The Magic Bullet

by Harry Stein

  “Try me.”

  And so, with his gentle prodding, she told the story of her illness, from the diagnosis eight months before, to the frustrations with local doctors in their hometown of Cincinnati, to their stormy relationship with the staff at the ACF. All the while, Roger mainly listened, cutting in only to make an acid remark about someone they’d had a particular problem with.

  When she’d finished, Logan started asking questions: What was it about the ACF that gave them the most trouble? Were they unhappy with the course of treatment or was it mainly a communications problem?

  “Both,” said Roger. “This is Rochelle’s life we’re talking about, almost no one in this whole damn place seems to get that.”

  Logan nodded. “I heard what you said before about your sense of having no control. I understand that. And I think we on this side have to make a real effort to be more sensitive to it. I promise you I will.”

  But, he explained, he expected that they would make an equal effort to recognize the constraints under which he and every ACF employee were operating; that, in short, they not give him grief about observing the protocols.

  “We’ve already agreed about the chemo,” Roger shot back. “Isn’t that enough for you people?”

  Logan tried hard not to betray his irritation; this was what he got for his trouble? “Absolutely,” he replied evenly. “Thank you.”

  It was, in any case, enough for the moment.

  “Look,” he said, “I’ve got to be running along. I’ll come by and see you tomorrow.”

  Rochelle looked at him gratefully. “Thank you, Dr. Logan,” she said softly.

  So, he thought, allowing himself a smile as he moved from the room, maybe that’s how to handle these two: divide and conquer.

  He was still smiling when he spotted Shein, emerging from the room across the hall.

  “You look pretty pleased for a guy we’re working to death.”

  With relief, Logan saw that Shein was unaware of his visit with Stillman. “Actually, sir—”

  “Seth … I’m the good guy around here, remember?”

  “Actually, Seth, I’m enjoying it.”

  “This from a guy who just walked out of a chamber of horrors!” He nodded toward the Boudin room. “That’s Larsen’s protocol she’s on. Ever hear the saying ‘Like doctor, like patient’?”

  “I’m trying to make the best of it. I work on the theory that there’s some good in everyone.”

  Shein clapped a hand on his shoulder. “Ah, an optimist. We don’t get very many of those around here.” He paused. “So you’re really doin’ all right? I didn’t sell you a bill of goods?”

  “Not at all.”

  Shein positively beamed. “Keep up with this crazy attitude, I’m gonna have to adopt you!”

  It always surprised Logan to hear himself described as a workaholic. Though in the hypercompetitive circles in which he operated the characterization could be useful—and he certainly never corrected such a misimpression—the truth was he was as good at chilling out as anyone. Karpe, at least, had been canny enough to see that; the element of his pitch the young doctor had found most seductive by far was the photo album of yachts, each owned by a patient, that the great doctor pulled from his desk toward the end of the interview. Logan had no trouble at all seeing himself lolling away weeks at a time on someone’s deck in the Mediterranean.

  It was not until the third Sunday after his arrival that Logan finally had more than a couple of hours for himself. He had planned to go furniture shopping—save for his bed, an overstuffed chair that dated back to his college years, and a pair of bookshelves, his small apartment was almost bare—but instead got distracted by a string of M*A*S*H reruns on the tube. Then, for more than an hour, he soaked in the tub, reading an odd little paperback on World War I flying aces he’d found when he unpacked his books. Then—what the hell, he decided, furniture can wait—he grabbed the Sunday Washington Post and headed for the small park he’d passed every morning en route to work.

  It was, he discovered, known formally as M. Allen Smith Park, and it was exactly what he needed on this lazy summer afternoon: high grass, lots of shade trees, CLEAN UP AFTER DOGS signs that seemed to be respected.

  He walked to a quiet area, kicked off his loafers, and lay down in the grass; then, through squinted eyes, gazed upward at the sun shafting through the trees. From a ballfield a hundred yards away came the sounds of a pickup softball game: dim exhortations aimed at the pitcher or batter, the crack of ball against aluminum, an occasional cheer. Closer by, in an enclosed playground area to his left, very young children on swings and slides made noises of abandon and joy so pure as to be almost beyond his understanding.

  Logan propped himself up on an elbow to study the scene. He noted how many of the parents were fathers; and calculated—a safe bet—that most were divorced. The kids were incredibly appealing but, God, they were demanding! Is this something he would ever do? He’d always taken it as a given that he would. Someday. Long, long after he’d gotten past the demands of the ACF.

  Now he opened the paper and began flipping through the news section. About midway through, a headline caught his eye: DOCTORS CLAIM BREAKTHROUGH ON PROSTATE CANCER.

  “Researchers at New York’s Memorial Sloan-Kettering Cancer Center report that a combination of radiation plus ‘souped-up’ chemotherapy has achieved dramatic results in patients with advanced prostate cancer,” it began. “The trial, headed by Drs. Lawrence Boyles and Kenneth Rotner, involved thirty-eight patients deemed incurable by existing methods. ‘Obviously, we are quite excited by these results,’ said Dr. Rotner, who explained that the team is planning a series of more comprehensive trials.”

  It went on this way for another six or seven paragraphs, but Logan had seen enough. He didn’t know the doctors involved personally, but he didn’t have to: their game was clear enough. Prostate research is an extremely tough one to get funding for—no organized lobby, zero glamour—and if they didn’t set off a few bells and whistles, who would?

  The real problem was the press itself. Easily cultivated, readily flattered by the attention of prominent doctors, reporters injected themselves into medical politics without even being aware of the fact. Wouldn’t these guys ever learn? How many years of reports of “breakthroughs” and “impending victories” would there have to be before they got it through their heads that medical miracles—Fleming’s penicillin or Salk’s vaccine—are, at best, once-in-a-generation events?

  Yet the media keep the engine churning endlessly. Who could ever forget the hoopla over interferon? It wasn’t the first time the medical press had found a cure for cancer, even that year, but rarely had it been quite so aggressive in its claims. When the drug proved a bust, they moved on; but countless doctors had to deal with the fallout, a level of despair that in many cases matched that brought on by the onset of the disease itself.

  The problem, of course, is that the truth—that progress is incremental and painfully slow—won’t get reporters their airtime or column inches. So the press reports medicine the same way it reports everything else, as high drama, a pitched battle between contending forces. “The War on Cancer,” it’s always called, “The Battle Against Crippling Childhood Illnesses,”

  “The Continuing Fight Against Heart Disease.” Never mind that there’s no intent there, that those malignant cells don’t know they’re hurting anyone.

  Logan lay back in the grass, closed his eyes, and smiled. It was a funny thought: the press almost made him ready to feel sorry for cancer. In its perpetual search for good guys and villains, it just badgered this poor disease unmercifully.

  “Hey? Excuse me?”

  Dan opened one eye and squinted at the silhouette looming over him. A guy with a baseball glove. “Yes?”

  “You want to play some ball?” He nodded vaguely in the direction of the field. “A couple of our guys’ve left.”

  The offer was tempting; Logan was a softball player from way back. “I don’t know
.” He raised one of his bare feet in the air. “I’m not really dressed for it.”

  “Don’t worry about it, we’re not exactly pros.”

  “You got a mitt I can borrow?”

  “You can use mine.”

  Logan turned out to be one of the better players on the field. Intense as they were, these guys were basically weekend hackers; and it was amusing to note how ready they were to jump down one another’s throats at every misplay in the field or missed opportunity at the bat.

  For two innings they pretty much ignored Logan, exiled to the fourth outfielder spot. But when he finally came to bat, and lined a triple over third to drive in two runs, he was instantly transformed into a hero. As soon as he’d come around to score, Kevin—the catcher, the man in charge—sat down beside him on the rickety bench. “Nice shot. You field as good as you hit?”

  “Depends on how hard the ball’s coming at me.”

  “I’m thinking of moving you to first base.”

  “Sure, sounds good.”

  “So, you from around here? We play every Sunday, you know.”

  “I just moved here.”

  “Oh, yeah? You with the government?”

  “I’m a doctor with the ACF.”

  The other, impressed, gave a low whistle. “Not bad.”

  “How about you?”

  “Me? I’m with the IRS, an attorney. We got four or five other lawyers here. Also a couple of congressional aides, a few accountants. We all live in town.” He paused, seemingly struck by a momentous thought. “Hey, Bruce Ryan’s a doctor.” He pointed at a rail-thin fellow in glasses coaching third base. “I’ll introduce you guys.”

  The next inning, Kevin was as good as his word. “So,” said Bruce Ryan, “you’re at the ACF.” Logan could not help but note this seemed less in the spirit of fellowship than sullen challenge.

  “Right. How about you?”

  “Just a radiologist. I’m with Prince William County Hospital, down in Manassas.”

  “Ah. That’s supposed to be a good facility.”

  “Don’t worry, I make good money.”

  What kind of answer did that call for? “Good. Glad to hear it.”

  “I knew another guy at the ACF.”

  “Oh, yeah, who’s that?”

  “I met him at a party a few years ago. A first-year fellow. I can’t exactly remember the name—Cooper-something.”

  “It doesn’t ring a bell. He must be gone by now.”

  “Coopersmith, I think. Real sharp guy. He was working on a protocol he’d set up.”

  Logan smiled indulgently. “No, that’s not possible. First-year fellows don’t run protocols. We get the scut work.”

  The other shook his head. “No, I’m sure of it. That’s why it made such a big impression on me, ‘cause he was so young.”

  “Well …” Logan shrugged. “I’m not going to argue with you.”

  “Anyway, that’s some hot-shit place. That’s the tradeoff, isn’t it: guys like you get the glory, guys like me get the dough.”

  Logan had run into this kind of nastiness more than once since making the decision to come to the ACF—mainly from doctors at Claremont headed to big-money practices. He knew it represented the most pathetic kind of insecurity: self-justification and envy masquerading as cockiness. But he hated it, and wished he were better at answering in kind.

  “I don’t see it that way” was all he could come up with now. “It’s not like they make you take a vow of poverty.”

  The other smiled. “Don’t take it wrong, someone over there must think you’re pretty good.”

  What he was starting to feel toward this guy went beyond simple dislike; it approached stupefaction. “Actually,” he said coolly, “a lot of people do. And they’re right.”

  Just then the batter lined to center for the third out of the inning.

  “What’s your name again?” asked Bruce Ryan. “Dan Logan?”

  “With a D and an L. Want me to write it down for you?”

  “Don’t worry,” he said, turning to head back out to the field. “Just curious, in case I ever hear it again.”

  Logan walked up to Kevin behind home plate. “Look, I’ve really got to get going. I’ve got a couch to buy.”

  “Oh, really?” The guy looked genuinely disappointed. “Well, look, we’re out here every Sunday, you know where to find us.”

  “Thanks.”

  As he walked from the field, Logan decided he’d stop by Baskin-Robbins for a coffee shake. He also made a mental note to check out a recent junior associate named Coopersmith.

  Before the end of the summer Daniel Logan was entirely at home at the ACF. He found what was asked of him was no more than he’d always asked of himself: lots of hard work and the willingness to take on more. “This place,” as Seth Shein put it to him one afternoon, in one of their increasingly frequent chats, “is the last true meritocracy. Like God, the ACF helps those who help themselves.”

  The routine into which he’d settled may have been the standard one for junior associates: three days a week working the hospital; the other two in the clinic, dealing with protocol patients on an outpatient basis; between the cracks evaluating new candidates for possible acceptance into ACF protocols in the Screening Clinic. Yet, almost alone among the junior associates, Logan’s work had never been singled out for criticism.

  Quite simply, he took the protocols as a sacred trust—eliciting consistent cooperation from even the most difficult patients and making himself so familiar with his patients’ medical histories, so alert to subtle changes in their appearance or test results, that already he’d headed off several potential crises.

  His superiors had been equally struck by his work in the Screening Clinic. For a protocol to yield the best possible results, every patient on it must perfectly match the profile established by its creator. Working with biopsy slides of promising candidates forwarded by their local pathologists, Logan actually came upon more than one misdiagnosis.

  It was as if all his years of training—hell, his entire existence—had been preparation for his work here. A skeptic by temperament and experience, he never accepted the seemingly obvious at face value; questioning all assumptions, carefully scrutinizing even routine incoming data. Yet, unlike most of his contemporaries, he could also make the creative leaps so essential to problem solving.

  Under the circumstances, he had little trouble understanding that some of his peers took his success personally; in their place, he might have felt the same way. At the ACF, more than at any other institution he’d known, another’s rising status could feel alarmingly like one’s own failure. So he tried to accept the inevitable sniping with relative good humor.

  “Hey,” as Barbara Lukas nodded in greeting one early morning, “got your Chap Stick ready? We’re going on rounds with Larsen.”

  “So?”

  “So who knows how many asses you’re going to have to kiss?”

  Smiling, Logan patted his breast pocket. “No problem, I always keep some handy.”

  “What is it with you, Logan? Don’t you even have the self-respect to be insulted?”

  “Not if that’s the best you can throw at me.”

  For all the trouble she gave him, Logan liked Lukas. Insecure, easily provoked to anger, far too outspoken, she herself had proven completely inept at the gamesmanship that seemed so vital to success at the ACF. In fact, this tiny, combative Duke grad had already been pegged by their superiors as a headache likely to blossom into a migraine.

  But Logan was perceptive enough to know it was the toughness that had gotten her here; and to recognize the vulnerability behind it.

  Then too—and this always counted heavily with him—he was aware that she was a truly gifted doctor.

  “Look,” he tweaked her now, “if you’re looking for personality guidance, just ask. For starters, Barbara, you gotta start smiling more.”

  “Can it, Logan.”

  “Hey, and maybe you oughta consider wearing a r
eal short skirt every once in a while. That’s guaranteed to win these guys over.”

  “Not funny,” she said, suppressing a smile.

  He shrugged. “Just trying to help.”

  “Thanks,” she said, turning on her heel. “And you should start smiling a lot less.”

  In brief, Logan was starting to feel he was one of the chosen. Lukas had it right: somehow, remarkably, thus far he had managed to remain on good terms with everyone who mattered. Either directly or by inference, half a dozen of the senior men had indicated that, when the time came, he would be welcome as a member of their team.

  Indeed, he’d already begun viewing the day when he’d have to actually make such a choice with apprehension. The consequences—possibly on the entire course of his career—were incalculable: the implacable enemies it would create, the doors it would forever slam shut.

  Just now, even Larsen seemed to be nurturing newfound regard for him. Logan figured this out the day Larsen unexpectedly took a seat beside him in the hospital cafeteria and began making his own tortured version of small talk.

  “So,” began Larsen, “you come to us from Claremont Hospital.…”

  Given that they’d been over this territory months before at his initial interview—and Larsen had been singularly disinterested in the fact then—Logan was at a loss. “Yessir, that’s true.…”

  Larsen nodded. “Very good, very good.…”

  “Thank you.” Logan bit into his burger, to keep his mouth occupied.

  “I understand they have a lot of wealthy Arab patients up there.”

  Logan nodded; in fact, at one time or another, the place had played host to half the Saudi royal family. “Yessir, that’s true.”

  Astonishingly—for it was the first time the younger man had ever heard such a thing—Larsen laughed: a dry, reedy sound, more like the clearing of the throat than anything suggesting joy. “I guess they know the score. When the chips are down, they run right to those Jewish doctors.”

  He laughed again and, rising to his feet, clapped a hand on Logan’s shoulder. “Keep up the good work, young man. Perhaps we’ll have a chance to work together more closely one of these days.”