The book begins with two of the chief characters, Celia Jordan and her husband, on a flight home to the US anticipating trouble that the reader is not yet fully in on, involving a certain Senator Donahue. The action then goes back some 40 years to when Celia, unmarried, was a drug sales rep for a pharmaceutical company and her husband-to-be an internist beginning his career at a New Jersey hospital. Andrew Jordan is perplexed with the case of a young woman dying from hepatitis A, not a usually fatal infection, that she acquired on a cheap holiday in Mexico. Celia happens to know that her company is researching a drug that would combat the woman's symptoms, and manages to get through the protocols to find some, and as a last desperate measure, the drug is administered and the woman's life is saved. The next morning, she and Andrew Jordan become engaged, largely, it appears, on a whim of Celia's.
Celia turns out to be someone who knows what she wants and gets it, and we soon learn the story of how she came to be in her present selling position, where she has made a name for herself by going out of her way to become more knowledgeable about her job, and, after one particularly bruising encounter, earn the respect rather than the ridicule of practising doctors.
On their honeymoon the two share their various family histories, Andrew's mother and father having separated and left him to the care of an aunt who has sacrificed all she has to get him to where he is, and Celia's father having died in the attack on Pearl Harbor.
On return from work, Celia is engaged to speak at the annual company conference, and is planning a major assault on what she sees as the lack of training and sharp practice that are rife among her own company. Her manager Sam Hawthorne strongly advises against this, but when Celia delivers her speech anyway, to the dismay of her company bosses, she is close to being fired when Sam intervenes to save her. She is soon promoted to a new position and then begins to rise through the company at the same time as starting a family. She is a woman who is determined to have the best of both worlds at work and at home, and manages to somehow fit it all in. By this time she has two children: Lisa, who appears to inherit much of her organisational sense, and Bruce, a history fanatic. Strains in the Jordans' marriage surface on a trip to Ecuador where both acknowledge they have let their standards slip, Andrew having spent many years covering for his chief at the hospital, who is a closet drug addict, and due to which at least one patient has died in preventable circumstances.
Sam Hawthorne is promoted to company president, and Celia is promoted behind him. Other characters who become important later include Bill Ingram, a Harvard Business School graduate with a similar no nonsense approach to Celia's. There is a deathbed encounter between Celia and the president who almost fired her, Eli Camperdown, at his home, at which he urges her to always follow her conscience. Years before, Celia had deflected the company away from marketing Thalidomide, and possibly saved them great trouble.
Sam meanwhile quickly makes two far-reaching decisions, one ultimately to be of great benefit, and the other a total disaster. He has a whim to set up a research unit to tap into what he sees as the great pool of British talent for new ideas, and at the same time buys up an abandoned French project for an antiemetic for use in pregnancy. Celia and Sam visit England to look at prospective sites for the unit, and there meet a young Cambridge researcher, Martin Peat Smith, who is researching memory loss and dementia, spurred on by the case of his mother, who no longer knows him. Sam offers Martin the job of head of the British unit, which Martin at first refuses but then Celia is able to persuade him with a head-on assault on his vulnerabilities.
Meanwhile back in the US, Celia has serious misgivings about the Montayne project and ends up resigning from the company, recalling Eli Camperdown as she does. She and Andrew embark on a round-the-world tour, ending up in Hawaii, where Andrew has secretly arranged a visit to her father's ship with the children, recalling a wish that Celia revealed on her honeymoon many years before.
She is recalled to the company amidst the news that Montayne is indeed the danger that she feared. Sam shortly afterward commits suicide, for reasons that Celia only partly understands: he gave some to his then-pregnant daughter about two years prior, and her child, now one, has been destroyed. A deeper secret concerning the licensing of the drug and blackmail of the FDA official responsible, a Dr Mace, remains hidden.
Celia takes over as vice president but is effectively running the company. After Sam's suicide, the board typically refuse to appoint her to the top job. They appoint a pro tem president, who is in post for 6 months before he dies. Celia then becomes president. She now has to get the company back on track, and quickly. Unfortunately, Senator Donaghue, a well known two-faced politician, has ordered a Senate enquiry into Montayne, amidst all the other legal actions that inevitably result. In a heated debate at the Senate, Celia publicly discredits Donaghue against the urging of her legal team (as he had originally been against delaying the release of Montayne, and he is very much in the control of the big-tobacco lobby), earning a brief reprieve but possibly stirring trouble for later on.
Back in England, Martin's research project is bearing little fruit, and has already survived one attempt to close it down by the Felding Roth board who are concerned at the expense and lack of progress in a time of severe financial pressure. (Before his death, Celia was sent by Sam to investigate and make a recommendation on the activities of the British Institute, and after a short visit during which she visits the institute and talks to various people, and she and Martin inevitably make love, she recommends that the project continue). His home life is enriched by a relationship with one of the technicians at the institute, Yvonne, who one morning makes a chance remark that triggers a new line of enquiry in Martin and the eventual development of a memory enhancing peptide, which is eventually developed and becomes a great success for Felding Roth, much to the disdain of the head of research Dr Lord. Vincent Lord is an ambitious scientist who rather feels that his talents are always overlooked, and took a very cold attitude to Celia on her rise through the company.
The financial rescue of the company, Martin Peat Smith's knighthood and eventual marriage to Yvonne after a separation, Vincent Lord's eventual breakthrough discovery of a free radical quenching drug of unquestionably great promise, follow. The company appears to be heading for calmer waters. Trouble strikes when it turns out that at least some of the research into Lord's discovery is falsified, and that Lord, rather than expose the fraud, has attempted to cover it up. Ultimately this creates trouble, and inevitably the matter comes to the attention of Dr Mace at the FDA and Senator Donaghue, who sense a chance to exact revenge on Celia and Felding Roth. At this point we are in the know about the opening conversation of the book and the story closes there.
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