“Whereas you might kill his tumour but turn him into a brain-damaged idiot?”
Neef was struggling to keep his temper but the stress he was feeling wasn’t helping. He kept thinking about what David Farro-Jones had said. “You told me at the outset there was no risk of healthy brain cells being damaged.”
“And there isn’t, in theory,” soothed Pereira. “Normal brain cells don’t divide so they can’t become infected by a retrovirus. Our gene delivery system is based on a retrovirus therefore normal brain cells can’t become infected.”
“But?”
“In practice, it can happen... occasionally. It’s just a phenomenon, that’s all.”
Neef stared at Pereira as if he were looking through the back of his head. “How many more phenomena haven’t you told me about?” he asked.
Pereira held up his hands and tilted his head to one side. “None, Mike, absolutely none.”
Neef was trying to decide whether Pereira was capable of using a strategy which would destroy a tumour but leave the patient brain damaged in order to claim a technical ‘cure’. He thought of the old surgical joke: the operation was successful, the patient died.
“Have all the Menogen virus vectors been passed by the Medicines Control Agency?” he asked.
“Not all of them, no.”
“But the ones you’re using in this trial have?”
“Of course, that was a condition of the National Gene Therapy Advisory Committee.”
“You said that the viruses are in the unit fridge?”
“Yeah.”
“I am going to ask David Farro-Jones to come over here and take samples from all the vials. I would like to be assured that the viruses are what you say they are and that they are present in the concentration you say they are in.”
Pereira’s face darkened. His eyes flashed with anger but he kept control. “And if I refuse?” he asked quietly.
“I’ll stop the trial before it starts.”
“Then, in the circumstances, I have no option,” said Pereira. “Go ahead. Do what you have to.”
Neef made the call to Farro-Jones, saying that he’d like to take him up on his offer of help. Farro-Jones said he’d be there within ten minutes.
Kate Morse knocked and came in smoothing her uniform front and then her hair. She stopped when she saw Pereira sitting there and sensed the tension in the room. “I’m sorry,” she said, “I didn’t realise you were with...”
“It’s OK, Kate; we’ve finished for the moment.”
“I just wanted to apologise for being late. Charlie’s come down with flu or something and you know what men are like. I had to make sure a complete life support system was within arms length.”
“No problem,” said Neef.
David Farro-Jones arrived from the medical school. He looked uncomfortable and embarrassed. “Morning Max, Morning Mike. So, what exactly is it you chaps want me to do?” he asked.
“I would like you to take pre-treatment samples of the viral vectors that Dr Pereira has prepared for administration to my patients and analyse them... as a formality,” said Neef. “Can you do this?”
“Of course,” replied Farro-Jones. “I did say I would be happy to help you chaps with any lab work you feel necessary.” He smiled at Pereira who did not smile back.
“Look Max, I hope you and I won’t fall out over this?” said Farro-Jones. “It’s really just a sensible control measure when you think about it. Don’t you think?”
Pereira gave a small smile and nodded. “If you like,” he said.
“There’s no reason at all for you two to fall out,” said Neef. “This request is entirely down to me.”
“So where are these viruses?” asked Farro-Jones.
Pereira went to fetch them from the fridge. He returned with a wire rack containing five glass vials. He put the rack down with slow deliberation on Neef’s desk.
“I can’t open them here,” said Farro-Jones. “They could become contaminated with bugs from the atmosphere. I’ll have to take them back to the medical school. We have a laminar air-flow cabinet there. We can open them safely with full aseptic precautions.” He turned to Pereira and asked, “Is this OK with you, Max?”
“I’d be kind of pissed off if you’d tried to open them here,” said Pereira. “On you go.”
“I just thought, maybe you’d like to be present when I open the vials?” suggested Farro-Jones.
“That won’t be necessary, David,” smiled Pereira. “I trust you.”
Neef knew the comment had been made for his benefit but he remained unrepentant. When Farro-Jones had left he said, “We’ll continue with the trial when David confirms the contents of the vials.”
“As you like,” said Pereira wearily and getting up to go. “Maybe you can give me a call when it happens.”
“Of course,” said Neef. “And Max...”
“Yeah?”
“You and I don’t know each other so we don’t have a foundation for a relationship based on trust. Let’s not bother to pretend. We do have to work with each other however, so there should be some ground rules.”
“Like what?”
“If there’s a choice to be made between what I see as my patients’ interests and the possibility of offending you, I’m liable to offend you quite a lot. Is that understood?”
“I haven’t heard a line like that since Dr Kildare,” said Pereira and with that, he left. He brushed past Kate Morse on the way out.
“Was it something I said?” she muttered.
Neef didn’t comment. He waited for Kate to speak.
“I think you should take a look at Jane Lees,” she said. “Her breathing’s very laboured and she’s having a lot of pain.”
“I’ll be right there,” said Neef. He got up to put his white coat on.
“You haven’t said what you’ll need for the trial patients,” said Kate.
“There’s going to be a delay on the trial,” said Neef. “A technical hitch.”
“Oh,” said Kate, remembering the manner of Pereira’s departure. “I see.”
Neef examined Jane Lees and made a change to her medication to ease the pain. He saw that Lawrence Fielding had written her up for an antibiotic. He was sounding her chest when Fielding joined him. “You examined her this morning?” Neef asked.
“First thing, replied Fielding. “I thought the pneumonia might be coming back.”
“I agree,” said Neef. “That’s what it sounds like, but I’m not convinced it’s pneumonia.”
“That’s what she was admitted to East Side General with in the first place,” said Fielding.
“Viral pneumonia,” said Neef. “So the antibiotic wouldn’t do her any good.”
“I’m aware of that,” said Fielding, uncharacteristically curtly. “I prescribed the antibiotic as cover against secondary bacterial infection.”
Neef looked up at Fielding and said, “Sorry, Lawrence, I’m a bit on edge today. About this pneumonia...”
“What about it?”
“Supposing it isn’t pneumonia at all. Supposing it were some kind of inflammatory response to the cancer agent she was exposed to and it only looks like pneumonia.”
“It’s possible, I suppose,” agreed Fielding. “That would explain why there was no response to the initial antibiotic therapy.”
“Precisely. Let’s try her on a steroid, see if we can suppress the response. We’ve nothing to lose.”
Eve Sayers appeared at two thirty. She was carrying a parcel that Neef would have bet a month’s salary, contained a fire engine.
“You got one then?” he asked.
“I got one,” smiled Eve. “It wasn’t easy. The shop assistant told me they’re not as popular as they used to be but I got one.”