minute, he patted her hand before replacing it gently on the bed and ushering them all out.

  ‘She won’t last the day,’ he said briefly. ‘Have you phoned her family?’ he asked the ward sister.

  ‘They’re on their way.’

  ‘Good.’

  Next was Mrs Eva Norton, a schoolteacher aged forty-nine with acute myeloid leukaemia. After several months on drug therapy, she had relapsed and was taking it badly.

  ‘I’m going to die, aren’t I, doctor?’

  ‘Well, we all are one day, but—’

  ‘How long have I got? Please be honest with me…’

  ‘I was about to say that I hope to keep you on this planet for longer than myself. This relapse is a set-back, but that’s all. I’m quite sure that we can get you into remission again, and then we’ll go for a marrow transplant.’

  ‘The last ditch, eh, doctor?’

  ‘Not at all,’ he said, injecting the words with belief. ‘I could name you a dozen people who are alive and well today thanks to a marrow transplant.’

  As though she hadn’t heard him, she said, ‘I keep asking myself what I’ve done to deserve this. Have I offended God in some way?’

  He said gently, ‘You know I can’t answer that, dear. Would you like me to ask the chaplain to come and see you?’

  ‘Certainly not!’ she said, some of her spirit returning. ‘That pompous old fool doesn’t know what he believes.’

  ‘Would you like me to call your parish priest?’

  ‘Yes, please,’ she said in a smaller voice.

  Outside, Connie said, ‘Isn’t it strange how people say “be honest with me” when they mean the very opposite. How do you rate her chances, John?’

  ‘It depends on whether we can find a compatible donor… ten per cent?’

  When the ward round was finished, Somersby asked Fraser along to his office. After enquiring how he was settling in, he said, ‘I’m going to ask you to take on laboratory liaison for a few months – no, it’s not because of your background,’ he added at Fraser’s smile, ‘it’s something all our registrars here do. Although, then again,’ he continued slowly, ‘it is partly because of your background.’ He met Fraser’s eyes. ‘I think we may have a problem here with our laboratory.’

  ‘What kind of problem?’ Fraser asked.

  Over the past few months, he told Fraser, several GPs and consultants had commented to him how the lab seemed to be becoming less helpful in its attitude, doing the bare minimum requested and nothing more.

  ‘Have you spoken to the lab manager about it?’

  ‘No, I haven’t, because I want you to look at the situation in the raw, so to speak.’

  *

  Laboratory liaison hadn’t been too onerous, mostly dealing with blood films referred to him by the scientific staff or fielding the numerous phone enquiries that needed a medical opinion, so he had plenty of time to try and diagnose the malaise that Somersby felt existed.

  The first thing he noticed was how easy and relaxed the atmosphere was when Terry Stroud, the lab manager, wasn’t there, and how everything closed up when he was.

  And yet there was nothing particularly menacing about Terry; he was smallish, dapper, somewhere in his fifties with thinning sandy hair and inoffensive brown eyes. He’d seemed pleasant and friendly enough when he’d shown Fraser round, although Fraser couldn’t help feeling that he didn’t really understand some of the things he was supposed to be explaining.

  Then, a few days after Fraser had started, Terry came in holding a form.

  ‘Steve?’ He went over to where Steve Lovell, who’d recently moved from another lab, was working. ‘Did you authorise this?’

  Steve looked at it. ‘Yes. Is there a problem?’

  ‘There certainly is, you can’t just do a Paul Bunnell test when it hasn’t been asked for.’

  ‘But there were atypical monocytes in the film, and—’

  ‘Then that’s what you should put on the form, and nothing else. You can’t do unauthorised tests – it’s against the regulations.’ He paused. ‘Is that clear?’

  Steve pressed his lips together, then said, ‘Yes.’

  ‘Good.’

  Fraser heard all this, also saw Sean Callaghan and the raven-haired girl whose name he didn’t know look at each other and raise their eyes to heaven, so as Terry was on his way out he called him into the doctor’s room and shut the door.

  ‘I couldn’t help overhearing you just now,’ he said. ‘D’you mind if I take a look at that form a minute?’

  Terry obviously did mind, a lot, but he handed it over. Fraser studied it, then said, ‘I don’t wish to seem controversial, Terry, but it seems to me that Steve was right to do a Paul Bunnell in this case.’

  ‘But you know the regulations, Fraser – no test is to be carried out without medical authorisation.’

  ‘Isn’t the fact that I’m here medical authorisation?’

  ‘No, I don’t think it is – the regulations state that only the patient’s GP is authorised to request tests.’

  ‘Ach, come on, Terry, that’s the letter of the law as opposed to its spirit. If Steve sent this out with just “atypical monocytes” written on it, the doctor might have no idea he was dealing with a case of glandular fever. The Paul Bunnell tells him he is.’

  Terry swallowed with irritation. ‘If he didn’t know, then he could phone you and ask.’

  ‘And then he’d have to call the patient back to the surgery, bleed him again and then send the sample to us again – is that a good use of resources?’

  ‘With respect, Fraser, that is not the point.’ Terry’s voice rose an octave as his eyes twisted around. ‘The fact is, Steve could be sued for assault, that’s what testing a patient’s blood without authorisation is. I’d have thought that you, as a docto
r, would have realised that.’

  Fraser stifled a groan. ‘Terry,’ he said, ‘there is no way we would allow Steve to be sued for using his common sense and saving everybody time and money.’

  ‘You can say that, Fraser, but if the GP or the patient decided to sue, it would be out of your hands, wouldn’t it? I suggest that you have a look at the regulations.’

  *

  The problem is Terry Stroud,’ he told Somersby a week later and explained why.

  ‘I don’t think he’s being deliberately malicious,’ he said. ‘I’ve talked to Sean and he says that Terry’s been getting more and more like this over the last year. He’s out of his depth, he can’t keep up with the technology, and it’s made him feel inadequate, so he uses the rules and regulations to try and assert his authority. Maybe he can’t help it, but he’s the problem.’

  Somersby sighed. ‘I wondered if it was something like that. The thing is, Fraser, what can we do about it?’

  ‘Early retirement? He’s fifty-seven – I checked.’

  ‘There are two problems there: one, he’s made it plain he doesn’t want to go; secondly, early retirement costs money and the Trust tries to avoid it unless there’s a very good reason.’

  ‘The standard of patient care is a pretty good reason.’

  ‘You really think it’s that serious?’

  ‘Aye, John, I do.’

  Somersby nodded to himself. ‘Then we’ll have to see what can be done.’

  The following week, he called a meeting of the department’s medical staff.

  ‘We have two items to discuss,’ he said. ‘We’ll start with Parc-Reed’s offer, since I’m sure Mr Farleigh’s time is as valuable to him as ours is to us.’ He smiled at the company rep seated at the far end of the table. ‘Over to you, Mr Farleigh.’

  ‘Thank you, Dr Somersby.’ Leo Farleigh opened his briefcase and took out some glossy sheets. ‘I’ll start by passing these round for you to study.’

  He was the archetypal rep, Fraser thought: very smartly dressed, every hair in its place, his square-jawed face closely shaved.

  ‘Has everyone got one? Good…’ The macho black moustache must be to compensate for his lack of inches… ‘Parc-Reed are about to launch a new leukaemia drug in the UK. You may have heard of it – Alkovin.’ He looked round at their faces – Somersby, Connie, Ian Saunders, Fraser, and the department’s two SHO’s, Mark and Sophie.

  ‘It’s a Vinca alkaloid, but with a completely new synthetic component. We’ve trialed it in the States and, in a combination with Daunorubicin and Prednisolone which we call DAP, it shows a remission rate of ninety-five per cent.’

  ‘Golly,’ said Sophie, who sometimes sounded as though she hadn’t left school.

  ‘Golly indeed,’ said Ian Saunders. ‘I think we’d all agree that that represents a major step forward.’

  Leo went on to tell them that the company now planned a trial in the UK and thought that Avon might be interested.

  ‘We’re offering you not only the opportunity to get in on the ground floor – there’s no doubt you could get a major paper out of this – but also preferential charges when Alkovin goes on to the market.’

  Prompted by Ian and Connie, he described the administration, dosage and contraindications of the drug.

  ‘What about side-effects?’ asked Somersby, who hadn’t spoken much until now.

  ‘Pretty much as you’d expect – nausea and vomiting, hair loss, some tissue necrosis on extravasion.’

  ‘What about neurological and psychotic effects?’

  ‘There is some neuropathy, as there is with all—’

  ‘That wasn’t what I asked,’ Somersby interrupted.

  ‘Perhaps I’d better explain,’ he said, looking round. ‘I’ve had a report of severe psychosis with this drug.’

  ‘May I enquire from where?’ Leo asked, suddenly alert.

  ‘A colleague in America. He’s observed depression, delusions and paranoia in a number of his patients.’

  ‘Depression can’t be uncommon in leukaemia patients, surely?’

  ‘This was clinical, as were the other symptoms.’

  ‘I assume this was in combination with Prednisolone?’

  ‘Yes.’

  ‘A drug that’s known to have neurological effects.’

  ‘Indeed, but not to this extent.’

  There was a short pause, then Connie said, ‘Can you check this out from your end, Leo?’

  ‘I’d be glad to. It would help if I could have the name of your source, Dr Somersby…’

  Somersby shook his head. That’s confidential, Mr Farleigh. But do check what I’ve said with your American colleagues. I’d be most interested in their reply. Meanwhile I’ll have another talk with my colleague… and perhaps we could meet again in a couple of weeks?’

  Ian looked as though he was about to say something, but a look from Connie stopped him.

  Leo said, ‘Well, thank you for your time, Dr Somersby. I’ll come back to you when I know more.’ A perceptible tightness in his voice betrayed the fact that he’d been expecting more from the meeting.

  After he’d gone, Connie said, ‘Would you tell us who your source is, John?’

  ‘He specifically asked me not to, so I think I’d better respect that. Sorry.’

  Ian said, ‘How much credence do you give it, John? I mean, Leo has a point about leukaemics tending to be depressed.’

  ‘Enough credence to make me want to know more before using it here.’

  ‘OK, John, I accept that, but ninety-five per cent… it’s a breakthrough… I think most of our patients would jump at it, depression or no.’

  ‘I take it you hadn’t heard about these side-effects?’

  ‘Of course not.’

  Somersby nodded. ‘Then I wonder whether Mr Farleigh has been a shade less than ingenuous with us.’

  ‘Oh, surely not—’ Connie began, but Somersby overrode her:

  ‘I think we’ll leave it there for now. I’ll have another talk with my colleague and we’ll see what Mr Farleigh comes up with. The other item I want to discuss,’ he continued, ‘is the laboratory…’ He explained how he’d become worried by the recent grumbles about the lab.

  ‘I think we’ve all been aware of it,’ said Ian, ‘but to be honest, I think it’s a fact of life, something we have to put up with.’

  ‘Can I say something?’ Mark asked tentatively.

  ‘Of course,’ Somersby said.

  ‘With all due respect to Dr Saunders, I think it’s worse than that. Some of the housemen and ward sisters have been telling me how unhelpful the lab’s become lately.’

  ‘Then why don’t they put in a complaint?’ Ian enquired, less than impressed by Mark’s due respect.

  ‘They say it’s never quite bad enough for that.’

  ‘Well, then—’

  ‘The fact is,’ Somersby interposed, ‘I asked Fraser to look into it discreetly. Perhaps you’d like to share your observations with us, Fraser.’

  Fraser repeated what he’d told Somersby earlier. There was a slight pause when he finished, then Connie said, ‘I’m sorry to sound cynical, but couldn’t Sean’s comments be down to the fact that he wants Terry’s job?’

  ‘That wasn’t my impression,’ Fraser said.

  Connie shrugged. ‘All right, I accept that Terry can be difficult, but I tend to agree with Ian – that he’s a cross we have to bear. For the moment, anyway.’

  ‘But it isn’t us that does the bearing, Connie,’ said Somersby. ‘It’s the GPs, the staff on the wards and in the lab and, ultimately, the patients.’

  They talked round it, but hadn’t reached any conclusion by the time they had to break up for the clinic.

  ‘You feel quite strongly about this, don’t you, John?’ Connie observed as they got up to go.

  ‘I do, yes. I think he should be retired.’

  ‘Well, we’d all better give it some serious thought, then.’

  Fraser had wondered at t
he time whether there had been a note of calculation in her voice, and a fortnight later, when Somersby turned down Parc-Reed’s offer, Connie and Ian raised so many objections to the retirement of Terry that the idea was dropped.

  However, in the weeks that followed, Terry moderated his behaviour slightly, but at the same time favoured Fraser with looks so malevolent as to suggest he knew what Fraser and Somersby had been planning for him.

  3

  May 1999

  He woke on the sofa parched and cramped at around four, drank some water and stumbled into bed. It was probably this that saved him from a worse hangover than the just-about bearable one he had when he woke in the morning.

  He showered, washed some paracetamols down with coffee, then backed his MG out of the garage and drove to the hospital.

  As he walked to the main entrance, a blackbird sang from a tree whose leaves were so green they seemed to fluoresce, and he was taken by a feeling of such profound surreality that he had to sit down on one of the red metal seats by the main door before his legs gave way.

  I’m Fraser Callan, he told himself. I’m Fraser Callan and I’ve come to see my fiancée… He began taking slow, deep breaths.

  ‘Are you all right, dear?’ said an old lady with a Zimmer frame.

  ‘I’m fine,’ he said. ‘But thank you for your concern.’

  ‘Seeing someone?’

  ‘Yes.’

  ‘Then you’d better have these, they’re no use to me.’ She tossed him a bunch of flowers wrapped in cellophane and stumped on her way without any further explanation.

  He made his way up to the ward and found the sister.

  ‘She’s expecting you,’ she said. ‘Before I take you in, you know she’s under reverse barrier?’

  ‘Yes.’

  ‘I know you’ve just come back from America, have you had any infections—’

  ‘No, sister.’

  ‘—no matter how trivial?’

  ‘No, sister.’

  ‘Even a cold—‘

  ‘No, sister.’

  ‘I suppose it’s no use asking you not to touch her?’

  ‘Not one whit, sister.’

  Filtered air hissed as she pushed open the door.

  Frances was sitting up in bed with a magazine she obviously hadn’t been reading.