The Magic Bullet

by Harry Stein

  And an instant later, as if rankled at having even briefly delivered unambiguous pleasure, he was into it: “I don’t like the drip. You gotta go with the bolus.”

  “We of course gave that a lot of thought,” ventured Logan. “Why would you say—”

  “Because taking risks is supposed to be your business,” he was cut off impatiently. “Not stupid risks, for Chrissakes, but, yeah, appropriate ones! Otherwise what kind of impact are you gonna make?”

  “Very little,” said Reston, softly.

  “Don’t just gimme the answer I wanna hear, Reston. Tell me something I don’t already know. Under the best of circumstances, what kinda toxicity you gonna get with this drug?”

  Reston visibly reddened. “A lot.”

  “Damn right. The stuff made your friend Tilley’s goddamn adrenal glands fall out! So why’re you pussyfooting around? The cancer’s gonna eventually kill ’em anyhow—why not hit the cancer cells hard and get out?”

  “We were trying to minimize damage,” offered Logan. “We’d like to end up with a living patient.”

  “Screw that. You do a trial like this, you face that there might be fatalities. Because basically what you’re doing is poisoning people within an inch of their lives. You can’t make omelettes without breaking eggs.”

  There was a long silence in the room.

  It was Sabrina who broke it. “Dr. Shein, we are talking about the therapeutic window, no? The dose that will be toxic to cancer cells but not toxic for healthy cells.”

  He nodded. “You got it.”

  “And this is a tiny, tiny margin … even for the best drugs.”

  “The trick is finding it. That’s what separates great cancer docs from the chaff—the willingness to go right to the edge and not flinch. It’s a helluva lot easier saying it than doing it.”

  Shein studied his listeners. Sabrina clearly had a handle on this; she’d go his way. So would Reston, if only to stay on his good side. But Logan seemed unconvinced.

  “Listen,” he added, directing his words Logan’s way, “it’s not like I don’t understand the impulse. You give a patient an intravenous drip with a subtoxic dose and she’ll love you to pieces. She’ll tell everybody, ‘My doctor’s a genius, he’s giving me chemotherapy and there are almost no side effects!’ ” He paused meaningfully. “But you know what you’re doing? You’re killing that patient with kindness.”

  He paused, as serious as Logan had ever seen him. “Your job is to come up with a treatment! Do that and—never mind if you’re a saint or an asshole—you’ll never have to worry about being popular again.”

  Logan could not argue with any of it. The fact was, hearing the man lay it out so starkly, his respect for him only increased: the guy had not only a high-tech, microchip-driven brain but, just as vitally, old-fashioned brass balls to go with it.

  Still, he hesitated—because he was also aware of something else. No matter how well intentioned Shein’s advice was, and no matter how ultimately sound, the senior man was in a no-lose position. Logan and the Compound J team could not proceed without his blessing. And yet, if things went wrong, he would not be the one to take the fall.

  “How about the adrenal problem?” pressed Logan. “With the dosage you’re suggesting, every patient in this trial could have her adrenal glands”—he hesitated—“fall out. Like Tilley’s.”

  Shein shrugged. “You’ll prophylax them with hydrocortisone. That’ll neutralize the toxic effects of the drug—provide the same hormone in pill form normally produced by the gland.”

  Logan considered this. “But that could be just the beginning. I mean, that’s what we were trying to get at with our Informed Consent provision. Who knows how many other problems you’re going to have to fix along the way?” He paused. “Well, I guess those are bridges that have to get crossed.”

  Shein smiled: he knew he had him. “Fortunately, you’ll have me to help devise solutions.”

  “We can count on that?”

  “Absolutely.” He stood up and reached for his coat. “By the way, when you rewrite the proposal, I want you to tone down that goddamn Informed Consent provision. You don’t have to go out of your way to imagine every possible side effect.”

  “We just wanted to be candid. And responsible.”

  “Listen, what you had there scared the hell outta me. The committee knows all that anyway.”

  “I suppose you’re right.”

  “Don’t forget, Logan, we’re all on the same side here.”

  That night, when Reston had gone, Logan produced a bottle of champagne of his own. Roederer Cristal—a hundred and forty bucks it had cost him.

  Yet, though he’d planned this moment for weeks, it was astonishing how soon it began to feel like an anticlimax.

  “Is there something wrong?” he asked Sabrina as they sipped their second glass. But, quietly exasperated, within he phrased it differently. What the hell’s wrong now?

  “I am just a little tired.”

  He slipped his arm around her. “Get used to it. The real work hasn’t even started yet.”

  “This Shein,” she said, with a forced smile, “he has the morals of a cabbage. But he is not dull.”

  “No—anything but that. Get him an organ grinder and a little suit and he’d do handstands in the street.” He paused. “I only wish he’d stop making nasty cracks all the time.”

  She looked at him closely. At the beginning his face had struck her merely as conventionally handsome; now she was equally taken by the deepening worry lines—evidence of what she knew to be character. “He doesn’t mean it. It is a sign he likes you.”

  “Right. Much more of his friendship and I’ll put a gun to my head.”

  For all his seeming self-assurance, Logan was, she’d come to know, deeply vulnerable; the product of an unsettled homelife she couldn’t pretend to understand. She sympathized with this—but it also left her ill at ease. Every bit as committed to career as he was, she’d long been equally disinclined to waste time and energy on complex romantic entanglements. She cared for this guy—more than for anyone in a long time. But increasingly, she couldn’t help thinking he’d been right from the start: this confusion of the personal and professional could be a terrible mistake.

  “I’m sorry, Logan,” she said, “this is a time we should be happy.”

  “Who says I’m not happy?” He smiled. “Are you kidding? All I’d need to make my life perfect at this moment is a great Havana cigar!”

  She laughed, but he knew he hadn’t begun to bridge the distance between them. “Look at it this way, Shein’s just my cross to bear. You’ve got Reston.”

  Reston! He, of course, was the crux of the matter. Could she open up to Logan? More than once she’d come close. But always it came down to the same pragmatic question: What kind of havoc would that wreak? What mattered now—all that mattered—was the well-being of the protocol. And for the foreseeable future, that seemed to mean making the best of life with Reston.

  “Well,” he suddenly spoke up, brightly enough that if she demurred it would come off as kidding around, “I think it’s time we did some real celebrating around here.” He nodded toward the bedroom.

  “Not yet, Logan. This is so nice.”

  Still, she was torn. For it was increasingly apparent the awkward personal situation might itself threaten the work. She simply could not trust Reston. Logan did, absolutely. As a result, she now sometimes found herself hesitant to confide in her lover/colleague even on scientific matters.

  She reached for the champagne. “If I show you something,” she spoke up suddenly, “can we keep it just for ourselves?”

  What now? “Animal, vegetable, or mineral?”

  “I’m serious, Logan. An article I found. About Nakano. Nothing so important—but I do not want John Reston involved.”

  “Ahh.” Christ, when’s she gonna get off this obsession with Reston? “What the hell, I guess so. John doesn’t care about any of the background stuff anyway. He thinks
it’s all pointless.”

  “This is a promise?”

  “If you want.”

  She rose, crossed the room, and retrieved a sheet of paper from her briefcase. “Here,” she said, handing it to him. “Not much—but it has some new details.”

  It was a Xerox copy of a newspaper clipping, dated August 18, 1924, and a mere three paragraphs in length, from the German daily Frankfurter Allgemeine Zeitung. Studying it, Logan quickly understood it was a sort of social announcement. Dr. Mikio Nakano, associate director of the Medicinal Chemistry Division of the I. G. Farben Company, was to speak the following day at the Frankfurt League of War Wives. His subject: I. G. Farben Wissenschaftler erzielen Fortschritte im Kampf gegen die Krankheiten der Menschheit (Advances made by I. G. Farben scientists against human disease). The item identified the speaker as a native Japanese, formerly an assistant to the great Paul Ehrlich. His age was listed as thirty-four.

  “Where did you get this?” asked Logan, looking up.

  “I contacted all the important German chemical firms. I asked if they had any information on this man.”

  “But I. G. Farben no longer exists.…”

  As they both knew, the lesson left by the giant chemical firm about the potential misuses of science was among the most shockingly savage on record: having enthusiastically participated in the program of genocide instituted by the Third Reich—even to the point of operating a slave labor camp within Auschwitz—the company had been dismantled by the Allies immediately after the war, its directors convicted as war criminals.

  “No. It came from one of the successor companies, Hoechst. It was in their files, all they had on this man.” She smiled. “I think the Germans do not throw much away.”

  “So we were right about this guy—he was with Ehrlich.”

  He looked at her. “You’re unbelievable, you know that?”

  “No, just curious. Same as you. We still know very little of his work.”

  But he could see she was her old self; her sense of intense preoccupation replaced, at least for the moment, by an openness appealing beyond description. “You’re also very beautiful,” he added, spontaneously. “I think you’ve definitely earned some more champagne.”

  “No, thank you.” She took his hand and kissed it gently. “I think now is the time to do the rest of our celebrating.”

  18 August 1924

  Leverkusen

  Why did I accept work at Farben? They use me like a trained monkey! Had to waste whole afternoon giving a speech. Me—with my German! Surely as painful for audience as for me.

  More proof Farben has little interest in project. Herr Direktor Ambros, once a supporter, says too much lab time spent on compound—questions its commercial potential. Harder than ever to get time in the laboratory for the work.

  Last night could not sleep. What would be worse—losing job or keeping it?

  Compound #157 useless. Unstable at room temperature and poorly soluble in aqueous media.

  Begin tomorrow on #158.

  Logan was a bit shaky when he arrived at the hospital the next day for his morning rounds—and even less inclined than usual to deal with Rochelle Boudin.

  Over the months, Rochelle had grown ever more difficult. Much as Logan prided himself on his skill with tough patients, with her it could be a physical effort to maintain his usual bedside manner of cheerful calm. Almost daily—even on those days when he was not charged with hospital duty—Logan received word Rochelle needed to see him. If it wasn’t about her dosing schedule, it might be the quality of the hospital food; or perhaps even a program on cancer research she’d seen the night before on PBS that she imagined had some bearing on her treatment.

  Logan recognized, belatedly, that he’d help bring this on himself. Because he’d made an effort to show her special consideration at the start, she’d come to take it as her due; now feeling entitled to make demands she wouldn’t make on any other doctor at the ACF.

  The truth, of course, was that what she mainly wanted was a friend—and never had it been more true than in recent weeks. Rochelle’s husband, Roger, who’d earlier made such a point of his devotion, had all but disappeared from view, and Logan noted that there was less and less conviction in her claim that he was just away on business.

  Obviously, such a scenario is always poignant. A severe illness is the ultimate test of the human bond, tending to point up moral bankruptcy in loved ones nearly as often as character; and had it been someone else, someone less manipulative or even slightly more considerate of others, Logan might have found her circumstance more touching.

  As it was, his dealings with Rochelle were governed only by a sense of obligation to the protocol of which she was a part. Which, finally—because the protocol in question was the volatile and unpredictable Larsen’s—was nothing more than a sense of obligation to his own future.

  Now, as he scrubbed down, splashing cold water on his face to wash some of the bleariness from his eyes, he was suddenly aware of someone waiting off to the side. Nurse Lennox.

  He turned and stared at her balefully. This woman was not in the business of giving him good news.

  “What?”

  “I hate to bother you with this, Doctor.”

  “Boudin?”

  She nodded. “She started asking for you yesterday afternoon, and began again as soon as she woke up this morning. Her latest white cell count is in.”

  “Oh, God.” In general, he had no problem with the ethical guideline giving patients full access to their medical records. But Boudin made a habit of abusing it, seeking test results before they’d even been seen by her doctors, often interpreting them in ways that had only the most tenuous link to medical reality. “What is it?”

  “Forty-two hundred. I have it right here.”

  She handed Logan the sheet and he briefly studied it.

  “So … I guess she wants to cut down on her dosage again, right?”

  She nodded. “That’s what she wants, all right.”

  “Jeez, what a pain …!”

  “Good luck.”

  “Yeah. I wish luck were all it took.”

  Resignedly, he started moving down the corridor toward her room, the challenge at hand all too familiar: How to keep this conversation down to five or ten minutes? How to get through it with minimal emotional fallout?

  “Dr. Logan?”

  Logan was so preoccupied, he momentarily failed to respond to the voice addressing him from behind—or maybe it was just that it was so uncharacteristically moderate.

  “Dr. Logan.”

  He wheeled, and was startled to see … Stillman!

  “D-Dr. Stillman,” he stammered, “I’m sorry, I didn’t hear you.”

  The senior man approached him, hand extended, smiling. “No problem. I was just wondering if you might have a couple of minutes to talk.”

  Logan hesitated. “Actually, I’m on my way to see a patient. But if it’ll only take—”

  “Who?”

  “Rochelle Boudin.”

  “Lucky you. No, you’d better take care of it, you don’t want Larsen on your ass.” Another smile, this one full of comradely understanding. “Come see me in my office afterward.”

  A moment later, stepping into Rochelle Boudin’s room, it was all he could do to mask his reaction—curiosity, tinged with anxiety—to what had just occurred.

  “Good morning, Rochelle,” he said with brisk efficiency. “I’m told you want to see me.”

  She was propped up in bed, Good Morning America showing on the mini-TV suspended at eye level. “Where were you yesterday?”

  “Rochelle,” he said, with exaggerated patience, “you know I’m not on hospital duty Wednesdays, I’m in the Screening Clinic.”

  “I mean yesterday evening. You used to come in the evenings.”

  He couldn’t deny it. Earlier in his tenure at the ACF, he’d often spent time with patients after-hours; a bit of apple-polishing for higher-ups that could also actually be a nice change of pace
. But since beginning work on the Compound J project, that had been out of the question. “Look, Rochelle, I’m sorry, it’s been a busy time.” He cleared his throat. “I’m told there’s something you want to discuss.”

  “Have you seen my white cell count?”

  “I have it right here.” He assumed his best sympathetic air. “I know it seems low. But I can assure you, we’re not close to the danger zone yet.”

  In fact, after seven months of having her bone marrow pulverized by chemo, Boudin was holding up remarkably well.

  “I want to cut the dose. I insist on it.”

  “Rochelle, you know perfectly well that according to the terms of the protocol—”

  “I’m so sick already,” she interrupted, “why can’t you just give me a break …?”

  “Please, Rochelle, you know that I—all of us—have only your best interest at heart.”

  “Do you?” she asked, suddenly girlish. “Sometimes I can’t tell.”

  “Listen, have you given any thought to what we talked about the last time?”

  The reference was to the implanting in her upper chest of a subclavian intravenous line. As often happened with long-term chemo patients, the veins closest to the surface had narrowed and virtually disappeared from sight, making the insertion of an intravenous drip a dicey and sometimes painful procedure. Such a line would make it as easy as inserting a plug into a socket.

  “I don’t know,” she said. “Would it hurt?”

  “Rochelle, we’ve been through this. Any pain would be minimal. The surgeon can do it in fifteen minutes, with a local anesthetic. When you’re finished with chemo, it’s just as easily removed.”

  “Do you think I should?”

  Under other circumstances, it might have been a reasonable question. Now it merely annoyed him. “Yes, I certainly do.”

  “Then I will. If you say so.”

  “Good, I think that’s the right decision. I’ll have the surgeon, Dr. Dawkins, come by.” Logan glanced at his watch. “Listen, Rochelle, I’ve got a very busy morning. Perhaps you can take this up with one of the other doctors.”