The Magic Bullet

by Harry Stein

  “It’s done me lots of good. I found out what disgusting little ass-kissers that place is turning out these days.”

  Unsettling as this was, Logan found it useful too—even reassuring. Who could doubt that this guy was wildly unstable? Or that—for all his accusations and complaints—that fact had been at the very heart of his problems?

  “Wait a minute,” said Coopersmith with sudden contrition, “don’t go yet. I don’t get to talk serious science much anymore.”

  “Sorry, I really can’t.”

  “C’mon, just one more beer.”

  Logan held up his glass, still more than half full. “No. I’ve got to drive back home.”

  “You’re being careful?” The other’s sudden, strangled laugh caught him by surprise. “You’re such a fucking jerk, Logan!”

  Well, the doctor said, in at least one sense she was already lucky. They wouldn’t have to put her under complete anesthetic for the biopsy. She’d get a local and be back home by afternoon.

  “Why?” she asked, relieved. “I thought it would be a lot more complicated than that.”

  Her questions, she recognized, standing back, always sounded weirdly dispassionate, as if this were happening to someone else. She figured it was probably her training as a reporter. But maybe it was just a defense.

  Well, came the explanation, during the preliminary exam the CAT scan had picked up a slightly enlarged lymph node near the spine, directly above the area of concern. They would be able to take a tissue sample from there instead of having to go into the bone; a far more dramatic procedure that would have required the participation of an orthopedic surgeon. In any case, soft tissue is always easier to work with than bone—easier to process and more readily converted into microscope slides.

  New questions came immediately to mind: Could an enlarged lymph node really be taken as a positive sign? Was the point here merely the ease of this procedure or her long-term health?

  But this time she let them pass.

  There were three others in the room, in addition to her private physician: an anesthesiologist, his assistant, and a nurse. All seemed pleasant enough and she had been assured they were trustworthy. The room itself was in a secluded wing of the facility; she could hear none of the usual hospital noises in the corridor outside, not even the sound of footfalls.

  The first shot of Xylocaine, delivered with a small needle, was designed to anesthetize the skin. It made possible the second—a three-inch needle from hell that went directly into the muscle.

  The talk in the room was about, of all things, TV. She admitted she had always been a big fan of medical shows, St. Elsewhere in particular, and wondered how accurate they thought it was. Not very, they said—except the nurse, who found the show’s depiction of doctor-nurse relations right on target. Which led to a discussion of differences in the way women and men see the world. And that, in turn, led her to her son and daughter.

  Anything but the matter at hand.

  She had to wait five minutes—to be certain the anesthetic had kicked in—before she was helped into the CAT scanner and carefully positioned by the doctors.

  She was aware that many other patients hated this enclosed cylinder, finding it claustrophobic. But she didn’t. “You know, I’m actually getting to like it in here,” she told them. “It’s like being in the womb.”

  But now she had to stop talking: the procedure demanded absolute stillness.

  The screen the doctors watched so intently showed everything—her internal organs, her skeletal structure. But their total focus was on the long needle, moving slowly toward the node. It took several minutes for the needle to travel the six centimeters.

  “Got it,” said her personal physician softly.

  He pulled back on the syringe attached to the needle and sucked in a tiny bit of tissue. The sample they needed was no larger than the head of a pin.

  Five minutes later she was out of the machine and in bed. They made her stay there two hours for observation and would have kept her longer, if she’d let them. “Listen,” she insisted, “I got lots of better things to do.”

  In fact, the anesthetic had done wonders for her disposition. She was in less pain than she’d been in weeks.

  The results would not be in for another twenty-four hours.

  Logan liked Faith Byrne the instant he met her.

  “So, Doctor,” she greeted him as he walked into the examining room to conduct her exam, “who does a girl have to suck up to around here to get well?”

  “You mean to get into the program?” He laughed. “I’m afraid sucking up won’t do it.”

  “Ah. In other words, it’s you.”

  This sixty-two-year-old widow from the Boston suburb of Brookline—slightly overweight, with lively blue eyes beneath a halo of white hair—was obviously going to keep him on his toes.

  “All right, a little sucking up won’t hurt. But, sorry, I’m still going to have to do the exam.”

  Still, from that moment on, Logan wanted her on the protocol. After all, where was it written that he shouldn’t look forward to seeing a patient?

  What he appreciated about Byrne as much as her good humor was her directness—for in Logan’s experience, invariably it was patients’ reluctance to say what was on their minds that caused problems.

  “I want to tell you it was my own decision to come down here and see you people,” she told him five minutes into their session. “My doctor wanted to give me the same old stuff. But I told him ‘no dice.’ ”

  “Why’s that?” Logan asked.

  “Look, I’m not an idiot, the cancer hasn’t hit my brain yet. I’ve read up on my chances.” She looked directly at the young doctor. “You’ll find I’m a strong, independent woman, not a babe in the woods.”

  Logan smiled. “I wouldn’t guess many people think otherwise.”

  “And”—she smiled back—“I’ve always got plenty to say.”

  In fact, during the initial session in the examining room, Logan learned more about Faith Byrne than he knew about some people he’d known all his life. He discovered that her husband, Ben, a salesman, had died of heart disease almost five years before; and that, though they’d had their problems—“Who doesn’t?”—the marriage had been a good one. Still, it was only since his death, working as a part-time copy editor at a local weekly newspaper, that she felt she’d really come into her own. She had two daughters. One, a married schoolteacher, lived in Minneapolis. The other, a social worker, was gay and lived in New York.

  “Actually, if you want to know the truth,” she confided, “I prefer the woman Ellen lives with to my son-in-law. If I’m ever gonna be a grandma, I really think it’ll be Ellen and Francine who make it happen, not Joyce and Ron out in Minnesota.”

  Fortunately, Logan was equally intrigued by the particulars of Byrne’s disease. The physical manifestation of her malignancy was unusual: hundreds of tiny pink nodules cutting an angry swath across the chest wall and extending around to the back, scattered tumors having reappeared at precisely the spot where she’d had a mastectomy some fifteen years ago.

  “I look at it,” she observed during the exam, “and it just seems unstoppable. When I get depressed, I feel like running out and trying every kind of acne cream I can find.”

  Though in that sense the case was atypical, the young doctor saw this as no impediment to her inclusion in the trial. The key fact was that Byrne’s malignancy had not yet invaded vital viscera. Too, she had been exposed to only minimal levels of adjuvant therapy; and that had been quite a while back, at the time of her mastectomy.

  Then there was something else: Faith was an irresistible chance to stick it to Stillman. For he found in her paperwork that this patient had had the chance to go with the senior man’s protocol—and rejected it.

  “Why’s that?” he soon felt comfortable enough to ask. For a patient seeking innovative treatment to turn down a doctor with Stillman’s reputation was almost unheard of.

  “Why? You’re ki
dding me, right? I met the guy. Call me weird, but I like to feel I’m gonna get more consideration than a slab of beef.”

  Despite himself, Logan burst out laughing.

  “I don’t think you’re supposed to do that, Doctor. He’s a colleague.”

  “You’re right. Sorry.”

  “But I guess you can’t help yourself—you’ve met him too.”

  The exam was all but over. “Well,” he pronounced, “I’ll want to look more closely at your case. And naturally talk it over with my colleagues. But I think I can tell you I’ll probably have good news for you.”

  She beamed. “Good. I knew this was going to work out.”

  Logan felt a momentary twinge of unease. Was she expecting too much? Did she fully grasp how remote were the chances of success of such an experimental trial? Had he, in brief, been as straight with her as the other way around?

  “Faith,” he gently launched into his standard litany, “it’s important that you know exactly what you’d be getting into. This is an unproven drug and there’s a real possibility of side effects. I want you to read the Informed Consent forms very carefully. And talk it over with your doctor. And come back to me with any questions you have.”

  “Of course, of course.” Nodding briskly, still smiling, she rose to her feet. “Just do me a favor. Tell your colleagues not to worry, we’re all going to have a wonderful relationship.”

  * * *

  When she was formally accepted five days later, Faith became the eighth woman attached on the protocol. A half dozen other likely prospects waited to be seen. Having begun in February, by now—the first week in April—the patient accrual process could be judged a success.

  The time had arrived to begin administering the drug.

  By custom and simple fairness, patients in such a test receive treatment in the order in which they’ve signed up. That meant Judith Novick leading off.

  Logan was keenly aware this was not ideal. The progress of the early patients—and especially that of the first—would be watched closely by their more senior colleagues; and of all the patients on their growing roster, Judith was in the worst shape.

  But, given the range of considerations involved, he kept his misgivings to himself.

  It was Reston, at a meeting one rainy Sunday morning at Logan’s place, who raised the issue. “Look,” he said, “this is something we’ve been avoiding. But I say we launch this thing with someone else.”

  “No!” Sabrina brought her hand down on the glass tabletop. “This is not tolerable! This is something we should not even talk of!”

  “Why not?” said Reston, turning on her. “We can do whatever we please. It’s our protocol—and it’s also our asses. That’s what we oughta be thinking about.”

  “This woman needs this treatment. She is counting on it.”

  “To begin with Novick is to compromise the whole program.”

  “John,” cut in Logan, “let’s not overstate things.”

  “Judith Novick is just too far gone,” he said flatly. “She was far gone when we accepted her and she’s deteriorated since. We can’t become too attached to individual patients.”

  Sabrina stared at him murderously. “We made a contract with Judith Novick. This cannot be changed now.”

  “Frankly, I was never crazy about giving her a spot in the first place.”

  “That is another lie! She was our first, we were happy to find her!” Sabrina looked toward Logan. “Anyway, what does it matter who is sicker or less sick? Our big concern is toxicity. Compound J can be just as toxic to a person with a small tumor as a large.”

  She had a point. At least in the early stages, their main goal was to prove that the drug wasn’t hastening anyone’s demise. If the cancer killed a patient—particularly one as advanced as Judith Novick—that would hardly be taken as a definitive judgment against the drug.

  “In fact,” added Sabrina, warming to the theme, “if Judith does well, it would look even better for us, no?”

  “Sabrina …” Reston smiled indulgently. “Look, I admire your compassion. Probably I could use more of it myself. But all I can see right now is that when Judith Novick goes, she’s gonna take one of our fifteen slots with her. And you damn well know as well as I do that, because she’s weak, the toxicity is likely to be heightened.”

  He waited for a response, but there was none. Reston almost dared believe he’d won the point. Turning to Logan, he spread wide his hands, a picture of sweet reason. “Look, Dan, why can’t we just drop her back a few slots? What difference would it make? We could substitute one of those hardy old dames of yours. Kober. Or Byrne.”

  “John, Mrs. Kober is number five on the list. Byrne’s eight.”

  He shrugged. “Fine, I respect your scruples. Let’s go with number two, Mrs. Sutton.”

  Logan looked toward Sabrina, then back to Reston. “So it’s up to me, right?”

  Neither of them felt it necessary to reply.

  “Well, then, we’re going to go ahead the way we planned.”

  Abruptly Reston was on his feet, the wooden dining room chair in which he’d been sitting crashing onto the floor behind him. “Shit, what kind of power does she have over you, anyway?”

  “What you say makes a lot of sense,” Logan replied calmly. “I’m just afraid that to change now would be to draw the wrong kind of attention to ourselves. We can’t afford to look insecure. Either we believe in Compound J or we don’t.”

  But already Reston had grabbed his coat and was heading for the door. “Screw you both! Screw this whole project!”

  For a long moment, Logan and Sabrina sat in silence.

  “He will be back,” she said finally, “the bastard.”

  “Why do you hate him so much?”

  She looked at him intently. “He’s just not my idea of a good scientist, Logan. You will see.”

  Two weeks later, on the morning of Judith Novick’s first treatment, Reston was by her hospital bedside with the others. If he was still smarting, he was keeping it to himself.

  An intense seriousness of purpose marked the occasion. This technically modest procedure was their Olympic debut, their Broadway opening; a time, if ever there was one, to look beyond petty squabbles.

  The patient, slightly propped up in bed, was pale, her grossly distended midsection appearing larger than ever beneath the flimsy hospital gown. Before Compound J could be administered, she had been scanned to measure the tumor site so a comparison could be made as treatment proceeded. Novick’s tumor measured an astounding ten by ten centimeters, and it was surrounded by fully ten liters of the malignant sewage known as ascites fluid.

  Novick hadn’t been allowed any solids since noon the previous day and she looked like she hadn’t slept much the night before. “You’re sure this isn’t going to hurt?” she asked, looking to Sabrina.

  “The procedure itself? I promise you, no.” She took the patient’s hand. “About the rest, we are being extremely careful. That is why we are all here.”

  “My husband wanted to know if he could be here while I’m getting it.” She indicated with her head. “He’s downstairs in the waiting area.”

  “Really, darlin’, I think that wouldn’t be the best idea,” spoke up Sadie McCorvey, the Irish research nurse who’d actually be performing the procedure. “You know as well as I how men can get in the way.”

  “I resent that,” laughed Logan.

  “Be my guest, Doctor, resent it all you wish—as long as you stay off to the side.”

  Logan wasn’t yet sure how he felt about McCorvey, allocated to the team on a part-time basis by Shein. She was new to the ACF, having worked for almost two decades in endocrinology at nearby George Washington Hospital, and he worried about whether she was up to the technical demands of this kind of work. On the other hand, her no-nonsense manner came with the kind of mordant, take-no-prisoners humor with which he himself was most comfortable; and, obviously, she was good with patients.

  “Don’t you worry,
dear,” she added now, leaning over the bed toward Novick, “it’ll be over sooner than you know.” In a couple of quick moves, she inserted the IV line into the patient’s arm and taped it in place. “Now we’ll begin the drug in just a few minutes. We’ll be starting you off with just a tiny dose to make sure you’re not allergic.”

  But the items that were wheeled into the room a moment later could not have been reassuring: an EKG machine, lights glowing; then the paddles, pre-juiced to 300 watt-seconds, so as to be ready to go if her heart stopped beating; followed by the mobile crisis center known as the “crash cart,” each of its drawers bearing a different drug in a hypodermic for ready administration. Isoproterenol for hypotension. Atropine to stimulate the heart rate. Epinephrine, to increase its contractility.

  Novick was so focused on these that she failed even to notice that McCorvey had removed the clamp on the IV sleeve. The Compound J team watched in silence, their gazes moving from the small overhead bottle bearing the clear liquid to the patient’s face, and then back again. If she was to have a negative reaction, it would come within the first five minutes.

  They waited eight.

  “Well,” spoke up Judith Novick finally, “when are you going to give it to me?”

  Sabrina laughed and pointed toward the bottle, the liquid flowing from it visible through the clear tubing. “You see. No problems.

  “I think perhaps her husband can come in now, no?” said Sabrina.

  McCorvey shrugged. “Fine by me.”

  “Let’s continue the slow drip for another ten minutes, just to be sure,” instructed Logan. “Then we can speed up the dose.”

  If it hadn’t been so unprofessional, he might’ve grabbed Sabrina and kissed her full on the lips. Instead, he turned from one to the other, grinning. “Let’s hear it for anticlimaxes, right?”

  A dozen times that day, as he went about his daily routine, the thought seized Logan’s consciousness: We’re really doing this thing! Soon, one way or another, we’ll know!

  He made three visits to Novick’s room during the next six hours. Sabrina made four. Even Reston stopped by a couple of times. Always she was resting comfortably, watching TV or reading; and by the end of the day, the doctors’ repeated appearances seemed to baffle her as much as they pleased her.