Chapter 5

The meeting started at 7.30am sharp. All the research meetings started at that time. Such was the power of Dr Jeffrey Harris that no one, with rare exception, was late. They all assembled in the seminar room, a large rectangular windowless room. In the centre stood a round teak conference table. Although round, there was never any question as to who sat at its head. The rest of the seating in the room conformed to a strict hierarchy. There were six chairs around the table other than Jeffrey Harris’. These were occupied by the six principal researchers, each with a laptop in front of them, earnest, white coated young men. They were all men. A female had so far not made it to the front row.

There was a second row of chairs, six again, each behind and to the left of the chairs in the front row. These were occupied by the senior assistants whose role was to brief their principals when the need arose. This row rarely spoke unless spoken to.

And behind that were a scattering of chairs in no particular row or order, where everyone else from the department could sit and listen to the proceedings and, if they felt compelled to, could contribute to the discussion.

It was at one of these chairs that Andrew sat, bleary-eyed. He’d had a late night and the 7.30am start did not agree with him that morning. He made an effort to attend the research meetings, not so much because he wanted to but because he knew that Jeffrey Harris expected it of him. Andrew had long ago realised that research only held a peripheral interest for him. His first love was clinical work. He had done his share of research during his training. A study on the skeletal muscles of alcoholics. It proved what everyone already suspected, that alcohol destroyed muscle as it did so many of the body’s tissues. His research was sound and he had been encouraged to continue with it but he tactfully declined. Research was not where he saw his career heading.

Dr Harris drew the meeting to order and with a nod of his head to Peter Goodman sitting to his left, the meeting commenced.

Peter Goodman, PhD, was the principal of the principal researchers and as brilliant a mind as Andrew had ever met. Short, stocky, his clothes always ill-fitting, his dark curly hair heading in a hundred directions at once. While his appearance was one of total disarray, when he spoke his words were precise, crystal clear, direct and to the point. He had the rare talent of making the complex seem simple and though one might not always agree with his theories, you could at least easily understand them.

That morning Peter was addressing the future direct­ion of the department’s research programme. Following the spectacular success with gliomas, Amaradine had been tried in a dozen other types of tumours without success. Clearly the drug was brain tumour specific. What none of them understood was how or why. After all, the drug had not been tailor-made. It was an accident and so its mechanism of action remained a mystery. And that is where they planned to head next. There had to be a part of the Amaradine molecule which was the key which fit into the lock of the glioma cell. If that part could be identified, then modified, other drugs could then be developed to fit the lock of other cancer cells. There was a way forward and that is where Peter Goodman wanted to go.

It meant getting back to basics. To fundamental molecular research. A slow, painstaking road paved with setbacks and dead ends. A very costly road. Funding so far had not been a problem. The NHMRC had been generous with grant moneys and the drug company WH Pharmaceut­icals, the manufacturer of Amaradine had turned on the tap and so far had given no indication that it would turn it off.

Andrew’s attention began to wane and his thoughts drifted as the discussion took a more technical course. Each of the investigators around the table was now becoming more animated as they planned strategy and allocated areas of responsibility. Andrew realised that the language was beginning to sound foreign to him and was relieved when at 8.30 Jeffrey Harris stood up and declared the meeting closed. He was about to leave when Harris approached him.

‘Well, what do you think Andrew? It’s exciting, isn’t it? I have told you this is where it’s all happening. I’m sorry you are not more involved my boy.’

He replied, ‘I like to be involved Jeffrey. But to tell you the truth, it is all a bit beyond me. I did not understand what they were talking about after ten minutes.’

‘Just between you and me Andrew, nor did I,’ Dr Harris said, his voice low. ‘Never mind, as long as we’ve got chaps like Goodman, we’ll be okay. I am just needed to steer the ship. The crew are doing all the real work. Oh, by the way. Elizabeth sends her love. She wants to have you over soon. She’s sorry it has not been sooner but you know, busy, commitments and all that.’

Andrew was very fond of Elizabeth Harris. As much as Jeffrey had taken under his wing, Elizabeth had done so and more. She had become a mother figure to him in those early years. The Harris’ were childless and Andrew’s arrival on the scene allowed Elizabeth to vent all her maternal instincts on him. He had spent many an evening, afternoon, whole weekends at the Harris while still a hospital registrar. Andrew was a frequent beneficiary of Elizabeth Harris’ culinary skills, often dining just with her, Jeffrey being caught up with work or yet another meeting. He had felt a genuine warm feeling coming from Elizabeth and reciprocated as much as he could, as much as his emotions would allow.

And yet, since returning from London, he had not once been invited to the Harris’ for dinner. It had initially puzzled Andrew why he had not been invited but he put the question out of his mind and assumed that the Harris’ were now far too busy for social interaction with him.

‘Tell Elizabeth I’m available whenever she has time for me,’ he said. ‘I am still addicted to her cooking.’

But Jeffrey Harris’ mind was clearly on other things. He was about to leave when he stopped and said:

‘Andrew, it’s about time you met Winston Heathfield.’

Andrew looked blank.

‘You know, Heathfield Pharmaceuticals, Amaradine. He is the Managing Director. The owner really, he and his family. It is still a private company. As a matter of fact, I’m having lunch with him today. You must come along. I’ll pick you up at the car park entrance at 12.45.’

Before Andrew had a chance to reply, Jeffrey Harris had left.

WH Pharmaceuticals. WH. Winston Heathfield. Of course, thought Andrew. He had probably been told or read the name countless times but never thought much about it. Well, well, he was going to meet the boss. It wasn’t a meeting he was particularly looking forward to. Andrew wasn’t the one for society chit-chat and kow-towing to the great and wealthy. But Jeffrey Harris had hardly given him a choice. He would pick him up at 12.45 and that was it.

At 12.55 they were both in Harris’ BMW 740 on the way to the city. Lunch, as Andrew had just found out, was to be at Florentino’s. Andrew had never been there. It was far too expensive. He presumed that he would not be paying. His apprehension was somewhat reduced by the slight feeling of anticipation at eating there although he remained uneasy and fairly silent during the rest of the trip.

They climbed up the stairs and were shown to the table where Winston Heathfield was already sitting, a glass of what looked like scotch in front of him. Andrew had come prepared to dislike the man, a fat overbearing tycoon which is how Andrew had pictured him. To his surprise there was a handsome, trim, tall, well-built man, probably in his late 50s. Winston Heathfield rose as they approached, a warm smile crossing his face, his hand now stretched out in welcome.

‘Hello Jeffrey. So this is your young Andrew Marshall. This meeting is long overdue, I’m sure.’

He quickly took Harris’ hand and then turned to take Andrew’s, his grip strong.

‘Welcome Dr Marshall. I’m glad Jeffrey has finally thought to introduce you in person. He talks about you often enough. Sit down. Care for a drink?’

As they sat, one on either side of Winston Heathfield, the waiter was already coming over to take their orders. Jeffrey ordered scotch with ice and Andrew asked for a beer.

Winston Heathfield continued, his gaze fixed on Andrew.

‘Have you settled in Andrew? Jeffrey keeping you busy?’

‘Oh yes,’ replied Andrew. ‘There is no shortage of work. It took a while to adjust to the new department though. It’s changed a lot while I was away.’

Heathfield beamed. “It has changed alright. I don’t know how you have worked in such a rundown place. It was certainly a challenge for my architect. You must admit he has done a brilliant job.’

Andrew had never thought about it, but now that he did, he realised someone must have redesigned the whole fifth floor and paid for the alterations. Had he thought about it, he would have assumed that the hospital had paid, with the Health Department’s money. But clearly that was not the case. It was WH’s money. Heathfield’s own architect. Very cosy. Very cosy indeed.

Andrew saw Heathfield looking at him and added, ‘It is very good. Spectacular really. More like a five-star hotel than a hospital.’

He hoped he was not going overboard but he did not really know what was expected of him.

‘It is good to have you Andrew. We need top people. There is still a long way to go,’ added Heathfield. Andrew assumed that a response from him was not required and in any case, Heathfield and Jeffrey Harris were soon deep in conversation. The topic seemed to be Winston Heathfield’s Gold Coast penthouse and Jeffrey’s impending use of it for a week over the Melbourne winter. They must be very close friends thought Andrew. It was not a thought he was very comfortable with.

They had ordered their food some minutes earlier and it arrived on plates too hot to touch and under gleaming silver covers. Each of the men had steaks, Andrew’s was medium, the others medium rare. There were carrots, broccoli and sliced potatoes on the side and a bottle of Heathcote Shiraz to wash it all down. It was an excellent meal finished off with an Italian espresso and a port for Winston. Jeffrey and Andrew declined, pleading an afternoon at work as their excuse. Andrew, for whom lunch was usually a sandwich on the run, had some difficulty rising from the chair, feeling bloated and giddy from the wine. He did not think he’d had too much although he was not really used to wine with lunch.

He and Jeffrey bid Heathfield goodbye, the latter shaking Andrew’s hand with his firm grip and they made their way back to Harris’ BMW for the return trip to Prince Charles.

Andrew was late and was glad to be dropped off at the hospital entrance, Jeffrey proceeding to park the car. Andrew was due in the glioma follow up clinic and was already 40 minutes late which annoyed and embarrassed him. He hoped the strong coffee would mask any lingering odour of alcohol. No one seemed to pay him any special attention. He slipped off his suit jacket, donned the white coat and called in the first patient for the afternoon.

Carmella Walters was a budding sculptor. Aged twenty eight, married with three children, she had been cured of a large and nasty frontal glioma which would have otherwise ruined her career and ended her life. She was doing well and was about to have her first exhibition. She was happy and grateful. So grateful that she presented Andrew with one of her works, a small bronze of a child, a boy holding a cricket bat, as a token of her gratitude. Andrew accepted the gift sheepishly. He had only met Carmella after the treatment and did not feel he deserved a gift, but did not want to offend her by refusing it. He scheduled her next review in six months, put the small sculpture into a cupboard and was about to call in the next patient when Diane Palmer, the clerk in charge of the clinic informed him that Mrs Wilson had not turned up. They would contact her later that day and schedule another time.

The follow up of all glioma patients was meticulous. No one was allowed to become “lost to follow up.” It was important both for the patient’s wellbeing and for the integrity of the treatment protocols. Mrs Wilson’s non attendance allowed Andrew to make up the time he had lost, so that the next patient was seen exactly on time.

Daryl Morgan was fifty, fair haired and fair skinned when he was not suntanned, a bricklayer by trade.

‘Good day Doc. You new here? Where is my old mate Edwards?’

‘I am Dr Marshall, Dr Andrew Marshall. Dr Edwards has left the clinic and I have taken over.’

Andrew had lost count of the number of times he had said those words. He reviewed Daryl Morgan’s file, he was 12 months past treatment and the last MRI scan was perfectly normal and obviously Daryl Morgan was in good health. After a brief examination which was also normal, he said ‘Good to see you doing so well Mr Morgan. There is no trace of any tumour.’

‘It’s Daryl, not Mr Morgan Doc. Of course I’m well. I’ve always been well. All I had was a hernia.’

Somewhat puzzled, Andrew reviewed the initial history. Sure enough, Daryl Morgan was admitted to Prince Charles for an elective inguinal hernia repair after being on a waiting list for ten months. He had the operation under a general anaesthetic, there were no complications and on day three post-operatively he had an MRI scan which showed a left frontal glioma. He had a biopsy which confirmed the diagnosis had a course of Amaradine and was cured. Andrew could find no reference to why an MRI scan was done and when he asked Daryl Morgan he did not seem to know either.

‘Search me. I thought I was going home the next day. The nurse comes in to tell me I need another X-ray. Who am I to argue. I get wheeled off and put into a scanner. The next thing I’m told is that I have a brain tumour. You could have knocked me over with a feather. I thought a hernia was bad enough. But, but it’s good news because they can fix it. So, I get some pills, my urine turns orange and a month later they tell me I’m cured. They’re the doctors. I’m just a bricklayer. I guess I should be grateful. That’s all I can tell you doc.’

Daryl Morgan left with another appointment for three months. Andrew reviewed the original MRI. There was a lesion in the left temporal lobe. It was quite small, no more than 2–3 cms, looked low grade. Presumably asymptomatic, that was not uncommon. But why the MRI? He again reviewed the hospital notes. Bloody residents, they never keep progress notes. Even the nursing notes, which were usually a better source of medical information than the doctor’s note, on this occasion were no help at all. Mr Morgan’s departure for the MRI Department and his subsequent return were dually recorded but did not mention the indication for the test.

The radiology reports were there, the first one documenting the lesion, the second one, dated one month later, noting the normal MRI.

And then he noticed it. It was there on the report. The first MRI report as well as describing the tumour noted the incidental finding of a septum cavum pellucidum. An anatomical variant. A split in the tissue separating the two ventricles. An unimportant and clinically irrelevant finding. But one not referred to in the normal MRI report a month later. After checking the MRI films himself, there was a septum cavum on the first MRI and a perfectly normal septum on the second. Andrew was quite certain that a septum cavum pellucidum could not just come and go. He considered the possibility that the eradication of the tumour by Amaradine had somehow altered the CSF dynamics to result in the change but he did not think so.

The memory of Mrs Gold’s artificial eye was still fresh in his mind and a mild, gnawing sensation was beginning in his belly. Howard Bell had never called back about Mrs Gold and now this odd discovery.

He picked up the phone and dialled Dr Bell’s extension. He identified himself and was about to present Dr Bell with the problem when the latter interrupted.

‘Glad you called Andrew. I was about to call you. Solved the artificial eye mystery. I checked the computer file. It was a labelling error. No more, no less. I don’t know how it happened. We’ve changed the software and I’m sure it could not happen again. Anyway it is all fixed up. We have traced Mrs Gold’s original films in the computer. There are new prints in her bag. Mystery solved. Simple.’

Andrew was about to ask about Daryl Morgan’s MRI but as Mrs Gold’s problem had such a simple explanation, Daryl Morgan’s probably did too and Andrew did not want to be thought of as a pest. He thanked Dr Bell and said no more. It was probably nothing. There probably was some explanation that he could not think of himself. He decided to let the matter drop. No use dwelling on it but the annoying sensation would not leave him.

At least not until that evening. He and Lisa went out to dinner. After the second glass of wine the annoying sensation disappeared and he wondered why he was making such a fuss. And then Lisa, who had been excited and babbling from the moment he had picked her up, told him that her flatmate Linda was moving interstate, the lease on the flat had been sorted out and that she wanted to move in with him, that she loved him madly and that she could not wait to be with him.

Andrew was ecstatic. They hurriedly finished their meal and headed back to the flat. They had barely got in the door when he grabbed her, kissed her and then carried her into the bedroom where they made love and where the problem of septum cavum pellucidum quickly melted away.