The Magic Bullet

by Harry Stein

  There was considerable irony in the fact that the patient in question turned out to be Hannah Dietz—who, following her toxicity problem, Reston himself had tried so hard to have removed from the protocol. In fact, uncertain as to how much the patient knew about that conflict or his role in it, Reston had come close to letting one of his colleagues deal with her now.

  But he was immediately reassured by the warmth of her greeting. “Dr. Reston, it has been far too long.”

  He smiled back. “Don’t you worry, Mrs. Dietz, I’ve been keeping up with your every move. I see you’ve licked that bleeding gums problem.”

  “Yes, yes. No more of that, thank goodness.” She nodded. “My Phil is such a good fellow. You know what he tells me all the time now? ‘We beat one, we’ll beat the other.’ ”

  “That’s important,” he said. “Any doctor who tells you a patient’s attitude doesn’t matter hasn’t been keeping his eyes open.”

  “I’m sure.” She smiled. “It’s just too bad the other is cancer.”

  Dietz’s case was distinct from the others on the protocol in that hers was a palpable tumor: a discrete rocklike mass of five by four centimeters, it was more easily monitored by touch than via X ray or CAT scan. So immediately, when Reston began manipulating the tumor, he was struck by the change. Not only had there been a significant reduction in size, but what remained was now rubbery, blending seamlessly into the surrounding tissue.

  Reston made little effort to hide his excitement.

  “Mrs. Dietz,” he announced, “I think I’ve got some unbelievable news for you! This tumor of yours seems almost gone.”

  Having grown accustomed to doctors speaking in measured tones, Mrs. Dietz took a moment to react. “Really?” was all she could find to say.

  He nodded vigorously. “I swear to God, I can hardly feel the bastard. Pardon my French.”

  She grinned. “At the moment, I do not mind your French one bit, young man.”

  “Would you like to call in your friend? What’s his name?”

  “Phil. Oh, yes, I would like that very much.”

  “Just for a minute, just to give him the news.”

  “She’s better?” asked Phil a moment later, incredulous. “Is this what it means?”

  Reston hesitated. “Let’s just say that we’re a lot better off than we were yesterday.”

  In fact, now that he was past his initial euphoria, he was painfully aware that he should never have led them to so definitive a conclusion; a tactile diagnosis can be inexact—and sometimes dangerously misleading. Until he had solid confirming data, it would remain the medical equivalent of hearsay.

  “Listen, Phil, I’m afraid you’ll have to leave us now. We’re going to have to run a couple of tests.”

  “Will it take very long?”

  “Not at all. Maybe forty-five minutes.” He began easing him toward the door. “And, please, at least for the time being, don’t mention this to anyone.”

  “Why?”

  “It’s just a bit premature. It would not be in Hannah’s best interest.”

  “Now, then,” said Reston, closing the door behind him and facing Dietz. “What we’re going to do now is do a biopsy.”

  She literally shrank back. “Will it, you know …?”

  “Hurt?” He smiled. “Nah, you’ll hardly feel it. You won’t even have to leave the room.”

  In fact, the most difficult part of the process was the administration of local anesthetic. The cytologist charged with performing the biopsy itself—a good friend of Reston’s—finished his part of the job in less than two minutes; with a modified hypodermic extracting from the tumor site two small specimens of pinkish matter.

  Under normal circumstances, it is several days before the results of such a test are available. But before the cytologist headed back toward his lab, Reston called him aside.

  “Listen, Roger,” he said, dropping his voice, “could you put a big rush on this one? That lady in there’s sitting on the bubble. I’d like to be able to give her some good news.”

  The other considered a moment, then nodded. “I don’t get to deliver enough of that myself. And she seems like a nice woman.”

  The results were back before noon the next day. The material removed from the lower outer quadrant of Hannah Dietz’s breast was nothing more than fatty tissue. Not a single malignant cell had been found.

  Reading over the data, Reston let out a whoop and dashed across campus. By the time he reached Seth Shein’s lab he was breathless, his faced bright pink.

  “What the hell happened to you?” asked Logan.

  “I got some news,” he panted. “Get out here.” He turned to Sabrina. “You, too, signorina.”

  In the hallway, he thrust the page their way.

  “Hannah Dietz …” began Logan.

  “Is clean. You’re holding her bill of health. We should get Shein out here, he’ll wanna know this too.”

  Logan smiled broadly. “Number two. I can hardly believe it.” He stopped. “Wait a minute, when did you examine her?”

  “Yesterday,” said Sabrina, eyeing the page.

  “Why didn’t you say something before this?”

  “He wants the credit,” said Sabrina in a low voice, turning to Reston with disdain. “This Reston, he does not change.”

  “I wanted to be sure,” he countered. “I didn’t want to waste anyone’s time. Including the patient’s.”

  “I presume,” said Logan, “that you told her before you came running over here.”

  He hesitated. “Not yet.”

  “Where is she?”

  “Over at the clinic with that boyfriend of hers.”

  “Well,” said Logan, starting to betray the full extent of his irritation, “don’t you think that’s something you should do?”

  Reston stared at him coolly. “Sure. But I’d like to tell Seth Shein first.”

  “We can handle that.”

  “I’m sure you could.” He snorted. “I’m sure you’d love to cut me out of this thing entirely, the way you have from the beginning.”

  Logan shook his head and sighed. “Never mind. I’ll tell Hannah.”

  “I will too,” said Sabrina.

  Fixing him with a look of unapologetic contempt, Logan bowed low, a musketeer pointing up a rival’s utter lack of class. “Go ahead, Doctor,” he said, gesturing extravagantly toward the door to Shein’s lab, “he’s all yours.”

  Of course, it was willful delusion on Reston’s part. Everyone at the ACF with any interest in Foundation politics knew who was most responsible for the Compound J trial: Logan and Como. It was they who’d done the important groundwork and, equally to the point, they who’d stuck by the protocol through the lean times; publicly defending it in the face of criticism that sometimes bordered on derision. If it now achieved any measure of success, there was no question they’d be the ones getting most of the credit.

  Which, the rumor mill at the ACF had it, was suddenly a very distinct possibility. Specifics were lacking; few had followed the trial closely enough to know even how many patients the Compound J team had accrued, let alone the particulars of their treatment.

  But all at once the tenor of comment about the protocol underwent a startling shift. Before, conventional wisdom was that the thing was a bust: there were toxicity problems, patients were being dropped from the program. Now the talk was of surprisingly positive results. Word had it that Seth Shein, no less, was talking in terms of “a breakthrough treatment.”

  True to form, Shein was publicly uncommunicative. A veritable student of the art of rumor-mongering, once he’d leaked just enough to set things in motion, he pulled back, deflecting questions with what was taken as bemused innocence. “Hey, I haven’t seen any results. What d’you think, I spend my life lookin’ over those kids’ shoulders?”

  But to Logan, he soon made his strategy explicit. “You’re doin’ great, unbelievable!” he put it to him a couple of days after learning of the second response. “I�
��d just like to see you build up the case a little bit more before we hit ’em with it.”

  Logan looked quizzical. “ ‘Hit ’em’?”

  “I’ve been thinkin’,” elaborated Shein, “about settin’ you up at Grand Rounds. Think you could handle that?”

  Logan looked at him incredulously. The Grand Rounds presentations, held every Tuesday morning in the ACF’s cavernous main auditorium, were the most prestigious forum afforded by the Foundation; speakers were generally top scientists, both American and foreign, hoping to draw attention to major research developments.

  “I’m thinkin’ after Labor Day,” added Shein. “They’ll be in a good mood from roasting their fat asses in the sun.”

  “You think I’m ready for Grand Rounds?”

  “Ah, bullshit,” said Shein, waving this away, “nothin’ to it.” He paused. “I’m gonna want you to go into detail about some of the responses you’ve had.”

  “Both of the responses,” corrected Logan. “There’ve been only the two.”

  “So far. Two outta fourteen ain’t bad. And I’m bettin’ there’ll be some more icing on that cake.”

  By now, Logan knew enough not to question Shein’s uncanny intuition. And, in fact, they had a third response only a couple of days later: sweet old Mrs. Kober, whose supraclavicular node, like the malignancies of Marjorie Rhome and Hannah Dietz, had seemingly vanished.

  Sabrina, who conducted the exam, brought Logan the news—along with a note from the patient.

  Dr. Logan,

  Don’t forget … we have a bet on the Giants versus the Cowboys next season at the Meadowlands.

  Sally Kober

  P.S.—Suddenly I am feeling much better about my chances of collecting. Thank you.

  It was a day after that that Logan was summoned back to Larsen’s office.

  “I’ve been expecting to hear from you,” began the head of the Department of Medicine, fixing him with a cool stare. “I thought it was understood, in light of our earlier conversation, that I would be kept informed of the status of your protocol.”

  Logan recalled no such understanding at all. “I’m sorry, sir,” he stammered, “there must have been some sort of misunderstanding.”

  “I’m sure,” said the other. “How convenient for you.”

  “But we’ve done exactly as instructed.”

  “You have, have you?” He arched his eyebrows, lending him a sudden resemblance to William F. Buckley. “I suppose you expect me to take your word on that?”

  “Dr. Larsen, I assure you that every patient we see is made aware of the toxicities associated with this drug.”

  It was true, the creatinine problem was now mentioned as a matter of course. But what Logan failed to note was that so, too, was the fact that the drug had begun showing highly impressive results.

  “And, as a consequence, how many of these patients have chosen to discontinue treatment?” asked Larsen.

  “None, sir.”

  “None?! And you expect me to believe that you’ve told them the whole truth? What kind of fool do you take me for, Logan?”

  “I’m sorry, sir, I don’t mean to imply that—”

  “You’re a liar, young man!” he suddenly shouted. “I’ve known it from the first day I met you. You should never have been accepted into this program!”

  But sitting there across from him, Logan felt a remarkable sense of well-being. This was the performance of a desperately insecure man, flailing about for a solution to a problem he knew was beyond his control. Larsen was aware of the growing regard for Compound J—and there wasn’t a damn thing he could do about it.

  “I’m sorry you feel that way, sir,” replied Logan, “I really am.”

  “Spare me your feelings,” spat back Larsen. He hesitated. What most concerned him—the responses the drug had lately elicited—was something he dared not broach. If the rumors had merit, he certainly had no intention of hearing it from this source. “You’d just better pray,” he added, “that when all is said and done, everything you’ve told me holds up.”

  “Yessir,” nodded Logan, far from intimidated. His heart was soaring. He’d beaten the son of a bitch! Look at him, reduced to firing blanks!

  “And that you have in no way brought disrepute upon this institution. Because there are still some of us who take things like that extremely seriously.”

  “Yessir.”

  Abruptly, Larsen stood up. “I really don’t think,” he said scornfully, “that you and I have anything more to say to one another.”

  The fourth response came a week later: Sharon Williams, the woman whose tumor had migrated to the bone.

  This one, however, was somewhat less definitive. Establishing a response against malignancies in the bone is a dicey proposition, since bone scans can take months to reflect the healing process. Rather, Logan made the judgment about Mrs. Williams based primarily on the testimony of the woman herself.

  Showing up at the clinic for her exam, she was positively glowing.

  “Something’s happening to me,” she announced. “It’s remarkable.”

  “How do you know?” asked Logan.

  “How do I know?” She put her hand on her hip and replied with exaggerated sauciness. “Honey, I know every inch of this body. I can feel it.” She paused. “Or, rather, I can’t feel it.”

  “You’re saying there’s been less pain?”

  She laughed. “Doctor, the pain is gone. For a year and a half, I’ve had to take codeine regularly every three hours just to keep going. But last week I stopped, and I haven’t even thought about it since.”

  In the absence of the usual confirming data, Logan and Sabrina were at first hesitant to count this as a response. Yet there was another fact that went a long way toward making the case. A marker of the disease, the antigen 1Y-32, present in an overwhelming percentage of breast-cancer patients, was suddenly absent in the blood of Sharon Williams. True enough, the 1Y-32 test was itself experimental—but in this case it jibed so well with other factors that making the leap seemed reasonable.

  “Besides which,” noted Logan, grinning but meaning it, “it’ll be terrific for the Grand Rounds presentation. The more variations of this disease we can claim to be getting at, the better.”

  The truth was, as the big day approached, Logan’s excitement and apprehension grew apace. Some evenings, awake in bed, he saw himself the focal point of a triumph as stirring as the one in his favorite medical movie classic, The Story of Louis Pasteur; his stunned audience leaping to their feet in spontaneous tribute. But just as often, the thought of even appearing before so vast and distinguished a throng, most of them highly skeptical and some frankly hostile, filled him with dread.

  Shein was naturally keyed into Logan’s mindset almost from the start. “Jeez, what the hell’s wrong with you?” he put it to him a week before the speech. “I mean, the crap you put yourself through!”

  As usual, Logan wasn’t sure whether Shein’s words were meant to taunt or reassure. Probably Shein didn’t know himself.

  “I know,” he conceded. “I guess it’s just nerves.”

  “What’re you worried about, Logan? You got it made.”

  “You keep forgetting, I’ve never done anything like this before.” He paused. “I guess I’m a little concerned that, you know, Dr. Markell is going to be there.”

  “That’s right, he is.” Shein nodded thoughtfully. “I see what you’re sayin’—you’d better be absolutely fuckin’ brilliant.”

  “Thanks. I needed that.”

  “Christ, Logan, Markell’s nothing to worry about. Believe me, I know—no one handles him better.”

  Logan was well aware of the extraordinary complexity of Shein’s relationship with the imperious head of the ACF. Though virtual opposites in manner and style, they were intellectual soulmates, sharing both a respect for talent and a contempt for those who got ahead without it. It made sense that, formerly Shein’s mentor, Markell—known in the infighting of institution politics as
a stone-cold killer—had turned into his protector; the reason, for all Shein’s calculated outrageousness, his enemies couldn’t touch him.

  But by the same token, free spirit that he fancied himself to be, Shein hated it that others were so aware of the fact. He chafed at being known as Markell’s boy, especially among his own people. More than once, Logan had been struck by how, out of the blue, awed and intimidated as he clearly was by Markell, Shein would make a point of slighting him.

  “I’ll tell you something else,” he breezily added now, “Markell’s screwed up plenty of times himself.”

  “So—what?—you’re saying he’ll understand if I’m a little shaky?”

  “Did I say that?” Shein grinned. “He’s got plenty of patience for his own fuck-ups—not for yours.”

  As the morning approached, Logan did what he always had when faced with a difficult challenge: he sought to overwhelm self-doubt through sheer preparation. He spent every available moment retracing the critical steps of the previous eight months; carefully reviewing his notes on the Tilley case and the articles unearthed by Sabrina that had helped them make important connections; returning to the voluminous files on the candidates for the protocol; rereading the case histories of each of the fifteen women who’d eventually been accrued; amassing the slides necessary to illustrate various aspects of the presentation.

  His plan was to recount the history of the Compound J protocol as a straightforward chronological saga, explaining as best he could the factors—prior research, new data, and simple intuition—that led to certain key decisions. In this way, he’d let the suspense build. Only in the final quarter hour would he reveal the striking responses the drug had now elicited in four patients.

  There was no way to guess how this would be greeted. He knew full well that everyone at the ACF had heard such claims before. Few in that audience would fail to understand that a handful of responses in a protocol setting do not automatically add up to a credible treatment approach, let alone a breakthrough. Still, the responses had been dramatic; and, more than that, the drug had apparently performed almost precisely as they’d predicted. At the very least, he felt he could make the case that Compound J was off to a flying start.