The Magic Bullet (33 page)

“No, you’re right, Doctor. It is about honesty. And competence.”

“
You
are the one who is not honest!” countered Sabrina; the very first time Logan had ever seen her so furious. “YOU! We are trying only to do what is best.”

“Look,” cut in Logan, “we are going to double-check the blood tests. We’ll triple-check them if you like. But the bottom line is that we cannot in good conscience continue to administer this drug to a patient who manifests this kind of reaction.”

He waited for a response. There was none.

“Now, Faith, as far as we’re concerned this examination is over. You may get dressed.”

Winston put a hand on the patient’s shoulder. “Go ahead,” she said gently. “You and I will talk in my office.”

As Byrne walked slowly toward the adjoining changing room, Winston, not unexpectedly, lingered behind.

“Are you waiting to have the last word?” asked Logan evenly.

“I just want you both to know that we are not going to let this stand. I’m not through with you.”

In an odd way, it was as if the pressure was off—at any rate, the pressure to be civil. Logan smiled. “You know, I’ve got an almost irresistible urge to tell you what I think of you—”

“Go ahead,” she replied too eagerly, chin forward. An invitation, it suddenly struck him, that could lead to a whole raft of new charges against him.

“But”—he turned to Sabrina, seemingly on the verge of an outburst of her own—“unfortunately, we’ve got better things to do.”

Arriving on campus the next morning, Logan was not surprised to find a note in his box instructing him to report to the office of Dr. Raymond Larsen.

“You’ve done it now, Logan,” began the head of the Department of Medicine. “I suppose I don’t have to tell you that.”

“How exactly do you mean, sir?” The fact that the senior man was so clearly enjoying this scene only reinforced his intention to play it as cool as humanly possible.

“I don’t appreciate that attitude, young man! Show me the respect of not insulting my intelligence!”

“Yessir. That wasn’t my intention, Dr. Larsen.”

“Let me come straight to the point. It has been five months since this protocol was approved, and I’ve heard nothing but bad news. Nothing! All you have established is that this drug is highly toxic.”

“I’m aware of that, sir. But it is still relatively early.”

“And,” he continued, brushing this aside, “it’s hard to imagine the reports of your personal conduct being any
worse. You just do not seem to know how to get along with patients.”

Logan simply stared at him.
This, from a man with the bedside manner of a serial killer
. “Sir, I really don’t think that’s fair,” he replied. “Aside from Ms. Winston, with whom I’ve had a conflict almost from the start, there’s no one—”

“I am not interested in your opinion.”

“And I really don’t think the news on Compound J has been all that bad. Dr. Shein—”

“Or in his. Dr. Shein is not the principal investigator on this study, you are.”

“Of course. I’m just trying to point out that we haven’t done much worse than other protocols at a comparable stage. Even at the moment, we’re not the only trial of this kind that’s failed to show significant early results.”

Though he’d been careful not to name names, the implication could hardly have been any clearer. Immediately, the vein in the older man’s temple began to throb. “I should not have to remind you that you are not Dr. Stillman! Nor do you have the standing to speak in such a manner of Dr. Stillman’s work!”

“I was just trying to—”

“Dr. Stillman knows enough not to cavalierly place his patients in jeopardy. He has never once placed the reputation of this institution at risk! Which, young man, whether or not you are aware of it, is precisely what your conduct has done! Do you understand what I am telling you?”

Logan started to respond, then stopped himself. It was no good. This guy didn’t even know how to pretend to be interested in a dialogue. “Yessir, Dr. Larsen,” he said. “I’m sorry. What would you suggest we do now?”

“I don’t
suggest
anything. You
will
do the following. How many patients remain on this protocol?”

“With Mrs. Byrne off—I assume she is off …?” When the other only continued to stare at him, he pressed on. “That leaves thirteen.”

“And they are continuing to come here to be examined on a regular basis, are they?”

“Yessir.”

He leaned forward in his desk chair. “Dr. Logan, it is not within my authority to close down this protocol completely. But it is to take those steps necessary to safeguard the integrity of the Department of Medicine.” He paused. “I expect you to inform each of those patients, on her next visit to the ACF, of the extraordinary risks we now know to be associated with this compound. Each shall then be given the option of leaving the protocol.” He shook his head, as if in consternation. “And I wish I were in a position to offer each of them my personal apologies.”

Logan stood there, dumbstruck. In effect, he was killing the program.
Was this the way it was going to end? Without his even making a coherent argument on its behalf?

But he also knew that words were not going to mean a thing. And none came.

“That will be all, Logan,” said Larsen suddenly, a military commander dismissing a contemptible underling. “Some of us do have work to do around here, you know.”

T
o date, Logan’s firsthand experience with Marjorie Rhome had been limited to a brief introductory meeting. Sabrina had conducted the woman’s initial interview and shepherded her onto the program; subsequently, as these things went, her exams at the Outpatient Clinic had been covered by either Sabrina or Reston.

Both confirmed Logan’s own first impression: that this woman was genuinely
nice
. Courteous. Cooperative. Above all—for, as he’d learned the hard way, this was the quality often hardest to come by in such a situation—possessed of real balance.

“Mrs. Rhome is not a whiner,” as Sabrina had described it. “She—what is the expression?—sees things from others’ shoes. She knows that when the news is bad, it doesn’t always mean it is somebody’s fault.”

Logan recalled this by way of reassurance. For Marjorie Rhome, the other patient with a creatinine problem, was due in for her exam this very morning—and it was Logan’s luck that he was going to have to conduct it.

Even before his conversation with Larsen, that prospect had loomed as gruesome; after all, there was every reason to suppose that her creatinine level, too, had edged beyond the acceptable range and she would be obliged to leave the program. But now, even the slim possibility that her level would be encouraging offered no hope. For here he was, under orders to trash his own program!

More than an hour later, sitting on a bench in the quad, watching the passersby on this brilliant summer morning, Logan could still scarcely believe it. He found himself trying to figure out exactly what he felt. Could it
really be … 
nothing!
But, no, retreating into his intellect, he recognized the reaction after all: shock. This was interesting, a whole different level of self-protection. Perhaps, if he was lucky, he would
never
feel its full effect.

Sabrina was different; that was why he would wait to call her. No need to hit her with it yet. That would be selfish, self-indulgent. She was stuck all morning in Shein’s lab. She would need time to absorb the calamitous news, and also space—sanctuary from the inquiring gazes of their fellow junior associates and, even more, from the bully himself. It wasn’t so much (as in his case) the blow to career prospects that Sabrina would take as devastating, or even the affront to her pride. It would be the magnitude of the offense to her powerful sense of justice.

Logan glanced at his watch: nearly noon. Where had the time gone? Slowly, as if the burden had been transformed into something physical, he bestirred himself and began making his way toward the Outpatient Clinic.

Marjorie Rhome was waiting for him in an examining room, ready in her hospital gown.

“Sorry I’m late,” he said, extending his hand, offering his customary version of a reassuring smile.

“No problem, Doctor, really.” A heavyset woman with a pleasantly round face and sharp blue eyes, she seemed just as concerned with reassuring him. “I think we just finished up here a little early.”

In fact, she’d already been on campus for some time, having blood drawn and posing for her monthly X ray.

“Well, I hope they haven’t made things too unpleasant for you.” He realized as he said it that the words were coming by rote. He was on automatic pilot.

“Oh, no, everyone’s been very nice. As always.”

“And you’ve been feeling all right? No new special aches or pains?”

“No, actually I’ve been feeling pretty darn well.”

“Good.”

Even as he continued to grin his idiot grin, he knew that soon he’d have to begin working toward the subject at
hand: her future with the protocol—and the near certainty that there would be none. But, no, the results of her blood work should be in anytime now. He’d wait for those.

“So,” he said, “if you’ll just take a seat on the edge of the examining table, we’ll try and make this as short and sweet as possible.”

“Okay.”

Before he began, Logan picked up her chart and scanned it. Yes, he was reminded, of course: Mrs. Rhome’s problem was intraparenchymal lung nodules—a dozen or so BB-sized growths in each lung field. Her prognosis could hardly be worse.

He flipped to the page on her personal history.

“So,” he said, “how are your kids?”

Her face lit up. “Oh, fine, thank you.” She laughed. “But keeping me busy. You know teens.”

“Actually, only by reputation.”

“Of course, you’re hardly older than that yourself.”

He smiled; imagining, in fact, the incredible degree of will this woman must possess to maintain even a semblance of a normal daily life. “It’s a boy and a girl, isn’t it?”

“You got it. Jen, my daughter, just found out she’ll be the captain of the high-school soccer team next season, isn’t that a kick?” She laughed. “That’s the big event at our house. I guess it doesn’t compare to what goes on around here.”

“Yes, it does. It compares favorably.” He moved over beside her. “Now, I want you to relax. Breathe normally.”

He placed his fingertips on either side of her neck and began working down, feeling for supraclavicular nodes.

“That’s good,” he concluded. “Still clear.”

“Can I talk now?”

“I really don’t think I could stop you.”

“Well, I just wanted to put in a good word about my son also. He’s pretty sensitive, so I like to give him equal time, even when he’s not around to hear it.”

Logan smiled. He’d been trying to think who this woman reminded him of, and suddenly it hit him: Jane
Withers, the onetime child star who’d grown up to be TV’s Josephine the Plumber. The physical resemblance was only part of it; even more so, there was the same relentless awshucks brand of optimism. “Go ahead, I’d love to hear about your son.”

“Well, his name’s Peter.…”

“Uh-huh. Mrs. Rhome, would you mind getting to your feet now?”

She slipped off the examining table. “He’s fourteen. And you’ll never guess what he announced the other day he wants to be.…”

Logan knew the answer; he’d heard this one before. “I have no idea.”

“A doctor! It’s ever since I’ve been coming here.”

Oh
,
God
, he thought, she’s
going to make this even harder than it is already
.

“I don’t know whether to be flattered or send him a warning.”

She laughed. “Oh, I don’t think even you’d be able to discourage him.”

“Now hold still a moment. Breathe in.”

Gently, he felt her abdomen for the liver edge. He couldn’t feel it. Also good—the organ wasn’t yet distended.

He was interrupted by a knock on the door. “Doctor?”

This is what he’d dreaded: a nurse bearing the results of Rhome’s tests. He opened the door and took them.

“Excuse me, Mrs. Rhome, just a moment.”

“Take your time, Doctor.” She resumed her perch on the examining table and, to his surprise, began
humming
.

There were three pages, but his eye went right for the line that mattered. “Creatinine: 1.9.”

He didn’t know whether to be pleased or despondent. On the one hand, she was still below the cutoff; technically, she could remain with the protocol. On the other hand, he’d just been robbed of his easy out. Now he would have to discuss the overall ineffectiveness—no, he’d have to be more forthcoming than that—the
dangers
of this trial.