The Magic Bullet

by Harry Stein

  The ice was finally broken late one Friday afternoon. Sabrina was preparing to head home when a nurse gave her word that Rachel Meigs, on duty in the Screening Clinic, needed to see her immediately. Meigs was one of their few peers who seemed sincerely interested in the success of the protocol.

  Pragmatic as she was by nature, Sabrina allowed herself some hope as she made her way to the clinic.

  “I think I’ve got a live one for you,” confirmed Meigs. She nodded toward the waiting room. “I finished the exam about half an hour ago.”

  Sabrina looked through the glass partition. Except for a young woman, evidently very pregnant, the room was empty.

  “That one?” she asked, incredulous. What was this? Did Meigs imagine a pregnant woman could even be considered for the program? Or was she merely having a joke at her expense?

  Meigs nodded. “That one. I think you’ll like her.”

  Entering the room, Sabrina extended her hand. “Hello, I am Dr. Como.”

  The woman struggled to her feet. “Hi. I’m Judy Novick.”

  Only now was it apparent: Aside from her bloated midsection, the woman was emaciated; instead of a robust pink, her skin was sallow.

  She wasn’t pregnant at all, her abdomen was full of tumor!

  It took just a moment to compute. Of course, a week or so earlier Sabrina had studied this woman’s X rays and the slides indicating a breast tumor that had metastasized to the liver. Novick was among those she and her colleagues had okayed for further investigation. It crossed Sabrina’s mind as she looked at her that once, not long ago, this woman had been very pretty.

  “You must be tired, no?”

  In fact, the procedures the patient had already undergone this afternoon hardly qualified as rigorous: a chest X ray, an EKG, drawing a little blood, some manual probing of the tumors. But her condition was such, Sabrina knew, she felt as if she’d just done a dozen rounds with the heavyweight champion. Rocking unsteadily on her feet, she appeared scarcely able to keep her balance.

  “Actually, yes, I am. Very.” Judy Novick smiled gratefully. “It’s been a long day.”

  “Come,” said Sabrina, leading her toward an examining room, “let’s go to a more comfortable place.”

  The numbers in the patient’s paperwork confirmed the visual evidence: the cancer was laying waste to her body at an awful rate. Yet, at least from the perspective of the protocol, there was also some good news. To date, the only treatment Novick had undergone was a single course of adjuvant therapy. She’d been referred to the program after the most active drugs available had proven useless.

  And she lived in Bedford, Pennsylvania, little more than two hours from the ACF.

  “Now,” offered Sabrina, as the patient stretched out on an examining table, “I am sure you have some questions, no? And I have some questions for you also.”

  “Well …” Novick began, then stopped. “I really don’t even know what all this involves. I’m only here because my doctor wanted me to come. And my family.”

  Sabrina nodded, showing nothing. According to the guidelines, candidate selections could not be made on the basis of criteria as vague or subjective as “morale” or “attitude”; yet she knew that once a patient has given up, her chances of doing well decreased markedly.

  “The first thing I will tell you,” replied Sabrina, “is that this is an outpatient trial. We might need you here in the hospital at the beginning, but afterward you would live at home.”

  “But what does it do? What kind of—” She stopped in midsentence. “I don’t even know exactly what I’m asking—I was never any good at science.”

  “What the trial will do?” Sabrina moved closer and made eye contact. Her tone was at once straightforward and sympathetic. “I can only tell you of our hopes. This is a new treatment—it is something some of us believe in very much. But I cannot say it will be easy.”

  “What kind of success have you had with it so far?”

  “I must tell you, this protocol is just now beginning. This is a very new idea.”

  “How many patients has it been tried on?”

  Sabrina hesitated. “You will be the first—number one.” She smiled. “This is kind of an honor, no?”

  The woman looked away. “I don’t know whether to be flattered or horrified.”

  Like Logan, Sabrina had never imagined this part of it would be so tricky. Suddenly she found herself having to sell the protocol—and to a patient she wasn’t even sure she wanted. “I understand,” she allowed. “I wish I could tell you for certain.…”

  “What you’re telling me instead is this is the only chance I’ve got.”

  That was something no reputable doctor would ever say to a patient, even if, as now, she believed it to be the case; playing God was not part of the job description. “You are possibly a good candidate for this treatment,” she offered simply. “And this is not a thing we can say to very many.”

  For a long moment, Novick said nothing.

  “Judy …? May I call you that?”

  “I was just thinking. It’s not an easy decision.”

  “I, too, would like to ask some things.”

  “Okay.”

  “You talk of your family. You are married?”

  As Sabrina well knew, a strong family—a devoted spouse, or sister, or parents—could provide crucial support in such a situation, logistical as well as emotional. It had to be anticipated that there’d be times when a protocol patient would be unable to feed herself, let alone, if it came to that, make it on her own to the ACF emergency room.

  “Yes, I’m married. He’s been wonderful.”

  “Good, this is so important.”

  “But I wouldn’t be doing this just for him,” she cut in, with sudden spirit. “I don’t want you to think that.”

  “No. I do not think that.”

  “I’m doing it because I think it’s the right thing.”

  “Of course.”

  Sabrina betrayed nothing; but the excitement was building within: hadn’t she just agreed to participate in the test?

  “Because it really is my only shot, isn’t it? I’m not one of those people who lie to themselves.”

  That put to rest Sabrina’s last lingering apprehension. Morale wouldn’t be a problem, after all.

  “Still,” Sabrina said evenly, “before we agree, you must think about it a little. I want you to look carefully at the Informed Consent Document. And talk with your family and with your doctor. And I must talk with my colleagues.”

  She nodded. “Fine. But if we’re doing this, I’d like to get started.” Perhaps unconsciously, she passed a hand over her distended belly. “The sooner the better.”

  3 October 1927

  Frankfurt

  Such a glorious afternoon! Took long lunch with Emma in the park. Still cannot believe my good fortune—her family does not disapprove! Not an endorsement, but one would have been a fool to expect such a thing. Surely warmth will come later, with understanding. I am proud, but must also be realistic. A Japanese son-in-law cannot be easy for any German family to accept.

  Reality is something I learn more about each day in the laboratory. Yet versions #284, 285, and (especially) 286 of compound continue to give hope. Melting point sharp, composition successfully determined by elemental analysis. When it works, nothing is more beautiful than chemistry.

  Except Emma.

  Must now write my family in Japan. How will they take idea of a German-Jewish daughter-in-law?

  It soon became clear to the Compound J team that Judy Novick’s attitude—wariness and skepticism mingled with hope—would be the norm among those drawn to the protocol. Most metastatic cancer patients tend to put up a brave front for a time. But eventually, physically debilitated and emotionally drained, they begin making peace with the apparently inevitable. Only a modest percentage, aware of the risks involved and the odds against long-term success, are ready to subject themselves to the hazards of experimental treatment.


  Yet, for precisely that reason, as the roster pool began filling out—with five women having signed on the bottom line by late March, the end of the second month—Logan was already looking upon the Compound J patients with admiration and gratitude. As word of the protocol spread, the patient accrual phase began clicking along surprisingly smoothly. Some days now there were as many as a half dozen serious inquiries; sometimes producing three or four legitimate prospects at the Screening Clinic a week.

  In fact, a greater concern now became the screening evaluations themselves—especially after Logan learned that Allen Atlas, while on clinic duty, had tried to disqualify a woman from the Compound J test who, in most respects, seemed an excellent candidate.

  “Get out of my face,” shot back Atlas, when Logan called him on it, “the woman has high blood pressure.”

  “Don’t fuck with me, Atlas,” he told him. “We both know what you’re trying to do.”

  “Right, asshole, my job. So let me do it.”

  “Uh-uh. You were doing a job, all right. For Larsen and Stillman.”

  Atlas’s face reddened, and for a moment Logan thought he might’ve gone too far; for all the viciousness of ACF politics, the junior associates pretended, at least, to be collégial. Such a charge, implying as it did deliberate sabotage of a protocol, was extremely serious. If brought to higher authorities, it could land one or the other of them in very hot water.

  But Atlas, enraged, didn’t even bother with the formality of a denial. “At least,” he spat back, “those guys know what the hell they’re doing.”

  When he calmed down, Logan was warier than ever. He and his colleagues decided that from now on, when any of their adversaries was slotted to screen a Compound J candidate, one of them would drop by the Clinic to oversee the exam. The silent, smoldering looks they had to endure were small cost for the certainty that no likely prospects would fall through the cracks.

  That is why Logan happened to be in the Screening Clinic when he was alerted by the beeper on his waist to an incoming call. The woman with whom he was talking, one Sally Kober, was missing a kidney as a result of an auto accident in her teens; since she was sixty-six, this was of little consequence—but under other circumstances, it might have been used to keep her out of the program.

  When the beeper sounded, Logan switched it off and smiled at the patient. “I’ll get that in a few minutes.”

  “Don’t you have to get it now? It might be an emergency.”

  “No emergency. Just a doctor calling about someone else who might be interested in this protocol. You’re already here.”

  “And immensely good company,” she observed, laughing.

  Though he tried always to keep a professional distance, Logan couldn’t help but be struck by this woman. A veteran of a radical mastectomy twenty years before, she seemed to be taking the appearance of the new node above the clavicle—an exceptionally ominous development—with amazing calm.

  “Now, just so I know where I stand,” she said, “—this thing I’ve got is pretty desperate, isn’t it?”

  “I wish the news were better,” he replied evenly.

  “Well, then, you seem to be in the majority.”

  Unconsciously, she passed a hand over her steel-gray hair. “Are you a football fan?”

  He nodded, confused. “The Dallas Cowboys.”

  “Oh, please, you struck me as someone with common sense!” She smiled. “I love the Giants.”

  “You’re excused—you live in New Jersey.”

  “I will bet you, right now, on the first game the Giants and Cowboys play next season.”

  “Why’d you want to do that? It wouldn’t be right taking your money.”

  She laughed. “It’s called faith. It’s a convenient way of betting on myself to still be here.”

  “I’ve only known you fifteen minutes, but that’s a bet I’ll take.”

  She waved her hand. “Please, enough flattery. Go return that call.”

  “Mrs. Kober, how much do you know about this protocol? Have you read the Informed Consent Document?”

  “My doctor recommended it, and you seem all right. I can’t see any good reason not to do it.”

  “I’m afraid that’s not good enough. I’m going to want you to read it over very carefully.”

  She thrust out her hand. “Hand it over. I’ll read it while you make your call.”

  As he dialed, still chuckling, he noted approvingly that the area code—804—was central and southern Virginia; little likelihood of transportation problems with this one.

  “Hello,” answered a male voice.

  Logan was momentarily taken aback. At a hospital or clinic, he generally got a receptionist. “Yes. I hope I have the right number. This is Dr. Daniel Logan at the American Cancer Foundation—I was given this number but no name.”

  “Yes, Dr. Logan. You’ve got the right number.”

  “Did you call? Are you a doctor?”

  “Yes, I’m a doctor. But I’m afraid I don’t have a patient to refer to you. My name is Ray Coopersmith.”

  As soon as Logan walked into the Hotel Jefferson in Richmond, he knew why Coopersmith had chosen it for their meeting. A vestige of the antebellum South, all potted plants and faded upholstery, this was as distant from the high-tech, high-pressure world of the ACF as one could get. Logan, jumpy throughout the two-hour drive south, was instantly heartened; their chances of being spotted here were roughly the same as coming up with a cure for cancer in a bathroom sink.

  Though it was early on a Saturday evening, the lobby was nearly deserted. Logan was about to take a seat in one of the overstuffed chairs beyond the imposing main staircase when he happened to look up. There he was: at a table behind a wrought-iron railing on the second floor, a man was nodding at him!

  “Nice place, don’t you think?” said Coopersmith, when Logan reached the top of the stairs. “I thought for a second you wouldn’t see me.” He extended his hand. “Ray Coopersmith.”

  “Dan Logan. Yes, very nice.”

  Logan didn’t know what he’d expected, but this wasn’t it. Though probably no more than a few years older than himself, Coopersmith looked middle-aged. Tall and rail thin, with dark hollows beneath penetrating eyes and thinning hair in need of a trim, he had the same edgy, unfocused quality Logan had noted in gamblers and junkies.

  As they took their seats at the small wicker table, Logan noticed, with a rush of sympathy, that the worn suit jacket the other man wore didn’t quite match the pants.

  “You want a drink?”

  “Sure. Thanks.”

  “Me too.” Coopersmith motioned for a waiter.

  Coopersmith ordered a gin and tonic, Logan a beer.

  They stared at one another for a long moment. Logan had no idea how to proceed and Coopersmith didn’t seem inclined to help.

  “You come here a lot?” Logan finally spoke up, lamely.

  “No.”

  “Do you live in Richmond?”

  “No.”

  “Where?”

  “Place called Hopewell. About twenty miles from here.”

  “So what are you doing with yourself these days?”

  “I’m getting by,” he said, with sudden, unmistakable rancor. “Don’t worry about me, I’m practicing medicine.”

  “Where’s that?”

  “At a clinic. In Petersburg. Why, you gonna check me out?”

  Logan chose to ignore this. “I read your protocol. It was very impressive.”

  The waiter brought the drinks, and they momentarily fell silent.

  “You’re obviously a gifted researcher,” picked up Logan.

  Incomprehensibly, Coopersmith snickered. “Maybe I’ll read yours sometime.” He tapped the side of his head and smiled. “Breast cancer. Smart. A glamour disease.”

  Logan didn’t know whether to be amused or offended. The remark was obviously intended as a put-down, but the man making it was more worthy of pity than scorn. “That isn’t why we’re doing it.”
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br />   “No, of course not. Me—genius!—I go after prostate—try to get funding for that.”

  This was the opening Logan had been looking for. “I heard it wasn’t lack of funding that got you in trouble.”

  Spasmodically, Coopersmith’s head jerked left, then right. “Who said that?”

  “Steven Locke. He said you faked your data.”

  “Bullshit! They wouldn’t give me the resources I needed. The people. The money.”

  “That doesn’t sound—”

  “What am I supposed to do? There was too much damn data, I couldn’t monitor it all. But I’m a scientist! I didn’t make up anything!”

  Logan nodded. What was the point in arguing with the guy?

  “The data was good data,” he insisted. “But they said it was uninterpretable.”

  “Who’s that?”

  “Larsen. Stillman. Kratsas. That whole bunch. They’re scum, they were against me from the start. What I’d give to ream out those fuckers!”

  Logan stared at him. That’s why this guy had gotten him down here? “Look, Ray, I appreciate the warning, but it’s not news about these guys. They’re already making all the problems for us they can.”

  “You don’t know what you’re talking about, you don’t know the half of it.”

  “Really, I understand what you’re saying. But we’re not in the same position you were. There are three of us. And ours is just a mini-test—fifteen patients.”

  “You’re such an arrogant SOB. You fit right in at that place!”

  Logan was caught short by the savagery of the attack. “What’s that supposed to mean?” he snapped.

  “Arrogant, complacent, and dumb as shit.” He shot him a malicious grin. “Bet you don’t like hearing that, do you?”

  Logan glanced at his watch. “Look, I’ve gotta be getting back.”

  “Before someone sees you with me?”

  “Because I don’t think this is doing either of us any good.”