The Magic Bullet

by Harry Stein

  “I’d like that, sir.”

  Not that he trusted Larsen for a minute. He knew how quickly the volatile chief of the Department of Medicine was liable to turn on him; and how, once incurred, his displeasure seemed to grow ever more dangerous.

  He was reminded of this the very morning of his exchange with Barbara Lukas. Less than an hour afterward he and Lukas were among the five first-year associates escorted by Larsen on their weekly teaching rounds. The group had visited four or five patients, Larsen holding forth after each visit in the corridor outside the patient’s room, when they entered the room of Congressman Al Marino.

  Marino was in for colon cancer. A ranking member of the House Science and Technology Committee, he was one of the handful of patients on the premises who enjoyed nonprotocol status.

  “Al, my friend, how are we doing today?” boomed Larsen, with a sudden ingratiating smile. The junior associates exchanged furtive looks; with every one of the patients they’d seen earlier, he’d been coolly impersonal to the point of rudeness.

  The congressman, sitting up in bed before a pile of documents, bifocals perched on the end of a bulbous nose, hardly moved. “I’m doing shitty. How are you doing?”

  Larsen moved over beside him. “I know that last course of chemo was a little rough. I’m sorry.”

  “Yeah,” he said disinterestedly.

  “Carol’s okay? I had a nice phone conversation with her a couple of days ago.”

  “She’s fine.”

  His reserve of happy chat exhausted, the doctor pulled out his stethoscope and got to work. “You know the drill, Al,” he said, summoning up a last bit of good cheer, “—heart, lungs, and abdomen. Nothing to it.”

  Running through the rote procedure in less than a minute, he called for the congressman’s progress chart. As he read it, his brow darkened. “Dr. Lukas,” he suddenly spoke up sharply, “are you responsible for this?”

  She hesitated, a doe caught in headlights. “Yes, sir.” But, characteristically, she instantly drew herself up straight, determined not to appear intimidated.

  “Would you mind telling me why these lab values are written in pencil?” The throbbing vein in his left temple was a familiar sign of building rage. “Were those lab values temporary? Was it your intention to go back and change them?”

  “No, sir. It was my understanding that—”

  “Excuse me, Doctor? WHAT was your understanding—that we encourage incompetence at this institution?”

  “No, sir, if you’ll allow me to finish?”

  “No! I will not allow you to waste Congressman Marino’s time or mine!”

  Suddenly the chart was flying across the room in her direction. “This kind of sloppy work will NOT be tolerated, Dr. Lukas. I strongly suggest you learn proper procedure by studying one of Dr. Logan’s charts!”

  He turned to the patient, who seemed disinterested in the whole thing. “I’m sorry, Congressman. I hope you won’t take it as the way things are done around here.”

  “Forget it, she’s just a kid.” He gave a wave of his hand and added the words that this day would spare the young doctor further torment. “Why don’t you lay off? She’s kinda cute.”

  Lukas stared straight ahead, unblinking, but Logan caught the stricken look in her eyes. He wanted to let her know how mortified he was to have been made part of her torment.

  But too, at that moment, on some level, his thoughts were on his own future. Like it or not, Larsen was not a force to be slighted, let alone ignored. Shortly, in spite of everything, when faced with the decision of which of the top guys to go with, he would have to consider that fact very, very carefully.

  Fortunately for Logan, there was one other junior associate who was an even more tempting target of scorn than he was. Allen Atlas, the junior associate out of Vanderbilt, had shown himself to be so nakedly ambitious that the others joked of forming a “suck-up watch,” to monitor his obsequiousness toward superiors.

  What was infuriating was how well it seemed to work. Indeed, lately he seemed to have made himself all but indispensible to Peter Kratsas, spending virtually every evening in the senior man’s lab, tabulating protocol data.

  “I really can’t stand that guy Atlas,” Reston put it to Logan one evening in his Dupont Circle apartment. “You notice how he’s started to parrot Kratsas on every damn subject?”

  Logan took a sip of red wine and smiled. “Why do I have the impression Kratsas encourages that?”

  “I’m not kidding, yesterday he actually starts talking to me about how much he loves Alfred Hitchcock movies.”

  “Look at it this way, he’s picking up as many enemies as friends.”

  “You know that from experience, right?”

  “Hey, I don’t need that from you. I get enough of it from Barbara Lukas!”

  “The difference is I don’t mean it as an insult. I’d change places with you in a second.”

  Logan laughed uncomfortably. Reston was right: talented as he was, no one who counted at the ACF seemed to have noticed, and the fact was becoming a matter of some awkwardness between them. Logan wished he could say something to ease his friend’s distress; or, even better, help him to shine. Instead, he was reduced to offering the kind of reassurance that sounded hollow even to him. “You’re just biding your time, that’s all,” he said now. He smiled. “And at least you’ve got a terrific woman.”

  In fact, under the circumstances Dan was almost grateful for his own dismal social life; at least it balanced things out a little. “Anyway,” he added, “don’t exaggerate. It’s not as if I run the place.”

  “Not yet. Thank God.”

  The exchange was typical of the friendship that had blossomed between Logan and Reston since their arrival at the ACF. Both, seemingly easy to read—one the dutiful subordinate, the other all cocky charm—were in fact intensely private. But with one another, using banter as camouflage, each was able to drop his guard.

  “Nah,” replied Logan now, with mock solicitude, “I’d be perfectly happy just to be director of research. You can run the place.”

  “That’s better.”

  “See, I know all about your ego needs.”

  “You’re right.” He laughed. “And I’d also be able to fire your ass if you started letting other people in on the secret.”

  Reston’s girlfriend, Amy, emerged from the kitchen, holding a knife and a couple of tomatoes. “Hey, John, aren’t you supposed to be doing dinner?”

  “Yeah, yeah.”

  As she wheeled and retreated back toward the kitchen, Reston and Logan rose to follow.

  “Hey, Amy,” said Reston, “we gotta set Logan up with someone. He’s trying to use our relationship to get me to feel sorry for him.”

  She stopped and smiled at Dan. “Are you kidding, there’re a thousand women on the Hill who’d love a guy like you.” Amy’s FCC office was in the heart of the government district. “What do you like? Congressional aides with great legs? Busty number-crunchers? Sharp lawyers ready to give it all up for Mr. Right?”

  “Could I get a combination of all three?”

  She tossed a tomato from hand to hand and laughed. “So we’re talking great sex and lifetime commitment.”

  Reston picked up a tomato and began expertly slicing it. “Nah, I think with Danny boy we better focus on the sex. Commitment’s not a big part of his resume.”

  Logan shot him a look. “That’s not true.”

  “Don’t worry, Amy’s not gonna give you crap about it. She knows how it is.”

  “You mean about guys being jerks?” She laughed. “Absolutely. I learn more every day at the feet of the master.”

  “Anyway,” added Reston, “I think Danny here’s already got someone in mind.”

  “C’mon, John, let’s drop it.”

  “Who?” asked Amy.”

  “Why don’t you let me do surgery on one of those?” Logan held out a hand, indicating Reston should toss him a tomato.

  “Whoa,” mocked his fr
iend, “talk about a smooooth change of subject.” He paused. “Sabrina Como.”

  “Ohh, the Italian bombshell.” She nodded at Logan. “You’ve got good taste.”

  Logan smiled uneasily. “I really don’t know where he comes up with this crap.” Actually, he knew perfectly well: Reston had been around more than once when Sabrina’s very presence turned him into a bumbling, awkward parody of his normal self. He was only grateful his friend hadn’t been with them on rounds the morning Logan caught the Italian, in quiet conversation with an anxious patient, leaning forward to daub the woman’s face with a washcloth; the quick flash of full breast in flimsy, lacy bra had haunted him since. “Look,” he added lamely, “I don’t know a thing about the woman, except that she’s a terrific doctor.”

  “Oh, right. Forgive me. You respect her as a peer, is all. My mistake.”

  Amy snorted. “John wouldn’t understand that. He has to respect a woman’s body before he’ll even notice she has a mind.”

  Reston popped a bit of tomato in his mouth. “Yum, yum, yum. So, what d’you think she thinks of you?”

  “I have no idea. For all I know she’s involved with someone.”

  “No, she’s not. I assume you like lots of garlic on your pasta?”

  “How do you know that?”

  “I checked it out with Sylvia”—the hospital pharmacist, also the hospital’s foremost gossip-monger.

  Logan shook his head. “I tell you, Amy, if this guy put half the energy into science he does into being a wiseass, he would be running the ACF.”

  Two hours later, they were sitting in the living room sipping Amaretto, still savoring the splendid northern Italian dinner Reston had whipped up.

  “See,” said Amy, snuggling up against him, “he’s good for something after all.”

  The wine had left Logan even more acutely conscious of being odd man out. He managed a laugh. “Oh, I’d say he makes a pretty good doctor.”

  “I’m a terrific doctor,” agreed Reston, slightly drunk. “The bastards just don’t know it.”

  Logan smiled. “Maybe his problem is humility.”

  “Right,” said Amy. “Let’s see him convince a shrink of that.”

  “I’ll tell you what my problem is,” said Reston. “The crap they have us doing at that place! Why don’t they take advantage of what we have to offer?”

  “It’s called paying dues.”

  “I thought we paid ’em at Claremont. We’re back to doing rectals, for Chrissakes!”

  There was a long pause. “You want some advice?” asked Logan seriously.

  “It depends.”

  “Cut out the griping. That’s the best way to insure you never get on their good side.”

  “So what am I supposed to do? Pretend I enjoy this treatment?”

  Logan’s heart went out to his friend. “Exactly,” he said soberly, “pretend to enjoy it so much you’ll never be able to thank them enough.”

  “Great. Like you do.”

  “Face it, that’s the game. The only chance guys like us have to get some real clout.” He hesitated. “Enough to maybe run a protocol of our own.”

  Reston cast him a morose glance. “What are you talking about—we’re just first-year associates.”

  “There’s no rule against it. I looked it up.”

  “Right. Even you couldn’t make that happen.”

  “You ever hear of Ray Coopersmith?”

  Reston hesitated. “Vaguely.”

  “Don’t BS me, why don’t you just say no?”

  “Because that’d be giving you the upper hand,” smiled Amy.

  “So …?” pressed Reston.

  “He was a first-year associate at the ACF four years ago—and he got a protocol through.”

  “Like hell. That’s impossible.”

  “I’ve seen the paperwork. Both the proposal itself and the Institutional Review Board’s approval form signing off on it.”

  The documents were in the antique wooden filing cabinet outside Larsen’s office with hundreds of others like them. A seldom-used Foundation resource, in theory they were available to all junior associates interested in the genesis of earlier protocols. Larsen’s secretary, Elaine, had grown so accustomed to the ever-curious young Logan studying these protocols that she’d scarcely noticed him, one recent lunch hour, systematically searching the files from three and four years back: going directly to the C’s.

  “Coopersmith?” asked Reston. “What kind of protocol?”

  “What difference does it make? What matters is he made it happen.”

  “In other words, it was a bust.”

  “Actually, I don’t know. I found the record of the proposal but not the results.” As they both knew, this was not unusual; protocol data could run hundreds of pages and were generally filed away on computer discs. “Anyway, it was something about shooting radio-labeled antibodies directly into the bloodstream to go after prostate tumors directly instead of relying on standard chemo. Interesting idea.”

  “Prostate? Who’d he get to sponsor this, Larsen?” The very idea was almost beyond imagination.

  Logan shook his head. “A genitourinary guy, someone named Locke. I think he’s now in private practice.”

  “So—what are you saying?—now you want to go off and do something on your own? You?”

  “Us. Maybe. Why not?”

  “Why not? Because, frankly, I don’t even register on their radar around here. And—don’t take this the wrong way, Danny boy—but you’re not exactly known for your guts.” Reston stopped, drawing it out; on some level he was enjoying this. “So just don’t pull my chain, all right?”

  Stunned, Logan was momentarily silent, then came back with surprising heat. “I’m just trying to … What the hell do you think gives you the right to—”

  “Look,” Reston cut him off. “I’m just saying I don’t need your pipe dreams right now. I’ve got my own problems.”

  “Fine,” snapped Logan, his face flushed. “Forget it.”

  Reston smiled. “Hey, don’t go away mad. I’m perfectly willing to talk—as soon as you’ve got something serious on the drawing board.”

  In fact, Logan had been toying with the beginnings of an idea for weeks—ever since the morning Larry Tilley had stepped into his examining room.

  For Tilley was potentially one of Gregory Stillman’s famous secret-bearers: a patient in whom disease so defies expected patterns that his case forces a competent researcher to rethink old assumptions.

  A Kansas City lawyer, thirty-four and gay, Tilley was on a Phase Two AIDS protocol for a drug called Compound J designed to interfere with viral reproduction—a protocol that seemed to be going nowhere. To date, Compound J appeared to be totally inactive.

  No real news there. The AIDS virus had long been a particular source of frustration to ACF researchers, on a par with the most baffling cancers in its sinister complexity. AIDS protocols were notoriously ineffective in yielding practical results, and as Shein one day put it, with characteristic gallows humor, “when one of those mothers bites the dust, it takes a lot of people with it.”

  As a protocol patient, Tilley was unaware of this, of course. He had come in from Kansas City for a series of tests. His numbers, like those of most on the protocol, were not good.

  But within minutes of the start of the examination, he casually mentioned something that got Logan’s full attention: Though he’d been feeling dizzy and weak a lot lately, it had nothing to do with overactivity. “In fact, it usually happens when I’ve been resting. I get up from a chair and I feel like I’m going to faint.”

  Logan, who’d been checking his lymph nodes, paused—what could that be about?—and momentarily excused himself. In the adjoining room he looked more closely at the paperwork forwarded by Tilley’s local hospital.

  Unable to pinpoint a cause for the unusual course of events, his private physician had first put forth a likely diagnosis of pancreatitis—a simple inflammation of the pancreas. After a couple
of days in the hospital, feeling better, Tilley had been sent home. But, literally within hours, the problem was back.

  Logan returned to the patient. “You seem to have stumped your doctors back there.”

  Tilley smiled. “They kind of threw up their hands and said I should come here to let you guys figure it out.”

  Logan liked Tilley immediately. No self-pity, lots of fight.

  “All right, let’s figure it out. Why don’t we start with an easy one? How do you feel when you stand up?”

  Sure enough, Logan noted that every time Tilley rose to his feet, his blood pressure dropped precipitously and his heart rate increased.

  “Well, we’ve established that the problem isn’t your imagination.”

  “Great. Even the boobs out in K.C. knew that.”

  Logan laughed. “Did the boobs ask if you’ve been thirsty a lot lately?”—worth asking, but just barely. From his days at Claremont, Logan recalled that such simultaneous changes in blood pressure and heart rate can be symptomatic of extreme dehydration; though on this cool fall day, it seemed almost impossible that a man not engaged in vigorous physical activity could become so seriously dehydrated.

  To his surprise, Tilley nodded. “But that’s just something that comes from taking the drug, isn’t it?”

  “Well, let’s see if this boob can clarify that a bit further. I’m going to want to run some tests.”

  “Does that mean I have to go back in the hospital?”

  “I don’t think that’s necessary. We have contracts with a number of hotels in the D.C. area. Why don’t we just have the ACF give you a free vacation?”

  Tilley smiled. “Thanks, Doctor.”

  “I’ll have someone make a reservation for you at the Madison Arms. Be here tomorrow at eight-thirty and we’ll get started.”

  “How long am I gonna have to stay?”

  It was part of Logan’s job to allay apprehension, but he would never intentionally mislead a patient. “I really can’t tell you, Larry. Probably no more than a few days. In the meantime, I’m going to give you a couple of liters of intravenous fluids and see if that helps.”