Authors: Harry Stein
“No!” Sabrina brought her hand down on the glass tabletop. “This is not tolerable! This is something we should not even talk of!”
“Why not?” said Reston, turning on her. “We can do whatever we please. It’s our protocol—and it’s also our asses.
That’s
what we oughta be thinking about.”
“This woman needs this treatment. She is counting on it.”
“To begin with Novick is to compromise the whole program.”
“John,” cut in Logan, “let’s not overstate things.”
“Judith Novick is just too far gone,” he said flatly. “She was far gone when we accepted her and she’s deteriorated since. We can’t become too attached to individual patients.”
Sabrina stared at him murderously. “We made a contract with Judith Novick. This cannot be changed now.”
“Frankly, I was never crazy about giving her a spot in the first place.”
“That is another lie! She was our first, we were happy to find her!” Sabrina looked toward Logan. “Anyway, what does it matter who is sicker or less sick? Our big concern is toxicity. Compound J can be just as toxic to a person with a small tumor as a large.”
She had a point. At least in the early stages, their main goal was to prove that the drug wasn’t
hastening
anyone’s demise. If the cancer killed a patient—particularly one as advanced as Judith Novick—that would hardly be taken as a definitive judgment against the drug.
“In fact,” added Sabrina, warming to the theme, “if Judith does well, it would look even better for us, no?”
“Sabrina …” Reston smiled indulgently. “Look, I admire your compassion. Probably I could use more of it myself. But all I can see right now is that when Judith Novick goes, she’s gonna take one of our fifteen slots with her. And you damn well know as well as I do that, because she’s weak, the toxicity is likely to be heightened.”
He waited for a response, but there was none. Reston almost dared believe he’d won the point. Turning to Logan, he spread wide his hands, a picture of sweet reason. “Look, Dan, why can’t we just drop her back a few slots? What difference would it make? We could substitute one of those hardy old dames of yours. Kober. Or Byrne.”
“John, Mrs. Kober is number five on the list. Byrne’s eight.”
He shrugged. “Fine, I respect your scruples. Let’s go with number two, Mrs. Sutton.”
Logan looked toward Sabrina, then back to Reston. “So it’s up to me, right?”
Neither of them felt it necessary to reply.
“Well, then, we’re going to go ahead the way we planned.”
Abruptly Reston was on his feet, the wooden dining room chair in which he’d been sitting crashing onto the
floor behind him. “Shit, what kind of power does she have over you, anyway?”
“What you say makes a lot of sense,” Logan replied calmly. “I’m just afraid that to change now would be to draw the wrong kind of attention to ourselves. We can’t afford to look insecure. Either we believe in Compound J or we don’t.”
But already Reston had grabbed his coat and was heading for the door. “Screw you both! Screw this whole project!”
For a long moment, Logan and Sabrina sat in silence.
“He will be back,” she said finally, “the bastard.”
“Why do you hate him so much?”
She looked at him intently. “He’s just not my idea of a good scientist, Logan. You will see.”
Two weeks later, on the morning of Judith Novick’s first treatment, Reston was by her hospital bedside with the others. If he was still smarting, he was keeping it to himself.
An intense seriousness of purpose marked the occasion. This technically modest procedure was their Olympic debut, their Broadway opening; a time, if ever there was one, to look beyond petty squabbles.
The patient, slightly propped up in bed, was pale, her grossly distended midsection appearing larger than ever beneath the flimsy hospital gown. Before Compound J could be administered, she had been scanned to measure the tumor site so a comparison could be made as treatment proceeded. Novick’s tumor measured an astounding ten by ten centimeters, and it was surrounded by fully ten liters of the malignant sewage known as ascites fluid.
Novick hadn’t been allowed any solids since noon the previous day and she looked like she hadn’t slept much the night before. “You’re sure this isn’t going to hurt?” she asked, looking to Sabrina.
“The procedure itself? I promise you, no.” She took the
patient’s hand. “About the rest, we are being extremely careful. That is why we are all here.”
“My husband wanted to know if he could be here while I’m getting it.” She indicated with her head. “He’s downstairs in the waiting area.”
“Really, darlin’, I think that wouldn’t be the best idea,” spoke up Sadie McCorvey, the Irish research nurse who’d actually be performing the procedure. “You know as well as I how men can get in the way.”
“I resent that,” laughed Logan.
“Be my guest, Doctor, resent it all you wish—as long as you stay off to the side.”
Logan wasn’t yet sure how he felt about McCorvey, allocated to the team on a part-time basis by Shein. She was new to the ACF, having worked for almost two decades in endocrinology at nearby George Washington Hospital, and he worried about whether she was up to the technical demands of this kind of work. On the other hand, her no-nonsense manner came with the kind of mordant, take-no-prisoners humor with which he himself was most comfortable; and, obviously, she was good with patients.
“Don’t you worry, dear,” she added now, leaning over the bed toward Novick, “it’ll be over sooner than you know.” In a couple of quick moves, she inserted the IV line into the patient’s arm and taped it in place. “Now we’ll begin the drug in just a few minutes. We’ll be starting you off with just a tiny dose to make sure you’re not allergic.”
But the items that were wheeled into the room a moment later could not have been reassuring: an EKG machine, lights glowing; then the paddles, pre-juiced to 300 watt-seconds, so as to be ready to go if her heart stopped beating; followed by the mobile crisis center known as the “crash cart,” each of its drawers bearing a different drug in a hypodermic for ready administration. Isoproterenol for hypotension. Atropine to stimulate the heart rate. Epinephrine, to increase its contractility.
Novick was so focused on these that she failed even to
notice that McCorvey had removed the clamp on the IV sleeve. The Compound J team watched in silence, their gazes moving from the small overhead bottle bearing the clear liquid to the patient’s face, and then back again. If she was to have a negative reaction, it would come within the first five minutes.
They waited eight.
“Well,” spoke up Judith Novick finally, “when are you going to give it to me?”
Sabrina laughed and pointed toward the bottle, the liquid flowing from it visible through the clear tubing. “You see. No problems.
“I think perhaps her husband can come in now, no?” said Sabrina.
McCorvey shrugged. “Fine by me.”
“Let’s continue the slow drip for another ten minutes, just to be sure,” instructed Logan. “Then we can speed up the dose.”
If it hadn’t been so unprofessional, he might’ve grabbed Sabrina and kissed her full on the lips. Instead, he turned from one to the other, grinning. “Let’s hear it for anticlimaxes, right?”
A
dozen times that day, as he went about his daily routine, the thought seized Logan’s consciousness:
We’re really doing this thing! Soon, one way or another, we’ll know!
He made three visits to Novick’s room during the next six hours. Sabrina made four. Even Reston stopped by a couple of times. Always she was resting comfortably, watching TV or reading; and by the end of the day, the doctors’ repeated appearances seemed to baffle her as much as they pleased her.
“Are you looking for something?” she asked Logan finally as he hovered above her with a stethoscope. “Is something wrong?”
“Not at all,” he exclaimed, feeling just slightly foolish. “Just making sure you’re okay.”
In fact, they were all hoping to find the same thing: evidence of a miracle. Generally, under the best of circumstances, a drug may take several weeks to show its effects. But once in a very great while, the impact on the tumor will be almost immediate.
Logan was back the next morning, and again late that afternoon—though, like the others, he made a point of being less intrusive. By staggering their visits, the three of them were still able to guarantee she was seen every couple of hours.
By the third day, she was ready to go home, and there was no plausible reason to keep her.
“Fine,” agreed Logan, “tell your husband he can pick you up tomorrow morning.”
“Great. I’m ready.”
Gingerly, he felt the tumor. By now, he knew it intimately—not
only its size, but its
feel
, its distinctive contours. “As long as you’re back here a week from Tuesday for your next treatment.”
“Of course.”
Could the tumor really be slightly softer than before? No, that had to be his imagination; he knew from experience that he could be as suggestible as anyone else.
“So everything’s status quo? No pain?”
“Same as this morning. Just fine.”
“Good, that’s what we like to hear—”
Abruptly, there came a knock at the door.
“What is it?”
“I’m sorry, Doctor,” said a nurse-trainee, opening the door a crack. “Mrs. Byrne is on the phone and she says it’s very important.”
“Okay, we’re almost done here anyhow.” He smiled at Judy Novick. “Just keep on keeping on. We’ll see you on Tuesday.”
A moment later, abruptly switching gears, he picked up the phone at the reception desk. “Faith?” he said, with concern. “This is Dr. Logan. Is something the matter?”
“With me, nothing. Except the cancer. What I want to know is what’s wrong with you.”
“I don’t understand.” There was a hardness to the voice that had nothing to do with the woman he’d seen here just a couple of weeks before.
“You told me I have to wait a month and a half to get my treatment.”
“Yes.”
“So how come someone else has already gotten hers? What do you do, play favorites?”
“Who told you that?” For precisely this reason, the ACF made a policy of not keeping protocol patients abreast of the status of others in their tests. This wasn’t a competition; in the final analysis, the order rarely had any bearing on patient performance.
“Never mind who told me. That isn’t the point.”
“Faith, listen to me, we’ve got a schedule we must abide by. The drug is administered according to when patients joined the protocol.”
“I don’t give a damn about that,” she shot back. “I’ve got cancer! I’ve got to look out for me.”
“Faith,” he said, with exaggerated calm, “we’ll have to discuss this later. I’m very busy right now.”
“When?”
“Later.”
As he headed for home a few minutes later, he felt confused, exasperated,
betrayed
. Unavoidably, the most disheartening question any doctor must face loomed increasingly large: how in the world could he have been so wrong? Could he no longer trust his own instincts?
I
t wasn’t hard to pinpoint Faith’s most likely source: Marion Winston, the patient care representative. As Logan well knew, Winston made it policy to contact every patient accepted onto the protocol. Her purpose was to let them know that, as she put it, she “was available to mediate in the event of misunderstandings with medical personnel.”
When Logan stopped by her office the next morning intending to raise the subject of Faith Byrne’s call, Winston stopped him short with her opening words.
“I heard from Mrs. Byrne at home last night. Apparently, you are not being very responsive to her needs.”
Logan was determined to keep this civil; he knew more than enough about this woman’s readiness to cause trouble.
“Listen, Ms. Winston, our job is to be fair to all the women on the protocol.”
“Good. Well, just so we’re clear: I see it as
my
job to empower these women. So that they can also help decide what’s”—she made quote marks with her fingers—“ ‘fair.’ ”
“I see. So you suggested that Faith call?”
“She was troubled, I let her know it was up to her to let you know that.”
“I see,” he repeated, with practiced calm.
How the hell to neutralize this nut case?
“Look, Ms. Winston …” he began again, “there’s no sense pretending. We both know you weren’t crazy about this protocol at the start. That’s all right. I’m just hoping we can work together now to minimize friction.”
“Of course.” She eyed him coolly. “That’s always my intention. This has certainly never been personal.”
He nodded; she said it with such certainty, he thought it was likely she actually believed it. “Well, I just want you to be aware that it can create problems for us when certain kinds of information are passed on to patients.”
“Dr. Logan, I know many doctors prefer to keep patients in the dark. It gives them more power. For
your
information, it’s my policy to let in the light wherever and whenever possible,”
“I’m just saying that Mrs. Byrne was made needlessly upset. There’s nothing we can do to help her.”
“Why not?”
“Because there’s a logical system to how these things are done. Anyway, it doesn’t even
matter
what order she goes in.”
“Perhaps not to you.”
“To
her
. To her chances.”
“Well, then, if it doesn’t matter, why don’t you just move her up? We both know there are others on this protocol who truly don’t care what order they go in.”
“Because that wouldn’t be right.”
“Why? If it doesn’t matter.” Her eyes narrowed. “You see what I’m saying? Your own position doesn’t make sense. Just switch her with someone else and be done with it.”
Logan’s head was starting to spin. He sighed. “I don’t know. Maybe. I’ll have to give it some thought.”
“Sorry, I’m afraid I have another appointment,” she said, abruptly rising to her feet. She offered what under other circumstances would pass as a friendly smile. “But I’m sure you know how much Faith and I would appreciate that.”