by Kate Ledger
“So it ramps up endorphins?” Simon didn’t mean to make his impatience obvious, but wanted to make sure Julie was taking it all in.
“We think the compound is interfering with the endorphin breakdown enzyme. The enzyme gets inhibited and doesn’t do its job. Suddenly the brain is awash in an overflow of its own wonderful, naturally occurring chemicals. The drug doesn’t create a sensation of arousal—we probably couldn’t put it on the market if it did—we’d produce a society of horn-dogs.” Greg smirked again. Simon distinctly did not look at Julie, who remained rigid in her seat. “But somehow, once a person begins to feel aroused—in other words, when another mental function is under way—the drug maintains the feeling of pleasure. It elevates and maintains interest.”
Simon listened. Well, so what about this pleasure sustainer? They knew so little about the compound, it was likely they didn’t know all it was capable of. His father’s unusual state after the trauma of the car accident must have related to the drug as well. Endorphins served as part of the body’s natural pain relief, just like opioids, attaching to specific receptors on the surface of a neuron and then transmitting a message to the inside of the cell. The broken rib, the bruises, certainly should have been painful, and yet Charles had hardly complained about anything. He found himself thinking about his father, and he felt certain that the medication had affected his father’s ability to perceive what he ought to have been feeling. He also was becoming certain that the company had no inkling about any effects as a painkiller.
“Is that its only effect, sexual dysfunction?” Simon probed.
“Only effect!” Greg sounded insulted. “What more could you ask? It’s what the world needs! So far, patients have reported the most minor side effects: dry mouth, frequent urination, sweaty palms. Other sexual dysfunction drugs on the market work by increasing blood flow to the penis. They work by widening the blood vessels. In other words, it’s a mechanical process. Bottom line is, they can help you get it up, but they can’t help you get in the game.”
Simon couldn’t help pressing again, just to make sure. “You’re not testing it for anything else?”
The question did not seem to interest Greg in the least. He leaned forward, his fingertips against the table, as he said, “We think we could blow Viagra out of the water.”
So Boeker Pharmaceuticals had no idea about the drug’s potential as a pain medication. There was a heat under Simon’s hair at the back of his neck, the prickle of secret knowledge. He was staring at untold potential. An answer. He’d witnessed the effects of the drug in his father’s car accident. There was no doubt in his mind. With a broken rib, the man had wanted to get down on his knees to fix a cabinet.
“Are there contraindications?” Simon asked.
“We think patients taking psychotropic drugs shouldn’t take it.”
“What about women?” he asked.
“Seems to work for women too, though I admit with this study we’ve been targeting men.”
“Any reason that women couldn’t take it?” Simon pressed.
“None established. But they’re not really part of our study.”
“But no known side effects other than the ones you described?”
“Right.”
Simon’s heart was racing. He banged both hands on the table and exclaimed, “I’m in! How do I do the trial? How do I begin?”
Across the table, Greg slid a confidentiality agreement and a pen. Simon barely pretended to read before scribbling his signature, and then Greg produced the protocol, bound with a plastic cover, explaining as Simon flipped through: The drug was given by injection. Simon had the option of giving the vials to his patients and prescribing them hypodermic needles to give the shots to themselves at home, or he could administer the sulmenamine in his office. He would have to follow up with patients by having them fill out frequent questionnaires about their sexual habits and their moods. There were forms to keep track of the vials and more forms to record notes about the patients.
“Typical paperwork,” Greg acknowledged. “First let me say, we know your time is precious. We want to compensate you for diverting attention from other things you need to do.”
Simon put up one hand. “Whoever I spoke to on the phone said you don’t do that anymore.”
“Well, that’s our official policy. Unofficially, we’d like the results as soon as possible. Our time’s precious, too. I can reimburse you for your time and expenses, what we estimate will come to about five hundred dollars per patient enrolled in the study.”
“I don’t want any money,” Simon said plainly. He glanced at Julie, hoping that she would take note.
Greg coughed into his fist. “Okay, then. Maybe we can work out some other form of compensation. I’ve never heard of someone not wanting to be paid—”
Simon interrupted, “How much of the drug can I have?”
Greg had a carton by his foot under the table. He set it on the desk and ripped back the cardboard flap, revealing small boxes lined with the tiny numbered vials, just like the ones that Charles had in his drawer. “How much? That depends. Truth is, we got a time crunch on our hands. This trial’s been going on for almost fifteen months already. When we started, the protocol team determined we needed a hundred patients to make our case. So far we only got seventy-four who fit the demographic. In short, we got three months left to sign up twenty-six patients and get some results.”
“Or what?” Simon wanted to know.
“They close down the trial. We move on. Company can’t afford otherwise.”
“What happens to the drug?”
“Shelved. Done.”
“And nobody could get it then?”
“Got to be honest with you, this is my project. I believe in this stuff and I want to see it succeed.” Greg pressed his two palms together in a gesture that looked like he was either imploring or about to dive. It turned out to be his special-deal pose. “Normally, we’d have you come in and go through training first, and then we’d deliver the drug to you. But I want to expedite. I have a case of the stuff in my car. We had a doctor go through all the paperwork and the training and back out yesterday, time pressure, yadda yadda. Anyway, because of the time constraints, I can bend the rules and leave that case with you. Do the training next week. You’ll have the drug on hand so you can start immediately after that.”
“I can get those patients,” Simon stated. “If you want, you can leave me more.”
Greg looked pleased. “That’s what I was hoping you’d say. My car’s parked on the street. I’ll be right back.”
When Greg stepped out, Simon turned to Julie. “They don’t even know what they’re sitting on here.” Julie nodded, working hard on a stubborn cuticle. “I want a stash on hand in the office. If what I saw in Florida is an indication of what this drug can do, it’s got incredible potential, this stuff.”
She tore at the edges of her fingers. Finally she spoke, “How, exactly, are you going to do this?” Her voice flatlined with disinterest. “With all the notes you have to take for them? Shouldn’t you just tell them what you think the stuff does?”
“These guys are all about making a buck. That’s not what I’m in it for. When everything’s said and done, I’d like to say I made the world a better place. Can’t be done through their twisted system.” He was already planning. “I’ll design my own trial. I’ll call all my patients, the ones with the most severe, intractable pain. I’ll tell them I’m offering a new pain treatment. Maxi Bailey. Jim Weaver,” he counted on his fingers enthusiastically. “I could come up with a whole list right off the top of my head.”
Standing up, he began pacing the office. Julie regarded him without shifting, the only flicker of motion her nails working the reddened skin. He hated himself for that terrible, loathsome moment in the basement. His stomach turned. He was always on the edge of fucking everything up. Always teetering on the precipice of disaster. And now it mattered that he have her on board with this plan.
“Do
you want to tell me why you’re being like this?” he asked suddenly, turning and leaning toward her across the table.
“Like what?” she retorted.
He lowered his voice. “Like you’re angry or something. Is it because of what happened—before? I told you I was sorry. It wasn’t personal.”
“Wasn’t personal,” she spat.
“Really, you should take it as a compliment, if anything.”
“Puh-lease.”
“Look, I realize there are things that shouldn’t happen. And that was something I shouldn’t have done. I don’t know how to take it back. Can I possibly say sorry enough times?” Then something dawned on him. Maybe it wasn’t that he’d kissed her, but that he’d stopped. Maybe she’d wanted something more to happen between them. “Oh,” he said.
She read the idea taking form in his head and she slammed both palms down on the table. “You are so arrogant,” she said. Her eyes blackened into slits.
“Me?” he asked, taken aback.
“So very arrogant.”
He was genuinely surprised. “I don’t think of myself that way.”
“Case in point,” she snapped.
Simon looked at her. He was so accustomed to feeling like he was in the doghouse, but so unaccustomed to being called on it. Emily did not engage him anymore. She’d simply stopped trying. And yet it felt good to be confronted. The heat of it felt real. He couldn’t help appreciating this Julie McKinley, and he felt approval for the way her cheeks flushed and her eyes blazed at him and her hands were spread on the table as if she were about to spring over it and claw at him. The kiss in the basement didn’t seem like such a big deal to him because he hadn’t meant anything by it—it had just happened. It wasn’t premeditated, for chrissake. He’d just felt—happy. But he couldn’t dwell on this nonissue. Bigger, more important things were happening with this drug that Greg was about to wheel into the office. The drug was an opportunity. And if they could focus on it, they could move past this other trivia, which didn’t have any substance and—no matter what she said—had nothing to do with arrogance.
“So are you going to help me with this?” he asked.
“With what? I still don’t understand what there is to do.”
“Look,” he said impatiently. “They’re testing this drug for sexual dysfunction or whatever. They have no clue what it can do for chronic pain. My gut’s telling me otherwise. Instinct, I guess. If I tell them—if I call up Boeker and say, hey, and I wait for them to test it and take it through whatever channels, then it just means that my patients who are suffering have to suffer even longer. And if I tell Greg, by the way, have you tried it for this, I might not get a supply. Anyway, these companies are all about profit, and only secondarily about patients. If we dare to try, we might discover we have something amazing on our hands.”
She looked at him, her lips narrowed into a line.
“It’s nonnarcotic,” he reminded her, “so all your gripes about over-medicating patients, all that stuff about overprescribing painkillers, would be resolved.”
“I don’t get it—you’re going to do what?” she asked. “You’re just going to give it to patients?”
“You heard him. It’s safe.”
Her head seemed to twitch momentarily, as though she were shaking against a noise she didn’t want to hear. “I don’t think I want to be a part of this,” she said slowly. “I mean I don’t know. I have my career to think about.”
About then, he decided he’d heard enough skepticism. Emily provided plenty of doubt—that voice that was with him constantly—and he was tired of feeling torn. “If you’re not interested in innovation,” he said haughtily, “then this might not be the right practice for you. If I can’t help my patients with treatments that are available, it’s my job to find out what else I can do. And if you’re not on board, then—” His voice dropped off.
“Then what,” she goaded.
“Then that’s that. I mean it. We’re done.”
“You’re firing me?” Her eyes went wide.
“I’m sorry that’s how it is,” he said. “But we need to agree. My mission’s to help my patients.”
“Are you serious?” Her voice hit an uncomfortable pitch. “I’ve never been fired from anything. By anybody.”
“I’ll be happy to write you a recommendation,” he pronounced curtly. “Wherever you decide to go.”
A noise sounded in the hallway, the scuffle of footsteps and the sound of the dolly being drawn along, scraping against the wall as Greg dragged it around the corner. Julie McKinley stood up. Before Greg was close enough to hear, she leaned over the table toward Simon, her eyes scrunched again, and the look in them could not be mistaken. “I’d sue you for sexual harassment,” she hissed, “but I know what would happen. It’d be my word against yours. So nothing.”
Greg wrestled with the dolly, whose wheel was stuck on the edge of the door. “I told you I was sorry about that,” Simon insisted to her, shaking his head, genuinely surprised that he had to keep restating it. “Why won’t you believe me?”
Then the wheels of the dolly were freed, and Greg steered a box stamped BOEKER into the room. He’d thrown the purple tie over his shoulder to keep it out of his way, probably when he was leaning into the trunk of his car, and it still draped behind him like a flag.
“Here’s a box,” Greg said. “Keep it on hand to start as soon as you finish the training. I know you can get the patients we need. I can just tell about you. And you know your patient base better than anyone.”
“I do, don’t I,” Simon said evenly, not looking at Julie.
She gathered the papers that were on the table in front of her and did not look at him again as she stalked out of the conference room. Took her things from the hall closet and walked right out of the office, her back stiff and her jaw jutted forward. She was good and gone by the time he escorted Greg to the door.
The first to try the medication was Jack Whitby. He wasn’t exactly a current patient—he wasn’t even Simon’s patient—but he suffered from chronic pain and no physician had been able to determine its source or offer anything that helped. Simon dialed Whitby’s number himself. He knew about Jack’s pain because of what had happened eight months ago at the Frith holiday Christmas party. Jack Whitby was a partner and CFO of Emily’s company, and in the middle of the black-tie affair at the Bethesda Hotel, he’d been seized by one of the hateful spasms.
They were all seated at a round table when it happened, the wife named Valerie, who wore a dress cut so low that it was clear at once she was his second marriage, then Jack Whitby, then Simon and then Emily, who had been busy the entire evening. Emily had presented the keynote speaker—what kind of Christmas party had a keynote speaker? Simon wondered—and she was flushed and, he thought, quite beautiful, despite being preoccupied and a little wooden in her manners. She was deep in conversation with the woman on her left, discussing what?—he couldn’t quite hear, but it involved a merger between two companies, only one of which was repped by Frith, and how could they position themselves to keep the account? On his other side was Whitby, a man with a square jaw and a kind of silver-fox sultriness. Whitby was fawning over the low-cut wife, whose hair could not naturally, at her age, have been quite that shade of blond.
Simon could still recall the start of that evening because of how he’d managed to annoy Emily. On each of the tables in the ballroom was a small Christmas tree, a bonsai-sized centerpiece, decorated in miniature as if it belonged in a dollhouse. The ornaments were the size of earrings, and there were little wrapped matchbook-sized presents arranged on a puddle of felt beneath the bottom fronds. Simon studied the arrangement, wondering which secretary had spent the last two weeks wrapping miniature gifts for his benefit. Then, he noticed, next to each elaborate Christmas tree stood a plastic menorah, almost as tall, a nod to the Hanukkah season. Hanukkah had come early that year and was long past, and the menorahs themselves looked like afterthoughts, Simon decided. They were crap
py plastic—as if they’d been popped out of a box from a dollar store and snapped apart by someone who’d had to bend them back and forth to separate them. As Emily remained engrossed on her other side, and the Whitby character had wrapped an arm around the preternaturally blond wife, Simon took the baby carrots off his plate and began fitting them into the menorah’s candlestick holders.
“What are you doing?” Emily said through her teeth, suddenly taking note of his artistry. The way she’d said it, she seemed to be saying, What are you doing to me?
But, of course, he hadn’t intended anything personally. He presented the menorah in front of her plate. The serving on his plate had provided only enough carrots to represent six nights of Hanukkah and the shamash. “It’s a tribute to the Jews in the room.” She glared at him, horrified. He shrugged and pointed at the display. “These weren’t decorated, but look what they did with the Christmas trees. Someone somewhere spent a lot of time on those trees.”
She might have reprimanded him, but suddenly on his other side they heard a gasp, a protracted sucking, like air drawn through a long straw. Jack Whitby stood frozen in a half-risen position, his hands clutching the edge of the table.
“Honey?” It came from the wife, its second syllable elevated into a shriek.
“What’s happening?” Emily asked, because the wife had jumped to her feet and was leaning over the CFO, trying to help him. “Is he okay?”
“Is it happening again?” the wife asked.
The man answered with another sucking noise.
Simon had been uncertain what was happening. At first he thought the man might be choking—Simon had performed a successful Heimlich maneuver once in a crowded mall and he was ready to do another. But it was the look on Jack’s face that made him realize something different was taking place.
“Back spasm,” the wife explained. “He can’t move.”