The Magic Bullet

by Harry Stein

  “I don’t want to talk about it with anyone else.”

  “Well, I’m sorry, I really do have to go.” And he turned, heading for the door.

  “Will you be back to see me later?”

  But he pretended not to hear, not stopping until he reached Stillman’s office.

  “How’d it go?” asked the senior man, as unsettlingly pleasant as before.

  Logan shook his head. “The woman’s a nightmare.”

  Stillman laughed. “Well, sit down, relax.” He indicated the chair facing his desk. “Who knows, maybe we can arrange it so you don’t have to do that sort of thing anymore.”

  Logan sat down and returned his smile. What the hell was this about? “That would be nice.”

  “I haven’t seen much of you lately. What have you been up to?”

  Logan offered a stiff shrug. “Nothing much. This and that.”

  “This and that? Sounds like you could put your time to better use.” He paused, leaning forward. “No sense beating around the bush. I’d like you to join my team.”

  “Your clinical research team?” Logan was stunned. “Really?”

  “That drug I talked about to you and what’s his name about …?”

  “John Reston.”

  He nodded. “… I’m almost ready to bring it to trial. We’re putting together the protocol right now, and I’m going to have to beef up on support staff.”

  “My God! That’s incredible.”

  If Stillman had sensed there was less than full enthusiasm in his tone, he didn’t let on. “I know I don’t have to try and sell you on this, Logan,” he said. “But I can tell you this could be a big drug. And big for everyone close to it.”

  “It’s incredibly flattering. Thank you.”

  Stillman waved this away. “Forget that, I want you because you’re good. I’ve seen your work in the Clinic and on the inpatient wards. Patient accrual is going to be a very important aspect of this trial.”

  He waited for a response. When Logan merely nodded, he pressed on. “Needless to say, assuming things work out satisfactorily, at the end you’ll get your name on the paper.” He laughed. “Not as a lead researcher, but it’ll be there somewhere.”

  Logan knew how unusual such an offer was. He appreciated what, under other circumstances, it would mean to his career.

  He also knew that he had to find a reason not to accept.

  Logan nodded again, then decided to take the risk. “Sir, could you possibly tell me a bit more about the drug?”

  Such a question from a junior researcher might have been seen as highly presumptuous. But Stillman, utterly confident, took it with good grace. “Well, as I told you before, it’s an anti-growth factor strategy. I’m really not ready to go into more detail than that.”

  Still not ready, Logan wondered, with the thing almost set to go before the Review Board? Something odd was going on here. “Sir, it’s just that, well, if I’m going to commit to work on the project, I’d really love to know just a little more about it.”

  “You would, huh?” Stillman leaned back in his chair. “Well, start by knowing this. This is the sexiest drug to come down through the pipeline in a while. It’s new and it’s different and the press is going to eat it up.”

  “That’s great.”

  “And,” he added, “you’d be a fucking fool not to leap at this chance.”

  Suddenly, sitting there, it hit him, a gut feeling so powerful he’d have bet his life on it: Stillman had zero faith in this drug! It was just another variation of the same old stuff. That’s why he wouldn’t come clean.

  This protocol posed no threat at all to Compound J. Stillman was thinking only short term—the hype, and the funding it would bring in.

  “Can I just think about it a little while?” Logan waffled. “I mean, it’s such a huge decision.”

  Stillman’s eyes flickered with annoyance, but he held it in check. “Certainly,” he said. “Of course.” He got to his feet and extended his hand. “Like I tell people, that’s one of the things I like about you, Logan. Not an impetuous bone in your body.”

  Logan and his associates had been aware from the start of a great irony: that before their protocol could go before the Review Board, they would have to get the man who’d be most unhappy about such a project to sign off on it. Raymond Larsen.

  Quite simply, as chief of the Department of Medicine, Larsen ran the system into which any new protocol had to be made to fit. He assigned beds and clinical time, determined the availability of the Outpatient Clinic, and, when scut work needed getting done, controlled access to first-year associates.

  Yet what might have appeared to outsiders a major potential obstacle, Logan recognized as merely an inconvenience. In his view, there was no chance Larsen would hold up the project: no responsible research scientist can afford to put himself in the public position of trying to block a reasonable idea. Too, vitally, Compound J had the backing of Seth Shein; and, Shein enjoyed the support of Kenneth Markell, the powerful head of the ACF.

  If nothing else, Larsen understood the realities of institutional politics.

  Which is hardly to suggest that Logan was comfortable putting the senior man in such a position—or that he imagined for a second that Larsen would take it with good grace. Sometime before, Shein had offered what seemed like the definitive take on the man: “You know why Larsen has to resort to mugging people? Because he doesn’t have the talent to make it on his own.”

  For the chief of the Department of Medicine, the Compound J protocol would represent a double humiliation; proof positive not merely that this first-year associate, this nothing, had rejected his overtures, but that he’d gone with his nemesis Shein instead.

  Clearly, Logan would have to make at least some attempt at damage control. Walking across the campus toward Larsen’s office in the Administration building, clutching the twelve-by-fourteen manila envelope bearing the final draft of the protocol, Logan again rehearsed how he would lay it before the older man: that he’d been working on this idea for quite a while now; that along the way, Shein had become interested in the project; but that he very much hoped he—Larsen—would now also offer a critique of the proposal.

  He was pleased to find that the senior man was not in.

  “May I leave this with you?” he asked Elaine, Larsen’s secretary.

  She looked at him with sudden curiosity. “What is it?”

  During his long sessions in the outer office, studying protocols from years past, they’d developed a relationship that sometimes actually bordered on cordiality. He decided to tell her the truth. “Actually, it’s a new protocol.”

  “By you?” She gave him a look that registered either bemusement or contempt. Logan couldn’t tell which. “Really …?”

  “Me and a couple of others.” He paused, smiling. “I was going to bring you some flowers so you’d be favorably disposed to our cause. But I thought it’d be a little obvious.”

  “You should’ve.”

  “When do you think Dr. Larsen might be in?”

  “Why, are you planning to bring him flowers?”

  Logan knew his smile was growing pinched. “I just wanted to talk to him, tell him a little bit about it in my own words.…”

  “I’m sure,” she said dismissively, “that he’ll enjoy that.” She pointedly laid the envelope to the side and went back to work.

  When Logan returned toward the end of the day, Larsen was back—and when he saw his face, he knew he’d read the proposal.

  But the man was a model of control.

  “Dr. Logan,” he said with a crisp nod, emerging from his office.

  “Dr. Larsen,” he returned. There was a momentary silence: wasn’t the reason for his being here obvious? “Sir, I was hoping you might have a few minutes to talk.”

  Larsen glanced at his watch. “I’m afraid that’s quite impossible, I’m due at the lab in five minutes.”

  “I see.”

  The senior man shuffled through so
me papers on his secretary’s desk, then suddenly looked up. “We’re doing some very interesting work on the development of the malignant phenotype. Some very exciting work.”

  Logan was speechless. Never before—not once—had he heard Larsen talk of his research; or, for that matter, express enthusiasm about anything. “That’s wonderful, sir,” he offered finally.

  “Yes, well … if you’ll excuse me.”

  Logan followed him out into the corridor. “Dr. Larsen …”

  Larsen, quickening his pace, made no reply.

  “Sir, is there another time I might see you?”

  “I’m very busy just now, young man.”

  “I just wanted a couple of words about—”

  Abruptly, Larsen stopped and faced him. “What?”

  The unmistakable note of anger made Logan flinch. But there was no turning back now.

  “I was wondering if you’ve had a chance to read what I left for you earlier.”

  “Yes, I looked through it. What exactly would you like me to say?”

  Logan had tried to persuade himself this would not sound unctuous. “Actually, sir, I’d appreciate any comments as to how it might be improved.”

  “My comments?” Larsen smiled, a sudden maliciousness in his eyes. “Very nice job, Logan. My compliments to you and your little friends. And Dr. Shein, of course.”

  “Well … would you have any specific recommendations?”

  He stood there a long moment, staring at him coolly. “I’m late, Logan.” And, turning on his heel, he strode away.

  By the next morning, word of the proposed protocol was already making its way through the ACF, a piece of gossip juicier than any love affair. Who WERE these three? How’d they gotten so tight with Shein? Could this thing actually have a shot at success?

  At least to his face, most of the peers Logan ran into in the hospital that day were supportive, managing to mask whatever envy they felt by good cheer. “Is this as good for all us little guys as it sounds?” asked one fellow first-year associate. “Or should I forget about that and get right down to hating you?”

  But the reaction Logan was most worried about was Stillman’s. It was not long in coming. Late in the afternoon, as he was about to call it a day, he saw the senior man heading his way.

  “So,” said Stillman sharply, before Logan could say a word, “I guess I’ve got your answer to my invitation.”

  “Dr. Stillman—”

  “Shut your mouth, you little shit! I have no interest in your explanation!”

  Logan nodded and stared at the floor.

  “Just know that I can make your life hell, Logan. You stuck a fucking pickax in my back, and now you’d damn well better watch yours!”

  “Well,” sighed Reston that evening, “it could’ve been a lot worse.”

  “How?”

  “He could have told you what he really thinks.”

  Logan returned Reston’s smile. He knew his friend was as shaken as he was. “Thanks. That’s reassuring.”

  “Look, Logan”—Sabrina’s tone was less consoling than practical—“what does it matter? We knew Stillman would not be so happy, right? Larsen also. And maybe others. But what can they do to us?”

  Logan shrugged. “I guess not much—once we get the proposal through.”

  “Exactly. This is my meaning.”

  “I’m just worried they’ll try to hurt the proposal with the committee. They’ve got almost six weeks to try and sabotage us.”

  “Remember what you say to me before, that maybe I am a little paranoid? Now it is my turn to say the same to you.” She looked from one to the other. “Our protocol is strong. The Institutional Review Board will see so. After that”—she gave a distinctly Italian gesture of acceptance; eyes heavenward, palms moving in the same direction—“it is not in your hands or my hands.”

  “She’s right,” concurred Reston eagerly. He looked at Sabrina. “You’re absolutely right.”

  “Yes,” she allowed, barely acknowledging him. “I am right.”

  “Well,” said Logan, “nothing we can do about it now anyway—except try and watch our step. Who knows what kinds of crap they could pull.”

  In fact, the petty annoyances began almost immediately. Suddenly various functionaries around the hospital and labs—a head nurse, the pharmacist in the Outpatient Clinic—were cooler than before, and slower to cooperate with routine requests for administrative assistance. Reston one day found that for no apparent reason his dial-out number—the code he needed to make long-distance calls—had been changed, and a new one was not readily available. Soon afterward he was reprimanded by a second-year associate for, of all things, taking a drink of water from a pitcher in a patient’s room; every patient’s water intake was closely monitored, he was sharply reminded—as though a few sips could make a meaningful statistical difference.

  As if to top this, a week later Sabrina was called into Peter Kratsas’s office and ordered to desist from giving her patients occasional pieces of chocolate.

  “He tells me these diets must be strict,” she reported late that evening. “He tells me this is a research institution, only research materials can be allowed. Even food! And, even while he tells me this, he is smiling, like it is a big joke!”

  “That’s exactly what it is,” concurred Logan. “Patients’ families bring them stuff to eat all the time.”

  Drawing her closer, he could feel the tenseness in her shoulders. They were a matched set; he’d left work with a killer headache of his own. “What’d you say to him?”

  “What can one say? He is the boss, no?”

  More than any other, this episode seemed to sum up the character of their foes. The reprimand had been intended to wound her on the deepest possible level; it was her talent as a nurturer they’d attacked, one of her real gifts as a physician. “Ignore ’em,” said Logan, wishing he’d remembered to pick up some aspirin on the way home, “what else can we do? It’s only temporary. Just a couple more weeks till we go before the Review Board.”

  For, of course, neither for a moment lost sight of the key fact: things were right on track. If their adversaries had real power to get at them, they’d never have had to resort to such pettiness.

  “That’s very easy for you to say, Logan,” she said, with a sudden smile. “Me, I have four pounds of Perugina chocolates in the closet. Soon I will have the mice and roaches.”

  “Easy? Who had his parking spot given to a visiting fellow from Estonia? Who has to walk half a mile every day from general parking?” He paused, his head throbbing, but managed to smile back. “I haven’t even told you the latest. Guess who just discovered he now needs clearance to get a Tylenol from the hospital pharmacy?”

  Ten days later—a Sunday, five days before the long-awaited Review Board session—they were awakened by the jangling of the telephone.

  It was Reston. “Do you have the Post delivered?”

  “Yeah,” replied Logan.

  “Go get it. Page six of the second news section. Call me back.”

  On the face of it, the story, headlined “Cancer Funding at Risk,” was just another piece bemoaning the effects of the budget crunch on high-level medical research. But to the trained eye it was immediately recognizable for what it was: a Stillman plant. Stillman himself was prominently featured, identified as “one of the world’s leading experts in breast cancer”—and, more to the point, as “the man behind what is said to be a new drug with ‘breakthrough potential.’ ” If, that is, it could get adequate funding. The problem was that other drugs, including “some said to have virtually no chance of practical application,” were diverting monies from Stillman’s miracle cure.

  “I’m concerned with saving the lives of real women,” Stillman told the pliant reporter. “Too often these days government invests in fantasy. And then we wonder why we don’t get results.”

  He called his friend back. “I don’t think we have anything to worry about. The bastard’s just blowing off steam.”
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  “Really?” asked Reston, desperate to be reassured but not quite trusting what he heard. “You think so?”

  “Read it again, John. Carefully.”

  For what Logan had immediately focused on was that the clear target of the attack—Compound J—was never cited by name; nor was it even suggested that any of the drugs eliciting Stillman’s displeasure might be linked to the ACF.

  In fact, what seemed to Logan most clear was that Stillman’s hands were tied: he simply could not risk shattering the carefully nurtured illusion that the ACF was above petty politics, a bastion of inspiration and hope staffed by men and women intent only upon doing God’s work. Ultimately, it was this that kept the Foundation so well funded—and all of them in business.

  As the Compound J team waited outside the Administration Building’s third-floor conference room, Logan’s confidence soared. Exchanging greetings as the Board members filed in, the junior associates felt themselves to be among peers.

  He was aware he even looked good. At Sabrina’s direction, both he and Reston had bought new suits for the occasion, conservative and far from the least expensive on the rack; almost as classy as the charcoal-gray Italian pinstripe suit she wore.

  Logan, having been chosen to represent the team, had a twofold task: to summarize for the Board members the key points in the document they’d all already read, while conveying that they had what it took to see the project through.

  Of the seven, Logan was already on a first-name basis with four: Dr. Lauren Rostoker, representing Surgical Oncology; Dr. Brendan Herlihy of the Department of Medicine; Dr. Myra Manello of Radiation Oncology; and, of all people, on behalf of Nursing Services, Marilyn Lennox. The remaining three had backgrounds not in traditional medicine, but in realms with which modern institutions must nonetheless concern themselves. They included a bioethicist based at Georgetown University; an Episcopal minister from nearby Annandale, Virginia; and someone from Patient Services named Marion Winston, a sort of ombudsperson for those receiving treatment at the ACF. But—yet another good omen—this last, a pleasant-looking, heavyset woman, took the time to introduce herself, shaking hands with each of them and wishing them luck.