‘Leukaemia as an inherited predisposition? I thought the latest research on leukaemia was centred on the possibility of viral causes.’
He joined her at the table, glaring across it as he rebutted her statement.
She nodded, glad he was up on the latest research.
‘A virus that causes leukaemia in mice has been discovered, and an enormous amount of work is being carried out based on this find. No actual human virus has been isolated as yet, although the animal work points to the possibility of it. At the moment, scientists are studying a number of suspect viral infections which could be linked to cancer.’
‘Can I hear a ‘‘but’’ hovering at the end of that sentence?’
A lightening of his voice told her he was calming down, perhaps even becoming interested. She tried some steak while she formulated an answer that wouldn’t set up more barriers, and found it melting in her mouth. It was all she could do to stop the whimper of sheer pleasure.
‘This is delicious—beautiful meat. I’d forgotten how good real food could be.’
Obviously startled by her statement, Connor lifted his head and studied her closely, eyes bright with disbelief.
‘You don’t eat real food?’
She grinned at his astonishment.
‘Not for the last month or so. Once this project was mooted, I had to finish what I was working on and also do an enormous amount of preparatory work, not only searching out all the latest papers that might help but boning up on the history of each patient. I’ve lived on takeaways delivered to the lab, and breakfast cereal on the rare occasions I was home.’
He smiled and she felt her body relax, the tension generated earlier melting away. Mind you, it wasn’t so surprising, the man had the kind of smile that would melt metal. The thought was so unexpected she found her cheeks grow warm and determinedly turned her attention from his smile and back to her dinner.
‘Patient histories?’ he repeated. ‘Is that where the ‘‘but’’ comes in?’
‘You’re not an easy man to divert, are you?’ she said. ‘And as I’m eating your food, I guess I have to answer.’
She put down her fork and leaned forward across the table, using the clean tip of the knife to draw squiggles on the tablecloth as she spoke.
‘With the virus that’s been isolated, researchers haven’t been able to transmit it from one animal to another through normal procedures like physical contact or air transmission.’ She paused and looked up from her squiggles, wanting to see his reaction as she continued. ‘With the lab mice, it’s transmitted vertically through families, Connor, though not inevitably. Sometimes it passes from one infected female to one or all of her embryos at a very early stage in their development yet at other times the offspring are not affected.’
His dark eyebrows drew together in a puzzled frown.
‘But what about siblings?’ he demanded. ‘Surely if it was passed down from parent to child all the children in the family would suffer and that doesn’t happen.’
‘We’ve known for some time there’s a higher statistical likelihood of a twin contracting the disease, but the fact that some do and some don’t, as with the mice, seems to suggest that, while there must be a degree of genetic involvement, the virus is only one of a number of things leading to malignancy.’
‘So?’ he asked, and she felt his hostility returning, although he was continuing to eat his meal as if unfazed by her words. She watched him for a moment, wanting to connect with the man on a friendly basis yet knowing it might not be possible, given his antagonism to her presence in the town and the job she was here to do.
‘One way we might be able to take the research further—and translate it from the animals to humans—is through retrospective research.’ The words sounded weak in her own ears. She tackled the salad, deciding the sooner she finished eating, the sooner she could get out of his house. Maybe when he’d had time to think things through…
‘Looking back at people who’ve had or still have the disease?’
Caitlin nodded. ‘That’s right. And seeking possible links between them. You know how science works. You build up a theory then proceed to shoot it down.’
He actually paused in his eating as if this might be worth considering, but when he spoke she realised he’d only been gathering ammunition for another attack.
‘But there must be other places in the world where leukaemia victims have been grouped in one area. In fact, I know there are. And other types of cancer in clusters. It’s a well-known occurrence, although in many instances inexplicable. So why Turalla?’
She tried another smile but it was a strain.
‘In places like Hiroshima after the war and Chernobyl after the nuclear explosion there were explainable incidences—radioactive contamination of both air and water—but to find new leads, science has to look for answers in the clusters where no contamination has been found—in towns like Turalla.’
Silence! A lack of response that went on so long Caitlin felt her own anger build. Once again she reined it in, though not tightly enough to stop having a small shot at him.
‘It’s the old Nimby attitude, isn’t it? Not in my back yard. Everyone would like an answer but don’t let the research affect my town.’
‘Hell!’ he muttered, and stood up, pushing back his chair so quickly it tumbled over. By the time he’d picked it up, he seemed calmer.
‘It’s not that at all. I know what you’re saying, and I understand the need for research, but haven’t these families been through enough? Haven’t studies been done elsewhere that could be related to this particular area without dragging these families into it?’
She watched Connor pace up and down beside the railing. He moved with the fluid grace of a big cat and once again she was touched by a shiver of some prescience she didn’t understand. She couldn’t match him for strength and wasn’t about to react to his anger. Use the facts, her old professor had stated over and over again, not emotional arguments.
‘Work has been done on what might be considered familial cancer in two strains of the disease, one prevalent in Africa and one in China. Both forms appear to be transmitted by a virus similar to the glandular fever virus. Scientists are trying to explain why some family members who contract the virus escape the cancer and others don’t. That’s the closest to what I want to study here.’
He stopped his pacing, as if struck by a winning argument.
‘But what can you do here if no virus linked to leukaemia has been isolated as yet?’
‘I can study the genetic make-up of all the members of the families involved, and eliminate the similarities. What’s left will be the differences and perhaps, even without a virus, those differences will tell us something.’
Caitlin watched as he digested this information. Not a man to give in easily, she decided. Where would he attack from next?
‘Do you realise not all the children had the same type of leukaemia? As I said, I wasn’t here at the time, but from what I can remember of their files, there were different diagnoses.’
Conceding his point with a nod of her head, she gestured to his chair. Although the thought of beating a hasty retreat was appealing, it would be better if they could sort out their problems now. To achieve any measure of success she needed this man’s support. Without it, she doubted she’d get much co-operation from the families concerned. It was time to try conciliation.
‘Look, we have to thrash this out between us. What if I make coffee and we sit down and talk it through?’
‘I’ll make coffee,’ he said gruffly, and disappeared through the door into the kitchen.
Caitlin collected up their plates and followed him.
‘Go and sit down,’ he said, shooing her out of the kitchen with a wave of one hand. ‘I’ll do the dishes later.’
Dismissed, she walked back onto the veranda. The moon had risen while they’d been eating and now hung, suspended, like a misshapen Chinese lantern set in the branches of the peppercorn tree.
A faint scent of eucalyptus filtered through the air, and somewhere an owl cried as it journeyed through the night in search of food. For all her haste to get away from her own home town, she felt the special ambience of a small country town settle about her. The unchanging rhythms of daily living far removed from the stress and pressures of the city were like a benediction on her soul.
‘They have a special kind of innocence, country towns,’ he said, as he returned with a coffee-pot in one hand and two tall mugs dangling from one finger of the other.
‘You stole my thoughts,’ she murmured.
The serenity of the evening seemed to envelop her, but it couldn’t last, any more than innocence could—not in the face of evil or a hidden scourge like cancer.
Connor set down the pot and mugs.
‘Milk or sugar?’
‘No, thanks, just plain black,’ she said, returning to the table and waiting while he poured the coffee. Standing close to him like this, she realised he was taller than she’d thought. The top of her head was five feet eight inches from floor level, yet he stretched at least six inches beyond that.
And solid height, well muscled by the look of the tautness of shirt across his torso, good strong neck—
‘OK—so talk!’ he said, moving to sit back down in his chair and waving her to the other side of the table.
Caitlin took her seat and sipped at her coffee, trying to gather thoughts that had strayed too far. For heaven’s sake! She’d been examining the man like a buyer at a cattle sale might examine a likely beast! What had they been discussing earlier? Her mind grappled for an answer.
He must have sensed her inattention for he prompted helpfully, ‘Not all the children had the same diagnosis.’
‘Of course!’ she muttered, still scrambling to recover the threads of the conversation. ‘Actually, four had acute lymphocytic or lymphoblastic leukaemia, the type they call ALL, and the other had one loosely tied to it—non-Hodgkin’s lymphoma. These are cancers where the possibility of a viral trigger is very strong, because the peak age for contracting them is between two and six, the age where children first come into a lot of contact with other children at playgroup, kindergarten or school. As in most cases of childhood leukaemia, something goes wrong with the production of lymphocytes.’
She looked up from her study of the coffee and added, ‘But you’d know all this.’
He half smiled his agreement. ‘Tell me again,’ he suggested. ‘It’s a long time since I actually studied it.’
Was he really interested? Caitlin was wary of assuming too much. The man’s moods swung like a pendulum.
‘Within both ALL and non-Hodgkins there are subgroups depending on the type of cell affected—B-cell, T-cell, etc. Because of similar cell involvement it’s often hard to differentiate between non-Hodgkin’s and ALL. In children, the malignant cells tend to grow in a diffuse pattern, not in the lumps and clumps we usually associate with lymphoma.’
‘So what you’re saying is, the five are more closely related than I’d thought. If that’s the case, why did one child die?’
He’d looked at her while he’d been speaking, but before she could reply he swung his head away, gazing out over the railing to where the moon had now risen above the trees and was casting its silvery light across the little park, softening its drabness.
‘Perhaps resistance to the treatment—or even a late diagnosis,’ Caitlin said, then added quickly before he could take offence, ‘The symptoms are so vague—pallor, loss of appetite, a general lassitude. Parents will often take a child to the GP two or three times before a blood test is ordered.’
His head turned towards her and he nodded slowly, then she saw a small, tight smile stretch his lips.
‘Not in this town—not now! I take blood if there’s even a suspicion it might be leukaemia.’
‘Yet you’re against me doing some research here that might help alleviate the curse of it for ever.’
Connor sighed, then stood up again, as if his body couldn’t contain his emotion when it was seated.
‘I’m not against your work but sceptical of what good it can do. The thought of stirring up old enmities again if there’s no chance of some end result…’
‘Need old enmities be stirred?’ she demanded. ‘I’m not here testing water or chemicals, I’m here to talk to families. If there’s some kind of genetic link—’
‘If!’ he snorted, disbelief so evident Caitlin wondered if the subject was worth pursuing. ‘And if you do, by some miracle, happen to find a link, what can you do?’
‘Nothing at the moment,’ she admitted, ‘but that’s no reason not to keep trying. Let’s simplify this to a hypothetical. Say, for instance, after DNA testing of the families involved, we find a strand of chromosomal material with five bumps on one side, then find that all the children who contracted cancer had only four bumps, while the children from the same bloodlines but with five bumps didn’t—’
‘Bumps? Now, there’s a precise scientific term!’ he muttered, but he’d come closer and seemed interested. ‘OK, let’s stick with bumps. Are you saying you could add another bump?’
‘Not right now, but immunologists are already working on ways of transporting killer T-cells, the cancer-fighting lymphocytes, into humans with cancer, and geneticists are working on infecting bacteria which can enter genetic material and actually alter it. It’s being done in test tubes, so eventually it can be done in human patients and at least we’d know what to work on, wouldn’t we?’
‘A bump-producing germ that could virtually inoculate at-risk children?’ he said quietly. ‘Put like that, I suppose I can’t object to your presence. What do you need from me?’
Connor asked the question but his heart quailed within him as he gave tacit agreement to this woman’s presence in Turalla. No matter how discreetly she went about her business, the reason for her visit would soon be known all over town. Was he wrong in anticipating trouble? Raising ghosts with his sense of apprehension?
‘Do you know the children? Their families? Anything about their history? What I’d like to do is work out some kind of genealogical chart and see if anything connects.’
Caitlin sounded so earnest he forgot the ghosts and smiled.
‘Setting up a theory in order to shoot it down?’ he teased, and won a smile that did peculiar things to his internal organs.
‘Exactly! It could well be a wild-goose chase, you know, but having this cluster is a unique opportunity to test this particular theory. Look, you’ve got to start from the fact that the usual incidence of ALL is thirty-three children in every million. What if we ignored the high incidence here in Turalla, and an opportunity to learn something new was lost?’
He glanced down at her hands, clasped around the coffee-mug, and noticed her whitened knuckles. Could she really care so much?
‘Is learning something new so important to you?’ he asked. ‘The be-all and end-all of your life?’
She shrugged but it was a half-hearted attempt at nonchalance.
‘Yes, it’s important to me,’ she stated flatly. ‘Whether it’s the be-all and end-all I don’t know.’
He dropped into his chair so he could see her face.
‘Then it’s never been tested, has it?’ he said. ‘You’ve never had to choose between your chosen path and someone else’s?’
He heard his own lingering bitterness in the words and was surprised, thinking it had burnt out long ago. She’d heard it too, for her eyes held questions he certainly wasn’t going to answer, but all she said was, ‘No. Perhaps I’ve been fortunate.’
Her voice was dismissive, as if the subject wasn’t important, but he couldn’t let go of it, couldn’t help needling this super-composed woman fate had seen fit to send him.
‘And if it ends up just a target, your theory, how do you handle that?’
Caitlin chuckled and he knew she’d fielded that question more than once.
‘I set up another, and another and another,’ she
told him. ‘Who knows which one will prove correct, which strand of thought might lead even a small way towards the centre of the puzzle? But we were talking about the children, the families…’
‘Lucy Cummings, Harry Jackson, Aaron Wilson and Annabel Laurence.’ If he added the child who died, Jonah Neil, it would make two girls and three boys, right on the button statistically as incidence was slightly higher in boys than girls.
But he didn’t mention Jonah.
‘Naturally, as I’m the only doctor in town they’re all my patients, but I rarely see them. I take blood when they’re due to go down to the city for follow-up appointments, three-monthly at first, then six-monthly. I think all of them are on yearly visits now. In fact, I seem to remember someone saying Harry doesn’t have to go back for two years.’
Simple background information, nothing even vaguely medical, yet the uneasiness returned. Stronger than uneasiness because it had his subconscious considering a holiday—or perhaps a transfer to a hospital a few thousand miles away.
Connor knew he wouldn’t leave Turalla when trouble in this beautiful package was standing on its doorstep, hand raised ready to knock—but it didn’t stop him wishing!
‘I’m sorry, I was miles away,’ he said, when her voice recalled him from his wayward thoughts.
‘Or wishing you were,’ she suggested, a half-smile tilting one side of her mouth upward and pressing a dimple into her cheek. ‘I was saying I’ve already spoken to Lucy’s parents about this. I met them when they were down for her check-up last week. I didn’t go into details, just said I’d like to look at family backgrounds.’
‘And how did they react?’ he asked, surprised he hadn’t heard anything of this. The rumour mill was usually super-efficient. Perhaps the Cummings family had stayed on for a holiday in the city.
The half-smile became a whole one—neat, even teeth gleaming in the moonlight.
‘A bit like you,’ she admitted. ‘They’d love to have answers to the ‘‘why’’ question all parents ask, but they’re dubious that anything could be found in past histories. Like most people, they feel if it’s genetic their other children would be at risk and they don’t want to even consider that thought.’
Outback Doctors/Outback Engagement/Outback Marriage/Outback Encounter Page 37