He watched her as she spoke, a slight smile playing about his lips. “It’s very kind of you,” he said. “I wouldn’t want you to think me ungrateful, but frankly I don’t really see any way out of my…misfortune. It’s happened. That’s it.”
Isabel felt his sense of defeat. There were times when the acceptance of defeat must seem the only option and an intelligent person in such circumstances might well become resigned.
“Would you be able to tell me—very briefly—what happened to you?”
He sighed. “Very well. I was a doctor. I still am, I suppose. Although, as you can see, I’m not actually practising anymore. I’m an infectious diseases specialist.” He had been looking at his hands as he spoke; now he raised his eyes to meet hers. “There was a time when everybody thought that they wouldn’t need us much longer. People thought that they’d won the battle against the microbe—but were we in for a little surprise on that front! Everything has come back with a vengeance: TB is the least of it, perhaps. The real nasties—Ebola, Marburg, and the rest—are lurking, and of course all sorts of new ones—avian flu and so on.”
Isabel nodded. “I suppose we’ve created exactly the right conditions for this,” she said. “Too many people. Too much travel. Environmental degradation.”
Her comment seemed to cheer him: she knew what she was talking about. “Exactly,” he said, his voice becoming enthusiastic. “Global warming is going to wreak havoc with health. Malaria in Europe and North America. And that will be just the beginning.”
She brought the conversation back to his case. “But I was told that you were working on MRSA when this…this thing happened.”
His enthusiasm visibly waned. “I was. I was very interested in a new antibiotic that had just been licensed. I knew the people who made it—one of the smaller drug companies, a bit of an outsider. They had a veterinary preparation and an antifungal cream—and then this very clever bit of chemistry. It was like finding oil for them.
“Anyway, any cases of MRSA infection in Scotland were more or less referred to me and I monitored the use of this drug. Everything was fine. Then, by highly unlikely coincidence, two cases turned up in Edinburgh, one after the other, when patients who had taken the drug experienced fairly serious side effects. Heart issues. I was asked by the Scottish government health people to look into it. The chief medical officer was concerned.
“I did it. I got hold of the records and had blood samples sent back for analysis. I tried to find out what happened.” He paused. “Are you following me?”
Isabel smiled. “So far. You’ve been very clear.”
He ignored the compliment, turning to stare out of the window. “We looked at the two patients. There was an interesting thing about one of them. He was a drug addict. He had got hold of our antibiotic from some pusher who said that it was a new drug that would give an unusual hit. How the pusher got his hands on it is beyond me, but it was probably theft from a pharmacy somewhere. These people will steal anything, sell anything, and take anything. As long as it’s a pill. And then word gets out on the street that something works and you have all sorts of people overdosing on the most peculiar substances. Laxatives even. Vitamins.
“I spoke to this patient and asked him how much he had taken. He gave me an answer which worried me, as it was not all that much in terms of an overdose. Ten times the therapeutic dose, in fact, but that was well within the limits of tolerance of that particular drug. Those limits are pretty large.”
He looked back at Isabel. “I don’t know if you’ve had any dealings with addicts. Have you? Do you know what they’re like?”
Isabel thought. There had been a student in her college at Cambridge who stayed in bed all day and made no sense most of the time. There had been a person in the apartment next to hers when she had been on that fellowship in Georgetown. He was an addict, she had been told, but he appeared perfectly inoffensive. A bit thin, perhaps, but inoffensive. I have had a sheltered life, she thought.
“No. I can’t claim vast experience.”
“Well, I’ll tell you something about them,” said Marcus. “Everything they say has to be distrusted. Everything. And so although I was worried, I thought that the chances were that he was lying. So I got hold of the blood that had been taken from him when he was admitted and sent it off to the lab for reanalysis. And when it came back, the result showed an overdose of about one hundred and fifty times the therapeutic dose. So this patient had swallowed a whole carton of the drug. But then that’s what they do. When they’re desperate, they pump the stuff in with reckless abandon.”
Isabel wondered what happened to the patient. She could not see him in her mind’s eye, for some reason. He was just a story.
“He recovered,” said Marcus. “He was discharged and went back to wherever he came from. Fife, I think. He’s probably overdosed on something else since then. Poor man. He won’t be long for this world, I suspect. But no sooner had we sorted him out than another one turned up. In this case the patient had been given a dose of the drug by a nurse here in Edinburgh. The nurse swore blind that the dose had been the normal one, but again the blood showed a massive overdose. Not as big as in the addict’s case, but pretty massive. Nobody could work out how on earth it happened, as the patient sided with the nurse and confirmed her story.”
“So somebody was lying?”
He thought for a moment. “Not necessarily. Errors can be made in how things are written down. Inadvertently move a decimal point one place in either direction and you get very different results, don’t you? But something had gone spectacularly wrong. Again, we were able to sort things out and the patient recovered reasonably well. She was a nice young woman, actually. A student at one of the universities, as I recall.”
“So you wrote up these results?”
“Yes. I made a report to the chief medical officer. I effectively gave the drug a clean bill of health. Then I wrote the two cases up as a case note for one of the medical journals. They published it. It was just a couple of paragraphs describing what had happened.”
“Then?”
Marcus was silent for a while. Isabel noticed that his hands, clasped together in his lap, were white at the knuckles. His voice, when he spoke again, sounded strained.
“A month later a man in Glasgow was admitted to hospital. He had been treated with the antibiotic. He…I’m sorry to say that he died from heart complications. He had not received an overdose—that was established. The press got hold of the case and they asked how somebody could die from taking a licensed medicine. Well, I could have given them an answer to that, but they were not in the slightest bit interested in a rational explanation about inevitable risk. They put pressure on the minister and they took another look at my report. They discovered that the doses I had described did not match a new set of lab reports on the blood. The figures were way off. And they also discovered that I had not declared a conflict of interest when I published that case note. I should have told them that I had received a research grant from the company that made the drug. And they were right: I should have done that. I don’t know why I didn’t. It was some years ago. It must have slipped my mind.
“There was an internal enquiry and I was censured. They said that I had been negligent in not checking the blood results when they were so obviously exceptionally high. They said that a prudent doctor would have had the samples tested again. They censured me, too, for not disclosing the conflict of interest and the journal published a withdrawal of my case note.”
He stopped and looked at Isabel. The air of defeat had returned. He seemed flattened, almost as if the breath had been knocked out of him—winded.