Medical thriller

Side Effect

Drug companies have been fined over four and a half billion dollars in the USA for offences related to marketing drugs.

This medical thriller gets behind the motives that underlie such behaviour. The author has twenty years of medical experience at high levels in health care management in the UK.

The story centres on a new cancer drug with a potentially lethal side effect.  In any circumstances it would be hard to diagnose the problem; but for professor Jim Brogan, the epidemiologist running the trials of the drug, things are made much more complicated.


Chapter 1


Danni flew down the vast field of unbroken powder snow, weaving sinuous patterns in the dazzling sunshine.  She came to a stop in a white cloud, the air around her full of glittering ice dust.  She turned to watch her companion trailing fifty meters behind.

‘You’ll have to get better than that, or you’ll never keep up with me.’

‘I’m not racing’ said Val.  She glanced across at Danni’s face, almost invisible behind goggles and a thick coat of sun block.  ‘Can you actually feel the sun behind all that stuff on your face?  This is supposed to be a pleasure trip not a ski race.’

For a split second, Danni’s shoulders dropped and Val realized she said the wrong thing.  It’s two years since she had that melanoma removed from her thigh and she’s still haunted by it, she thought.

It passed, and Danni laughed.  ‘Can’t be too careful, Mr. Sun doesn’t like me.’

The huge mountain dwarfed the two women, flashes of yellow and red in the bright sun.  Val looked around shading her eyes.

‘Have you seen how steep this is?’  She turned back towards Danni.  ‘Do I look scared?  Can you see my legs shaking?  It’s really steep.’

‘When I look down there all I think of is lunch’ said Danni.  ‘Look you can see the village; we’ll be down in no time.’

‘Oh sure you will be... but I’m not the one who’s done promotions for ski clothes and bagged free lessons.  I’m the terrified one that makes you look good.’

The mountain fell away in front of them; big heaps of snow thrown up into giant moguls.  A novice would have been petrified.  Meribel nestled in the valley far below.  Ice crystals still hung glittering in the air; a scene straight off a postcard.  Val swung her backpack around and reached in to pull out a bottle of juice, drinking slowly as she scanned the hills.

‘It is so stunning; you can see for miles.’  She almost had her breath back.  ‘You know the last time I came up here I couldn’t see a thing, a complete blizzard, it didn’t seem so steep then.  It made it so much easier, if you can’t see, you don’t know it’s steep.’  She laughed, ‘that sounds silly, but it made everything soft.  It’s not so bad like that.  Looking at it now, it’s so clear it takes my breath away, but it looks twice as steep.’  She passed the bottle to Danni.  ‘Do you want to finish this?  I know you think lunch is two minutes down there, but it’s going to take me a bit longer.’

Danni threw her head back and drank as though she was pouring sunshine down her throat; she turned to toss the bottle back to Val.

Adjusting her goggles, she said. 

‘It’s brilliant.  Jim was mad not to come.  What work could have been so important to miss this.’

‘You can talk, you wouldn’t be here if he was.’

‘I know.  I’m dead grateful really.  You take your time’ she said.  ‘I’m going to zap down this.  I don’t think my legs are working properly yet; I need to push myself.  I’ll wait for you down there somewhere.  It’s only steep for a bit, you’ll see.’

She slid gracefully forwards, searching the terrain ahead for the best route down.  Val stood watching, lost in her thoughts.  Last night she’d slept in Lyon after dinner with Mary, her teenage daughter and the French family she was staying with, assuring them of the welcome their daughter would get when she came to England.  This morning she’d collected Danni from Chambery airport and here they were, three hours later, on top of the world.

‘Watch me.’  Danni’s words hung in the breeze behind her as she threw herself down the mountain.  She skated to pick up speed like a downhill racer, and flew over the first mogul, spraying loose power into the air behind her.  Val stuffed the bottle in her pack and slid forward tentatively, watching Danni flashing down the slope ahead of her; a slim figure moving along with the liquid grace that came from years of practice, carving tracks between the mounds of snow

Val watched in awe, although it had been a few years since she’d seen Danni ski, she knew about the promotions she’d run and the endless hours of practice.  Now she looked like a competition skier, with a touch of ballet dancer thrown in.

‘Just as well she won’t be watching me’ muttered Val to herself as she set off, sliding forwards, sizing up the slope and keeping one eye on the figure halfway down the mountain, shrinking rapidly into the distance as she watched.


And then the picture shattered.  Val caught her breath when Danni pitched forwards as her legs folded under her.  It didn’t make sense.  Experienced skiers may fall, but they know what’s happening and their recovery starts before they hit the ground.  This looked terribly wrong; she fell like a rag doll, tumbling down the front of a steep bump hitting the next one with her shoulder, snow flying up as her head caught the deeper powder in the valley.  Val winced as Danni rolled, skis arching through the air over her head as she disappeared over the top of the next bump, picking up speed before crashing into the side of the next mogul.  Bouncing and twisting violently, her body hurtled over another mound of snow, one ski ripping off and flying through the air as she fell.

The yellow figure in the cloud of white powder bounced and flew, airborne one second and hidden the next.  She lost the other ski slid, tumbling down; crashing over bump after bump after bump; lost in a flurry of snow that sprayed all around until she disappeared in a white plume.

Val stared, paralyzed for a moment until adrenaline and panic kicked in.  All thought of steepness went out of her head.  She forgot every technique she had ever learnt for skiing in control, and went straight down, ignoring the bumps, ignoring the hill, ignoring the sharp icy powder flying across her face.  Her body stretching down into the troughs, bending and flexing like rubber, as the hill got steeper and rougher.  In the back of her mind a little voice said, ‘Take care, you’re more use if you get there alive’ but the little voice trailed yards behind.  Val let everything go, she’d never skied like this before, and for sure she never would again, but she just had to get to Danni, who had still not moved.

Stopping might have been a problem if Val had thought about it.  Flying down a really steep slope, she slammed around at right angles to the hill and dug the skis in hard, sending powder and ice flying everywhere.  Her legs soaked up the terrain like pistons as her body angled almost flat to the snow to stop herself pitching down the slope.  As she came to rest, she kicked off her skis and knelt down alongside Danni.

She yelled at Danni but got no response.  She reached around the side of her neck feeling for a pulse.  Did she dare move her?  Had she broken her neck?  How do you tell?  She couldn’t feel a pulse, and there was no sign of movement.  Gently prizing the goggles off her face, she lifted an eyelid.  She watched carefully in the bright light and just detected a change, the wide black pupil contracting slowly.  There was still hope.  Val pulled open Danni’s jacket, put an ear against her chest, and thought she could hear a faint beat?  She tipped her head back, took a deep breath and blew into Danni’s mouth, watching as her chest rose.  She stopped and heard the breath come back out again.  She did five more breaths and then stood up to look around.  Nothing but snow, not a sign of a soul.

She screamed

‘Help’ as loud as she could.

‘Au Secours,’ she yelled, remembering, she was in France.  Back on her knees, she breathed into Danni again.  Should she pump her chest?  Did heart massage do damage if the heart hadn’t stopped?  She tried to remember which mattered most, the breathing or the heart.  Why hadn’t she gone to first aid classes?  She put her ear to Danni’s chest again, trying hard to listen.  She could hear something, but her own heart thumped so loudly that it almost drowned every other sound.  Danni’s neck lay in front of her pale and vulnerable.  It always looked so simple in the movies when they took the pulse.  Where do you put your fingers?  A sigh came from Danni’s lips as air escaped.  Some air must have gone in. 

Val’s freezing fingers could feel nothing, and snow covered everything she touched.  She blew more air into Danni’s mouth and tried to pull off her glove, exposing her wrist.  Somewhere there must be a pulse.  She blew in another lungful of air and then stopped to feel carefully for a pulse.  She could feel a weak beat.  Val blew again and then counted the beats, about twenty in fifteen seconds.  She blew again and then counted her own pulse — more like thirty.  Why didn’t Danni breathe?

Should she try to phone?  Who could she phone?  Remember it’s 911 in France.  She had to keep Danni breathing, what ever she did, without that she’d be dead anyway.  She breathed for Danni again.  How many breaths each minute were you supposed to do?  She did three more while she tried to remember which pocket she’d put her phone in.  Danni still looked pink, her lips weren’t going blue and that thin pulse kept going.  After the third time she took it, Val knew she could tell her own heartbeat from Danni’s.

She dragged her phone out of her jacket and then heard a voice.  She turned to look up the slope and saw a man coming down.  A ski patrol!  She might be tired, but the man coming down the slope gave her some energy to keep going.  Three more breaths and she saw his skis stop beside her.  Still gasping for breath herself, she tried to explain what had happened.

He dragged a radio out of his jacket while she kept blowing.  The relief at the patrolman’s arrival began to disappear.  What good could he do?  Even if they were keeping Danni alive, how could they get down the mountain?

Still on her knees trying to blow breath into Danni, she heard him say something.  She looked up quickly as he touched her shoulder.

‘I have to keep going’ she said.  How should she say that in French?

‘I do now.’  He said, ‘you rest.  More come.’

What did he mean, more come?  She staggered out of the way, as he knelt beside Danni and did what she’d been doing.  Thank God for that, she must have been doing it right.  Her chest heaved in the thin air as she stood up and looked around.  Two more men were coming down the snow with a stretcher sled.

She looked at the sled.  How could they get Danni on that and still keep her breathing?  The man on the ground signed to her to take over again so she got back on her knees and went at it.  Her wrists ached, her back hurt, but what else could she do?  At the side of her vision, she could see the stretcher being opened up.  Then she heard the noise right above them.  A chopper!  Oh what a sound!  She blew a deep breath into Danni and said out loud.

‘Hang on Danni, hang on.’ 

It landed on a flat patch of snow a little below them and off to the left.  Looking up as she did yet another breath, she saw the side open and two men get out.  The patrolmen were obviously talking to the aircrew on the radio.  One of them turned to her.  He spoke slowly, in broken English, checking that she understood.  They were planning to put Danni on the stretcher and dash for the chopper.  They would have to stop the breathing for a minute, but they’d start again as soon as they got to the chopper.  Val opened Danni’s eye again and still the pupil moved.  They had to go for it.

One desperate heave got Danni onto the stretcher sled and then they were off.  She stood amazed as they headed straight for the chopper, counting seconds in her mind as they shot down the slope, swinging around in a cloud of spray to stop right by the machine.  They couldn’t have been more than forty-five seconds.  She watched as they put an oxygen mask on Danni’s face, then they heaved her into the chopper, one of the patrolmen leaped in with the crew.  In seconds the rotor whirled and the machine lifted off into the clear mountain air.  Val looked around and saw Danni’s skis back up the slope, a hat, and a glove lying forlorn on the snow.

She stood there a little longer, watching, praying quietly as the chopper disappeared into the distance.  Val checked herself; all the work in the thin mountain air had left her still breathing hard, and her arms shook from the effort.  Should she leave the skis?  Somehow, it didn’t seem right; Danni might want them, and she couldn't just abandon them.  She struggled back up, digging her boots into the packed snow to climb the steep bumps and retrieve the skis.  She picked up the hat and glove, stuffed them in her jacket and turned back down the slope.  The chopper had disappeared from view.  It all seemed unreal.  The silence of the mountains filled the space where the sound of the helicopter had been.  The sunlight made rainbows in the ice crystals still floating in the air, the only signs of the desperate speed of her descent just minutes ago.  She clambered over the bumps, sliding down the biggest one on her behind, and sat in the snow next to her skis.  Her arms ached now.  She could feel herself trembling all over.  The stretcher men stood quietly waiting.  Could she get down to them?

‘Deep breath’ she told herself, ‘get your skis on, take it steady.’  Putting skis on halfway down a steep slope is never easy.  She stood up, and carefully placed the skis across the snow.  She tried to stand on one leg to hit the loose snow off her boot with her pole, and almost fell over.  She’d done this a hundred times in the past, though not with a racing pulse and shaking muscles.  She could feel the men watching, feel her heart thumping, and couldn’t help thinking about Danni.  Bottom leg first, toe into the binding and stamp down.  She felt the reassuring clunk as the rear binding locked; the second one had to be easier.  The simple act of concentration began to calm her nerves; the stretcher patrol waited.  Holding Danni’s skis and poles over her shoulder she slid down to them.  No flashy stuff now.  Weaving through the bumps, careful not to fall or drop the skis until she came to rest alongside them.  One of them spoke to her in English.

‘Are you OK?’  Somehow, there’s a social pressure to say yes, but she had to work hard to avoid bursting into tears.

‘Where will they take her?’

‘To the hospital down in the valley.’  He gave Val a card.  ‘They get there in a few minutes.’  The unspoken hope hung in mid air.  ‘Are you her friend?’  She tried to look at the card but it made no sense.  She stuffed it into her pocket and turned back to the patrolman.

‘Yes, we came here together.’

‘What will you do?’

‘Drive down to the hospital.’  Val shrugged, what did they expect her to say? ‘Are you going down now?’  The patrolmen nodded.

‘Can I put these skis on the sled, I feel a bit shaky.’

‘You can ride if you wish.’

It crossed Val’s mind, but just the exchange of words had done something; it dragged a weak smile out of her,

‘I’m not that bad,’ she said, ‘just not used to carrying skis.’

They made their way down the hill in silence.  In the village, Val took the skis off the sled and the men wrapped up the stretcher and set off to make some sort of report.  She tried to put both sets of skis over her shoulder, but couldn’t, her arms were just too weary so she resorted to clutching everything together in an ungainly bundle.  Danni would hate it; Danni was always so stylish.  Around her people bustled by, lost in their own conversations.  If she could hold back the tears a little bit longer, she could make it to the apartment. Danni had insisted on that, she’d picked an apartment that let you straight onto the snow.

‘We’re going skiing, not walking, love.’  Danni had said.  ‘We don’t want to be spending the holiday tramping about in ski boots.’

Val wrestled the skis into the locker along with her own and took the lift up to the flat.  She dragged off her jacket, gasping as Danni’s hat and glove fell out and almost lost it right then.  For two minutes, she lost herself in the struggle to get rid of ski clothes and dress more normally.  Transferring her purse and phone, she thought of phoning Jim but got no answer.  Get to the hospital.  Get to Danni, don’t think, don’t imagine, don’t cry, just get there.  Everything else could wait.

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