Gold Standard Read online

  About The Author

  David Finchley was born in in 1946, in post-war Germany. He moved to Australia with his family at the age of ten. After completing school, he studied Medicine at Melbourne University, going on to specialise in Neurology.

  He continues to practice Neurology. Having been able to reduce his workload, he has now had the time to pursue his long-held desire to write. Gold Standard is his second novel.

  Published in Australia by Sid Harta Publishers Pty Ltd,

  ABN: 46 119 415 842

  23 Stirling Crescent, Glen Waverley, Victoria 3150 Australia

  Telephone: +61 3 9560 9920, Facsimile: +61 3 9545 1742

  E-mail: [email protected]

  First published in Australia March 2015

  This edition published March 2015

  Copyright © David Finchley 2015

  Cover design, typesetting: Working Type Studio, Melbourne

  The right of David Finchley to be identified as the Author of the Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

  This book is a work of fiction. Any similarities to that of people living or dead are purely coincidental.

  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means without the prior written permission of the publisher, nor be otherwise circulated in any form of binding or cover other than that in which it is published and without a similar condition being imposed on the subsequent purchaser.

  Finchley, David

  Gold Standard

  ISBN: 9781925280838 (eBook)

  Digital edition distributed by

  Port Campbell Press

  www.portcampbellpress.com.au

  eBook Conversion by Winking Billy

  GOLD

  STANDARD

  David Finchley

  Chapter 1

  Dr Andrew Marshall climbed the stairs two at a time as he had always done. It was five floors, twenty four stairs per floor, and one hundred and twenty in total. He had climbed them often enough in past years to remember those figures exactly. He could still take the stairs with an even stride, seemingly with little effort. He was pleased with his physical condition. An onlooker would not fail to be impressed with his appearance. He was tall, one hundred and ninety centimetres, well built with not an ounce of fat. His brown hair was wavy but neat, his eyes a speckled green, deep set and piercing. He had a handsome face, perhaps a little soft and feminine – he would have preferred the rugged look, but nevertheless, handsome enough.

  As he climbed, his thoughts were of that day. It was a special day for him. He felt he was coming home. His skin tingled slightly with anticipation as he approached the fifth floor. There was apprehension too. He was returning to familiar territory but in a new role. He was conscious that the white coat had given way to a suit. A pure wool, blue, pinstripe from Harrods of London, admittedly purchased at a summer sale but impressive nevertheless. He had left Prince Charles Hospital three years previously as a registrar in Neurology and was today returning as a Consultant Neurologist. This had been his ambition since his second year after graduation when he first worked as a Neurology Resident Medical Officer. First worked for the much feared Dr Jeffrey Harris. He had only been in the job for two weeks when he realised that he had found his vocation and it was another two months before he could summon up enough courage to approach Dr Harris and declare his interest.

  ‘Dr Harris, could I have a word with you?’

  ‘Yes, what is it Andrew?’

  ‘Dr Harris, I, er, would just like to say how much I’ve enjoyed this job and that, well, er, and that I would like to train in neurology’ was his reply, stumbling and hesitant. Dr Harris first said nothing but fixed Andrew with a stare that had been famous along the length and breadth of the corridors of Prince Charles.

  Oh shit, thought Andrew. Here comes the famous Harris brush off. But instead, Dr Harris smiled, or at least his mouth twisted into something that could be interpreted as a smile and said:

  ‘I think you will do. Talk to me again when you have got your first part.’

  And with that he turned around and walked off.

  Andrew was left standing in the doorway of Dr Harris’ office, somewhat stunned but at the same time elated. From anyone else those few words would mean very little but from Dr Jeffrey Harris they were positive encouragement.

  And Jeffrey Harris was as good as his word. Two years later, with Andrew seated in his office, having just passed the first part of his FRACP examination at his first try, Dr Harris confirmed that Andrew Marshall would do.

  ‘The job is yours my boy. You get out of it what you put in, but do a good job and I promise you will be trained well and eventually there might even be a consultant post for you. You probably know that Dr Love is close to retirement and we will need a replacement, someone good.’

  That was five years earlier and he had done a good job. He worked for Dr Harris for two years and then, with his help, obtained an appointment as a Neurology Registrar at the National Hospital for Nervous Diseases at Queen Square, London. For the next two years he finished off his training at The London Hospital as Senior Registrar cum Junior Consultant for another year.

  And now he was back. Dr Love had retired after thirty years of service and Andrew had been appointed whilst still in London as a Junior Consultant to the Neurology Department of Prince Charles Hospital, Melbourne. Andrew was fully aware of the fact that the department to which he was returning bore little resemblance to the one which he had left three years before. This knowledge only added to his anticipation.

  Moments later he reached the landing on the fifth floor where the Department of Neurology was situated. He had expected some changes but was not quite prepared for what he saw. Prince Charles Hospital was designed in the shape of a cross with four arms of equal length, each identified by the floor number, in this case five and the direction in which each arm faced, north, south, east and west. The north wing contained the Outpatient Department and the other three the Inpatient wards. At least that is how things were when Andrew had last been there. What greeted him now was totally different. The north wing was still Outpatients but the other three wings had disappeared. Andrew recalled being able to stand in the foyer, stairs to one side, lifts to the other, and the east and west and south wards leading off in the appropriate directions. Now the foyer had become a reception area topped by a sign announcing this to be “Prince Charles Hospital Department of Neurosciences.” Andrew presumed that the three wards led off from behind the reception area and that all three now belonged to Neurosciences. He stood there, a little in awe of it all when a voice brought him back to reality.

  ‘Yes, can I help you?’

  Andrew looked down to see a young, quite attractive brunette sitting behind the marble reception desk, her eyes looking up at him enquiringly.

  ‘I’m Dr Marshall.’ He was not sure what to say next, he did not expect his name would mean anything. The receptionist had not been there three years ago. But to his surprise, her manner immediately changed and with a smile she said:

  ‘Welcome back Dr Marshall. I’m Sally Cunningham. I’m the receptionist of the department. Dr Harris told me you would be arriving today. He left instructions to be notified the minute you arrive. Would you sit down please, I’ll find Dr Harris for you straight away.’

  And with that she stood, turned to reveal a neat figure and marched off through an opaque glass door, disappearing from view. Andrew sat down in the adjacent waiting area, picked up a Time magazine from the side table and was about to turn the front cover when Dr Harris burst through the glass door, moved deftly around the reception desk and straight up to Andrew.

  ‘
Andrew my boy. Good to see you. When did you get back to town? Did you have a good flight? Not jet-lagged are you? There is a lot of work waiting for you. It has been six months since Brian Love left you know. While you have been gallivanting around Europe, the work had been piling up. Come my boy, let me show you around.’

  Andrew felt a pang of guilt. His post in London had finished three months earlier but he had been determined to fulfil one is his great ambitions and tour Europe before coming home. He had hired a car and with a friend drove through the places which for him had been only names in books or scenes in the movies. He knew that Dr Harris had to use his not inconsiderable clinical clout at Prince Charles to have Andrew appointed to a position that Andrew could not take up immediately. Andrew appreciated his efforts and was determined to vindicate the faith that Dr Harris had shown him.

  Having given what Andrew presumed was a welcoming speech, Dr Harris began to move back through the reception area, beckoning Andrew to follow. Once through the glass door, Andrew could fully appreciate the changes that had taken place. The south ward was still the same as he remembered it, a 35 bed Neurology ward. The east and west wards, previously occupied by the beds of the Cardiology and Gastroenterology Departments had been incorporated into the Neurosciences Department. The east ward had been turned into research laboratories and the west into an office administration area. Impressive, Andrew thought to himself. He knew the department would take off after the trial results were published but this was really impressive. It matched anything he had seen overseas. And he was part of it and proud to be so.

  Andrew reflected on how one man, determined and unstoppable, could achieve so much. The transformation of the department was due entirely to the efforts of Dr Jeffrey Harris. Due to his vision and unrelenting determination to follow through in what he believed. It had all started so innocently. A chance observation leading at first to a tentative conclusion which, as more results came in, steadily grew in importance and significance and became an outstanding breakthrough in medical science. Andrew was there at the beginning and although away for three years, had made sure that he kept up with all the developments that had occurred.

  What Dr Harris had done was nothing less than to discover a cure for one of nature’s deadliest diseases, cerebral glioma; a type of brain tumour. The word “cure” was rarely used in medical circles but, in this instance it was exactly appropriate. Cerebral glioma, once a disorder with a near one hundred percent fatality rate, could now be stopped, cured, eradicated. Not palliated, not partially removed by surgery and burned with radiotherapy which rendered the patient bald and retching, but cured, cured with a drug that could be taken by mouth and its only side effect was that it turned the urine temporarily orange. It must have been that way when Fleming had discovered Penicillin. It was simply outstanding in its impact.

  All it has all started so innocently. Dr Harris had been treating a patient with Parkinson’s disease. The patient was a fifty five year old solicitor, married, father of three boys and also a personal friend of Dr Harris. After two years of good disease control, his condition began to deteriorate and had reached the stage where he was considering giving up his legal practice. Dr Harris had tried every known combination of drugs but to no avail. The disease continued to progress relentlessly and it appeared that poor Lionel Myer would soon end up in a wheelchair. It was then that Dr Harris came across a paper in an obscure Scandinavian journal. Dr Harris was an avid reader and subscribed to more journals than Andrew even knew were published. The paper was the case record of a woman with severe Parkinson’s disease, unresponsive to all conventional medication, who was given a drug called Amaradine with excellent response, although her improvement was only short lived. The drug was not known to Dr Harris but enquiries with Walter Long, the Chief Hospital Pharmacist, revealed that Amaradine was closely related chemically to the drug Amantadine, an anti viral agent first introduced for treatment of influenza. Amantadine, by accident, had been found to be helpful in Parkinson’s disease and although of limited value in the treatment of the condition, still had a useful place. Chief Pharmacist Long was also able to reassure Dr Harris that Amaradine was a safe, non toxic drug, readily available in the oral form.

  In desperation Dr Harris commenced Lionel Myer on Amaradine, expecting little but anxious to do everything possible for his friend. It was two weeks after Mr Myer had commenced treatment with Amaradine that he returned to see Dr Harris complaining of headache. Dr Harris was away at a conference and Mr Myer was seen by the Senior Registrar, Dr Charles Officer. Although a most capable and usually self assured clinician, Dr Officer was somewhat apprehensive at having to treat Mr Myer who he knew from various case discussions was difficult medically and what was worse, was a good personal friend of Dr Harris. Dr Officer thoroughly examined Mr Myer, found no obvious physical cause for the headache and made a provisional diagnosis of tension headache, quite understandable in the circumstances of Mr Myer’s declining health and fast disappearing legal practice. To cover himself, he ordered an MRI scan of Mr Myer’s brain and arranged for him to be reviewed with the results three weeks later when Dr Harris would be back from the conference.

  It was on that next visit on Wednesday 25th of August to be exact, when it had all started. Andrew had heard the details of what happened so often that he felt he had actually been there himself. As Dr Harris opened his consulting room door, he found a beaming Lionel Myer striding into the room, almost unrecognisable as the man who had shuffled in to see him a few weeks earlier. Mr Myer was naturally delighted and commenced the consultation by presenting Dr Harris with a fifteen year old Glenfiddich single malt whisky to show his gratitude. Dr Harris too was elated. Clearly the Amaradine had worked and worked to a spectacular degree. Dr Harris was experienced enough and cautious enough to know that with a chronic and progressive condition such as Parkinson’s disease, such improvement was often only temporary. Nevertheless, at least for the time being, Mr Myer was better. He had in fact already thrown himself back in to his legal practice with a vigour that he had not possessed for months.

  It was towards the end of the consultation, as Dr Harris was writing out a new prescription for Amaradine that he noticed a blue X-ray bag containing the MRI scan which his secretary, Mrs Scott, had put on his desk. Referring to the notes he saw Dr Officer’s entry of three weeks previously and a reference to the MRI scan. He also noted Dr Officer’s diagnosis of tension headache which he felt was probably correct and which he was quite sure the much improved and much happier Mr Myer no longer ­experienced.

  To his horror, as he put the MRI scan up to the viewing screen, there was an ugly, mottled mixture of black, white and grey occupying and distorting the right frontal region of Lionel Myer’s brain. Even before he read the accompanying radiologist’s report, Jeffrey Harris knew that this was a highly malignant cerebral glioma, probably a grade 3 or grade 4 astrocytoma and that his good friend Lionel Myer’s happiness would be sadly short lived. He had six months at the most, even with the most aggressive treatment. Not that there was very much treatment available for this terrible condition.

  Dr Harris switched off the X-ray viewer and sat back, thinking of what words to use to pronounce his friend’s death sentence. But instead of telling him the truth, he said:

  ‘Look Lionel. The scan is not quite right. I don’t think it is anything serious but I want to have it repeated.’

  Afterwards, when he reflected on it, he was not quite sure why he arranged for the repeat MRI scan. Perhaps he was just putting off the difficult task of breaking the news to Lionel or perhaps it was inconsistency between the grossly abnormal MRI scan and the obviously healthy patient sitting opposite him. Whatever it was, before Lionel Myer even had the chance to reply, Dr Harris was on the telephone to Dr Howard Bell, the Director of Radiology, setting up an appointment for another scan at 4 o’clock that afternoon. At 5.15pm that afternoon Lionel Myer was sitting once more in Dr Harris’ office, his face rather more grave in appearance. And Dr Ha
rris was standing at the X-ray viewer staring at Lionel Myer’s normal MRI scan, having just hung up the phone from speaking to Dr Bell who did not mince words about wasting resources, cronyism and urgent MRI scans which turned out to be normal.

  ‘Go home Lionel. The scan is all clear. See me again in two weeks’, was all Dr Harris managed to say.

  When Lionel had left, Dr Harris remained sitting at his desk for a long time. He rang his wife to say that he would be late and not to wait with dinner. What a close call he thought. If I hadn’t repeated the scan, by now surgery would be planned, probably for early next week. Unnecessary surgery. Surgery that could result in complications, perhaps death, because somehow an MRI belonging to god knows who ended up in Lionel Myer’s X-ray bag. After Lionel had left, Dr Harris stared at each of the X-ray films to be sure that it was Lionel Myer’s name that appeared on the top left hand corner, which it did. The name was correct, the date was correct, only the X-ray pictures were not correct, Lionel Myer did not have a tumour in his right frontal lobe. Someone certainly did, someone who by now may have been reassured that his MRI scan, presumably also mislab­elled, was normal and that he had nothing to worry about.

  Dr Harris knew that he must sort this out. He had already rung Radiology but there was no one there who could help him and he would have to take it up with Maggie the Chief Radiographer, first thing in the morning. This was an error of enormous proportion. Not just a simple clerical error. People’s health, possibly life, was at stake. The ramifications of such an error were colossal. Sure, he had discovered this one but what others had there been, or could there be in the future, should such labelling errors occur again.

  Dr Harris did not sleep well that night and it was promptly at 8.30am that he was in Maggie Nelson’s office explaining to her in a polite but urgent voice what had happened. Maggie, a pleasant, plump, red headed spinster in her late 40s, ran a good department. She was dedicated and obsessive and was clearly shocked about what Dr Harris had told her. There was no need to spell out to her the possible conseq­uences of the mistake that had been made. With Dr Harris in tow, Maggie Nelson strode determinedly to the MRI scan department and while Dr Harris stood back at the doorway, she spent the next twenty five minutes speaking to the MRI scan department radiographer, looking through the department records, her face in total concentration.