Ken McClure: Pandora's Helix

Michael Neef, consultant in paediatric oncology at St George’s Hospital, checked his watch as he descended the spiral steps to the Pathology Department. He was running late but felt he had to respond to a friend and colleague’s request that he ‘pop down’ to the PM suite for a moment. He and pathologist, Frank MacSween had known each other long enough to respect each other’s opinion. If Frank said there was something worth taking a look at, it usually meant there was.

Neef, a tall, well-built man in his middle thirties with swept back dark hair and a handsome face, marred only by the legacy of a broken-nose after a motor cycle accident in his teens, pushed through the swing doors of the path lab and nodded to the duty technician before entering the changing rooms. He helped himself to a green cotton gown and tied it loosely behind him. He didn’t bother with the footwear option, leaving the row of Wellington boots under the wooden bench undisturbed; he wouldn’t be staying long if he could help it.

He didn’t like pathology; he never had. He appreciated it had to be done but that was as far as it went. The sights and smells of the place made him feel claustrophobic and not just the post mortem suite. The dark wooden shelving in the labs with their jars and bottles of hellish contents put his teeth on edge and everywhere there was the sickly sweet smell of tissue fixatives. While the upper world of medicine smelt of antiseptic and ether, the underworld of pathology smelt strongly of alcohol and formaldehyde. He did however, pause to slip on a plastic apron over the gown, always a wise precaution if you were going to be standing close to the table.

Neef entered the PM suite. It was a long, low-ceilinged room, white tiled and lit by fluorescent lighting that gave everyone prison pallor and highlighted every pore on a human face. He saw MacSween at work at the furthest away of four pedestal tables. He was crouching over a cadaver with his spectacles perilously close to the end of his nose but being retained by his mask. His bushy, eyebrows hooded his eyes. Water gurgled down the drain channels of the steel table, preventing him from hearing Neef come in. It wasn’t until he reached up to re-position the overhead lamp that he saw Neef approach.

“Ah, Michael, thank you for coming,” he said, straightening up and putting his gloved hands to the small of his back as if to emphasise his stiffness.

“What have you got, Frank?” asked Neef.

“Put on a mask and I’ll show you.”

MacSween looked down at his subject and for a moment the only sound in the room was that of the extractor fan positioned in the ceiling above the table. There was a fault in it; the even sound of the motor was marred by an intermittent metallic click that defied syncopation. The fan stooped briefly then started again.

MacSween said, “This is Melanie Simpson, aged thirteen.”

Neef looked at the child’s body. “I’m sorry, I don’t seem to...”

“No, she’s not one of yours. She was brought over from University College Hospital. They’re short-staffed in pathology at the moment; Eddie Miller’s not well.”

MacSween looked up briefly and caught Neef’s eye. They both knew that Eddie Miller, one of the pathologists at University College Hospital, had a serious drink problem but he was close to retirement and his colleagues were covering for him. The general view was that a career of over thirty years in pathology deserved a dignified end. A black tie dinner, a crystal decanter presentation, speeches of appreciation, a bouquet for his wife, the whole bit. In the meantime his workload was being channelled towards routine post-mortems. Pathology on the living — the screening of biopsies and urgent tissue samples from the theatres, was carried out exclusively by his more sober and competent colleagues. Eddie seemed to have accepted the situation. He had no choice. Any attempt to concern himself with a live patient and he would hit the pavement, thirty years or not.

“So what’s the problem?”

“I’ve never seen anything quite like this,” said MacSween. “Melanie had severe pneumonia. Both lungs.”

“Pneumococcal? Klebsiella?” asked Neef.

“Surprisingly neither. It wasn’t bacterial at all so they assumed it was viral.”

“Unusual for viral pneumonia to be this virulent.”

“It is,” agreed MacSween, “but that isn’t why I called you. Look closely at her lungs. She should have been one of your patients.”

Neef looked at the lungs which had been removed and were lying in two adjacent steel dishes.

“Good God,” whispered Neef. “They’re covered in small tumours. Have the lab examined them?”

“I’ve just had Charlie Morse do some quick sections; they’re malignant all right. “If the pneumonia hadn’t killed her, the lung cancer would.”

Neef picked up a probe from the tray at the side of the table and examined the lungs more closely. “Strange,” he murmured. “No obvious candidate for a primary focus. What about her other organs?”

MacSween shook his head and said, “Only the lungs are affected. That’s why I called you down. I’ve never come across this in a child. As you say, it clearly wasn’t just a case of a single tumour and then metastasis. There are multiple primary foci but all in the lungs.”

“So what do you think?” asked Neef, still mesmerised by the sight of the diseased lungs.

“I was hoping you were going to come up with a suggestion,” said MacSween. “You’re the cancer expert.”

“Neef shook his head. “It clearly wasn’t spontaneous. Apart from anything else, kids this age simply don’t get lung cancer. And the degree of tissue invasion suggests that some powerful carcinogen must have been involved or maybe even a radiation source.”

“Like an atom bomb in the High Street, you mean,” said MacSween wryly.

“I take your point,” said Neef, “Radiation sources capable of causing this amount of damage are few and far between so my best guess would be intimate contact with some powerful carcinogenic chemical.”

“And they’re not so few and far between.”

“Unfortunately not. It seems like every day we hear about a new one.”

“Thirteen years old, look at her. She was just a bairn.”

Both men looked at the ivory white face of the dead girl, eyes closed, her blonde hair held tightly behind her by the head block on the table. Her cheeks were unblemished and translucent giving her an ethereal appearance. She wouldn’t have looked out of place on a stain glass window.

“She didn’t even have a taste of life, damn it,” muttered MacSween.

Neef glanced sideways at him and saw his eyes were moist. “You’re not supposed to think like that,” he said as a friend. “You’re a pathologist, remember? You’re supposed to stand at the table eating your sandwiches and being cynical, like they do on television.”

“Sod television,” said MacSween.

Neef gave a shrug as if possibly embracing the philosophy and MacSween gave a slight grin. “So what do we do?”

“We’ll have to call the Public Health people in on this,” replied Neef.

“You don’t want to wait until the lab have had a chance to identify the carcinogen?”

“It’s too serious,” said Neef. “They’re going to have to trace the source so they might as well start looking while the lab do their tests. This is going to make some epidemiologist’s day.”

“We’ll have to tell University College. She’s one of their patients, remember? We don’t want to stand on anyone’s toes.”

Neef nodded. “It’ll be interesting to hear what Public Health say,” he said thoughtfully. “It’s hard to think what carcinogens a thirteen year old schoolgirl could possibly come up against to cause this much damage.”