Chapter 1
Madam I’m Adam
Samant cycled slowly back through the business park the way he had come. He passed a group of workmen walking home and was passed in turn by an ancient bicycle with no lights and a loose black mudguard that rattled over the bumps in the road. The night was cold, black and windless. Through the mist he could see the headlamps of cars on the main road suddenly slowing down to traverse a roundabout before racing off in the direction of Oxford.
He left the road to recover a dirt track that was flanked on one side by a wire fence and on the other by a thick hedge. When he came to a padlocked gate he suddenly stopped pedalling and stood astride his bicycle, gazing at the prison-like windows of the Nebotec building.
One of the windows on the ground floor was lit up, and from time to time he could make out a figure moving about the room. The window was partly shielded by vertical slats, half drawn. A tall potted plant on the sill cut out a quarter panel of view but still he could see movement and identify its nature. Nothing special — a woman in a white coat, walking quickly around the room, sitting down then almost immediately getting up again. Her movements looked purposeful, almost angry, as if she were doing something routine but necessary. At one point she stopped and seemed to frown. The frown, he guessed, was one of pure concentration.
Watching someone secretly, spying on them, even when he or she cannot clearly be seen, stimulates a desire to know more about that person, a wish to remain hidden as long as possible in order to see as much as possible. What Samant saw roused in him strong emotions: shame, excitement, passion — fear too that he be might be discovered either by the person observed or by someone passing who would accuse him of doing something wrong, being a peeping tom.
He turned off his bicycle light and stood watching the woman in the white coat appear and disappear from view. For a few minutes he did not see her; then, just as he was thinking of resuming his journey, she suddenly reappeared in the office. At the same time a dark figure, that of a tall man, crossed over from the building to what he knew were the Nebotec offices. He concentrated so hard on the figure that he barely registered a pale bicycle light tracking stage left through the mist toward the Nebotec buildings.
The woman in the white coat began moving about the office again, back and forth, in one direction then another; her movements were jerky and at one point she was almost running. That was how his wife moved when she was cooking several dishes and had to watch them as well as the children. In fact she was probably doing that right now in preparation for his return home from work.
It was the loud roar of motors, several of them, from a line of lorries being released from the neighbouring refrigeration works that brought him out of his thoughts. His eyes followed the path of the vehicles until they disappeared into the mist.
He took one last look toward the window that was still lit up. The room was now empty or at least showed no movement. For a few seconds he stood, his head still, his body rigid, as if by this means hoping to induce some activity. But there was none to be seen and he reluctantly remounted his bicycle and continued his journey along the dirt track toward Oxford.
Adam Gabriel was not one, for want of a better phrase, to blow his own trumpet. There was in his appearance nothing to attract attention. Thin, narrow-shouldered, and shorter than the average height, he was dwarfed in all ways by most of the professorial giants who inhabited the medical faculty at Oxford. In contrast to those boastful behemoths who were driven by an ambition to create large, powerful research empires he had not succeeded, or in truth even attempted, to foster good relations with the research councils or to sweet talk wealthy donors into funding a new building or a large-scale programme of research. His scientific work was well-regarded but he had not sought to profit the University (or himself) by patenting his discoveries or turning them into spin-off companies. On administrative committees he let others do the talking, rarely challenging their determination to control the agenda unless it contained a threat from the University or the National Health Service (his other nominal employer) to cut budget or staff in his department. Then he would make something of a noise — not much but just enough for it to be noted that his voice retained more than a trace of an Australian accent.
Some forty or so years ago, Gabriel had emerged from his high school in the inner suburbs of Melbourne where, despite a history of hardened truancy, he had obtained a place to study medicine at university. He was just as truant in attending lectures over the six years of his medicine course which he had chosen for no better reason than it was the longest on offer. Good at exams but bad at life, Gabriel liked to study in his own way and in his own time, a large part of which he spent reading novels and plays or watching old black and white films on television; he had in fact an impressive encyclopaedic knowledge of films — mostly between 1930 and 1960, although at a pinch it could be stretched to 1970 — and he could usually identify a film from just a brief glance at a scene, often recalling arcane details about it such as the name of the screenwriter or a supporting actor.
After graduating, Gabriel worked in one uninspiring medical house job after another before deciding to try his luck in Britain. There too he drifted for a year or so until, one damp July morning, he happened to spot an advertisement for a research studentship in pathology at one of the London teaching hospitals. A week later, after submitting a hand-written letter of application, a rather nervous Gabriel was summoned to a tiny dishevelled room that functioned as an office and tea room for those working in experimental pathology. There he found himself in front of an ad hoc interview committee. He was not introduced to the three men who faced him but he knew who they were. There was Forsyth from the School of Pathology, Byers, the microbiologist, and Deakin, the professor of biochemistry whom, rumour had it, was being considered for a Nobel prize. This distinguished interview committee then proceeded to explore not only Gabriel’s rather limited knowledge of pathology but also what he considered his equally limited background. At no stage of the interview did the committee look particularly impressed with his answers but, after the questioning abruptly ended, the three men exchanged glances and almost without a word Gabriel was offered a studentship in what Forsyth apologetically described as his “small research team”.
Gabriel accepted the post on the spot. No one mentioned money because it was generally understood that there was not a lot to talk about.
The first few months in the laboratory were disappointing as his work went unsupervised and most of his experiments failed. It was not long, however, before Gabriel realised that he had been directed into the solitary pursuit of pathology by those who understood his character better than he did himself; for, just as at school, he appreciated the advantages of working alone, teaching himself laboratory methods and exploring in his own way research ideas. In the end his experiments led to a novel finding, one which appeared insignificant at first but later had Forsyth jumping up and down in excitement when it was pointed out to him by Gabriel that it could be developed into a new technique to diagnose a rare cancer.
In the late eighties, Forsyth suddenly upped sticks from London and went to Oxford to follow, as he saw it, his destiny and take the chair there. Gabriel in due course followed and also met his own — Pat Stanley, a tutorial Fellow in English. In Oxford he broke away from Forsyth’s influence and focused more and more on tumour biology and pathology, soon gaining a reputation as an outstanding diagnostic opinion.
As so much of Gabriel’s time was spent looking at tumours and working with cancer cells, it was perhaps inevitable that he should come to look upon the world as more malignant than benign. Tumour cells were for him something of a perverse reflection of the normal, possessing, as they did, the same intracellular machinery as normal cells but using it in a fundamentally selfish way to promote their own survival and propagation. Some cancer cells proliferated with amazing speed, destroying all before them like barbarian hordes. Gabriel’s laboratory research studied the biological causes of this aggressive behaviour; but it was what he could not study in the laboratory — the lack of reasoning behind this process — that most puzzled him. It simply made no sense to him, struck him as just as perverse in fact, that the overgrowth and spread of tumour cells should lead to the death of the patient — and with it the death of every cell in the body including, of course, the tumour cells themselves?
Such gloomy reflections had an erosive effect on Gabriel’s character if not his career. As the latter developed he became more and more convinced that it was futile to strive for more when life was so determinedly and painfully pointless. He worked long hours and often went home tired. Truth be told, he enjoyed his work, which he regarded as something akin to doing crossword puzzles for a living. He got just as much satisfaction from identifying the diagnostic clues hidden in a microscope slide as in figuring out the cryptic elements of a Four Across or Ten Down; and just like crosswords his work filled in time, which meant that less remained for gloomy thoughts. His previous interests now gave him little pleasure. Though he retained his knowledge of films he no longer watched them. His main activity outside work was in a sense a continuation of it — judging people and analysing them pathologically as he did tumours in order to determine if they were for him benign or malignant.
When Forsyth died suddenly of apoplexy, Gabriel inherited his chair and with it the administrative duties of the department. This was a new challenge for Gabriel and one that ill-suited his instinct to resolve scientific problems by simplifying rather than complicating them. The University and hospital were now ruled by handsomely remunerated managers (many of them erstwhile clinical colleagues) who wore grey suits, shiny ties and had a knighthood to boot. They were forever demanding more accountability and greater efficiency of staff and departments. The old pragmatic approach of a handful of highly qualified, underpaid men had given way to the bureaucracy and intrigue of a bloated corporation. Gone forever were the days of Forsyth when you could easily and quickly sort out problems. Now, before anything could be decided, you had to attend wearisome meetings with uncompromising managers. All Gabriel’s knowledge and experience counted for nothing in this new age which pursued goals that he (and they) knew were contradictory: cutting costs whilst increasing services. Gabriel did his best to protect the funding and staffing of his department, but too often he found himself in the position of a normal cell in the face of a rapidly growing tumour.
Against this, Gabriel still enjoyed his clinical work and the esprit de corps of staff in his department who were loyal to him as they could see he worked long hours and performed something of a miracle in keeping the show on the road. All of which goes some way to explaining why, returning from a research meeting in Madrid, Gabriel had come straight from the airport back to the Pathology Department and was now looking down a double-headed microscope at the request of a junior registrar in need of an urgent tumour diagnosis.
“So what do you think the diagnosis is?” Adam Gabriel asked, leaning back from the microscope.
“I’m not sure,” the registrar answered, her eyes still glued to the eyepieces. She focused the microscope lens on the slide containing a tiny C-shaped piece of tissue not much larger than a pin head. “The cells have very big nuclei and there is a lot of proliferation. It looks like it’s a rapidly growing tumour.”
“I agree it doesn’t look very nice and I suppose we’re both glad not to have such a tumour in one of our bones but do you think it’s malignant or not.”
“I’m really not sure,” answered the registrar, Melanie Stokes. “That’s why I’m showing it to you, Prof.” Her face wore a smile that apologised for her ignorance.
“How old is the patient?” Gabriel asked.
“He’s—” Melanie searched for the Pathology request card and read out, “sorry, it’s a she. The date of birth is...” She did a rapid calculation in her head and said, “She’s about fifteen.”
“What’s the X-ray show? Have you seen it?”
She hesitated before answering, “Not yet. It’s not on a CD but on old style X-ray films. The case is from Turkey.”
“The radiology is important because it tells you where the tumour is in the bone, how big it is, whether it looks invasive or not. You need all that information to make the diagnosis.”
Melanie Stokes looked contrite and Gabriel gave her a forgiving smile. She looked very self-contained behind her thick black-rimmed glasses. She had worked in pathology for only a year but already had a good idea of what to look for down the microscope. She may not have been certain of the significance of everything she observed but that would come with time. Bone tumours were rare. Melanie would see very few cases if she became a general pathologist like most of the trainees who passed through Gabriel’s department. Still, she needed to know what to do when she would encounter such a case in the future.
“Pathology is a bit like spotting who are the good guys and who are the bad guys in a western,” Gabriel added. “The trouble is malignant tumour cells don’t always look like baddies and wear black hats; they can be white — or grey for that matter. And benign cells can look like baddies.”
From the look on Melanie’s face Gabriel was aware that his analogy was lost on her. “I’ll bet London to a brick, Melanie, that you’ve seen very few westerns, at least of the type I grew up with.” He smiled before adding, “You may finish your rotation through this department not knowing much about bone tumours but you should at least end up knowing something about westerns.”
Melanie was not sure whether this was the moment to admit to Gabriel her utter lack of interest in westerns and her belief that not even a lengthy rotation in Gabriel’s department would heighten their appeal.
She dodged the issue by remarking, “By the way, the surgeon wants this result urgently. I couldn’t find Tom Duncan or Dr Reynolds when the slides came through last night. I mentioned the case to Tom this morning but he said it would be best to wait and show it to you today as you’d be sure to be in.”
Rousing himself, Gabriel leaned forward. “Back to business then.” He refocused the slide under the microscope and, after viewing it for a few seconds, said, “Well, it’s a small biopsy but it does suggest a number of diagnostic possibilities. We really need to have a look at the radiology before we can say for certain what this is. Tell me, do you have any idea at this stage what sort of tumour it might be?”
There was an awkward pause before Melanie was able to summon a response. “It’s got some areas of cartilage and a funny pink matrix around some cells which are rather large and look malignant. It could be an osteosarcoma.”
“I entirely agree about the cells,” said Gabriel, “but I’m not so sure they’re malignant. The patient is the right age for osteosarcoma. And you’re right, there is some cartilage there, but that doesn’t rule out—” Gabriel stopped himself before declaring aloud what he suspected the diagnosis to be. He dropped his voice almost to a whisper, before continuing,”— other possibilities.”
He sat back from the microscope and saw that Melanie Stokes was hanging on his every word. A fresh weight of responsibility descended upon him. “The X-rays will be very useful in this case. Why don’t you go down to the ward and bring them back here so we can look at them together?”
As Gabriel walked back to his office he reflected on the case which he had just been shown. It was most likely a benign tumour; it would cause problems and need surgical treatment — its mere presence in the bone weakened it — but it would not grow quickly and spread to other parts of the body; it did not have the potential to kill the patient, like an osteosarcoma. In a way the patient had been lucky for the cells that made up the tumour had stopped just short of transforming into full-blown malignant cells.
Why was it that happened in some people? Why did cancers arise in some but not others? We would all die but it would be better if we were not to die a horrible death from cancer. That was how his own father had died and he knew there was a risk — a statistically significant one — he was likely to go the same way.
Entering his office, Gabriel looked with dismay at a long table by the window on which stood a microscope and next to it a tall stack of trays filled with glass slides; these contained the tumour cases which he had to diagnose. It was always the same when he left the department even for a short time: the work just piled up. He glanced at his desk, large, modern — too modern for his taste — and the rows of long shelves above that were filled with textbooks, one of which was his own.
His secretary Jane had already gone home but, as was her custom, she had left a number of messages on his desk. Like festival flags the messages were written on different colour paper, signalling their relative importance. On yellow paper — most urgent — were those from surgeons wanting to know the diagnosis of tumours that had been sent to him; there was one requesting the result on the case he had just looked at with Melanie. On pink paper — these could wait if he wished — was one from Poole who requested a meeting later this week to discuss Pathology Department staffing and the Agenda for Change, the latest buzz term for financial cuts in the National Health Service. Poole was a physician who in Gabriel’s opinion had gone over to the dark side and become a full-time manager. It no doubt comforted his NHS masters that Poole was a man who could lie brazenly and make simple matters appear complex and complex ones simple. As far as Gabriel could determine, Poole’s principal role was to get more work out of his medical colleagues whilst providing them with fewer resources to do it and at the same time getting them to fill in endless forms. Gabriel was not on easy terms with him. Not that he was on easy terms with anyone except those few who knew him well enough to realise that the mask of confidence he wore hid a mass of resignation and self-doubt.
In the midst of all the pink and yellow was a message on white paper — indeterminate importance — from Anna Taylor, one of his old doctoral students. In her own way she too had gone over to the dark side, abandoning a promising career in academic pathology to join her husband who worked for a medical biotechnology company in Oxford. The message was dated Friday afternoon last week and requested Gabriel to contact her when he returned to Oxford.
Gabriel had not heard from Anna since she had left his department over a year ago and he wondered what had prompted her to contact him. He had no time to dwell on this question for at that moment Melanie Stokes appeared, carrying a large envelope filled with radiographs.
“These are the films of the case we discussed, Prof.”
“Let’s have a look at them.”
Gabriel fished out a plain X-ray of the shoulder from amongst the many other films in the envelope; it was what he felt would be most useful to look at in this case and he placed it on the viewing screen.
“I thought so,” he said. “You see where the tumour is — it’s at the end of the bone. Look how sharp the boundary is between the tumour and the rest of the bone. You don’t see that in a malignant tumour. It’s expanded the bone but not spread outside it. That would be unusual for an osteosarcoma of that size. It’s most likely a chondroblastoma. That explains the small bits of cartilage and those plump cells with large nuclei. You’d better let the surgeon know the diagnosis. He’ll be tickled pink to know it’s not malignant.”
Melanie Stokes looked astonished that Gabriel had settled on a diagnosis after such a brief glance at one X-Ray. “Don’t you want to see the other films?” she asked.
“I don’t think they’ll tell me much more than this one. These tumours almost always arise in this location — heaven knows why — and it’s unlikely to be anything else. It’s benign.”
The registrar continued to stare at him. It was not that she did not believe his diagnosis; it was just that she could not see how he had arrived at it so quickly and so definitely.
“As I said, it’s just like recognising good guys and bad guys in a western. Pattern recognition: that’s how you make a diagnosis most of the time down the microscope. I can tell what this tumour is because I’ve seen lots of them. It will be the same for you when you get a bit more experience. Of course, it’s not always straightforward. The pattern may not be obvious and then you really have to examine the cells critically to see if they provide a clue to the diagnosis. It’s not always easy and there are times you can’t be sure whether a tumour is benign or malignant — or even whether it’s a tumour at all. The important thing is to make sure that you only report what you see.” Gabriel scratched his temple. “You should go and read up about chondroblastoma and have another look at this case before writing your diagnostic report. That’ll help you to recognise it next time. I’ll go over it with you tomorrow.”
Not long after Melanie Stokes left him, Liz Reynolds, the Reader in Gabriel’s department, appeared at his door.
“You’re back, I see,” Liz said.
“Yes, but for what reason I’m not sure. Look at that.” Gabriel pointed to the pile of slides he had to report.
“That will teach you to go off to Europe on conference jollies. Did you have a good time?”
“I hardly saw anything of Madrid. I had too much work to do, chairing sessions and attending committee meetings. I spent most of my time at the conference hall and the hotel. I barely had time to see the Goyas in the Prado. How about you?”
“The same as ever,” she said. “I was here all day yesterday and the day before. I didn’t finish my work until late when I had a tutorial at the college. We really need some more help to deal with the diagnostic workload.”
A tall thin woman of about forty with grey-streaked black hair, prominent white teeth, russet cheeks and tear drop eyes, Liz Reynolds looked more like a hard-working farmer’s wife than the clever pathologist she was. For all her fresh air appearance though, she had a business-like side, getting straight to the point after their few pleasantries were exchanged.
“I’m supposed to have drawn up a short list for the Clinical Tutor post in Pathology. Human Resources wanted it yesterday. But I thought I should discuss it with you first.”
“Is there a problem? Isn’t there anyone suitable?” Gabriel suspected that as usual Liz Reynolds had already made up her mind there was a problem and was going to present him with the solution to it.
“It’s not a great field of applicants. Most of them haven’t done much research and I do feel we need someone fairly experienced in this position. There’s Tom Duncan, of course, and he would certainly do, but it would be good if he had some competition. That’s why I wanted to sound you out over the possibility of Anna Taylor coming back. She rang me last week and said that she’d seen the ad but wasn’t sure whether to apply or not. She wasn’t sure what you’d think about it.”
“So that’s why I’ve got a message to ring her.”
Liz looked a little surprised. “I suppose so. The thing is she feels that she let you down when she left. After all, you just about created a job for her to stay here a couple of years ago—”
“And at the last minute she let me down and took another job,” Gabriel broke in to say. “It took me a lot of effort to sort out that post with management. So what does she do? She goes and marries an entrepreneurial Oxford type — always talking about patents and “opportunities” — who persuades her to join him at Nebotec, the outfit to which Ken Palmer, our beloved colleague, has sold his soul. It caused a big stink in her Indian family because he was English. Her father was hopping mad. Rang me to complain. He thought I was responsible! I suppose she wanted to have babies with him. She must have had them by now.”
Liz gazed at him blankly. There was a moment’s silence before she said, “Nice to see that you’re as politically correct as ever.”
Gabriel leaned his chair back, nudging the microscope eyepieces. “Don’t get me wrong, Liz. I’m tired and just talking off the top of my head. I don’t hold anything against Anna. The past doesn’t enter into it. She should apply if she wants — for whatever reason. We’ll appoint her if she’s the best candidate.”
“She looks very competitive, given the CVs I’ve read.”
“Then I’d encourage her to apply.”
A muted smile was frozen on Adam Gabriel’s face. Looking at him, Liz wondered what impression he made on those who did not know him well. He looked younger than his sixty years because he was still relatively thin and had managed to keep most of his hair; only the fact that it was grey around the temples betrayed his age; the other signs — a sagging chin, the lines around his mouth when he smiled and the furrows on his brow — had to be looked for before he could be safely categorised in terms of age. He dressed casually when he was at work, not wearing a tie most of the time. “I don’t see why I need to dress up every day,” he had told her once. “I don’t see patients, only doctors, and they couldn’t give a stuff whether I’m wearing a bag of fruit or a blue singlet.” But there Liz thought he was wrong. She was sure they did mind and that Gabriel would be taken more seriously if more often — not just when he had formal meetings — he made a greater effort to look professorial. Really, his wife ought to look after him better.
“I’m glad to hear that you’ve got no hard feelings. And, by the way, she doesn’t have any children.”
“Not sure whether I’m glad or sad to hear that,” Gabriel answered ironically. “So has she applied?”
“Not yet. She said that she wanted to talk to you about it first.”
“She doesn’t need to do that.”
“I just about promised her that I’d get you to call her. I’d be grateful if you would.”
“What for?” Gabriel’s embarrassment took the form of aggression. “She either wants the job or she doesn’t.”
“I’m sure she does. I got the impression that she wasn’t enjoying her job at Nebotec.”
“I’m not surprised.”
“She said something about it being necessary to make a fresh start. Look, do me a favour and give her a call now. I need to get the short list in by tomorrow. She sent me her application by email but I said I wouldn’t let it go forward before she spoke to you. Please, Adam.”
“Oh, all right.”
Gabriel dialled the number on the note left him by his secretary.
A man’s voice, which Gabriel initially struggled to identify as that of Anna’s husband, answered by reciting the last four digits of the number that he had dialled. Gabriel realised immediately that Anna had given him her private rather than work number. He could not conceal his surprise to be talking to someone he had not expected to answer the phone.
“Oh hullo, is that Matt Taylor?” He paused slightly as if not certain what to say next but then added quickly, almost in the same breath, “How are you? This is Adam Gabriel. I worked with Anna at Oxford... Yes, that’s right. I supervised her doctorate. We’ve met— at a college dinner, more than a few years ago now, and at an IACR conference in Denver, if I remember correctly. I wonder if I could speak to Anna, please...”
His body suddenly stiffened. His eyes, which were focused on the X-Ray placed on the viewing box, opened wide as if they had suddenly spotted another abnormality in one of the bones. He clutched the phone tightly.
“Something’s happened... something terrible,” he heard. “Anna’s dead.” There was a pause. “She’s been murdered.” Another pause. “I can’t say much more about it but it happened when she was at work...”