The Magic Bullet

by Harry Stein

  “Who from?”

  “Just something to do with the protocol,” he evaded. “It’s nothing.”

  “From a doc?”

  “A researcher, retired. An old guy. It’s nothing.”

  “They really come out of the woodwork, don’t they?” he said pleasantly. “You should see some of the kooks I hear from after starting a trial. All these losers with something to say.”

  “Oh, yeah?” For the life of him, Logan couldn’t figure out why Shein was being so damn friendly. Was he ever going to figure out where he stood with this guy?

  “The old ones, they’re the worst. Either they’re bored and want you to amuse them with details of the work, or they have advice to give you based on hundred-year-old science. Which one’s this one?”

  Logan smiled. “He wants to hear about the work.” Worse, was he ever going to get past this need for Shein’s approval? Sabrina was right, it was like his father all over again!

  “Lemme see it,” said Shein, sitting beside him on the bench.

  “It’s a personal letter.”

  “C’mon, will you?” He held out his hand. “I’ll show you mine if you’ll show me yours.”

  Reluctantly, Logan handed it over—then, as the senior man started to read, watched for a reaction.

  My dear Dr. Logan:

  Greetings and best wishes. My name Rudolf Kistner. I live now in the city of Köln, as a pensioner. I write to you in the English that I learned years past in the Gymnasium in the time of the First War.

  Shein looked up. “You didn’t say he was German. Stop holding out on me, Logan.”

  “Holding out on you?”

  “I’m joking, Logan. Jeez, when’d you get so damn sensitive?”

  Formerly I am an organic chemist. I write you because I learn from my readings of the protocol you conduct at the American Cancer Foundation. This is interesting to me, because many years ago I worked also with compounds of sulfonate derivatives against cancer. In those times, we had many hopes for such drugs.

  Surely, you are a busy man. But it would be a great favor if perhaps you could take a moment to tell me of your labors. I am old now, but I have much time to think and wonder. For this, one is never too old.

  With very sincere regards, Rudolf Kistner

  Shein handed back the letter. “Christ, the guy’s gotta be ninety years old. Straight outta the Dark Ages.”

  “What do you think I should write him back?” For, in fact, given the letter’s place of origin, Logan’s curiosity was piqued.

  “Tell him to go fuck himself.” Shein grinned. “Nicely—you’ve got the ACF’s reputation to consider.” He paused, turned more serious. “Sorry to hear about that woman’s prothrombin time problem. You got it under control?”

  Logan hesitated, acutely aware that Hannah Dietz’s toxic reaction, mild as it was, could be used to slight the protocol. “Absolutely. The Vitamin K tuned her right up.”

  “Good, that’s good.”

  “We’re just going to have to keep a close watch on her.”

  “Uh-huh.”

  What now? Far from concerning Shein, the Dietz problem barely seemed to hold his interest.

  A moment later he found out why.

  “Listen, Logan,” he said, turning to face him, “I gotta tell you something. You really got that sick fuck going!”

  It took a couple of seconds for Logan to figure it out. “Stillman?”

  Shein laughed. “He’s scared to death he’s gonna be shown up by a bunch of punk kids!”

  “Us?” asked Logan, reasonably. “Why?”

  “Why?” Shein’s voice dropped. “Because Stillman’s finally faced the fact that his protocol’s gonna be a total disaster, that’s why. He has the evidence in hand. He knows the stuffs just gonna keep laying there and pretty soon everyone else will too.” He laughed again. “Poor son of a bitch!”

  Logan didn’t need to ask how Shein knew—the guy had sources everywhere.

  Anyway, just as meaningful to him at the moment was the revived sense of intimacy between the older man and himself.

  “That’s great,” he said, uncertainly. “Are congratulations in order?”

  Shein clapped him on the back. “Damn right they are, Logan. The bigger his failure, the bigger my success.” He stood up. “Now what I need from you is not to let up. Wring some activity outta that stuff of yours and it’ll be the stake through his heart!”

  * * *

  Sabrina, when she reached Logan that night from the hospital, was not amused by any of this. “This Shein cannot be listened to. Every minute he will change what he says.”

  “I know that, Sabrina,” he said—though, in fact, he could not help but view the senior man’s latest attitude change more hopefully. “I’m the one he keeps jerking around.”

  “Yes—but then you jerk me.” He could hear the exhaustion in her voice. It was the end of another very long day—one even longer than most. A couple of hours earlier word had come in that Judith Novick had died.

  “You I don’t mind jerking,” he tried to lighten things up, “as long as you jerk me back.”

  “Anyway, on the subject of Stillman, I have heard something today also. About Reston …”

  “From who?”

  “Rachel Meigs.” Her friend who was assisting on the Stillman protocol. “She says Reston makes fun of Compound J right in front of them. Even Atlas.”

  Silence. What was there to say?

  “He talks about the Hannah Dietz case. He makes these bleeding gums sound like, I don’t know, a massive coronary.”

  Logan had no trouble at all imagining the scene. “He’s trying to protect his own miserable ass,” he said bitterly.

  “I despise this guy.”

  “You’re not gonna hear me argue, Sabrina. You were right all along.”

  “It isn’t why I tell you this, to be right. But it is important to face. Because it is something we must to deal with.”

  “Unless the protocol pans out. I know this guy. Believe me, if things start going better, Reston’ll be right back with the program.”

  She was in her private office, meeting with two associates, when she was told her doctor had been waiting some time to see her. It wasn’t exactly that she’d forgotten he was due, just that she’d been so determined to carry on business as usual.

  “We’re going to need some privacy,” she said, dismissing both women with a curt nod. “I hope this won’t take too long. Why don’t we plan on resuming around five?”

  The younger of the women, fairly new to the job and eager to impress, quickly gathered up her things and headed for the door. But the other, Beverly, her chief of staff, lingered a moment and gave her hand a squeeze. “Good luck.”

  Having given up smoking nearly fifteen years ago, she rarely even craved a cigarette anymore. But suddenly, now, she did.

  There was a knock at the door.

  “It’s open.”

  As soon as she saw his face, she knew the news was bad.

  “So,” she said, forcing a smile, “they got it done in less than twenty-four hours. Tell them I’m impressed.”

  “I will.” He offered a small smile of his own—a doctor’s smile, not nearly so sincere as a competent politician’s. “Mrs. Rivers, I hope you’ll forgive me, I’ve taken the liberty of—”

  Abruptly, John entered the room. He was ashen faced—not a politician now, but an ordinary husband. My God, she thought, he knows too!

  Wordlessly, he took a perch on the arm of her chair and kissed her cheek. “I love you, Elizabeth,” he said.

  “That bad?” she said, glaring at the doctor. Lord help me, she thought, I’m not prepared for this! Why didn’t I prepare?

  “I’m afraid that the biopsy shows there is a malignancy present.”

  There it was: the death sentence.

  “Could you be a little more specific?”

  But as he launched into a jumble of medical jargon, she scarcely even listened.

  “So y
ou’re saying this is bone cancer?” asked John.

  “No, sir. Based on what we see, the disease originated in the breast and metastasized to the bone.”

  “Then what are we talking about”—he hesitated—“breast surgery? I don’t understand.”

  The doctor shook his head sympathetically, secretly surprised that a man renowned for his wide-ranging knowledge could know so little about something that in his own circle was regarded as elementary. “I’m afraid, sir, that at this point surgery on the breast would only eliminate a small portion of the disease.”

  “I see.” Briefly, he glanced out the window at the vast expanse of lawn. “I take it this is certain? No chance of a mistake?”

  “No, sir. I’m afraid not.”

  He placed a reassuring hand on her shoulder. “What is the next step? Can you give us any kind of realistic prognosis?”

  “Look, we’ve come a long, long way. There are some very effective treatments. I recommend the first thing we do is call in Dr. Markell from the ACF.”

  “How dare you?” she suddenly erupted.

  They both turned to her in surprise. She was in a rage, glaring at the doctor.

  “This is MY life! What in hell do you think gives you the right to supersede my wishes?”

  “Mrs. Rivers, I’m sorry, it just seemed to me that your husband had the right—”

  “Well, that’s not your call to make! How DARE you!”

  “—that your husband had the right—”

  “That’s crap, you were worried about your own ass!”

  “Elizabeth, please, you’re upset.”

  “Damn right I’m upset! I’ve got cancer! And his only thought is how he’s going to look in front of the President!”

  “Mrs. Rivers, I assure you that’s not true. I’m sorry, perhaps I did use poor judgment.” He looked to her husband, then back at her. “I can only tell you I’ve known many patients with metastatic breast cancer who have done very well. That’s what you must focus on now.”

  But her fury was spent. Suddenly, there were tears in her eyes, and a moment later she was sobbing. “I don’t understand it, I’ve done everything I’m supposed to. Self-examinations. Mammograms.”

  Her husband took her in his arms. “It’s not your fault, darling, it’s nobody’s fault. The doctor’s right—what we’ve got to think about now is fighting it.”

  With his free hand, he snatched up a phone from the table and punched in three numbers. “Diane, cancel my appointments for the next couple of hours. I’ll be reachable upstairs in the private quarters.”

  The doctor shifted uneasily. “I understand you want to be alone. You’ve got a lot to talk about.”

  “Yes, well …” President Rivers rose to his feet and extended his hand to his wife. Slowly, wearily, she drew herself from the chair. “We should probably talk tomorrow.”

  “I just want to say in the strongest possible terms that there is every reason for optimism.” He nodded out the window, in the general direction of the ACF, across the river in Virginia. “They’re doing remarkable things there, just remarkable.”

  Their first year at the American Cancer Foundation came to an end the second week in June. That weekend, Shein held his annual party to welcome the new crop of raw rookies.

  Logan elected to miss it. That was all he needed just now—to spend an entire afternoon making nice to Larsen and Stillman and their assorted underlings.

  For, increasingly, he was aware that the Hannah Dietz case had left Compound J riper than ever for ridicule. True enough, in a strictly medical sense the protocol was not fundamentally compromised: Dietz’s toxicity having been minimal and eminently treatable.

  But—especially coming as it did within weeks of Novick’s fall—there was also the psychological factor. Like it or not, the Compound J protocol was now regarded at the ACF as being in some trouble. Before, its opponents had merely been able to say it was a harebrained idea that amounted to nothing. Now they could say something else—and it made Logan almost physically ill to think of the pleasure they got saying it: It was a harebrained idea that makes people even sicker.

  More than ever, Logan knew, time was working against them.

  The great irony—at least if Shein could be believed—was that Stillman’s own protocol was already, demonstrably, a complete bust.

  Then, again, could Shein be believed? Certainly Stillman gave no sign that his protocol was in trouble. His public posture was that it was proceeding exactly as planned; the drug’s lack of activity described as anticipated, his sole aim at this early stage being to establish nontoxicity.

  As much to the point, Shein had said not another word about it. In fact, the next time they saw each other, the conversation might as well never have happened.

  “Hey,” the senior man greeted him, “you’re looking good. Good color. Looks like you’ve been getting some sun.”

  “Thanks.”

  “Don’t reach for compliments, Logan. Maybe if you worked a little harder you’d get some results.”

  Shein’s return to humiliation mode could not have come at a worse time. With the rookies coming in to take over the hospital scut work, the second-year associates were now moving up to lab work—which, for both Logan and Sabrina, meant going to work directly under Seth Shein.

  And, as if his opening put-down hadn’t been enough, ten minutes later, facing his entire flock of second-year associates, the senior man gave an introductory talk that registered as a personal message to the Compound J team.

  “Well, boy and girls,” he began, “I know you and you know me, so we can save all kinds of time. The work we’re gonna do here won’t always be fun. And there won’t be a helluva lot of glory.” He glanced at Logan and Sabrina. “Sorry, it’s back to real life.”

  That brought smirks from several others in the room. “But here’s the upside,” he continued. “As you all know—as some of you especially know—I do play favorites. So work hard to stay on my good side. And never, ever make me look bad.”

  The worst part was that Logan was no longer sure he could blame him. If Compound J failed to pan out, he, Sabrina, and Reston would of course take the hardest hit. Pegged as arrogant kids whose ambition had proven greater than their judgment or skill, they’d be unceremoniously hustled off the fast track, and kept off it for the forseeable future. But as their most ardent supporter, Shein would be in for his share of grief too. Surely it was his prerogative, now, to think about cutting his losses.

  The pity, for Logan, was that there’d never been a time when favoritism would have been more welcome. While most other junior associates, including Sabrina, had little experience in organic chemistry beyond a few basic undergraduate courses, he not only held an advanced degree in the field but had trained under a renowned Nobelist; where the others found the routine lab work doled out by Shein instructive, he found it as mind numbing as anything they’d left behind at the hospital.

  Not that the project to which Shein assigned them wasn’t ambitious: determining the base sequence of the gene that encodes a protein involved in transforming healthy prostate cells to malignant ones. It was just that he found himself the scientific equivalent of a laborer on the Great Wall of China; doing grunt work on a tiny section of a project so large that its importance to the big picture was almost beyond imagination.

  The second-year associates’ role was simply to clone and sequence this gene so that other, more senior people would have material to work with. For Logan, day after day it was like following directions in a cookbook: Add three lambdas of the restriction enzyme Xba to DNA; spin for fifteen minutes; cool at four degrees Celsius; add 300 microliters of chloroform and 150 microliters of phenol; spin for five minutes; remove phenol and chloroform; add 300 microliters of one molar sodium chloride and one milliliter ethanol; keep at minus twenty degrees overnight.

  Under the circumstances, he soon began regarding the routine sessions with the protocol patients as a relief; a chance, if only fleetingly, to exe
rcise a little control. Now, even the hours perusing accumulated protocol data became less a chore than a pleasing change of pace. Studying the numbers, trying to discern the significance of modest fluctuations from week to week, was the only creative challenge he had left.

  Thus it was that he and Sabrina happened to be in the chart reading room—the librarylike chamber in the hospital basement—when Logan started going over the numbers of a patient named Marjorie Rhome. By the luck of the draw, he hadn’t seen Mrs. Rhome, a forty-eight-year-old dental assistant from Dover, Delaware, in over a month; on each of her last three visits, Reston had handled her.

  Her file, like that of every other patient in the protocol, was now massive: over a hundred pages of printouts, nurses’ notes, and comments by the examining physician in the outpatient clinic. Every medicine she had ever taken was listed here, as well as the result of every test; for blood work alone, that meant thirty-three individual results for each semiweekly visit.

  For fifteen minutes, sitting in a wooden carrel, he scanned the file. Then, on the fourth to last page, listing the results of her blood work from three weeks before, something caught his eye: the woman’s creatinine level, a measure of kidney function, was at 1.7. Immediately, he skipped ahead to the final page, listing the results of last week’s visit. The level had jumped to 1.8. Normal is 1.4.

  “Sabrina!”

  Sitting five feet away at the adjacent carrel, she was startled. “What is it, Logan?”

  “Look at this.”

  She, too, immediately grasped its significance. “My God,” she said softly.

  An elevation of the blood creatinine level meant the kidneys were not clearing it properly. Which meant that in all probability they were not clearing far more dangerous substances; particularly potassium, which can make the human heart flutter chaotically or even come to a dead standstill.

  “That idiot must’ve missed it,” said Logan bitterly. As far as Logan was concerned, the final straw on Reston—the definitive proof that he’d turned his back on the protocol—had been his erstwhile friend’s decision to do his lab work under Larsen’s associate, Kratsas. “He didn’t give a damn. For him it was just busywork.”