A Single Cell
He knew where to bury the body before he'd even killed him. He’d spent half his life running around this forest. He’d mapped every trail, every cut through and hidden glade. He had even sussed out the best place to park his grey Fiesta so it couldn’t be observed from the smallest of the forest slip roads. He lined the car boot with protective plastic. He switched off every digital tracking device. On his journey here, he avoided main roads, surveillance cameras, and driven within the prescribed speed limits but never too slowly as to attract attention. He paid cash for the spade from a village hardware shop. According to a local weather site there was less than a five percent chance of rain, and the half-moon provided sufficient reflective light so he would only need to use his fully charged state-of-the-art head torch if necessary.
It was enough to say that he was prepared for everything except the one thing which happened. When he flicked open the boot, the back of the spade reared up catching him a glancing blow, but forceful enough to make him stumble. He tripped backwards over a surface root. He was more surprised than dazed, shocked that his plans were unravelling so quickly and still uncomprehending how this could happen when it shouldn’t be possible. He tried to twist away but was already on the defensive, flinging his arms in front of him in a vain attempt to fend off the second blow. The keys flew out of his hand, landing in scrubland behind him. The black metal smashed against his right temple; a wet, muffled thud which reverberated through his head with disorientating ferocity.
“You didn't think it would be that easy, did you?”
He recognised the voice and the dripping scorn laced with righteous anger.
But he didn't remember anything after the third blow.
Three Years Earlier
“Why do you want to study medicine?”
Five of them sat opposite. Two rectangular tables pressed together provided an additional barrier separating them from him. There was a jug of water and a small stack of disposable plastic cups on the table. Charlie Gorham had refused the offer of water, an act which he now regretted. The Dean told him to take the seat provided and then introduced him to his colleagues on his right and left. They were too far away to shake their hands and instead he nodded and mumbled perfunctory greetings to each. He shouldn't be nervous. He had received two offers already and was already an old hand at medical school interviews but this was his best chance of a scholarship. And this was his number one pick. The room warm and his shirt stuck to his back. He'd over tightened his tie. He held the gaze of the silver bearded middled aged man to his left who'd asked him the question which every prospective student expected. He placed his hands on his knees, slowly exhaled and then gave his most confident response.
“I’ve wanted to study medicine from the first moment my father gave me an imitation Gladstone bag on my fifth birthday. It contained a plastic stethoscope, a tendon hammer and a tiny torch.”
Every word a lie.
There was no conceivable way he could tell them even the smallest grain of truth.
His application was never motivated by altruism or a spirit of public service. Something darker and more specific. Something which had haunted him for years.
His father never encouraged him or gave him a present as trite as this. Or if he had, Charlie Gorham had long since forgotten. His father died eleven years ago. It was the moment which changed the course of Charlie’s life and set him on a path which led him here, sitting in front of these five people, trying to persuade them that he was worthy of a place at the Best Medical School in London.
He had only been eight at the time of his father’s death. His mother drowned three years later.
St Pat’s was the only place he wanted to study medicine; the place where his father had been murdered.
Charlie Gorham was clever.
Charlie Gorham preferred his own company to that of others.
Whether these two traits were causally linked or independent variables was debatable but Charlie was careful to disguise his intelligence and his latent misanthropy. In his experience it was safer to adopt a low profile. Observe from the side-lines. This was his mantra. Showing off attracted attention and attention had a habit of tripping you up or biting you in the arse.
To all intents and purposes he was charming and normal and possessed all the things which made him look like a responsible and civilised member of the human race.
But he was missing something. He didn't know what this was, but it set him apart; He was careful to project what others expected while a part of him lurked unseen, observing.
He didn’t like this about himself. He would have been happy to be like other people. He had never asked to be different, and he tried hard to adapt so that he wasn’t.
If he had a superpower, it was his ability to read people. And imitate them. It was better to fit in. Or at least appear to fit in. To be another faceless member of the crowd.
He liked London, not just for the anonymity it provided but he’d been born here, at the same hospital at which he now studied. After his father’s death, he had been taken to live with his aunt in a small village on the outskirts of Maidstone; one dreary street with a pub at one end and a church at the other, and in between a recreational field with a slide, some broken swings and a garish coloured seesaw with yellow peeling paint. It had taken Charlie several years to comprehend that the rec - as the locals called it - was not the wreck which he'd supposed it to be when his aunt had first told him to go and play with the other kids.
London screamed possibilities; eight million of them, on every street, at every minute of everyday. The heaving energies of so many dreams and thwarted desires pulsed through him with a vigour which left him gasping. He had been starved of so much that to touch this, even if only indirectly, as a passing peripheral in the dramas of so many, left him aching for more.
He loved exploring. At nights, after the physiology and pharmacology tutorials, after the lectures on the Krebs cycle and Starling’s law, after he cycled the three miles from Waterloo to the Aldwych, to Kingsway and Southampton Row and then back to Cartwright Gardens and his single room on the twelfth floor of his intercollegiate hall, after eating his one meal of the day in the basement cafeteria, and completing his evening studies, he would tighten the laces on his shoes, stretch his calves and hamstrings and then head down the eleven flights of steps to the waiting streets below. It was his favourite time of day. Free to run, to roam wherever he wanted; north passed the prostitutes of Kings Cross, east to the murky lanes and hidden hostelries of Holborn and beyond, west to the wide-open boulevards of Harley Street and Upper Wimpole, or south to the glamour of Shaftesbury with its myriad of milling tourists corralled like crowds of clucking hens.
Charlie always thought it strange that running had been one of the main punishments at school. “Two laps of the field, Charlie! Step on it. Now!” For him it was always the key to freedom; to escape his aunt’s house, his school and everything about a life which had turned him into someone he had never asked to be. But in London he could afford to relax. He wasn’t running awa, but for the first time moving towards something. And he had never felt more alive; more impatient for the chances to confirm the truth of his father’s death.
He didn’t really see Sam as an opportunity - she was out of his league - but he was attracted to her. He was still shy around women. He had gone to an all-boys selective grammar school and the opposite sex weren't just another country they were exotic creatures from another universe. Older. Grown up. More contained. But in his first week at St Pat’s the obvious dividing lines weren't just sex but money and privilege. It was clear who possessed that sense of entitlement and equally clear who didn't. It wasn't just the way they dressed - although there were a few privately educated prats who insisted on wearing blazers and old school ties - it ran deeper; the confidence that they belonged, that they believed in themselves. Charlie couldn't help despising and admiring these traits by turns. They didn't mind making fools of themselves. They would ask stupid questions in lectures. They would drink themselves to oblivion in Lustys. Or they would just play at being obnoxious knobheads, not caring about consequence. They could get away with this. And they did. Every time. St Pat’s had a reputation for attracting the richest and the best and they were more than happy to live up to expectations which had been built over generations of students before them.
Sam was a Harlow to his Gorham; their surnames sufficiently close that they shared the same tutorials and practicals for the major first year disciplines; anatomy, physiology and biochemistry. There was nothing quite like dissecting a dead body to draw you together. Theirs was called Irma. He couldn't remember whether this was her real name or one they had invented. There were six of them in their dissection class but the only one he paid attention to was Sam. She was the only one who wasn’t a complete phoney.
Irma had been pickled in formalin - the smell so strong it made your eyes water - swaddled from neck to toe in white cloth which when peeled away revealed her grey lifeless form beneath. Everything had been sucked from her, leaving a desiccated imprint of a person akin to a forgotten leaf pressed between the fading pages of a forgotten book. Sam was the first to note her missing breasts and the bilateral mastectomy scars.
“She must have died of breast cancer.” Sam’s gloved index finger traced the silver line of the scar on her right chest. “Where do I start?” She had already unfurled her dissecting kit, the individual brown pockets containing several scalpels, tweezers, forceps and a single probe. Sam was the only one to have unwrapped hers before the body had even been exposed.
Charlie watched the Prosector demonstrate the best way of holding a scalpel and then guided Sam's hand, pressing the blade against the skin in an upward arc from the fine sparse grey pubic hairs to an inch below the xiphisternum. Successive cuts revealed a small amount of fat, then peritoneum and then omentum. “We call this a central laparotomy incision. Ably demonstrated by...”
“Samantha. Samantha Harlow. Sam to my friends.”
It was definitely flirtatious.
She looked up, her eyes fixed on Charlie. He didn't know what prompted him but he winked back at her. She smiled as if she understood, and then refocused on Irma's open abdomen before plunging her gloved hands into the newly exposed cavity. There were a lot of guts to unpack. Who knew that so much could be hidden within such a small space?
Sam was pretty but didn't trade on her looks. If she wore make up it was artfully applied. Her dress sense simple and understated, combos of trousers and a variety of plain T’s. She had a favourite faded denim designer jacket with embroidered lapels and a green Kanken backpack. Her most striking feature was her blaze of red hair whose style seemed to change several times each day. But it was her dynamism which made her impossible to ignore. She was the centre of every discussion. A natural contrarian. A disrupter. A passionate defender of whatever she believed because her positions would change in relation to the weather, her mood or the opposition. She was bewilderingly bright and Charlie was captivated but his attachment to her remained confined to the dissecting room and the labelling of anatomical landmarks. He was frustrated because despite his best attempts to impress, she wasn't. It didn't matter that he was the only one who had heard of the Ligament of Treitz, who could name the three arteries supplying the gastrointestinal tract, and who could place his finger on the Porta hepatis - this didn't cut it with Sam. He didn't know what she wanted but it wasn't him. And initially he accepted this; accepted she was better than him. There had been that weird moment when she had smiled at him after her first cut and they got on well enough since then but their relationship - if it could be called such - was a product of expediency and function. And he would have to settle because this was all that he was only ever going to get. And he did, watching as she fluttered between different cliques, as she casually flicked her hand through her hair, a constant distraction but a distraction that was impossible to ignore.
His mother was convinced that Primrose had killed his father. He was the only one in the laboratory on the Saturday afternoon of his father’s death. Primrose had discovered him lying collapsed on the floor.
He'd been plain old Dr P then; a simple post grad Research Fellow. His mother kept several press cuttings in a grubby manila folder and had ringed Primrose’s name wherever it appeared; in his father’s obituary in the BMJ, the Lambeth Herald’s report of the Coroner’s Inquest or in several preprints of articles they had jointly published. Charlie had since reviewed whatever he could find of relevance online. His father's death had propelled Primrose's career into a higher orbit; his elevation swift – a publication in Nature, the awarding of the Prideaux Chair for Molecular Biology and then an eye watering grant from the Welcome Foundation. But the strangest of his transformations was from Clinical Scientist to Media Darling. Even if Charlie had wanted to forget his mother’s accusations, he couldn't. Primrose was everywhere, presenting a weekly science digest on Radio 4, giving an invitational Reith lecture in 2019, and then compering a popular six-part BBC series on Sunday evenings about the beginnings of life. As impressive as this was, nothing could compare to his heady social media profile. It may have been an accident but Primrose had become an Influencer. A man of distinction. It was ridiculous that he had thousands of followers on TikTok, Insta and Snapchat. Charlie had seen many of his offerings - outtakes from the television series, crouching in the desert with sand running through his hands, swimming with luminescent algal blooms, proselytising about the wondrous and miraculous with an earnest credibility which Charlie couldn’t help being irritated by. Was he the only one who saw there was nothing authentic about him and yet he had become the popular voice of science and everyone seemed to be in awe and fawn all over him?
Charlie would normally sit at the back but for Primrose’s introductory talk, he was one of the first to arrive. He took a seat front and centre. The lecture theatre was steeply banked, lending an intimate closed-in feeling to the auditorium. Some lecturers ignored their audience and monologued through dull presentations. But Primrose preferred the cut and thrust of debate and dialectic. Charlie was prepared. He'd downloaded and reviewed Primrose’s lecture from the previous year.
When Primrose entered the lecture theatre, there was an immediate hush. He was taller than Charlie expected - six foot two or three – in his early forties but with a boyish busyness and an energy which was almost palpable. He plugged his laptop into the projector and then dimmed the lights. The first slide appeared: Three words in bold, black print.
A SINGLE CELL
“Hopefully most of you will know who I am, but for those who don't, where have you been?”
There were titters of low-level affirmation before the next slide.
Professor Paul Primrose MBBS FRCP PhD
An Introduction to Molecular Biology
“When I was a student, which contrary to popular opinion was not so long ago, a lecturer whose name I have long since forgotten, made an indelible impression on my younger self. ‘Half of what you learn here,’ he said, ‘will turnout to be wrong. But you won't know which half until you’re at least halfway through your career.’ At the time I thought this arrant nonsense. We were taught by the those at the cutting edge of their respective fields. But the facts of yesteryear are the fish and chip paper of tomorrow's world. And he was right. It is better to question the status quo than blindly accept what you've been told.”
“Even by you?” Charlie had said this under his breath, but loud enough to induce a few chortles in the nearby seats.
Primrose stood on the dais a few yards in front of him, his fingers clenching the silver siderails either side of the lectern. He smiled and looked down at him. “I don't mind interruptions but prefer if you will raise your hand if you have a question. Your name is?”
“Gorham. Charlie Gorham.” It was his mother’s maiden name. It didn't seem to register.
“Well, Mr Gorham, as you are so keen to contribute, can you please tell me how many red blood cells an average man will destroy each day?”
“On what may I ask?”
“Whether I’m running a marathon, or have been infected by the EB virus, or have sickle cell or...”
“All of which are remarkably unlikely. Let’s assume you’re just an average healthy man and you’re not planning to run twenty-six point two miles.”
“Two hundred billion or thereabouts. About three million red cells are destroyed every second. Isn’t that right?”
Primrose unfurled his fingers from the sidebars and walked a few steps to his left so that he was standing facing Charlie. “Have we met before?”
“I don't think so.”
Primrose focused on Charlie for a moment longer, and then with ponderous deliberation, stared up into the auditorium. “How many of you agree with Mr Gorham’s confident assertion. Do we actually destroy three million of our precious red cells every second of every day?”
Charlie looked over his shoulder. Only a few students raised their hands, but he was pleased to note that Sam was one of them.
“Seven,” Primrose counted. “No, six. Have you changed your mind, dear?” A woman with a white ruffed collar nervously nodded. “I’m afraid you shouldn't have. Mr Gorham is remarkably well informed. He is right that we destroy about two hundred billion red cells every day. And this is just one of the hundred or so specialised cells from which we are all constructed. Our bodies are exceedingly good killing machines. Destroying the old and damaged, continuously recycling and renewing. An average erythrocyte lasts a hundred and twenty days. A platelet a mere five. Whereas cells in our central nervous system are irreplaceable and must survive a lifetime. Each of us is constructed of about...”
The next slide was just a number:
30, 000, 000, 000, 000
“Thirty trillion cells. A three followed by thirteen zeros! We are, at once, stupendously complicated and yet can be reduced to a basic unicellular structure. This is the real triumph of evolutionary progress.”
The fourth slide was of a simple black and white annotated picture.
“A single cell. The secret of life itself. And of course death. Because you can never have one without the other. This is what we will study this term. The building blocks of everything. And from this you'll have the foundations to work out how cancers arise, how they can be detected and targeted. And how ground-breaking research in this very hospital offers the tantalising possibility of curing the hitherto incurable. These are indeed exciting times. And you will do well to listen and think because maybe,” and he glanced at Charlie as he said this, “one of you will be the next me!”