Authors: Harry Stein
Obviously, such a scenario is always poignant. A severe illness is the ultimate test of the human bond, tending to point up moral bankruptcy in loved ones nearly as often as character; and had it been someone else, someone less manipulative or even slightly more considerate of others, Logan might have found her circumstance more touching.
As it was, his dealings with Rochelle were governed only by a sense of obligation to the protocol of which she was a part. Which, finally—because the protocol in question was the volatile and unpredictable Larsen’s—was nothing more than a sense of obligation to his own future.
Now, as he scrubbed down, splashing cold water on his face to wash some of the bleariness from his eyes, he was suddenly aware of someone waiting off to the side. Nurse Lennox.
He turned and stared at her balefully. This woman was not in the business of giving him good news.
“What?”
“I hate to bother you with this, Doctor.”
“Boudin?”
She nodded. “She started asking for you yesterday afternoon, and began again as soon as she woke up this morning. Her latest white cell count is in.”
“Oh, God.” In general, he had no problem with the ethical guideline giving patients full access to their medical records. But Boudin made a habit of abusing it, seeking test results before they’d even been seen by her doctors, often interpreting them in ways that had only the most tenuous link to medical reality. “What is it?”
“Forty-two hundred. I have it right here.”
She handed Logan the sheet and he briefly studied it.
“So … I guess she wants to cut down on her dosage again, right?”
She nodded. “That’s what she wants, all right.”
“Jeez, what a pain …!”
“Good luck.”
“Yeah. I wish luck were all it took.”
Resignedly, he started moving down the corridor toward her room, the challenge at hand all too familiar:
How to keep this conversation down to five or ten minutes? How to get through it with minimal emotional fallout?
“Dr. Logan?”
Logan was so preoccupied, he momentarily failed to respond to the voice addressing him from behind—or
maybe it was just that it was so uncharacteristically moderate.
“Dr. Logan.”
He wheeled, and was startled to see … Stillman!
“D-Dr. Stillman,” he stammered, “I’m sorry, I didn’t hear you.”
The senior man approached him, hand extended, smiling. “No problem. I was just wondering if you might have a couple of minutes to talk.”
Logan hesitated. “Actually, I’m on my way to see a patient. But if it’ll only take—”
“Who?”
“Rochelle Boudin.”
“Lucky you. No, you’d better take care of it, you don’t want Larsen on your ass.” Another smile, this one full of comradely understanding. “Come see me in my office afterward.”
A moment later, stepping into Rochelle Boudin’s room, it was all he could do to mask his reaction—curiosity, tinged with anxiety—to what had just occurred.
“Good morning, Rochelle,” he said with brisk efficiency. “I’m told you want to see me.”
She was propped up in bed,
Good Morning America
showing on the mini-TV suspended at eye level. “Where were you yesterday?”
“Rochelle,” he said, with exaggerated patience, “you know I’m not on hospital duty Wednesdays, I’m in the Screening Clinic.”
“I mean yesterday evening. You used to come in the evenings.”
He couldn’t deny it. Earlier in his tenure at the ACF, he’d often spent time with patients after-hours; a bit of apple-polishing for higher-ups that could also actually be a nice change of pace. But since beginning work on the Compound J project, that had been out of the question. “Look, Rochelle, I’m sorry, it’s been a busy time.” He cleared his throat. “I’m told there’s something you want to discuss.”
“Have you seen my white cell count?”
“I have it right here.” He assumed his best sympathetic air. “I know it seems low. But I can assure you, we’re not close to the danger zone yet.”
In fact, after seven months of having her bone marrow pulverized by chemo, Boudin was holding up remarkably well.
“I want to cut the dose. I
insist
on it.”
“Rochelle, you know perfectly well that according to the terms of the protocol—”
“I’m so sick already,” she interrupted, “why can’t you just give me a break …?”
“Please, Rochelle, you know that I—all of us—have only your best interest at heart.”
“Do you?” she asked, suddenly girlish. “Sometimes I can’t tell.”
“Listen, have you given any thought to what we talked about the last time?”
The reference was to the implanting in her upper chest of a subclavian intravenous line. As often happened with long-term chemo patients, the veins closest to the surface had narrowed and virtually disappeared from sight, making the insertion of an intravenous drip a dicey and sometimes painful procedure. Such a line would make it as easy as inserting a plug into a socket.
“I don’t know,” she said. “Would it hurt?”
“Rochelle, we’ve been through this. Any pain would be minimal. The surgeon can do it in fifteen minutes, with a local anesthetic. When you’re finished with chemo, it’s just as easily removed.”
“Do you think I should?”
Under other circumstances, it might have been a reasonable question. Now it merely annoyed him. “Yes, I certainly do.”
“Then I will. If you say so.”
“Good, I think that’s the right decision. I’ll have the surgeon, Dr. Dawkins, come by.” Logan glanced at his watch. “Listen, Rochelle, I’ve got a very busy morning.
Perhaps you can take this up with one of the other doctors.”
“I don’t want to talk about it with anyone else.”
“Well, I’m sorry, I really do have to go.” And he turned, heading for the door.
“Will you be back to see me later?”
But he pretended not to hear, not stopping until he reached Stillman’s office.
“How’d it go?” asked the senior man, as unsettlingly pleasant as before.
Logan shook his head. “The woman’s a nightmare.”
Stillman laughed. “Well, sit down, relax.” He indicated the chair facing his desk. “Who knows, maybe we can arrange it so you don’t have to do that sort of thing anymore.”
Logan sat down and returned his smile.
What the hell was this about?
“That would be nice.”
“I haven’t seen much of you lately. What have you been up to?”
Logan offered a stiff shrug. “Nothing much. This and that.”
“This and that? Sounds like you could put your time to better use.” He paused, leaning forward. “No sense beating around the bush. I’d like you to join my team.”
“Your clinical research team?” Logan was stunned. “Really?”
“That drug I talked about to you and what’s his name about …?”
“John Reston.”
He nodded. “… I’m almost ready to bring it to trial. We’re putting together the protocol right now, and I’m going to have to beef up on support staff.”
“My God! That’s incredible.”
If Stillman had sensed there was less than full enthusiasm in his tone, he didn’t let on. “I know I don’t have to try and sell you on this, Logan,” he said. “But I can tell you this could be a big drug. And big for everyone close to it.”
“It’s incredibly flattering. Thank you.”
Stillman waved this away. “Forget that, I want you because you’re good. I’ve seen your work in the Clinic and on the inpatient wards. Patient accrual is going to be a very important aspect of this trial.”
He waited for a response. When Logan merely nodded, he pressed on. “Needless to say, assuming things work out satisfactorily, at the end you’ll get your name on the paper.” He laughed. “Not as a lead researcher, but it’ll be there somewhere.”
Logan knew how unusual such an offer was. He appreciated what, under other circumstances, it would mean to his career.
He also knew that he had to find a reason not to accept.
Logan nodded again, then decided to take the risk. “Sir, could you possibly tell me a bit more about the drug?”
Such a question from a junior researcher might have been seen as highly presumptuous. But Stillman, utterly confident, took it with good grace. “Well, as I told you before, it’s an anti-growth factor strategy. I’m really not ready to go into more detail than that.”
Still not
ready
, Logan wondered,
with the thing almost set to go before the Review Board?
Something odd was going on here. “Sir, it’s just that, well, if I’m going to commit to work on the project, I’d really love to know just a little more about it.”
“You would, huh?” Stillman leaned back in his chair. “Well, start by knowing this. This is the sexiest drug to come down through the pipeline in a while. It’s new and it’s different and the press is going to eat it up.”
“That’s great.”
“And,” he added, “you’d be a fucking fool not to leap at this chance.”
Suddenly, sitting there, it hit him, a gut feeling so powerful he’d have bet his life on it: Stillman had
zero
faith in this drug! It was just another variation of the same old stuff. That’s why he wouldn’t come clean.
This protocol posed no threat at all to Compound J.
Stillman was thinking only short term—the hype, and the funding it would bring in.
“Can I just think about it a little while?” Logan waffled. “I mean, it’s such a huge decision.”
Stillman’s eyes flickered with annoyance, but he held it in check. “Certainly,” he said.
“Of course.”
He got to his feet and extended his hand. “Like I tell people, that’s one of the things I like about you, Logan. Not an impetuous bone in your body.”
L
ogan and his associates had been aware from the start of a great irony: that before their protocol could go before the Review Board, they would have to get the man who’d be most unhappy about such a project to sign off on it. Raymond Larsen.
Quite simply, as chief of the Department of Medicine, Larsen ran the system into which any new protocol had to be made to fit. He assigned beds and clinical time, determined the availability of the Outpatient Clinic, and, when scut work needed getting done, controlled access to first-year associates.
Yet what might have appeared to outsiders a major potential obstacle, Logan recognized as merely an inconvenience. In his view, there was no chance Larsen would hold up the project: no responsible research scientist can afford to put himself in the public position of trying to block a reasonable idea. Too, vitally, Compound J had the backing of Seth Shein; and, Shein enjoyed the support of Kenneth Markell, the powerful head of the ACF.
If nothing else, Larsen understood the realities of institutional politics.
Which is hardly to suggest that Logan was comfortable putting the senior man in such a position—or that he imagined for a second that Larsen would take it with good grace. Sometime before, Shein had offered what seemed like the definitive take on the man: “You know why Larsen has to resort to mugging people? Because he doesn’t have the talent to make it on his own.”
For the chief of the Department of Medicine, the Compound J protocol would represent a double humiliation;
proof positive not merely that this first-year associate, this
nothing
, had rejected his overtures, but that he’d gone with his nemesis Shein instead.
Clearly, Logan would have to make at least some attempt at damage control. Walking across the campus toward Larsen’s office in the Administration building, clutching the twelve-by-fourteen manila envelope bearing the final draft of the protocol, Logan again rehearsed how he would lay it before the older man: that he’d been working on this idea for quite a while now; that along the way, Shein had become interested in the project; but that he very much hoped he—Larsen—would now also offer a critique of the proposal.
He was pleased to find that the senior man was not in.
“May I leave this with you?” he asked Elaine, Larsen’s secretary.
She looked at him with sudden curiosity. “What is it?”
During his long sessions in the outer office, studying protocols from years past, they’d developed a relationship that sometimes actually bordered on cordiality. He decided to tell her the truth. “Actually, it’s a new protocol.”
“By
you?
” She gave him a look that registered either bemusement or contempt. Logan couldn’t tell which.
“Really …?”
“Me and a couple of others.” He paused, smiling. “I was going to bring you some flowers so you’d be favorably disposed to our cause. But I thought it’d be a little obvious.”
“You should’ve.”
“When do you think Dr. Larsen might be in?”
“Why, are you planning to bring him flowers?”
Logan knew his smile was growing pinched. “I just wanted to talk to him, tell him a little bit about it in my own words.…”
“I’m sure,” she said dismissively, “that he’ll enjoy that.” She pointedly laid the envelope to the side and went back to work.
When Logan returned toward the end of the day, Larsen
was back—and when he saw his face, he knew he’d read the proposal.
But the man was a model of control.
“Dr. Logan,” he said with a crisp nod, emerging from his office.
“Dr. Larsen,” he returned. There was a momentary silence: wasn’t the reason for his being here obvious? “Sir, I was hoping you might have a few minutes to talk.”
Larsen glanced at his watch. “I’m afraid that’s quite impossible, I’m due at the lab in five minutes.”
“I see.”
The senior man shuffled through some papers on his secretary’s desk, then suddenly looked up. “We’re doing some very interesting work on the development of the malignant phenotype. Some very exciting work.”
Logan was speechless. Never before—not once—had he heard Larsen talk of his research; or, for that matter, express enthusiasm about
anything
. “That’s wonderful, sir,” he offered finally.
“Yes, well … if you’ll excuse me.”
Logan followed him out into the corridor. “Dr. Larsen …”
Larsen, quickening his pace, made no reply.
“Sir, is there another time I might see you?”
“I’m very busy just now, young man.”
“I just wanted a couple of words about—”