Authors: Harry Stein
Abruptly, Larsen stopped and faced him. “What?”
The unmistakable note of anger made Logan flinch. But there was no turning back now.
“I was wondering if you’ve had a chance to read what I left for you earlier.”
“Yes, I looked through it. What exactly would you like me to say?”
Logan had tried to persuade himself this would not sound unctuous. “Actually, sir, I’d appreciate any comments as to how it might be improved.”
“My
comments
?” Larsen smiled, a sudden maliciousness
in his eyes. “Very nice job, Logan. My compliments to you and your little friends. And Dr. Shein, of course.”
“Well … would you have any specific recommendations?”
He stood there a long moment, staring at him coolly. “I’m late, Logan.” And, turning on his heel, he strode away.
By the next morning, word of the proposed protocol was already making its way through the ACF, a piece of gossip juicier than any love affair.
Who WERE these three? How’d they gotten so tight with Shein? Could this thing actually have a shot at success?
At least to his face, most of the peers Logan ran into in the hospital that day were supportive, managing to mask whatever envy they felt by good cheer. “Is this as good for
all
us little guys as it sounds?” asked one fellow first-year associate. “Or should I forget about that and get right down to hating you?”
But the reaction Logan was most worried about was Stillman’s. It was not long in coming. Late in the afternoon, as he was about to call it a day, he saw the senior man heading his way.
“So,” said Stillman sharply, before Logan could say a word, “I guess I’ve got your answer to my invitation.”
“Dr. Stillman—”
“Shut your mouth, you little shit! I have no interest in your explanation!”
Logan nodded and stared at the floor.
“Just know that I can make your life hell, Logan. You stuck a fucking pickax in my back, and now you’d damn well better watch yours!”
“Well,” sighed Reston that evening, “it could’ve been a lot worse.”
“How?”
“He could have told you what he
really
thinks.”
Logan returned Reston’s smile. He knew his friend was as shaken as he was. “Thanks. That’s reassuring.”
“Look, Logan”—Sabrina’s tone was less consoling than practical—“what does it matter? We knew Stillman would not be so happy, right? Larsen also. And maybe others. But what can they do to us?”
Logan shrugged. “I guess not much—once we get the proposal through.”
“Exactly. This is my meaning.”
“I’m just worried they’ll try to hurt the proposal with the committee. They’ve got almost six weeks to try and sabotage us.”
“Remember what you say to me before, that maybe I am a little paranoid? Now it is my turn to say the same to you.” She looked from one to the other. “Our protocol is strong. The Institutional Review Board will see so. After that”—she gave a distinctly Italian gesture of acceptance; eyes heavenward, palms moving in the same direction—“it is not in your hands or my hands.”
“She’s right,” concurred Reston eagerly. He looked at Sabrina. “You’re absolutely right.”
“Yes,” she allowed, barely acknowledging him. “I am right.”
“Well,” said Logan, “nothing we can do about it now anyway—except try and watch our step. Who knows what kinds of crap they could pull.”
In fact, the petty annoyances began almost immediately. Suddenly various functionaries around the hospital and labs—a head nurse, the pharmacist in the Outpatient Clinic—were cooler than before, and slower to cooperate with routine requests for administrative assistance. Reston one day found that for no apparent reason his dial-out number—the code he needed to make long-distance calls—had been changed, and a new one was not readily available. Soon afterward he was reprimanded by a second-year associate for, of all things, taking a drink of water from a pitcher in a patient’s room; every patient’s water intake
was closely monitored, he was sharply reminded—as though a few sips could make a meaningful statistical difference.
As if to top this, a week later Sabrina was called into Peter Kratsas’s office and ordered to desist from giving her patients occasional pieces of chocolate.
“He tells me these diets must be strict,” she reported late that evening. “He tells me this is a research institution, only research materials can be allowed. Even food! And, even while he tells me this, he is smiling, like it is a big joke!”
“That’s exactly what it is,” concurred Logan. “Patients’ families bring them stuff to eat all the time.”
Drawing her closer, he could feel the tenseness in her shoulders. They were a matched set; he’d left work with a killer headache of his own. “What’d you say to him?”
“What can one say? He is the boss, no?”
More than any other, this episode seemed to sum up the character of their foes. The reprimand had been intended to wound her on the deepest possible level; it was her talent as a nurturer they’d attacked, one of her real gifts as a physician. “Ignore ’em,” said Logan, wishing he’d remembered to pick up some aspirin on the way home, “what else can we do? It’s only temporary. Just a couple more weeks till we go before the Review Board.”
For, of course, neither for a moment lost sight of the key fact: things were right on track. If their adversaries had real power to get at them, they’d never have had to resort to such pettiness.
“That’s very easy for you to say, Logan,” she said, with a sudden smile. “Me, I have four pounds of Perugina chocolates in the closet. Soon I will have the mice and roaches.”
“Easy? Who had his parking spot given to a visiting fellow from Estonia? Who has to walk half a mile every day from general parking?” He paused, his head throbbing, but managed to smile back. “I haven’t even told you the latest.
Guess who just discovered he now needs clearance to get a Tylenol from the hospital pharmacy?”
Ten days later—a Sunday, five days before the long-awaited Review Board session—they were awakened by the jangling of the telephone.
It was Reston. “Do you have the
Post
delivered?”
“Yeah,” replied Logan.
“Go get it. Page six of the second news section. Call me back.”
On the face of it, the story, headlined “Cancer Funding at Risk,” was just another piece bemoaning the effects of the budget crunch on high-level medical research. But to the trained eye it was immediately recognizable for what it was: a Stillman plant. Stillman himself was prominently featured, identified as “one of the world’s leading experts in breast cancer”—and, more to the point, as “the man behind what is said to be a new drug with ‘breakthrough potential.’ ” If, that is, it could get adequate funding. The problem was that other drugs, including “some said to have virtually no chance of practical application,” were diverting monies from Stillman’s miracle cure.
“I’m concerned with saving the lives of real women,” Stillman told the pliant reporter. “Too often these days government invests in fantasy. And then we wonder why we don’t get results.”
He called his friend back. “I don’t think we have anything to worry about. The bastard’s just blowing off steam.”
“Really?” asked Reston, desperate to be reassured but not quite trusting what he heard. “You think so?”
“Read it again, John. Carefully.”
For what Logan had immediately focused on was that the clear target of the attack—Compound J—was never cited by name; nor was it even suggested that any of the drugs eliciting Stillman’s displeasure might be linked to the ACF.
In fact, what seemed to Logan most clear was that Stillman’s hands were tied: he simply could not risk shattering
the carefully nurtured illusion that the ACF was above petty politics, a bastion of inspiration and hope staffed by men and women intent only upon doing God’s work. Ultimately, it was this that kept the Foundation so well funded—and all of them in business.
A
s the Compound J team waited outside the Administration Building’s third-floor conference room, Logan’s confidence soared. Exchanging greetings as the Board members filed in, the junior associates felt themselves to be among peers.
He was aware he even
looked
good. At Sabrina’s direction, both he and Reston had bought new suits for the occasion, conservative and far from the least expensive on the rack; almost as classy as the charcoal-gray Italian pinstripe suit she wore.
Logan, having been chosen to represent the team, had a twofold task: to summarize for the Board members the key points in the document they’d all already read, while conveying that they had what it took to see the project through.
Of the seven, Logan was already on a first-name basis with four: Dr. Lauren Rostoker, representing Surgical Oncology; Dr. Brendan Herlihy of the Department of Medicine; Dr. Myra Manello of Radiation Oncology; and, of all people, on behalf of Nursing Services, Marilyn Lennox. The remaining three had backgrounds not in traditional medicine, but in realms with which modern institutions must nonetheless concern themselves. They included a bioethicist based at Georgetown University; an Episcopal minister from nearby Annandale, Virginia; and someone from Patient Services named Marion Winston, a sort of ombudsperson for those receiving treatment at the ACF. But—yet another good omen—this last, a pleasant-looking, heavyset woman, took the time to introduce herself, shaking hands with each of them and wishing them luck.
The Board stayed behind closed doors for no more than fifteen minutes, presumably discussing the protocol in very general terms. Then the three junior associates were invited to join them.
“Well,” began the Department of Medicine’s Herlihy, chairing the meeting from the head of the conference table, “right off the bat, I must say a lot of solid thinking went into this idea.” He paused, waiting for those pleasant words to register. “However, as you know, we are able to approve only a very small number of protocol plans. Only those that meet the strictest criteria, not just for scientific merit but ethical accountability.” He nodded their way. “Now, I gather you, Dr. Logan, are speaking on behalf of the team?”
“Yessir.”
Logan rose and took a seat in the empty chair at the opposite end of the table. He smiled. “Ladies and gentlemen, on behalf of my colleagues and myself, I want to thank you for your time and consideration. I’m sure I have little to tell you today that you don’t already know. We are proposing a Phase Two pilot trial of the compound known as Compound J for metastatic breast cancer. In order for the trial to have appropriate statistical power, we feel we need to accrue forty patients over the next twelve months.…”
And he began to lead them through the case for Compound J; emphasizing, particularly to the lay people on the Board, the significance of the various reports of the drug’s activity spanning decades and great distances. “I will not pretend to you that we know more about this drug than we do,” he wound up, with what he hoped was just the right note of deference and candor. “But what we have already observed is compelling: clear evidence that this drug is capable of binding growth factors to their cell-surface receptors. The truly astonishing thing is that, as long as this drug has been around, it has
never
undergone a rigorous and closely monitored clinical trial for activity against this
disease. That is a situation that, with your help, we now hope to rectify. Thank you.”
And nodding once again to the board members, he sat down.
“What about your Informed Consent Document?”
It was Winston, the patient care rep.
“Pardon?”
“Is it your position that this document displays sensitivity to the needs of the women you would enlist for such a trial? That it serves
them
well?”
Logan hesitated. What could she be getting at? “We think the Informed Consent Document does what it is supposed to do,” he offered finally. “Which is present all the most likely problematic scenarios.”
“Oh, does it? Dr. Logan. As you’ve acknowledged yourself, this is a very toxic drug. I am not a physician, but I have it on the very best authority that you do not come close to covering all likely eventualities. For example, you never even address the possibility of cerebral hemorrhage. Or heart attack.”
In fact, the woman was only confirming her ignorance—of all the possible calamitous effects of Compound J, the chances these were among them were infinitesimal. Still, Logan worried she might be scoring points with the others; following Shein’s instructions to the letter, in the final draft of the proposal, they
had
passed lightly over the unsettling matter of side effects. He was suddenly aware that the room seemed to be overheated.
“Ms. Winston, I really don’t think the possibilities you raise merit serious consideration.”
“The point, Doctor,” spoke up the bioethicist, “is that some of us feel that a less than thorough investigation has been made as to the downside of this drug. Some of us feel that rather strongly.”
There was a superior note to the guy’s tone that drove Logan crazy. What the hell did
he
, who’d never in his life so much as touched a patient, know about the thoroughness
of their investigation? He felt like diving across the table and taking him by the throat.
“Well,” he said evenly, “all I can tell you is that we’ve spent a great deal of time on this. Certainly, if we’d been completely exhaustive, other possible eventualities might have been listed. I acknowledge that. But it would have been pure speculation. That’s the point: we need to know more about this drug.”
“I see”—Winston again—“and you’re planning to use these patients as human guinea pigs.”
“I didn’t say that. That’s not fair.” He stopped, collected himself. “Isn’t it fair to say there’s a certain degree of uncertainty in a test of any new compound?”
He looked hopefully at the medical personnel around the table: the surgeon, the radiologist, the nurse. Surely, they were with him on this.
But no one gave a word of support.
“Dr. Logan,” said Winston, her voice taking on a dangerously hard edge, “we are not raising these questions in a vacuum. We must all be aware of the fact that the public’s confidence in breast cancer trials has been badly shaken in recent years by doctors more concerned with their own reputations than with the well-being of patients. Frankly, in your case, we would find such questions less troubling if certain other aspects of your history had not been brought to our attention.”