The Dutch Institute

By Wim Huppes

Survive long enough and you become the problem.
Dr. Marten Keyser has incurable cancer. With nothing to lose he survives by pursuing a drug regime of his own devising. Already unpopular with the powerbrokers in the dystopian healthcare system, he then develops a light-based therapy, but his low-cost innovation threatens the power balance and a cat-and-mouse game of survival ensues. In the face of mounting intrigue aggravated by the Coronavirus pandemic, Marten and his wife delve into high-level corruption, struggle to save their relationship, and build new alliances that might offer them a safe future.

• Language: English
• Publisher: Austin Macauley Publishers
• Release date: Jun 30, 2022
• ISBN: 9781398448957

Wim Huppes

For forty years Wim Huppes was an insider with intimate knowledge of the corridors of power. This book could only be written when Wim himself had nothing to lose, havingbeen given up with incurable cancer. In pursuitof a cure in turbulent times of the Corona pandemic, he was intimidated, arrested on severaloccasions and his medicines, instruments and paperwork was confiscated. His experience informed this work of fiction. His professional background includes: Internist with annotation oncology – UtrechtUniversity PhD thesis in biotechnology – VU University Amsterdam Representativeat the European Medicines Agency

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About the Author

For forty years Wim Huppes was an insider with intimate knowledge of the corridors of power. This book could only be written when Wim himself had nothing to lose, having been given up with incurable cancer. In pursuit of a cure in turbulent times of the Corona pandemic, he was intimidated, arrested on several occasions and his medicines, instruments and paperwork was confiscated. His experience informed this work of fiction. His professional background includes:

Internist with annotation oncology – Utrecht University

PhD thesis in biotechnology – VU University Amsterdam

Representative at the European Medicines Agency

Dedication

For Henk Trentelman, a cancer patient who lived on long after the medical world had given up on him.

Copyright Information ©

Wim Huppes 2022

The right of Wim Huppes to be identified as the author of this work has been asserted by the author in accordance with Sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publishers.

Any person who commits any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

This is a work of fiction. Names, characters, businesses, places, events, locales, and incidents are either the products of the author’s imagination or used in a fictitious manner. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.

A CIP catalogue record for this title is available from the British Library.

ISBN 9781398448940 (Paperback)

ISBN 9781398448957 (ePub e-book)

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First Published 2022

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Prologue

‘The Kremlin was a puppet on a string,’ said Ivan Volkov of the Russian secret service SWR. ‘Unaware to our President we were mere servants of an obscure Dutch institute.’

Dmitri Gritsin chuckled somewhat. On his laptop he saw his partner sitting straight at his desk on the ground floor of the SWR complex in southeast Moscow. As he zoomed in on the shorn head, the windows in the background with snow-covered woodlands disappeared from view. The sparkling green eyes revealed nothing but resolve.

‘You understood my protégé Marten, didn’t you? asked Dmitri. ’The servitude sprang from a foreign elite suffering from Dutch disease.’

Ivan had started to twirl his wedding ring.

Sitting in his favourite spot—the window seat of his office on the 22nd floor of the World Trade Centre in Amsterdam—Dmitri was letting himself be mesmerised by a sheet of paper whirling skyward. Its fluttering impact on his large window impelled him to mutter ‘Jesus is alive’.

Bringing himself back to the conversation Dmitri said, ‘I am content that you made the Kremlin take a new, promising path. By having them submit the Sputnik V dossier to the World Health Organisation you brought the president into the new world order, our resurrection will succeed.’

‘I am aware that Marten is adamant about me going all the way,’ said Ivan. ‘Indeed, the Kremlin must terminate the doctor’s judicial courts now.’

While Ivan was staring with wide-open eyes in the lens, Dmitri kept a lid on his frustration. Dependence was a bitch, yet he needed the president aboard throughout the paradigm shift to climb up from his 84th place in the Russian oligarch ranking.

‘Last time we spoke,’ said Dmitri, ‘you admitted that neither is the aircraft industry ruled by courts of pilots. Nor the transport sector by lorry drivers.’

‘Don’t run ahead of yourself,’ said Ivan. ‘The Dutch elite not only hold on to their economic boycott of Russia but also continue to peel the Ukraine away from us. Those spine chilling manipulators are trying to drive us into the abyss. Their prime minister stated in public that he will never talk to us.’

‘Nonetheless you must transform us into a biotech powerhouse,’ said Dmitri.

‘How many times did Marten assert that cancer remains the most important market segment?’ asked Ivan. ‘May I suggest that you find a way to boost his jaw-dropping biotech? Didn’t Marten say he wishes to go with the flow?’

Dmitri stood up and started to pace along the windows on the south side of his posh office while searching for words to butter up Ivan. Then he walked to his big screen, squared his shoulders and outwardly calm he said soothingly, ‘Watch! I’ll let him break the dam and cause a flood.’ A moment passed before Ivan’s mouth broke into something resembling a grin.

‘We’ll see,’ said Ivan, promptly breaking the connection.

Part One

The Rats’ Nest

Dauntless

Slowly, I lowered myself onto a chair at the kitchen table. Christmas was approaching and would be my last, as cancer had spread all over my body. Simply walking through the house was hard enough, while a year ago, I was still taking a daily run. I felt ashamed of my own stupidity, of behaving like an ostrich.

Me avoiding doctors for decades, as I wasn’t up to genuflecting to their guidelines. Although a few AI-guided, thin robotic needles outperformed the urologists, they insisted on putting eight probes with the diameter of the head of a pin into the tiny prostate and still missed many cancers. However, not mine.

Thanks to Shifrah’s insistence I had major abdominal surgery last summer. She begged my oncologist at the University Medical Centre for additional therapy. As the guideline dictated pointless chemotherapy, I was dreaming of a world in which patients could choose experimental treatments. With my head resting on my hands, I stared ahead of me. Half an hour later I refocused on my daughter’s text message:

‘Dear dad, next week we are coming home with Christmas. Kisses, Aviva.’

Her message lifted my mood a little. She was studying in England and had not been home since the summer vacation. Nevertheless, Christmas 2019 would be our last. I felt warm tears flowing over my cheeks, they dripped onto the glossy varnished tabletop. Resolutely I wiped them away and dried my tears with my T-shirt.

The doorbell startled me. Who would call around at this late hour? I shuffled to the front door and opened it. Our neighbour from the house behind ours was staring at me with undisguised curiosity. Mother Hen, as we jokingly called her, handed me a pan of hot broth. ‘For you. How is it going? Are things okay? When do you have to be back at the hospital?’

‘I am fine. Thanks for the soup.’ Before she could say anything in reply, I pushed the door shut with my foot. It was kindly meant, yet Mother Hen tittle-

tattled to people in the neighbourhood, while we needed to act like nothing was amiss. As my fingers were being warmed by the pan, I figured that broth came in handy.

When I turned around Shifrah was coming down the stairs. In her silk pyjamas she was slimmer than ever. The scent of Chloe, her favourite perfume since we first met, wafted towards me. My senses felt sharp. She was the one for me, I felt that in the core of my being. Almost floating she came nearer. In a trance, I followed her towards the kitchen.

‘Did Mother Hen pop by to take care of you, darling?’ she asked as I sat down. I immediately shifted my position. A wooden kitchen chair with a simple steel frame is ideal for no one, especially not for cancer patients. ‘Although I do trust your instincts,’ she said, ‘it’s awful that it had to come to this.’ She nodded towards the small brown bottle standing on the table.

There was sadness in her pale face. I stood up and drew her to me passionately but noticed that my body failed to respond. Shifrah took a step back. What I really needed to do was stop the hormone injections I was given as a matter of routine for a year since I was diagnosed. I knew damn well it was only having the side effect. Poor Shifrah, the last type of man she found attractive was an impotent nerd.

Shifrah blew her nose, sat down and leaned across the kitchen table towards me. Her warmth felt good. At this table, we shared so many lovely moments.

‘You are just so lucky I enjoy reading,’ she said. ‘Any other wife would have divorced you a long time ago.’

She stood up and walked over to the sink. I felt a knot in my stomach but thought it better to hold my tongue. She leaned back against the low granite countertop, an authentic element in our 1920s house. ‘You’ve got the brown bottle,’ she said. ‘This time you really are a long way off the beaten track. Why not first try the Pembralim of Meroik Pharma?’

Shifrah wanted to help me. Instinct made her check whether there still were solutions in the doctors’ guidelines. It felt good that she wouldn’t hear a word said about euthanasia in the New Year. However, the ridiculously expensive tests got Pembralim reimbursed for lung cancer, melanomas and bladder cancer. Not for prostate cancer. With the exception of melanomas, the gains were insignificant: one in five patients won a couple of months, only one in a thousand had a complete remission.

‘There’s no point in badgering them for a place,’ I said.

‘They are no doubt besieged by quite a few of the half a million men who have been given up on, all of whom delusional as Pembralim is far from brilliant.’

‘I’m so fed up with the crap the doctors talk.’ She clenched her fists. ‘If there is an option to be developed with half a million men, why should I have to lose you then?’

As a sign of surrender, I raised my arms for a moment. ‘Doctors have their guidelines enforced by the Dutch state,’ I said against my better judgement. ‘Which in turn rules globally.’

My gaze wandered to the bottle on the kitchen table. Patients had nothing to say, and for me, there was no time left for self-deception, although I did empathise with her fear. The anxiety of me becoming society’s whipping boy was overwhelming to both of us. Especially doctors going outside the guidelines was an anathema.

She pushed off against the countertop, walked the few steps to me and placed one hand on my shoulder. I scraped back my chair. The steel feet scratched against the black and white floor tiles. While standing up facing her, I stroked her neck with the back of my forefinger. Her darkly made-up eyebrows creased in a frown, while she looked down at the floor. Playfully I wound a curl of her hair around my finger. She pushed my hand away and hopped up back onto the countertop.

‘Tell me.’ Full of tears her eyes widened, looking even bigger. ‘What does Pembralim cost through your network?’ I shook my head. ‘Ah, don’t be so difficult,’ she sighed while wiping her tears with the back of her hands.

‘Yesterday the Guernsey wholesaler answered my email,’ I said. ‘He is willing to sell a month’s dose for $12k. We would rapidly blow our savings and be unable to pay for Aviva’s course. All that for a tenth-of-a-percent chance.’

The guidelines framework of the doctors was frustrating. ‘I need a hug,’ I said. She jumped down from the counter and took hold of my hand. ‘Just buy it. We’d ask your mother for money and take out an additional home equity loan.’

I shook my head. ‘Darling, please no.’

She gestured, spreading her arms wide. Then she looked again at the brown bottle on the kitchen table. I saw her shoulders drooping. ‘So, you are sticking to finding your own way.’

I felt too gripped by anxiety to argue. ‘You go to bed now, you’ve got to get up early tomorrow.’ She leaned forward and kissed me on my forehead. ‘I trust your Frisian instincts: stubborn but straight.’Taking a step backward she said, ’Your ancestry of cheese and salted herring producers was based on salt making on the arctic borders. Millennia of natural selection enabled the manoeuvring between drowning and poverty. If anyone can keep the authorities at bay while ridding himself of cancer it is you.’

She took the half-full bottle of Medoc and a glass from the countertop, threw a last glance at the kitchen table and hurried upstairs. I stood up and followed her into the hall. She flew up the stairs, her head of black curls bobbing up and down as she went. If I didn’t follow her, she would feel lonely in our marriage. By the time I reached our bedroom, the wine stood on her bedside table.

‘Whatever happens, I wish to celebrate Christmas with you and Aviva,’ she said, crying softly. I slipped into bed beside her and gave her a passionate kiss goodnight before she pushed me away.

On my way downstairs to the kitchen, I took the electronic scale for weighing letters from the study. From the dresser in the dining room, I collected a shot glass then sat back down at the kitchen table. I placed the small glass on the scale. Now that I was taking control of my situation, suddenly I no longer felt the pain. I should have been pursuing my own treatment much earlier. Two months had passed before I had been able to see the oncological specialist and another five months were lost on the waiting list for robotic surgery. All the while my cancer was doubling in size every three weeks, as documented in the laboratory. By the time of my operation, my body was riddled with small metastases.

Subsequently, in desperation, I had tried a couple of drugs, which as a physician I was able to get from a befriended pharmacist. I tolerated them badly, and cancer retreated only a wee bit.

It was quiet in the kitchen; my calm breathing made the only sound. I stretched my arms and back. It prevented cramps caused by the pain in my bones. Bloody pain. Bloody cancer. Bloody chemo. Bloody oncologists.

I forced myself to sit still. Outside it was pitch black and the rain wasn’t relenting at all. I inhaled deeply, blew out slowly and relaxed. Once Shifrah was lying in bed, she drank a glass of red wine, at most made a few calls, zapped and read, but wouldn’t get up again.

Using the table to support myself, I stood up, drank a few sips of water from the tap and sat back down at the table. I had to focus. The mail carrier had delivered a small brown bottle earlier in the day. It was the shape of a small cola bottle. It contained dichloroacetate, a liquid no longer routinely used to disinfect drinking water. It kills bacteria by robbing them of energy.

That’s therapeutic value to me. Although cancer has myriad variants, mine lacks the power station with which all multicellular organisms burn carbohydrates to carbon dioxide. Instead, my cancer ran on fermentation, identical to the energy sourcing of bacteria.

The label on the bottle carried two shields edged in red. The one at the bottom had alarmed me: skull and crossbones. In fat black letters, it read ‘corrosive and poisonous.’ Owing to food safety regulations, the lethal dose of dichloroacetate had been determined in mice. The safe dose I had estimated at a quarter of that lethal dose, adjusted for my body weight.

With my only hope in my hands, I dragged my chair closer to the kitchen table and carefully twisted the bottle cap. A sharp, vinegary odour burned in my nostrils. I held my breath and poured a little of the liquid slowly into the shot glass. The digital scale crept up to six grams.

My hands trembling, I twisted the cap closed and set the bottle back down. A droplet of the liquid slid down the bottle. A sinister-looking white vapour rose as soon as it landed on the table and it started eating through the thick layer of varnish on the surface. It needed considerable dilution; otherwise, my oesophagus would be eaten away.

I stood up and took Mother Hen’s lukewarm broth from the countertop. Carefully I poured the dichloroacetate into the broth. Just one step away from my daring experiment. Better this than rotting away slowly. I raised my eyes to heaven, thought of my wife, my daughter, my life, took a deep breath, brought the pan up to my mouth and drank it all down.

The Rats’ Nest

Shifrah Keyser pressed herself against the outside wall of the Institute. Low in the sky hung dark clouds, releasing yet another shower of hail. It was bleak weather in Amsterdam, even in February. She wound her scarf more tightly around her head and tucked the ends into the collar of the long coat.

Ahead of her lay a vacant lot and beyond that ran the railroad. Past the tracks, certainly, no closer than 500 yards, was the next wall of grimy high-rise offices. Here against the outside wall, she stood well concealed. On this side of the building, there were only the narrow windows of the stairwell housing the fire escape. From the Institute itself, she was not visible.

Ever since Marten’s death sentence last summer, a bad temper was making life difficult for her. Sitting at a screen, a bureaucrat of an oncologist had passed judgement by reading the guideline aloud. Chemotherapy using Atatin was the next step for her beloved husband. Whatever the oncologist said to the contrary, they would be draining life from Marten with the poison.

Only then, as the icing on the cake, could he participate as a guinea pig in a study that wasn’t designed to offer the slightest shred of hope. In a sudden, overpowering fright she had started screaming. Marten had half-carried her out of the consulting room. In the car, she had cried the whole way home.

Her fear had quickly turned into anger she couldn’t shake off. ‘Take it or leave it,’ the oncologist had said. The words kept coming back. In the next half a year her anger had grown into resentment of the compulsory Dutch society.

Mind-controlled rank-closing physicians sacrificing Marten for their part in the gain, no doubt. Keen on revenge she stood in the perfect spot for keeping an eye on the main entrance of the Institute.

For Marten, there had been only one option left. In spite of the state’s watchful institutions, they had taken action themselves. He had re-joined the ranks of the living thanks to another of his home-based experiments; there were so many she had lost count. The lucky devil hadn’t even been left with any significant side effect from the dichloroacetate. In the past six weeks, he had been regaining some of his fitness by going running. His life remained in danger though because the substances he had been using to date, including dichloroacetate, could only give a few months.

Despite the cashmere of her coat, she was shivering. She knew exactly how the Institute kept hold of power. After all, before his sickness, Marten had spent five years working here. With his colleagues, they had amused themselves during coffee breaks with morbid humour about Eric Stronghold. He supposedly led a network that used the country’s executive power to line their own pockets. His office was rumoured to contain piles of dossiers that couldn’t bear the light of day.

Shifrah ran her finger down a crack in the concrete wall of the dreary office building. Gossip and rumours were a source of information for her to be used. Tonight she wanted to find evidence of the fraud to blackmail Stronghold, to make his Institute help Marten instead of obstructing him by blocking every move outside the doctor’s guidelines.

The thought of taking back control over his body cheered her. Marten had done so much for her, and now she would organise a favour for him in return. She wiggled her toes and blew into her cupped hands. In the distance a light-rail train road over the railroad bridge. Its cars were covered in graffiti. Already three trains had passed by. Had she arrived too late?

An automobile approached. Carefully, using her hand to support herself against the wall, she peered around the corner. A grey Toyota drove toward her, past the main entrance. She ducked back behind the wall. She heard the barred gate clang open and the car drive into the underground parking garage.

The barren field before her was now white, covered with hail. She rubbed her hands together. A Sounding Board meeting of the bigwigs would be held this afternoon. She had to sit tight until they turned up. From his colleagues, Marten had heard that they would all come because a couple of start-ups were looking for board members. On the agenda was their part in the Throne Speech the king would read out dutifully to the House of Representatives to outline the next political year.

Eighteen months ago, Marten was still an unworldly do-gooder. At the Institute, he had been trying to change the system from the inside out, working flat out on regulation to accelerate biotechnological research. His leisure hours were spent on influencing the public debate by writing opinion pieces for the media. In his quest, he had neglected her. Her lovely husband, so smart and yet so dumb.

She remembered getting angry a year ago when she had said to him, ‘I’ve been saying for weeks that you need to see a doctor. You are having trouble peeing.’ Marten had answered, ‘You are right, I’d better make an appointment.’ When it turned out, two months later, that the level of the prostate tumour marker in his blood was elevated, they landed in a nightmare.

‘It was stupid of me to accept the waiting list,’ Marten had now—a year later—admitted. She could not forgive him for ciphering himself away. Like a scared kid fretting about the wrong kind of pre-operative scan. Didn’t everyone know that a doctor’s first response was to avoid getting involved? ‘Everything’s fine’ they’d say, changing their tune at some point too, ‘It’s too late.’

Marten’s cancer had reactivated his childhood fear of abandonment. Convincing independent behaviour had only started to appear half a year ago when he declined chemotherapy. ‘Now that I’ve been through the medical mill myself, I realise I am better off believing in my own ability,’ he had said. ‘My insecurity was holding me back, but enough is enough. I’d have to be crazy not to put my expertise to good use.’

She felt contempt when he buoyed himself up with such vague words. Since he let loose of the physician brethren his compulsion to follow his own intuition wholeheartedly was blowing things out of proportion. He knew exactly which foreign teams of experts he wanted to join and what they would be researching. Although his political risk-taking made her despair, she wanted him to stay alive—for herself and most of all for their daughter. Aviva couldn’t wish for a better father.

The throbbing of a heavy-duty engine sounded. She peered cautiously around the corner. At last, a limousine stopped in front of the entrance. Beneath an umbrella, held by a chauffeur, a well-dressed man walked to the covered entrance. Shifrah instantly recognised the former minister of liberal persuasion. There were dozens of medical institutes, wasn’t he currently president of the board of the Institute of Medical Licenses?

A second limousine drove up and a woman stepped out who Shifrah did not know. The limousines were now coming and going. The passengers entered the building right away or stood under the portico, talking. A politician from the Socialist Party arrived, an emperor’s favourite. Marten had told her that of all people that windbag made a huge contribution to Stronghold’s Sounding Board, so she was not surprised to see him here.

She straightened up and quickly brushed the bits of freezing, white hail from her black coat. The strap of her handbag was about to slide from her shoulder. She pulled it back up and hurried to the entrance. Nonchalantly she walked through the glass revolving door.

The hum of the voices of dozens of distinguished people echoed off the concrete walls of the imposing reception hall. Security guards were helping the receptionist at the desk to register the visitors. Marten was right: It was far too busy for anyone to notice her. She looked like an insider thanks to the genuine Dior coat she had borrowed for the occasion from a friend.

Her large leather handbag was on trend, even though it held fifteen yards of rope, a climbing harness and a folded backpack. Nor did her black brogues look out of place; she saw other women wearing a flat heel.

Shifrah felt her cheeks glowing. She took off her scarf and unbuttoned her coat. A feeling of being watched crept over her. She looked about her. The members of the Sounding Board only had eyes for each other.

In contrast, on the other side of the hall stood a young woman staring at her. She was skinny and her head was bald. It couldn’t be! It was Helga, a cancer patient, who had recently come to the house to see Marten. A feeling of compassion came over Shifrah and she weaved her way towards her, avoiding the administrators now gathered in groups, chatting.

Eager to attract Shifrah’s attention, Helga started beating her fists against the glass door of the cabin. Many of the princes and princesses in the hall started to gaze at Helga, then Shifrah saw two security guards move in her direction and the guests went on with their business.

Nonetheless, Shifrah felt anxious, sweat was breaking out on her face. One security guard was opening the glass door. The other security guard was eyeing her with suspicion. ‘Madam,’ she said, ‘the reception is at the other side.’

While smiling politely at the guard she relaxed her shoulders, brushed a speck of lint from her coat and walked the few steps to the reception. She remembered that Marten had once told her that dissatisfied patients were IDed, photographed and taken to one of those reception rooms to write down their request on a form.

Out of the corner of her eyes, she saw that Helga was escorted to a taxi. Shifrah turned on her heel and found herself face to face with William de Ridder.

‘Shifrah,’ he said animatedly. ‘What are you doing here?’ He was pleased to see her and a chat could not be avoided. ‘You left us five years ago when you took a promotion at the Steen Meier bank if I recall correctly.’

‘I still miss the cosiness of the Contoino Bank,’ she said.

‘Have you heard that I initiated a Danish pharmaceutical start-up?’ ‘Yes, my colleagues are impressed.’

She had heard that William was producing a slightly adapted drug, just unique enough to be eligible for a patent. Around the Institute swam schools of hammerhead sharks, as insiders homed in on investment opportunities to take part in the billions in profits. William’s infighting must have been rewarded by Stronghold.

‘I have recently been appointed as a board member of the Care Mandate Institute,’ William said. ‘This is my first meeting as a Sounding Board member.’

‘William, how interesting.’ She