When she’d finished, she called Jackie. Jackie was already at work, but this time she had her mobile switched on. “I’m ready,” she said. “Just say the word, and I’ll be there before the contractions have got into gear.”
“It’s not time yet,” Jenny assured her. “Any day now, any way now, I shall be released—but I’m hoping not before lunchtime.”
“You sound a lot saner than you did yesterday,” Jackie observed.
“I was always sane,” Jenny assured her. “It’s the world that’s mad. I saw Lieutenant Lunsford again, but he didn’t seem to enjoy it. He’s glad he’s a dad, I think, but that doesn’t mean he wants to complete the mission. Isn’t it always the way?”
“Great to hear you so cheerful,” Jackie said. “Must go now. Get them to call me the minute the dam bursts.”
“I will,” Jenny assured her. Then she called Steve. Miraculously, he answered too.
“It’s okay,” she told him. “The kid’s healthy, and I’m in safe hands. Expect to be an uncle some time in the next twenty-four hours.”
“What the hell was all that stuff about the army picking you up?” Steve wanted to know.
“I’ve joined up. I can’t explain why—it’s a need-to-know sort of thing. I’m okay, though. As well as can be expected, and maybe better. I’ll call when I can. Bye.”
She put the phone under her pillow, wondering how long it would be before they served lunch, and whether they’d let her have elevenses between. She was, after all, eating for two—and there was a war on.
<
* * * *
the trial
Tom Wharton shook his head sadly as he moved away from Mrs. Heatherington’s bed, reluctantly marking a red X against her name. It was the third X in a row, and it was a bitter disappointment. There was only one more of the new intake to be checked, and if that one turned out to be a reject too the trial would be stalled for an entire week.
The main problem was that by the time Alzheimer’s sufferers actually got admitted to a ward they were usually too far gone even to attempt the battery of cognitive tests that the trial required as a key indicator. Sufferers who were still in the community, on the other hand, mostly hadn’t had their diagnosis confirmed with sufficient certainty. Patients suitable for the trial had to be caught within a very narrow margin of the observation regime, and the trial’s protocols were way too tight to allow Tom any wriggle-room when it came to judgments of suitability.
“Hello, Mr. Asherson,” he said, as he arrived by the next bedside. “How are you feeling today?”
“Name, rank and serial number, you fascist bastard,” Mr. Asherson replied. “That’s all you’ll get from me.” Asherson was no spring chicken, but he was significantly younger than Mrs. Heatherington and most of the other human wrecks littering the ward. He was sitting up in the bed, and there was an angry but slightly puzzled glare in his eyes, as if something he couldn’t quite put his finger on had deeply offended his moral sensibilities. His memory was playing tricks, though. He’d spent the greater part of his working life in secondary schools teaching biology and physical education; he wasn’t old enough ever to have been a prisoner of war.
“That’s all I need, Mr. Asherson,” Tom said, cheerfully, as he flicked over the sheets on is clipboard looking for further background information. “What is your name, rank and serial number?”
“William Asherson,” the old man replied. “Sergeant-Major. Six...six...six...?” I his impetus ran out.
Tom found the detailed notes he was looking for. The serial number that William Asherson had been given during his only brief spell of military experience—while he was on National Service in 1949-50—had not, in fact, begun with the digits 666, and he had only attained the lowly rank of corporal before returning to civilian life. He had apparently exaggerated his achievements to his family, though; there was a scrawled note from the appraisal nurse to the effect that Asherson’s daughter, Mrs. Patricia Lockley, had confirmed—in flat contradiction to Army records—that he really had been a sergeant-major, even though she knew that his claim to have once been in the SAS was a pure fantasy, belatedly made up to impress his infant grandson in the 1980s.
“I’d just like to run a few little tests, Mr. Asherson, if that’s all right,” Tom said, carefully maintaining his broad smile. “Nothing painful or tedious—just puzzles, really.”
“If it’ll get me out of here,” Asherson replied. “I need to get out. I don’t belong here with all these old people. They’re all sick, you know. Sick, sick, sick.”
Tom was heartened by the relative sanity of this response. It meant that Asherson was still in good enough condition to engage in what passed for merry banter in these parts. He sat down beside the bed, detached the screen from his laptop, and placed it carefully in front of the patient—who looked at it with frank distaste but refrained from doing any violence to it.
Half an hour later Tom had determined that Mr. Asherson was in good enough condition to relish a certain amount of attention and a little mental exercise, and was able to grapple more-or-successfully with the series of mental tests used to measure the effects of LAW-1917. The old man had become frustrated when he failed tests that he felt he ought to have passed—some of which he seemed certain that he had passed, in spite of the computer’s insistence that he had not—but he had completed each one without forgetting what it was that he was trying to do, and that could be counted a triumph in itself, in this particular context.
His achievements entitled Mr. Asherson to a big tick on Tom’s list—whose inscription brought a big sigh of relief from the beleaguered junior doctor. The trial was making painfully slow progress, but at least it was still on track. William Asherson would be the eleventh subject out of a required sixteen—always provided, of course, that Patricia Lockley could be persuaded to sanction his acceptance on to the program. It was very rare for anyone to refuse, though; most relatives considered it a great opportunity for their fast-fading loved ones to be given privileged access to new experimental treatments.
“If I can get the consent form signed today, I’ll see you again tomorrow, Mr. Asherson,” Tom said, making the effort to be pleasant even though he confidently expected that Mr. Asherson would not retain the slightest memory of him until the next day. “You’ll have a room all to yourself, and you’ll be known as Patient K. That’ll be your codename for a secret mission—perhaps the last you’ll ever have to carry out.”
“Never volunteer,” the newly-promoted Patient K advised him. “All present and correct, sir—sod off and die, you Sandhurst ponce. Get me the hell out of here. Sick, sick, sick.”
“Just sick enough—not to mention just thick enough—to earn you a big tick, Mr. Asherson,” Tom said, blithely. “You’re the pick of the bunch today. That’s the advantage of having been a teacher; you might lose your marbles but you never lose the habit of rising to a challenge.”
* * * *
As he supervised the final preparations in the treatment room the following morning, Tom tried hard to think of any advantages there might be in carrying out trials on Alzheimer’s patients, which might compensate for all the awful inconveniences. The only obvious one, he decided, was the lack of half-informed bolshiness. Alzheimer’s sufferers were notoriously stroppy, of course—but only randomly. They weren’t calculatedly stroppy, in the grimly determined way that many healthy volunteers now set out to be in the wake of the TGN-1412 disaster at Northwick Park, perennially on the lookout for the possibility of a juicy compensation payout to augment their participation fees.
Mr. Asherson was certainly stroppy enough, in his own quietly perverse fashion. He hadn’t taken well to being moved.
“Putting me in solitary, are you, you black bitch?” he said to Sarah Odiko, the nurse who was assisting Tom. “You won’t break me. Name, rank and serial number.”
“Please don’t abuse the staff, Mr. Asherson,” Tom said. He had changed his tone from cheery to soothing, because that usuall
y worked best in the circumstances. “You’re very lucky to be here. There are people clamoring to be let in on trials like these.”
He was telling the truth. The Northwick Park incident hadn’t inhibited the flow of volunteers at all. Indeed, by informing a much larger population of cash-strapped young men about the easy money to be made from participation in drug trials—which usually didn’t send their immune systems into crazy overdrive—it had actually increased recruitment, albeit with the compensating downside that the volunteers in question were much louder in the proclamation of their “rights”. Not that they actually cared about the precise exercise of the principle of informed consent, of course, or the minute details of the experimental design; they just wanted to lay the groundwork for future lawsuits, in case anything did go wrong.
That wasn’t the only way in which Tom’s job had become a great deal more stressful since the TGN-1142 affair. He knew as well as everyone else that the disaster could just as easily have struck St Jude’s as any other hospital, and that no matter how many extra precautions were taken, something similar might happen to him at any time. While no one had known that an “immune system frenzy” was anything more than a conjectural possibility, ignorance had permitted complacency, but now the possibility had been luridly demonstrated it hung over every new trial of a monoclonal antibody like the sword of Damocles. It wasn’t as if the regulatory authority could just slap a ban on the whole class of treatments—so many of them worked that the small risk of the occasional trial going badly awry was not only acceptable but necessary.
“I need to get out of here,” the newly-appointed Patient K complained. “Have to see a man about a horse.”
“No you don’t, Mr. Asherson,” Nurse Odiko informed him. “You’ve got a catheter for that.”
“You have to take your medicine now, Mr. Asherson,” Tom said. “Just drink it down.”
“No,” Asherson said. “Nasty taste.”
“It doesn’t taste nasty, Mr. Asherson,” Tom assured him. “It’s wonderful stuff. Just between the two of us, though, it’s been a bit awkward finding people who can benefit from it. It’s specific to a narrow range of neuronal intranuclear inclusions, you see, and if the results of the trial are to be meaningful it’s necessary to be sure that the magic bullet is being aimed at the right target. If the trial were to record a negative result, and post mortems carried out six months or a year down the line were then to reveal that a significant number of our subjects had been suffering from CJD or some other exotic CAG-repetition dysfunction, the whole thing would have to be done over—and my reputation would be indelibly scarred. Fortunately, Mr. Asherson, we know that you have exactly the right kind of gunk gumming up your tired old brain, and you’re still sufficiently compos mentis to do the cognitive tests I have to administer,” He paused to check whether the sound of his voice was having the desired effect. It wasn’t. “That’s puzzles, to you,” he added, with a sigh. “Just swallow it, for Christ’s sake. You’re not scared, are you? What kind of soldier-turned-teacher are you?”
“Sandhurst twat,” Asherson opined, looking at Tom the way he might have looked at a slug on his kitchen table—but he eventually consented to swallow his allotted dose of LAW-1917.
“That’s good,” Tom said, as Sarah Odiko moved into position to monitor Patient K’s heart-rate and blood-pressure. He carried on talking, for distraction’s sake, making every effort to keep his voice level and friendly. “Everything will be fine, Mr. Asherson. We’re pretty sure about that, because patients A to J were all okay. The disaster at Northwick Park wouldn’t have been nearly so bad, you know, if they’d staggered the administration of the drug. Once the first patient had gone into frenzy, the others could have been spared the necessity. While I’m only able to administer LAW-1917 to one or two patients a week, there’s no danger of a simultaneous meltdown of my entire sample. On the other hand, if the Northwick Park trial had been staggered, no one would ever have known for sure whether or not the first patient’s reaction was an idiosyncratic one that might not have affected the other members of the group. In my experience, every trial tends to turn up one hypersensitive reaction and one contradictory reaction, no matter how consistent the rest of the results are. Humans just aren’t as similar to one another as mice. On the other hand, they can do cognitive tests, so you get a much clearer idea of the nature and extent of the effect that drugs are having on their gummed-up brains. It’s all a matter of swings and roundabouts, isn’t it, Mr. Asherson?”
“Met Eileen at the fair,” Asherson commented. “Real fair— coconut shies and everything. Lousy Ferris wheel, but what did I care? Sick, sick, sick. Is Eileen coming to see me today? She came to see me yesterday.”
Tom carefully refrained from reminding Asherson that his wife was dead, and that the woman he occasionally mistook for her was his daughter. “Everything okay, Sarah?” he said to the nurse.
“Fine,” she said. “BP up to one-thirty over ninety. Pulse eighty-five.”
“Good,” Tom said. “I’ll do the first set of tests now, to set the baseline. Wheel the screen into position, will you?”
The display-panel used for the tests in the dedicated trial room was much more impressive than the one on Tom’s laptop. It was a nineteen-inch flat screen mounted on the end of a mechanical arm connected to the main body of the computer by a slender bundle of cables enclosed in a plastic tube. Tom was able to sit beside the bed, facing the screen aslant, with the keyboard on a mobile desk in front of him.
“You know how we do this one, don’t you, Mr. Asherson?” Tom said “All you have to do is watch out for the lemon, and touch the screen when it appears.”
Asherson couldn’t remember how to do the test, but he caught on quickly enough when it was demonstrated. He was willing to oblige, in spite of uttering the judgment that it was all a waste of time and that he really need to get away. He became less and less willing as the run went on, but Tom was able to complete the series. The results, as expected, were much the same as those he’d obtained the day before.
“That’s fine, Mr. Asherson,” Tom said, when he was through. “You can have your lunch now, and then a little nap, if you want. I’ll tell your daughter that she can come in to see you, so that she can make sure that you’re comfortable. I’ll come back at five to do the second run—by which time of course, you’ll probably have forgotten all about the first run, so it will all seem fresh. We won’t have to worry too much about the possibility of educative bias, unless you actually begin to show some improvement. That’s another advantage this trial has over the ones that only test the healthy, now I come to think about it. Things aren’t as bad as we sometimes imagine, are they? Okay, Sarah—you’re in charge.”
“Officers are wankers,” Patient K opined. “Lions led by donkeys, we were. Sick, sick, sick.”
According to Mr. Asherson’s biography, which Tom had scrutinized more carefully since awarding the big tick, the teacher had served briefly in the Far East before completing his National Service, but he’d never been in anything the Army was prepared to define as a “conflict situation”. No matter what he’d told his children and his grandchildren thereafter, or what he was trying to tell Tom now, he’d never had the chance to be a real lion. He’d still been at school during World War II, and hadn’t even suffered the indignity of being an evacuee.
“Lie down like a lamb, there’s a good chap,” Tom said, in his best paternal manner. “We’ll see what kind of hero you are tonight—when your brain might be a little clearer, with luck and the benefits of LAW-1917. If so, we should see some real improvement tomorrow—although I shouldn’t tell you that, strictly speaking, in case the expectation actuates some kind of placebo effect.”
By now, Tom was genuinely optimistic about the possibility of improvement. Patients A to J had all shown some improved brain function, although some had done far better than others—and none of it was likely to be the result of a placebo effect, given the condition of the subjects. Those wh
o’d done best of all, in fact, were still showing clear benefits two to six weeks later, and there seemed to be every possibility that more than half of their number would hang on long enough to take further treatment, if and when the program was able to move into Phase Two. All in all, the trial was going well in spite of the time it was taking.
* * * *
Simon Phipps, the English rep from the company on whose behalf the trial as being carried out, was waiting in Tom’s office when he got back.
“It’s going well,” Tom said, turning his clipboard around so that Phipps could see the long columns of numbers, ticks and crosses.
“Patient K,” Phipps read off the top of the sheet. “He’s your only one this week? That still leaves L to P to find.”
“Four more weeks,” Tom said. “Six tops. In the meantime, you can buy me lunch. Have to be the canteen, mind—the protocol requires me to stay on the premises during the period of administration, in case of an adverse reaction.”
In the Flesh and Other Tales of The Biotech Revolution [SSC] Page 18