[2003] LOSS & PORPHYRY the novels  

0069 – Part 11 – Meeting the Hospital Consultant

At last the haematologist, the consultant I was awaiting appeared. Bill Howell was a tall, distinguished figure - dark black hair streaked with grey, surmounting aquiline features. He wore the dark suit of a businessman, which successful hospital consultants affected; almost as if commercial success was a better measure of their position than academic achievement.

After a suitable exchange of pleasantries, I opened the main part of the meeting: 'As you know, we have just moved into the cell separator field. I think you are also aware of our American scientists who have developed the new equipment.' It was a safe assumption. I had already discovered that there was a small group of consultants who dominated the international circuit, and that there was a corresponding coterie of research scientists from the major suppliers who were on first name terms with them; and we had our own members of this cosy cartel. 'The reason for this meeting is not to try and sell you our new machine. I know that you already have one of our competitor's machine; and it works well.' This was in part true. I was almost certain that the hospital would not be in the market for any new machines within the next two years. That having been said, I never neglected a possible sale, no matter how distant the possibilities. My best sales pitches had begun when the prospect's defences were down; when the purchase of a machine was furthest from their minds. It was at times like that when I first insinuated my sales pitch. It often took many months to close the subsequent sale, but the battle was often won in those first few weeks when my competitors were nowhere in sight.

'You will also appreciate that, being new to this market, we are very ignorant of what makes it tick. Basically, I would be grateful if I could pick your brains about what is important in terms of British needs?' This was really what my visit was all about. I needed guides to show me the best trails through the jungle of my new territory; and I always believed in obtaining the best guides possible, I always went straight to the top.

'What you have to understand is that your equipment is at the leading edge of technology; if not even experimental. The existing equipment, which I admit is not as good as your own, is being used to explore areas we don't really understand. It's used in oncology, cancer treatment, and in immunology, treatment of the body's defence mechanisms. There have been some results that look interesting, but the real problem is that there are areas where it is very difficult to decide whether a treatment is working or not. The progress of the disease is very variable. Quite often the patients go into spontaneous remission. As a result, it is not easy to say whether an apparent improvement is due to the treatment or might have occurred even without it. It means that results typically have to be handled by statistical methods, which means long trials with my patients. There are no miracle cures, unfortunately.'

I relaxed. I noted, with satisfaction, that Bill believed that the competitor's kit was not as good as mine. That was a good start. I didn't expect to make a sale in the short term, but Bill was one of the opinion-leaders, one of the trend-setters. That was one of the main reasons for my visit. If Bill believed, as apparently he did, in the superiority of our machines then a number of the more immediate prospects would be influenced by that opinion. It was good news.

But I didn't have time to rest on my laurels. I was too busy hanging on to every word, and desperately trying to comprehend what they meant. I was, after all, very new to this business; and I was having to keep up with the rapid flow of very sophisticated ideas from one of the foremost researchers in the field. It was not an easy task. I had prepared well, though, rapidly making my way through a range of medical textbooks, including at least one on clinical haematology. Much of the content was beyond my comprehension, but at least I was beginning to understand the terminology.

More important, my perspective of medicine had already shifted dramatically - just as a result of this reading. Before this enlightenment I had subscribed to the popular view of doctors as some mysterious form of miracle-workers. I had expected that they would always know exactly what they were talking about; after all, theirs was the expert opinion most respected by everyone. This image was, in any case, that ardently promoted by most doctors. To an outsider they seemed infallible; the modern knights defending civilisation against the curse of illness.

The picture I had by then obtained from the text-books was very different. Medicine proved to be a very inexact science. I had inevitably compared it with the rigorous certainties of physics learned in my undergraduate days. Even if physicists now emphasised that most theories were only approximations rather than absolute laws, these 'rules of thumb' still proved accurate to within the odd part in a billion or so. I had been horrified to discover that, on the other hand, much of medicine had difficulty in even describing its diseases; let alone understanding what caused them, or beginning to offer a cure.

This was particularly true, it seemed to me, of haematology. I had ploughed through what seemed like endless pages of definitive latin names, accompanied by photographs of exotically stained blood cells under the microscope. It had only dawned on me slowly that the latin sounding names were no more than dog-latin descriptions of what these stained cells looked like. The only science involved was in choosing the correct dye to best show up the abnormalities. Thereafter the poet took over, to convert these images into names; which subsequently became dignified as diseases.

The problem was that these so-called diseases were in fact merely symptoms. In many cases it was not even clear if they were the product of a single disease. If these links were tenuous, they became almost fictional when the medical profession tried to group the various symptoms into categories of disease; hoping that similar symptoms implied similar causes. Such cures that there were seemed to have arisen from happy accident. In this vein, the pharmaceutical companies tried many thousands of substances, with remarkably little theory behind their choices, until one fortuitously had an effect.

It had been a chastening experience, as well as an enlightening one. It exposed me to the limits of man's knowledge. My physics training had left me with an abiding impression of science as all conquering, able to resolve the secrets of even the most distant constellations. Yet here I found that medicine could barely understand the simplest functions of a man's body. It also brought home to me the ultimate frailty of that body; intimations of mortality. I was forced to come to terms, at least in part, with my own limitations; and with my personal insignificance on the cosmic scale.

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