The Magic Bullet

by Harry Stein

  “Are you looking for something?” she asked Logan finally as he hovered above her with a stethoscope. “Is something wrong?”

  “Not at all,” he exclaimed, feeling just slightly foolish. “Just making sure you’re okay.”

  In fact, they were all hoping to find the same thing: evidence of a miracle. Generally, under the best of circumstances, a drug may take several weeks to show its effects. But once in a very great while, the impact on the tumor will be almost immediate.

  Logan was back the next morning, and again late that afternoon—though, like the others, he made a point of being less intrusive. By staggering their visits, the three of them were still able to guarantee she was seen every couple of hours.

  By the third day, she was ready to go home, and there was no plausible reason to keep her.

  “Fine,” agreed Logan, “tell your husband he can pick you up tomorrow morning.”

  “Great. I’m ready.”

  Gingerly, he felt the tumor. By now, he knew it intimately—not only its size, but its feel, its distinctive contours. “As long as you’re back here a week from Tuesday for your next treatment.”

  “Of course.”

  Could the tumor really be slightly softer than before? No, that had to be his imagination; he knew from experience that he could be as suggestible as anyone else.

  “So everything’s status quo? No pain?”

  “Same as this morning. Just fine.”

  “Good, that’s what we like to hear—”

  Abruptly, there came a knock at the door.

  “What is it?”

  “I’m sorry, Doctor,” said a nurse-trainee, opening the door a crack. “Mrs. Byrne is on the phone and she says it’s very important.”

  “Okay, we’re almost done here anyhow.” He smiled at Judy Novick. “Just keep on keeping on. We’ll see you on Tuesday.”

  A moment later, abruptly switching gears, he picked up the phone at the reception desk. “Faith?” he said, with concern. “This is Dr. Logan. Is something the matter?”

  “With me, nothing. Except the cancer. What I want to know is what’s wrong with you.”

  “I don’t understand.” There was a hardness to the voice that had nothing to do with the woman he’d seen here just a couple of weeks before.

  “You told me I have to wait a month and a half to get my treatment.”

  “Yes.”

  “So how come someone else has already gotten hers? What do you do, play favorites?”

  “Who told you that?” For precisely this reason, the ACF made a policy of not keeping protocol patients abreast of the status of others in their tests. This wasn’t a competition; in the final analysis, the order rarely had any bearing on patient performance.

  “Never mind who told me. That isn’t the point.”

  “Faith, listen to me, we’ve got a schedule we must abide by. The drug is administered according to when patients joined the protocol.”

  “I don’t give a damn about that,” she shot back. “I’ve got cancer! I’ve got to look out for me.”

  “Faith,” he said, with exaggerated calm, “we’ll have to discuss this later. I’m very busy right now.”

  “When?”

  “Later.”

  As he headed for home a few minutes later, he felt confused, exasperated, betrayed. Unavoidably, the most disheartening question any doctor must face loomed increasingly large: how in the world could he have been so wrong? Could he no longer trust his own instincts?

  It wasn’t hard to pinpoint Faith’s most likely source: Marion Winston, the patient care representative. As Logan well knew, Winston made it policy to contact every patient accepted onto the protocol. Her purpose was to let them know that, as she put it, she “was available to mediate in the event of misunderstandings with medical personnel.”

  When Logan stopped by her office the next morning intending to raise the subject of Faith Byrne’s call, Winston stopped him short with her opening words.

  “I heard from Mrs. Byrne at home last night. Apparently, you are not being very responsive to her needs.”

  Logan was determined to keep this civil; he knew more than enough about this woman’s readiness to cause trouble.

  “Listen, Ms. Winston, our job is to be fair to all the women on the protocol.”

  “Good. Well, just so we’re clear: I see it as my job to empower these women. So that they can also help decide what’s”—she made quote marks with her fingers—“ ‘fair.’ ”

  “I see. So you suggested that Faith call?”

  “She was troubled, I let her know it was up to her to let you know that.”

  “I see,” he repeated, with practiced calm. How the hell to neutralize this nut case? “Look, Ms. Winston …” he began again, “there’s no sense pretending. We both know you weren’t crazy about this protocol at the start. That’s all right. I’m just hoping we can work together now to minimize friction.”

  “Of course.” She eyed him coolly. “That’s always my intention. This has certainly never been personal.”

  He nodded; she said it with such certainty, he thought it was likely she actually believed it. “Well, I just want you to be aware that it can create problems for us when certain kinds of information are passed on to patients.”

  “Dr. Logan, I know many doctors prefer to keep patients in the dark. It gives them more power. For your information, it’s my policy to let in the light wherever and whenever possible,”

  “I’m just saying that Mrs. Byrne was made needlessly upset. There’s nothing we can do to help her.”

  “Why not?”

  “Because there’s a logical system to how these things are done. Anyway, it doesn’t even matter what order she goes in.”

  “Perhaps not to you.”

  “To her. To her chances.”

  “Well, then, if it doesn’t matter, why don’t you just move her up? We both know there are others on this protocol who truly don’t care what order they go in.”

  “Because that wouldn’t be right.”

  “Why? If it doesn’t matter.” Her eyes narrowed. “You see what I’m saying? Your own position doesn’t make sense. Just switch her with someone else and be done with it.”

  Logan’s head was starting to spin. He sighed. “I don’t know. Maybe. I’ll have to give it some thought.”

  “Sorry, I’m afraid I have another appointment,” she said, abruptly rising to her feet. She offered what under other circumstances would pass as a friendly smile. “But I’m sure you know how much Faith and I would appreciate that.”

  When Judith Novick showed up at the hospital the following Tuesday for her second treatment, the change was unmistakable. Though she was still unsteady on her feet—and, to the naked eye, her tumor appeared undiminished in size—her color was dramatically better, and so was her disposition.

  “I’ve been feeling great,” she confirmed. “Less tired than anytime I can remember.”

  Standing beside her in the examining room, Logan and Sabrina exchanged a quick glance, sharing their pleasure.

  But Sabrina deliberately understated it to the patient. “This is good,” she said evenly, “a very good sign.”

  For, of course, both doctors knew that such a reaction—if, indeed, what they were seeing was even a reaction to the drug—could prove fleeting.

  Still, checking the tumor, there was no question it was slightly more yielding to the touch: more like a tennis ball than a hardball. And when they measured it, they found that it had even shrunk three quarters of a centimeter—not statistically significant, but still a very encouraging development.

  In any case, Novick wasn’t waiting for the doctors’ authorization to celebrate her sudden new vigor. “This past week has been so wonderful,” she announced. “I’ve been seeing people again. My husband took me to the movies. The other day I even went out shopping.”

  “That’s terrific, Judy,” agreed Logan. “Just wonderful.” He hesitated, not wanting to play the ogre. “Just r
emember: Go slow, take it easy. We’re still very early in this process.”

  “Of course. I know that. I don’t have any illusions.” Suddenly she smiled and her face looked nothing short of radiant. “But, I’ll tell you, I almost don’t care. I never thought I’d ever feel this good again—not even for a day.”

  15 May 1929

  Frankfurt

  Improved results on latest series of experiments. Version #337 showing heightened activity in laboratory rats. Some tumors shrinking twenty-five percent! Could this be a breakthrough? Must guard against overoptimism. Sixteen years on the project already, and toxicity as great a problem as ever.

  Was definitely the right decision to come to Christian Thomas Company. Herr Thomas follows work closely. Very interested in progress, yet also recognizes synthetic biological problems.

  Emma an even greater source of comfort. She keeps me balanced, listens to my frustrations and complaints. Wish I could be as good a husband to her. If it ever comes, my success will be her success.

  As she lay in bed, waiting for her treatment to begin, Faith Byrne appeared as calm as could be expected. “That’s our girl,” encouraged Nurse McCorvey, inserting the IV line into her arm. “You’re not gonna feel a blessed thing.”

  Since Faith had assumed the fourth slot—it had previously belonged to a certain Hannah Dietz, who welcomed the delay—they’d been through the procedure three times by now; it was starting to feel routine. In fact, standing off to the side, Logan was the lone representative of the Compound J team on hand. They’d decided that “witness duty” would revolve among the three of them.

  “That’s right,” echoed Marion Winston, “easy as pie.” The patient care representative placed her hand lightly on the patient’s arm. “I wish I were as comfortable as you look in that bed.”

  “Hey,” said Faith, through a tight smile, “feel free to change places. And I mean anytime.”

  Though they’d had their first face-to-face meeting only the evening before, on Faith’s arrival at the ACF, the rapport between Winston and Byrne was obvious. Watching, even Logan had to agree that Winston had a special touch with patients in need of reassurance.

  “How long will it be?” Faith strained to get a look at the overhead bottle bearing the Compound J.

  “Just a minute now,” said McCorvey. “You want me to tell you when it starts?”

  “Of course. It’s my life.”

  “Then just hold on, dear. I’ll let you know.” McCorvey waited a few seconds and gingerly removed the clamp. “Now.”

  The patient exhaled deeply and, staring up at the ceiling, lay perfectly still, working at trying to relax. Logan snuck a peek at his watch. Nine thirty-eight. At, say, ten of, he’d be able to think about leaving.

  Two minutes went by. Then a third.

  “Something’s not right,” spoke up Faith suddenly. “I feel strange.”

  Instantly, Logan was at her bedside.

  “What, Faith? What is it?”

  “Stop the medicine! Please!”

  “What is it? Tell me.” Logan looked over at McCorvey. Her face reflected his own intense concern.

  “I feel chilled all over! I’m getting nauseous!”

  Reflexively, Logan weighed the data before him, focusing on the worst-case scenario: She could be undergoing anaphylaxis—a severe toxic reaction, similar to that produced by a bee sting in someone with an extreme allergic sensitivity.

  But, no, he discounted the possibility almost at once. The symptoms of anaphylactic shock hit immediately after administration; within seconds, the patient will start wheezing, then usually black out. Faith’s breathing was not labored, and her color was good.

  “What’s her pressure?” he asked McCorvey.

  She checked the monitor. “One twenty-five over eighty.”

  “Heart rate?”

  “Seventy-five.” Also normal.

  The problem, he could only conclude, was nothing more than acute anxiety.

  Logan nodded toward the crash cart. “Prepare a milligram intravenous of lorazepam.” A Valium analog.

  He leaned in close to the patient and spoke soothingly. “Faith, I’m almost certain it’s nothing serious. We’re going to give you something to help you relax.”

  “No! What I need is epinephrine!”

  Under other circumstances, Logan might have laughed: talk about a little knowledge leading to big-time lunacy! Epinephrine is more commonly known as adrenaline; by speeding up the heart rate by forcing the muscle to contract spasmodically, it can lead to angina, especially in someone of Faith Byrne’s age.

  “I really don’t think that’s necessary,” he reassured. “Let’s just see how you do over the next few minutes.”

  “Doctor, the woman is telling you she’s in crisis!”

  Startled, Logan looked across the bed at Winston. “Please, Ms. Winston, the situation is in hand.”

  “I’m not sure it is! I would like you to call for backup!”

  Goddamn it! What was it with this bitch?

  “I assure you that isn’t necessary,” he replied calmly. “What Mrs. Byrne is describing is not life threatening.”

  If he could just hold things together another a couple of minutes, he knew, matters would resolve themselves. It would become obvious there’d been no reason for concern.

  “Listen,” he added, “I just think we have to be careful not to overreact. Nurse McCorvey …?”

  He saw McCorvey glance Winston’s way before responding. “Yes, Doctor?”

  Christ, was she going to be a problem too?

  “You’ve been through a number of these treatments. Perhaps if you would reassure—”

  “Never mind your reassurance, Doctor! What Faith needs is help!”

  “Ms. Winston,” he said evenly, buying time, “we’ve been through this procedure several times already. There’ve been no adverse effects.”

  Momentarily, this seemed to defuse the crisis. But with a sudden wail, Faith Byrne again commanded all eyes. “Oh, God, please, don’t let them kill me.”

  Winston took her hand. “I promise you, that’s NOT going to happen. Dr. Logan, I must insist that—”

  “No, it’s not,” he cut her off. By now he had to make a physical effort to maintain the surface calm he needed to do his job. “But if it’ll set your mind at ease …”

  He picked up the phone and punched in the nurses’ station. “This is Dr. Logan in room three fourteen. I’d like some backup here, please, stat.”

  As he hung up, he glanced at his watch; then, to be sure, waited another thirty seconds. “I just want to tell you, we’re already past the danger point. And, as you see, Mrs. Byrne has had no adverse reaction to this drug.”

  He half expected an apology. Instead, Winston only squeezed Faith’s hand a little tighter. “See that. Nothing to worry about.”

  Now that all concern had passed, Logan eyed the patient care rep with cool disdain. “Ms. Winston, you are not medical personnel. I would really appreciate it if you would stand back now.”

  “That’s your response, Doctor, to what’s just happened here? I happen to be doing my job.”

  “Yes? Well, you’re going to have to learn that the rest of us have jobs to do also. You’re going to have to learn it and respect it.”

  “What is this about? What is this problem?”

  And there, in the doorway, stood Sabrina.

  “Dr. Como,” exclaimed Winston. “Thank God!”

  Logan nodded Sabrina’s way. “I’m afraid we’ve had a bit of a misunderstanding. But I think it’s fair to say everything’s under control now.” He looked down at the patient. “Are you feeling better, Faith?”

  “I don’t know. I guess so.”

  “Nonetheless,” said the patient care rep, “I believe Mrs. Byrne would feel a lot more comfortable if Dr. Como took over now.”

  Logan just stared at her. Go fuck yourself, lady! You can go straight to hell! “Is that true, Faith? Is that what you want?”

 
; Byrne didn’t hesitate. “Yes. It is.”

  “Well, then, that’s that.” Fuck you too! “Dr. Como,” he said, with a brittle smile, “I guess it’s all yours.”

  “Yes,” she said, a portrait in studied neutrality. “Thank you, Dr. Logan.”

  And Logan strode from the room, leaving the woman he loved to supervise what had, in fact, from the beginning, been an entirely routine procedure.

  Over the days that followed, Logan couldn’t stop replaying the incident in his head. This woman had done nothing less than challenge his very credibility as a doctor. And on his own protocol!

  Still, the best policy was to play it cool. He hoped against hope that word of what had happened would not get around the ACF. After a week, he’d almost begun to believe it was possible.

  Then, late one afternoon, Allen Atlas sidled up beside him in the otherwise deserted junior associates’ lounge. “So, I hear you’ve been rejected by one of your protocol patients.”

  Logan turned to face him. The bastard was grinning broadly.

  “Say, Logan, isn’t it supposed to work the other way around? I know in Dr. Stillman’s protocol, it’s the doctor who’s in charge.”

  “Don’t worry about me. Or our protocol.” He paused; then, despite himself, the words came rushing out. “The results have been very encouraging so far.”

  “You’re completely full of shit, Logan.”

  But for all his ostentatious contempt, Atlas couldn’t entirely disguise his interest.

  “Very encouraging,” repeated Logan, in too deep to pull back now. “We’ve already had a partial response. Some tumor shrinkage.”

  “Some tumor shrinkage? Big fucking deal.”

  “Correct me if I’m wrong, Atlas, but you didn’t used to have such a filthy mouth. What’s with you, you even have to imitate the way these guys talk?”

  “Talk to me when you have a serious response. Anything less than fifty percent shrinkage in a big tumor means shit, Logan, and you know it.”