Clashing Oars

This was a difficult assignment. I was no longer the naïve development specialist of yesteryear. By now, I had worked on several complex conflict management problems, but this one was troubling. It was the first time I had been asked to work under cover to identify possible fraudsters. There were ethical issues in telling people you were reviewing the clinical trial procedures when you were doing much more.

I strolled over to the Rowing Club to work out an approach. The river was sparkling in the low autumn sun and its peaceful banks were a welcome respite from the stew of busyness of St. Angela’s teeming corridors. The ever-smiling and helpful Maria was tidying up the newspapers after the lunchtime rush, and getting the club ready for a party. I was drawn into the excitement of putting up the bunting and balloons, and popping streamers everywhere. Tonight’s “do” was Professor Sharkey’s bash for his firm to celebrate the end of the rowing year.

Our fun was interrupted by a noisy confrontation outside the club. The angry shouting drew us out on to the bank to see rowers from two teams pushing and shoving each other, and some brawling. What a sight. Maria identified Dr. Tibbles, Prof Sharkey’s senior resident, as the man running around waving a broken oar, chasing after another and accusing him of sabotage. Dr. Tibbles, I learnt, had a reputation for being a bit of a “street fighter”; a finger-wagging shouter who never listened; and a very thin-skinned man who rose to anger with alarming ease.

The object of his ire was Dr. Messenger, Prof Jett’s senior resident. He was by all accounts a brilliant doctor, but a delinquent. He held all in contempt; he knew he was clever, tall and handsome; and he knew he could outmatch anyone on the technicalities of both rowing and of medical practice. He loved to wind up Dr. Tibbles – “Tibby”, his nickname for Dr. Tibbles, “ready for your milk?” He thought fast and reacted fast; Dr. Messenger was a powder keg.

The brawl was the talk of the town at St. Angela’s. Who started it?; who swung the first punch?; who broke the oar?; who … did it matter? The brawlers retired to their respective locker rooms to fester, and get ready for the afternoon rounds. And Maria and her helpers got on with making the Club ready for the party. All were welcome, except Jett’s boys.

The Pen Pusher’s Warning

News of the fight spread fast. From the river bank to the hospital foyer, to the lifts and the gaggles of secretaries on each floor, and to the Executive Floor and the Chief Executive’s Office. Alex, our seasoned but weary CEO, crumpled in despair when he was told the details by Sue who had already gathered “the evidence”. Alex called for a crisis meeting between Profs Sharkey and Jett and their “boys”. All were to gather in the Main Lecture Theatre at 4 pm, no exceptions.

At 4 pm, the annoyed gathering took their usual seats. Seniors at the front, juniors at the back; Jett’s to the left and Sharkey’s to the right; and Alex sitting in the pit next to that old beaten-up overhead projector. “What’s this about?” was the phrase buzzing among the restless medics, as if they didn’t know.

“Car parking”; “mess bills”; “no eggs in the canteen” – the usual banter designed to put down the despised beings known as administrators, managers, “pen-pushers”. All said with seething contempt.

In this angry, febrile atmosphere, Alex calmly took out his best fat fountain pen, laid it on the overhead projector, switched it on, and beamed a ten-foot square image of his pen to the audience. That got their attention; the naughty boys sat up and listened. Speaking quietly but assertively, Alex told the gathering “this nonsense, this brawling and rowing, has got to stop”. “Why?” some joker yelled, and the riposte was accompanied by much laughter. Alex ignored the heckler and warned them that any repeat of this afternoon’s behaviour would be met with disciplinary action, and even dismissals.

Alex was worried. As he looked up from the pit to the top back row, unseen by all except him, standing there observing everything, was Verona Pharmaceuticals’ investigator Mr. Paris. His solemn expression was chilling as he thought through his approach and stared back at Alex. Alex was desperate to keep St. Angela’s licence as a Clinical Trials Unit and this fracas was not going to be impressive to a key funder.

The two factions glared at each other and (half) promised to keep the peace. Under the beaming light of the massive projected pen, the medics rose in recess. Prof Sharkey turned to his boys and reminded them, loudly, of the end of term party that evening in the Rowing Club – “you’re all invited”. Turning to Jett’s boys he said: “But not you lot,” and left with Dr. Tibbles at his side. At the door, Dr. Tibbles looked back and growled at Dr. Messenger “you owe us an oar.”

The End of Term Party

Meanwhile, Maria had done a great job. The Club looked festive and ready for a party. The polished champagne glasses were neatly lined up, and all Maria’s Spanish lady friends helped to fill them with the freely-flowing bubbly. A buzz of excitement filled the air as the party got going. Prof Sharkey, the generous host, stood by the door to welcome everyone, while Dr. Tibbles and Sharkey’s “boys” watched out for any intruders from the Jetts.

The place heaved with music and dancing. The party goers burst the Club’s seams and they overflowed onto the balcony. It was a cool spot out there in the night, but a welcome relief from the steamy heat and noise of the party. Miss Nurse formed a gaggle with her new interns out there where she could hear what they were saying. Sipping her champagne, she joined in the excitement of the youngsters taking part in their first hospital party. It was such fun. They were all dressed up and the girls looked lovely, although she noticed some were wearing precariously high-heeled shoes.

One such new intern was Jules. A bit of a stunner, she danced away the night with no shortage of admiring partners. Rosie, one of Miss Nurse’s newly qualified pharmacists, kept an eye on the interns. She served the drinks, made the introductions, and networked like crazy. While laughing and talking to everyone, she glanced over people’s shoulders looking out for someone who clearly was not there.

Down on the dimly-lit bank, there was mischief in the making. The volatile Dr. Messenger, and a few of Jett’s boys, had been to the hospital’s pub, the Sammy, for a few beers after their shifts had finished. Bored and annoyed at their exclusion from the party, they crept along the river bank like otters, keeping low and lithe, to sneak up on and gate-crash the party. Pleased with their progress, they rested, somewhat inebriated, lying flat out on the cold lawn. Giggling, they looked up at the silver dollar full moon and teased their new intern, Ronnie, for being in love.

Ronnie, the nice young doctor that Maria called “the dreamer”, was keen to see his beloved Rosie again. She had ignored him while finishing her exams, but now that they were over, perhaps she might notice him again. Emboldened by his friends’ goading, he climbed the Club’s fire escape and melted into the party crowd on the balcony hoping for a glimpse of Rosie. Bang! Ronnie was poleaxed. Who was that? He had seen a movie star – Jules. His heart raced; his mouth went dry; he was in love, but not with Rosie anymore. Jules saw him too, and smiled, and they stared fascinated at each other for what seemed like an age. “Who are you?” Ronnie asked nervously; “what do you do?”; “and will you marry me?” Tibby saw them and was on his way across the crowded room to sort out the Jett interloper. Ronnie’s friends pulled him away just in time, and they ran off into the night, gleeful at having busted Sharkey’s party.

Sepulchral Calm in the Clinical Trials Unit

In contrast to the cacophony of the night before, Miss Nurse was at her desk the next morning, as usual, in the sepulchral calm of the Clinical Trials Unit. It was a secure glazed pharmacy within the main pharmacy, accessed by a coded entry keypad. Mr. Paris had requested that she explain the dispensing procedure, including noting the security numbers, for Trial Code Number HGH141.

Verona Pharmaceuticals’ statistical analysis on St. Angela’s data submissions had shown some irregular patterns, as well as an unexplained surge in patient numbers. All seemed to be within the Trial Protocol but Mr. Paris was uneasy.

He was a very thorough auditor. He checked the seals and allocation numbers on each trial medication box against the stock register. He checked the dates of use against the submission records. He checked the log of authorised signatories. Turning to me, he asked me to find out the names of all the doctors who could prescribe in the trial, and the relationships between them.

Miss Nurse was asked to explain how the hospital’s Ethics Committee worked. Being its long-standing secretary, she gave him a comprehensive list of the Committee’s work programmes and decision points. She could show him the records and minutes, and even explained the colour coded pens that were used to counter-sign the trial prescriptions. The well-ordered records were not allowed to be taken out of the Trials Unit. And she normally only opened the clip boxes housing the records to show the pharmacists and interns how to record their dispensed items.

Verona Pharmaceuticals’ all important share price was always sensitive to market fluctuations. It was particularly volatile when news, either positive or negative, was anticipated about the trial results from a drug in the company’s development pipeline. The financial authorities were like hawks on share price movements in case they had been informed, possibly by careless leaks, by insiders. This practice of manipulating the share price is known as “insider trading” and it is illegal, as is fixing and manipulating the market. It requires knowledge, skill and cunning.

On leaving the Unit, Mr. Paris spotted Jules, Miss Nurse’s new intern. She was a looker, as they say, even in her white coat. She was tall and slim in her high heel shoes, and her sweet smiling face was draped by her long wavy hair. “Who’s that?” he inquired. “Our new intern, Jules; she’s just learning the trial ropes,” replied the observant Miss Nurse.

Those Shoes

Miss Nurse called Jules to her desk. “You look like you’ve been at the party all night; you’re a bit of a mess; go and wash your face.” Jules did look the worse for wear and complied meekly. “And tie your hair up” said Miss Nurse to the party-goer. As Jules turned to go to the washroom, Miss Nurse fixed her gaze on Jules’ shoes.

“Jules, those shoes, do you think they are safe in here when you have to go up and down the ladders to reach the top shelves?” Looking at her high fashion sling-backs – a type of shoe favoured by young girls at that time – Jules replied, “no”. “Good, then put on some sensible flat shoes and dress like a professional”. “OK” was Jules reply as she crept out to the washroom to get ready to look like a “professional”. Meanwhile, Miss Nurse picked up the sling-backs and put them in her bin.

In the days that followed, Jules drifted around the place, dreaming of Ronnie. He did the same of Jules. They were made for each other – a pair of dreamers; a pair of naive interns as yet untainted by the biffo politics of organisational life. Sweet Youth – we’ve all been there.

Come back next time to find out what happened at the Grand Round meeting, and where Paris’s inquiries took him …